A summary of presentations from the weekly Summit partner webinars
October 28, 2021 – The latest Summit summary
- CDC Guidelines for COVID-19 Vaccine Boosters – Andrew Kroger (CDC)
- AVAC Hill Briefing Update – Abby Brownas (Adult Vaccine Access Coalition)
- NFID Conference Update – Marla Dalton (NFID) and Diana Olson (NFID)
CDC Guidelines for COVID-19 Vaccine Boosters – Andrew Kroger (CDC)
Andrew Kroger, MD, MPH, Medical Officer, Communication and Education Branch, Immunization Services Division, CDC, gave a presentation on CDC guidelines for COVID-19 boosters.
COVID-19 Vaccine Dosing and Administration
As you know, there are three COVID-19 vaccines currently available in the U.S.: Pfizer-BioNTech (mRNA vaccine), Moderna (mRNA vaccine), Janssen (Johnson & Johnson) (adenovirus vector vaccine). Today I will be talking about booster dose and additional primary dose recommendations.
Booster doses can be mixed-matched (i.e., the brand of vaccine used for the booster can be different than the brand used for the primary series). However, the additional primary dose, when indicated, should ideally be the same brand as the initial doses.
To review, all three vaccines are FDA-authorized. Moderna is authorized for age 18+, Janssen is authorized for age 18+, and Pfizer-BioNTech is authorized for age 12–15 [editor’s note: since this talk was given, Pfizer-BioNTech COVID-19 vaccine is now authorized for 5-15 years] and FDA-approved for age 16+. All vaccines are given as intramuscular injections.
The Pfizer-BioNTech COVID-19 vaccine is given in two 0.3 mL doses at three weeks apart; the booster dose, when indicated, is given 6 months after the primary series and is also 0.3 mL per dose. [Editor’s note: Pfizer-BioNTech dose for 5-11-year-olds is 0.2mL of the formulation with an orange bordered label and orange vial cap; the vial for persons 12 years and older had a purple border on the label and purple cap.]
The Moderna COVID-19 vaccine is given in two 0.5 mL doses one month apart. A booster dose of Moderna vaccine, when indicated, is given 6 months after completing the primary series and is 0.25 mL/dose; this booster dose is half the amount as a dose for the primary series.
The Janssen COVID-19 vaccine is a one-dose (0.5 mL) vaccine; a booster dose (with any of the 3 vaccines) is recommended for everyone 18 years and older who received a primary Janssen dose. The booster should be given at least 2 months after a primary dose of the Janssen vaccine. When Janssen is used as a booster dose, the dose is 0.5 mL dose which is the same dose as for the primary dose.
Additional dose after a primary vaccine series: administration of an additional vaccine dose when the initial immune response following a primary vaccine series is likely to be insufficient. An additional mRNA COVID-19 vaccine dose is recommended for moderately to severely immunocompromised people at least 28 days after an initial 2-dose mRNA primary vaccine series.
Booster dose: an additional dose of vaccine is administered when the initial sufficient immune response to a primary vaccine is likely to have waned over time.
Booster Recommendation – Part One
CDC recommends that people who received an mRNA COVID-19 primary series and are aged ≥65 years, residents aged ≥18 years in long-term care settings, or aged 50–64 years with certain underlying medical conditions should receive a single COVID-19 vaccine booster ≥6 months after completion of their primary mRNA vaccine series. People aged ≥18 years who received a Janssen primary series should also receive a single COVID-19 vaccine booster ≥2 months after their Janssen primary dose. Currently, a booster dose is not recommended in people aged <18 years.
The following people may receive a booster after making an individual risk decision/shared clinical decision-making:
- people age 18–49 with underlying medical conditions
- people age 18–64 at occupational or institutional risk (e.g., healthcare workers, teachers, persons living or working in settings like correctional facilities, homeless shelters, etc.).
See CDC’s Expands Eligibility for COVID-19 Booster Shots for a complete list of booster eligibility.
