About the COVID-19 Vaccines

April 19, 2023 – Following FDA regulatory action, the CDC has taken steps to simplify COVID-19 vaccine recommendations and allow more flexibility for people at higher risk who want the option of added protection from additional COVID-19 vaccine doses.

These changes include:

  • CDC’s new recommendations allow an additional updated (bivalent) vaccine dose for adults ages 65 years and older and additional doses for people who are immunocompromised. This allows more flexibility for healthcare providers to administer additional doses to immunocompromised patients as needed.
  • Monovalent (original) mRNA COVID-19 vaccines will no longer be recommended for use in the United States.
  • CDC recommends that everyone ages 6 years and older receive an updated (bivalent) mRNA COVID-19 vaccine, regardless of whether they previously completed their (monovalent) primary series.
  • Individuals ages 6 years and older who have already received an updated mRNA vaccine do not need to take any action unless they are 65 years or older or immunocompromised.
  • For young children, multiple doses continue to be recommended and will vary by age, vaccine, and which vaccines were previously received.

Alternatives to mRNA COVID-19 vaccines remain available for people who cannot or will not receive an mRNA vaccine. CDC’s recommendations for use of (monovalent) Novavax COVID-19 vaccines were not affected by these changes.

Pfizer-BioNTech COVID-19 Vaccine Information

Vaccine Summary

The Pfizer-BioNTech COVID-19 vaccine for those 6 months through 4 years is a three-dose bivalent series, the first 2 doses given 21 days apart and the third dose given at least 8 weeks after the second dose.

The Pfizer-BioNTech COVID-19 vaccine for those 5 and older vaccine is one bivalent dose.

  • Individuals that have received one or more previous doses of monovalent COVID-19 vaccine should receive a single dose of a bivalent COVID-19 vaccine at least 2 months after any monovalent COVID-19 vaccine.
  • Immunocompromised individuals 6 months and older who have received 1 dose of bivalent COVID-19 vaccine: An additional dose of a bivalent COVID-19 vaccine may be administered at least 2 months following the dose of the bivalent COVID-19 vaccine.
  • People 65 years and older are eligible for an additional dose of bivalent vaccine at least 4 months after their last bivalent dose.
  • Children 6 months - 4 years old who received a three-dose original monovalent Pfizer primary series should receive an updated bivalent Pfizer dose given at least 2 months after completing the three-dose monovalent primary series.
  • Children 5 years old who received Pfizer may only receive an updated Pfizer bivalent dose.
  • People 6 years and older can receive an updated Pfizer or Moderna dose, regardless of which brand they received for their primary series or previous monovalent booster dose. 

The clinical trials revealed no major unanticipated adverse events.

Resources

Dry Ice Safety

Moderna COVID-19 Vaccine Information

    Vaccine Summary

    The Moderna COVID-19 vaccine for those 6 months-5 years is a two bivalent dose series, given one month apart.

    The Moderna COVID-19 vaccine for those 6 years and older is one bivalent dose.

    • Individuals that have received one or more previous doses of monovalent COVID-19 vaccine should receive a single dose of a bivalent COVID-19 vaccine at least 2 months after any monovalent COVID-19 vaccine.
    • Immunocompromised individuals 6 months and older who have received 1 dose of bivalent COVID-19 vaccine: An additional dose of a bivalent COVID-19 vaccine may be administered at least 2 months following the dose of the bivalent COVID-19 vaccine.
    • People 65 years and older are eligible for an additional dose of bivalent vaccine at least 4 months after their last bivalent dose.
    • Children 6 months to 4 years who received a two-dose original monovalent Moderna primary series should receive an updated bivalent Moderna dose at least 2 months after completing the two-dose monovalent primary series.
    • People 5 years and older can receive an updated Pfizer or Moderna dose, regardless of which brand they received for their primary series or previous monovalent booster dose.

    No serious safety concerns were found.

    Resources

    Novavax COVID-19 Vaccine, Adjuvanted

    Vaccine Summary

    The Novavax COVID-19 Vaccine, Adjuvant for those 12 years old and older is a two-dose primary series. The second dose is given at least three weeks after the first dose. It contains the SARS-CoV-2 spike protein and Matrix-M adjuvant. An adjuvant increases a vaccine’s ability to stimulate the body’s immune system to fight off disease (to improve vaccine effectiveness).

