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TO:
HEADS OF PROVINCIAL HEALTH DEPARTMENTS
HEADS OF PHARMACEUTICAL SERVICES
DISTRICT AND PHC MANAGERS
COVID-19 VACCINE PROGRAMME MANAGERS
COVID-19 VACCINATION SITE MANAGERS
COVID-19 VACCINATORS


SUBJECT: VACCINATION OF IMMUNOCOMPROMISED ADULTS

  1. Individuals with a compromised immune system are not only vulnerable to COVID-19, but also may have a reduced immune response to COVID-19 vaccines.
  2. The following individuals are considered to be immunocompromised:
    Individuals with the following conditions:
    Haematological or immune malignancy
    Moderate to Severe Primary immunodeficiency disorder
    HIV infection with CD4 count < 200 cells/µL within the last 6 months
    AspleniaIndividuals receiving the following treatments:
    High dose steroids or systemic biologics (e.g. for autoimmune conditions)
    Long term renal dialysis
    Transplant recipients (Solid organ or bone marrow)
  3. As from 1st December 2021, these individuals will be eligible to receive an additional dose as part of their primary COVID-19 vaccine schedule to enhance immune protection.
  4. An immunocompromised individual who has received two doses of the Cominarty® (Pfizer) vaccine must receive a third dose of Cominarty® (Pfizer) vaccine, whilst an individual who has received the one dose Covid Vaccine Janssen® (J&J) schedule should receive a second dose of the Janssen® vaccine.
  5. It is recommended that the additional dose be given between one and three months after the previous dose with the recommended period being at the discretion of the referring clinician. The advice regarding the recommended interval between the additional and previous doses provided by the clinician on the referral form (see attached) should be followed by the vaccinator. There is no upper limit with regards the time interval between the additional and the previous dose.
  6. The EVDS will allow additional doses to be recorded as long as at least 28 days have elapsed since the previous dose was administered.
  7. Additional doses should only be administered to individuals 18 years and older. (Note: this recommendation does not apply to children and adolescents)Process for accessing an additional dose
  8. Additional doses must be prescribed by a doctor or a nurse prescriber who must complete the referral form that is contained in Annexure A. The referring doctor or nurse must retain a copy of the referral form.
  9. Immunocompromised individuals can register for an additional vaccination dose on the EVDS Registration Portal (https://vaccine.enroll.health.gov.za) by selecting the relevant button on the landing page. The individual should use the same identity number used for EVDS registration, and answer the Yes/No questions presented.
  10. Alternatively, the person can present at a vaccination site where they will be assisted to register.
  11. Upon successful registration, an SMS will be sent to the mobile number on record for the individual on the EVDS. The vaccination code for these doses will start with the prefix AD-IC-XXXXXXXX. It will therefore be possible to identify them through this code.
  12. The individual should present with the completed referral letter or an equivalent letter issued by their medical scheme at a vaccination site.
  13. Based on the contents of the referral form, the vaccinator must confirm that the individual meets the criteria to receive an additional dose on the basis of being immunocompromised.
    This must be recorded on the EVDS. The
    MP number of the referring doctor or the South African Nursing Council annual practicing certificate number of the referring professional nurse must also be recorded on the EVDS.
  14. The additional dose should then be administered and recorded on the EVDS. As noted above, the individual must receive the same vaccine as they have previously received (see paragraph 4).
  15. Additional doses will appear on an individual’s vaccine certificate.
  16. A copy of the completed form must be kept at the vaccination site.

DR NICHOLAS CRISP
ACTING DIRECTOR-GENERAL: HEALTH
DATE: 26
th November 2021

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