Get help Covid-19 (coronavirus) Covid-19 (coronavirus) Information on Covid-19 - Vaccination, Priority Lists, and Timing of Vaccination Latest on the Rollout of the Vaccination Programme - March 31st AstraZeneca Vaccination Programme Restarted Vaccine Allocation Strategy - Update from Minister Stephen Donnelly Information on vaccines for patients on immunosuppressives Guidance for vaccination in rheumatology patients Which groups of rheumatology patients should be prioritised for Covid-19 vaccination? Recommendations on selection of Covid-19 vaccine by patient sub-group Recommendations for the optimal timing of Covid-19 vaccination National framework for living with Covid-19 Symptoms of Covid-19 and how to protect yourself Latest on the Rollout of the Vaccination Programme - 27 May Vaccination is taking place at the moment for people in Cohorts 1-7 according to the HSE's vaccine allocation groups and pregnant women. On top of this, all those aged over 45 can register for their vaccination. While those over 45 can register to receive a vaccination and those in the high risk cohorts due to their immunosuppressive medications will be contacted to receive their vaccine, supplies are still limited and it is not possible to give an exact date when all the cohorts will receive their vaccinations. As well as details on the various cohorts, the HSE have details on how each cohort should be contacted to receive their vaccination at this site. The latest figures on the breakdown of the vaccination rollout is available from the HSE here. You do not get to choose which vaccine you get. The type of vaccine offered to you will be based on supply. Advice on timing of medications and vaccination - 27 May During the rollout of the Covid-19 vaccine it has been important not to delay vaccination. Therefore, the advice has been to postpone methotrexate after vaccination. It is advised to skip the scheduled dose of methotrexate due immediately after vaccination. There is no evidence that there is a benefit from stopping most other treatments, as always, it is advisable to consult with doctors/rheumatologists on specific, individual circumstances. Rollout of the Vaccination Programme - 19 April The registration process has opened for Cohorts 5 and 6 (all people aged 65-69). Everyone in these Cohorts will receive their vaccination at a vaccination centre. Cohort 4, people aged 16-69 who are at very high risk, are being vaccinated at the moment through their hospital team, if they are in regular contact with hospital or disability services. If they are not in regular contact with these services their GP will contact them for vaccination. For rheumatology patients Cohort 4 is mostly but not confined to those on rituximab, those with severe underlying conditions and/or those who are extremely unwell. Many people on immunosuppressive medications will be vaccinated under cohort 5 or cohort 7 depending on their age. Those in cohort 7 (people aged 16-64 at high risk) will be contacted by their GP for vaccination. This is how the HSE is moving through its vaccine allocation groups. Back to top AstraZeneca Vaccination Rollout Restarted After Temporary Pause The HSE has restarted the use of the AstraZeneca Covid-19 vaccine in Ireland. Following a review by the European Medicines Agency (EMA) the HSE has stated that the AstraZeneca COVID-19 vaccine is safe and effective, and to attend your appointment if this vaccine is offered to you. Further information on why the pause took place, the details of the review and AstraZeneca vaccination are available from the HSE website here. If you have an appointment for an AstraZeneca vaccine you should attend as the vaccine is safe and effective. If you have an appointment for the Pfizer/BioNTech or Moderna vaccine, go to your appointment as planned, as they were not included in this safety alert. Back to top Update on the Vaccine Allocation Strategy - 23 February 2021 The Government announced some changes to the vaccine allocation priority lists on 23 February. The changes are based on the latest clinical and medical advice that those being moved up the list would suffer the worst outcomes if they were to get the disease. Cohort 4, who will be vaccinated immediately after the over 70s living in the community, will now be those aged 16-69 with a medical condition that puts them at very high risk of severe disease and death. Severe immunocompromise due to disease or treatment, under the following conditions, would lead to vaccination in Cohort 4. Transplantation: - Listed for solid organ or haematopoietic stem cell transplant (HSCT) - Post solid organ transplant at any time - Post HSCT within 12 months Genetic diseases: - APECED** - Inborn errors in the interferon pathway Treatment: - included but not limited to Cyclophosphamide, Rituximab, Alemtuzumab, Cladribine or Ocrelizumab in the last 6 months. Medical conditions and the magnitude of the risk they pose will continue to be monitored and periodically reviewed. For more information click here. Back to top Information from the HSE for patients on immunosuppressives re the Covid vaccines: The Oxford-AstraZeneca non-replicating vector vaccine is deemed safe for patients on immunosuppressives. The Pfizer-BioNTech and Moderna mRNA vaccines are not live vaccines and are recommended for patients on immunosuppressives. Back to top Specific Guidance for Covid-19 vaccination in rheumatology patients (VCD19-001-001/12.02.2021) Published 12 February 2021, HSE National Health Library & Knowledge Service Prof David Kane, National Clinical Programme for Rheumatology (1/1/21) Influenza and Pneumococcal vaccination are recommended for all rheumatology patients receiving immunotherapy and ALL patients being considered for SARS-CoV-2 vaccination should be strongly advised to have Influenza and Pneumococcal vaccinations. There is very good quality evidence of mortality reduction for patients who have influenza and pneumococcal vaccination. Back to top Which (if any) groups of Rheumatology patients should be prioritized for Covid-19 vaccination? In addition to existing known high risk groups, rheumatology patients on the following immunosuppressives should be prioritized for Covid-19 vaccination as they have a higher risk of hospitalization / death from COVID-19 while all other rheumatology patients on immunosuppressives will be offered the vaccine in due course. High Risk*People taking Prednisolone at low to moderate doses (5mg/ day1 or greater but less than 10mg day) for 2 weeks or longer (or equivalent doses, see