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Update to “guidelines on COVID-19 vaccination in patients with immune-mediated rheumatic diseases: a Brazilian Society of Rheumatology task force”
Advances in Rheumatology volume 62, Article number: 29 (2022)
The Committee of Endemic and Infectious Diseases and the Executive Board of the Brazilian Society of Rheumatology (SBR) proposed an update to the “Guidelines on COVID-19 vaccination in patients with immune-mediated rheumatic diseases: a Brazilian Society of Rheumatology task force”  based on recently published scientific evidence  and on the new recommendations of the Brazilian National Immunization Program (NIP) for vaccination of immunocompromised persons [3, 4]. According to the NIP documents [3, 4], the primary vaccination series is composed of three doses of Coronavac or ChAdOx-1 (AstraZeneca) or mRNA BNT162b2 (Pfizer), or two doses of Ad26.COV2.S (Janssen). A booster is recommended four months after the primary vaccination schedule, preferably with an mRNA vaccine or a non-replicating viral vector. The NIP recommendations for immunocompromised patients, endorsed by the SBR, are summarized below:
An 8-week interval between the second and third doses was chosen over a shorter interval of 3 weeks to potentiate vaccine responses and minimize possible adverse events ;
Persons 18 years and older who received the three-dose primary vaccination series should receive a fourth booster dose four months after the third, preferably with AstraZeneca, Janssen or Pfizer ;
Persons 18 years and older who received one dose Janssen vaccine should complete the primary vaccination series with a second dose of the Janssen vaccine eight weeks after the first dose and receive a third booster dose four months after the second dose, preferably AstraZeneca, Janssen, or Pfizer ;
Pregnant and postpartum women (up to 45 days following end of pregnancy) should receive a booster dose four months after the primary vaccination series of Pfizer vaccine and, if not available, Coronavac vaccine ;
Adolescents from 12 to 17 years old should receive three doses in the primary vaccination series and a fourth booster dose Pfizer four months after the third one ;
Children from 5 to 11 years old should receive the Pfizer two-dose primary vaccination series with an 8-week interval between the first and second doses .
Availability of data and materials
Brazilian Society of Rheumatology
National Immunization Program
Tavares ACFMG, Melo AKG, Cruz VA, Souza VA, Carvalho JS, Machado KLLL, et al. Guidelines on COVID- 19 vaccination in patients with immune- mediated rheumatic diseases: a Brazilian Society of Rheumatology task force. Adv Rheumatol. 2022;62:3. https://doi.org/10.1186/s42358-022-00234-7.
Bar-On YM, Goldberg Y, Mande M, Bodenheimer O, Freedman L, Kalkstein N, et al. Protection of BNT162b2 vaccine booster against COVID-19 in Israel. N Engl J Med. 2021;385:1393–400. https://doi.org/10.1056/NEJMoa2114255.
MINISTÉRIO DA SAÚDE. Nota Técnica nº 8/2022- SECOVID/GAB/SECOVID/MS: Recomendação para administração do esquema primário e dose de reforço de vacinas contra a COVID-19 em pessoas imunocomprometidas a partir de 12 anos de idade. Brasília, 2022.
MINISTÉRIO DA SAÚDE. Nota Técnica nº 2/2022- SECOVID/GAB/SECOVID/MS: Vacinação não obrigatória de crianças de 05 a 11 anos contra Covid-19 durante a pandemia da Covid-19. Brasília, 2022.
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Tavares, A.C.F.M.G., de Melo, A.K.G., Cruz, V.A. et al. Update to “guidelines on COVID-19 vaccination in patients with immune-mediated rheumatic diseases: a Brazilian Society of Rheumatology task force”. Adv Rheumatol 62, 29 (2022). https://doi.org/10.1186/s42358-022-00256-1