It's great to see the continued momentum in the state's quest to get all Alabamian's vaccinated. As COVID-19 vaccine availability expands to include more age groups, providers are naturally going to get more questions about the vaccine, potential side effects, interactions, etc. The Risk Consultants at Inspirien Insurance Company have compiled a list of 10 frequently asked questions regarding the vaccine to expedite clinical visits and support clinicians in their quest to combat COVID-19. These FAQ's were obtained from evidenced based sites such as the CDC, The American Medical Association, and The New England Journal of Medicine.

Is a patient who is immune-compromised, has an immune disease or has cancer eligible to take the COVID-19 vaccine?

According to Dr. Carlos del Rio, a Global Health Expert at Emory University "there is no contraindication in my mind to take the COVID-19 vaccine." Dr. Rio goes on to note that clinical trials did not include those individuals in an immune-compromised state, so the efficacy of the vaccine is still unknown and may not be the same as an individual who is not in an immuno-compromised state. Patients are advised to not take the vaccination if they have had an allergic reaction to the vaccine or any component of the vaccine.

What are the most common side effects after getting the COVID-19 vaccine, and how long do they last?

According to the CDC, it is normal to experience some side effects that may last for a few days after receiving the vaccine, the most often seen side effects are:

• Pain/swelling at the injection site
• Fever/Chills/Fatigue

Should a patient who has already had COVID-19 take the vaccine?

Yes, it is recommended that patients who have had COVID-19 take the vaccine for further protection. Dr. Rio says that people who have had COVID-19 are advised to wait 90 days before receiving their first dose to ensure their immune system is the most responsive.

What is known about the efficacy of each vaccine and is one vaccine preferred over the other?

According to the vaccine FAQ's from the New England Journal of Medicine, Dr. Paul E. Sax, a professor of Medicine at Harvard Medical School and an infectious disease expert, says that both vaccines are "remarkably effective." Dr. Sax also notes that the results of the clinical trials were highly successful, making the effectiveness of the vaccine comparable to the effectiveness of the measles vaccine, and protection from disease is far better than anticipated. Ultimately, both the Pfizer and the Moderna vaccine are equally effective in disease prevention. There are age requirements for each vaccine. The Pfizer/BioNTech vaccine is authorized for ages ≥16 years, and Moderna's for ≥18 years. Apart from the age requirements, there is no benefit of one over the other. Once the vaccination process is started, it is recommended that patients receive both doses from the same manufacturer. https://www.nejm.org/covid-vaccine/faq

If a patient has had the first dose of the COVID-19 vaccine and then tested positive can they still get the second vaccine dose?

Yes, and this is quite common. For optimal protection, Dr. Rio recommends that people who test positive after receiving their first dose wait 21 to 28 days before taking the second. However, people who received convalescent plasma or monoclonal antibodies should wait 90 days before completing the vaccine process.

Once fully vaccinated, how long will the vaccine last?

Per the CDC, currently, researchers are still working on determining the length of immunity from the vaccination. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/faq.html

What is the best way to approach vaccine hesitancy in my patients?

Dr. Sax says there is no one size fits all approach to addressing vaccine hesitancy. The best method is to provide facts and credible information on how vaccines work and vaccine efficacy, and address patient concerns in a non-confrontational way. The CDC has prepared a vaccine communication toolkit, https://www.cdc.gov/vaccines/covid-19/health-systems-communication-toolkit.html to help support vaccination efforts. https://www.nejm.org/covid-vaccine/faq

What instructions should be given to patients after vaccination?

Clinicians may provide patients with information from the Emergency Use Authorization fact sheet issued by the FDA for each vaccine, which can be found at the link: https://www.cdc.gov/vaccines/covid-19/eua/index.html

Can a patient with a history of allergic reactions still receive the vaccine?

Yes, unless the patient has had a severe reaction to the first dose. Dr. Sax recommends that patients who have had prior allergic reactions to vaccines be observed for 30 minutes post-vaccination, rather than the standard 15 minutes.

What documentation is required when administering the COVID-19 vaccine?

According to the CDC, health care providers enrolled in the COVID-19 Vaccination program are required to:

Document in their medical record system the vaccine administration within 24 hours, including:

Location of administration and address

Recipient name, ID, Sex, DOB and address

Administration date

CVX (product) MVX (manufacturer) lot and dose number

Administering providers name and suffix and address if different than administration address

Administration site

Vaccine expiration date

Route of administration

Report administration data no later than 72 hours to their jurisdiction's IIS after vaccine administration. Additional reporting requirements can be found here: https://www.cdc.gov/vaccines/covid-19/reporting/requirements/index.html

According to the jurisdiction, providers may report daily inventory using VaccineFinder https://vaccinefinder.org/ or to their jurisdiction's IIS to upload to VaccineFinder.

Vaccine administration errors, serious adverse events, and cases of COVID-19 who have been admitted to the hospital or died following a vaccine should be reported to https://vaers.hhs.gov/index.html

The CDC recommends providers to refer to their COVID-19 vaccination provider agreement for all provider requirements.

We encourage readers to check out our website at www.inspirien.net for our complete COVID-19 Toolkit, as well as more information about the services we offer and how we could best assist with any of your Risk Management needs. Our Risk Management and Loss Control Consultants are always monitoring and updating information. To stay up to date on the last information available, we recommend you check the ADPH and CDC websites at www.alabamapublichealth.gov and www.cdc.gov.

The team at Inspirien would like to extend a heartfelt thank you to the clinicians and healthcare providers who have so diligently fought this virus over the last year.

Wendy Shurette is a Risk Management Consultant with Inspirien.