COVID update September 2021
COVID continues to be an issue, but it is equally important to ensure we are able to do as many things as possible and for children that includes going to school and experiencing life. There remain some questions about how beneficial the vaccine is to children, but it reduces disease severity in adults and is certainly recommended for children with underlying medical problems, particularly those affecting the immune system. Many of our patients are on drugs that have an effect on the immune system and therefore need to be vaccinated.
The vaccine has already been offered to everyone aged 16 years and above. Normally this would consist of two doses, but it has now been recommended that the following groups should receive a third dose when they first get vaccinated:
- Individuals on immunosuppressive therapy at the time of vaccination including:
- those who were receiving or had received immunosuppressive therapy for a solid organ transplant in the previous 6 months
- those who have received rituximab in the previous 6 months
- Individuals with chronic immune-mediated inflammatory disease who were receiving or had received immunosuppressive therapy prior to vaccination including:
- high-dose corticosteroids (equivalent to ≥ 20mg prednisolone per day) for more than 10 days in the previous month
- long-term moderate dose corticosteroids (equivalent to ≥10mg prednisolone per day for more than 4 weeks) in the previous 3 months
- non-biological oral immune modulating drugs, such as methotrexate >20mg per week (oral and subcutaneous), azathioprine >3.0mg/kg/day, 6-mercaptopurine >1.5mg/kg/day, mycophenolate >1g/day in the previous 3 months
- certain combination therapies at individual doses lower than above, including those on ≥7.5mg prednisolone per day in combination with other immunosuppressants (other than hydroxychloroquine or sulfasalazine) and those receiving methotrexate (any dose) with leflunomide in the previous 3 months
- Individuals who had received high-dose steroids (equivalent to >40mg prednisolone per day for more than a week) for any reason in the month before vaccination.
These figures are based on adults and a child's consultant will advise on whether they reach the threshold for the 3rd dose.
It has recently been decided that all children between 12 and 15 years of age will be offered a COVID vaccination. This is routinely a single dose but if the child has an underlying health condition as listed above, they should be offered two doses of the Pfizer vaccine with an interval of 8 weeks between doses.
It is also advised that children and young people aged 12 years and over who are household contacts of persons (adults or children) who are immunosuppressed should be offered two doses, rather than just one, of the Pfizer vaccine on the understanding that the main benefits from vaccination are related to the potential for indirect protection of their household contact who is immunosuppressed.
If the patient suffers from nephrotic syndrome, it is advised to chat with your consultant as there may be a small risk of causing a relapse when getting the COVID vaccine. Urine should be monitored closely after the vaccination.
As with all medications, there are risks, but these are outweighed by the risks associated with not having the vaccine. It is hoped that by immunising everyone we can reduce the risk of severe disease, especially in those with underlying medical problems.
All our patients should also receive the flu vaccine as an injection. It can be given at the same time as the COVID vaccine.