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COVID-19 rapid Nice guideline summary: Immunocompromised children

Nice has published advice to maximise the safety of immunocompromised children and young people during the pandemic

Unplanned learning

It may be useful to print this summary as a resource for your pharmacy team – PDF available here.

Immunocompromised children and young people have been shown to experience mild, self-limiting symptoms when infected with COVID-19. Patients and their parents or carers should be reassured of this and given support to alleviate their anxiety regarding COVID-19.

Patients should attend all scheduled appointments unless advised otherwise. Where possible, non-face-to-face alternatives should be arranged (eg telephone or video consultations). Specialist teams should be contacted for individual advice if the patient has been told they are in the shielded group or if COVID-19 is suspected.

For patients with complex needs, advise parents or carers to have a plan in place should they themselves become ill.

Managing the underlying condition

Patients not known to have COVID-19

Patients already taking immunosuppressive medication should continue with their usual treatment and monitor plans at home. Remind patients and parents or carers of the usual safety-netting advice for their condition. For stable patients, an assessment may be made to see if it is possible to increase the interval between blood tests for drug monitoring.

The risks and benefits of starting immunosuppressive therapy should be discussed with the patient and their parents or carers.

If patients need to have face-to-face appointments:

  • Attend with just one parent or carer
  • Avoid using public transport to get to and from apppointments
  • Advise parents and carers not to bring other children to the appointment
  • If COVID-19 symptoms are suspected, let the team know in advance.

Minimise time in the waiting area by:

  • Careful scheduling
  • Encouraging patients not to arrive early
  • Texting or phoning patients when you are ready to see them
  • Delivering treatment promptly (eg having immunisations ready)
  • Dispensing prescriptions rapidly.

Patient known or suspected to have COVID-19

Children and young people often show no or mild symptoms of COVID‑19 – very few will develop severe or life-threatening symptoms. Therefore, there may be less risk in starting or continuing immunosuppressants for patients in this group who need them.

However, for children and young people who are immunocompromised:

  • There may be greater vulnerability to COVID‑19
  • COVID-19 can be difficult to diagnose
  • Symptoms of COVID-19 can overlap with symptoms of other diseases
  • Immunosuppressant medication may lead to atypical presentations of COVID-19 (eg those taking prednisolone may not develop a fever).

Appropriate infection prevention and control measures should be followed for those with signs or symptoms of COVID-19. If serious illness is suspected (eg meningitis), the patient should be treated in line with usual care for these infections. Otherwise investigation and initial clinical management guidelines should be followed.

When considering stopping the usual treatment for these patients, the specialist team should be consulted if risks and benefits will be discussed with patients and parents or carers.

Supplying medicines

Dispense the usual quantities of medicines to meet the patient's clinical needs. Prescribing larger quantities of medicines puts the supply chain at risk.

Repeat prescriptions should be provided for oral medicines or other at-home treatments without patients needing to attend hospital.

This summary is intended as a quick resource for pharmacy teams on the Nice COVID-19 rapid guideline: children and young people who are immunocompromised. For more detailed information, please see the full guideline.

References

National Institute for health Care and Excellence (2020) Nice COVID-19 rapid guideline: children and young people who are immunocompromised. Nice guideline (NG174).

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