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COVID-19 Update for Virginia<\/strong><\/p>\n August 16, 2021<\/p>\n Dear Colleague:<\/p>\n Thank you for your continued partnership in responding to the COVID-19 pandemic.\u00a0 Please visit the Virginia Department of Health (VDH) website<\/a> for current clinical and public health guidance, epidemiologic data, and other information.\u00a0 Updates on the following topics are included in this correspondence:<\/p>\n CDC Recommends an Additional Dose of mRNA Vaccine Following a Primary Series in Certain Immunocompromised People<\/strong><\/p>\n On August 12, 2021, the U.S. Food and Drug Administration (FDA) authorized a third dose of Pfizer-BioNTech or Moderna COVID-19 vaccines following a primary series for individuals who are moderately to severely immunocompromised.\u00a0 FDA updated its fact sheets for healthcare providers administering vaccine and for recipients and caregivers for the Pfizer-BioNTech<\/a> and Moderna<\/a> vaccines.<\/p>\n On August 13, 2021, the Centers for Disease Control and Prevention (CDC) adopted<\/a> the Advisory Committee on Immunization Practices advice to recommend an additional dose of Pfizer-BioNTech COVID-19 vaccine (aged \u226512 years) or Moderna COVID-19 vaccine (aged \u226518 years) for moderately to severely immunocompromised individuals. CDC also revised its Clinical Considerations for COVID-19 Vaccination<\/a> and developed a new communication tool for clinicians, Talking with Patients Who Are Immunocompromised<\/a>.\u00a0 In response, VDH issued a press release<\/a> and updated its Vaccination FAQs<\/a> for the public and healthcare providers.<\/p>\n When considering this new recommendation, it is important to define some key terms:<\/p>\n The recommendation for the additional mRNA dose following a primary series applies<\/strong> to Pfizer-BioNTech or Moderna vaccine recipients who are moderately or severely immunocompromised.\u00a0 The recommendation does not apply<\/strong> to immunocompromised people who received the Johnson & Johnson (Janssen) COVID-19 vaccine because available data are insufficient to recommend an additional dose of this vaccine.\u00a0 FDA and CDC will provide further guidance when these data become available.\u00a0 Other fully vaccinated individuals do not need a booster dose right now.\u00a0 The need for and the timing of booster doses has not been established.\u00a0 Public health officials are actively planning for this possibility, in case such booster doses are recommended in the future.<\/p>\n Beginning August 14<\/strong>, COVID-19 vaccine providers in Virginia may administer the additional mRNA dose for eligible patients.\u00a0 The third dose should be the same manufacturer as the previous two doses when possible, but this is not required.\u00a0 It should be administered at least 28 days after the second dose of the mRNA vaccine and the vaccine dosage has not changed.\u00a0 Eligible patients are not required to show proof of their medical condition.\u00a0 Details about how to record the additional dose into the electronic systems are available in the Vaccination FAQs<\/a>.\u00a0 Side effects to an additional mRNA dose are expected to be similar to those with the 2-dose series, with fever and pain at injection site being most commonly reported.\u00a0 Patients should be encouraged to enroll in v-safe<\/a> to report any side effects.\u00a0 Healthcare providers should report any vaccine errors or adverse events into the Vaccine Adverse Event Reporting System (VAERS)<\/a>.<\/p>\n Healthcare providers should advise all<\/strong> immunocompromised persons who get vaccinated, including those who receive an additional mRNA dose, that they might not have strong protection after COVID-19 vaccination.\u00a0 That is why they should continue to follow COVID-19 precautions (e.g., wear a mask, stay at least 6 feet from others they don\u2019t live with, and avoid crowds and indoor areas with poor air flow) to help prevent COVID-19.\u00a0 VDH strongly recommends that their household members and other close contacts get vaccinated to provide increased protection to the immunocompromised person.\u00a0 Immunocompromised persons should also discuss monoclonal antibody treatment options<\/a> with their healthcare provider in case they get exposed to or infected with COVID-19.<\/p>\n CDC Strengthens Vaccine Recommendation for People Who Are Pregnant, Breastfeeding, or Thinking of Becoming Pregnant<\/strong><\/p>\n On August 11, 2021, CDC strongly recommended COVID-19 vaccination for everyone aged 12 years and older, including people who are pregnant or breastfeed and those who are trying to become pregnant now or thinking of becoming pregnant in the future, as well as their partners.\u00a0 This stronger recommendation was based on new data on the safety of COVID-19 vaccines during pregnancy.\u00a0 A preprint analysis<\/a> of data from the v-safe pregnancy registry found no increased risk of miscarriage among pregnant people who received an mRNA COVID-19 vaccine before 20 weeks of pregnancy.\u00a0 This adds to a previous report<\/a> that reviewed data from CDC\u2019s vaccine safety monitoring systems and found no safety risks for pregnant individuals who received vaccines during late pregnancy or their babies.\u00a0 Additional details about these recommendations are available in CDC\u2019s Clinical Considerations for COVID-19 <\/a>Vaccination<\/a>.<\/p>\n Pregnant and recently pregnant people are at increased risk for severe disease, and it is important to improve vaccination coverage among these patients.\u00a0 As of August 7, 2021, only 23% of pregnant people aged 18\u201349 years identified in CDC\u2019s Vaccine Safety Datalink<\/a> had received at least one dose of COVID-19 vaccine.\u00a0 Healthcare providers should strongly recommend<\/strong> these patients to get vaccinated, especially as the more infectious Delta variant spreads across Virginia.<\/p>\n VDH Reminds Healthcare Providers of Testing and Masking Recommendations<\/strong><\/p>\n Virginia is currently experiencing a high level of community transmission<\/a>.<\/u> Testing for SARS CoV-2<\/a> remains a critical prevention strategy, particularly in the context of increasing cases and exposures.\u00a0 Healthcare providers should test individuals who have symptoms of COVID-19 or who have had close contact with someone with COVID-19, including people who are fully vaccinated.\u00a0 In addition, CDC and VDH continue to recommend that during times of substantial and high transmission, all people aged 2 years or older, including those who are fully vaccinated, wear a mask<\/a> in public indoor settings.\u00a0 Fully vaccinated people might choose to mask regardless of the level of transmission, particularly if they or someone in their household is immunocompromised or at increased risk for severe disease, or if someone in their household is unvaccinated.\u00a0 On August 11, 2021, I reissued a Public Health Order<\/a> that requires all students, teachers, staff and visitors to wear masks indoors at public and private K12 schools to reinforce this public health guidance and state law<\/a>.\u00a0 Healthcare providers should continue to remind their patients of the current mask recommendations and strongly recommend that patients adhere to public health prevention recommendations.<\/p>\n\n
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