Health Advisory: COVID-19 Updates for Providers

Actions Requested

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 U.S. Vaccine Adverse Events Reporting System (VAERS) at https://vaers.hhs.gov/reportevent.html.
- Report cases to Kitsap Public Health District’s 24-hour reporting line at (360) 728-2235. Include vaccine manufacturer, vaccination date, dose number, VAERS number, and history of prior SARS-CoV-2 infection.
Vaccinate everyone 12 years or older against COVID-19.
Build trust in COVID-19 vaccines.
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.
Refer patients who can’t easily leave home and need COVID-19 vaccine to call us at (360) 728-2219 or email covidvaccine@kitsappublichealth.org. We can get vaccine to them.
Call Kitsap Public Health District COVID Program staff with questions: (360) 728-2235.

Background

COVID-19 vaccine

As of May 30, Kitsap County residents had received approximately 239,547 total doses of COVID-19 vaccine. Over 53% of Kitsap residents ages 12 and older have initiated; 47.4% have completed vaccination (as of June 5). See our vaccine demographics page for details: https://kitsappublichealth.org/CommunityHealth/EpiData/EpiDataCOVID19VaccineDemographics.php.

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. Cases are predominantly male adolescents and young adults. Disease onset occurs more often following dose 2 than dose 1, and typically within several days after vaccination. Most cases appear to be mild, and follow-up is ongoing. It is not currently clear if there is a causal association with COVID-19 vaccination. CDC continues to recommend COVID-19 vaccination for people 12 years or older.

CDC is monitoring myocarditis and pericarditis in multiple safety systems, including VAERS and the Vaccine Safety Datalink (VSD). To date, a safety signal has not been identified in VAERS or VSD.

CDC posted Clinical Considerations: Myocarditis and Pericarditis after Receipt of mRNA COVID-19 Vaccines Among Adolescents and Young Adults, as well as related resources for the public. To support ongoing monitoring for this potential adverse event, evaluate patients with chest pain for myocarditis or pericarditis and inquire about recent COVID-19 vaccination. Promptly report any such cases to VAERS and to the Health District.

Clinical features of myocarditis and pericarditis include:

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

Elicit a detailed history, including vaccination status and potential exposures to COVID-19. Test patients for COVID-19 infection with a molecular (PCR) test. Initial evaluation should include ECG, troponin level, and inflammatory markers such as C-reactive protein and erythrocyte sedimentation rate. It is important to consider other potential causes.

Additional information

Follow-up of patients with myocarditis, consult recommendations from 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 WHO Global Advisory Committee on Vaccine Safety (GACVS) reviews cases of mild myocarditis reported with COVID-19 mRNA vaccines, World Health Organization (WHO) May 26, 2021 press release.
Myocarditis and Pericarditis Following mRNA COVID-19 Vaccination, CDC.
Selected Adverse Events Reported after COVID-19 Vaccination, CDC.

New vaccination incentives

On June 3, Gov. Jay Inslee announced COVID-19 vaccination incentives. The state will draw winners from the Washington State Immunization Information System (WA IIS). Accurate and prompt vaccination records are crucial to properly incentivize vaccine recipients.

Enter all COVID-19 vaccination records into WA IIS as quickly as possible.
Make sure patient information is accurate and up to date.
Make sure you enter all submitted patient information. Many people are having trouble getting MyIR Mobile to recognize them because the provider did not enter their phone number or other crucial information.

Be prepared, patients may contact you to verify their vaccination status. If they do so, you may:

Send them to MyIR Mobile if they can read English and have internet access and skills.
Send them to the Washington State Department of Health (DOH) call center at (800) 525-0127 if they prefer a different language or don’t have internet access or skills. Operators can help callers access and verify their vaccination records in WA IIS and can help in many languages or connect with an interpreter.
Supply them with a WA IIS or electronic health record (EHR) printout if the above options don’t work for them.

Additional Vaccine Resources

COVID-19 vaccine locator, DOH.
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.
J&J/Janssen 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 COCA Call: Johnson & Johnson/Janssen COVID-19 vaccine and cerebral venous sinus thrombosis with thrombocytopenia update for clinicians on early detection and treatment, CDC.

Recent MMWR publications

COVID-19 situation update

On June 6, Kitsap County confirmed 38 new COVID-19 cases and no new deaths. Our totals are 8,536 cases and 112 deaths. In the last week, 99 Kitsap resident cases were reported.

On our 14-day case rate per 100,000 is 84.5. Our 7-day new COVID-19 hospitalization rate per 100,000 is 0.4. You can see this data on our COVID-19 surveillance report page: https://kitsappublichealth.org/communityhealth/EpiData/EpiDataCOVID19VaccineDemographics.php.

Kitsap County COVID-19 case data continue to show significant disparities by race and ethnicity, particularly affecting American Indian/Alaska Native, Black, Latinx, and Native Hawaiian and Other Pacific Islander communities. You can also see these trends on our COVID-19 case demographic data page: https://kitsappublichealth.org/communityhealth/EpiDataCOVID19Demographics.php.

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. Individuals with questions or who need help registering for testing can call the Kitsap Public Health District at (360) 728-2235, Monday through Friday, from 8 a.m. to 4 p.m.

LAB	TIME TO PROCESS TEST	TESTS PROCESSED DAILY
FidaLab	24-48 hours	600
Kaiser	24 hours	600-700
Lab Corp	48 hours	Unknown
Northwest Pathology	24-48 hours	20,000
Quest	24-48 hours	600
UW Virology	18-24 hours	3,000-6,000
Atlas Genomic	9 hours	10,000

Patient education

Continue to share the following materials with patients:
Immediately report COVID-19 positive cases by calling (360) 728-2235 and asking for someone in the COVID Program or fax the positive result to (360) 813-1168.

Additional COVID-19 case resources