COVID-19 Update for Virginia

COVID-19 Update for Virginia

August 16, 2021

Dear Colleague:

Thank you for your continued partnership in responding to the COVID-19 pandemic.  Please visit the Virginia Department of Health (VDH) website for current clinical and public health guidance, epidemiologic data, and other information.  Updates on the following topics are included in this correspondence:

  • CDC Recommends an Additional Dose of mRNA Vaccine Following a Primary Series in Certain Immunocompromised People
  • CDC Strengthens Vaccine Recommendation for People Who Are Pregnant, Breastfeeding, or Thinking of Becoming Pregnant
  • VDH Reminds Clinicians of Testing and Masking Recommendations

CDC Recommends an Additional Dose of mRNA Vaccine Following a Primary Series in Certain Immunocompromised People

On August 12, 2021, the U.S. Food and Drug Administration (FDA) authorized a third dose of Pfizer-BioNTech or Moderna COVID-19 vaccines following a primary series for individuals who are moderately to severely immunocompromised.  FDA updated its fact sheets for healthcare providers administering vaccine and for recipients and caregivers for the Pfizer-BioNTech and Moderna vaccines.

On August 13, 2021, the Centers for Disease Control and Prevention (CDC) adopted the Advisory Committee on Immunization Practices advice to recommend an additional dose of Pfizer-BioNTech COVID-19 vaccine (aged ≥12 years) or Moderna COVID-19 vaccine (aged ≥18 years) for moderately to severely immunocompromised individuals. CDC also revised its Clinical Considerations for COVID-19 Vaccination and developed a new communication tool for clinicians, Talking with Patients Who Are Immunocompromised.  In response, VDH issued a press release and updated its Vaccination FAQs for the public and healthcare providers.

When considering this new recommendation, it is important to define some key terms:

  • An “additional dose after an initial primary vaccine series” refers to the administration of an additional vaccine dose when the initial immune response following a primary vaccine series may have been insufficient.
  • A “booster dose” refers to a dose of vaccine administered when the initial sufficient immune response to a primary vaccine series is likely to have waned over time. The need for and timing of a COVID-19 vaccine booster dose for people without weakened immune systems has not been established.
  • “Moderately to severely immunocompromised people” includes people with a range of conditions, such as recipients of organ or stem cell transplants, people with advanced or untreated HIV infection, active recipients of treatment for cancer, people who are taking some medications that weaken the immune system, and others. A full list of conditions and factors to consider for making this determination can be found in CDC’s clinical considerations guidance.

The recommendation for the additional mRNA dose following a primary series applies to Pfizer-BioNTech or Moderna vaccine recipients who are moderately or severely immunocompromised.  The recommendation does not apply to immunocompromised people who received the Johnson & Johnson (Janssen) COVID-19 vaccine because available data are insufficient to recommend an additional dose of this vaccine.  FDA and CDC will provide further guidance when these data become available.  Other fully vaccinated individuals do not need a booster dose right now.  The need for and the timing of booster doses has not been established.  Public health officials are actively planning for this possibility, in case such booster doses are recommended in the future.

Beginning August 14, COVID-19 vaccine providers in Virginia may administer the additional mRNA dose for eligible patients.  The third dose should be the same manufacturer as the previous two doses when possible, but this is not required.  It should be administered at least 28 days after the second dose of the mRNA vaccine and the vaccine dosage has not changed.  Eligible patients are not required to show proof of their medical condition.  Details about how to record the additional dose into the electronic systems are available in the Vaccination FAQs.  Side effects to an additional mRNA dose are expected to be similar to those with the 2-dose series, with fever and pain at injection site being most commonly reported.  Patients should be encouraged to enroll in v-safe to report any side effects.  Healthcare providers should report any vaccine errors or adverse events into the Vaccine Adverse Event Reporting System (VAERS).

Healthcare providers should advise all immunocompromised persons who get vaccinated, including those who receive an additional mRNA dose, that they might not have strong protection after COVID-19 vaccination.  That is why they should continue to follow COVID-19 precautions (e.g., wear a mask, stay at least 6 feet from others they don’t live with, and avoid crowds and indoor areas with poor air flow) to help prevent COVID-19.  VDH strongly recommends that their household members and other close contacts get vaccinated to provide increased protection to the immunocompromised person.  Immunocompromised persons should also discuss monoclonal antibody treatment options with their healthcare provider in case they get exposed to or infected with COVID-19.

CDC Strengthens Vaccine Recommendation for People Who Are Pregnant, Breastfeeding, or Thinking of Becoming Pregnant

On August 11, 2021, CDC strongly recommended COVID-19 vaccination for everyone aged 12 years and older, including people who are pregnant or breastfeed and those who are trying to become pregnant now or thinking of becoming pregnant in the future, as well as their partners.  This stronger recommendation was based on new data on the safety of COVID-19 vaccines during pregnancy.  A preprint analysis of data from the v-safe pregnancy registry found no increased risk of miscarriage among pregnant people who received an mRNA COVID-19 vaccine before 20 weeks of pregnancy.  This adds to a previous report that reviewed data from CDC’s vaccine safety monitoring systems and found no safety risks for pregnant individuals who received vaccines during late pregnancy or their babies.  Additional details about these recommendations are available in CDC’s Clinical Considerations for COVID-19 Vaccination.

Pregnant and recently pregnant people are at increased risk for severe disease, and it is important to improve vaccination coverage among these patients.  As of August 7, 2021, only 23% of pregnant people aged 18–49 years identified in CDC’s Vaccine Safety Datalink had received at least one dose of COVID-19 vaccine.  Healthcare providers should strongly recommend these patients to get vaccinated, especially as the more infectious Delta variant spreads across Virginia.

VDH Reminds Healthcare Providers of Testing and Masking Recommendations

Virginia is currently experiencing a high level of community transmission. Testing for SARS CoV-2 remains a critical prevention strategy, particularly in the context of increasing cases and exposures.  Healthcare providers should test individuals who have symptoms of COVID-19 or who have had close contact with someone with COVID-19, including people who are fully vaccinated.  In addition, CDC and VDH continue to recommend that during times of substantial and high transmission, all people aged 2 years or older, including those who are fully vaccinated, wear a mask in public indoor settings.  Fully vaccinated people might choose to mask regardless of the level of transmission, particularly if they or someone in their household is immunocompromised or at increased risk for severe disease, or if someone in their household is unvaccinated.  On August 11, 2021, I reissued a Public Health Order that requires all students, teachers, staff and visitors to wear masks indoors at public and private K12 schools to reinforce this public health guidance and state law.  Healthcare providers should continue to remind their patients of the current mask recommendations and strongly recommend that patients adhere to public health prevention recommendations.

The COVID-19 trends in Virginia and across the country are deeply concerning.  I sincerely thank all of you on the frontlines for your heroic actions and continued partnership.  If you have questions about COVID-19, please contact your local health department.


M. Norman Oliver, MD, MA

State Health Commissioner