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Update # 44 mRNA COVID-19 Vaccine 3rd Dose Recommendations

On August 13, 2021, NH DHHS issued a health alert on mRNA COVID-19 vaccine 3rd dose recommendations.

Key Points and Recommendations:

  • On August 12th, the U.S. Food and Drug Administration (FDA) authorized use of a 3rd dose of the Pfizer-BioNTech and Moderna COVID-19 vaccines for certain immunocompromised persons. The Emergency Use Authorization (EUA) amendment does NOT apply to the Janssen COVID-19 vaccine, or to individuals who received the Janssen vaccine as a primary series.
  • CDC has updated their Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Authorized in the United States.
  • The CDC’s Advisory Committee on Immunization Practices (ACIP) recommended a 3rd dose of either the Pfizer-BioNTech COVID-19 vaccine (for persons ≥12 years) or Moderna COVID-19 vaccine (for persons ≥18 years) following a primary 2-dose mRNA vaccine series, for people who are moderately to severely immunocompromised due to a medical condition or immunosuppressive treatment. For a list of potential conditions that would cause a person to be moderately and severely immunocompromised, see CDC’s clinical guidance linked above.
  • Additional ACIP recommendations include the following:
    • The 3rd dose should be the same mRNA vaccine as the primary series.
    • An alternate mRNA vaccine product can be used if the primary series product is not available.
    • The 3rd dose should be administered at least 28 days after completion of the initial primary series.
    • Currently there are insufficient data to support administration of an mRNA COVID-19 vaccine dose after a primary Janssen COVID-19 vaccine in immunocompromised persons.
    • Serologic/antibody testing to assess immune response prior to administering a 3rd vaccine dose is NOT recommended at this time.
    • Patients seeking vaccination in locations outside their medical homes (e.g., commercial pharmacies) can self-attest as to their immunocompromising condition.
  • Continue to counsel your patients who are immunocompromised that they remain at risk from COVID-19 (even after a 3rd dose of the vaccine), and should continue to take precautions to protect themselves from COVID-19, including wearing a mask, staying 6 feet apart from others they don’t live with, and avoiding crowds and poorly ventilated indoor spaces.
    • Close contacts of immunocompromised people should be strongly encouraged to be vaccinated against COVID-19 with a primary vaccine series.
  • For public health purposes, immunocompromised people are still considered “fully vaccinated” when they are at least 14 days beyond receipt of their second dose of either the PfizerBioNTech or Moderna vaccines, or 14 days beyond receipt of the single dose Janssen vaccine.
  • See ACIP meeting presentation slides for a science overview of the impact of an additional 3rd dose in people who are immunocompromised:
    • Preliminary experimental and observational data suggest that a 3rd mRNA COVID-19 vaccine dose in immunocompromised people may enhance antibody response and increases the proportion of people who have an immunologic response to the COVID-19 vaccine.
    • There is no efficacy or effectiveness studies of COVID-19 prevention following a 3rd dose.
    • No serious adverse events were observed following a 3rd dose, and reactogenicity of a 3rd dose was similar to prior doses.
  • A CDC Clinician Outreach and Communication Activity (COCA) webinar is planned for providers early next week to discuss these updates: (pending scheduling).
  • NH DPHS will discuss these updated recommendations at our upcoming Healthcare Provider and Public Health Partner webinar this Thursday 8/19, from 12:00 – 1:00 pm: