Module 15: COVID-19

Etiology of COVID-19

- Caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)

- SARS-CoV-2 belongs to the Coronaviridae family

- RNA viruses

- Found in many mammalian and avian species, including humans, dogs, cats, pigs, monkeys, bats, cattle, chicken, and birds

- Cause respiratory, gastrointestinal, and neurological problems.

Transmission of SARS-CoV-2

- Inhalation of very fine respiratory droplets and aerosol particles.
- Deposition of respiratory droplets and particles on exposed mucous membranes in the mouth, nose, or eye by direct splashes and sprays
- Touching mucous membranes with hands that have been soiled either directly by virus-containing respiratory fluids or indirectly by touching surfaces with virus on them
- Incubation period: 5 days (range 2-7 days)

COVID-19 Symptoms

- Fever, dry cough, shortness of breath, fatigue, myalgias, nausea, vomiting, or diarrhea, headache, weakness, rhinorrhea, loss of taste or smell

COVID-19 Complications

- Pneumonia, acute respiratory distress syndrome, acute liver injury, cardiac injury, heart failure, dysrhythmias, myocarditis, thromboembolic events, kidney injury, neurologic manifestations, shock, long COVID, death

Groups at Highest Risk for Severe Disease and Complications

- Older adults (especially age > 65 years)
- People from certain racial and ethnic minority groups
- People with disabilities
- People with underlying medical conditions

High Risk for Severe Disease and Complications
People with Underlying Medical Conditions

- Cancer
- Chronic lung, kidney, or liver disease
- Neurological or mental health conditions or dementia
- Diabetes
- Down syndrome
- Heart disease
- HIV infection
- Immunocompromised state
- Overweight and obesity
- Pregnancy
- Sickle cell disease and thalassemia
- Current or former smoking
- Solid organ or stem cell transplant
- Cerebrovascular disease or stroke
- Substance use disorder
- Tuberculosis

Groups at Risk for Exposure or Transmission

- People who live or work in long-term care settings, correctional facilities, or homeless shelters
- First responders (healthcare workers, firefighters, police, congregate care staff)
- Education staff (teachers, support staff, daycare workers)
- Food and agriculture workers
- Manufacturing workers
- U.S. Postal Service workers
- Public transit workers
- Grocery store workers

COVID-19 Vaccines in the US

* A third dose is authorized for immunocompromised persons, given 28 days after the second dose.

Which of the following vaccines are mRNA vaccines?

- Pfizer-BioNTech
- Moderna
- Pfizer-BioNTech (Comirnaty)

Additional Dose for Immunocompromised Patients

- A subsequent dose of vaccine is administered to people who likely did not mount a protective immune response after primary vaccination.
- mRNA vaccine effectiveness against laboratory-confirmed COVID-19-associated hospitalization was found to be 77% among immunocompromised adults, compared to 90% for immunocompetent adults
- Third dose optimizes vaccine-induced protection
- Third dose is recommended for those who are moderately and severely immunocompromised
- Third dose is authorized for only the 2-dose mRNA vaccines, given at least 28 days after the second dose
- A booster dose is recommended 6 months after the third mRNA dose

Booster Doses

- A subsequent dose of vaccine is administered when protection from primary vaccination is likely to have waned over time
- One dose is recommended:
1. 6 months after completing the primary series of either mRNA vaccine
2. 2 months after completing the primary series of the Janssen vaccine
- Booster dose may be homologous or heterologous
- Homologous booster dose: a subsequent dose of vaccine that is the same product as the primary series
- Heterologous booster dose (mix-and-match booster): a subsequent dose of vaccine that is a different product than the primary series

Assessing International Vaccination Status

- Individuals vaccinated outside of the US may need additional vaccines or doses depending on what was previously administered.

COVID-19 Vaccine Safety

- Delayed-onset local reactions may occur after mRNA vaccination -- these are not contraindications nor precautions to additional doses.

Screening for Anaphylaxis

* A contraindication to mRNA COVID-19 vaccines is a precaution to Janssen COVID-19 vaccine, and vise versa. Both mRNA vaccines contain polyethylene glycol (or PEG), and the Janssen vaccine contains polysorbate 80.

Which of the following is a common side effect from COVID-19 vaccinations?

- Injection site pain

Co-administration with Other Vaccines

- COVID-19 vaccines may be administered before, at the same time as, or after other vaccines.
- With simultaneously administering COVID-19 vaccines with other vaccines, consider the reactogenicity profile of other vaccines.
- Administer in different limbs, when possible.

Administration After a SARS-CoV-2 Infection

- Duration and type of immunity following a SARS-CoV-2 infection is not fully understood
- The risk of subsequent infection is further reduced when someone previously infected gets vaccinated
- Everyone eligible for vaccination should be vaccinated, regardless of a history of infection
- Defer vaccination if someone with a current infection until symptoms resolve and the person is no longer in isolation.

Documentation Requirements for COVID-19 Vaccines

- Document vaccine administration if your medical record system within 24 hours of administration
- Report administration data to your jurisdiction's system (e.g., immunization information system, or IIS) within 72 hours after administration
- Report inventory daily using VaccineFinder or your jurisdiction's IIS
- Report the following to Vaccine Adverse Event Reporting System (VAERS):
1. Vaccine administration errors
2. Serious adverse events
3. Multisystem inflammatory syndrome
4. Cases of COVID-19 that result in hospitalization or death after the recipient has received COVID-19 vaccine

Emergency Use Authorization (EUA) Fact Sheets

- Available when a vaccine is granted an EUA by the FDA
- Used in lieu of the Vaccine Information Statement (VIS)
- Provide to all vaccine recipients before vaccinating
- 2 fact sheets are approved for COVID-19:
1. Vaccine recipients and caregivers
2. Vaccine providers

COVID-19 Vaccination Record Cards

- Each patient should receive a personal vaccination record card, which includes:
1. Patient name, date of birth, and medical record or IIS number
2. Vaccine name, manufacturer, and lot number
3. Date administered
4. Sit or provider
- Cards are included in the ancillary supplies shipped with the vaccines
- Third and booster doses should be added to the card when applicable.

A contraindication to receiving a COVID-19 vaccination includes:

- A known (diagnosed) allergy to a component of a COVID-19 vaccine

Which COVID-19 vaccination has 2 doses administered 28 days apart?

- Moderna

Which of the following is true regarding risk for COVID-19?

- Older adults and people with underlying medical conditions are some of the patients at highest risk for severe disease and complications

Which of the following is true regarding transmission of SARS-CoV-2?

- Infected individuals who may be presymptomatic, asymptomatic, or symptomatic can transmit the virus.

Documentation requirements for COVID-19 vaccinations include:

- Report administration data to your jurisdiction's system (e.g., IIS) within 72 hours after administration

Which of the following is true regarding 3rd dose and booster doses for COVID-19?

- The third dose and booster dose recommendations for immunocompromised patients are only for mRNA vaccines.