    An updated bivalent mRNA vaccine dose is recommended for everyone, given at least 2 months after any monovalent COVID-19 vaccine. Novavax COVID-19 boosters are available for adults if they have completed primary series vaccination but have not previously received a COVID-19 booster—and if they cannot or will not receive an updated mRNA dose.

    No serious safety concerns were found.

    Resources

    Vaccine Requirements

    Is the COVID-19 vaccine required?

    It will be your choice whether to get the vaccine for COVID-19, but some employers, colleges, and universities may require it.

    Can I opt out of the COVID-19 vaccine requirement?

    It varies by employer. Talk with your employer or human resources office about their vaccine opt out or accommodation policies.

    How do I prove that I got vaccinated?

    Talk with your employer or human resources office about what they require for proof of vaccination. If you lost your card, you can get proof of vaccination for free through MyIRMobile. For language assistance or additional help getting your records, please call 833-VAX-HELP (833-829-4357) or email waiisrecords@doh.wa.gov.

    What if I can’t or don’t want to get the COVID-19 vaccine?

    Washington requires health care, long-term care, cabinet-agency state employees and employees in education (public and private K-12 school, childcare, early learning, and higher education) to be fully vaccinated by October 18, 2021, as a condition of employment. If you need an accommodation, talk with your employer or human resources office. You may be able to continue working with additional safety requirements, such as regular COVID-19 testing, masking, or other measures.

    Is the COVID-19 vaccine required for my patients?

    Most likely not. Washington currently only requires cabinet agency state employees, health care workers, long-term care workers, and employees in education (public and private K-12 school, childcare, early learning, and higher education) to get the COVID-19 vaccine. However, your patient’s employer, college, or university could decide to require the vaccine for their staff or students.

    It’s your patient’s choice to get vaccinated, but you can talk to them and encourage them to get the vaccine. Check out the Power of Providers Initiative for resources.

    What should I do for patients who can’t or don’t want to get the COVID-19 vaccine?

    You may choose to document the patient’s reason for not getting the COVID-19 vaccine in their health record.

    If your patient’s employer or college/university requires the COVID-19 vaccine, or they are required to have the vaccine per Gov. Jay Inslee’s August 9 proclamation, they should check with their employer or college/university to find out how they collect proof of vaccination, if they have an opt-out policy, and what they would need to do to opt out. The Department of Health is not involved in the employer’s or college’s/university’s policy.

    Your patients do not need to get an exemption form from the Department of Health (DOH) for the COVID-19 vaccine. DOH does not have exemption forms for the COVID-19 vaccine. The Washington state Certificate of Exemption (COE) is only for parents/guardians who wish to exempt their child from the immunizations required for children in K-12 schools, preschools, or child care. Currently, Washington does not require the COVID-19 vaccine for children to attend school or child care, so it is not included on the COE. Any DOH Certificate of Exemptions including COVID-19 vaccines are fake.

    Frequently Asked Questions

    Does the COVID-19 vaccine work against variant strains?

    COVID-19 vaccines are working well to prevent severe illness, hospitalization, and death, even against variants. However, public health experts are seeing reduced protection against mild and moderate COVID-19 illness, especially among-high risk populations.

    The updated COVID-19 vaccines were created to help boost immunity and provide better protection from the omicron variant. It’s important to get all recommended doses available for best protection.

    Vaccination is the best protection against COVID-19. High vaccination coverage will reduce the spread of the virus and help prevent new virus variants from emerging. Visit our page on the COVID-19 variants for more information.

    Should I administer extra vaccine doses to my patients?

    People 6 months and older who are moderately to severely immunocompromised who previously received a bivalent (updated) mRNA vaccine dose have the option to receive one or more additional bivalent mRNA doses at least 2 months after their last bivalent dose. Please visit the CDC's Clinical Guidance for COVID-19 Vaccination page for the latest vaccine recommendations for people who are moderately to severely immunocompromised.

    Please do not administer any doses of vaccine beyond the doses recommended by CDC, even if your patient requests it. Also, please do not administer any doses of vaccine to someone outside of the recommended age range for that vaccine.

    Is the vaccine effective in all age groups?

