Third doses of Pfizer for immunocompromised individuals (given at least 28 days after second dose) are currently authorized under an amended EUA for individuals ages 5 and up.

Tromethamine (Tris) buffer replaced phosphate buffered saline (pbs) in both the vaccine authorized for children 5-11 and an additional formulation (available soon) authorized for those 12 and older. The Tris buffer in the vaccine for those 5-11, which is a very small amount at 0.15 mg, is an inactive ingredient and serves as a stabilizer used to aide in a simpler and longer storage period. This switch will allow for the Pfizer vaccine to be stored at normal refrigeration temperatures for up to 10 weeks, which may increase the vaccine’s availability to underserved areas.

Contrary to claims on social media, it is not being used to reduce blood acid levels in patients.

Tromethamine has been used safely as an ingredient in FDA approved vaccines, like Ebola Zaire, smallpox and dengue fever, as well as the FDA authorized Moderna COVID-19 vaccine.

Yes, if your child is over the age of 5, they are eligible for COVID-19 vaccination. Experts at the FDA and CDC have reviewed data from Pfizer clinical trials supporting the efficacy of a smaller dosage in children ages 5 to 11. Prior to that authorization, Pfizer was made available for children ages 12 to 17.

Pediatricians, infectious disease doctors and other experts overwhelmingly recommend COVID-19 vaccination in most cases.

With many children back in school and participating in extracurricular activities, COVID-19 vaccination among children as young as age 5 is critical to preventing infection and possible severe disease, as well as reducing the spread of COVID-19. There are approximately 28 million children between the ages of 5 and 11 in the United States, and there have been nearly 2 million cases of COVID-19 within this age group during the pandemic. While fewer children have been sick with COVID-19 compared to adults, children can be infected with the virus, and there is no way to tell in advance if a child will get a severe or mild case.After a natural infection, some children have developed a rare but serious disease that is linked to COVID-19 called multisystem inflammatory syndrome (MIS-C).

As more variants of COVID-19 develop, vaccination continues to be our best tool to reduce the chances that the virus has to mutate.

Choosing vaccination will:

• Protect your child from severe illness and disease
• Maintain in-person school, sports and extracurricular activities
• Protect your family members by reducing transmission
• Protect our communities from future variant development

Pfizer data shows that their COVID-19 vaccine is more than 90% effective in kids ages 5-11 after more than 2,000 children participated in their clinical trial. Getting vaccinated for COVID-19 is the safest way to build immunity from infection. Hundreds of millions of Americans have been safely vaccinated, including more than 11 million children ages 12-17 – that’s nearly half of all those in that age group – and no serious safety concerns have been identified.

As always, we encourage you to speak with your family doctor or pediatrician to help guide you. Here is a video from the American Academy of Pediatrics with more information on how mRNA vaccines work.

Side effects from the COVID-19 vaccines in children and adults are very similar. Your child may experience mild side effects like a sore arm, body aches, chills, headache, nausea, tiredness or fever. These are normal signs that their body is building protection, but they should go away in a few days.

Although some reports of both myocarditis and pericarditis have been observed after some COVID-19 vaccinations, these reports are very rare. Myocarditis is a much more common complication from a COVID-19 infection.

In almost all cases, both myocarditis and pericarditis is mild and resolves quickly.

COVID-19 vaccines have undergone – and will continue to undergo – the most intensive safety monitoring in U.S. history. CDC and FDA will continue to monitor safety using our established and new safety monitoring systems. Parents/caregivers can enroll their child in v-safe, a free and easy-to-use smartphone-based app, where they can complete health check-ins after COVID-19 vaccination and report how their child is feeling after vaccination. Additionally, patients, caregivers, and vaccine providers are also asked to report adverse events after vaccination to the Vaccine Adverse Event Reporting System (VAERS), even if it is not clear that the vaccine caused the adverse event. CDC reviews all of the information and reports any serious adverse reactions.

The COVID-19 vaccines reduce the risk of infection dramatically, which in turn prevents transmission in both symptomatic and asymptomatic cases.

It is true that adults and children can transmit COVID-19 if they are infected, even if they aren’t experiencing symptoms. However, symptomatic infection increases transmission risk because of virus spread through coughing and sneezing.

Getting the COVID-19 vaccine can protect your child and others by reducing both infection and, as a result, overall transmission risk to classmates, family members and friends who may be susceptible to severe illness.

The Pfizer-BioNTech Vaccine for children ages 5 through 11 has the same active ingredients as the vaccine given to adults and adolescents. However, the vaccine for children comes in a different vial with a different color cap. The Pfizer-BioNTech Vaccine that is given to adults and adolescents cannot be used for children ages 5 through 11 years. Children ages 5 through 11 will receive an age-appropriate dose that is one-third of what adolescents and adults receive. Smaller needles, designed specifically for children, are used for children ages 5 through 11 years. COVID-19 vaccine dosage does not vary by patient weight but by age on the day of vaccination. Children are still required to get two doses three weeks apart to be considered fully vaccinated.

Vaccines.gov lists locations on an interactive map where doses for children are available. You can also text your ZIP code to 438829, or call 1-800-232-0233 to find locations near you.

We encourage Missouri vaccinators to partner with schools, districts and communities to host pediatric vaccination clinics. These vaccine providers can encourage school-based and extracurricular vaccination for younger school-aged children to hold targeted programs to ensure equity and coverage.

