The CRG continues to meet regularly. At the latest meeting the roll out of Covid vaccines to Cohorts 4 and 7 was discussed. I have been asked to provide a summary of the discussion for everyone. Everything is subject to change; this summary is current at 8/4/2021. Thanks also to Jean for the excellent summary of the IMO webinar circulated earlier. It is the astrazeneca vaccine that will be used in General Practice for these patients. It is an opt in system and you opt in by submitting an order for vaccines. It seems the vast majority of practices in the country are taking part. What happens to the patients of the practices that don’t take part has not been determined yet until such time as the numbers are known. Astrazeneca will be delivered in quantities of 100 or multiples of 100. They will be delivered in a week in which you do not have a Pfizer delivery. There will be 4 deliveries 1: Cohort 4 dose 1 2: Cohort 7 dose 1 3: Cohort 4 Dose 2 12 weeks after 1 4: Cohort 7 dose 2 12 weeks after 2 Clearly you will not have exactly 100 Cohort 4 patients so once they are done you can include cohort 7 patients. While there are clinical definitions for the groups it has been clearly stated that the GP’s clinical judgement can be used to determine if a particular patient qualifies. When making returns you only have to specify they are in this group, you will not have to specify which condition the patient has. It is a significant challenge for practices to organise and deliver these vaccines and the CRG is very aware of this. There is support available and ultimately it is up to the practices to determine how best they can achieve the vaccinations. Centric are here to help and assist, for instance through utilizing the web sites, deploying the simply booking app and as an information source. We also need to know from you what additional supports you require so please let us know through your Regional Manager and every effort will be made to provide what you need. Identifying patients Some of the categories are difficult to find and it is recognised that we may not be able to absolutely 100% identify every single patient. It is likely many of these patients will contact the practice in any event and eventually everybody will be offered a vaccine. As well as using the searches below we are piloting some schemes to help identify patients and if successful we will communicate these to you. To identify patients, you can use the same techniques as for finding the CDM patients and I attach one of the original guides for doing this. I also attach two recent tips which looked at other ways of identifying cohorts 4 and 7 including those in the age range that have had flu vaccines previously. Here is a reminder of the overall cohorts. ・ 1. Adults aged ≥65 years who are residents of long-term care facilities<https://www.gov.ie/en/publication/39038-provisional-vaccine-allocation-groups/#adults-aged-65-years-who-are-residents-of-long-term-care-facilities> ・ 2. Frontline healthcare workers<https://www.gov.ie/en/publication/39038-provisional-vaccine-allocation-groups/#frontline-healthcare-workers> ・ 3. People aged 70 and older<https://www.gov.ie/en/publication/39038-provisional-vaccine-allocation-groups/#people-aged-70-and-older> ・ 4. People aged 16-69 with a medical condition that puts them at very high risk of severe disease and death<https://www.gov.ie/en/publication/39038-provisional-vaccine-allocation-groups/#people-aged-16-69-with-a-medical-condition-that-puts-them-at-very-high-risk-of-severe-disease-and-death> ・ 5. People aged 65-69 whose underlying condition puts them at a high risk of severe disease and death<https://www.gov.ie/en/publication/39038-provisional-vaccine-allocation-groups/#people-aged-65-69-whose-underlying-condition-puts-them-at-a-high-risk-of-severe-disease-and-death> ・ 6. Other people aged 65-69 and key workers essential to the vaccine programme<https://www.gov.ie/en/publication/39038-provisional-vaccine-allocation-groups/#other-people-aged-65-69-and-key-workers-essential-to-the-vaccine-programme> ・ 7. People aged 16-64 who have an underlying condition that puts them at high risk of severe disease and death<https://www.gov.ie/en/publication/39038-provisional-vaccine-allocation-groups/#people-aged-16-64-who-have-an-underlying-condition-that-puts-them-at-high-risk-of-severe-disease-and-death> ・ 8. Residents of long-term care facilities aged 16-64<https://www.gov.ie/en/publication/39038-provisional-vaccine-allocation-groups/#residents-of-long-term-care-facilities-aged-16-64> ・ 9. People aged 64 years and younger, and people aged 16-64 living or working in crowded settings (in parallel)<https://www.gov.ie/en/publication/39038-provisional-vaccine-allocation-groups/#people-aged-64-years-and-younger-and-people-aged-16-64-living-or-working-in-crowded-settings-in-parallel> Here are the clinical definitions for Cohort 4 and 7 Cohort 4: People aged 16-69 with a medical condition that puts them at very high risk of severe disease and death Cancer All cancer patients actively receiving (and/or within 6 weeks of receiving) systemic therapy with cytotoxic chemotherapy, targeted therapy, monoclonal antibodies or immunotherapies and radical surgery or radiotherapy for lung or head and neck cancer. All patients with advanced/metastatic cancers. Chronic kidney disease Chronic kidney disease, on dialysis, or eGFR <15 ml/min. Chronic neurological disease or condition Chronic neurological disease or condition with evolving ventilatory failure (requiring non-invasive ventilation), for example: motor neurone disease, spinal muscular atrophy. Chronic respiratory disease Chronic severe respiratory disease, for example: severe cystic fibrosis, severe COPD, severe pulmonary fibrosis. Diabetes Diabetes and HbA1C ≥58mmol/mol Immunocompromised Severe immunocompromise due to disease or treatment, for example: ・ transplantation: - Listed for solid organ or haematopoietic stem cell transplant (HSCT) - Post solid organ transplant at any time - Post HSCT within 12 months ・ genetic diseases: - APECED** - Inborn errors in the interferon pathway ・ treatment: - included but not limited to Cyclophosphamide, Rituximab, Alemtuzumab, Cladribine or Ocrelizumab in the last 6 months Inherited metabolic diseases* Disorders of intermediary metabolism/at risk of acute decompensation, for example: Maple Syrup Urine Disease. Intellectual disability* Down Syndrome. Obesity BMI >40 Kg/m2. Sickle cell disease* Cohort 7: People aged 65-69 whose underlying condition puts them at a high risk of severe disease and death Cancer Haematological - within 1 year. Haematological - within 1 - 5 years. Non-haematological - within 1 year. All other cancers on non-hormonal treatment. Chronic heart (and vascular) disease Chronic heart disease, for example: heart failure, hypertensive cardiac disease. Chronic kidney disease Chronic kidney disease with eGFR <30ml/min. Chronic liver disease Chronic liver disease, for example: cirrhosis or fibrosis. Chronic neurological disease or condition Chronic neurological disease or condition significantly compromising respiratory function and/or the ability to clear secretions, for example: Parkinson's disease, cerebral palsy. Chronic respiratory disease Other chronic respiratory disease, for example: stable cystic fibrosis, severe asthma (continuous or repeated use of systemic corticosteroids), moderate COPD. Diabetes All other diabetes (Type 1 and 2). Immunocompromised Immunocompromise due to disease or treatment, for example: high dose systemic steroids (as defined in Immunisation Guidelines for Ireland Chapter 3), persons living with HIV. Inherited metabolic diseases* Disorders of intermediary metabolism not fulfilling criteria for very high risk. Intellectual disability* Intellectual disability*** excluding Down Syndrome. Obesity BMI >35 Kg/m2. Severe mental illness* Severe mental illness, for example: schizophrenia, bipolar disorder, severe depression. *additional or updated medical conditions ** APECED - autoimmune polyendocrinopathy candidiasis ecto- dermal dystrophy *** WHO definition of intellectual disability as “impairments in adaptive, social, and intellectual functioning (IQ<70), requiring daily support, with onset in the developmental phase (<18 years)” Michael Joyce