The Ministry of Health has clarified the vaccination and revaccination schemes for COVID-19 » Medvestnik


The Ministry of Health has increased the number of authorized vaccines for immunization against COVID-19 to nine. The previous version of the document contained five immunobiological drugs.

Authorized vaccines

For immunization, “AURORA-CoV” (formerly called “EpiVacCorona-N”), “Gam-COVID-Vac-M” for immunization of adolescents 12-17 years old, “Convasel” and the nasal vaccine “Gam-COVID-Vac” can also be used. (or nasal “Sputnik”).

Updated vaccination and revaccination schedules for adults

The third version of the document contains a detailed diagram of the vaccines used in adults.

For primary vaccination, the Ministry of Health recommends only six drugs: Sputnik V, Sputnik Light, EpiVacCorona and AURORA-CoV, CoviVac and Convasel. The data is contained in the immunization scheme for persons over 18 years of age in the document.

Age restrictions for elderly patients have been established for EpiVacCorona and AURORA-CoV – their administration is not recommended for people over 60 years of age.

Administration of a nasal vaccine is allowed only during revaccination. This is possible if the drug “Sputnik V” or “Sputnik Light” was initially administered. In addition to the drug in the form of nasal drops, intranasal administration of Sputnik V is allowed, but only with a special dosing device, or spray nozzle, as indicated in the document.

The nasal vaccine leads to an increase in the titer of IgA antibodies in nasal secretions and blood, as well as virus-neutralizing antibodies in the blood.

The Ministry of Health has approved the new drug “Convasel” for primary and secondary vaccination. Convasel can be administered regardless of the vaccine initially administered.































Primary vaccination

Revaccination

Gum-COVID-Vac

(both components)

Gam-COVID-Vac (both components)

Gam-COVID-Vac (nasal drops)
(both components)

EpiVacCorona/AURORA-CoV

CoviVac (both stages)

Sputnik Light/

Gam-COVID-Vac (1st component)

Convasel (both stages)

Sputnik Light/

Gum-COVID-Vac

(1st component)

Gam-COVID-Vac (both components)

Gam-COVID-Vac (nasal drops)

(both components)

EpiVacCorona/AURORA-CoV

CoviVac (both stages)

Sputnik Light/Gam-COVID-Vac

(1st component)

Convasel (both stages)

EpiVacCorona/

AURORA-KOV

Gum-COVID-Vac

(both components)

EpiVacCorona/AURORA-CoV

CoviVac (both stages)

Sputnik Light/

Gam-COVID-Vac (1st component)

Convasel (both stages)

CoviVac

Gum-COVID-Vac (both components)

EpiVacCorona/AURORA-CoV

CoviVac (both stages)

Sputnik Light/

Gam-COVID-Vac (1st component)

Convasel (both stages)

Convasel

Gam-COVID-Vac (both components)

EpiVacCorona/AURORA-CoV

CoviVac (both stages)

Sputnik Light/

Gam-COVID-Vac (1st component)

Convasel (both stages)

Vaccination of adolescents

The immunobiological drug “Gam-COVID-Vac-M” is recommended for teenagers. The vaccine can be administered from 12 to 17 years of age inclusive. Immunization is carried out in two stages, three weeks apart.

Vaccination of patients with cancer

The Ministry of Health for the first time gave recommendations on immunization of patients with solid tumors and oncohematological diseases.

For patients who have completed treatment of the underlying disease, Sputnik V is recommended. Administration of the vaccine is possible regardless of the form and stage of the disease.

When undergoing hormonal therapy or treatment without hematological toxicity, there are no restrictions on the administration of Sputnik V.

Temporary restrictions on vaccination are possible during chemotherapy and when granulocyte levels decrease after it. During chemotherapy and radiation therapy, administration of PARP and tyrosine kinase inhibitors, immunization is carried out two weeks before the course, in the interval between courses, before or after completion of the course of radiation therapy.

After immunotherapy, vaccination is not recommended for four weeks. The restriction applies to cases of treatment with rituximab, obinutuzumab, blinatumomab, alemtuzumab, antithymocyte globulin.

With stem cell and bone marrow transplantation, vaccination is possible after 3-6 months. If graft-versus-host disease develops or graft rejection occurs, vaccination is postponed for the specified period.

If surgical treatment is necessary, the vaccine is administered two weeks before the planned operation or four weeks after it.

An adequate response to vaccination is achieved in 90% of patients, but there is wide variability in the amount of antibodies formed. Their levels are lower than in healthy patients.

There are no data on the effect of vaccines on carcinogenesis; it is impossible to assess the risk of tumor development or progression of the process.

Updated recommendations for people living with HIV

The Ministry of Health has updated recommendations on immunization of HIV-infected people.

The Sputnik Light vaccine can be used in the presence of immunosuppression and immunodeficiency. Immunization with the drug is allowed in patients who have previously recovered from COVID-19 and during repeated vaccination.

If the CD4+ level decreases to less than 350 cells/µl, a booster administration of Sputnik Light is possible three months after the initial vaccination.

Previously made recommendations for vaccination with Sputnik V remained in force without restrictions depending on antiretroviral therapy regimens, immune status and viral load.

Vaccination of people with rheumatic diseases

In the absence of contraindications, vaccination of patients with rheumatic diseases and their family members is necessary. Immunization is possible against the background of low activity of the process or remission. Vaccination should be carried out 4 weeks before prescribing drugs with immunosuppressive activity.

Patients with drug allergies and systemic lupus erythematosus should be supervised by staff for at least 1 hour after immunization.

Antibody testing is not necessary.

When treating with glucocorticoids, the dose should be reduced to less than 10 mg/day if possible.

When treating with methotrexate, it is necessary to discontinue the drug 1 week before vaccination. Tofacitinib, baricitinib, upadacitinib, and cyclophosphamide should be discontinued for 1 week after each vaccine dose.

If the patient receives abatacept, when administered subcutaneously, the drug is discontinued 1 week before vaccination and 1 week is missed after immunization with the first dose of the vaccine. When administering the drug intravenously, treatment should be stopped 4 weeks before immunization and 1 week after the first dose of the vaccine.

When treated with rituximab, vaccination should be carried out no earlier than 1 month, however, the optimal period of immunization is six months after the last administration of the drug.

Vaccination with Gam-COVID-Vac, AURORA-CoV and CoviVac is possible if the potential benefits outweigh the risks.

Vaccination of tuberculosis patients

Possible with a stable course of the process or its stabilization during therapy. The duration of a stable course is at least two months from the start of chemotherapy.

Primary and re-vaccination is carried out with any registered vaccine. No change in treatment regimen is required.

For tuberculosis in HIV-infected people, immunization is recommended when the CD4 level is above 200 cells in 1 μl, no earlier than 2 months after the appointment of therapy. Vaccination is possible in the absence of signs of progression of tuberculosis or other diseases.



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