Yes. You can get a COVID-19 vaccine and other vaccines, including a flu vaccine, at the same visit. Experience with other vaccines has shown that the way our bodies develop protection, known as an immune response, after getting vaccinated and possible side effects of vaccines are generally the same when given alone or with other vaccines.

Click here to view immunizations schedules by age group.

COVID-19 vaccine dosages are based on age and not size or weight. If a child turns from 11 to 12 years of age in between their first and second dose and receives the pediatric Pfizer-BioNTech COVID-19 Vaccine for their first dose, it is recommended by CDC to administer the second dose using dosing guidance for those 12 and up.

No. There is no evidence that any vaccines, including COVID-19 vaccines, can cause female or male fertility problems.

• CDC Recommendation for Pfizer in ages 12-15:
  https://www.cdc.gov/mmwr/volumes/70/wr/mm7020e1.htm?s_cid=mm7020e1_w
• CDC Report on Pfizer vaccine safety in ages 12-15:
  https://www.cdc.gov/mmwr/volumes/70/wr/mm7031e1.htm?s_cid=mm7031e1_w
• CDC Report on COVID-19 hospitalization among unvaccinated adolescents:
  https://www.cdc.gov/mmwr/volumes/70/wr/mm7036e2.htm
• CDC Report on COVID-19 vaccination reducing risk of reinfection compared to unvaccinated individuals:
  https://www.cdc.gov/mmwr/volumes/70/wr/mm7032e1.htm
• CDC Long-COVID in adults and children:
  https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html
• medRxiv Study on Natural Immunity in Children:
  https://www.medrxiv.org/content/10.1101/2021.10.17.21265121v1
• American Academy of Pediatrics State-Level Data Report (weekly updates):
  https://www.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/children-and-covid-19-state-level-data-report/
• Missouri Case Data by Age:
  https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/data/public-health/demographics.php

Booster doses of Pfizer (given at least 5 months after initial series) are available for those 12 and up.

Booster doses of Moderna (given at least 5 months after initial series) are available for those 18 and up.

Booster doses of Johnson & Johnson (given at least 2 months after an initial series) are available for those 18 and up.

Third doses of Pfizer for immunocompromised individuals (given at least 28 days after second dose) are currently authorized under an amended EUA for immunocompromised individuals ages 5 and up.

Third doses of Moderna for immunocompromised individuals (given at least 28 days after second dose) are also authorized under an amended EUA for immunocompromised individuals ages 18 and up.

A third dose of the Pfizer (5 and up) or Moderna (18 and up) vaccines may be administered 28 days after a second dose to moderately to severely immunocompromised people due to a medical condition or combination of immunosuppressive medication or treatments including but not limited to the following:

• Immunocompromised due to solid organ transplant and taking immune suppressing medications
• Immunocompromised due to active treatment for solid tumor and hematologic malignancies
• Immune compromised due to Receipt of CAR-T cell or hematopoietic stem cell transplant (within 2 years of transplantation or taking immunosuppression therapy)
• Moderate to severe primary immunodeficiency (eg., DiGeorge, Wiskott-Aldrich Syndromes)
• Immunocompromised due to Advanced or untreated HIV infection
• Immunocompromised due to “Active treatment with high-dose corticosteroids or other drugs that may suppress immune response: high dose corticosteroids (ie.,≥ 20 mg prednisone or equivalent per day), alkylating agents, antimetabolites, transplant-related immunosuppressive drugs, cancer chemotherapeutic agents classified as severely immunosuppressive, tumor-necrosis (TNF) blocker or other biologic agents that are immunosuppressive or immunomodulatory”

Research shows that all COVID-19 vaccines authorized in the United States continue to be highly effective at preventing severe illness and death. Health experts from the CDC’s Advisory Committee on Immunization Practices voted to expand booster eligibility to all individuals ages 12 and up who received an initial series of Pfizer, as well as those ages 18 and older who completed an initial series of Moderna and Johnson & Johnson, critical scientific evaluation. The decision took into account the current state of COVID-19 activity, the latest vaccine effectiveness data and a review of safety data from those who already received a booster. See the evidence ACIP used to recommend booster doses by clicking here.

Learn more about COVID-19 booster doses from the Centers for Disease Control and Prevention.

Announcements from federal health officials for third doses came after the analysis of studies demonstrating that immunosuppressed people are more likely to get severely ill from COVID-19, are at higher risk for prolonged infection, are more likely to transmit the virus, and experience lower vaccine effectiveness. See the evidence ACIP used to support a third dose by clicking here.

In line with federal guidelines, Missouri uses a self-attestation model for individuals seeking a third dose. Individuals will not be required to provide documentation of their health status, and they can get third doses at all venues where first and second doses are available.

Self-attestation form for third doses (immunocompromised)

For a third dose, mRNA vaccine products may be interchanged if the original product is not available or unknown. Individuals getting a third dose should wait at least 28 days between their second and third doses.

Individuals receiving a booster dose should wait at least 5 months after their initial series of Pfizer or Moderna, or wait 2 months after their initial dose of Johnson & Johnson. Booster doses may be mixed and matched in eligible individuals after the completion of a primary vaccination series.

Yes, pregnancy is considered a factor that puts an individual at high risk for becoming severely ill with COVID-19. Pregnant and recently pregnant people (for at least 42 days following end of pregnancy) are more likely to get severely ill from COVID-19 compared with non-pregnant people, and we encourage these women to get a booster dose.

