Clinical Information for COVID-19 Vaccine Providers – Washington State Department of Health

Should I administer extra vaccine doses to my patients?

An additional dose is for patients who completed the initial vaccine series but didn't have a strong enough immune response. A booster dose is for patients when it's likely that their immunity after the initial vaccine series waned over time.

The Centers for Disease Control and Prevention (CDC) and the Western States Scientific Review Workgroup recommend a booster dose for everyone 12 years and older.

CDC also recommended an additional dose of mRNA (Pfizer-BioNTech or Moderna) COVID-19 vaccines for certain immunocompromised groups. These patients may also get a booster (fourth) dose after getting the additional (third) dose.

Additional dose

People who are immunocompromised and got an mRNA COVID-19 vaccine.*

See the Centers for Disease Control and Prevention's (CDC) interim clinical considerations for a list of immunocompromising conditions.

Booster dose

People 12 years and older who got the Pfizer-BioNTech COVID-19 vaccine as their primary series.

At least five months after your second dose.**

For patients who are moderately to severely immunocompromised, at least five months after the patient's additional (third) dose.

People 18 years and older who got the Moderna COVID-19 vaccine as their primary series.

At least five months after your second dose.**

*Use the same vaccine brand as the patient's initial vaccine series, if possible. If you don't have it available, the other mRNA vaccine brand may be used.

**For booster doses, patients 18 years and older can get the same or a different vaccine for their booster dose than they received for their primary series. However, people ages 17 and younger may only get the Pfizer COVID-19 vaccine for their booster dose.

Please do not administer any doses of vaccine beyond the doses recommended by CDC, even if your patient requests it. Also, please do not administer any doses of vaccine to someone outside of the recommended age range for that vaccine or dose.

The Centers for Disease Control and Prevention (CDC) recommends an additional dose of the Pfizer-BioNTech or Moderna COVID-19 vaccines only to certain immunocompromised groups, including patients who have:

You can find more information on additional doses for immunocompromised people in CDC's interim clinical considerations for COVID-19 vaccines.

The Centers for Disease Control and Prevention (CDC) and the Western States Scientific Safety Review Workgroup recommend a booster dose for everyone 12 years and older.

We don't know the safety or efficacy of giving someone a COVID-19 vaccine authorized or approved in the United States after they received a COVID-19 vaccine not authorized or approved by the U.S. Food and Drug Administration (FDA).

Although they are not authorized by the FDA, the Centers for Disease Control and Prevention (CDC) does not recommend revaccinating patients who completed a COVID-19 vaccine series authorized by the World Health Organization (WHO). However, CDC recommends providers offer an FDA authorized or approved COVID-19 vaccine to patients who:

For more information, see the interim clinical considerations for COVID-19 vaccines.

You may have patients who completed a COVID-19 vaccine series as part of a U.S.-based clinical trial involving a COVID-19 vaccine not currently authorized by the U.S. Food and Drug Administration (FDA).

Do not give the patient any additional doses.

Considered fully vaccinated two weeks after completing the series.

Not considered fully vaccinated.

Offer an FDA-authorized or FDA-approved COVID-19 vaccine. Encourage patients to follow current prevention measures.

Check if an independent group (e.g., a data and safety monitoring board) confirmed the vaccine's efficacy.

If confirmed, your patient is considered fully vaccinated two weeks after completing the series. Do not give the patient any additional doses.

Not considered fully vaccinated.

Offer an FDA-authorized or FDA-approved COVID-19 vaccine series. Encourage patients to follow current prevention measures.

For more information, please see the Centers for Disease Control and Prevention's (CDC) clinical considerations for COVID-19 vaccines.

Yes, the Johnson & Johnson (J&J) vaccine is authorized for use in Washington state; however, in December 2021, the Centers for Disease Control and Prevention (CDC) recommended people choose to get an mRNA COVID-19 vaccine (Pfizer or Moderna) instead of the J&J vaccine. This is due to the rare risk of thrombosis with thrombocytopenia syndrome (TTS), a condition in which a low blood platelet level interferes with the formation of blood clots, as well as the risk of Guillain-Barr Syndrome (GBS), an autoimmune disorder which can result in permanent nerve damage.

Previously, in April 2021, the Washington State Department of Health (DOH) briefly paused the use of the J&J vaccine amid reports of thrombosis, but soon cleared usage with approval from the Advisory Committee on Immunization Practices (ACIP).

