NHS Covid vaccine 2021 39;Mix and match39; UK Covid vaccine trial expanded

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NHS Covid vaccine NHS Covid vaccine UK Covid trial 'Mix expanded match' and vaccine

Tue, 13 Apr 2021 08:00:00 +0100

A major UK trial looking at whether Covid vaccines can be mixed with different types of jabs used for first and second doses is being expanded



By Michelle Roberts
Health editor, BBC News online

A major UK trial looking at whether Covid vaccines can be mixed with different types of jabs used for first and second doses is being expanded.

Combining vaccines might give broader, longer-lasting immunity against the virus and new variants of it, and offer more flexibility to vaccine rollout.

Adults over 50 who have had a first dose of Pfizer or AstraZeneca can apply to take part in the Com-Cov study.

Their second dose could be the same again, or a shot of Moderna or Novavax.

Chief investigator on the trial Prof Matthew Snape, from the Oxford Vaccine Group, said he hoped to recruit 1,050 volunteers who had already received one dose on the NHS in the past eight to 12 weeks.

More than 800 people are already taking part in the research and have received two doses of either Pfizer, AstraZeneca or a mix.

Results of this first stage are expected next month and the expanded trial should have some reportable findings by June or July – although the study will run for a year.

Health experts generally agree that the mixing and matching of the vaccines should be safe.

The trial will check for any side-effects or unwanted reactions.

Participants will have blood taken to check how well the vaccines trigger an immune response – in the form of antibodies and T cells – to combat Covid.

Meanwhile, a scientist advising the government has said a lot of experts are "very concerned" after a cluster of cases of the South African coronavirus variant were found in London.

Surge testing is available in Lambeth and Wandsworth after 44 confirmed cases and 30 more probable cases in those areas, according to the Department of Health.

Prof Peter Openshaw, a member of the Covid-19 clinical information network, told the BBC's Newsnight: "I think we're all just hoping that the staged reduction in lockdown is going to be OK.

"If we get rapid spread of the South African or other more resistant variants, it may well be that we are going to have to put the reductions of lockdown into reverse."

Prof Snape said: "If we can show that these mixed schedules generate an immune response that is as good as the standard schedules, and without a significant increase in the vaccine reactions, this will potentially allow more people to complete their Covid-19 immunisation course more rapidly.

"What I'm hoping is that we won't rule out any combinations.

"That's how we need to look at it: Are there any combinations we shouldn't be giving, because they don't generate a good immune response? And I'm hoping that won't be the case."

He said the option to mix vaccines "will give us lots of flexibility, not just in the UK, not just in Europe – where we're looking at restricting use of some vaccines for some age groups – but across the world, where we have, perhaps, a little bit more intermittent supply of vaccines.

"Let's hope that we can actually use this to get two doses of vaccine to as many people as possible."

In other developments:

So far more than 32 million people in the UK have received the first dose of a coronavirus vaccine, while 7.8 million people had both doses.

Outside of the trial, people should still receive the same type of Covid-19 vaccine for their first and second doses, although they can be given different brands if the same vaccine is not available.

The Moderna vaccine is already approved for use in the UK and works in a similar way to the Pfizer/BioNTech one, using a small amount of genetic code from coronavirus to teach the body how to fight off infection.

The Oxford-AstraZeneca vaccine is slightly different and uses a harmless, modified virus to carry instructions on how to beat Covid.

The Novavax jab has not been approved yet in the UK, but is expected to be soon, since trials show it is safe and effective.

It uses proteins from coronavirus that can train the immune system without causing infection.

The UK is not the only country considering using mixed dosing.

Head of China's Center for Disease Control and Prevention, George Gao, recently said China should consider it to boost vaccine effectiveness.

Russia's Sputnik V vaccine involves using two slightly different doses to give immunity.

Prof Jeremy Brown, a member of the UK's Joint Committee of Vaccination and Immunisation, which advises on vaccines, said in coming years people will eventually "have to" have a mix of Covid-19 jabs.

He told the BBC: "It's practically going to have to be that way because, once you've completed a course of, say, the Moderna or Pfizer or the AstraZeneca, with two doses – in the future, it's going to be quite difficult to guarantee you get the same type of vaccine again."

The trial of mixed vaccines is funded by the vaccine taskforce and supported by the National Institute for Health Research.

It is being run from nine different sites across England:

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NHS Covid vaccine NHS Covid vaccine

Tue, 13 Apr 2021 08:00:00 +0100

Initial glitch as over-45s rush to book jab, while third vaccine offers alternative to AstraZeneca for under-30s


Initial glitch as over-45s rush to book jab, while third vaccine offers alternative to AstraZeneca for under-30s

First published on Tue 13 Apr 2021 02.57 EDT

The NHS’s booking website allowing people aged 45 and over to schedule their coronavirus vaccination initially crashed, moments after it was opened.

The website appeared to go down just after slots were made available.

Users were met with the message: “The NHS website is currently experiencing technical difficulties.

We are working to resolve these issues.

Thank you for your patience.”

Shortly after the vaccine booking site was hit by the technical issues, the vaccines minister, Nadhim Zahawi, tweeted that the problem had been “fixed”.

It is understood NHS Digital was able to get the website back up and running on Tuesday morning, with all issues being resolved and people able to book appointments.

Meanwhile, England was gearing up to offer its first doses of the Moderna jab, the third Covid-19 vaccine introduced in the national deployment.

