Recommendations for enhanced primary series (third dose) COVID-19 vaccination for people with rheumatic diseases: chapter of Rheumatologists, College of Physicians, Singapore.
10.4103/singaporemedj.SMJ-2022-070
- Author:
Chuanhui XU
1
;
Manjari LAHIRI
2
;
Amelia SANTOSA
2
;
Li-Ching CHEW
3
;
Stanley ANGKODJOJO
4
;
Melonie SRIRANGANATHAN
5
;
Warren FONG
3
;
Thaschawee ARKACHAISRI
6
;
Ernest SURESH
7
;
Kok Ooi KONG
1
;
Aisha LATEEF
2
;
Tau Hong LEE
8
;
Keng Hong LEONG
9
;
Andrea LOW
3
;
Teck Choon TAN
10
;
Ying-Ying LEUNG
3
Author Information
1. Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore.
2. Division of Rheumatology, Department of Medicine, National University Hospital, Singapore.
3. Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
4. Department of General Medicine (Rheumatology), Sengkang General Hospital, Singapore.
5. Division of Rheumatology, Department of Medicine, Changi General Hospital, Singapore.
6. Rheumatology and Immunology Service, Department of Paediatric Subspecialties, KK Women's and Children's Hospital, Singapore.
7. Department of Medicine, Ng Teng Fong General Hospital, Singapore.
8. National Centre for Infectious Diseases, Singapore.
9. Leong Keng Hong Arthritis and Medical Clinic, Singapore.
10. Division of Rheumatology, Department of Medicine, Khoo Teck Puat Hospital, Singapore.
- Publication Type:Practice Guideline
- Keywords:
COVID-19;
enhanced primary series;
people with rheumatic diseases;
recommendations;
vaccination
- MeSH:
Humans;
COVID-19/prevention & control*;
COVID-19 Vaccines/administration & dosage*;
Rheumatic Diseases/immunology*;
Singapore;
SARS-CoV-2;
Vaccination/methods*;
Delphi Technique;
Immunization, Secondary
- From:Singapore medical journal
2025;66(10):532-539
- CountrySingapore
- Language:English
-
Abstract:
INTRODUCTION:This review aims to provide evidence-based recommendations for an enhanced primary series (third dose) coronavirus disease 2019 (COVID-19) vaccination in people with rheumatic diseases (PRDs) in the local and regional context.
METHODS:Literature reviews were performed regarding the necessity, efficacy, safety and strategies for enhanced primary series COVID-19 vaccination in PRDs. Recommendations were developed based on evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Evidence was synthesised by eight working group members, and the consensus was achieved by a Delphi method with nine members of an expert task force panel.
RESULTS:Two graded recommendations and one ungraded position statement were developed. PRDs have impaired immunogenicity from the COVID-19 vaccine and are at an increased risk of postvaccine breakthrough severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and poor clinical outcomes, compared to the general population. We strongly recommend that PRDs on immunomodulatory drugs be offered a third dose of the messenger RNA (mRNA) vaccine as part of an enhanced primary series, after the standard two-dose regimen. We conditionally recommend that the third dose of mRNA vaccine against SARS-CoV-2 be given at least 4 weeks after the second dose or as soon as possible thereafter. There is insufficient data to inform whether the third mRNA vaccine should be homologous or heterologous in PRDs.
CONCLUSION:These recommendations that were developed through evidence synthesis and formal consensus process provide guidance for an enhanced primary series COVID-19 vaccination in PRDs.