No, the Advisory Committee on Immunization Practices (ACIP) does not recommend titer testing before vaccination

You should use the same vaccine brand to administer additional doses to immunocompromised patients. However, if you don't have the same brand available, the other mRNA vaccine brand may be used.

For booster doses, patients 18 years and older can get the same or a different vaccine brand than they received for their primary series. However, people ages 17 and younger may only get the Pfizer COVID-19 vaccine for their booster dose because it's currently the only vaccine authorized for this age group.

The Advisory Committee on Immunization Practices (ACIP) recommended the following age groups to receive vaccine:

The Pfizer and Moderna vaccines are recommended over the J&J vaccine due to the rare risk of TTS (Thrombosis with Thrombocytopenia Syndrome), a condition in which a low blood platelet level interferes with the formation of blood clots, and GBS (Guillain-Barr Syndrome), an autoimmune disorder which can result in permanent nerve damage.

Yes. You can vaccinate people ages 5 and over with the Pfizer-BioNTech vaccine. Youth who are 5 to 17 years of age may need consent from a parent or guardian to get the vaccine, unless they are legally emancipated.

If you have questions about what you can accept as parental consent, please consult your legal counsel. If your office or organization already has guidance on this for other vaccines, you may wish to consult those as well. You can use this sample consent for minor vaccination as a starting point.

Yes, data show that COVID-19 vaccines are safe during pregnancy. The Centers for Disease Control and Prevention (CDC), American College of Obstetricians and Gynecologists (ACOG), and Society for Maternal-Fetal Medicine (SMFM) recommend the COVID-19 vaccine for people who are pregnant, lactating, or planning to get pregnant. Some studies show that a vaccinated parent can even pass antibodies against COVID-19 along to their baby through pregnancy and lactation. Unvaccinated pregnant people who get COVID-19 are at increased risk of severe complications like preterm birth or stillbirth. In addition, people who get COVID-19 while pregnant are two to three times more likely to need advanced life support and a breathing tube.

You can read more about the recommendation from the American College of Obstetricians and Gynecologists (ACOG) and refer to resources on this list from ACOG. You can also use these talking points on reproductive health to answer patient questions.

Generally, the COVID-19 vaccines should not be given to anyone who is under the authorized age or has a history of severe allergic reactions to an ingredient or previous dose of the COVID-19 vaccines.

The Pfizer COVID-19 vaccine should not be given to anyone:

The Moderna COVID-19 vaccine should not be given to anyone:

See the Advisory Committee on Immunization Practices' (ACIP) interim clinical considerations for COVID-19 vaccines for more information.

The COVID-19 vaccines should not be given to people with a known history of severe allergic reaction, such as anaphylaxis, to any ingredient or a previous dose of the COVID-19 vaccines.

People who have had a severe allergic reaction to other vaccines or injectable therapies may still be able to receive this vaccine. However, providers should do a risk assessment and counsel them about the potential risks. If the patient decides to get the vaccine, providers should observe them for 30 minutes to monitor for any immediate reactions. People who report having mild or childhood allergic reactions to medications or vaccines may still get the vaccine.

See the Advisory Committee on Immunization Practices' (ACIP) interim clinical considerations for COVID-19 vaccines for more information.

People who currently have COVID-19 should wait to get vaccinated until they feel better and their isolation period is finished if possible. People recently infected with COVID-19 can choose to wait up to 90 days after their illness passes before getting vaccinated.

People who were recently exposed to COVID-19 should also wait to get the vaccine until after their quarantine period, if they are able to safely quarantine away from other people. If there is a high risk they could infect others, they may be vaccinated during their quarantine period to prevent spreading the disease. Providers should take steps to ensure the environment is safe to protect others during the vaccination.

Yes, the Advisory Committee on Immunization Practices (ACIP) recommends anyone who previously had COVID-19 to get the vaccine. A history of having COVID-19 doesn't affect the recommendation.

Yes. The Advisory Committee on Immunization Practices (ACIP) changed their recommendations on May 12, 2021. You can now administer COVID-19 vaccines and other vaccines to patients without waiting 14 days.

Yes, you can still get a COVID-19 test after recently getting vaccinated. It will not affect the results of a SARS-CoV-2 nucleic acid amplification or antigen test.

No, patients do not need to reschedule their screening mammogram if they were recently vaccinated. The COVID-19 vaccine may cause swollen lymph nodes, or unilateral lymphadenopathy, after administration and in some cases, it will be important to ensure further evaluation. You should:

You can read more about the recommendation from the Society of Breast Imaging.

Link:

Clinical Information for COVID-19 Vaccine Providers - Washington State Department of Health