Guide Use of mRNA COVID-19 Vaccines for Special Populations

Which adults should receive an mRNA COVID-19 vaccine?

Almost everyone. The Pfizer-BioNTech and Moderna products are not live vaccines...and benefits typically outweigh theoretical risks.

Urge colleagues and patients to get either vaccine series.

History of allergic reactions. Vaccinate most people with a prior severe reaction to food, latex, or oral meds.

Ask if they've had hives, wheezing, or anaphylaxis within 4 hours of exposure to any other vaccines or injectable meds. This immediate allergic reaction is a precaution to COVID-19 vaccination.

These people CAN also be vaccinated. Balance the benefits of protecting them from COVID-19 against the rare risk of a reaction.

Don't vaccinate people who report a history of an immediate or severe allergic reaction to inactive ingredients, such as polyethylene glycol (PEG) or polysorbate...or to a first COVID-19 vaccine dose.

Special populations. Feel comfortable vaccinating people who are immunocompromised due to meds or conditions...pregnant...or breastfeeding. Help them make an informed decision...since data are limited.

For example, pregnant patients seem to be at higher risk for severe COVID-19. Educate that animal studies don't raise concerns about mRNA COVID-19 vaccines in pregnancy...and these vaccines don't affect our DNA.

Tell anyone planning a pregnancy that there's no evidence to suggest mRNA COVID-19 vaccines cause infertility.

Prior or acute COVID-19 infection. Vaccinate...even if people happen to contract COVID-19 between getting their first and second dose.

But delay vaccinating any patient who is acutely ill until they're stable...mainly so side effects don't muddy the clinical picture.

And consider further delaying if vaccine supply is limited...since reinfection within 90 days is uncommon.

Wait at least 90 days to vaccinate someone who receives convalescent plasma or monoclonal antibodies to treat COVID-19...due to possible interference with the vaccine immune response.

For now, continue to emphasize wearing masks, distancing, etc...even AFTER immunization.

Get answers to many other questions in our chart, Communicating About COVID-19 Vaccination...such as age and ethical considerations.

Key References

  • (2-1--21)
  • (2-1-21)
  • MMWR Morb Mortal Wkly Rep 2021;70(2):46-51
  • MMWR Morb Mortal Wkly Rep 2021;70(4):125-9
  • (2-1-21)
Hospital Pharmacist's Letter. February 2021, No. 370201

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