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Information on COVID-19 and vaccination


17 Nov 2021

Dear Rheumatology Patient,

Third dose mRNA COVID-19 vaccination as part of primary enhanced series for patients who are immunocompromised

We are encouraging all our patients who are immunocompromised to have a 3rd dose of a mRNA COVID-19 vaccine as early as 2 months after their second dose.

Immunocompromised refers to:

a. Patients with autoimmune rheumatological conditions, e.g. rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, vasculitis, primary Sjogren’s syndrome, polymyositis/dermatomyositis, spondyloarthritis, psoriatic arthritis

AND

b. Who are on drugs which suppress their immune system, e.g. methotrexate, mycophenolate mofetil, cyclosporine, tacrolimus, cyclophosphamide, biologics, tofacitanib, baricitinib, prednisolone more than 10mg daily, azathioprine, sulphasalazine, leflunomide.

Patients who are on intravenous rituximab must contact their Rheumatology Doctor to discuss timing of their vaccinations

Patients who are on hydroxychloroquine and/or on prednisolone 10mg daily or less are not regarded as immunocompromised. These patients may continue with the normal COVID-19 vaccination timetable.

You will require a memo from your Rheumatology Doctor to bring to the vaccination centre. Please contact us (see below) to request for the memo.


For a completed copy of the MOH Memo for the Primary Enhanced Series Vaccination (endorsed by your Doctor-In-Charge), or to discuss the health protocols and other vaccine matters, please scan the QR code below or use the following link https://form.gov.sg/6191fef36761d90013091c36 to leave your details.

MOH Memo for RHI patients 1.png

MOH Living with COVID-19 Protocols 1, 2, 3 adjusted for patients who are immunocompromised

Similarly, the MOH Living with COVID-19 Protocols 1, 2, 3 are adjusted for patients who have autoimmune rheumatological conditions and are on drugs which suppress their immune system.

Protocol 1:

If you are unwell, you should see a doctor and have a PCR test. If tested positive, the Doctor may admit you but you should self-isolate whilst waiting for your PCR result.

Protocol 2 (adjusted):

If you test positive on ART but you are well i.e. no symptoms, you should see a Doctor and have a PCR test. Do not wait 72 hours to repeat another ART. This is because patients with autoimmune rheumatological conditions who are immunocompromised (as stated above), may not have symptoms in early COVID-19 infection.

Protocol 3 (adjusted):

If you are identified by MOH as a close contact of a COVID-19 case (served with a Health Risk Warning), you should follow Protocol 3 and test with an ART. If you test positive on ART but you are well i.e. no symptoms, you should see a Doctor and have a PCR test.

Patients who are on hydroxychloroquine and/ or on prednisolone 10mg daily or less are not regarded as immunocompromised. These patients may follow the MOH Health Protocols which apply to the general public.


Summary of Recommendations for COVID-19 Vaccination in patients with Rheumatological conditions

Am I suitable to receive the vaccine?

Is it safe to get vaccinated?

Recommendation

I have a rheumatological disease e.g. rheumatoid arthritis, SLE, psoriatic arthritis, vasculitis

Yes

All patients with these conditions are encouraged to receive the COVID-19 vaccine

However, if your condition is not controlled, or you are unsure about this, please contact your primary Rheumatologist

I am on immunosuppressive drugs for my rheumatological condition e.g. methotrexate, sulfasalazine, mycophenolate mofetil, prednisolone etc.

Yes

Persons on oral and injection forms of immunosuppressive drugs can be vaccinated (except for rituximab that needs special consideration).

 

I am on rituximab or had rituximab in the last 6 months

Please contact your primary rheumatologist to discuss if you should have the vaccine

I have a history of allergic reactions to other vaccines

No

Please speak to your primary Rheumatologist

I have a history of severe drug reactions e.g. Stevens-Johnson-Syndrome (SJS), Toxic Epidermal Necrolysis (TEN), Drug Rash with Eosinophilia and Systemic Symptoms (DRESS), Drug-induced Hypersensitivity Syndrome (DiHS)

Yes

This guideline has been recently updated by MOH dated 31 May 2021 (MOH Circular No. 66/2021)

I have a history of anaphylaxis** or allergies to drugs, food, insect stings or unknown triggers

Yes

You may speak to your primary Rheumatologist if you have concerns


** Anaphylaxis is a life-threatening allergic reaction with two or more of the following three criteria:

  • Hives or face / eyelid / lip / throat swelling     
  • Difficulty breathing or
  • Dizziness

Please refer to the Patient Information Sheet for more detailed information on the COVID-19 vaccines in patients with rheumatological conditions. [PDF|560KB]

Version 2: 1 June 2021 (based on MOH circular No. 66/2021)

Prepared by Dr Yeo Siaw Ing and Dr Ng Chin Teck, Senior consultants, Rheumatology and Immunology, SGH

Approved by Dr Andrea Low, Head, Rheumatology and Immunology, SGH