Update for people with liver disease on the Covid-19 vaccine

Posted on: 24th May 2022

If you or a loved one has a liver condition, you may have questions about the COVID-19 vaccine and its effectiveness particularly if you are immunosuppressed.

Below you will find information about the latest updates and a series of FAQs for patients - both those who are immunosuppressed and those who are affected by another liver condition - about the COVID-19 vaccine programme.

Booster update - 24th May 2022

Guidance from the JCVI recommends that a third dose be offered to individuals aged 12 years and over who were severely immunosuppressed at the time of their first or second dose.

It is recommended that the third dose be given at least eight weeks after the second as part of the primary course of immunisation. However, in some cases, a clinician might advise a different interval because of ongoing treatment or starting treatment which will suppress the individual’s immune system.

People in the severely immunosuppressed group have already been offered a follow up booster and they are now eligible for a Spring booster. For many people, the latter will be their second booster (fifth dose).

Those who have completed their three-dose primary course, but not yet had a booster, should receive their Spring booster at least 91 days after their third dose.

For those who have had their spring booster and wondering what will happen next, the JCVI have issued interim advice to the government regarding an autumn booster.  More information here: he Joint Committee on Vaccination & Immunisation (JCVI) has given interim advice on the groups who should be offered an autumn booster of the #COVID19 vaccine

FAQs for liver disease patients who are immunosuppressed
We are aware that if you or a loved one is immunosuppressed you have particular worries about the coronavirus (COVID-19) and the effectiveness of the vaccine. We have raised these concerns with government and seek clarification from DHSC and clinicians on a regular basis. Here are some answers to some of the most pressing questions you may have.

A study by researchers at Oxford University Hospitals into the effects of the Covid-19 virus on patients with auto-immune hepatitis (AIH) suggests that patients with AIH using immunosuppression medication have similar outcomes to people with other forms of liver disease.

This suggests that the use of immunosuppression is not a risk factor for death from COVID-19.

Researchers collected data between March 2020 and October 2020 for nearly 1,000 patients with chronic liver disease and Covid-19 infection, including 70 with AIH.

The results showed that there were no differences in rates of hospitalization, intensive care unit (ICU) admission, and death between AIH patients and those with other types of liver disease.

When compared to patients without liver disease, patients with AIH had higher rates of hospitalisation but no increased risk of intensive care admission or death.

 

There is a spectrum of immunosuppression among patients with liver disease and only a very small proportion are considered severely immunosuppressed.  This includes but is not limited to:

  • individuals who are receiving immunosuppressive or immunomodulating biological therapy and individuals treated with steroid sparing agent
  • Individuals treated with or likely to be treated with systemic steroids for more than a month at a dose equivalent to prednisolone at 20mg or more per day for adults.
  • Anyone with a history of haematological malignancy, and those who may require long term immunosuppressive treatments.

Patients identified as severely immunosuppressed should be contacted by their medical team as advised by JCVI.   They are advising that household contacts aged over 16 of severely immunosuppressed people are vaccinated as a priority.

For more information contact your consultant or visit: Coronavirus » Vaccination of permanent adult household contacts of severely immunosuppressed individuals alongside JCVI priority cohort 6 (england.nhs.uk)

All three of the COVID-19 vaccines - Pfizer/BioNTech,  AstraZeneca/Oxford, Moderna - that have been approved for use in the UK are considered safe for patients who are immunosuppressed.

While the vaccine might provide a lower level of protection in people who are immunosuppressed compared with the rest of the population, it is still very important to have it as will provide with significant protection against catching COVID-19.   It is also important that you receive two doses of the vaccine to maximise the protection that vaccination offers you.

Data from the NHS Blood and Transplant registry supports the recommendation that people who have had an organ transplant or are on the waiting list should have both their vaccinations.

Research into the effectiveness of the vaccine in people who are immunosuppressed is currently taking place and we received the following update from the DHSC in June 2021.

"We are largely awaiting results of the OCTAVE study for this. As part of the National Core Studies Immunity Programme, UK Research and Innovation (UKRI) is providing initial funding of £1.8 million for 12 months towards the OCTAVE study.

The OCTAVE study will examine the effectiveness of COVID-19 vaccines in clinically at-risk groups. This includes COVID-19 vaccine responses in patients with certain immunosuppressed conditions, including those with inflammatory disorders, high risk cancer patient groups, and patients with severe kidney and liver disease. Cancer patient groups include those with blood cancer (leukaemia, myeloma, and bone marrow (stem cell) transplants).

Key sample timings include 28 days and 6 months post vaccine boost. Results will be available within 3 months of sampling date. It is estimated that that initial results for the immediate response to vaccine (28 days post vaccine) will be available across the majority of the cohort by the middle of June.

This will provide us with a more accurate picture of how effective the vaccine is if you are immunosuppressed."

An antibody test is a blood test, which tests if your immune system is making proteins (antibodies) to fight COVID-19.

Antibody testing in the general population is not being systematised in part because clinicians are not able to calibrate what a ‘good’ level of immune response is yet for COVID. Some studies are monitoring this such as Virus Watch (see below):

About Virus Watch

Virus Watch is a research study run by University College London, in cooperation with the NHS. The study has released its preliminary findings (yet to be peer reviewed) on 14 May 2021, available at the following: Findings – Virus Watch Study – join with your household to help us stop the spread of COVID-19 (ucl-virus-watch.net)

The study found that 96.42% of Virus Watch participants were antibody positive 28-34 days after a single dose of a COVID-19 vaccine. This increased to 99.08% 7-14 days after a second vaccine dose.

Antibody positivity rates rose faster in participants who received the Pfizer vaccine compared to the AstraZeneca vaccine, but by 4 weeks after the first vaccine dose antibody positivity rates were equivalent for both Pfizer and AstraZeneca vaccines.

The study found evidence that antibody levels were lower with increasing age following the first dose of vaccine. They were also lower in people with some long term health conditions including diabetes, heart disease, cancer and those currently on immunosuppressive therapies. However, following a second dose of either the AstraZeneca or the Pfizer vaccine, high antibody levels were observed for nearly all individuals including those with long term health conditions.

The British Liver Trust will be working closely with the public health bodies and experts to confirm plans to further protect patients who are immunosuppressed.

It is thought that the most likely course of action will be a third booster dose of the vaccine in the autumn/winter.

 

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