Hundreds of millions of Americans have been safely vaccinated, with the vast majority experiencing minor, temporary side effects. No safety concerns were identified for the Pfizer and Moderna vaccines in subgroup analyses by age, race, ethnicity, underlying medical conditions, or previous SARS-CoV-2 infection. In addition, the single-dose Janssen vaccine has also met safety and efficacy standards.

As an additional layer of checks and balances, an external advisory board made up of medical and research professionals using additional public health data have reviewed final COVID-19 vaccine data and recommended the Pfizer, Moderna and Janssen vaccines be made available for emergency use.

America’s best medical and research professionals have been working for years on coronavirus vaccines for SARS and MERS. SARS and MERS are different than COVID-19 but belong to the coronavirus family. The lessons learned through those developments are being applied today. Specifically, the effort to develop a COVID-19 vaccine began more than one year ago.

Vaccine safety monitoring systems are in place to collect side effect data. If an unexpected adverse event is seen, experts quickly study it further to assess whether it is a true safety concern. Experts then decide whether changes are needed in U.S. vaccine recommendations. This monitoring is critical to help ensure that the benefits continue to outweigh the risks for people who receive vaccines.

Although the timeline has been accelerated, it doesn’t mean we skipped the integrity of the trial and approval processes. Scientists have had a jump on developing the COVID-19 vaccine, using their experience from previous coronavirus vaccine efforts. Another way scientists preserved safety and saved time was by working on efforts simultaneously, rather than one after another like the traditional process. For example, COVID-19 vaccines were in Phase III clinical trials at the same time they were being manufactured. When it was proven safe and effective, the manufactured vaccines were deployed. If the vaccines don’t pass the approval process, which is verified by an independent committee of health experts, the unproven vaccines won’t be used.

You should delay your vaccination if you have had a known SARS-CoV-2 (virus that causes COVID-19) exposure until your quarantine period has ended, unless residing in a congregate setting (health care/long-term care facility, correctional facility, homeless shelter, etc.).

Routine testing for pregnancy or antibody tests is not recommended in relation to vaccine use.

COVID-19 and other vaccines may now be administered without regard to timing. This includes simultaneous administration of COVID-19 and other vaccines on the same day.

Yes, patients should receive the same vaccine for both the first and second doses of Pfizer or Moderna. Your vaccination provider will give you a vaccine card stating the manufacturer name and other critical information you will need for a second dose.

Those who are eligible for a booster dose may receive any of the COVID-19 vaccines authorized in the United States after the completion of a two-dose series of Pfizer or Moderna, or one dose of the Johnson & Johnson vaccine. To learn more, click here.

Pfizer’s vaccine has been approved for individuals 16 and older, and authorized for those ages 5-15. Moderna and Janssen's vaccines have been authorized for those 18 and older.

The Pfizer and Moderna vaccines are not recommended for individuals who have experienced a serious reaction (e.g., anaphylaxis) to a prior dose of a COVID-19 vaccine or to any of its components. Those who have had a severe allergic reaction to any ingredient of the Janssen vaccine should not receive the Janssen vaccine. For information on vaccine components, refer to the manufacturers’ package inserts from Pfizer, Moderna, and Janssen.

The ingredients used in the mRNA vaccines developed by Pfizer and Moderna are simple. They contain mRNA, as well as lipids to ensure safe delivery of the mRNA that will initiate an immune response.

Ingredients of the Janssen COVID-19 vaccine include: recombinant, replication-incompetent adenovirus type 26 expressing the SARS-CoV-2 spike protein, citric acid monohydrate, trisodium citrate dihydrate, ethanol, 2-hydroxypropyl-β-cyclodextrin (HBCD), polysorbate-80, sodium chloride.

Although FDA approved adjuvants (aluminum salts) and preservatives (ethlymercury) have a history of safe use in vaccines, they were not used by Pfizer, Moderna or Janssen.

After getting vaccinated, you might have some side effects, which are normal signs that your body is building protection. Common side effects are pain, redness, and swelling in the arm where you received the shot, as well as tiredness, headache, muscle pain, chills, fever, and nausea throughout the rest of the body. These side effects could affect your ability to do daily activities, but they should go away in a few days. Click here to earn more about what to expect after getting a COVID-19 vaccine.

No. Every day, a healthfy immune system successfully fights off thousands of germs. Antigens are parts of germs that cause the body’s immune system to go to work to build antibodies, which fight off diseases. The antigens in vaccines come from the germs themselves, but the germs are weakened or killed so they cannot cause serious illness. Even if people receive several vaccinations in one day, vaccines contain only a tiny fraction of the antigens they encounter every day in their environment. Vaccines stimulate the immune system to produce antibodies to fight off serious vaccine-preventable diseases.

Pfizer’s clinical trial enrolled 44,000+ participants with 42% globally having racially and ethnically diverse backgrounds. Of Moderna’s 30,000 trial participants, 37% were from minority communities, including 6,000 Hispanic and 3,000 Black participants. Janssen’s trial included 43,783 participants in the United States, Latin America and South Africa.

According to the CDC, people are considered fully vaccinated for COVID-19 ≥2 weeks after they have received the second dose in a 2-dose series (Pfizer-BioNTech or Moderna), or ≥2 weeks after they have received a single-dose vaccine (Johnson and Johnson (J&J)/Janssen ).

The following recommendations apply to non-healthcare settings. For related information for healthcare settings, visit Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination.

