Know When and How to Dispense COVID-19 Vaccine Boosters

You'll hear even more questions about COVID-19 vaccines...now that Moderna and Johnson & Johnson/Janssen boosters are authorized.

What's the difference between a "booster" and "additional dose"?

Keep in mind 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.

Who needs a booster? Dispense 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).

Johnson & Johnson/Janssen is different. Give a booster at least TWO months after the first dose...to ANY patient 18 and older.

Be aware, CDC now says it's okay to "mix and match" any brands for boosters. But there aren't enough data yet to say whether one combo is preferred over another. Consider vaccine supply, patient preference, etc.

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 Johnson & Johnson/Janssen).

Who needs an additional dose? Continue to give an additional dose of an mRNA COVID-19 vaccine (Moderna, Pfizer-BioNTech) to patients with a weakened immune system at least 4 weeks after dose 2.

In this case, try to use the same brand as the initial series if possible. But if it's not available, don't turn a patient away.

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.

What are considerations with co-administration? Keep in mind, any COVID-19 vaccine can be given at the same time as other vaccines (flu, etc). Help prevent mix-ups among different vaccines.

Add labels to syringes if needed...keep doses separate...and bring only the needed vaccines to the administration area. If you immunize, verbally verify with the patient which vaccine you're giving.

Continue to focus on offering COVID-19 vaccines to UNimmunized patients. Get our FAQ, Communicating About COVID-19 Vaccination, to help your pharmacist address concerns...and debunk myths.

And use our COVID-19 Vaccines chart to keep up with emerging details about pediatric vaccines, storage, and more.

Key References

  • https://www.cdc.gov/coronavirus/2019-ncov/vaccines/booster-shot.html (10-21-21)
  • https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/immuno.html (10-21-21)
  • https://www.fda.gov/media/153128/download (10-21-21)
Pharmacy Technician's Letter. November 2021, No. 371101



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