Provider Update – July 23, 2021

Vaccine ECHO for Providers

Please join the COVID-19 Vaccine ECHO for Providers on Tuesdays, 2:00 PM Alaska. At this week’s Provider ECHO, we’ll be hearing from a behavioral health scientist about behavior change and vaccine acceptance. In conjunction, please bring your stories, questions, and tips about what has worked well (or hasn’t worked at all!) in discussing COVID vaccine with people who still have concerns.

Register in advance for this meeting. After registering, you will receive a confirmation email containing information about joining the meeting. Each week we discuss updates for the week and any questions you may have.

ACIP Meeting

The ACIP met yesterday to discuss GBS and additional COVID doses for the immunocompromised. No votes were taken, but evidence was presented showing that the benefit of the vaccines (both mRNA and J&J) outweighs the risk of GBS. There was discussion about immunocompromised individuals experiencing COVID, as well as groups representing immunocompromised, discussed the need for a third dose of vaccine. The workgroup recommends that conditions and treatments associated with moderate to severe immune compromise be considered for an additional dose, but there was not enough data for the ACIP to vote at this time. Providers are limited in ability to recommend a third dose under EUA. Slides are available.

Guillan-Barre Syndrome (GBS): Summary of Work Group Interpretation and Next Steps (slides):

The workgroup presented data on the benefits of COVID-19 vaccination including:

• Evidence indicates those who are vaccinated are unlikely to transmit SARS-CoV-2
• Many populations prefer a one dose vaccine series and this likely playing a role in achieving health equity
• The workgroup reaffirms that all eligible persons should receive the COVID-19 vaccine and strongly supports continued use of the Janssen COVID-19 vaccine. Patients with a history of GBS are recommended to discuss the best vaccine choice for them with their doctor.

ACIP members brought up the following concerns:

• Members feel GBS is a significantly severe side-effect and messaging needs to be strong regarding the risk prior to Janssen vaccination.
• Concerns were raised that a similar recommendation/approach should have been taken after reports of myocarditis and TTS. Some ACIP members felt GBS was being taken more seriously than other reported side-effects (myocarditis and TTS).
• Members request a strong recommendation that providers “should make patients aware” of the risks.

Summary of Data and Clinical Considerations for Additional Doses in Immunocompromised (slides)

• The workgroup presented limited data on offering additional doses to the immunocompromised:
• 44% of hospitalized breakthrough cases in a US study were in immunocompromised persons
• Small studies show that two doses of COVID-19 vaccines confer a lower antibody response in immunocompromised persons and in some groups a third dose of mRNA vaccine increased antibody response.
• In these studies, no serious adverse events were reported after a third dose
• The workgroup recommends that conditions and treatments associated with moderate to severe immune compromise be considered for an additional dose.

ACIP Announcements:
The work group will be prepared to discuss myocarditis in adolescents at an ACIP meeting when they discuss the Moderna COVID-19 vaccine for adolescents. No current COVID ACIP meeting scheduled, but some August meetings are anticipated.

Moderna Orders

A correction from the previous Provider Update email: the cut-off for ordering Moderna 10-dose vials will be next Tuesday, July 27, when it will be removed from VacTrAK as an option.