Pediatric Vaccination, Immunity Study and 4th Boosters
​for Select Patients

November 4, 2021 | 5 min. to read

Today’s issue features the latest announcement from the Centers for Disease Control and Prevention (CDC) regarding vaccination for children, and findings from a new CDC study indicating that the COVID-19 vaccine is more effective in protecting against subsequent infection than natural infection. It also includes an update from the CDC regarding the recommendation of fourth doses for moderately and severely immunocompromised patients, as well as information about upcoming mass vaccination clinics for members of the NM workforce.
 
CDC RECOMMENDS VACCINATION FOR CHILDREN 5 TO 11 YEARS
On November 2, the CDC announced its recommendation that children ages 5 to 11 years be vaccinated against COVID-19 with the Pfizer-BioNTech pediatric vaccine, and on Wednesday, the Illinois Department of Public Health indicated adoption of the CDC recommendation. Pediatric vaccination will be offered soon at select NM Pediatric and Family Medicine practices. For the latest information on vaccination availability and locations, please visit the COVID-19 Vaccines page on the COVID-19 Resource Center at nm.org/covid19.
 
CDC STUDY SHOWS mRNA VACCINE OFFERS GREATER IMMUNITY THAN INFECTION
Last week, the CDC released findings from a new study that shows vaccination provides greater protection against subsequent COVID-19 infection than previous infection alone. The report concludes that all eligible persons should be vaccinated as soon as possible, including unvaccinated persons previously diagnosed with COVID-19. 
 
The CDC used hospitalization data from various states across the country to compare the odds of contracting laboratory-confirmed COVID-19 between unvaccinated patients with a previous SARS-CoV-2 infection and patients who were fully vaccinated with a COVID-19 mRNA vaccine without prior SARS-CoV-2 infection. Recognizing that both vaccination and previous infection without vaccination offer some level of immunity, the CDC states in the study summary:
 
Among COVID-19 hospitalizations in adults aged ≥ 18 years whose previous infection or vaccination occurred 90 to 179 days earlier, the adjusted odds of confirmed COVID-19 among unvaccinated adults with previous SARS-CoV-2 infection were 5.49-fold higher than the odds among fully vaccinated recipients of an mRNA COVID-19 vaccine who had no prior documented infection (95% confidence interval = 2.75–10.99).
 
In the study, the benefit of vaccination compared with infection without vaccination appeared to be higher for recipients of Moderna than Pfizer vaccine. The protective effect of vaccination also trended higher for adults aged 65 years and older than for those between 18 and 64.
 
For more information about the study or to view the full report, please visit the CDC website. For patient vaccination availability and locations, please visit the COVID-19 Vaccines page on the COVID-19 Resource Center at nm.org/covid19.
 
FOURTH DOSES FOR PATIENTS WHO ARE MODERATELY OR SEVERELY IMMUNOCOMPROMISED
Last week, the CDC updated its interim clinical guidance regarding booster vaccinations for moderately and severely immunocompromised individuals. While the CDC states that a patient’s clinical team is best positioned to determine the appropriate timing of vaccination, they offer the following recommendations:
 
For those who received the primary Pfizer or Moderna vaccine series and booster
Moderately and severely immunocompromised people ages 18 years and older who completed a primary series of an mRNA COVID-19 vaccine and received an mRNA booster dose may receive an additional single mRNA or viral vector COVID-19 dose at least six months after completing the third mRNA vaccine dose. In such situations, people who are moderately and severely immunocompromised may receive a total of four COVID-19 vaccine doses.
 
For those who received the primary Pfizer or Moderna vaccine series with no booster
A person who is moderately or severely immunocompromised and has received two doses of an mRNA vaccine, and 28 days or more has elapsed since the second dose, should receive an additional mRNA dose immediately (if Moderna is used, administer 100µg), followed six months or more later by a single mRNA or viral vector COVID-19 vaccine booster dose (if Moderna vaccine booster is used, administer 50µg).
 
For those who received the primary Johnson & Johnson vaccine with no booster
Moderately and severely immunocompromised people ages years and older who received the single-dose Johnson & Johnson COVID-19 vaccine should receive a single COVID-19 booster vaccine at least two months after receiving their initial J & J primary dose. If Moderna is used in this circumstance, the booster dose and the additional dose should be the 50µg dose.  A person who received one primary dose of the J & J COVID-19 vaccine should not receive more than two COVID-19 vaccine doses as detailed in Appendix A.
 
For more information about booster vaccination doses, please view the CDC Interim Clinical Guidance for Use of COVID-19 Vaccines page. For patient vaccination availability and locations, please visit the COVID-19 Vaccines page on the COVID-19 Resource Center at nm.org/covid19.
 
VACCINES FOR COVID-19 AND FLU AVAILABLE ACROSS NM
Workforce vaccine clinics for the Pfizer COVID-19 vaccine booster and first and second doses, as well as flu shots, are available through November 19. Once those clinics conclude, one additional COVID-19 vaccine clinic will be offered the week of December 6.
 
Members of the NM workforce can schedule appointments now for any of these vaccine clinics. Effective January 1, 2022, COVID-19 vaccination will be required for all employees and physicians who work at or provide services within an NM facility, unless there is an approved medical or religious exemption.
 
COVID-19 booster vaccines
A booster should be given at least six months after the second dose of the Pfizer or Moderna vaccine, or two months after the first dose of the Johnson & Johnson vaccine. Individuals are not required to get a booster from the same manufacturer as the initial vaccination. The Pfizer booster and first and second doses are being offered at all sites except McHenry Hospital. At McHenry, Moderna booster vaccines are being offered. No first and second doses of Moderna will be available.
 
The Moderna booster also is being offered at many pharmacies and community sites. If you get the booster outside of NM, documentation can be submitted through the immunization upload process on NM Interactive (login required) by following this path: NMI > Resources > Safety & Risk > Immunization Doc Upload. Please use this tip sheet for additional support.
 
Flu vaccines
As in prior years, the flu vaccine is required for all members of the NM workforce, and the deadline to receive it is December 1.
 
Please complete your seasonal influenza vaccine consent form prior to visiting a flu vaccination station. The consent form is posted on the Seasonal Influenza Program page on NMI (login required). You can also access the consent form through the NM Workforce app.
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The CDC’s expanded vaccination recommendation for children is another important step towards ending the pandemic. Please continue to educate those who remain unvaccinated, as well as those patients who qualify for boosters and additional doses, by sharing the facts and latest research to explain the importance of vaccination. Thank you for your continued commitment to the patients and communities we serve. 

Gary A. Noskin, MD
Senior Vice President, Quality
Northwestern Memorial HealthCare
Chief Medical Officer
Northwestern Memorial Hospital ​

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