Underlying Medical Conditions
For a person with an underlying medical condition, improved management of that condition can decrease risk of severe illness from COVID-19. If fully vaccinated, people with underlying medical conditions might have an increased risk of severe illness from COVID-19 over time as antibody titers wane. Some examples of underlying medical conditions with increased risk of severe COVID-19 disease include:
- chronic kidney disease
- COPD (chronic obstructive pulmonary disease)
- diabetes mellitus, type 1 and type 2
- heart conditions (such as heart failure, coronary artery disease, or cardiomyopathies)
- obesity (BMI ≥30 kg/m2)
- pregnancy and recent pregnancy
Individual Risk-Benefit Assessment Considerations
People age 50-64 years with an underlying medical condition have full recommendation (i.e., should get a booster), but if between age 18–49 with an underlying medical condition, an individual risk-benefit assessment should be made (i.e, these groups may get a booster). Given the rapidly changing clinical, public health, and scientific landscape amidst the COVID-19 pandemic, an individual risk assessment considering the potential benefits and risks of a COVID-19 booster dose is needed.
Individual Risk-Benefit Assessment for People who MAY receive a COVID-19 Vaccine Booster Dose
CDC’s Patient Counseling section on the Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Approved or Authorized in the United States web page offers information on considerations that can be used for risk-benefit analysis.
- Risks of the booster include rare serious adverse reactions (myocarditis, pericarditis, anaphylaxis) and common risks of transient local and systemic symptoms.
- Risks of COVID-19 infection are severe infection (underlying conditions), risk of spreading to others, and inability to meet obligations due to infection.
- Benefits of the booster include reduced risk of illness, including severe illness.
- Risks of COVID-19 exposure are greater in certain occupational and institutional settings. In addition to increased risk of exposure in certain settings, some people may have waning immunity and become more susceptible as more time passes following vaccination with the primary series.
Exposure and Transmission Because of Occupational or Institutional Setting
The CDC recommends that people age 18–64 years who had a primary series with an mRNA vaccine may receive a booster at least 6 months after completing the primary series if they are at increased risk of exposure to and transmission of COVID based on their occupation or institutional setting.
Booster Recommendation – Part Two
For the nearly 15 million people who got the Janssen COVID-19 vaccine, booster shots are recommended for all those age 18 and older and who were vaccinated two or more months ago (shorter interval than mRNA vaccines).
Mix and Match – Which Pairs?
The CDC does not recommend mix and match of mRNA primary series vaccine doses. However, should this happen, doses are counted and not invalidated. The individual is still considered fully vaccinated in that circumstance.
It is not recommended to mix and match between the primary series and the additional primary dose for immunocompromised persons. Should this happen, the dose will also be counted, but it is not recommended. It is considered okay to mix and match between the primary series and the booster dose.
Mix and Match – The Finer Points
Both the interval between primary series and booster and the eligibility criteria depend on the primary dose administered (Janssen or an mRNA vaccine). Two helpful scenarios of mix and match can be found below:
- Someone age 18 who received Janssen 2 months ago can now receive Pfizer-BioNTech, Moderna, or Janssen as a booster – no additional eligibility criteria are needed other than being 18 years or older
- Someone age 18 who received Moderna 2 months ago is not eligible for the booster. If they meet the criteria for a booster (e.g., have a high-risk condition, or work in a high-risk setting), then they would be eligible for a booster dose at six months post-primary series.
Fully Vaccinated People
People are considered fully vaccinated against COVID-19 at two or more weeks after their second dose of mRNA vaccine or at least 2 weeks after a single dose of Janssen vaccine. CDC has developed public health recommendations for fully vaccinated people. You do not have to have the booster dose to meet the definition of “fully vaccinated”.
If someone had a COVID-19 infection and also is also fully vaccinated, are there any contraindications to getting the booster 6 months post-second dose of mRNA vaccine?
Having had COVID-19 is neither a contraindication nor a precaution to receipt of the vaccine or booster dose. There is guidance currently to wait 30 days post COVID-19 infection to be vaccinated.[Editor’s note: CDC current statement in the COVID-19 Vaccine Clinical Considerations document states: “People with known current SARS-CoV-2 infection should defer vaccination at least until recovery from the acute illness (if symptoms were present) has been achieved and criteria to discontinue isolation have been met. Current evidence about the optimal timing between SARS-CoV-2 infection and vaccination is insufficient to inform guidance. This recommendation for vaccination applies to people who experience SARS-CoV-2 infection before receiving any vaccine dose and those who experience SARS-CoV-2 infection after the first dose of a COVID-19 vaccine, but before receipt of subsequent doses.”
