Memorandum: COVID-19: Update on COVID-19 Vaccinations in Department of Veterans Affairs (VA)

033022 — COVID-19 Update on COVID-19 Vaccinations in Department of Veterans Affairs Final

1. Background: The Centers for Disease Control and Prevention (CDC) updated guidance on March 29, 2022, to allow a second booster with an mRNA COVID-19 vaccine to be administered at least 4 months after a first booster of any authorized or approved vaccine for: individuals at least 50 years of age, individuals with immune compromise, or individuals of any age who received Janssen (Johnson & Johnson) COVID-19 for their initial vaccine and booster dose.
   1.  A second booster dose of the Pfizer-BioNTech COVID-19 Vaccine or Moderna COVID-19 Vaccine may be administered to individuals 50 years of age and older at least 4 months after receipt of a first booster dose of any authorized or approved COVID-19 vaccine.
   2. A second booster dose of the Pfizer-BioNTech COVID-19 Vaccine may be administered to individuals 12 years of age and older with certain kinds of immune compromise at least 4 months after receipt of a first booster dose of any authorized or approved COVID-19 vaccine.
   3. A second booster dose of the Moderna COVID-19 Vaccine may be administered at least 4 months after the first booster dose of any authorized or approved COVID-19 vaccine to individuals 18 years of age and older with certain kinds of immune compromise.
   4. A second booster dose may be administered with either the Pfizer-BioNTech or Moderna COVID-19 vaccine at least 4 months after receipt of a booster dose for any person who had Janssen (Johnson & Johnson) COVID-19 for both their initial vaccine and their booster dose.
2. VA follows CDC guidance on COVID-19 vaccination which is being updated to reflect these changes, and is available here: Interim Clinical Considerations for Use of COVID-19 Vaccines | CDC
3. Caution should be taken including consideration of time outs to check vaccine manufacturer, presence of immune compromise, dosing and intervals/timing:
   a. Ask the patient whether they have moderate to severe immune compromise, to ensure appropriate vaccine doses and intervals.
   b. Check COVID-19 vaccines given, to ensure the right interval based on initial vaccine series for each patient, or
4. Check dose prior to administering additional or booster doses of Moderna COVID-19 vaccine, because of different (lower) dosing for the booster dose, when compared to the initial vaccine series and the third dose for immune compromised individuals.
   4. CDC guidance includes ability to administer COVID-19 and influenza vaccines in the same visit.
5. Sites may opt to utilize standing orders.
   1. Standing orders from CDC are expected to be updated soon. Standing orders can be found here:
      1. Pfizer-BioNTech COVID-19 Vaccine Standing Orders for Administering Vaccine (cdc.gov)
      2. Moderna COVID-19 Vaccine: Standing Orders for Administering Vaccine to Persons 18 Years of Age and Older (cdc.gov)
      3. Janssen COVID-19 Vaccine (Johnson & Johnson): Standing Orders for Administering Vaccine to Persons 18 Years of Age and Older (cdc.gov)
   2. Sites that do not locally develop standing orders may opt to utilize the COVID-19 vaccine sample national templates which will be available on the COVID-19 vaccine SharePoint: VHA COVID-19 Vaccine – Home (sharepoint.com). These sample templates should be reviewed and approved locally using local facility processes and should be replaced with CDC standing orders when released.
6. Walk-in vaccination should continue to be offered. To minimize access barriers for patients who present for vaccination, it is acceptable to puncture a multi-dose vial to administer vaccine for a single patient, even if wastage of some or all of the remaining doses in that vial may occur. It is also acceptable to accept self-report that an individual has moderate to severe immune compromise.
7. Questions can be submitted to the COVID-19 Resource Room (SharePoint).