section 3). Very High riskPrednisolone 40 mg/day3 or greater for more than 1 week, or 10mg/day or greater for 2 weeks or longerOrCyclophosphamide, Rituximab, Alemtuzumab, Cladribine or Ocrelizumab in the last 6 months.OrPeople with autoimmune disease and with clinical immunosuppression manifest by recurrent infections and/or significant laboratory evidence of immunosuppression (severe neutropenia (ANC less than 0.5 x 109/L), lymphopenia & hypogammaglobulinaemia).” * From HSE COVID-19: Interim Clinical Guidance: Immunosuppressant Therapy v5 updated 29th October 2020) Back to top Recommendations for selection of Covid-19 vaccine by patients sub-group There will be a number of Covid-19 vaccines with different mechanisms. The HSE has concluded agreements with 5 suppliers for the main vaccine designs (mRNA (Moderna, Pfizer), non-replicating vector vaccines (University of Oxford) and inactivated virus vaccines). The Pfizer-BioNTech mRNA and Moderna mRNA vaccines which are currently licensed are not live vaccines and are recommended for patients on immunosuppressives. The Oxford-AstraZeneca non-replicating vector vaccine is also deemed safe for patients on immunosuppressives. Back to top Recommendations for optimal timing of administration of Covid-19 vaccine (a) Patients on Methotrexate Several studies have addressed the optimal timing of Influenza vaccination in rheumatology patients on low dose methotrexate and of Influenza and pneumococcal vaccination in rheumatology and oncology patients on Rituximab. Patients on methotrexate who held their medication for 2 weeks after administration of influenza vaccination had a 4 fold increase in neutralizing antibody titres without a significant increased risk of disease flare compared to those who did not interrupt their MTX dosing. Longer periods of treatment interruption up to 4 weeks showed no increased benefit. It is not known if this translates into reduced influenza infection rates though the supposition that it does is logical based on what we know about vaccines and how they work. For surgery it is already established practice to time surgery at the end of a biologic treatment cycle and restart at 10-14 days after to reduce peri-operative infection and minimize flare. Therefore depending on your patient’s circumstances you may recommend that where possible patients on methotrexate should ideally schedule Covid-19 vaccination at the end of a treatment cycle and hold treatment for a maximum of 2 weeks if the treating clinician and patient agree on this strategy.There is no evidence that this strategy is of benefit with other DMARDs. (b) Patients on Corticosteroids It is not possible for patients on steroids to discontinue treatment for the purposes of Covid-19 vaccination - minimization of steroid dose under supervision of their doctor where possible may be of benefit to patients receiving the vaccine (c) Patients on Rituximab Patients on rituximab have reduced numbers of B cells and a poorer antibody generation response to vaccines. It is recommended that patients should have Covid-19 vaccination ideally 4 weeks before they receive rituximab treatment and if on treatment that it be scheduled for the end of a treatment cycle (e.g. 6 months after last dose for optimal effect). In patients approaching a new treatment cycle in Q1 2021, clinicians should now consider identifying and pausing therapy if they can predict availability of vaccination for that patient. Clearly the main difficulty is predicting timing of vaccination for these patients. Back to top National Framework for living with Covid-19 Ireland is currently placed on Level 5 restrictions: for full details of the measures that are now in place please follow this link. Covid-19 and arthritis Do not alter your medications without specific instructions to do so by your rheumatology team, who have your medical records. If you develop symptoms of any infection, including Covid-19, in consultation with your rheumatology team, immunosuppressive therapy should be paused for the duration of the infection until you feel well. Being on immunosuppressive treatments does not increase your risk of getting a Covid-19 (Coronavirus) infection There is no evidence to date that being on an immunosuppressive treatment puts you at higher risk of severe disease with Covid-19. However, as other infections can cause severe illness in people who are on immunosuppressive treatment, you should take extra care. Keep taking steroids if you are usually on them unless your doctor tells you otherwise. Stopping steroids suddenly can make you very unwell. If you become unwell due to Covid-19 or another infection, continue to take your steroids. Further information about immunosuppressive medications, steroids and risk is available here. If you have any questions about Covid-19, please contact our helpline by phone: 0818252846 or by email to [email protected]. You can also connect with our private Facebook support group. Back to top Symptoms of COVID-19 and how to protect yourself Physical distancing should continue to be maintained at all times. You are still advised to: wash your hands well and often cover your mouth and nose with a tissue or bent elbow when coughing or sneezing, and discard used tissue safely distance yourself at least 2 metres away from other people, especially those who might be unwell limit your contact with others when out and about keep your close contacts to a small number of people limit the amount of time you spend in direct contact with other people avoid crowded areas. If an area looks busy, go somewhere else or return at a quieter time wear a face covering in situations where physical distancing is not possible, for example shops and busy public transport, or if you are meeting someone who is vulnerable to the virus, for example people who are extremely medically vulnerable and people over 70 years. Wearing cloth face coverings may help prevent people who do not know they have the virus from spreading it to others. Guidance on safe use of face coverings is available here. keep a log of all of your contacts throughout the day Know the symptoms of Covid-19. They are: a fever (high temperature - 38 degrees Celsius or above) a cough - this can be any kind of cough, not just dry shortness of breath or breathing difficulties loss or change to your sense of smell or taste flu like symptoms If you have symptoms, self-isolate and contact your GP immediately. Further information about Covid-19 is available on the Department of Health website Back to top Updated 27 May 2021