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COVID advice for Paediatric Rheumatology patients

Updated September 2021

A coronavirus is a type of virus, which presents with symptoms of:

  • a high temperature
  • a new, continuous cough
  • a loss of, or change to, your sense of smell or taste

The evidence shows that most cases in children and young people are mild, even in those on medications for arthritis. The virus causing COVID-19 infection is called SARS Cov2 and like the common cold, COVID-19 infection usually occurs through close contact (within 2 meters for more than 15 minutes) with a person with coronavirus via cough, sneezes or hand contact.

Current government advice is as follows:

Coronavirus remains a serious health risk. You should stay cautious to help protect yourself and others.

  • Meet outside, or open windows and doors for indoor visitors
  • If you think you have symptoms stay at home and take a PCR test
  • Wear face coverings in crowded places and on public transport
  • Check in to venues when you go out
  • Wash your hands with soap regularly, and for at least 20 seconds
  • Get vaccinated

Further government advice is available here:

https://www.gov.uk/coronavirus

https://www.nhs.uk/conditions/coronavirus-covid-19/

If your child develops symptoms and you are concerned this may be coronavirus:

● Follow government advice as per NHS website (link above)

● Don’t stop medication unless this is advised by your health professional team

● Follow ‘stay at home’ government advice for households with possible infection:

https://www.gov.uk/government/publications/covid-19-stay-at-home-guidance/stay-at-home-guidance-for-households-with-possible-coronavirus-covid-19-infection

If your child is on regular medications of methotrexate, mycophenolate mofetil, azathioprine, leflunomide or biologics (eg etanercept, adalimumab, tocilizumab, infliximab, anakinra, abatacept):

  • If in contact with suspected infection – continue medications as usual
  • If coronavirus symptoms develop, follow government advice
  • If the symptoms remain mild, continue medications as usual
  • If your child becomes unwell with persistent cough or fever, withhold the above medication/s, and notify your team who will advise when to restart treatment

Being on any of the above medications does affect your child’s immune system. However the scientific evidence shows that these medications do not put your child at risk of severe infection were they to catch COVID19.

If your child is on steroid treatment (‘prednisolone’): do not stop steroids abruptly; continue them on the regime advised by your health professional team. Contact your team if you wish to discuss this further.

Shielding is no longer required for any child or young person

A small number of children were thought to be ‘clinically extremely vulnerable (CEV)’ due to the medications taken or the combination of illnesses they have. They were placed on the CEV list (or Shielding List), held by NHSE. The decision about who should be on this CEV list was made following national guidance early in the pandemic. You will have been notified if your child was on this list, and you were advised to take extra precautions during the first peak of the pandemic in England. This is known as ‘shielding’.

UK paediatric rheumatology consultants discussed the scientific evidence collected during the pandemic so far in the summer of 2020, following which the national advice changed. It was agreed that no child or young person needs to be on the ‘clinically extremely vulnerable (CEV)’ list because of their rheumatology disease. This applies both to the old and the new variants of SARS Cov2. This was communicated prior to the return to school in September 2020. A few CYP remained on the list for other reasons.

From August 2021, following an evidence review which found the COVID-19 risk for Children and Young People (CYP) to be very low, UK Chief Medical Officers have accepted the recommendation from the UK Clinical Review Panel to remove all remaining CYP from the Shielded Patient List. Very rare exceptions may apply for specific clinical circumstances.

All children and young people are currently advised to follow national and local guidance regarding their education, and can go into school. If there is a case/s of coronavirus at your child’s school, you should adhere to the advice given by the school.

For our rheumatology patients, the National advice remains as follows:

There is no evidence that children and young people with rheumatological conditions are more likely to be infected with COVID-19 than those without rheumatological conditions. If they do become infected with COVID-19 there is no evidence that children and young people with rheumatological conditions will become more unwell compared with children and young people without rheumatological conditions. This advice includes those on immunosuppressive medications. Our advice is paediatric rheumatology patients should continue to attend school.

https://www.rcpch.ac.uk/resources/covid-19-shielding-guidance-children-young-people

https://www.gov.uk/government/news/majority-of-children-no-longer-need-to-shield

Use of Non-steroidal anti-inflammatory drugs (NSAIDs) e.g. Ibuprofen

There were early media reports regarding the use of NSAIDs in relation to COVID-19. These have been thoroughly investigated and the resulting report is in the link below:

https://www.gov.uk/government/news/commission-on-human-medicines-advice-on-ibuprofen-and-coronavirus-covid-19

  • Taking NSAIDs does not increase the risk of catching the virus
  • If you think your child needs the medication for pain or swelling you should continue
  • For treatment of possible COVID-19 symptoms (fever and cough), paracetamol can be used, if it is suitable for your child to take this medication. Ibuprofen can be used in addition or as an alternative.