On Tuesday, the vaccination will be available at 21 sites, including the Madejski Stadium in Reading and the Sheffield Arena.

It will offer an alternative to the Oxford/AstraZeneca vaccine for under-30s, after concerns about a possible link to very rare blood clots.

The Pfizer jab has already also been available.

England follows Wales and Scotland, which began using the Moderna vaccine last week.

The Vaccines Taskforce has secured 17m doses of the Moderna vaccine for the UK.

Prof Stephen Powis, the medical director of NHS England, said having the Moderna vaccine marked another milestone in the national programme.

He said more sites would offer the Moderna vaccine as supplies arrived, urging people to get vaccinated when they were invited, as it is “our hope at the end of a year like no other”.

What are the most common side-effects from the Covid vaccines?

According to Public Health England, most side-effects from the Covid vaccines – Pfizer/BioNTech and Oxford/AstraZeneca – are mild and short-lived.

These include soreness where the jab was given, feeling tired or achy and headaches.

Uncommon side-effects include having swollen lymph nodes.

Why do the common side-effects occur?

“The sore arm can be either due to the trauma of the needle in the muscle, or local inflammation in the muscle probably because of the chemicals in the injection,” said Prof Robert Read, head of clinical and experimental sciences within medicine at the University of Southampton and director of the NIHR Southampton Biomedical Research Centre.

“The other common side-effects – the muscle aches, flu-like illness and fatigue – are probably due to generalised activation of the immune system caused by the vaccine.

What this means is that the white blood cells that are stimulated by the vaccine to make antibodies themselves have to secrete chemicals called cytokines, interferons and chemokines, which function to send messages from cell to cell to become activated.”

Are blood clots a side-effect of the vaccines?

The Oxford/AstraZeneca jab has been linked to a small but concerning number of reports of blood clots combined with low platelet counts (platelets are cell fragments in our blood that help it to clot).

These include a rare clot in the brain called cerebral venous sinus thrombosis (CVST).

In an unvaccinated population, upper estimates suggest there may be 15 to 16 cases per million people per year.

The Medicines and Healthcare products Regulatory Agency (MHRA) said recipients of the Oxford/AstraZeneca jab should look out for new headaches, blurred vision, confusion or seizures that occur four days or more after vaccination.

The MHRA also flagged shortness of breath, chest pain, abdominal pain, leg swelling and unusual skin bruising as reasons to seek medical advice.

Up to and including 31 March, the MHRA said it received 79 reports of cases of blood clots combined with low platelets, including 19 deaths, following more than 20m doses of the Oxford/AstraZeneca jab.

That equates to about four cases for every million vaccinated individuals.

Two cases of blood clots with a low platelet count have also been reported among recipients of the Pfizer/BioNTech jab.

The European Medicines Agency is also examining three cases of venous thromboembolism blood clots involving the Johnson & Johnson jab.

The MHRA says blood clots combined with low platelets can occur naturally in unvaccinated people as well as in those who have caught Covid, and that while evidence of a link with the Oxford/AstraZeneca vaccine has become stronger, more research is needed.

Nicola Davis Science correspondent

All people aged 50 and over and those in high-risk groups in the UK have been offered a coronavirus vaccine before the mid-April deadline set by the government, allowing the second phase of the deployment to younger cohorts to begin.

Boris Johnson hailed the passing of “another hugely significant milestone”.

However, there are fears of a slowdown in supply of vaccines and possible fall in confidence after a change in advice on who could get the Oxford/AstraZeneca jab.

With more than 32 million people having had a first dose and 7.6 million of those having received their second, the prime minister said “many thousands of lives” had been saved.

But there were concerns not everyone had been offered a jab they could access.

Last month, the Guardian reported that a number of high-risk people had still not had their first vaccine.

People unable to leave their homes were meant to be visited by a mobile vaccination team, similar to the service offered to care home residents.

But the Guardian understands that months on, a number of older and disabled people who are too unwell to leave their homes are still waiting, with some told to travel miles to a vaccine centre.

Public Health England released operational details about the Moderna jab on Monday, including information on the dose, the interval between first and second jab, the storage temperature and whether people who receive the jab would need to be monitored afterwards.

The vaccine needs to be stored at a temperature of -25C to -15C and once thawed can be stored at 2C to 8C for up to 30 days.

The minimum interval between first and second dose of the Moderna vaccine is 28 days.

Patients who receive the Moderna jab will need to wait at the vaccination centre and be observed for a period of 15 minutes after they receive the vaccine.

On Monday evening, and earlier than expected, Johnson announced the target had been reached.

The Joint Committee on Vaccination and Immunisation (JCVI) – the body advising on which groups should be prioritised for a jab – is to publish its final advice later this week on who should be next in line.

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Johnson suggested the current plan would continue, meaning people in their late 40s would be offered a vaccine next.

The JCVI’s interim plan published earlier in the year said the rollout should continue down the adult age groups.

Sir Simon Stevens, the chief executive of the NHS in England, said: “Vaccinating 19 out of 20 people aged 50 and over is an incredible milestone.

Thanks to our NHS nurses, doctors, pharmacists, operational managers and thousands of other staff and volunteers, the NHS Covid vaccination programme is without a doubt the most successful in our history.”


– April 13, 2021
NHS Covid vaccine 2021 39;Mix and match39; UK Covid vaccine trial expanded
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