6/20/21 – Health Advisory: COVID-19 Updates for Providers

Requested actions

• Be aware, the Food and Drug Administration (FDA) extended the shelf life of Janssen (Johnson & Johnson) COVID-19 vaccine from 3 months to 4½ months.
  • Visit Janssen’s lot expiry checker to determine the updated expiration of your Janssen (Johnson & Johnson) vaccine.
• Be aware of local and national reports of myocarditis and pericarditis among people who received COVID-19 mRNA vaccine within the last 2 weeks.
  • Promptly report cases to the Vaccine Adverse Events Reporting System (VAERS).
• Vaccinate everyone 12 years or older against COVID-19.
  • Review all patients’ vaccination records and help them get up to date with vaccines. You can administer COVID-19 vaccine simultaneous with, or within any number of days of, other vaccines.
• Be prepared to help patients verify their vaccination status.
  • Send them to MyIR Mobile if they can read English and have internet access and skills.
  • Send others to the Washington State Department of Health (DOH) call center at (800) 525-0127. Operators can help callers access and verify their vaccination records in WAIIS and help those who need other language services or interpretation.
  • Supply patients with a WAIIS or electronic health record (EHR) printout if the above options don’t work.
• Complete a survey by the Washington Chapter of the American Academy of Pediatrics (WCAAP) and DOH by June 20, 2021 to better understand provider’s need in administering COVID-19 vaccine to adolescents.

Background

Myocarditis and pericarditis following COVID-19 vaccination

On May 17, the Centers for Disease Control and Prevention (CDC) Vaccine Safety Technical Subgroup reported a few cases of myocarditis and pericarditis among people who received COVID-19 mRNA vaccine. No similar reporting pattern is observed after receiving Janssen (Johnson & Johnson) COVID-19 vaccine. Local and national investigations continue. Of cases reported in Washington, 90% are males under 30 years. Those who presented for care, promptly improved after treatment and rest. Disease onset occurs more often following dose 2 than dose 1, and typically within several days after vaccination.

CDC continues to recommend COVID-19 vaccination for people 12 years or older.

Clinical features of myocarditis and pericarditis include:

• Chest pain or pressure.
• Shortness of breath.
• Palpitations.
• Electrocardiogram (EKG) changes.
• Elevated cardiac biomarkers.

Clinical recommendations:

• Promptly report cases to VAERS at https://vaers.hhs.gov/reportevent.html.
• Consider myocarditis and pericarditis in adolescents and young adults with clinical signs and symptoms. In this younger population, coronary events are less likely to be a source of these symptoms.
• Elicit a detailed history, including vaccination status and potential exposures to COVID-19. Ask about medical, travel, and social history.
• Test patients for COVID-19 infection with a molecular (PCR) test.
• For initial evaluation, consider ECG, troponin level, and inflammatory markers such as C-reactive protein and erythrocyte sedimentation rate. It is important to consider other potential causes.
• For suspected cases, consider consultation with cardiology for assistance with cardiac evaluation and management. Evaluation and management may vary depending on the patient’s age, clinical presentation, potential causes, or practice preference of the provider.

Additional information

• Follow-up of patients with myocarditis, consult recommendations, American Heart Association and the American College of Cardiology.
• Clinical considerations: Myocarditis and pericarditis after receipt of mRNA COVID-19 vaccines among adolescents and young adults, CDC.
• COVID-19 subcommittee of the World Health Organization (WHO) Global Advisory Committee on Vaccine Safety (GACVS) reviews cases of mild myocarditis reported with COVID-19 mRNA vaccines, WHO news release, May 26, 2021.
• Myocarditis and pericarditis following mRNA COVID-19 vaccination, CDC.
• Selected adverse events reported after COVID-19 vaccination, CDC.
• Myocarditis and pericarditis resources for the public, CDC.

Additional vaccine resources

• COVID-19 vaccine locator, DOH.
• COVID-19 vaccine for providers
• COVID-19 vaccine provider toolkit and resources, DOH.
• COVID-19 vaccination for providers, CDC.
• Clinical considerations for COVID-19 vaccination and guidance for managing anaphylaxis, CDC.
• COVID-19 vaccine quick reference guide for healthcare professionals, CDC.
• COVID-19 vaccine training module on best practices for providers, CDC.
• Janssen (Johnson & Johnson) health alert, CDC.
• Vaccine-induced immune thrombotic thrombocytopenia frequently asked questions, American Society of Hematology (ASH).
• Diagnosis and management of vaccine-induced immune thrombotic thrombocytopenia webinar, ASH and CDC.
• April 15, 2021 Clinician Outreach and Communication Activity (COCA) call: Janssen (Johnson & Johnson) COVID-19 vaccine and cerebral venous sinus thrombosis with thrombocytopenia update for clinicians on early detection and treatment, CDC.

COVID-19 testing

Abbott Laboratories extended all BinaxNOW tests’ shelf life to 12 months. See Abbott’s BinaxNOW COVID-19 Ag Card Product Expiry Update for new expiration dates by lot number.

COVID-19 test processing

Labs report varying amounts of time to process COVID-19 tests. To support faster turnaround, we encourage providers to use in-state labs. The table below shows COVID-19 test processing times for in-state private labs.

Patient education

Share the following materials with patients.

• What to do if you have COVID-19.
• What to do if you may have been exposed to COVID-19.
• What to do if you have COVID-19 symptoms and have not been tested or exposed.

Additional resources

• Our COVID-19 page for healthcare providers.
• Washington COVID-19 risk assessment dashboard.
• CDC guidance for healthcare providers and facilities.
• DOH COVID-19 data dashboard.
• DOH COVID-19 page.
• CDC COVID-19 page.
• SARS-CoV-2 sequencing and variants in Washington.