IMPORTANT—CDC Updated the Interim Clinical Considerations for Use of mRNA COVID-19 Vaccines last updated January 21, 2021

This message was sent to AIM, FAB, Health Systems, INE, IAP, LHD Health Officers, LHD Medical Directors, MACI, MACI 2, PH Imms Leads, COVID-19 Vaccine Providers, and Imms All Staff. I apologize for any duplication.

 

Good Afternoon Immunization Partners,

CDC recently released updates to the Interim Clinical Considerations for Use of mRNA COVID-19 Vaccines. We thought we would share what has been updated. It is important to review these updates and bookmark the Clinical Considerations Guidance as it provides a great deal of information on the recommendations and use of the mRNA COVID-19 vaccines. Here is a summary of the recent changes (last updated January 21, 2021):

• Updated recommendations on intervals between the first and second dose. The last paragraph under this bullet was updated. The update gives guidance on scheduling the 2^nd

The mRNA COVID-19 vaccine series consist of two doses administered intramuscularly:

• Pfizer-BioNTech (30 µg, 0.3 ml each): 3 weeks (21 days) apart
• Moderna (100 µg, 0.5 ml): 1 month (28 days) apart

Persons should not be scheduled to receive the second dose earlier than recommended (i.e., 3 weeks [Pfizer-BioNTech] or 1 month [Moderna]). However, second doses administered within a grace period of 4 days earlier than the recommended date for the second dose are still considered valid. Doses inadvertently administered earlier than the grace period should not be repeated.

The second dose should be administered as close to the recommended interval as possible. However, if it is not feasible to adhere to the recommended interval, the second dose of Pfizer-BioNTech and Moderna COVID-19 vaccines may be scheduled for administration up to 6 weeks (42 days) after the first dose. There are currently limited data on efficacy of mRNA COVID-19 vaccines administered beyond this window. If the second dose is administered beyond these intervals, there is no need to restart the series.

• Updated recommendations on interchangeability of vaccine products. A section was added to talk about strategies to ensure the 2^nd dose is received, which includes information on VaxText (a 2^nd dose reminder) and also how to handle situations in which you do not know what COVID-19 vaccine a patient received.

A section has been added regarding strategies to help ensure that patients receive the 2^nd dose with the appropriate interval between doses:

Providing COVID-19 vaccination record cards to vaccine recipients, asking recipients to bring their card to their appointment for the second dose, and encouraging recipients to make a backup copy (e.g., by taking a picture of the card on their phone).

• Encouraging vaccine recipients to enroll in VaxText^SM, a free text message-based platform to receive COVID-19 vaccination second-dose reminders.
• Recording each recipient’s vaccination in the immunization information system (IIS).
• Recording vaccine administration information in the patient’s medical record.
• Making an appointment for the second dose before the vaccine recipient leaves, to increase the likelihood that patients will present at the same vaccination site for the second dose.

Using the above strategies, every effort should be made to determine which vaccine product was received as the first dose, in order to ensure completion of the vaccine series with the same product. In exceptional situations in which the first-dose vaccine product cannot be determined or is no longer available, any available mRNA COVID-19 vaccine may be administered at a minimum interval of 28 days between doses to complete the mRNA COVID-19 vaccination series. If two doses of different mRNA COVID-19 vaccine products are administered in these situations (or inadvertently), no additional doses of either product are recommended at this time.

• Updated language on vaccination of persons with a history of SARS-CoV-2 infection. Information was added to this section that while vaccine supply remains limited, persons with recent documented infection may choose to temporarily delay vaccination.

While there is no recommended minimum interval between infection and vaccination, current evidence suggests that the risk of SARS-CoV-2 reinfection is low in the months after initial infection but may increase with time due to waning immunity. Thus, while vaccine supply remains limited, persons with recent documented acute SARS-CoV-2 infection may choose to temporarily delay vaccination, if desired, recognizing that the risk of reinfection, and therefore the need for vaccination, may increase with time following initial infection.

• New vaccination recommendations in persons with a history of dermal fillers.

Persons with a history of dermal filler use
Infrequently, persons who have received dermal fillers may develop swelling at or near the site of filler injection (usually face or lips) following administration of a dose of an mRNA COVID-19 vaccine. This appears to be temporary and can resolve with medical treatment, including corticosteroid therapy. mRNA COVID-19 vaccines may be administered to persons who have received injectable dermal fillers who have no contraindications to vaccination (see ‘contraindications’ section below). No additional precautions are needed. However, these persons should be advised to contact their healthcare provider for evaluation if they develop swelling at or near the site of dermal filler following vaccination.

• Additional resources on vaccine excipients (Appendix B). Please review the Clinical Considerations Guidance for Appendix B.

The full URL to the Interim Clinical Considerations for Use of mRNA COVID-19 Vaccines Currently Authorized in the United States: https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html

 

Thank you for all your hard work to protect Michiganders from vaccine-preventable diseases!

 

-The Immunization Nurse Education Team,
Andrea, Heidi, Maria, and Terri