People deemed clinically extremely vulnerable prioritized for COVID-19 vaccine

THE Province announced on Tuesday that people at higher risk from COVID-19 due to existing medical conditions, such as various forms of cancer, transplant recipients and severe respiratory conditions, will be able to register for their COVID-19 vaccine beginning Monday, March 29.

The accelerated timelines for B.C.’s COVID-19 immunization plan mean approximately 200,000 people in B.C. aged 16 years and older who are clinically extremely vulnerable (CEV) are eligible to receive their first dose of COVID-19 vaccine in the coming weeks. Some of the CEV population will have already been immunized as part of B.C.’s age-based vaccine program (currently 75 years and older).

“B.C. has made tremendous progress on our age-based vaccine program,” said Adrian Dix, Minister of Health. “Now, we are able to expand to those people who are at increased risk from COVID-19 due to underlying medical conditions or various medical treatments. Clinical experts have now determined those who have a high risk of severe illness from the virus and now have the vaccine supply to protect these most vulnerable people.”

Expert physicians and providers in cancer care, kidney diseases and other conditions causing compromised immunity worked with public health and international COVID-19 data to define B.C.’s updated CEV list to ensure those most at risk of severe illness from COVID-19 are prioritized first (see backgrounder).

Those people identified as CEV will receive a letter in the mail in the coming days with information on how to book an appointment, beginning March 29. People who receive this invitation letter must bring it with them to their vaccination appointment.

If people who believe they are in the CEV group have not received a letter by April 15, 2021, they can contact the provincial call centre or visit the get vaccinated provincial online registration and booking system, which is scheduled to launch on April 6, to confirm if they are on the CEV list. If they are not on the CEV list, they can reach out to their physician or nurse practitioner about their eligibility.

“Since day one of our immunization plan, we have set out to protect those who are most at risk to COVID-19,” said Dr. Penny Ballem, executive lead, B.C.’s immunization plan. “We used clinical evidence from around the world and clinical expertise and patient registries in B.C. to develop this list and look forward to taking another important step forward in our immunization plan.”

Dr. Bonnie Henry, Provincial Health Officer, said: “Through this additional immunization, we are able to relieve a significant burden from those who are extremely clinically vulnerable to severe illness from COVID-19. This is another encouraging step forward for all of us as we continue to ramp up our immunization efforts.”

The CEV-based booking process will run parallel to the ongoing age-based booking schedule.

This schedule is being accelerated, starting with those born in 1945 able to book starting Wednesday, March 24. The revised health authority eligibility call-in schedule follows:

* age 76 (born in 1945) – Wednesday, March 24 at noon

* age 75 (born in 1946) – Thursday, March 25 at noon

* age 74 (born in 1947) – Friday, March 26 at noon

* age 74+, and CEV population (must have invitation letter to book) – Monday, March 29 noon

Learn More:

For the full CEV list and criteria, visit: http://gov.bc.ca/cevCOVID

BACKGROUNDER
Determining clinically extremely vulnerable populations

Clinically extremely vulnerable (CEV) people will receive a letter to the address on their medical file associated with their Personal Health Number, notifying them and inviting them to book their vaccine appointment.

Letters will be mailed out over the weeks of March 22 and 29. Some patients may also be contacted by their treatment clinic or their local health authority. Following an extensive process of assessing which populations to include in this group, the conditions identified below are CEV and therefore prioritized for vaccination.

The CEV populations were determined through the following approach:

1. Scientific evidence from other countries and across Canada was gathered about those who have ended up in hospital, ICU or passed away from COVID-19.

2. B.C. data was reviewed to see what risk factors were most linked to serious illness or to death from COVID-19.

3. Clinical experts from throughout B.C., including experts in cancer care, kidney disease, transplant, rheumatology, diabetes and developmental concerns, came together to review all the data and give clinical advice.

4. The work was supported by an ethics expert, to help ensure this list is as fair and equitable as possible to the whole population of B.C.

5. Pediatricians were engaged for relevant CEV groups.

CEV eligibility list:

People who have undergone a transplant:

* received a solid organ transplant at any time in their life

People with specific cancers:

* people who have had systemic therapy for cancer now or have had it in the past 12 months. This includes chemotherapy, molecular therapy, immunotherapy, monoclonal antibodies and hormonal therapy for cancer.

