Be Ready With Answers About Bivalent COVID-19 Boosters

Please see the FDA announcement authorizing Moderna and Pfizer-BioNTech Bivalent COVID-19 Vaccines for Use as a Booster Dose in Younger Age Groups.


Lots of questions will come up about updated COVID-19 boosters.

All boosters of Pfizer-BioNTech for patients age 12 and up and Moderna for 18 and up are now bivalent...with 2 mRNA components.

They’ll still cover the original SARS-CoV-2 virus...but also Omicron BA.4/BA.5, the variants currently circulating.

Explain that human data for COVID-19 vaccines with Omicron BA.1...and animal data with BA.4/ a better immune response against Omicron versus another original monovalent booster.

Expect side effects similar to the monovalent vaccines.

Offer a bivalent COVID-19 booster to all patients age 12 and up who finished the primary series or got a booster at least 2 months ago...regardless of the number of prior boosters they’ve had.

Give whichever age-appropriate bivalent booster you have in stock.

But reinforce that UNvaccinated patients still need a PRIMARY series with the original vaccines first...before a bivalent booster.

Recommend eligible patients at higher risk of severe COVID-19 (age over 65, immunocompromised, etc) get the updated booster promptly.

Also catch patients up when giving flu or other routine immunizations (Tdap, etc). Give injections at least 1 inch apart...or in different limbs, especially with high-dose or adjuvanted flu vaccines.

It’s okay if a lower-risk patient prefers to wait a bit for the booster...such as 3 months after a COVID-19 infection or until a couple weeks before a large gathering. Some experts suggest the “sweet spot” is 3 to 6 months after the last COVID-19 vaccine dose or infection.

For now, give just ONE bivalent booster...additional boosters aren’t recommended, even for immunocompromised patients. This shift may be setting us up for annual COVID-19 boosters...similar to flu.

Use 0.3 mL (30 mcg) for Pfizer-BioNTech or 0.5 mL (50 mcg) for Moderna bivalent boosters. Stay alert for errors.

Keep in mind, COVID-19 vaccines are no cost to patients until at least Jan 2023...including admin fees, if not covered by payers.

Post our resource, COVID-19 Vaccines, for dosing, storage, etc.

Key References

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Pharmacist's Letter. October 2022, No. 381001

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