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For Health Care Providers
COVID-19 Primary Series and Booster Vaccination Guidance
Completing all recommended COVID-19 vaccine doses is important
Vaccination with COVID-19 vaccines currently approved or authorized by the Federal Drug Administration (FDA) has been shown to prevent infection, severe disease, hospitalization, and death caused by coronavirus disease 2019 (COVID-19). Efforts to increase the number of people who are up to date with the recommended COVID-19 vaccine doses will assist in preventing these serious outcomes. For considerations with being up to date on COVID-19 vaccinations, refer to CDC: Stay Up to Date with Your COVID-19 Vaccines.
It is important for people to receive all recommended doses of COVID-19 vaccine, and in general, all doses should be the same vaccine product. In situations where the product used for the person's first dose is not available, providers may administer a different product to avoid missed opportunities and complete the primary series. Refer to CDC: Interchangeability of COVID-19 vaccine products for additional details. Pfizer, Moderna and Novavax COVID-19 vaccines are recommended over the Johnson & Johnson (Janssen) vaccine except in limited situations.
Intervals between doses depend on the vaccine product, the person's age, and if the person is immunocompromised. An 8-week interval between the first and second primary series doses of Moderna, Novavax, and Pfizer-BioNTech COVID-19 vaccines may be optimal for some people ages 6 months–64 years, especially for males ages 12–39 years, as it may reduce the small risk of myocarditis and pericarditis associated with these vaccines. A shorter interval (3 weeks for Novavax and Pfizer-BioNTech; 4 weeks for Moderna) between the first and second doses remains the recommended interval for people who are moderately or severely immunocompromised; adults ages 65 years and older; and in situations in which there is increased concern about COVID-19 community levels or a person’s higher risk of severe disease.
Providers should refer to CDC: Interim Clinical Considerations for Use of COVID-19 Vaccines: Overview of COVID-19 Vaccination to understand the interval between each dose for COVID-19 vaccine products that require more than one dose for a primary series.
Additional primary series dose for moderately or severely immunocompromised people
Antibody response after vaccines, including COVID-19 vaccines, is likely to be suboptimal in people with altered immunocompetence at the time of vaccination. Therefore, an additional dose was added to the primary series for moderately or severely immunocompromised people. Refer to CDC: Guidance for COVID-19 vaccination for people who are moderately or severely immunocompromised for more specific information on this population.
COVID-19 vaccines continue to work very well at reducing the risk of severe illness, hospitalization, and death, but data suggest that protection against COVID-19 infection decreases over time.
People ages 6 months and older are recommended to receive one bivalent mRNA booster dose after completion of any FDA-approved or FDA-authorized primary series or previously received monovalent booster dose(s) with the following exception: Children 6 months through 4 years who receive a 3-dose Pfizer-BioNTech primary series are not authorized to receive a booster dose at this time regardless of which Pfizer-BioNTech vaccine (i.e., a monovalent or bivalent) was administered for the their primary series dose.
The original monovalent mRNA vaccines are not authorized as a booster.
Novavax monovalent vaccine is authorized in people 18 years and older in limited situations.
Refer to CDC: Interim Clinical Considerations for Use of COVID-19 Vaccines: Overview of COVID-19 vaccination for more details.
Vaccination reminders are critical to ensure compliance with vaccine dosing intervals and to achieve optimal vaccine effectiveness.
Use these tips for COVID-19 vaccine reminders:
- Use reminder/recall systems through MIIC or your electronic health record (her). In MIIC, utilize the Client Follow-Up (CFU) feature to learn which of your clients are recommended/overdue for vaccine. For user guidance on CFU in MIIC, please visit Client Follow-Up MIIC User Guidance and Training Resources.
- Partner with MDH to text your clients who are recommended or overdue for COVID-19 vaccine. The process of getting this activity set up and implemented is very simple and the maintenance is automated. MDH has successfully implemented texting with several organizations. Please reach out to the MIIC Help Desk to get started. For more information refer to Reminder/Recall Using Text Messages (PDF).
- Make sure each person getting vaccinated knows how long they must wait in between their vaccinations.
- Make every attempt to schedule the next dose appointment at the time of the first dose, or schedule both appointments when scheduling the first appointment.
- Complete a COVID-19 vaccination record card (vaccine manufacturer, lot number, date of dose received, and the date the next dose is due) for each person who is vaccinated. Encourage them to keep the card and bring it to the next dose appointment.
- If the vaccination record card is full, start a new card and staple both cards together.
- If the patient has a smartphone, ask them to:
- Take a photo of their vaccination card and/or enter the date when the next vaccine is due into their electronic calendar.
- Sign up for the Docket app to securely access their full immunization history in MIIC. For sign up instructions, refer to Easy Access to Your and Your Family's Immunization Records (PDF).
- Encourage enrollment in V-safe After Vaccination Health Checker, which uses free text messaging to receive COVID-19 vaccine dose reminders for primary doses.