Which adults should receive mRNA COVID-19 vaccine? Almost everyone. The Pfizer-BioNTech and Moderna products are not live vaccines, and benefits typically outweigh theoretical risks. Urge patients to get either vaccine series when eligible.
History of allergic reactions. Vaccinate most patients with a prior severe reaction to food, latex, or oral medications. Ask if patients have had hives, wheezing, or anaphylaxis within 4 hours of exposure to any other vaccines or injectable medications. This immediate allergic reaction is a precaution to COVID-19 vaccination. These patients CAN also be vaccinated. Balance the benefits of protecting patients from COVID-19 against the rare risk of a reaction. Observe these patients and those with prior anaphylaxis due to any cause for 30 minutes. Others can leave after the usual 15 minutes. Brush up on your emergency management plan and confirm that your kit has at least 3 doses of in-date epinephrine. Don't vaccinate patients with a history of an immediate or severe allergic reaction to excipients, such as polyethylene glycol (PEG) or polysorbate or to a first COVID-19 vaccine dose.
Special populations. Feel comfortable vaccinating patients who are immunocompromised due to medications or conditions (pregnant or breastfeeding). Help these patients make an informed decision since data are limited. For example, pregnant patients seem to be at higher risk for severe COVID-19. Educate that animal studies don't raise concerns about mRNA COVID-19 vaccines in pregnancy and these vaccines don't affect our DNA. Tell patients planning pregnancy that there's no evidence to suggest mRNA COVID-19 vaccines cause infertility.
Prior COVID-19 infection. Vaccinate these patients, even if they happen to contract COVID-19 between getting their first and second dose. But consider delaying after a recent infection, especially if vaccine supply is limited, since reinfection within 90 days is uncommon. Wait at least 90 days to vaccinate if patients receive convalescent plasma or monoclonal antibodies to treat COVID-19, due to possible interference with the vaccine immune response. For now, continue to emphasize wearing masks, distancing, etc, even AFTER immunization.
REFERENCES
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Interim Clinical Considerations for Use of Pfizer-BioNTech COVID-19 Vaccine | CDC. (2020, December 21). Retrieved from www.cdc.gov website: https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html
Management of Anaphylaxis at COVID-19 Vaccination Sites | CDC. [online] Available at: https://www.cdc.gov/vaccines/covid-19/clinical-considerations/managing-anaphylaxis.html
Allergic Reactions Including Anaphylaxis After Receipt of the First Dose of Moderna COVID-19 Vaccine — United States, December 21, 2020–January 10, 2021. MMWR. Morbidity and Mortality Weekly Report, [online] 70. Available at: https://www.cdc.gov/mmwr/volumes/70/wr/mm7004e1.html
Vaccinating Pregnant and Lactating Patients Against COVID-19. [online] Available at: https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2020/12/vaccinating-pregnant-and-lactating-patients-against-covid-19