Some of our cancer patients have been refused COVID vaccines. I thought I'd summarise guidance (taken from UK chemotherapy Board, Thames Valley Haematology and PHE guidelines) that applies to Oxford Uni/AZ (AZ) and Pfizer/BioNTech (Pf) vaccines. Note, neither are "live" vaccines.

The following patients SHOULD be considered for vaccination. Those on: 1) chemotherapy - ideally 2 weeks before starting treatment/when blood counts are at their highest (just before chemo). If on chemo, avoid vacc on same day as chemo. 2) immunotherapy drugs (pembrolizumab,nivo)

3) monoclonal antibodies (cetuximab, Herceptin etc) - no reason to interrupt continuous treatment ie keep treating and vaccinate. 4) hormone therapies (tamoxifen etc). 5) clinical trials unless protocol prohibits.

6) those on oral anticoagulants or with low platelets (>20 ) although use firm pressure to the vaccination site for 5 minutes after the injection.

Those NOT for vaccination: 1) hypersensitivity to the 1st dose of that vaccine. Those who had hypersensitivity to the Pf vaccine can be considered for a second dose of the AZ vaccine (should be observed for 30 minutes afterwards). 2) anaphylaxis to excipients (see later)

3) Acute neutropenia (neutrophils <1 x 10e9) until neutrophils are over 1. Patients with chronic neutropenia can be vaccinated. 4) within 3 months of allogenic bone marrow stem cell transplant (BMT). 5) Within 4 weeks of autologous BMT. 6) Within 7 days of a febrile illness

Allergies are more complicated. Angioedema/Anaphylaxis patients were excluded from AZ and Pf trials so need careful discussion with GPs. Recent guidance says those with food allergies/anaphylaxis are safe to have Pf vacc but AZ situation less clear.

Those with prior hypersensitivity to Pf vacc can be considered switching to have a second dose with AZ but observed for 30 minutes afterwards.

Those with anaphylaxis to chemotherapy need to be careful. AZ contains Polysorbate/Tween 80 which is in chemos like docetaxel and etoposide. Pf contains Polyethylene glycol (PEG) which is in Caelyx/liposomal doxorubicin and some nanoparticles.

There can be cross-over between polysorbate and PEG allergies so discuss with oncologist if any chemotherapy anaphylaxis in the past. Useful sites for updates are http://gov.uk  and http://sps.nhs.uk