Fully vaccinated people can (according to CDC guidance):

• Participate in many of the activities that they did before the pandemic.
• Resume domestic travel and refrain from testing before or after travel and from self-quarantine after travel.
• Refrain from testing before leaving the United States for international travel (unless required by the destination) and refrain from self-quarantine after arriving back in the United States.
• Refrain from routine screening testing if feasible.

To reduce the risk of becoming infected with SARS-CoV-2 (the virus that causes COVID-19) including the Delta variant, and potentially spreading it to others, CDC recommends that fully vaccinated people:

• Wear a mask indoors in public if they are in an area of substantial or high transmission.
  • Fully vaccinated people might choose to mask regardless of the level of community transmission, particularly if they or someone in their household is immunocompromised or at increased risk for severe disease, or if someone in their household is unvaccinated.
• Get tested if experiencing COVID-19 symptoms.
• Get tested 5-7 days after close contact with someone with suspected or confirmed COVID-19.
• Wear a mask indoors in public for 14 days after exposure or until a negative test result.
• Isolate if they have tested positive for COVID-19 in the prior 10 days or are experiencing COVID-19 symptoms.
• Follow any applicable federal, state, local, tribal, or territorial laws, rules, and regulations.

To ensure you are viewing the latest federal guidance, please click here. The CDC guidance will be updated and expanded based on the level of community spread of SARS-CoV-2, the proportion of the population that is fully vaccinated, and the rapidly evolving science on COVID-19 vaccines.

According to the CDC, people are considered fully vaccinated for COVID-19 ≥2 weeks after they have received the second dose in a 2-dose series (Pfizer-BioNTech or Moderna), or ≥2 weeks after they have received a single-dose vaccine (Johnson and Johnson (J&J)/Janssen ).

Fully vaccinated people who have come into close contact with someone with COVID-19 should be tested 5-7 days following the date of their exposure and wear a mask in public indoor settings for 14 days or until they receive a negative test result. [ii] They should isolate if they test positive. Fully vaccinated people who live in a household with someone who is immunosuppressed, at increased risk of severe disease, or unvaccinated (including children <12 years of age) could also consider masking at home for 14 days following a known exposure or until they receive a negative test result. Most fully vaccinated people with no COVID-like symptoms do not need to quarantine or be restricted from work following an exposure to someone with suspected or confirmed COVID-19, if they follow the testing and masking recommendation above.

Fully vaccinated people should monitor for symptoms of COVID-19 for 14 days following an exposure.

Although the risk that fully vaccinated people could become severely ill and die of COVID-19 is low, any fully vaccinated person who experiences symptoms consistent with COVID-19 should isolate themselves from others, be clinically evaluated for COVID-19, and tested for SARS-CoV-2 if indicated. The symptomatic fully vaccinated person should inform their healthcare provider of their vaccination status at the time of presentation to care.

To ensure you are viewing the latest federal guidance, please click here. The CDC guidance will be updated and expanded based on the level of community spread of SARS-CoV-2, the proportion of the population that is fully vaccinated, and the rapidly evolving science on COVID-19 vaccines.

Yes. Whether you are trying to become pregnant now or want to get pregnant in the future, obstetricians recommend getting vaccinated against COVID-19. It is widely accepted in the medical community that the impact of being infected by COVID-19 during pregnancy can be devastating.

There is currently no evidence that COVID-19 vaccination causes any problems with pregnancy, including the development of the placenta. In addition, there is no evidence that fertility problems are a side effect of any vaccine, including COVID-19 vaccines.

States are required to verify that the vaccinators have licenses for the states they will be vaccinating in and that they are in good standing. The Bureau of Immunizations within DHSS will verify licenses utilizing professional boards of registration.

The overwhelming majority of people who are infected by SARS-CoV-2, the virus that causes COVID-19 recover after some time. That means in most cases, a patient's immune response is adequate enough to suppress the virus and eliminate it from their body. That gives medical professionals confidence that a vaccine could initiate a similar response without the risks of a natural infection.

We also had a jumpstart on the development of this vaccine. America’s best medical and research professionals have been working for years on coronavirus vaccines for SARS and MERS. SARS and MERS are different than SARS-CoV-2 but belong to the coronavirus family. The lessons learned through those developments are being applied today. Specifically, the effort to develop a COVID-19 vaccine began months ago.

Yes, those who have or have a history of thrombocytopenia, who have or have a history of a low platelet count, prior surgery (cardiac, orthopedic, trauma), cardiovascular disease, oral contraceptive use or hereditary thrombophilia. If you experience any of the following symptoms seek medical attention right away: Shortness of breath, chest pain, leg pain or swelling, backache, persistent abdominal pain, severe and persistent headaches, visual changes or easy bruising or tiny blood spots under the skin beyond the site of the injection.

The federal government of the United States requested pause in the use of this vaccine out of an abundance of caution on April 13 and announced administration could resume on April 23.

Six reported U.S. cases of a rare and severe type of blood clot in individuals occurred after receiving the J&J vaccine. These adverse events are extremely rare. Nearly 7 million people in the United States had received Johnson & Johnson shots prior to the pause. Cases occurred among women between the ages of 18 and 48, and symptoms occurred 6 to 13 days after vaccination.

Yes. Following a thorough safety review, including two meetings of the CDC’s Advisory Committee on Immunization Practices, the U.S. Food and Drug Administration and the U.S. Centers for Disease Control and Prevention have determined that the recommended pause regarding the use of the Janssen (Johnson & Johnson) COVID-19 Vaccine in the U.S. should be lifted and use of the vaccine should resume.

