COVID vaccination for patients with PNH and aplastic anaemia
22nd September 2021 Update for patients with PNH
3rd COVID vaccination update:
National guidance review (JVCI) – we recommend that all patients who are receiving treatment with a complement inhibitor for PNH (eculizumab, ravulizumab, or on trial inhibitors for PNH) should receive a third COVID vaccine (Pfizer or Moderna). This is irrespective of which vaccine patients may already have received.
We are sure you are aware that the COVID vaccination has now been approved for use by the MHRA. There are several different vaccinations that will be available. Patients will be invited for vaccination according to their clinical indications/criteria as published by the government (see below and reference https://www.gov.uk/coronavirus).
The clinical trials were undertaken in healthy volunteers and not in patients that have PNH or aplastic anaemia.
Due to the severity of COVID-19 infection, we advise the majority of our patients undergo the vaccination when invited to do so unless you have a specific reason not to.
The vaccinations currently are intra-muscular (given into a muscle) if you have a low platelet count of less than 30×10*9/l should seek advice from your local haematologist before proceeding as this can be associated with bleeding.
Following the government advice on the 08/04/2021 (see link below*)
We encourage all patients to undergo vaccination for coronavirus when invited to do so. Following the incidence of a small number of patients having episodes of thrombosis following the AstraZeneca vaccination we advise the following in line with government recommendations:
- If you have received your first vaccination without thrombotic complications, please go ahead and receive your second vaccination.
- If you have not received your first vaccination and you are under 30 years of age you should be offered an alternative vaccine, if available. However if no alternative vaccination is available, consider accepting AstraZeneca vaccination
If you would like to discuss your vaccination further, please contact your PNH team (Leeds, London or Scotland)
For patients with PNH
For patients on complement inhibition such as Soliris, vaccination can be undertaken when invited to do so, there are no timing restrictions advised.
There is a small risk the vaccination may affect you PNH symptoms, particularly if you are not on complement inhibition (with a high PNH clone). This is theoretical and not proven. We would advise if symptoms do occur that you contact the PNH team.
For patients with aplastic anaemia
Where possible we would advise proceeding with vaccination unless you have a contra-indication.
If you are within 6 months of receiving ATG it is possible you may not respond to the vaccine, we would advise discussion with your local haematology team before undergoing vaccination.
If you have low platelets (less than 30×10*9/l) then you should contact your local haematology team before proceeding as the vaccination is currently given into a muscle.
If you have any questions please do not hesitate to contact the your PNH team (Leeds, London or Scotland) or your local haematology team.
The priority list for vaccination is as follows (https://www.gov.uk/coronavirus):
- residents in a care home for older adults and their carers
- all those 80 years of age and over and frontline health and social care workers
- all those 75 years of age and over
- all those 70 years of age and over and clinically extremely vulnerable individuals
- all those 65 years of age and over
- all individuals aged 16 years to 64 years with underlying health conditions which put them at higher risk of serious disease and mortality
- all those 60 years of age and over
- all those 55 years of age and over
- all those 50 years of age and over
COVID 19 guidance
The PNH service continues to follow the Department of Health advice. As the lockdown restrictions are easing along the government timelines, we advise you follow guidance for your locality.
We have retained the below information for reference currently.
Clinically extremely vulnerable
Advised to stay at home, except for exercise or essential health appointments
This guidance is for everyone in England who has been identified as clinically extremely vulnerable. If you are in this group, you will previously have received a letter from the NHS or from your GP telling you this. You may have been advised to shield in the past.
This would include patients who have a diagnosis of Aplastic Anaemia who are awaiting or have undergone bone marrow transplantation, or if you are on an immunosuppression currently such as ciclosporin, tacrolimus etc.
In the current time of publicity about the infection with Coronavirus, we kindly ask you to look at this information before contacting the PNH National Service, so that we can better address your remaining questions.
The guidelines are being updated regularly so please refer to current government guidelines in your area, these might change due to local lockdown rules or change in policy.
This is for all patients with PNH whether they are on treatment or not.
- Make sure you have a thermometer
- Take your medication as prescribed – please check you have enough supply
- If you have symptoms of PNH such as black or red urine, please contact us.
- If you have a temperature of 38°C or over, contact the PNH National Service:
In addition: if you are on a complement inhibitor (eg. eculizumab, ravulizumab or a clinical trial drug) it is important that:
- Your treatment is NOT to be interrupted.
- You will need a full course of ciprofloxacin (10 days of 500mg bd), not just the two rescue doses that we have prescribed previously. This is to be used after contacting, and being instructed to by the PNH Service. This is to increase cover; you also need to contact your PNH team if you are unwell.
NB: Please note if you are treated through Kings College you have not been issued with additional ciprofloxacin due to proximity to the treatment Centre
- Do not take paracetamol for a high temperature unless instructed to do so by the PNH Service.
- If you have respiratory symptoms definition: sore throat, cough, shortness of breath seek advice.
- Soliris is licensed only if administered by a health care professional. So unfortunately we are unable to facilitate self-administration.
Patients who are immunocompromised and/or on complement inhibition
- Patients who are immunocompromised, for example patients taking treatment for aplastic anaemia (such as ciclosporin, eltrombopag, danazol or oxymetholone, post ATG or stem cell transplantation), and patients who are treated with complement inhibitors (such as eculizumab, ravuluzimab or a clinical trial drug) need to protect themselves, to reduce the risk of being infected.
Please do not hesitate to contact the PNH team for further advice if needed, we understand the complexity and how difficult it is for each individual.