COVID-19 Vaccines

COVID-19 VACCINES

Contraindications: COVID-19 vaccines are contraindicated in patients with a severe allergic reaction (eg, anaphylaxis) after a previous dose or to a component of the vaccine, or an immediate allergic reaction1 of any severity after a previous dose or known (diagnosed) allergy to a component of the vaccine.

• Those with a contraindication to one mRNA COVID-19 vaccine should not receive doses of either mRNA vaccine.

 

Precautions: caution in patients with a history of an immediate allergic reaction1 to any other vaccines or injectable therapies, contraindication to other COVID-19 vaccines, and patients with moderate to severe acute illness2 (eg, current SARS-Cov-2 infection). The Janssen vaccine includes additional precautions for women aged <50yrs and patients with a history of or risk factors for thrombosis due to rare cases of thrombosis with thrombocytopenia syndrome (TTS) after vaccine administration.

• Those with a contraindication to mRNA vaccines (including due to a known polyethylene glycol allergy) have a precaution to Janssen COVID-19 vaccine. Those with a contraindication to Janssen vaccine (including due to a known polysorbate 80 allergy) have a precaution to mRNA vaccines. Consultation with an allergist-immunologist should be considered and vaccination with either COVID-19 vaccine should only be undertaken in an appropriate setting under the supervision of a healthcare provider experienced in the management of severe allergic reactions.

• Those who have previously received 1 dose of mRNA vaccine with a contraindication to the 2nd dose should wait at least 28 days to receive the Janssen vaccine.

 

Underlying conditions: vaccines may be administered to patients with immunocompromising conditions, autoimmune conditions, history of Guillain-Barré syndrome, Bell’s palsy, dermal filler use.

 

Prior SARS-CoV-2 infection: vaccines may be administered regardless of history of prior symptomatic or asymptomatic infection.

 

Pregnancy and lactation: any authorized COVID-19 vaccines may be administered, however, patients should be aware of the rare risk of TTS after administration of the Janssen vaccine.

 

Vaccine coadministration: COVID-19 vaccines and other vaccines may be administered without regard to timing; simultaneous administration on the same day and coadministration within 14 days are now accepted.

 

Passive antibody therapy: defer vaccination for ≥90 days for persons who received passive antibody therapy (eg, monoclonal antibodies or convalescent plasma) as part of COVID-19 treatment.

 

*COVID-19 vaccines are not interchangeable.

Developer Vaccine Status Efficacy Dosing Storage/Stability4 Side Effects5,6
mRNA3
Pfizer-BioNTech BNT162b2 EUA for ≥12yrs

Prevention of symptomatic disease:

• ≥7 days after 2nd dose:
≥16yrs: 95.1%
12-15yrs: 100%

• ≥7 days up to 6mos after 2nd dose: 91.3%

 

Prevention of severe disease:

• CDC data: 100%

• FDA data: 95.3%

 

Against variants:

• B.1.351 (S. Africa): 100%

30mcg (0.3mL) IM × 2 doses, 21 days apart7,8

Ultra-Cold Freezer
(–80°C to –60°C/–112°F to –76°F): until expiration date

 

Thermal Shipper9
(–90°C to –60°C/–130°F to –76°F): up to 30 days from delivery

 

Freezer10
(–25°C to –15°C/–13°F to 5°F): up to 2wks

 

Refrigerator
(2°C to 8°C/35°F to 46°F): up to 1 month (up to 6hrs after dilution)

 

Room Temperature
(up to 25°C/up to 77°F): up to 2hrs

Inj site pain, swelling and/or erythema, fatigue, headache, myalgia, chills, arthralgia, fever, nausea, malaise, lymphadenopathy.
Rare: severe allergic reactions, including anaphylaxis, and other hypersensitivity reactions (eg, rash, pruritis, urticaria, angioedema)
Moderna mRNA-1273 EUA for ≥18yrs

Prevention of symptomatic disease:

• ≥14 days after 2nd dose: 94.1%

• ≥14 days up to 6mos after 2nd dose: >90%

 

Prevention of severe disease:

• ≥14 days up to 6mos after 2nd dose: >95%

 

Against variants:

• B.1.351 (S. Africa): 6-fold reduction in antibodies

100mcg (0.5mL) IM × 2 doses, 28 days apart7,8

Freezer
(–50°C to –15°C/–58°F to 5°F): until expiration date

 

Refrigerator
(2°C to 8°C/36°F to 46°F): up to 30 days (up to 12hrs after vial puncture)

 

Room temperature
(8°C to 25°C/46°F to 77°F): up to 24hrs (up to 12hrs after vial puncture)

Inj site pain, swelling and/or erythema, fatigue, headache, myalgia, arthralgia, chills, nausea, vomiting, axillary swelling/tenderness, fever.