Are there any updates to the website on adding groups at risk of severe COIVD-19?
To my knowledge, there have not been any recent changes to the list. [Editor’s note: the list of conditions can be found at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care/underlyingconditions.html.)
One important message to note is that patients can self-attest to having a condition and receiving the booster dose without documentation.
Is it anticipated that children age 5–11 will be allowed co-administration of COVID-19 vaccine with the flu vaccine?
I don’t anticipate a change in the co-administration language.
AVAC Hill Briefing Update – Abby Brownas (Adult Vaccine Access Coalition)
Abby Bownas, Manager, Adult Vaccine Access Coalition (AVAC), gave an update briefing presentation on AVAC Hill.
AVAC is a group of over 65 organizations, patient advocacy groups, provider groups, etc. that are looking to improve immunization policy, quality measures, information systems, access, and the landscape for adult immunization.
Now that COVID-19 vaccinations are well underway, it’s time to start thinking about how routine immunization rates can be increased, as many vaccinations were missed over the last year due to the pandemic. The AVAC Hill Briefing allowed a chance to come together, discuss policy recommendations, and increase awareness.
Update AVAC Briefing on October 28, 2021: “Fully Vaccinated?”
This meeting was moderated by LJ Tan, MS, Ph.D., Immunization Action Coalition. Welcome remarks for the meeting came from Reps. Ami Bera (CA-07) and Larry Bucshon (IN-08). Speakers included Christine Liow, MPH, Avalere Health, Kelly Danielpour, Vaxteen, Synovia Moss, MPA, NCNW Good Health Wins, and Jeffery Goad, Pharm.D., MPH, National Foundation for Infectious Diseases.
During the meeting, speakers talked about research, education, access issues, provider issues, the spectrum of where we are with missed doses, why vaccination is important, and policy recommendations. There was also a release of a series of new graphics.
New graphics are available for distribution across social media. Some of the messages include:
- “Prior to the pandemic, the U.S. spent an estimated $26.5 billion annually to treat vaccine-preventable diseases such as flu, pneumococcal, shingles, and pertussis.”
- “3 out of 4 adults are missing one or more of four critical vaccines for flu, pneumococcal, shingles, and Td or Tdap.”
- “26 million routine adolescent and adult vaccine doses were missed in 2020 as a result of the COVID-19 pandemic.”
- “A healthcare provider’s recommendation is a key predictor of an adult’s decision to get vaccinated.”
- “More than 75% of the U.S. population received a first dose of the COVID-19 vaccine in less than a year. While disparities have narrowed, Black and Hispanic people are less likely than white people to have received a vaccine.”
Protect All Adults from Vaccine-Preventable Disease and Disability
The rates of adult vaccination have been made worse by the COVID-19 pandemic. NAIIS calls on all clinicians, pharmacists, and other healthcare providers to help adults get up to date with recommended vaccines by routinely assessing patients’ vaccination needs, recommending, and offering recommended vaccines. Please support the Call to Action.
What Congress Can Do
There are several bills that AVAC is supporting right now, including:
Protecting Seniors through Immunization Act (HR1987/S912), which eliminates cost-sharing for recommended adult vaccines under traditional Medicaid under Medicare Part D for beneficiaries. Sponsors: Reps. Kuster/Bucshon; Sens. Hirono/Capito/Whitehouse/Scott.
Helping Adults Protect Immunity Act (S581/HR550), which eliminates beneficiary cost-sharing for recommended adult vaccines under traditional Medicaid and provides enhanced FMAP. Sponsors: Sen. Brown and Rep. Soto.
Immunization Infrastructure Modernization Act (HR550), which authorizes IIS modernization activities. Sponsors: Reps. Kuster/ Bucshon.
Community Immunity During COVID-19 Act (HR736/S167), which provides funding to support local initiatives to boost vaccination rates during the COVID-19 pandemic. This supports educational efforts that flow directly into the CDC and then from the CDC out into the community. Sponsors: Rep. Underwood and Sen. Smith.
