COVID-19 Vaccine: Practical Clinical Considerations
Authors: Christine Laine, Deborah Cotton, Darilyn V. Moyer
Journal: Annals of Internal Medicine (2021)

Special Articles26 March 2021COVID-19 Vaccine: Practical Clinical ConsiderationsFREEChristine Laine, MD, MPH, Deborah Cotton, MD, MPH, Darilyn V. Moyer, MDChristine Laine, MD, MPHEditor in Chief, Annals of Internal Medicine Search for more papers by this author, Deborah Cotton, MD, MPHDeputy Editor, Annals of Internal Medicine Search for more papers by this author, Darilyn V. Moyer, MDExecutive Vice President and Chief Executive Officer, American College of PhysiciansSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M21-1260 CME/MOC SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail There remain many unknowns about COVID-19 vaccine, but there has been great progress since Annals of Internal Medicine and the American College of Physicians hosted our first COVID-19 vaccine forum in October 2020. That initial forum described the science, approval process, development of clinical indications, and policy environment of vaccines that were in initial phase 3 trials (1). Subsequent forums in December 2020 and January 2021 addressed promoting vaccine acceptance (2) and distribution (3), respectively. Now only 5 months later, the discussion during our most recent forum on 24 March 2021 centered around questions about the 3 vaccines that have received emergency use approval by the U.S. Food and Drug Administration (FDA) and that are, thankfully, being administered with increasing rapidity in the United States.As of 22 March, the Centers for Disease Control and Prevention reported that 17.4% of U.S. adults are fully vaccinated and 32% had received at least 1 vaccine dose (4). The FDA review of a fourth COVID-19 vaccine appears to be imminent. As vaccination continues to expand, physicians and other clinicians have many practical questions about the vaccines and the postvaccination world.Are there people who should not receive COVID-19 vaccination? How should we advise pregnant women about vaccination? If someone develops COVID-19 after their first vaccine dose, should they receive monoclonal antibody? And what about the second dose? Does vaccination reduce viral transmission? If it does, why do we still need to wear masks and socially distance ourselves from others? Will booster vaccination be necessary and, if so, with what frequency? Should the identification of SARS-CoV-2 variants temper enthusiasm that the current vaccines will end the pandemic? When will international travel be safe?The forum held on 24 March 2021 aimed to address the issues on many clinicians' minds. Panelists included infectious disease experts Dr. Deborah Cotton (Annals Deputy Editor and Professor of Medicine and Epidemiology at Boston University), Dr. Carlos del Rio (Professor of Medicine, Global Health, and Epidemiology at Emory University), and Dr. Paul Sax (Professor of Medicine at Harvard University). View the program in the Video that accompanies this article to learn how the experts answered these and other questions. They also raised the vexing issues of health inequities both within and beyond U.S. borders.As we move past the pandemic's 1-year anniversary, the panelists offered welcome optimism. There are very few absolute contraindications to COVID-19 vaccination. The vaccine likely not only reduces COVID-19 morbidity and mortality but also transmission. The panelists noted that changes in infection control practices that health care settings initiated because of the pandemic have also reduced other respiratory illnesses. As data emerge to suggest that some patients have symptoms that persist long after their initial COVID-19 diagnosis, the panelists reminded us that by reducing the numbers of people who develop COVID-19, vaccination will consequently also reduce the numbers at risk for postacute sequelae. They contrasted the rapidity with which we learned about SARS-CoV-2 to the slower scientific progress during the emergence of HIV infection 40 years ago.While we have much more to learn about SARS-CoV-2 and the virus is certain to continue to present challenges going forward, the progress that the scientific, health care, and public health systems have made thus far warrants celebration.References1. Laine C, Cotton D, Moyer DV. COVID-19 vaccine: what physicians need to know. Ann Intern Med. 2020;173:830. [PMID: 33074704]. doi:10.7326/M20-6841 LinkGoogle Scholar2. Laine C, Cotton D, Moyer DV. COVID-19 vaccine: promoting vaccine acceptance. Ann Intern Med. 2021;174:252-253. [PMID: 33347321]. doi:10.7326/M20-8008 LinkGoogle Scholar3. Laine C, Cotton D, Moyer DV. COVID-19 vaccine