    Yes, the clinical trials showed similar results in different age groups, including those over 65 years of age.

    What types of symptoms are normal after receiving the vaccine?

    Like other routine vaccines, the most common side effects are a sore arm, fatigue, headache, and muscle pain. These symptoms are a sign that the vaccine is prompting an immune response. For most people, these side effects occurred within two days of getting the vaccine and lasted about a day. People who were 55 years or older were less likely to report having side effects than younger people.

    In clinical trials, scientists found these effects to occur in approximately:

    Pfizer

    • Eighty percent of people reported pain at the injection site
    • Fifty percent of people reported fatigue and headache
    • Thirty percent of people reported muscle pain

    Moderna

    • Ninety percent of people reported pain at the injection site
    • Seventy percent of people reported fatigue and headache
    • Sixty percent of people reported muscle pain

    Novavax

    • Eighty-two percent of people reported pain at the injection site
    • Sixty-two percent of people reported fatigue 
    • Fifty-four percent of people reported muscle pain
    Are there any restrictions on who can receive the vaccine?

    Generally, the COVID-19 vaccines should not be given to anyone who is under the authorized age or has a history of severe allergic reactions to an ingredient or previous dose of the COVID-19 vaccines.

    Pfizer-BioNTech

    The Pfizer COVID-19 vaccine should not be given to anyone:

    • Under 6 months of age
    • Outside of the appropriate age dose
    • With a history of severe or immediate allergic reactions to an ingredient of the Pfizer-BioNTech vaccine, such as polyethylene glycol or polysorbate
    • Who had a severe or immediate allergic reaction to their first dose of an mRNA COVID-19 vaccine (Pfizer or Moderna)

    Moderna

    The Moderna COVID-19 vaccine should not be given to anyone:

    • Under 6 months of age
    • Outside of the appropriate age dose
    • With a history of severe or immediate allergic reactions to an ingredient of the Moderna vaccine, such as polyethylene glycol or polysorbate
    • Who had a severe or immediate allergic reaction to their first dose of an mRNA COVID-19 vaccine (Pfizer or Moderna)

    Novavax

    • The Novavax vaccine currently should not be given:
    • To anyone under the age of 12 years old until further research can support its use in that age category. 
    • Outside the appropriate age dose.
    • To anyone with a history of myocarditis or pericarditis.

    See the Advisory Committee on Immunization Practices’ (ACIP) interim clinical considerations for COVID-19 vaccines for more information.

    Should I administer the vaccine to patients with a history of allergies?

    The COVID-19 vaccines should not be given to people with a known history of severe allergic reaction, such as anaphylaxis, to any ingredient or a previous dose of the COVID-19 vaccines.

    People who have had a severe allergic reaction to other vaccines or injectable therapies may still be able to receive this vaccine. However, providers should do a risk assessment and counsel them about the potential risks. If the patient decides to get the vaccine, providers should observe them for 30 minutes to monitor for any immediate reactions. People who report having mild or childhood allergic reactions to medications or vaccines may still get the vaccine.

    How quickly is someone protected from COVID-19 after receiving the vaccine?

    It will take about two weeks after someone receives a bivalent dose to have maximum protection. Protection may wane over time, so it’s important to stay up to date with all doses recommended to you.

    What is the recommended dosage and schedule?

    Pfizer-BioNTech (Comirnaty)

    • 6 months through 4 years: three 0.2mL (3mcg) bivalent doses, the first 2 doses given at least 21 days apart. The third dose given at least 8 weeks after the second dose.
    • 5 through 11 years old: one 0.2 mL (10mcg) bivalent dose.
    • 12 years and older: one 0.3 mL (30mcg) bivalent dose.

    An updated bivalent mRNA vaccine dose is recommended for everyone, given at least 2 months after any monovalent COVID-19 vaccine.

    People 6 months and older who are moderately to severely immunocompromised who previously received a bivalent (updated) mRNA vaccine dose have the option to receive one or more additional bivalent mRNA doses at least 2 months after their last bivalent dose. Please visit the CDC's Clinical Guidance for COVID-19 Vaccination page for the latest vaccine recommendations for people who are moderately to severely immunocompromised.

    People 65 years and older are eligible for an additional dose of bivalent vaccine at least 4 months after their last bivalent dose.

