Information on COVID-19 and vaccination

19 February 2022

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 to complete the primary enhanced series. A 4th booster dose may be recommended 5 months after the 3rd dose. Please discuss with your Rheumatology Doctor, who will provide you with a memo to bring to the vaccination centre. Please contact us (see below) to request for the memo.

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.

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

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 with no or mild 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 Notice), you should follow Protocol 3 and test with an ART. If you test positive on ART but you are well with no or mild symptoms, you should see a Doctor and have a PCR test.

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.

Best Wishes
Rheumatology Team
Department of Rheumatology and Immunology
SGH