The two agencies have determined the following:

• Use of the Janssen COVID-19 Vaccine should be resumed in the United States.
• The FDA and CDC have confidence that this vaccine is safe and effective in preventing COVID-19.
• The FDA has determined that the available data show that the vaccine’s known and potential benefits outweigh its known and potential risks in individuals 18 years of age and older.
• At this time, the available data suggest that the chance of TTS occurring is very low, but the FDA and CDC will remain vigilant in continuing to investigate this risk.
• Health care providers administering the vaccine and vaccine recipients or caregivers should review the Janssen COVID-19 Vaccine Fact Sheet for Healthcare Providers Administering Vaccine (Vaccination Providers) and Fact Sheet for Recipients and Caregivers, which have been revised to include information about the risk of this syndrome, which has occurred in a very small number of people who have received the Janssen COVID-19 Vaccine.

CDC’s independent Advisory Committee on Immunization Practices met to discuss the latest data on TTS, hearing from the vaccine manufacturer Janssen and the COVID-19 Vaccine Safety Technical (VaST) Subgroup, as well as a risk benefit analysis. ACIP is committed to be vigilant and responsive to additional information that could impact the risk benefit analysis of any of these vaccines. Vaccine safety monitoring will continue and any new information about TTS will be brought to ACIP as needed.

COVID-19 vaccines are working well to prevent severe illness, hospitalization, and death, even against the widely circulating Delta variant. However, public health experts are starting to see reduced protection, especially among certain populations, against mild and moderate disease. Early data indicates that immunity wanes after 6 months of protection, so boosters are recommended for certain populations who received either Pfizer or Moderna and all individuals who received Johnson & Johnson.

As of November 2021, Missouri has reported more than 6,250 individuals who have been infected by COVID-19 twice. To see Missouri’s data on reinfections, click here.

To learn more about booster eligibility and supporting data, click here.

COVID-19 vaccines are effective at preventing infection, serious illness, and death. Most people who get COVID-19 are unvaccinated. However, since vaccines are not 100% effective at preventing infection, some people who are fully vaccinated will still get COVID-19.

An infection of a fully vaccinated person is referred to as a "vaccine breakthrough infection."

• Fully vaccinated people with a vaccine breakthrough infection are less likely to develop serious illness than those who are unvaccinated and get COVID-19.
• Even when fully vaccinated people develop symptoms, they tend to be less severe symptoms than in unvaccinated people. This means they are much less likely to be hospitalized or die than people who are not vaccinated.
• According to the CDC, studies show so far that vaccinated people are 8 times less likely to be infected and 25 times less likely to experience hospitalization or death than unvaccinated people.

To learn more, click here.

To see Missouri’s data on breakthrough infections, click here.

At this time, the CDC does not recommend taking pain relievers before a COVID-19 vaccination appointment because there is not enough information to determine the impact the medications may have on the immune response. However, they may be used post-vaccination to ease discomfort.

According to the CDC, people are considered fully vaccinated for COVID-19 ≥2 weeks after they have received the second dose in a 2-dose series (Pfizer-BioNTech or Moderna), or ≥2 weeks after they have received a single-dose vaccine (Johnson and Johnson (J&J)/Janssen ).

The following recommendations apply to non-healthcare settings. For related information for healthcare settings, visit Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination.

Fully vaccinated people can:

• Participate in many of the activities that they did before the pandemic.
• Resume domestic travel and refrain from testing before or after travel and from self-quarantine after travel.
• Refrain from testing before leaving the United States for international travel (unless required by the destination) and refrain from self-quarantine after arriving back in the United States.
• Refrain from routine screening testing if feasible.

To reduce the risk of becoming infected with SARS-CoV-2 (the virus that causes COVID-19) including the Delta variant, and potentially spreading it to others, CDC recommends that fully vaccinated people:

• Wear a mask indoors in public if they are in an area of substantial or high transmission.
  • Fully vaccinated people might choose to mask regardless of the level of community transmission, particularly if they or someone in their household is immunocompromised or at increased risk for severe disease, or if someone in their household is unvaccinated.
• Get tested if experiencing COVID-19 symptoms.
• Get tested 5-7 days after close contact with someone with suspected or confirmed COVID-19.
• Wear a mask indoors in public for 14 days after exposure or until a negative test result.
• Isolate if they have tested positive for COVID-19 in the prior 10 days or are experiencing COVID-19 symptoms.
• Follow any applicable federal, state, local, tribal, or territorial laws, rules, and regulations.

To ensure you are viewing the latest federal guidance, please click here. The CDC guidance will be updated and expanded based on the level of community spread of SARS-CoV-2, the proportion of the population that is fully vaccinated, and the rapidly evolving science on COVID-19 vaccines.

To see Missouri’s data on reinfections and infections following vaccination, click here.

COVID-19 is a deadly disease that causes severe illness – and in some cases, long term symptoms that we have yet to fully understand. The COVID-19 vaccine candidates have been created to decrease death and severe illness.

Although a high percentage of people recover from COVID-19, some are hospitalized and experience severe illness. It is also somewhat common to have the virus but never experience symptoms, and it is possible to spread the virus to others even when symptoms are not present. When you make the choice to be vaccinated, you are protecting not only you but also those around you from the chance of death and severe illness caused by COVID-19.

