BCHHS Public Health Provider Alert: COVID-19 vaccine update

April 29, 2021

As of today, per the NCDHHS dashboard, 45.7% of the population of Buncombe County has received at least 1 dose of COVID-19 vaccine and 37.3% are fully vaccinated. We still have lots of work to do and are thankful that more local pharmacies and medical offices are offering vaccines. Buncombe County and many other vaccine providers in our community are working with trusted community partners and local businesses to take vaccine into communities and worksites in an effort to increase vaccination rates. Please continue to promote COVID-19 vaccination to your patients, coworkers, family and friends. Information on where to access vaccine can be found at myspot.nc.gov.

UPDATE ON BUNCOMBE COUNTY’S COVID-19 VACCINE CLINICS

  • Buncombe County is now offering walk-in Pfizer COVID-19 vaccinations to individuals 16 years of age and older at the county’s vaccine clinic at AB Tech (16 Fernihurst Dr., Asheville, NC 28801). The clinic is open Monday, Wednesday, Thursday and Friday from 9a-4p. Individuals also can continue to make 1st dose appointments online at www.buncombeready.org or by calling 828-419-0095 Monday-Friday, 8a-8p (switches to 8a-5p on 5/15).
  • The last day for the county’s 2nd dose drive-through clinic at Biltmore Church-Arden (35 Clayton Rd.) will be Thursday, May 6th. Beginning Monday, May 10th, the county will consolidate its 1st and 2nd dose clinics at the AB Tech site.
  • If you know of individuals living in Buncombe County who are homebound and want to be vaccinated with Pfizer or J&J COVID-19 vaccines, they or their caregivers can call 828-419-0095 to be put on the county’s homebound vaccination list. Their caregivers also can be added to the list to be vaccinated at the same time.

MINOR CONSENT FOR COVID-19 VACCINE

  • Per NC General Statute 90-21.5, a minor may give consent for medical health services for the prevention, diagnosis, or treatment of reportable communicable diseases. This enables minors in NC to consent for COVID-19 testing and vaccination, as COVID-19 is a reportable disease.
    • There’s no official minimum age in the minor consent law. The decision of whether to accept a minor’s consent for testing or vaccination rests on a conclusion by the medical provider about the minor’s capacity to make decisions. If the minor appears to understand their health status, their health care needs and options, such that they are able to make a decision about them, then they have decisional capacity, and no documentation is needed from the guardian.
    • Currently, individuals 16-17 years of age can receive the Pfizer vaccine. It is expected that authorization for Pfizer and Moderna vaccine administration to younger children will be given sometime this summer.

J&J COVID-19 VACCINE UPDATE

  • Yesterday, the CDC issued a MMWR titled Updated Recommendations from the Advisory Committee on Immunization Practices for Use of the Janssen (Johnson & Johnson) COVID-19 Vaccine After Reports of Thrombosis with Thrombocytopenia Syndrome Among Vaccine Recipients—United States, April 2021.
  • The CDC also updated its webpage on Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Authorized in the U.S. In addition to the updated recommendation on the use of the J&J COVID-19 vaccine, the clinical considerations document includes:
    • Recommendations for people vaccinated with COVID-19 vaccines not authorized in the US
    • Clarification that people with prolonged post-COVID-19 symptoms should be offered COVID-19 vaccination
    • Information on how healthcare providers with complex COVID-19 vaccine safety questions not answered by CDC guidance can request a consultation from the Clinical Immunization Safety Assessment COVIDvax project
    • Considerations for use of the J&J COVID-19 vaccine in certain populations, including:
      • Women aged <50 years
        • “Women aged <50 years can receive any FDA-authorized COVID-19 vaccine. However, they should be aware of the rare risk of Thrombosis with Thrombocytopenia Syndrome (TTS) after receipt of the Janssen COVID-19 vaccine and the availability of other FDA-authorized COVID-19 vaccines (i.e., mRNA vaccines). The highest rates of TTS per vaccine doses administered were identified in women <50 years of age. TTS reporting rates to VAERS were 7.0 cases per million Janssen COVID-19 vaccine doses administered to women aged 18−49 years and 0.9 per million to women aged ≥50 years.”
      • People with a history of thrombosis or risk factors for thrombosis
        • “Although the etiology of TTS associated with the Janssen COVID-19 vaccine is unclear, it appears to be similar to another rare immune-mediated syndrome, heparin-induced thrombocytopenia (HIT). Until more information becomes available, experts advise that persons with a history of an episode of an immune-mediated syndrome characterized by thrombosis and thrombocytopenia, such as HIT, should be offered another FDA-authorized COVID-19 vaccine (i.e., mRNA vaccine) if they are within at least 90-180 days after resolution of their illness.”
        • “Based on current knowledge, experts believe that people with risk factors for VTE (e.g., inherited or acquired thrombophilia including Factor V Leiden, prothrombin gene 20210A mutation, antiphospholipid syndrome, protein C, protein S or antithrombin deficiency), or a prior history of other types of thromboses (including cerebral venous sinus thrombosis [CVST]) not associated with thrombocytopenia are unlikely to be at increased risk for TTS. Likewise, although the risk of thrombosis is increased during pregnancy and the postpartum period, and with certain hormonal contraceptives (e.g., combined oral contraceptives, patch, and ring), experts believe that these factors do not make people more susceptible to TTS after receipt of the Janssen COVID-19 vaccine. These people can receive any FDA-authorized vaccine, including the Janssen COVID-19 vaccine.
    • Updated information and recommendations for vaccination of pregnant people
      • “CDC recently released the first U.S. data on the safety of mRNA COVID-19 vaccines administered during pregnancy. The report analyzed data from three vaccine-safety-related databases: VAERS, the v-safe active surveillance system, and the v-safe pregnancy registry, which collects more detailed data on people who are pregnant and their infants. Early data from these systems did not identify any safety concerns for pregnant people who were vaccinated or for their babies. Most of the pregnancies in these systems are ongoing; additional follow-up is needed, particularly among those vaccinated in the first and second trimesters of pregnancy.”
  • The CDC also held a COCA call yesterday on the J&J COVID-19 Vaccine and Thrombosis with Thrombocytopenia Syndrome (TTS):  Update for Clinicians. Slides and a recording are available at the link.
    • TTS has not been reported following administration of more than 190 million doses of the mRNA-based Pfizer and Moderna vaccines. The underlying cause of TTS syndrome remains under investigation, having been associated with both Oxford/AstraZeneca and Janssen adenovirus-vector vaccines.
    • Healthcare providers (HCPs) are urged to maintain a high index of suspicion for TTS symptoms, including severe headache, backache, new neurologic symptoms, severe abdominal pain, shortness of breath, leg swelling, petechiae (tiny red spots on the skin), or new and easy bruising, with typical onset 1–2 weeks post-vaccination.

UPDATED RECOMMENDATIONS FOR FULLY VACCINATED PEOPLE

  • As you likely heard, on 4/27, the CDC updated their recommendations for fully vaccinated people in non-healthcare settings and included separate recommendations for healthcare settings.
    • Of note, the guidance states that immunocompromised individuals should consult with their healthcare provider about these recommendations, even if fully vaccinated.
    • This webpage distills the recommendations for non-healthcare settings into an infographic.