Clarify When and How to Give COVID-19 Vaccine Boosters

You'll need to clear up confusion about COVID-19 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).

J&J's authorization is different. Give a booster at least TWO months after the first ANY patient 18 and older.

Explain that J&J 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 J&J 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.

There aren't enough data yet to say whether one combo is preferred over you can be flexible. Give any brand for a booster based on patient preference (side effects, etc), vaccine supply, etc.

Stay alert for 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 J&J).

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. J&J 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.

Use our FAQ, Communicating About COVID-19 Vaccination, to address concerns (myocarditis, etc)...and debunk myths (infertility, etc).

Key References

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Pharmacist's Letter. November 2021, No. 371101

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