Both the Pfizer and Moderna vaccines have an approximate 95% efficacy rate and are highly effective in preventing severe disease. In December, the CDC published that the Pfizer and Moderna vaccines had a constant efficacy rate across age, sex and ethnicity categories, as well as among individuals with underlying medical conditions and those who have been previously infected by SARS-CoV-2. Additionally, initial clinical data showed protection is achieved 28 days after the initiation of the Pfizer vaccine, which consists of a 2-dose schedule.

According to Moderna's website, initial trial data was used to estimate a vaccine efficacy of 94.5%. Initial data from Moderna also shows the vaccine may provide some protection against asymptomatic SARS-CoV-2 infection.

AstraZeneca estimates a 90% efficacy rate from a specific 2-dose schedule.

Janssen’s clinical trials showed an 85% efficacy rate in preventing hospitalization and complete protection against death caused by SARS-CoV-2 after one dose, and up to 94% efficacy after a booster dose is administered.

All authorized vaccines are highly effective. The different types of vaccines were not studied in head-to-head comparisons or trials; therefore, they should not be compared to each other.

The COVID-19 vaccines reduce the risk of infection dramatically, which in turn prevents transmission in both symptomatic and asymptomatic cases.

It is true that adults and children can transmit COVID-19 if they are infected, even if they aren’t experiencing symptoms. However, symptomatic infection increases transmission risk because of virus spread through coughing and sneezing.

Getting the COVID-19 vaccine can protect your child and others by reducing both infection and, as a result, overall transmission risk to classmates, family members and friends who may be susceptible to severe illness.

To ensure you are accessing the most recent data on this topic, we encourage you to visit CDC’s science brief on infection-induced and vaccine-induced immunity here.

Key findings and considerations as of Nov. 5, 2021 are as follows:

• Available evidence shows that fully vaccinated individuals and those previously infected with SARS-CoV-2 each have a low risk of subsequent infection for at least 6 months. Data are presently insufficient to determine an antibody titer threshold that indicates when an individual is protected from infection. At this time, there is no FDA-authorized or approved test that providers or the public can use to reliably determine whether a person is protected from infection.
  • Multiple studies have shown that antibody titers correlate with protection at a population level, but protective titers at the individual level remain unknown.
  • The immunity provided by vaccine and prior infection are both high but not complete (i.e., not 100%).
  • Whereas there is a wide range in antibody titers in response to infection with SARS-CoV-2, completion of a primary vaccine series, especially with mRNA vaccines, typically leads to a more consistent and higher-titer initial antibody response.
  • For certain populations, such as the elderly and immunocompromised, the levels of protection may be decreased following both vaccination and infection.
  • Current evidence indicates that the level of protection may not be the same for all viral variants.
  • The body of evidence for infection-induced immunity is more limited than that for vaccine-induced immunity in terms of the quality of evidence (e.g., probable bias towards symptomatic or medically-attended infections) and types of studies (e.g., observational cohort studies, mostly retrospective versus a mix of randomized controlled trials, case-control studies, and cohort studies for vaccine-induced immunity). There are insufficient data to extend the findings related to infection-induced immunity at this time to persons with very mild or asymptomatic infection or children.
• Substantial immunologic evidence and a growing body of epidemiologic evidence indicate that vaccination after infection significantly enhances protection and further reduces risk of reinfection, which lays the foundation for CDC recommendations.

Emerging data also indicate that reinfection by SARS-CoV-2 (in an endemic environment) may occur around 16 months for individuals in an endemic state.

The two mRNA vaccines require two doses. Johnson & Johnson’s vaccine requires one dose; however, experts recommend a booster dose of J&J for all individuals two months after the first dose.

It is important that patients return for the second dose to develop the highest level of protection from SARS-CoV-2. Patients who do not receive the second Pfizer vaccination dose at 21 days or the Moderna vaccination at 28 days should still receive that second dose as soon as possible thereafter.

A vaccine is necessary to help you and your community shape a new normal. Stopping a pandemic requires using all the tools available. Vaccines boost your immune system so it will be ready to fight the virus if you are exposed. Other steps, like masks and social distancing, help reduce your chance of being exposed to or spreading the virus.

Yes. We are seeing evidence of reinfection in patients. Early evidence suggests natural immunity from SARS-CoV-2 may not last very long, but more studies are needed to better understand this. Vaccination should not occur until the patient has met criteria to discontinue isolation.

Patients who do not receive the second vaccination dose at 21 days for Pfizer or 28 days for Moderna should still receive that second dose as soon as possible thereafter. However, if it is not feasible to adhere to the recommended interval and a delay in vaccination is unavoidable, the second dose of Pfizer-BioNTech and Moderna COVID-19 vaccines may be administered up to 6 weeks (42 days) after the first dose. There are currently limited data on efficacy of mRNA COVID-19 vaccines administered beyond this window. If the second dose is administered beyond these intervals, there is no need to restart the series.

Scientists are working to learn more about these variants to better understand how easily they might be transmitted and whether currently authorized vaccines will protect people against them; however, early evidence suggests the vaccines remain effective against the variant. Currently, there is no evidence that these variants cause more severe illness or increased risk of death. New information about the virologic, epidemiologic, and clinical characteristics of these variants is rapidly emerging. The Missouri State Public Health Laboratory, in collaboration with the CDC, is monitoring the situation closely.

Antibody testing is not currently recommended to assess for immunity to COVID-19 following COVID-19 vaccination or to assess the need for vaccination in an unvaccinated person. Since vaccines induce antibodies to specific viral protein targets, post-vaccination serologic test results will be negative in persons without history of previous natural infection if the test used does not detect antibodies induced by the vaccine.

