When and how to give COVID-19 vaccine boosters

Give a Moderna or Pfizer-BioNTech (Comirnaty) booster at least SIX months after the second dose to patients 65 and older, long-term care residents...
Abdelwahab Ward, BS Pharm, PharmD

As a pharmacist, you’ll need to clear up confusion about COVID-19 vaccines, now that Moderna and Johnson & Johnson/Janssen boosters are authorized. But also keep the focus on vaccinating UNimmunized patients.

Terminology. Clarify that “boosters” aim to maintain protection after an adequate initial immune response. “Additional doses” are for patients who likely had an INadequate response to the initial series.

Boosters. Give a Moderna or Pfizer-BioNTech (Comirnaty) booster at least SIX months after the second dose to patients 65 and older, long-term care residents and those 18 to 64 with chronic conditions (diabetes, etc) or occupational exposure (healthcare workers, etc).

Johnson & Johnson/Janssen vaccine’s authorization is different. Give a booster at least TWO months after the first dose to ANY patient 18 and older. Explain that Johnson & Johnson/Janssen vaccine has a shorter window and broader patient group due to possibly less robust efficacy compared to mRNA COVID-19 vaccines. Reassure that side effects after a booster seem similar to those seen after the primary series. And limited data suggest no higher risk of rare clots with Johnson & Johnson boosters than with the first dose. You can now “mix and match” any brands for boosters. Preliminary evidence suggests this approach boosts antibodies at least as well as using the same brand as the primary series with similar side effects. Work with staff to prevent vaccine errors. Moderna’s booster is a HALF dose (0.25 mL), based on how it was studied. Other boosters are the same as the initial dose (0.3 mL for Pfizer-BioNTech, 0.5 mL for Johnson & Johnson).

Additional doses. Also continue to give an additional mRNA COVID-19 vaccine dose to immunocompromised patients at least 4 weeks after dose 2. In this case, try to use the same brand patients got for the initial dose if possible. But if it’s not available, don’t turn a patient away. Stick with the usual 0.5 mL for additional Moderna doses or 0.3 mL for Pfizer-BioNTech. Johnson & Johnson isn’t authorized for additional doses yet. If immunocompromised patients already got an additional dose of an mRNA COVID-19 vaccine, don’t give them a booster for now. Give any COVID-19 vaccine with other vaccines (flu, etc) if needed.

References

  1. CDC (2021). COVID-19 Booster Vaccine. [online] Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/booster-shot.html.
  2. Centers for Disease Control and Prevention. (2021). Coronavirus Disease 2019. [online] Available at: https://www.cdc.gov/media/releases/2021/p1021-covid-booster.html.
  3. CDC (2021). COVID-19 Vaccination. [online] Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/immuno.html.
  4. Vaccines and Related Biological Products Advisory Committee October 14-15, 2021 Meeting Presentation. FDA (2021). Available at: https://www.fda.gov/media/153128/download
Abdelwahab Ward, BS Pharm, PharmD