Haematology patients, their household members and the health professionals delivering their care should be prioritised for COVID-19 vaccination, according to a Haematology Society of Australia and New Zealand  (HSANZ) consensus position statement.

The statement, developed in collaboration with infectious disease specialists, says the high mortality associated with COVID-19 in haematology patients should see them at the top of the vaccination queue.

HSANZ said the benefits from the current range of vaccines, none of which were live vaccines, outweigh possible unknown factors in haematology patients – assuming no known contraindications to the contents of the vaccine.

The statement provided some practical recommendations around vaccine administration and precautions, including:

• Patients requiring treatment for a haematological malignancy should be vaccinated before treatment with chemotherapy, cellular therapies or T- or B-cell depleting treatments if possible.
• Vaccination should be timed with the aim of achieving optimal protection at the earliest opportunity without compromising disease treatment outcomes. Where possible, vaccination should be completed at least two weeks before immunosuppressive treatment.
• For patients who have already commenced disease-specific therapies, we do not generally recommend interruption of treatment during vaccination. It is appropriate to delay vaccination for at least three months after B cell depleting therapy or stem cell transplantation. For such patients the vaccination of household contacts is an essential preventative measure.
• Given the likelihood of reduced immunogenicity to COVID-19 vaccination in patients with haematological malignancies, particularly those who are on immunosuppressive therapies, vaccination should not replace other measures to reduce risk of COVID-19 infection.
• After vaccination, patients should be advised to continue to practice usual public health measures (e.g. masks, social distancing, ensuring good indoor ventilation, and hand hygiene) because the immunogenicity and efficacy of vaccination in haematology patients is unknown.
• All haematology patients including those with haematological malignancies and recipients of cellular therapies, should also receive vaccinations against influenza, pneumococcus and other pathogens, as per standard guidance.
• Patients with suspected or confirmed previous COVID-19 infection should be vaccinated as per international guidelines as immunity may wane.
• Household transmission is one of the most common mechanisms of SARS-CoV-2 transmission. Therefore, vaccination of household members and/or carers of haematology patients with high efficacy vaccines should be prioritised.
• Acknowledging the lack of data for efficacy and safety of COVID-19 vaccines in haematology patients, we recommend the most efficacious vaccine in haematology patients, health care workers delivering their care and household members. This preference, however, should not delay vaccination with more immediately available vaccines.