Care homes with outbreaks ‘should receive prompt Covid vaccination’ – NHS

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Care homes with coronavirus outbreaks should receive vaccination promptly, the NHS has said, after it emerged homes with cases were struggling to get access.

Vulnerable residents in care homes with Covid-19 cases in some areas of England were unable to get the Pfizer/BioNTech vaccine as it was rolled out in December, care groups said.

It is understood that concerns about residents missing out were raised in the week leading up to Christmas by providers.

As part of preparing for the vaccine, they had been advised that staff should check there had been no outbreak in the past four weeks, in a checklist issued by the NHS that week.

According to the Government’s “green book” on immunisation, there is “limited evidence” to support using either of the approved vaccines to interrupt transmission during outbreaks or as post exposure prophylaxis – for use shortly after exposure to the virus to prevent infection.

It reads: “The use of vaccine to provide direct protection to vulnerable individuals in prolonged community outbreaks should be discussed with the local health protection teams.”

The National Care Forum (NCF), which represents not-for-profit providers, said this had been interpreted in some areas as homes with outbreaks being unable to receive vaccines, and had been calling for urgent policy clarification.

New NHS guidance released on New Year’s Eve now says if there is a low number of cases, or cases are well-isolated within the home, then prompt vaccination of unaffected or recovered staff and residents should be planned.

A risk assessment must take place, considering whether the outbreak is emerging or resolving, the ability to isolate or cohort cases, and the practicalities of keeping vaccine teams to a separate, unaffected area.

Local health teams should consider sending healthcare workers who have already been vaccinated into homes with outbreaks for their protection, it adds.

It says: “Whilst vaccination against Covid may be temporarily deferred in some individuals e.g. acutely unwell or still within four weeks of onset of Covid symptoms, all other staff and care home residents should receive prompt Covid vaccination.”

The NCF said it is important that local interpretations of the guidance do not result in areas of the country where there are blanket bans on homes with cases receiving the vaccine.

Executive director Vic Rayner said: “Government commitments to the vaccination of all care home residents in January are hugely welcome. For homes who have already received their first dose, it has been warmly welcomed, and residents have been keen to embrace the assurance that vaccination brings.

“However, it is essential that every effort is made to vaccinate as many residents as possible, and local health, public health and care homes must work together to ensure that even where an outbreak is happening that those residents not currently testing positive for Covid-19 are vaccinated.

“Whilst vaccination may not break the cycle of transmission, its potentially life-saving qualities for these most vulnerable people are recognised and every possible stone must be turned to get the vaccine into all homes.”

Public Health England (PHE) defines an outbreak as two or more confirmed or clinically suspected coronavirus cases within 14 days.

A care home is classed as outbreak-free 28 days after the last confirmed or clinically suspected case.

Its most recent surveillance data shows there were 341 acute respiratory outbreaks in care homes in the UK involving at least one case of coronavirus reported in the week ending December 29.

Since November 30, there have been 1,000 outbreaks with at least one coronavirus case reported in care homes, with numbers rising.

Mike Padgham, chairman of the Independent Care Group, called for practical support and funds to help smaller care homes ensure vaccination can take place safely where there are cases.

Access to vaccination in North Yorkshire has so far been “patchy”, he said, including for homes which are Covid-free.

He said: “I welcome the fact that care homes are still a priority, there is a way round vaccinating people in care homes and staff where there has been an outbreak.

“But cohorting and getting routes through (for vaccination teams) is not going to be easy in smaller, non purpose-built homes.”

Care groups are also concerned about homes’ vaccine access varying according to location and size.

Professor Martin Green, chief executive of Care England, said Clinical Commissioning Groups (CCGs) must be aware that vaccinating residents and staff is the “number one priority”.

He continued: “At present there is a bit of a postcode lottery in terms of access to the vaccine, so clear communication is necessary if the deadline of vaccinating all care home residents by the end of January is to come to fruition.

“We welcome any means to accelerate the vaccine for care home residents and staff, including care homes for younger adults with learning disabilities.”

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