DHSS is not offering replacement cards; however you can complete a Request for Official State of Missouri Immunization Records form, and DHSS can send you a copy of the immunization record on file in ShowMeVax, the statewide immunizations registry. Submit the completed form to have your request processed, either by email or fax: ImmunizationRecordRequests@health.mo.gov / 573-526-0238 (fax).

This may vary for each vaccinator. Just like a regular doctor's appointment, we recommend you call ahead to ask what you will need to provide. Examples may include a driver license and insurance provider information, if applicable. COVID-19 vaccinations are completely free for all individuals, regardless of residency or insurance status.

There are specific requirements for minors (under age 18) getting vaccinated:

• Minors under the care of a parent/guardian must have:
  • a parent/guardian present at the time of vaccination who is willing to sign the requisite paperwork; or
  • notarized written consent in cases where the parent/guardian is not present at the vaccination; or
  • un-notarized written consent, if verbal confirmation can be obtained by telephone, in cases where the parent/guardian is not present at the vaccination.
• If the minor is under the care of:
  • a relative caregiver, a “relative caregiver” affidavit must be provided for the minor to receive the vaccination.
  • the Department of Social Services, written consent from Children’s Division (or designee) or Division of Youth Services must be provided for the minor to receive the vaccination.
• If the minor is married, pregnant, or a minor parent, documentation of this should be shown at the time of the vaccination.
• If the minor is homeless, such documentation may be letters from persons/entities such as (but not limited to): a director or designee of a governmental or nonprofit agency that receives public or private funding to provide services to homeless persons; a location education agency liaison for homeless children and youth; a school social worker/counselor; or a licensed attorney representing the minor in any legal matter.

Missourians' healthcare information is, and will continue to be, safe. We will never use individual patient information that you provide in unethical ways. Limited data is reported from your local vaccination site to state and federal government.

Nothing. The federal government is providing the vaccine free of charge to all people living in the United States, regardless of their immigration or health insurance status.

COVID-19 vaccination providers cannot:

• Charge you for the vaccine
• Charge you directly for any administration fees, copays, or coinsurance
• Deny vaccination to anyone who does not have health insurance coverage, is underinsured, or is out of network
• Charge an office visit or other fee to the recipient if the only service provided is a COVID-19 vaccination
• Require additional services in order for a person to receive a COVID-19 vaccine; however, additional healthcare services can be provided at the same time and billed as appropriate

COVID-19 vaccination providers can:

• Seek appropriate reimbursement from the recipient’s plan or program (e.g., private health insurance, Medicare, Medicaid) for a vaccine administration fee
  • However, providers cannot charge the vaccine recipient the balance of the bill
• Seek reimbursement for uninsured vaccine recipients from the Health Resources and Services Administration’s COVID-19 Uninsured Program

Individuals aware of any potential violations of these requirements are encouraged to report them to the Office of the Inspector General, U.S. Department of Health and Human Services, by calling 1-800-HHS-TIPS or the website TIPS.HHS.GOV.

No resident may be charged for the COVID-19 vaccine, so uninsured Missourians cannot be denied vaccination based on their health insurance status.

Those who may have the virus need to know so they can take measures to keep from infecting others. Testing also helps inform us of the status of viral activity in our communities so we can make informed and safe decisions.

A simple test can provide peace of mind for you, your family and your community. Testing is not only for those who have symptoms, but important for periodic surveillance especially when interacting with vulnerable populations and crowds. Many camps, events, and travel now require evidence of a test result before participation.

A COVID-19 test is a one-time assessment, and will only show if the individual is infected at the time of the test. For those experiencing symptoms of COVID-19, testing is highly recommended. Those who have not been fully vaccinated and have had significant contact with someone with confirmed COVID-19 should get tested.

The State continues to offer community testing events in areas throughout the state in a regular weekly cadence. Additionally, most urgent care clinics now have rapid testing resources available. Free at-home kits are available to order, and rapid tests are available over the counter through several retailers.

Contact your health care provider or an urgent care clinic near you, or visit Health.Mo.Gov/CommunityTest to find additional testing options.

Yes! At-home tests that check for presence of SARS-CoV-2, the virus that causes COVID-19, are available for free to Missouri residents.

A Missourian choosing this testing option will order the free testing kit online, and the kit will be delivered to the home in two days. The kit is good for six months and comes with easy-to-follow instructions. Once the individual performs the collection by nasal swab, the testing kit needs to be returned to a FedEx collection site within 24 hours. Shipping is also free. Test results are then provided via email within two days.

These tests were authorized for emergency use by the FDA.

State-sponsored community testing events are free COVID-19 testing options that are available to anyone without a specific reason for needed for testing. At-home tests that check for presence of SARS-CoV-2, the virus that causes COVID-19, are also available for free to Missouri residents (see above).

Clinics or other providers may charge a fee or bill your insurance, if applicable.

Testing has become widely available in the United States. Below are the types of tests you may seek, depending on your situation.

• PCR: high-sensitivity, high-specificity tests used to diagnose a current or recent COVID-19 infection by detecting genetic material specific to SARS-COV-2.
• Antigen: used to diagnose a COVID-19 infection by detecting a specific protein from the virus. These tests often have a quick turnaround time and are referred to as “rapid tests.”
• Antibody (serlogy): used to detect antibodies made by your immune system in response to a COVID-19 exposure. Antibody tests are not used to diagnose active infection.

