10/23/21 Health Advisory: COVID-19 Updates for Providers

| October 25, 2021
syringe in a vial

Requested actions

  • Be aware, on October 22, the Centers for Disease Control and Prevention (CDC) recommended a single booster dose of Moderna SARS-CoV-2 vaccine to certain high risk populations at least 6 months after their primary series under the Food and Drug Administration’s (FDA) expanded emergency use authorization (EUA). We are awaiting additional guidance from the Western States Scientific Safety Review Workgroup and WA Dept. of Health.
    • All people 65 years or older or people who live in long-term care facilities should receive a booster dose.
    • People between 50 and 64 years old with underlying medical conditions should receive a booster dose.
    • People between 18 and 49 years old with underlying medical conditions may receive a booster dose based on their individual risks and benefits.
    • People between 18 and 64 years old in an occupational or institutional setting where the burden of disease and risk of infection are high may receive a booster dose based on their individual risks and benefits.
  • Be aware, the CDC also recommended a booster shot for all recipients of the Johnson & Johnson/Janssen vaccine who are 18 and older at least 2 months after initial administration.
  • Be aware, on October 20, the FDA extended the Emergency Use Authorization (EUA) to allow for a heterologous (or “mix and match”) booster doses in eligible individuals following completion of primary vaccination with a different available COVID-19 vaccine.
  • Be aware, there is a national shortage of the BinaxNOW COVID-19 rapid antigen tests. Use other antigen or PCR tests while supplies are limited.
  • Help patients access their vaccine records and explain the different ways to show vaccination status. There are options for everyone, including those who need language assistance or don’t have access to a computer or smartphone.

Background

COVID-19 vaccine booster dose updates

Following a vote by the Advisory Committee on Immunization Practices (ACIP) on October 21, CDC recommended a single booster dose of Moderna’s mRNA vaccine to certain high-risk populations at least 6 months after their primary series under the FDA’s expanded EUA:

  • All people 65 years or older or who live in long-term care facilities should receive a booster dose.
  • People between 50 and 64 years old with underlying medical conditions should receive a booster dose.
  • People between 18 and 49 years old with underlying medical conditions may receive a booster dose based on their individual risks and benefits.
  • People between 18 and 64 years old in an occupational or institutional setting where the burden of disease and risk of infection are high may receive a booster dose based on their individual risks and benefits.

The booster dose of Moderna will be half of the primary series dose (50 mcg in 0.25 mL). The multiuse vials will be unchanged, so there will be 20 booster doses in each vial of Moderna vaccine. Note that the third dose of Moderna vaccine recommended for immunocompromised individuals will still be the full 0.5 mL dose, two months following initial vaccination. There is no guidance yet about whether this group who receives a series of three prime doses will require a booster six months after the primary series is complete.

The CDC also approved a single booster dose of Johnson and Johnson’s viral vector vaccine at least two months after receiving the first dose to all individuals under the FDA’s expanded EUA. This will be the same 0.5 mL dose as the prime dose.

For the first time, the FDA has approved heterologous vaccine administration. For instance, people who received a single dose Johnson and Johnson vaccine for their primary series, can choose any of the three available vaccines for their booster dose. This is based on the results of a preprint study showing robust immune response and comparable safety to using mixed vaccine types

We encourage you to reach out to your eligible patients and discuss whether a booster dose would benefit them. It is important to remind younger populations and people without compromised immune systems that the original vaccine series still offers excellent protection against severe COVID-19 infections, hospitalization and death. In Washington, 94% of COVID-19 deaths (and over 99% of deaths in people under age 65) from February through June of 2021 were in people who were not fully vaccinated.

A Clinician Outreach and Communication Activity (COCA) call on Tuesday, October 26th from 11:00 a.m. to 12:00 p.m. will cover what clinicians needs to know about administering booster doses.

COVID-19 vaccine resources

COVID-19 testing

There is a national shortage of the BinaxNOW COVID-19 rapid antigen tests. We encourage you to use other antigen or PCR tests while supplies are limited.

Abbott Laboratories extended all BinaxNOW tests’ shelf life to 12 months. See Abbott’s BinaxNOW COVID-19 ag card product expiry update for new expiration dates by lot number.

Testing to return to school

Families need help navigating the K-12 testing requirements to return to school when a student has COVID-like illness (CLI). Children presenting with CLI should receive a PCR test before returning to school. Over-the-counter antigen tests are not acceptable proof of testing.

  • If a person with CLI tests negative for SARS-CoV-2 with a molecular test, they may return to school if they are not a close contact of someone with COVID-19 and subject to quarantine.
  • If a person with CLI tests negative for SARS-CoV-2 with an antigen test, per CDC antigen testing guidance, a confirmatory lab-based molecular test is recommended.
    • An alternative to confirmatory nucleic acid amplification testing (NAAT) is serial antigen testing performed every 3-7 days for 14 days.

COVID-19 test processing

Labs report varying amounts of time to process COVID-19 tests. To support faster turnaround, we encourage providers to use in-state labs. The table below shows COVID-19 test processing times for in-state private labs.

Lab Time to process test Tests processed daily
FidaLab 24-72 hours 800-1,200
Kaiser 24-72 hours 800-1,000
LabCorp 24-48 hours Unknown
Northwest Pathology 24-48 hours 20,000
Quest 24-48 hours 1,300
UW Virology 24-48 hours 7,000-9,000
Atlas Genomic 24-48 hours 10,000

Patient education

Share the following materials with patients.

Additional resources