SARS-CoV-2

SARS-CoV-2, the highly contagious virus that causes COVID-19, is spread predominantly through respiratory droplets produced when an infected person coughs, sneezes, or talks.⁴⁰ Symptoms vary widely from mild to severe and include loss of taste or smell, fever, chills, muscle or body aches, sore throat, nausea or vomiting, cough, and breathing difficulties. Symptoms may appear 2-14 days after exposure to the virus; however, some infected patients never develop symptoms and asymptomatic spread is significant.^41,42 The number of deaths in the patient cohort over the age of 65 is 97 times greater than for the patient cohort age 18 – 29.⁴³ Numerous medical conditions (Box 5) increases one’s risk of developing severe or fatal disease.⁴³

Box 5. Conditions Associated with Increased COVID Disease Severity⁴³

Cancer	Mental Health Conditions
Chronic Kidney Disease	Overweight and Obesity
Chronic Lung Disease	Physical Inactivity
Cystic Fibrosis	Pregnancy
Dementia	Sickle Cell Disease or Thalassemia
Diabetes (Type 1 or 2)	Smoking (current or former)
Disabilities	Solid Organ or Blood Stem Cell Transplant
Heart Conditions (e.g., Heart Failure, Coronary Artery Disease, Cardiomyopathies)	Stroke or Cerebrovascular Disease
HIV	Substance Use Disorder
Immunocompromised Condition	Tuberculosis

Active Immunization: SARS-CoV-2.⁴⁴

The first two COVID-19 vaccines (Pfizer-BioNTech [BNT162b2] and Moderna [mRNA-1273]) developed to prevent SARS-CoV-2 infection received Emergency Use Authorizations from the FDA in December 2020 (Table 7). Both vaccines employ the mRNA technology platform and appear to be very efficacious in generating immunity. BNT162b2 is approved for use in persons ≥12 years of age and mRNA-1273 is approved for persons ≥18 years of age. On February 27, 2021, the FDA issued Emergency Use Authorization of the single-dose COVID -19 vaccine (Jannsen/Johnson & Johnson) [JNJ-778436735]). It was an adenovirus serotype 26 vector-based vaccine for persons ≥18 years of age and is no longer available in the U.S.⁴⁵ The safety of these vaccines for pregnant and breast-feeding women has not been officially established; however, the American College of Obstetricians and Gynecologists recommend otherwise eligible pregnant or lactating women be vaccinated.⁴⁴ Other manufacturers (e.g. AstraZeneca/Oxford, Novavax, others worldwide) have developed additional candidate vaccines and approval for children has been granted.

The current recommendation from the CDC is that everyone over 6 months of age get a 2023-2024 dose of one of the three available types of vaccines. For those over 12 years of age, these are the nRna vaccines Comirnaty (Pfzier-BioNTech) and Spikvax (Moderna), and the subunit protein adjuvanted Novamax COVID-19 vaccine.⁴⁶

Table 7. 2023-2024 SARS-CoV-2 Vaccines.⁴⁶

Vaccines	Indications	Schedules	Adverse Effects
Comirnaty	Preexposure	1 IM Dose (at least 4 months after if previously vaccinated against COVID-19)	Injection site pain, erythema and swelling, fatigue, axillary swelling / tenderness, fatigue, chills, headache, fever, muscle and joint pain, rare risk of myocarditis and pericarditis. Avoid if an allergic reaction to a Pfizer BioNTech COVID-19 vaccine occurred
Spikevax		1 IM Dose (at least 2 months after if previously vaccinated against COVID-19)	Pain at injection site, fatigue, headache, joint and muscle pain, chills, axillary swelling/tenderness and nausea/vomiting. Rare risk of myocarditis and pericarditis. Avoid if an allergic reaction to a Moderna COVID-19 vaccine occurred.
Novamax COVID-19 Adjuvanted		1 IM Dose if previously vaccinated against COVID-19 2 IM Doses, 0 and 21 days if not previously vaccinated	Injection site pain, erythema and swelling, fatigue, headache, myalgia, fever, nausea/vomiting. Rare risk of myocarditis and pericarditis. Avoid if an allergic reaction to a Novamax COVID-19 vaccine occurred.

0/21Next