The Centers for Disease Control and Prevention (CDC) recently endorsed two new recommendations from the Advisory Committee on Immunization Practices (ACIP) to the mRNA COVID-19 vaccine guidance. The West Virginia Department of Health and Human Resources, Bureau for Public Health (BPH) encourages all providers to review the following vaccine guidance to ensure the best possible protection for all West Virginians.

Change in Interval for Booster Dose for Moderately to Severely Immunocompromised Individuals Ages 12 Years and Older

mRNA COVID-19 Vaccine Primary Series
The booster interval for moderately to severely immunocompromised individuals has been shortened. A single booster dose is recommended at least 3 months after the third dose in the primary series, for a total of four doses, preferably with an mRNA COVID-19 vaccine. If the Moderna COVID-19 vaccine (ages 18+ only) is used for the booster dose, a 50 µg (0.25 mL) dose should be used.

Janssen COVID-19 Primary Vaccination (Ages 18 + Years)
A single booster dose is recommended at least 2 months after the second (additional) dose, for a total of 3 doses (1 Janssen vaccine dose followed by 1 additional mRNA vaccine dose, then 1 booster dose). mRNA vaccines are required for the additional primary dose and preferred for the booster dose. If the Moderna vaccine is used for the booster dose, a 50 µg (0.25 ml) dose should be used.

Extended Interval Between 1st Dose and 2nd Dose for Some People for mRNA COVID-19 Vaccine

mRNA COVID-19 vaccines are FDA-approved or authorized for a 3-week (Pfizer-BioNTech vaccine) or 4-week (Moderna vaccine) interval between the first and second dose. A 3 or 4-week interval continues to be the recommended interval for people who are moderately to severely immunocompromised, adults ages 65 years and older, and others who need rapid protection due to increased concern about community transmission or risk of severe disease. In some people, particularly males ages 12-39 years, an 8-week interval may be preferable because it may reduce the very low risk of myocarditis associated with mRNA COVID-19 vaccines in this population.

Pfizer-BioNTech COVID-19 Vaccine (Gray Cap) – Ages 12 Years and Older
In addition to the above updates in clinical considerations for intervals between vaccine doses for certain groups, it is also important to reiterate recent updates pertaining to the Pfizer-BioNTech COVID-19 vaccine for ages 12 and older. Specifically, there are significant differences between the gray-cap and purple-cap vaccines. The gray-cap vaccine cannot be stored in a non-ULT freezer for any length of time (but may be stored in a ULT freezer for up to 9 months). However, the gray cap can be stored in the refrigerator for 10 weeks. Another significant difference is that the gray cap vaccine does not require mixing with diluent.

For questions about this advisory, contact the Office of Epidemiology and Prevention Services (OEPS) at 1-800-423-1271, ext. 1; 304-558-5358, ext. 2; or the 24/7 answering service at 304-342-5151.