Timing of COVID-19 vaccination in the major burns patient.

Dear Editor,

The COVID-19 pandemic continues to challenge our healthcare system and impact on burn care delivery [1]. The arrival of the COVID-19 vaccinations offer a strategy to contain the pandemic with vaccine rollout prioritising medically vulnerable patients. Patients with burn injury often have significant comorbidities or acquired organ and immune dysfunction [2]. Such patients may be more vulnerable to subsequent contraction of COVID-19 and potentially have an increased mortality risk. In the unique setting of burn injury there is little evidence of when is the correct time to administer the vaccine.

There is a long history of variolation dating back to as early as 430BC [3] with Edward Jenner credited with the first vaccine and subsequent eradicaton of smallpox [4]. In burn care there is an established practice in many countries of tetanus vaccination or immunoglobulin administration in those deemed to have higher risk injury [5]. While there are recommendations on the CDC website for immunocompromised patients regarding SARS-CoV-2 there is limited evidence. The Centre for Disease Control and Prevention (CDC) recommends completion of COVID-19 vaccination 2 weeks prior to starting immunotherapy but there are no recommendations with regards to critical care or burns patients.

COVID-19 is a novel and potentially life threatening illness for which vaccines offer an important means to reduce morbidity and mortality in vulnerable patients

We believe that patients with significant burn injury requiring hospital admission constitute a vulnerable group and should be vaccinated against SARS-CoV-2 once they have recovered from the acute phase of burn injury. In our unit we use clinical status and C-reactive protein less than 40 to arbitrarily indicate a burn patient is out of acute immune response phase.

We believe this is an important issue which requires consideration in the burn community.

Conflict of interest

None of the listed authors have any conflict of interest or financial disclosures.