Clinical Immunology/Immunodeficiency

COVID-19/Coronavirus

This is a fast moving situation and we will try and update this website with new information as it becomes available. All non-urgent outpatient clinics and much day-case activity has been cancelled due to the coronavirus pandemic. It is very important that patients on immunoglobulin replacement should continue to receive their infusions. Therefore, day-case immunoglobulin infusions will continue, although the frequency of administration may be reduced. Depending on the availability of staff due to redeployment to other departments and sickness, we may be able to provide a limited service. This will generally be over the phone, video call or in exceptional circumstances in person. If patients have had an appointment cancelled then patients can expect to receive a new appointment after normal services resume. Patients should please contact the department on 0117 4148392 or 0117 4148393, or at allergyandimmunology@nbt.nhs.uk if they feel that their medical problem is urgent. 

Unfortunately, because Coronavirus is a new infection we do not have much evidence on which to base an analysis of the risk in patients with immunodeficiency. The PID UK, UK PIN and British government websites (links below) may be helpful in accessing up-to-date information.

The government has indicated that people who are classified as ‘extremely vulnerable’ should be ‘shielding’ (staying at home) for a period of at least 12 weeks for their own protection, as it is felt they are at very high risk of severe disease. 12 weeks should commence from around the 23rd March 2020 (or from the day that patients received a letter indicating they are in this group). This is subject to change. ‘Extremely vulnerable’ people include those ‘with rare diseases and inborn errors of metabolism that significantly increase the risk of infections (such as severe combined immune deficiency (SCID))’, and include patients with a significant primary immune deficiency and a co-morbidity for example. Further recommendations and advice for who is extremely vulnerable and should be ‘shielding’, and what additional precautions should be taken for patients with immune deficiency is available from UK PIN (see below), and for those on immunosuppression from the British Association of Dermatologists (see below). 

If patients develop symptoms of COVID-19 (high temperatures above 37.8 degrees C and/or new and continuous cough) then clinical advice should be obtained from NHS 111 online (https://111.nhs.uk/) or by calling NHS 111 if patients don’t have internet access. 999 should be called if patients are seriously ill. The Clinical Immunology department may be able to provide a virtual appointment (over the phone or video call), see patients in person and/or supply patients with prescriptions for medication (e.g. antibiotics) depending on staff redeployment. If patients have symptoms of COVID-19 (as above) and are due to come to the hospital (for an immunoglobulin infusion or other reason) then they should please contact the hospital for consideration of rescheduling of appointment.

Government advice on Coronavirus, extreme vulnerability and shielding can be found at https://www.gov.uk/coronavirus

PID UK (Primary Immunodeficiency UK) is a patient organisation who have produced patient information leaflets on Coronavirus for both primary and secondary immunodeficiency. These are available at http://www.piduk.org/.

The UK PIN (UK Primary Immunodeficiency Network) are an organisation of specialist doctors in Clinical Immunology in the UK. They have produced expert guidance on patients with both primary and secondary immunodeficiency as to who should be ‘shielding’ and any additional measures that should be made. This is available at http://www.ukpin.org.uk/news-item/2020/03/24/covid-19-uk-pin-update. If patients are not clear on what category they are in then they should please get in touch either over the phone or by email at link to Allergy & Immunology Staff Contact Details**.

The British Association of Dermatologists have produced guidance for patients on immunosuppressive medications, as to who should be shielding. This is available at https://www.bad.org.uk/healthcare-professionals/covid-19/covid-19-immunosuppressed-patients. Please click the link to view the grid.

Clinical Immunology/Immunodeficiency Service

We run regular Adult Immunology/Immunodeficiency (and Allergy) clinics on Tuesday mornings, Thursday afternoons, and all day Friday seeing patients referred (see Patient Referral Pathways) to our service with suspected or confirmed immune deficiency. Criteria and advice for whom to refer can be found on the Remedy website at https://remedy.bnssgccg.nhs.uk/media/1337/immunology-referral-guidance.pdf .

Our service provides replacement antibodies (immunoglobulin) to patients with confirmed antibody deficiency. This can be given in hospital (as a day case) or at home.

 

Last updated: 13/05/2020