HEALTH ADVISORY
SUMMARY
- Currently, only 55% of Fairfax Health District residents who are eligible for a SARS-CoV-2 vaccine booster dose have received one. The proportion is substantially lower among African Americans and Hispanics.
- Recently published studies from multiple US states documents that receipt of a COVID-19 mRNA vaccine booster dose significantly increases effectiveness in preventing infection, emergency department (ED) visits, and hospitalization associated with Omicron and Delta variant infection (see references under Additional Information).
- CDC recommends all persons, including those who are immunocompromised, ages 12 years and older should receive an mRNA vaccine booster dose, even if they were age 11 years old at the time of the primary series.
- While vaccination rates in the Fairfax Health District (and the rest of Northern VA) are generally high, booster dose rates need to be improved to avoid future surges in cases and outbreaks that could result in increased numbers of hospitalizations and mortality.
- Healthcare providers are urged to take a systematic approach similar to that used for other immunizations to identify and remind patients who have not received a COVID-19 vaccine booster dose, to monitor coverage in the practice, and to provide patient education and materials regarding the importance of the booster dose.
SUGGESTED ACTIONS
- Healthcare providers should be familiar with CDC recommendations and clinical considerations for the use of SARS-CoV-2 vaccines including booster doses, found here: Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Approved or Authorized in the United States
- People with normal immunity and those who are moderately or severely immunocompromised should receive booster vaccinations based on the recommendations in the tables below.
| Primary Series Vaccine Manufacturer | Age Group | Number of Doses in Primary Series | Number of Booster Doses | Interval Between 1st and 2nd dose | Interval Between Primary Series and Booster Dose |
|---|---|---|---|---|---|
| Pfizer-BioNTech | 5-11 years | 2 | NA | 3 weeks | NA |
| Pfizer-BioNTech | ≥12 years | 2 | 1 | 3 weeks | ≥5 months |
| Moderna | ≥18 years | 2 | 1 | 4 weeks | ≥5 months |
| Janssen | ≥18 years | 1 | 1 | NA | ≥2 months |
| Primary Vaccination | Age Group | Number of Primary Vaccine Doses | Number of Booster Doses | Interval Between 1st and 2nd Dose | Interval Between 2nd and 3rd Dose | Interval Between 3rd and 4th Dose |
|---|---|---|---|---|---|---|
| Pfizer-BioNTech | 5-11 years | 3 | NA | 3 weeks | ≥4 weeks | NA |
| Pfizer-BioNTech | ≥12 years | 3 | 1 | 3 weeks | ≥4 weeks | ≥3 months |
| Moderna | ≥18 years | 3 | 1 | 4 weeks | ≥4 weeks | ≥3 months |
| Janssen | ≥18 years | 1 Janssen, followed by 1 mRNA | 1 | 4 weeks | ≥2 months | NA |
- Lack of knowledge among patients is a frequent barrier to adult immunization. Healthcare provider should provide education and benefits of COVID-19 vaccination/booster to patients as a trusted source of health information. Answers to frequently asked patient questions can be found here: COVID-19 Vaccine FAQs for Healthcare Professionals
- Evidence-based, systematic approaches to increase vaccination coverage are recommended by the Task Force on Community Preventive Services and include reminder or recall systems, provider assessment and feedback, and standing orders. Providers should implement these systems in their practices to increase SARS-CoV-2 booster dose vaccination and protection against mild/moderate as well as severe COVID-19.
ADDITIONAL INFORMATION
References
Accorsi EK, Britton A, Fleming KE, et al. Association between 3 doses of mRNA COVID-19 vaccine and symptomatic infection caused by the SARS-CoV-2 Omicron and Delta variants. JAMA 2022;327:639-651. Doi:10.1001/jama2022.0470.
Thompson MG, Natarajan K, Irving SA, et al. Effectiveness of a third dose of mRNA vaccines against COVID-19-associated emergency department and urgent care encounters and hospitalizations among adults during periods of Delta and Omicron variant predominance – VISION Network, 10 states, August 2021-January 2022. MMWR 2022;71:139-145.