Rare: severe allergic reactions, including anaphylaxis, and other hypersensitivity reactions (eg, rash, pruritis, urticaria, angioedema)

VIRAL VECTOR11
Janssen (Johnson & Johnson) JNJ-78436735 EUA for ≥18yrs

Prevention of moderate to severe disease:

• ≥14 days after dose:
Overall: 66.9%
US: 74.4%
S. Africa12: 52.0%
Brazil13: 66.2%

• ≥28 days after dose:
Overall: 66.1%
US: 72.0%
S. Africa12: 64.0%
Brazil13: 68.1%

 

Prevention of severe/critical disease:

• ≥14 days after dose:
Overall: 76.7%
US: 78.0%
S. Africa12: 73.1%
Brazil13: 81.9%

• ≥28 days after dose:
Overall: 85.4%
US: 85.9%
S. Africa12: 81.7%
Brazil13: 87.6%

5 × 1010 viral particles (0.5mL) IM × 1 dose8

Refrigerator
(2°C to 8°C/36°F to 46°F): up to 3mos (up to 6hrs after vial puncture)

 

Room temperature
(9°C to 25°C/47°F to 77°F): up to 12hrs (up to 2hrs after vial puncture)

Inj site pain, swelling and/or erythema, headache, fatigue, myalgia, nausea, fever.
Rare: severe allergic reactions, including anaphylaxis, clotting events such as TTS (esp. women aged 18-49yrs)
AstraZeneca-Oxford AZD1222 Phase 3 clinical trials in US

Prevention of symptomatic disease:

• ≥15 days after 2nd dose:
Overall: 76%
≥65yrs: 85%

 

Prevention of severe/critical disease, including hospitalization:

• 100%

5 × 1010 viral particles (0.5mL) IM × 2 doses, 4-12wks apart15 Refrigerator
(2°C to 8°C/36°F to 46°F): at least 6mos
 
PROTEIN SUBUNIT14
Novavax NVX-CoV2373 Phase 3 clinical trials in US

Prevention of mild/moderate/
severe disease:

 

UK trial:

• 14 days after 1st dose: 83.4%

• After 2nd dose:
Overall: 89.7%
Original strain: 96.4%
B.1.1.7 variant: 86.3%

 

South Africa trial:

• Predominantly variant strains (mostly B.1.351): 48.6% overall

• HIV-negative: 55.4%16

 

Prevention of severe disease, including all hospitalization and death:

• UK & South Africa trials: 100%

0.5mL IM × 2 doses, 21 days apart Refrigerator
(2°C to 8°C/36°F to 46°F): up to 6mos
 
NOTES

Key: EUA = Emergency Use Authorization (given by FDA); IM = intramuscular

 1 Defined as any hypersensitivity-related signs or symptoms such as urticaria, angioedema, respiratory distress, or anaphylaxis that occur within 4hrs following exposure to a vaccine or medication.

 2 If known current COVID-19 infection, vaccination should be deferred until person has recovered and has met criteria to discontinue isolation.

 3 Nucleoside-modified mRNA encoding the viral spike (S) glycoprotein of SARS-CoV-2.

 4 Stability is for unopened vials unless otherwise specified. Frozen vaccines must be thawed and diluted before use, either in refrigerator or at room temperature, and should not be refrozen.

 5 mRNA vaccines: most systemic post-vaccination symptoms are mild to moderate in severity, occur within the first 3 days of vaccination, and resolve with 1-3 days of onset. Symptoms are more frequent and severe following 2nd dose and among younger people compared with older (eg, >55yrs/Pfizer-BioNTech, ≥65yrs/Moderna). Those with prior SARS-CoV-2 infection may be more likely to experience symptoms such as fever, chills, and myalgia after the 1st dose.

 6 Janssen vaccine: most systemic post-vaccination symptoms are mild in severity, resolve within 1-2 days after vaccination, and are more frequent in younger vs older people (≥60yrs).

