Clarify When and How to Give COVID-19 Vaccine Boosters

You'll need to clear up confusion about COVID-19 that Moderna and Johnson & Johnson/Janssen boosters are authorized.

But also keep the focus on vaccinating UNimmunized patients.

Terminology. Clarify that "boosters" aim to maintain protection after an adequate initial immune response. "Additional doses" are for patients who likely had an INadequate response to the initial series.

Boosters. If you give COVID-19 vaccines in-house, evaluate whether patients are eligible based on risk factors and vaccine history.

Give a Moderna or Pfizer-BioNTech (Comirnaty) booster at least SIX months after the second dose to patients 65 and older...long-term care residents...and those 18 to 64 with chronic conditions (diabetes, etc) or occupational exposure (healthcare workers, etc).

J&J's authorization is different. Give a booster at least TWO months after the first ANY patient 18 and older.

Explain that J&J has a shorter window and broader patient group due to possibly less robust efficacy compared to mRNA COVID-19 vaccines.

Use whichever vaccine you stock. Preliminary evidence suggests "mixing and matching" any brands boosts antibodies at least as well as using the same brand as the primary series...with similar side effects.

Reassure that side effects after a booster seem similar to those seen after the primary series. And limited data suggest no higher risk of rare clots with J&J boosters than with the first dose.

Stay alert for errors. Moderna's booster is a HALF dose (0.25 mL), based on how it was studied. Other boosters are the same as the initial dose (0.3 mL for Pfizer-BioNTech, 0.5 mL for J&J).

Additional doses. Also continue to give an additional mRNA COVID-19 vaccine dose to immunocompromised patients at least 4 weeks after dose 2.

In this case, try to use the same brand patients got for the initial dose. But if it's not available, give the mRNA COVID-19 vaccine you have.

Stick with the usual 0.5 mL for additional Moderna doses...or 0.3 mL for Pfizer-BioNTech. J&J isn't authorized for additional doses yet.

Use our FAQ, Communicating About COVID-19 Vaccination, to address concerns (myocarditis, etc)...and debunk myths (infertility, etc).

Key References

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Hospital Pharmacist's Letter. November 2021, No. 371101

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