Can I have routine vaccinations under lockdown?

'Business as usual' for vaccines

'Business as usual' is the last thing anyone expects to hear, especially from GPs. But that's how Dr Simon Poole describes his surgery's approach to vaccinations. Of course, he admits, it wasn't this way to begin with.

"When lockdown first occurred, people were not quite sure what to do and were frightened away from contacting us," he says. "So we had a quiet few days. But it was only a few days. A week into the lockdown people were beginning to ring up and ask a whole host of questions.

"People might have been a bit confused initially," he adds, "but now they have the clear message that vaccinations must continue."

Helen Donovan is a public health nurse. She also leads the public health response at the Royal College of Nurses.

"It is really important that parents know the vaccination programme for children is continuing, even at this time," she says. "It is completely understandable that some may have concerns about coming in when the general advice is to stay at home. They should be reassured that protection measures are in place.

"Parents should have the confidence that nursing staff will make sure that they are in the surgery for as short a time as possible and will maintain social distancing as far as possible. But we really can't risk outbreaks of vaccine-preventable disease."

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Infections

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Infections

HPV vaccine

Human papillomavirus (HPV) is a tiny germ that almost everyone gets at some point in their life. Usually it is fairly harmless, but infection with some types of HPV can cause cancer of the neck of the womb (cervix), anus and penis. These cancers take many years to develop after the infection with HPV. Genital warts are also caused by HPV. The HPV vaccine should dramatically reduce cervical, anal and penis cancer cases in the future and lead to fewer cases of genital warts. It may also reduce other cancers thought to be sometimes due to HPV. HPV vaccines were introduced in the UK for girls in 2008 and for boys in 2018. Men who have sex with men (MSM) can also access the HPV vaccine until the age of 45. Women are still advised to attend for cervical screening tests, even if they have been immunised against HPV.

by Dr Colin Tidy, MRCGP

Vaccinating safely

Naturally, lockdown has increased worries about catching COVID-19 in the community, but like other practices and hospitals, Dr Poole's surgery has two different zones in the practice. Patients visit one or the other depending on whether or not they have COVID-19 symptoms.

"People have expressed some anxiety at times about coming in which is understandable, but we are maintaining 'hot' and 'cold' areas," he says. "With people potentially carrying it and being asymptomatic, we can't absolutely guarantee being free of COVID-19 - but nowhere can. We see people and do vaccinations in 'cold' areas where we're not seeing people with suspected COVID-19."

In fact, given that practices have already checked people are free from any COVID-19 symptoms before allowing them into the 'cold' area of the practice, your risks are probably lower than in a shop or other public place.

Flu vaccinations

Public health experts have already urged GPs and pharmacists to review their orders for autumn flu vaccine clinics this year. NHS England predicts 'substantially expanded' demand, and so does Dr Poole.

"It's not a particular issue for us at this point," he explains, "but we do anticipate busier flu jab clinics."

Flu jabs are usually available from late September or early October. GPs and pharmacies both offer appointments. If you're not eligible for an NHS flu vaccination, you'll be able to get one privately from a pharmacist with an appointment booked through Patient Access.

Childhood immunisations

Dr Poole adds that where households have had suspected cases of COVID-19, they should follow the guidelines about isolating for 14 days. Likewise where households have one or more vulnerable people who are shielding, he recommends patients call the surgery to discuss concerns.

"Have a conversation with the nurse to find out when they feel that it will be safe to bring your little one in to vaccinate," he says.

"For vulnerable and shielding people, essentially it depends on what the vaccine is. But a scheduled vaccination is usually important to go ahead with."

Dr David Elliman, a consultant at Great Ormond Street, has been an expert in measles and mumps for decades. A paper published on 6 May looked at how the introduction of physical distancing affected the numbers of vaccinations in 2020, compared with 2019. Research showed that parents continued to take their children for the six-in-one vaccine at eight weeks.

"The first vaccine coincides with a routine review so there's an opportunity to remind people of that one," Dr Elliman says.

However, there was a fall in the number of parents who brought their child for the MMR. Research is underway to work out why.

"Unless people have been sent reminders, they may have forgotten about it," he suggests. "That, in addition to perhaps not being clear whether the GP would still be open for immunisation, may have contributed to the fall, as well as the parents' concern about taking their child."

The paper's authors recommended that vaccinations normally delivered in schools - against HPV, meningitis and the three-in-one booster for teenagers (Td/IPV) - will need catch-up programmes following school closures.

Protecting your child - more important than ever

With the reduction in children having the MMR vaccination in the first few weeks of the pandemic, there is a real risk that the proportion of children protected could fall below the threshold (of about 90%) to provide 'herd immunity'. And that in turn raises the spectre of outbreaks of measles and mumps, which carry significant risk of serious and even fatal complications.

Although vaccination rates for MMR rose after the now entirely discredited paper in the Lancet about a possible link with autism was withdrawn, they have remained close to the 90% level and any drop could trigger further outbreaks.

In addition to the direct risk of these infections, measles can damage a child's immune system for up to three years after they recover from it. This could in turn lay them open to an increased risk of COVID-19 infection.

The long-term view

Last year doctors were worried to see rates of coverage for all childhood vaccinations fall for the fifth consecutive year. Small breakthroughs before lockdown - a significant reduction in meningitis B cases in young children, a sharp drop in HPV infections, and the promise of a new vaccine reminder scheme - gave cause for hope.

"We have been concerned over the last years of the gradual decline in uptake. But we have been heartened to see that the data for the end of 2019 were showing a small increase, which is testament to all the hard work," Helen adds. "We must not allow this pandemic to undo all that good work."