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COVID-19 vaccines & PH

Reviewed 22nd September 2021

Please scroll to the bottom of this page for FAQs about vacccines and pulmonary hypertension

The COVID-19 vaccine is safe and effective and gives you the best protection against coronavirus.

Latest updates

15th September 2021

Booster vaccines for everyone over 50 and younger adults with health conditions including PH are now starting to be offered across the UK.

The Joint Committee on Vaccination and Immunisation (JCVI) said it should be given at least six months after the second dose and they have recommended that the Pfizer-BioNTech version is administered. Frontline health and social care workers, and adult household contacts of immunosuppressed individuals, are also eligible for this booster.

For people who cannot have the Pfizer or Moderna because of issues like allergies, the AstraZeneca vaccine can be used as a booster instead.

In other recent vaccine news, all children aged 12-15 in the UK will now be offered a single dose of the Pfizer vaccine, following recommendations from Chief Medical Officers. The programme will be based in schools and parental consent will be sought.

10th September 2021

The Pfizer and AstraZeneca vaccines have both been approved for use as ‘booster vaccines’ by the UK medicines regulator (JVCI). A final decision is yet to be made around whether they are needed, and who should be eligible.

2nd September 2021

People over 12 with severely weakened immune systems – including those who have undergone transplants – are being advised to have a third vaccine to ‘top up’ protection. They will be contacted soon, according to authorities.

The separate booster programme, which prioritises those most at risk from COVID-19, is also set to be rolled out imminently. Read more on BBC News here.

In additional news, a Kings College study has suggested that being fully vaccinated cuts the risk of COVID-19 infection turning into long Covid by 50%. Read more here.

1st September 2021

A new clinical trial will investigate whether a third dose of vaccine for people with weakened immune systems gives a stronger immune response than 2 doses.

Participants will be given either Pfizer, Moderna or Novavax as a third dose of vaccine. The government-funded study follows the results of the OCTAVE trial showing that 89% of people who are immunocompromised or immunosuppressed generate antibodies, and 60% generate a strong antibody response after 2 doses

27th August 2021

A small study suggests that parents of clinically extremely vulnerable 12-15 year-olds should be reassured the side-effects of the Pfizer-BioNtech vaccine are mild and clear up quickly. Read more here

Please be aware of scams relating to vaccines. Click here for info.

Common questions

What vaccines are available?

Four vaccines have been approved for use in the UK and three are currently being administered. They are the Pfizer/BioNTech, Oxford/AstraZeneca and Moderna vaccines.

The single-dose vaccine from Janssen will be available later in the year.

Are people with chronic thromboembolic pulmonary hypertension (CTEPH) at more risk of clotting side effects from some of the vaccines?

There is no evidence that people with chronic thromboembolic pulmonary hypertension (CTEPH) are at greater risk of developing clots from the AstraZeneca and Janssen (Johnson & Johnson) vaccines.

Dr Mark Toshner, PH consultant at Royal Papworth Hospital and local investigator in the Oxford/AstraZeneca vaccine trial, said: “This side effect isn’t like a ‘normal’ clot. The body is generating an antibody that, by coincidence, recognises a particular protein involved in the clotting factors around platelets [cells in your in blood, which help stop bleeding].

That is not a classic cause of clots in people with CTEPH and we haven’t seen any patients with CTEPH who have had this particular complication. We don’t think it is a particular risk factor for them.
We can be confident that the rare risk of clotting with the AstraZeneca and Janssen vaccines does not appear any more relevant to our PH patients.”

Will I get a booster jab?

If you have pulmonary hypertension, you will be offered a ‘booster’ vaccine this autumn, giving you better protection ahead of the winter.

The Joint Committee on Vaccination and Immunisation (JCVI) said it should be given at least six months after the second dose and they have recommended that the Pfizer-BioNTech version is administered. Frontline health and social care workers, and adult household contacts of immunosuppressed individuals, are also eligible for this booster. For people who cannot have the Pfizer or Moderna because of issues like allergies, the AstraZeneca vaccine can be used as a booster instead.

When can children with PH have a vaccine?

Children aged 12 – 17 are now being offered a COVID-19 vaccination.

They are being offered a single dose of the Pfizer vaccine, following recommendations from Chief Medical Officers. The programme is based in schools and parental consent will be sought.

Are the vaccines safe?

Yes. They have met strict standards of safety, quality and effectiveness set out by the independent Medicines and Healthcare products Regulatory Agency (MHRA).

Any coronavirus vaccine that is approved must go through all the clinical trials and safety checks all other licensed medicines go through. The MHRA follows international standards of safety.

Other vaccines are being developed. They will only be available on the NHS once they have been thoroughly tested to make sure they are safe and effective.

So far, thousands of people have been given a COVID-19 vaccine and reports of serious side effects, such as allergic reactions, have been very rare. No long-term complications have been reported.

The Royal Pharmaceutical Society have issued this statement about their confidence in the vaccine approval process.

Were the vaccine trials rushed, and does that mean safety has been compromised?

PH Consultant Dr Mark Toshner, who helped lead the clinical trial for the Oxford/AstraZeneca vaccine, told us:

“I hear the word ‘rushed’ a lot but it’s the wrong word as it suggests there might be a degree of changes in our normal safety procedures – and that’s absolutely not the case. I can be unequivocal about that because I was involved in the trial.

In fact, I’ve been astonished by the level of regulatory oversight and the reporting of safety in vaccine trials, and it’s made me think about some of the trials I run in pulmonary hypertension.

For example, the last PH trial I had recruited less than 30 people and there were four ‘serious events’ in that trial. [An ‘event’ is a reaction or adverse experience, and may mean someone being admitted to hospital, even if there is nothing really wrong].

