- Update: Clinical Considerations for mRNA COVID-19 Vaccines – Sarah Mbaeyi (CDC)
- COVID Epidemiology and Influenza Surveillance Update – Alicia Budd (CDC)
Update: Clinical Considerations for mRNA COVID-19 Vaccines – Sarah Mbaeyi (CDC)
Sarah provided a presentation on recent updates to the clinical considerations for use of mRNA COVID-19 vaccines. CDC has established a webpage where providers can find the most current information on this topic. Sarah noted that recent additions to this webpage include:
- Clarification on the 4-day grace period for 2nd dose vaccine administration – Although a 4-day grace period may be applied retrospectively, providers should not routinely schedule patients to receive their 2nd dose earlier than the recommended interval (21 days for Pfizer-BioNTech vaccine and 28 days for Moderna vaccine). There is no maximum interval recommended for administration of the 2nd
- Interchangeability of mRNA COVID-19 vaccines – Both doses in the series should be given with the same vaccine product. However, if two doses are inadvertently administered with different products, no additional doses of either product are recommended.
- Strategies for 2nd dose compliance – Vaccine recipients should be given a reminder card to return for their 2nd dose, and the vaccination should be recorded in the IIS and in the patient’s medical record. They should receive an appointment for the 2nd dose when the 1st dose is given.
- Timing of 2nd dose in person who develops SARS-CoV-2 after 1st dose – Administration of the 2nd dose should be deferred until a person has recovered from acute symptomatic SARS-CoV-2 illness and criteria have been met for the person to discontinue isolation. Due to theoretical concerns about interference, persons who have received monoclonal antibodies or convalescent plasma treatment should defer the 2nd dose for 90 days.
- Patient counseling around 2nd dose – Patients should be counseled on (1) the importance of completing both recommended doses, (2) the high likelihood of vaccine recipients experiencing local and/or systemic reactions, and (3) the importance of receiving the 2nd dose even if reactions occurred with the 1st
- Contraindications to receiving 2nd dose – Persons should not receive the 2nd dose of either mRNA COVID-19 vaccine if they had a severe reaction (anaphylaxis) or immediate (within 4 hours) allergic reaction of any severity following the 1st dose of COVID-19 vaccine, or if they have had an immediate allergic reaction of any severity to a COVID-19 vaccine ingredient, including polyethylene glycol (PEG). Although it is not a vaccine ingredient, an immediate reaction to polysorbate also is a contraindication, due to potential cross-reactive hypersensitivity with PEG.
Sarah noted that the Clinical Immunization Safety Assessment (CISA) Project is an additional resource for COVID-19 vaccine safety questions and consultation.
In answering a question, Sarah noted that there is not a fever threshold that can be used to distinguish between a reaction to vaccination and COVID infection. Sarah reviewed systemic reactions to vaccine. To assist with guidance on how to deal with a healthcare worker with symptoms after vaccination, CDC has published Post-vaccine considerations for healthcare personnel. Another document, Post-vaccine considerations for residents of long-term care facilities, highlights similar information for LTCF residents.
Finally, callers asked if there has been any association between receipt of COVID vaccine and development of shingles, and Sarah said that, to her knowledge, that has not occurred. There also have been no deaths reported after vaccine receipt.
COVID Epidemiology and Influenza Surveillance Update – Alicia Budd (CDC)
Flu activity in the U.S. remains very low. While COVID activity indicators are increasing nationally, Alicia noted that these reports are likely a few weeks behind due to the impact of the holidays.
At clinical labs, less than 1% of respiratory specimens tested positive for influenza. The only exception to this is region 6 (south central), where reporting levels are still low, but slightly higher than the rest of the country. Similarly, reports of positive specimens from public health laboratories also remain low. Data from both reporting sources indicate the small amount of influenza being seen is a relatively even mix of types A and B.
Testing for SARS-CoV-2 indicates a generally increasing trend in the proportion of specimens found to be positive. However, this increase varies by region, with generally higher percentages reported from east coast, central, and south central areas.
Although the number of outpatients seeking care for influenza-like illness (ILI) remains relatively stable, the number of patients with COVID-like illness has increased substantially. Again, this varies from region to region.
Lab-confirmed hospitalizations for flu are not yet being reported because the numbers (101) are so low. Hospitalizations for COVID were at their highest rates in late November/early December, with 16.9/100,000 hospitalizations. There has been a decline in the last couple of weeks, but reporting may have been impacted by the holidays.
The first influenza-associated pediatric death for the 2020–2021 season was reported at the end of November. This was determined to be influenza type B. Deaths due to pneumonia/influenza/COVID (PIC) have been increasing since the beginning of October.
Global flu activity remains very low. Among the few positives sampled, the mix is relatively even between influenza A and B.
Alicia closed her presentation by providing links to several helpful data resources:
In response to questions, Alicia explained that it is difficult to know if the precautions taken to prevent the spread of COVID-19 have resulted in our lower flu rates. It is possible that there is some viral interference. In previous pandemics, the pandemic strains have tended to overtake the flu virus, and this interference resulted in lower flu virus transmission. To date, there don’t appear to be many cases of co-infection between the two viruses. Finally, Alicia said data is insufficient to determine whether receipt of flu vaccine results in lower COVID mortality, but CDC will continue to examine this question as more data becomes available. More information on this topic was just published in the British Medical Journal (BMJ) in “Inactivated trivalent influenza vaccination is associated with lower mortality among patients with COVID-19 in Brazil.”