* people who are receiving radiation therapy for cancer now or in the past six months

* people having or who have had targeted cancer treatments that can affect the immune system, such as CAR-T cell treatments in the past six months

* people who have blood or bone marrow cancer (such as leukemia, lymphoma, myeloma and myelodysplastic disorders)

* people who have had a bone marrow or stem cell transplant in the past six months, or are still taking immunosuppressant medicine related to the transplant

People with severe respiratory conditions: cystic fibrosis, severe chronic obstructive pulmonary disease (COPD), severe asthma:

* cystic fibrosis: anyone with this condition (aged 16 and older)

* people who have been hospitalized because of COPD at least one time since April 2018

* people who have been hospitalized because of asthma at least one time since April 2018

People with rare blood diseases:

* people who have homozygous sickle cell disease

* people who have highest-risk thalassemia, meaning thalassemia and two of the following:
* transfusion dependent

* receiving iron chelation therapy

* pre-transfusion hemoglobin level of less than 70 in the last two to three years

* people who have iron overload

* people who have had their spleen taken out as treatment for thalassemia or have other significant health conditions

* people who are over the age of 50

* adults with atypical hemolytic uremia syndrome (aHUS) or paroxysmal nocturnal hemoglobinuria (PNH)

Other rare diseases:

* people who have a condition for which they see a metabolic (biochemical diseases) specialist and who are known to have a metabolically unstable inborn error of metabolism

* people who have severe primary immunodeficiency, meaning these people have combined immune deficiencies affecting T-cells; familial hemophagocytic lymphohistiocytosis or have Type 1 interferon defects

People who have had their spleen removed (splenectomy):

* received a splenectomy at any time in their life or have been told they have a spleen that does not function (functional asplenia)

People with diabetes who take insulin:

* currently using insulin for diabetes (pump or injection)

People with developmental disabilities that increase risk:

* people with a significant developmental disability, such as Down syndrome and other conditions, that is significant enough the person requires support for activities of daily living and therefore use or receive support from:
* Community Supports for Independent Living

* Community Living British Columbia

* Nursing Support Services program for youth aged 16 to 19

People on dialysis or with Stage 5 chronic kidney disease:

* dialysis (hemo and peritoneal)

* glomerulonephritis receiving steroids

* chronic kidney disease stage 5 (eGFR <15 ml/min)

People who are pregnant and have heart disease:

* people who are pregnant and have a serious heart condition, congenital or acquired, that requires the person to see a cardiac specialist during their pregnancy

People with neuromuscular/neurologic or muscle conditions who require respiratory support:

* people with significant muscle weakness around their lungs, such that they need to use a ventilator or use bi-level positive airway pressure (BiPAP) continuously

* These include many patients with spinal muscular atrophy, Pompe disease and Duchenne muscular dystrophy, as well as a range of other conditions that lead to muscle weakness around lungs and where the individual is using home ventilation or BiPAP on a continuous basis.

People whose immune system is affected by immunosuppression therapies they take, including people taking high dose steroids or other medicines known to suppress the immune system:

* people taking the following biologics since December 15, 2020: Abatacept, Adalimumab, Anakinra, Certolizumab, Etanercept, Golimumab, Infliximab, Ixekizumab, Ocrelizumab, Sarilumab, Secukinumab, Tocilizumab, or Ustekinumab

* people taking the following oral drugs since December 15, 2020: Azathioprine, Baricitinib, Cyclophosphamide, Cyclosporine, Leflunomide, Mycophenolate, Sirolimus, Tacrolimus, Tofacitinib, Upadacitinib, Methotrexate, Dexamethasone, Hydrocortisone, Prednisone, or Methylprednisolone

* people taking the following oral or injectable steroid products since December 15, 2020: Dexamethasone, Hydrocortisone, Methylprednisolone or Prednisone

* people 16 to 18 years of age, taking Canikinumab or Vedolizumab since December 15, 2020

* people taking Rituximab since February 15, 2020

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