COVID-19

Test Your Knowledge: Co-Administration of COVID-19 Vaccines and Pediatric Vaccines

AUTHOR:
John W. Harrington, MD
Director, Division of General Academic Pediatrics, Children’s Hospital of The King’s Daughters, Norfolk, VA

President Joe Biden has announced that all individuals aged 16 years or older can receive the COVID-19 Pfizer vaccine. A 16-year-old girl presents to your clinic for a sick visit 10 days after her annual visit, at which time she received the meningococcal A booster and her first meningococcal B vaccine. She now wants to travel with her family outside the country and wants to make sure she can receive all of the required vaccines as quickly as possible. In addition, she would like to receive her first dose of the Pfizer COVID-19 vaccine at today’s appointment.

 

 

Answer and discussion on next page.

Correct answer: D

As we move forward in the pandemic, we may learn more about which vaccines can be given with the COVID-19 vaccines and how far apart they should be separated. However, the current guidance from the Centers for Disease Control and Prevention is that you cannot administer the COVID-19 vaccine within 2 weeks of any other vaccine, and any other vaccine cannot be administered within 2 weeks of the COVID-19 vaccine.1 Answer C is wrong because the meningococcal B vaccine booster would be administered only 10 days after the first COVID-19 vaccine dose and would break these guidelines. Only answer D is correct, because this would allow for the full 2-week period.

Thinking ahead, as COVID-19 vaccines become available for even younger adolescents and children, we may have to either delay our normally scheduled vaccines to give COVID-19 vaccines and then bring back the patient for their regularly scheduled vaccines. Knowing how difficult it has been to maintain immunizations for our children during the pandemic and now having this wrinkle of unavailability of vaccine, it does not take an epidemiologist to figure out that we will likely have significant decreases in our overall immunization coverage of children for vaccine-preventable diseases.2 This data will need to be followed carefully for immunization coverage in specific populations and to inform insurance companies that are making contractual arrangements with any at-risk or profit-sharing providers, especially clinically integrated networks. 

We may also require specific alerts in our electronic medical record (EMR) systems to let providers know that they may be giving a vaccine too early or within the window of unavailability. Our health care system is already putting these rules in place for our EMRs so that patients aged 16 years or older will not get vaccines inappropriately, if the vaccine was given within our institutional system. Unfortunately, our current EMR systems are not integrated with all the current places that may ultimately be giving the COVID-19 vaccine to children younger than age 16 years—pharmacies, retail or central locations, and pop-up clinics. Many states have immunization registries that are accessible by all medical facilities and physician practices. It would make sense to have all of these convenient places, at which physicians wish to administer the COVID-19 vaccine, the ability to register these vaccinations at a central location. This documentation has become a legal requirement for those administering vaccines and was recently passed as law in Virginia by the assistance of the Virginia American Academy of Pediatrics.3

References

  1. Frequently asked questions about COVID-19 vaccination. Centers for Disease Control and Prevention. Updated April 13, 2021. Accessed April 14, 2021. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/faq.html
  2. Dinleyici EC, Borrow R, Palazzi Safadi MA, van Damme P, Munoz FM. Vaccines and routine immunization strategies during the COVID-19 pandemic. Hum Vaccin Immunother. 2021;17(2):400-407. https://doi.org/10.1080/21645515.2020.1804776  
  3. Martin M. Participation in Virginia’s immunization information system is critical for keeping Virginia health. Virginia Mercy. Published online March 12, 2021. https://www.virginiamercury.com/2021/03/12/participation-in-virginias-immunization-information-system-is-critical-for-keeping-virginia-healthy/