 7 2nd dose should be administered as close to the recommended interval as possible. 2nd doses inadvertently administered earlier than the recommended dosing interval (earlier than the 4-day grace period) do not need to be repeated. If 2nd dose is not administered within 42 days of the 1st dose, the series does not need to be restarted (only limited data available on efficacy beyond this window).

 8 Providers should observe patients for the occurrence of immediate adverse reactions for at least 15mins after vaccinations and for 30mins for those with the following precautions: history of any immediate allergic reaction to any other vaccines or injectable therapy, contraindication to mRNA COVID-19 vaccine who receive Janssen vaccine and vice versa, or history of anaphylaxis due to any cause.

 9 For temporary storage only. Dry ice must be replenished within 24hrs of delivery and every 5 days. Remaining doses must be transferred to refrigerator.

10 Vials stored in freezer may be returned one time to ultra-cold freezer at which time the 2-week time frame is suspended.

11 Recombinant, replication-incompetent Ad26 vector, encoding stabilized variant of the SARS-CoV-2 Spike (S) protein.

12 Sequencing of cases showed 94.5% prevalence of the B.1.351 variant.

13 Sequencing of cases showed 69.4% prevalence of the P.2 variant.

14 Engineered portion of viral spike (S) glycoprotein from SARS-CoV-2, combined with adjuvant (saponin-based Matrix-M).

15 Longer inter-dose interval of 12 weeks or more have been evaluated in clinical trials with increased efficacy reported.

16 Results from the South Africa Phase 2b trial showed a 55.4% efficacy for the prevention of mild, moderate and severe COVID-19 disease in the HIV-negative trial participants.

REFERENCES

AZD1222 US phase III primary analysis confirms safety and efficacy. [press release]. AstraZeneca PLC; March 25, 2021.

Interim clinical considerations for use of COVID-19 vaccines currently authorized in the United States. ACIP COVID-19 Vaccines Work Group. Centers for Disease Control and Prevention Web site. https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html. Published March 1, 2021. Updated May 14, 2021. Accessed May 21, 2021.

COVID-19 Vaccine AstraZeneca confirms 100% protection against severe disease, hospitalisation and death in the primary analysis of Phase III trials. [press release]. AstraZeneca PLC; February 3, 2021.

COVID-19 Vaccine: Quick Reference Guide for Healthcare Professionals. Centers for Disease Control and Prevention Web site. https://www.cdc.gov/vaccines/covid-19/downloads/covid19-vaccine-quick-reference-guide-2pages.pdf. Accessed May 25, 2021.

Emergency use authorization (EUA) for an unapproved product review memorandum. The Food and Drug Administration Web site. https://www.fda.gov/media/146338/download. Accessed May 24, 2021.

FDA in brief: FDA authorizes longer time for refrigerator storage of thawed Pfizer-BioNTech COVID-19 Vaccine prior to dilution, making vaccine more widely available. [press release]. Silver Spring, MD: US Food and Drug Administration; May 19, 2021.

Janssen COVID-19 Vaccine. [package insert]. Horsham, PA: Janssen Biotech, Inc.; 2021.

Moderna COVID-19 Vaccine. [package insert]. Cambridge, MA: Moderna, Inc.; 2021.

Moderna provides clinical and supply updates on COVID-19 vaccine program ahead of 2nd annual Vaccines Day. [press release]. Moderna, Inc.; April 13, 2021.

Novavax confirms high levels of efficacy against original and variant COVID-19 strains in United Kingdom and South Africa trials. [press release]. Novavax Inc; March 11, 2021.

Pfizer-BioNTech COVID-19 Vaccine. [package insert]. New York, NY: Pfizer, Inc.; 2021. Mainz, Germany: BioNTech Manufacturing GmbH; 2021.

Pfizer and BioNTech confirm high efficacy and no serious safety concerns through up to six months following second dose in updated topline analysis of landmark COVID-19 vaccine study. [press release]. Pfizer Inc; April 1, 2021.

Oliver S, Gargano J, Marin M, et al. The Advisory Committee on Immunization Practices’ Interim Recommendation for Use of Pfizer-BioNTech COVID-19 Vaccine — United States, December 2020. MMWR Morb Mortal Wkly Rep. 2020;69:1922-1924. DOI: http://dx.doi.org/10.15585/mmwr.mm6950e2.

Created 5/2021

This article originally appeared on MPR