NFID Conference Update – Marla Dalton (NFID) and Diana Olson (NFID)
Marla Dalton, CAE, NFID Executive Director and CEO, NFID, and Diana Olson, Senior Director, Strategic Communications, NFID, gave an update presentation on the NFID conference.
The NFID in conjunction with CDC held the 2021 NFID Influenza/Pneumococcal Disease News Conference on October 7, 2021. This served as an official kick-off to influenza vaccination season and served as an opportunity to share critical public health messages on why it’s more important than ever to get vaccinated against the flu, as well as other diseases.
The moderator was William Schaffner, MD, NFID Medical Director, and Rochelle P. Walensky, MD, MPH, Director of CDC, and an array of panelists participated in a news conference and also took other media calls. In addition to discussing flu vaccination coverage last season, they also discussed the results of a new NFID survey designed to better understand the knowledge and attitudes about flu and pneumococcal disease and practices around vaccination in the context of the pandemic.
What did the survey reveal?
The survey showed that 44% of U.S. adults are either unsure or don’t plan to get a flu vaccine this season. Of even more concern, 23% of those at higher risk for flu-related complications said they were not planning to get vaccinated this season. The primary reasons for not getting the vaccine are because they don’t feel they work very well or because they believe they never get the flu. View the results. The results webpage also includes resources and graphics that can be shared across social media.
Top-Tier Media Coverage
Despite a heavy COVID-19-dominated news landscape, thanks to partners and supporters, NFID was able to generate a lot of media attention. Media in top-tier print, online, and TV outlets resulted in four billion impressions to date. There were more than 450 people attending, including 37 members of the press. As of October 21, over 700 stories (45 original) were generated; highlights include ABC News, Associated Press (picked up by 226+ outlets, reaching 45 states), Axios, Forbes, Healio, Healthline, New York Times, Washington Post, and USA Today.
Media Outlets Extend Message reach on Social
All of the media coverage included the key message with a strong call to action that annual vaccination is the best way to prevent the flu. Many of the media outlets were able to extend the reach with key messaging by social media. A special thanks is due to Families Fighting Flu and Vaccinate Your Family for live Tweeting the news conference. Thank you to all that participated and shared messages on social media. To date, more than 2,200 social media posts used #fightflu and #preventpneumo in their messaging.
NFID Flu Vaccine Clinic October 5, 2021
NFID was able to hold a flu vaccine clinic at the NFID headquarters a few days before the news conference. U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra got vaccinated at NFID headquarters, along with partner organization representatives, and shared their vaccine photos on social media using #FightFlu. They also shared their thoughts on the importance of vaccination on an ongoing NFID blog post.
Support NFID #FightFlu Campaign
Join NFID’s Leading by Example initiative to show your commitment to flu prevention. Share flu vaccination photos on social media using #FightFlu and tag @NFIDvaccines. (NFID paddles and masks make great props!)
If your organization has not done so yet, pledge your support for flu prevention by joining the Leading by Example Organization/Company Pledge. Share photos of your leaders getting vaccinated on social media, tag @NFIDvaccines, and use #FightFlu. There are sample social media posts available.
Building and Sustaining Strong Momentum Throughout the Season
NFID will continue to share resources throughout the remainder of the flu season and there are several upcoming activities to look forward to:
- There will be a campaign focusing on those with chronic health conditions
- National Influenza Vaccination Week will be in December
- There will be a survey of black adults on knowledge about flu and flu vaccines (early next year)
You can watch a recording of the news conference and access a lot of supporting materials at www.nfid.org/2021flunews.
Carolyn Bridges (IAC)
- We have moved all of our communications to Mailchimp, so please add NAIIS: email@example.com your contacts to receive all future communications.
- The Immunization Action Coalition (IAC), with funding support from Seqirus, is offering a limited quantity of FREE Flu Vaccine buttons and stickers in English and Spanish to support your flu vaccine promotion efforts this season. Order the flu buttons and stickers.
- IAC hosted two influenza webinars this September that can now be viewed online.
- We would welcome having more NAIIS member organizations add their support to the Call to Action on adult immunization. Access the call to action and click on the top righthand button to add your organization.