11/23/21 Health Advisory: COVID-19 vaccine booster doses available to everyone 18 years or older

| November 23, 2021
Syringe in vial

COVID-19 Updates for Providers

Requested actions

  • Be aware, following the Food and Drug Administration’s (FDA’s) decision to update its emergency use authorizations (EUAs) to allow COVID-19 vaccine booster doses for everyone 18 years or older, Centers for Disease Control and Prevention (CDC) and Western States Scientific Safety Review Workgroup recommend:
    • People 50 years or older and all residents of long-term care (LTC) facilities should receive a booster dose of Pfizer or Moderna vaccine at least 6 months after completion of primary vaccination.
    • People 18 years or older may receive a booster dose of Pfizer or Moderna vaccine at least 6 months after completion of primary vaccination.
  • Be aware, this is a change from the prior recommendation which prioritized booster doses based on age, medical history or risk of home- or job-related exposure.
    • Continue to recommend booster doses for all Johnson & Johnson (J&J) vaccine recipients at least 2 months after their primary vaccination.
    • Offer the same or different vaccine for the booster dose than the patient received for their primary vaccination.
    • Continue to report all COVID-19 vaccine doses administered into the Washington Immunization Information System (IIS) to better reflect where patients can find COVID-19 vaccine.
  • Promote childhood immunization, including non-flu Vaccines for Children (VFC) doses and COVID-19. Be aware, Pierce County providers ordered 22% fewer non-flu VFC doses during the pandemic compared to the previous 2 years.
  • Be aware, incorrect information is printed on the labels of some Pfizer pediatric COVID-19 vaccine vials. All Pfizer pediatric COVID-19 vaccine should be discarded 12 hours after dilution.
  • Be aware, rates of depression, suicide ideation, anxiety and post-traumatic stress disorder continue to be very high among healthcare providers. Washington State Department of Health (DOH) released guidance on combating moral injury in healthcare workers.
  • Help patients access their vaccine records and explain the different ways to show vaccination status. Options exist for everyone, including those who need language assistance or don’t have access to a computer or smartphone.

Background

Booster dose updates

On Nov. 19, CDC and the Western States Scientific Safety Review Workgroup recommended a booster dose for everyone 18 years or older, following the FDA’s decision to update its EUAs allowing booster doses for everyone 18 years or older. This is a change from the prior recommendation which prioritized booster doses for people based on age, medical history or risk of home- or job-related exposure.

As some people continue to be at higher risk of severe illness and death, CDC made some distinction to its recommendations:

  • All recipients of J&J COVID-19 vaccine should receive a booster dose at least 2 months after their primary vaccination.
  • People 50 years or older and all residents of LTC facilities should receive a booster dose of Pfizer or Moderna COVID-19 vaccine at least 6 months after completion of primary vaccination.
  • People 18 years or older may receive a booster dose of Pfizer or Moderna COVID-19 vaccine at least 6 months after completion of primary vaccination.

Heterologous (mix-and-match) booster doses are still authorized. Offer the same or different vaccine for the booster dose than the patient received for their primary vaccination. People are still considered fully vaccinated 2 weeks after their second dose of Pfizer or Moderna or 2 weeks after their single dose of J&J.

These decisions were made following observation of waning vaccine effectiveness over time—especially during the spread of the Delta variant—despite protection remaining high for severe disease and hospitalization. Furthermore, a Kaiser Family Foundation survey found 4 in 10 vaccinated adults were unsure whether they were eligible for a booster dose. The same survey found 6 in 10 adults say boosters show “scientists are continuing to find ways to make vaccines more effective.” CDC recognized vaccine recommendations based on risk and exposure are difficult to implement and moved to more broad recommendations to help increase protection against COVID-19.

Booster doses of Pfizer and J&J vaccine are identical to primary doses. The Moderna vaccine booster dose is half the primary dose (50 mcg in 0.25 mL). Moderna multi-use vials are unchanged, so each vial will have 20 booster doses. The third dose of Moderna vaccine recommended for people with compromised immune systems is still the full 0.5 mL dose.

Reach out to your eligible patients and discuss whether they would benefit from a booster dose. Continue to offer COVID-19 vaccine primary series and promote vaccination. The Health Department will offer booster doses to newly eligible people once Washington State has a standing order.

COVID-19 vaccine resources

COVID-19 testing

  • Families need help navigating K–12 testing requirements to return to school when a student has COVID-like illness (CLI). Children who present with CLI need a PCR test to return to school. Over-the-counter antigen tests are not acceptable proof of testing.A person with CLI who tests negative for SARS-CoV-2 with:
    • A molecular test—may return to school if they are not a close contact of someone with COVID-19 and subject to quarantine.
    • An antigen test—CDC guidance recommends a confirmatory lab-based molecular test.
      • An alternative to confirmatory nucleic acid amplification testing (NAAT) is serial antigen testing performed every 3–7 days for 14 days.

    For questions or help accessing resources, email epitesting@tpchd.org, call (253) 649-1247 or visit tpchd.org/covidtest.

    COVID-19 test processing

    Labs report varying amounts of time to process COVID-19 tests. To support faster turnaround, we encourage providers to use in-state labs. The below table shows COVID-19 test processing times for in-state private labs. If you have questions about Health Department-facilitated antigen tests, contact epitesting@tpchd.org.

    Lab Time to process test Tests processed daily
    FidaLab 24–72 hours 800–1,200
    Kaiser 24–72 hours 800–1,000
    LabCorp 24–48 hours Unknown
    Northwest Pathology 24–48 hours 20,000
    Quest 24–48 hours 1,300
    UW Virology 24–48 hours 7,000–9,000
    Atlas Genomic 24–48 hours 10,000

    Patient education

    Share the following materials with patients.

    Immediately report COVID-19

    • Cases in the following people—call (253) 649-1412.
      • Healthcare workers (e.g., EMS, medical, nursing, any healthcare facility employee).
      • Public safety workers (e.g., law enforcement, firefighter).
      • Live or work in a long-term care facility, senior living center, permanent supportive housing or similar congregate setting (e.g., shelter, correctional facility) housing people at high risk for severe outcomes.
      • Anyone who dies with COVID-19.
      • Anyone with suspected MIS-C.
    • All other cases—fax the following to (253) 649-1357 or call (253) 649-1413.
      • Patient—first name, last name, date of birth, gender, race, ethnicity, preferred language, phone number, address and zip code.
      • Specimen—collection date and type (NP, nasal swab, blood, etc.).
      • Test—type (PCR, NAAT, antigen, antibody/serology) and result (detected, not detected, inconclusive).
      • Ordering facility.
    • For all cases, report the person’s race, ethnicity and preferred language.

    Contacting the Health Department

    • Urgent issues—call (253) 649-1412.
    • Non-urgent issues—call (253) 649-1413 and leave a message. Includes reporting notifiable conditions 24 hours a day, 7 days a week. Leave the patient’s name, date of birth and disease.

Additional resources