DHS Supports CDC Recommendation for Updates to the COVID-19 Booster Schedule and Number of Doses Needed for Immunocompromised Individuals
The Wisconsin Department of Health Services (DHS) supports the Centers for Disease Control and Prevention (CDC) recommended updates for people who are moderately or severely immunocompromised that address the number of COVID-19 vaccine doses needed and the appropriate COVID-19 vaccination dosing schedule.
DHS supports changing the interval for an mRNA booster dose from 5 months to 3 months for people who are moderately or severely immunocompromised. These individuals should receive a booster dose at least 3 months after the last (third) dose of an mRNA COVID-19 vaccine. This only applies to moderately or severely immunocompromised individuals that are 12 years of age and older for Pfizer-BioNTech recipients and 18 years of age and older for Moderna recipients.
DHS also supports Johnson & Johnson (Janssen) recipients who are moderately or severely immunocompromised receive an additional dose of mRNA vaccine only at least 28 days after their first primary Johnson & Johnson (Janssen) dose. A booster dose of an mRNA COVID-19 vaccine or Johnson & Johnson (Janssen) would then follow 2 months after an additional mRNA dose. An mRNA vaccine is preferred for the booster dose.
Note that in December, CDC made a “preferential recommendation” that the mRNA COVID-19 vaccines should be given instead of the Johnson & Johnson (Janssen) vaccine, when possible and appropriate.
Overview of CDC Changes to Clinical Considerations
On February 4, the Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices’ (ACIP) members recommended the interval changes for boosters for moderately or severely immunocompromised individuals.
The Interim Clinical Considerations were published on February 11 to reflect these changes, which include:
- Clarification of existing recommendation to receive a 3-dose mRNA vaccine primary series followed by a booster dose for a total of 4 doses.
- New guidance to shorten the interval between completion of the mRNA vaccine primary series and the booster dose to at least 3 months (instead of 5 months).
- New guidance for those who received the Janssen COVID-19 vaccine primary series to receive an additional dose and a booster dose, for a total of 3 doses to be up to date.
- Updated guidance that it is no longer necessary to delay COVID-19 vaccination following receipt of monoclonal antibodies or convalescent plasma.
- Updated guidance on receiving a booster dose if vaccinated outside the United States.
- Updated contraindication and precaution section to include history of myocarditis or pericarditis after an mRNA COVID-19 vaccine as a precaution.
DHS Recommends
Primary series for people moderately or severely immunocompromised
- mRNA COVID-19 vaccines: A 3-dose primary series for people ages 5 years and older who are moderately or severely immunocompromised at the time of vaccination. The same mRNA vaccine product should be used for all doses of the primary series.
- Pfizer-BioNTech COVID-19 Vaccine (5 years and older): The second dose is administered 21 days after the first dose; the third dose is administered at least 28 days after the second dose.
- Moderna COVID-19 Vaccine (18 years and older): The second dose is administered 28 days after the first dose; the third dose is administered at least 28 days after the second dose. The dose is 100 mcg (0.5 ml) for all doses in the primary series.
- Johnson & Johnson (Janssen) vaccine: A primary Janssen vaccine dose for people ages 18 years and older who are moderately or severely immunocompromised, followed by a second (additional) dose using an mRNA COVID-19 vaccine at least 28 days later. If Moderna COVID-19 vaccine is used for the second dose, administer a 100 mcg (0.5 ml) dose.
- Note that in December, CDC made a “preferential recommendation” that the mRNA COVID-19 vaccines, Pfizer and Moderna, should be given instead of the Johnson & Johnson vaccine, when possible and appropriate.
Booster for people moderately or severely immunocompromised
Booster doses are recommended for people 12 years of age and older after completion of primary vaccination series.
- mRNA COVID-19 vaccine primary series: A single booster dose at least 3 months after the third dose in the primary series, for a total of four doses, preferably with an mRNA COVID-19 vaccine. If Moderna vaccine is used for the booster dose, a 50 mcg (0.25 mL) dose should be used.
- Johnson & Johnson (Janssen) COVID-19 primary vaccination: A single booster dose at least 2 months after the 2nd (additional) dose, for a total of 3 doses (1 Janssen vaccine dose followed by 1 additional mRNA vaccine dose, then 1 booster dose). mRNA vaccines are preferred for the booster dose. If the Moderna vaccine is used for the booster dose, a 50 mcg (0.25 ml) dose should be used.
- Special situation: Many recipients of Janssen COVID-19 vaccine may have already received a booster dose (Pfizer-BioNTech, Moderna [50 mcg, 0.25 ml], or Janssen vaccine), without having had the 2nd (additional) mRNA vaccine dose. In this situation, regardless of type and timing of vaccine received as the 2nd dose, administer a Pfizer-BioNTech vaccine or a Moderna vaccine (100 mcg [0.5 mL]) as the 3rd dose at least 2 months after dose 2.
CDC Clinical Considerations and MMWR
The updated CDC Interim Clinical Considerations were released and MMWR are anticipated to be published shortly.
Updated Emergency Use Authorizations Fact Sheets
Immunization Policy and Procedure Manual
The Immunization Program Policy and Procedure (P&P) Manual has been updated.
Other resources
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