distribution and allocation: what physicians need to know. Ann Intern Med. 2021;174:413-414. [PMID: 33492990]. doi:10.7326/M21-0331 LinkGoogle Scholar4. Centers for Disease Control and Prevention. COVID vaccine tracker. Accessed at https://covid.cdc.gov/covid-data-tracker/#vaccinations on 22 March 2021. Google Scholar Comments 0 Comments Sign In to Submit A Comment Dr.Pevsnernone26 March 2021 Celebration Warranted I whole heartedly concur that a celebration is warranted. Thanks to the panel for creating an update that shows not just promise but progress! Thomas Jefferson Saddoris IIProvidence and Adventist Hospitals in Portland OR.27 March 2021 Very valuable This Covid-19 forum from ACP was very valuable, highly informative, timely, and most interesting. This program easily distracted me from Saturday afternoon March Madness. As a practicing internist age 79 full time direct patient care, I felt a sense of pride of our medical profession with the review by these dedicated and knowledgeable teachers and investigators. They represent the best models of our public health science efforts. Thank you for this experience and I look for more soon. Thomas J Saddoris II MD T. NguyenUCLA1 April 2021 Access Access is to those elderly who are not capable and comfortable with making an appointment over the internet. Immediate family- spouse/children- of healthcare providers should have priority. No appointments. Just get in line and head count. Open again the next day, the same. Dr. Deborah Blenknone12 April 2021 Encouraged I also am grateful for this realistically encouraging article, but I am also much encouraged by Dr. Siddoris, who at 79 is in full time direct patient care practice! Thank you for being there as a role model and teacher! Our colleagues in psychiatry and the social sciences often speak of the damage done by ageism; hopefully this will enter the consciousness of those in all medical disciplines. Dr PADMASHRI GULATIGulati Eye Hospital & Medical care Centre, Railway Hospital, Jhansi , India19 April 2021 immunological Equity Very informative session on practical tips on Covid 19 vaccination on this forum. Immunological equity is the need of the day as rightly pointed out by Dr Carlos,and yes, postponing it to the 2nd trimester in pregnant women is a good idea. Hyeyoung LeemHero dental9 September 2021 RDH Forum was very helpful to understand behine vaccine. Von BrownChildren's National Medical Center14 January 2023 COVID-19 Vaccine: Practical Clinical Considerations This seminar was very informative and helpful when discussing vaccinations/boosters with pregnant relatives and friends, or elderly family members, such as my mother and others. Author, Article, and Disclosure InformationAuthors: Christine Laine, MD, MPH; Deborah Cotton, MD, MPH; Darilyn V. Moyer, MDAffiliations: Editor in Chief, Annals of Internal Medicine Deputy Editor, Annals of Internal Medicine Executive Vice President and Chief Executive Officer, American College of PhysiciansDisclosures: Disclosure forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M21-1260.Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Stephanie Chang, MD, MPH, Deputy Editor, reports employment with the Agency for Healthcare Research and Quality, travel compensation from the Guidelines International Network, and participation in the Patient-Centered Outcomes Research Institute methodology committee. Vineet Chopra, MD, MSc, Deputy Editor, reports grants received from the Agency for Healthcare Research and Quality and royalties from UpToDate and Oxford University Press. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interests to disclose. Eliseo Guallar, MD, MPH, DrPH, Deputy Editor, Statistics, reports that he has no financial relationships or interests to disclose. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose.Corresponding Author: Christine Laine, MD, MPH, Editor in Chief, Annals of Internal Medicine, 190 N. Independence Mall West, Philadelphia, PA 19106; e-mail, claine@acponline.org.This article was published at Annals.org on 26 March 2021. 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Moyer, MDCOVID-19: Evaluation and Care of Patients With Persistent Symptoms Following Acute SARS-CoV-2 InfectionChristine Laine, MD, MPH and Deborah Cotton, MD, MPH May 2021Volume 174, Issue 5 Page: 694 Keywords COVID-19 Disclosure Food and Drug Administration Health care Health care quality Health services research Infectious disease epidemiology Prevention, policy, and public health Research quality assessment Vaccines ePublished: 26 March 2021 Issue Published: May 2021 Copyright & PermissionsCopyright © 2021 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...