Know When and How to Dispense COVID-19 Vaccine Boosters

You'll hear even more questions about COVID-19 vaccines...now that Moderna and Johnson & Johnson/Janssen boosters are authorized.

What's the difference between a "booster" and "additional dose"?

Recall 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.

Who needs a booster? Moderna or Pfizer-BioNTech (Comirnaty) boosters are given 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).

But Johnson & Johnson/Janssen is different. Boosters should be given at least TWO months after the first dose...to ANYONE 18 and older.

If you dispense COVID-19 vaccines, expect to use whichever brand you stock. CDC now says it's okay to "mix and match" brands for boosters.

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 Johnson & Johnson/Janssen).

Who needs an additional dose? An additional dose of mRNA COVID-19 vaccine (Moderna, Pfizer-BioNTech) is indicated for patients with a weakened immune system at least four weeks after the second dose.

In this case, clinicians may try to use the same brand as the initial series. If it's not available, they can use what you have.

For additional Moderna doses, draw up the usual 0.5 mL...or 0.3 mL for Pfizer-BioNTech. J&J isn't authorized for additional doses yet.

What are considerations with co-administration? Any COVID-19 vaccine can be given at the same time as other vaccines (flu, etc). Help prevent mix-ups among different vaccines.

For example, store vaccines apart from each other.

And for vaccine clinics, label syringes to differentiate vaccines...and bring only needed vaccines to administration areas.

Use our COVID-19 Vaccines chart to keep up with emerging details about pediatric vaccines, storage, and more.

Key References

  • https://www.cdc.gov/coronavirus/2019-ncov/vaccines/booster-shot.html (10-29-21)
  • https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/immuno.html (10-29-21)
  • https://www.fda.gov/media/153128/download (10-29-21)
Hospital Pharmacy Technician's Letter. November 2021, No. 371101



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