COVID-19 Update for Virginia
December 20, 2021
Dear Colleague:
Thank you for your continued partnership in responding to the COVID-19 pandemic. Please visit the Virginia Department of Health (VDH) website for current clinical and public health guidance, epidemiologic data, and other information. Updates on the following topics are included in this correspondence:
- CDC Prefers mRNA Vaccines Over the Johnson & Johnson COVID-19 Vaccine
- Providers Required to Report All Immunizations to Virginia Immunization Information System Starting January 2022
CDC Prefers mRNA Vaccines Over the Johnson & Johnson COVID-19 Vaccine
On December 16, the Centers for Disease Control and Prevention (CDC) recommended mRNA COVID-19 vaccines (i.e., Pfizer-BioNTech or Moderna) over the Johnson & Johnson (J&J) vaccine for both primary and booster vaccination of those 18 years of age and older. CDC’s Advisory Committee of Immunization Practices (ACIP) unanimously recommended this after reviewing all available data on thrombosis with thrombocytopenia syndrome (TTS) after J&J vaccination and assessing the risks, benefits, and availability of the J&J and mRNA vaccines.
TTS is a rare, but severe condition that can lead to brain hemorrhage and possibly death. In April 2021, the U.S. Food and Drug Administration (FDA) and CDC recommended pausing the use of the J&J vaccine to review available evidence on reported TTS cases after J&J vaccination. Ten days later, they recommended resuming administration of the vaccine after an in-depth safety review showed that the benefits of the vaccine outweighed the rare risk of TTS. Since then, FDA and CDC have closely monitored adverse events reported after J&J vaccination. According to FDA and CDC, the latest evidence supports a causal relationship between the J&J vaccine and TTS. The rate of reported TTS following J&J vaccination is 3.8 cases per million doses overall, and rates are higher than previously reported in men as well as women in a wide age range among those 18 years and older. About 15% of these TTS cases are fatal.
Healthcare providers continue to play a critical role in educating their patients about the benefits and risks of vaccination to guide decision-making. Two-dose mRNA vaccines may be used in most vaccine-eligible populations and settings. Vaccine providers should offer an mRNA vaccine series even if they are uncertain how or when a patient will receive the second dose.
CDC states the J&J vaccine may still be offered when other authorized or approved COVID-19 vaccines are contraindicated or not accessible or when the patient prefers a J&J vaccine despite the safety concerns, and it is still preferable to not providing any COVID-19 vaccine. Providers should maintain a high clinical suspicion for symptoms that might represent TTS in patients who have recently received the J&J vaccine, and they should be aware that the use of heparin may be harmful to these patients and alternative treatments may be needed. The American Society of Hematology has information about the diagnosis and treatment of suspected TTS.
Please continue to encourage patients 5 years of age and older to get their primary series and those 16 years and older to get their booster dose. They can visit vaccinate.virginia.gov or call 1-877-VAX-IN-VA (1-877-829-4682) to find a free COVID-19 vaccine. Vaccination remains the best method to prevent severe illness, hospitalization, and death from COVID-19. CDC revised the Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Approved or Authorized in the United States to reflect their new recommendation. FDA also updated fact sheets for healthcare providers and recipients and caregivers to include a contraindication to the administration of J&J vaccine to those with a history of TTS after receiving a J&J or other adenovirus-vectored COVID-19 vaccine.
Providers Required to Report All Immunizations to Virginia Immunization Information System Starting January 2022
The Virginia Immunization Information System (VIIS) is a free statewide registry system that combines immunization histories for persons of all ages from both the public and the private sector. The goal of VIIS is to support individuals, families and clinicians in making the best healthcare decisions by providing a statewide, readily accessible and reliable Immunization Information System. Many of you use VIIS regularly in your day-to-day operations, including COVID-19 vaccine providers who are required to report all COVID-19 vaccine administrations to VIIS per the CDC Agreement. VIIS has a website you can log into to review immunization history for your patients or add immunizations to their records. It also has the ability to connect directly to your electronic medical record system. VIIS completed a major system upgrade this year and future enhancements are planned for 2022 to improve its efficiency, functionality, and user experience.
As a reminder, pursuant to Chapter 211 of the 2021 Special Session I, as of January 1, 2022, any healthcare provider, as defined in §32.1-127.1:03, in the Commonwealth that administers immunizations shall report such patient immunization information to the Virginia Immunization Information System (VIIS) pursuant to §32.1-46.01.
VDH has partnered with ImmunizeVA to provide you additional resources about VIIS. If you are not already actively submitting immunization administration data to VIIS or unsure if you are, please contact our team as soon as possible. Please reach out to VIISInfo@vdh.virginia.gov and a VIIS Trainer will contact you.
The Provider Enrollment Process consists of the following:
- Discussion with a VIIS Trainer.
- Identify main points of contact for VDH at your organization.
- Determine what access levels your employees will have.
- Complete and submit a registration in the Virginia Electronic Registration for Immunization Programs (VERIP)
- Attend a live webinar VIIS training session.
- Access to VIIS will be granted.
As we onboard healthcare providers across the state, we appreciate your patience during this time while the VIIS team members work to process all enrollment requests.
Thank you again for your continued partnership as we respond to the COVID-19 pandemic. I hope you have a safe and happy holiday season.
Sincerely,
M. Norman Oliver, MD, MA
State Health Commissioner