Last updated on 27 February 2024
Purpose
1. This Operations Instruction seeks to inform Vaccination Providers on the instructions to operationalise the COVID-19 vaccination for children aged 6 months to 4 years who are receiving the Pfizer-BioNTech/Comirnaty XBB.1.5 Monovalent vaccine.
Intended Audience
2. The intended audience are as follows
Introduction
3. MOH will adopt a phased approach to vaccination operations, with the end intent to vaccinate the entire Singapore resident population.
Principal Considerations
4. The principal considerations are as follows:
a) Client Safety
i. Minimum age of eligible client to receive the mRNA COVID-19 vaccination should be calculated based on the date of birth, not just the birth year. The authorised minimum age specified for each vaccine type can be found on the respective MOH Guidance document for Vaccination Providers.
ii. For clients who are receiving the vaccines for the first time, the second dose of the primary series could be offered to be received at the same venue as the first dose, and the vaccine should be from the same manufacturer as the first dose. Vaccination Providers should pay attention to the interval between the doses.
b) Minimise Vaccine Supplies Wastage
Due to the short shelf-life of the vaccines after opening of vials and reconstitution, Vaccination Providers should take reasonable efforts to minimise vaccine wastage.
Concept of Operations
5. Health Appointment System
a) Vaccinations will be administered to individuals aged 6 months to 4 years at designated
Joint Testing and Vaccination Centres (JTVCs) or any designated vaccination sites if the vaccine is made available to them.
b) Parents/Legal guardians of eligible children may schedule their child's/ward's vaccination appointment using the Health Appointment System (HAS) at
https://book.health.gov.sg/.
c) Vaccination Providers will continue to achieve the throughput as per MOH's latest instructions.
(Note: Clinics who wish to register for the Health Appointment System may do so
here.)
Updates to Clinical Guidance
6.1 Individuals who have not been vaccinated against COVID-19 with effect from 1 March 2024 are now recommended to receive two initial vaccine doses. This includes children aged 6 months to 4 years who were previously recommended to receive 3 doses for their primary series vaccination.
Vaccine |
Eligible Age |
Dose(s) and Recommended Intervals |
Pfizer-BioNTech/Comirnaty XBB.1.5 monovalent COVID-19 Vaccine |
6 months to 4 years |
Primary series vaccination -
2 doses of 3mcg (0.2mL)
-
8 weeks apart
|
2023/2024 additional dose -
1 dose of 3mcg (0.2mL)
-
1 year after the last dose
|
6.2 The advice to avoid strenuous physical activity after vaccination is updated to apply to only male vaccinees aged 12-29 years, for a duration of 1 week.
6.3 COVID-19 vaccines can now be administered concurrently with other non-COVID-19 vaccines across all ages eligible for the vaccine.
6.4 There is no longer a stipulated period of observation after COVID-19 vaccination, other than for persons at increased risk of anaphylaxis who should be observed for 30 minutes. These individuals include those who had a past history of:
Allergic reactions (that is, immediate hypersensitivity reactions) to other COVID-19 vaccines, OR,
Any anaphylaxis
6.5 Emergency drugs/equipment requirements for COVID-19 vaccine providers is now aligned to that required under prevailing regulatory requirements relevant to the licensable healthcare service which the licensee is licensed for and is stipulated in the "Licence Conditions for Providing or Intending to Provide Emergency Life Saving Measures".
6.6 There is no more restriction of nonsteroidal anti-inflammatory drugs (NSAIDs) use after COVID-19 vaccine administration.
Administration of Vaccine to Children Aged 6 Months to 4 Years
6.7 Vaccination centres should refer children with conditions listed in
Table 1 to the hospital for their COVID-19 vaccination.
Table 1: Referral for vaccination in hospital
Specialty |
Consider Vaccination in Hospital |
Cardiology | -
Persistent fluid overload or pulmonary hypertension and/or in NYHA class 3 or 4 symptoms
-
Severe, symptomatic stenotic valvular heart disease (with angina, faints, shortness of breath)
-
Hypertrophic cardiomyopathy with outflow tract obstruction
|
Respiratory | -
Advanced neuromuscular conditions with chronic respiratory failure, especially those on prolonged BiPAP support
-
Chronic lung disease with need for respiratory support (i.e., on supplemental oxygen or requiring suctioning)
|
6.8 Table 2 provides a non-exhaustive list of conditions that can be vaccinated at community vaccination sites.
Table 2: Non-exhaustive list of conditions that can be vaccinated at community vaccination sites
Specialty |
Can be safely vaccinated in community vaccination sites |
Allergy |
All patients with non-vaccine related allergies can be safely vaccinated in a community vaccination centre. |
Cardiology |
Except for conditions in Table 1, all other patients can be safely vaccinated in a community vaccination centre. |
Nephrology |
Haemodialysis and peritoneal dialysis patients
Transplant patients
Complex renal patients with comorbidities
Patients on immunosuppression |
Neurology and Rehabilitation Medicine |
Patients with neuroimmunological conditions (e.g. MS, NMOSD, autoimmune encephalitis etc) can be safely vaccinated in community vaccination centres
Patients on immunosuppression should discuss with their attending physician before COVID-19 vaccination |
Oncology |
See paras 6.4 and 6.5.
Patients with stem cell transplants should discuss with their primary specialist before COVID-19 vaccination. |
Respiratory |
Except for conditions in Table 1, all other patients can be safely vaccinated in a community vaccination centre
Cystic fibrosis and other forms of severe bronchiectasis can be vaccinated. |
Rheumatology |
Patients on Rituximab should discuss with their primary rheumatologist before COVID-19 vaccination. |
Cardiothoracic and Vascular Surgery |
Safe to vaccinate in a community vaccination centre. |
Psychological Medicine |
Safe to vaccinate in a community vaccination centre. |
6.9 It is safe for children currently on cancer treatment (chemotherapy/immunotherapy/ radiotherapy) to be vaccinated. However, they may be advised to consult their oncologist on the optimal timing, weighing better vaccine effectiveness against the risks of delay in view of their vulnerability to COVID-19 infection.
6.10 Children with cancer who have not been on chemotherapy/immunotherapy/radiotherapy for the past 3 months can be vaccinated. This includes children currently on hormonal therapy. Hormonal therapy is not considered chemotherapy or immunotherapy. There is no need for a memo from the oncologist.
6.11 There may be instances where Community Vaccination Centres may refer children for vaccination at a hospital in-situ vaccination site for non-medical reasons, for example, unwillingness to be vaccinated at a Community Vaccination Centre due to heightened parental concerns over their child/ward's pre-existing medical condition, or children who are uncooperative in a community vaccination centre setting. In such instances, it should be emphasised to parents that this referral is specifically for COVID-19 vaccination and there is no scheduled review with any paediatrician at the hospital's in-situ vaccination site on the day of the vaccination.
6.12 MOH has provided the following clinical guidance materials to support vaccination provider staff who are carrying out vaccinations. Personnel who are carrying out vaccinations should ensure that they are familiar with the materials before carrying out vaccinations.
COVID-19 Recovered Persons
6.13 Recovered persons who had not completed COVID-19 vaccination previously can complete 2 doses of the vaccine to finish their primary vaccination series. They are recommended to receive the vaccine 3 months or more after the date of infection.
6.14 Recovered persons who had not completed COVID-19 vaccination previously are considered to have completed their primary vaccination series if they received at least one dose of mRNA/Novavax vaccines or two doses of Sinovac vaccine at a minimum interval of 28 days after the date of infection.