    Moderna

    • 6 months through 5 years old: two 0.25mL (25mcg) doses, given one month apart.
    • 6-11 years old: one 0.25mL (25mcg) bivalent dose.
    • 12 and older: one 0.5 mL (50mcg) bivalent dose. 

    An updated bivalent mRNA vaccine dose is recommended for everyone, given at least 2 months after any monovalent COVID-19 vaccine.

    People 6 months and older who are moderately to severely immunocompromised who previously received a bivalent (updated) mRNA vaccine dose have the option to receive one or more additional bivalent mRNA doses at least 2 months after their last bivalent dose. Please visit the CDC's Clinical Guidance for COVID-19 Vaccination page for the latest vaccine recommendations for people who are moderately to severely immunocompromised.

    People 65 years and older are eligible for an additional dose of bivalent vaccine at least 4 months after their last bivalent dose.

    Novavax

    • 12 years and older: two 0.5mL doses given 21 days apart.
    • An updated bivalent mRNA vaccine dose is recommended for everyone, given at least 2 months after any monovalent COVID-19 vaccine. mRNA vaccines are preferred, but the Novavax COVID-19 vaccine is still available if you aren’t able or willing to get another vaccine. Novavax COVID-19 boosters are available for adults if they have completed primary series vaccination but have not previously received a COVID-19 booster—and if they cannot or will not receive an updated mRNA dose.

    Protection may wane over time, so it’s important to get any recommended doses on time.

    How much of the vaccine is in each multi-dose vial?

    Pfizer-BioNTech 12 years + adolescent/adult bivalent formula (gray cap): Each vial contains 6 doses (0.3 mL) of the vaccine.

    Pfizer-BioNTech 5-11 pediatric bivalent formula (orange cap): Once diluted, each vial contains 10 doses (0.2 mL) of the vaccine.

    Pfizer-BioNTech 6 months-4 years pediatric/infant bivalent formula (maroon cap): Once diluted, each vial contains 10 doses (0.2 mL) of the vaccine.

    Moderna 12 years+ adult/adolescent bivalent formula (blue cap with gray label): Each vial contains 5 doses (0.5mL) of the vaccine.

    Moderna 6 months-11 years pediatric bivalent formula (blue cap with gray label): Each vial contains 10 doses (0.25mL) of the vaccine.

    Moderna 6 months-5 years pediatric/infant bivalent formula (magenta cap/yellow label): Each vial contains 2 doses (0.2mL) of the vaccine.

    Novavax COVID-19 vaccine, adjuvanted 12 years+ adolescent/adult primary series and adult monovalent booster formula (royal blue cap): Each vial of vaccine contains 10 doses of 0.5mL each.

    Please review the Vaccine Product Characteristics Chart for more information.

    Can I use any extra doses in the vaccine vials?

    You may find that some vials contain extra doses. Given the public health emergency, you can use every full dose you can get from the Pfizer-BioNTech and Moderna vaccine vials. However, you should be sure to:

    • Maintain the dilution concentration of the Pfizer-BioNTech vaccine. See the Pfizer-BioNTech diluent poster (PDF) for more information.
    • Discard any amount of vaccine remaining in the vial that is less than a full dose. Do not pool liquid from multiple vials to create a dose.

    If you administer extra doses, you will need to reconcile your inventory in the Washington State Immunization Information System (WAIIS). We recommend you do this every Tuesday for accurate reporting. If you use an electronic health record (EHR) to input data into the WAIIS, you may need to reconcile more often. Instructions are available in the extra dose reconciliation guide (PDF).

    My patient/client is moderately or severely immunocompromised. What is the COVID-19 vaccination recommendation for them?

    People 6 months and older who are moderately to severely immunocompromised who previously received a bivalent (updated) mRNA vaccine dose have the option to receive one or more additional bivalent mRNA doses at least 2 months after their last bivalent dose. Please visit the CDC's Clinical Guidance for COVID-19 Vaccination page for the latest vaccine recommendations for people who are moderately to severely immunocompromised.

    As medical providers it is imperative to understand the vaccine recommendation for this high-risk population. Please encourage your immunocompromised patients or clients to get vaccinated and ensure they receive all doses recommended to them.