So that’s four in a trial of 30 patients. I would not classically stop my trials for that number, because of how serious PH is and the benefits outweighing the risks.

In the vaccine trials, hundred of thousands of people were being vaccinated and the media were reduced to reporting single events. Trials were completely suspended until those single events were pored over in great detail.

It’s a bit like if you were take the city of Sunderland, and watch every single person in Sunderland for medical emergencies and report every single person admitted to hospital, everyone who had a heart attack, stroke, or cancer – we’d be doing that hundreds of times a day.

So in some ways it’s astonishing that we were reduced to talking about one, two, or a handful of individual cases. And that just shows the safety of vaccines.

Vaccines have an amazing safety record, particularly compared to drug therapies.”

Do the vaccines interact with PH medication?

PH Consultant Dr Mark Toshner, who helped lead the clinical trial for the Oxford/AstraZeneca vaccine, told us:

“The history of vaccines is that they don’t interact with drugs. It’s as rare as hens’ teeth to find any interaction and that’s because they are not medications like you would classically think of and they are also incredibly strong acting.

Studies have not specifically demonstrated yet the current vaccines and if there are any interactions (often vaccines don’t do those studies) but I expect these will be no different. So, I don’t expect there to be any drug interactions but one of the good things about the set-up in the UK is that we have a very well matured, tertiary response to looking after people with pulmonary hypertension. As you know we are all in specialist centres, so it’s something we will be able to evaluate from the specialist centres and it’s something we will be keeping an eye on.

So, I think I can offer reassurances, but we don’t actually have clear data. However, historically vaccines just don’t interact with therapies, it’s just not a recognised problem.”

Can I choose which vaccine I have?

No, you cannot usually choose which vaccine you have. Any vaccines that are available will have been approved because they pass the MHRA’s tests on safety and efficacy, so people should be assured that whatever vaccine they get will be highly effective and protect them from coronavirus.

What should I take with me when I have my vaccination?

If you are taking medication, please bring a list of these with you to the vaccination centre. Do not bring the medicines themselves.

If you are taking a blood thinner called ‘warfarin’ you will also be going for regular blood tests to monitor the thickness of your blood using a test called INR. The INR test result is a number (for example 2.5). Please make sure you know your latest INR reading and when that was last checked. If you don’t know this, you can get if from your GP surgery. If you are taking warfarin but we don’t know your INR reading it can sometimes mean your vaccination cannot go ahead. The vaccination computers at the centre do not link back to your medical records so staff can’t look up your result on the day.

Should I have a vaccine if I have had a transplant, or if I am on the waiting list?

The following information was published by NHS Blood and Transplant on 30th June 2021:

The NHS recommends that vaccination is the best protection for everyone from severe disease, risk of hospitalisation and death due to COVID-19.

Recipients of solid organ and islet transplants and patients listed for a transplant were not included in vaccination trials in the UK. As a result, there has been uncertainty about the level of protection from vaccination in these groups as compared to healthy volunteers and the general population. There was concern that the vaccine may not be as effective for patients classified as clinically extremely vulnerable from COVID-19 due to underlying health conditions and/or the need to take anti-rejection medication (immunosuppression).

Recently, data from Public Health England, which identifies patients testing positive for COVID-19, and the national vaccine registry were linked with the NHS Blood and Transplant (NHSBT) transplant registry. The combined data was used to identify transplant recipients and patients on the transplant waiting list in England who have received one or two doses of the COVID-19 vaccine and who have subsequently tested COVID-19 positive. This is a practical way to look at the impact of vaccination and its ability to prevent the most severe forms of COVID-19.

Analysis performed by NHSBT shows that approximately 80% of transplant recipients and patients waiting for a transplant in England had received both doses of the vaccine by 24th June 2021. The uptake of COVID vaccination was lower in London (75%) and in people from Black, Asian, Mixed Race and Minority Ethnic backgrounds (65-75%).

Between 8th Dec 2020 – 24th of June 2021:

  • Of approximately 6700 transplant recipients who had not received even one vaccine dose, 7% (466) contracted COVID-19. Of these, 50% (236) died within 28 days of a positive COVID test.
  • Of approximately 39,000 transplant recipients who had received both vaccine doses, less than 1% (76) contracted COVID-19 two weeks or more after second vaccine dose. Of these 8% (6) died within 28 days of a positive COVID-19 test.
  • Of approximately 650 patients on the transplant waiting list who had not received even one vaccine dose, 8% (51) contracted COVID-19 two weeks or more after second vaccine dose. Of these 17% (8) died within 28 days of the positive test.
  • Of approximately 3100 patients on the transplant waiting list who received both vaccine doses, less than1% (5) contracted COVID-19 two weeks or more after the second vaccine dose and none died within 28 days of the positive test.

This data strongly supports the recommendation that, in the absence of any other health contraindication, suitable transplant recipients and patients on the transplant waiting list should accept the offer of two doses of the vaccine for maximum protection against contracting or dying from COVID-19. This analysis also confirms that amongst transplant recipients and patients waiting for a transplant, unvaccinated patients had a very high chance of dying if they contracted COVID-19.

Studies will continue on how best to measure and improve the effectiveness of the response to COVID-19 vaccination in immunosuppressed or immunocompromised patients. Transplant recipients and patients waiting for a transplant and their close contacts must continue to follow latest government advice, to reduce the risk of infection, even when vaccinated.

I feel worried about having a vaccine. What should I do?

Talk to someone you trust, like your PH specialist, about any concerns you have.

Be careful about where you take your information from. Social media is not a good source of information. We recommend the NHS website and the links listed below.

You will not be forced to have a vaccination.

Useful links

Click here for more information about the vaccine rollout process

Click here for more information on the Pfizer/BioNTech and Moderna vaccines (known as ‘RNA vaccines’)

Click here to learn more about the differences between the vaccines