COVID-19 vaccination

Children and young people under our care who are 12 years old and over may be offered the COVID-19 vaccine if they are taking immune modulating medications (eg those in the list at the bottom of page 1). This is because their medications would have placed them on the CEV (clinically vulnerable / shielding) list if they were an adult. Whilst the current data we have does not suggest that young people on these medications are at additional risk, we would be happy for our 12-18y.o. patient group to receive the COVID-19 vaccine.

It is a killed vaccine and there is no risk of being infected with the virus, even in those on immune modulating medications. There is a chance that the young person will not make as strong an immune response, but this is not predictable. It will be important that both doses of the vaccine are received in accordance with the nationally agreed time frame. We understand that siblings may also be offered the COVID-19 vaccine due to their sibling’s condition or medications.

At this time, only the Pfizer-BioNTech COVID-19 vaccine is licensed to be given to those from 12yrs of age and over. Those who are 16yrs. and over are eligible for any of the licensed vaccines and may be offered the AstraZeneca or Moderna COVID-19 vaccines.

The rollout is being coordinated by Primary Care Networks and local vaccination hubs. If your child or young person is eligible for a COVID-19 vaccine, you will be contacted in due course by your Primary Care Network to arrange this.

For further information, please refer to the following websites:

https://www.rcpch.ac.uk/resources/covid-19-vaccination-children-young-people

https://www.gov.uk/government/publications/covid-19-the-green-book-chapter-14a

https://www.rheumatology.org.uk/practice-quality/covid-19-guidance

Further advice

If you need further advice about your medication or you become unwell and the doctor looking after you needs advice, please contact the paediatric rheumatology advice line at the hospital where you have your specialist appointments, during working hours (8:30-16:00, Monday to Friday).

Addenbrookes Hospital: 01223 254 988

Norfolk and Norwich Hospital: 01603 287 911

Additional resources

Helpful information from the charity Versus Arthritis

https://www.versusarthritis.org/news/2020/april/coronavirus-covid-19-and-arthritis-where-to-go-for-information/

And from Kids with Arthritis (CCAA)

https://www.ccaa.org.uk/coronavirus-support-resources/

Specific advice relating to hospital attendance

Outpatient appointments

Regarding your child’s out-patient appointment at Addenbrookes, Jenny Lind, and our paediatric rheumatology outreach clinics:

We are prioritising urgent cases where there may be a flare up of disease or new disease and it is important for us to examine your child. Other appointments will be telephone or video appointments via ‘attend anywhere’. The outpatient team will contact you to confirm whether your appointment is by phone/video or in clinic. If you have not had contact prior to your appointment, please phone the clinic to confirm the arrangements. If you are attending clinic, only one parent can accompany your child (and no siblings).

If you think your child may have COVID-19 or is unwell, please do not bring them to their hospital appointment, but contact your team to let them know you cannot come.

Routine blood monitoring

In order to reduce hospital attendance we will increase the interval between blood tests for certain patients on disease modifying anti rheumatic medications (DMARDs) and biologics to 3 months. This extension will only apply to those who have been on these medications for at least 6 months and have not had an abnormal result in the last 3 months.

Booked infusions of medications

These are going ahead and are now largely taking place in the usual venue. The configuration of the wards may change as we enter a winter season during which we anticipate infections such as flu and RSV to return to normal levels. Please confirm the venue and procedure for your infusion before you attend. Hospital policy again allows one parent to accompany your child and no siblings.

If you have to self- isolate due to suspected COVID 19 infection in your home, you should not attend for your infusion. Please contact us to defer the infusion date to after the isolation period.

Covid isolation for the purpose of a hospital ends after 14 days.

COVID isolation for the purpose of a hospital ends after 14 days

PLEASE NOTE ADVICE IS CHANGING ON A FREQUENT BASIS AND WE WILL CONTINUE TO PROVIDE THE MOST UP TO DATE RECOMMENDATIONS FOR OUR PATIENTS AS BEST WE CAN.