To learn more about testing types and results, visit CDC.gov.

Missouri is participating in the national surveillance for COVID-19 variants of concern. Our state’s public health laboratory is sequencing a limited amount of samples for presence of genetic material specific to each variant. To see the latest data, visit CDC.gov.

Since February 2021, the Missouri Department of Health & Senior Services has been collaborating with the Missouri Department of Natural Resources and the University of Missouri to test wastewater samples for the presence of COVID-19variants in our communities. You can learn more about Missouri’s Sewershed Surveillance Project by clicking here at Health.Mo.Gov/coronavirus.

Rumor: COVID-19 vaccines causes autoimmune disorders.
Fact: The mRNA in the COVID-19 vaccines is heavily modified to not trigger the immune system in a way that would cause autoimmunity as a complication. Currently, many studies are underway to investigate safety and risk of disease flare after administering COVID-19 vaccines in patients with autoimmune diseases. Modified mRNA vaccines have been already used for several years for other indications, and there is no data indicating that mRNA vaccine can cause an autoimmune disease. Overall, vaccine experts and physician scientists agree that the benefits of vaccines outweigh the potential risks.

Rumor: The vaccine was rushed, so it can't possibly be safe.
Fact: No corners have been cut in developing a COVID-19 vaccine. Scientists have had a jump on developing the COVID-19 vaccine, using their experience from previous coronavirus vaccine efforts. Another way to preserve safety and save time is by working on efforts simultaneously, rather than one after another. For example, COVID-19 vaccines were in phase 3 clinical trials at the same time they were being manufactured. When their safety and efficacy was proven, manufactured vaccines could be used. If they didn’t pass the approval process, the unproven vaccines wouldn’t have been used.

Rumor: The vaccines can give you COVID-19.

Fact: You cannot get COVID-19 from the vaccines. None of the authorized and recommended COVID-19 vaccines (or others currently in development) contain the live virus that causes COVID-19. This makes it impossible to get COVID-19 from the vaccine. The vaccines teach our immune systems how to recognize and fight the virus that causes COVID-19.

Some individuals may contract COVID-19 after being vaccinated because they may have been exposed to COVID-19 prior to being vaccinated or before they obtain their second dose of vaccine. After receiving two doses of the Pfizer or Moderna vaccines, individuals could have 94-95% protection from contracting COVID-19 (based on clinical trial efficacy). Janssen’s clinical trial data show an estimated 85% efficacy rate against severe forms of COVID-19. If an individual still contracts COVID-19 after being fully vaccinated, the person will most likely have extremely mild symptoms or be asymptomatic.

Rumor: There are new strains of SARS-CoV-2 in the United Kingdom and South Africa, so the new vaccines won’t be effective.

Fact:According to medical experts, including current and former U.S. Surgeon Generals, there is no firm reason to believe that the vaccines that have been developed and approved in the U.S. will not be effective against new strains of the virus.

Rumor: You can get Bell’s palsy from the COVID-19 vaccines.

Fact: Bell’s palsy is not considered to be a side effect of the vaccines. Cases of Bell’s palsy, a temporary condition, were reported in few participants in the mRNA COVID-19 vaccine clinical trials. However, the Food and Drug Administration (FDA) does not consider these to be above the rate expected in the general population. They have not concluded these cases were caused by vaccination. Additionally, those who have previously had Bell’s palsy may receive a Pfizer, Moderna or Janssen COVID-19 vaccine.

Rumor: I can get HIV from the COVID-19 vaccines.

Fact: You cannot get HIV from any of the COVID-19 vaccines. Both Pfizer and Moderna vaccines are mRNA vaccines encoding spike protein specific only to the virus causing COVID-19, and only contain necessary ingredients to ensure a safe delivery of the mRNA to initiate an immune response. Participants in the clinical trial of the Australian COVID-19 vaccine (not Pfizer or Moderna) developed positive HIV tests, but those were all false positive tests. The Australian vaccine was using sequences similar to the tiny part of the HIV virus to stabilize their vaccine to improve delivery, and all participants were informed that they may develop false positive HIV test.

Rumor: I can test positive for COVID-19 after being vaccinated.

Fact: Vaccines currently in clinical trials in the United States won’t cause you to test positive on viral tests, which are used to see if you have a current infection. This rumor is false even for the Janssen vaccine, which uses viral vector (carrier) technology aided by a modified adenovirus. Adenoviruses cause the common cold and differ greatly from coronaviruses. Additionally, the adenovirus used as a carrier in Janssen’s vaccine has been modified to ensure no illness will result.

If your body develops an immune response, which is the goal of vaccination, there is a possibility you may test positive on some antibody tests. Antibody tests indicate you had a previous infection and that you may have some level of protection against the virus. Experts are currently looking at how COVID-19 vaccination may affect antibody testing results.

Rumor: If I get vaccinated and am then tested for COVID-19, I will receive false positive results.

Fact: Receiving the COVID-19 vaccine will not affect your PCR or antigen test results since these tests check for active disease, not immunity. There is no live virus present in any of the COVID-19 vaccines.

The vaccine is intended to induce an immune response, so a serology test (antibody test) may be positive in someone who has been vaccinated.

Rumor: The flu vaccine will also work against coronavirus.

Fact: Influenza and COVID-19 (SARS-CoV-2) belong to two different RNA virus families, so one vaccine is not interchangeable for another. Influenza belongs to the Orthomyxoviridae family, while SARS-CoV-2 is classified in the Coronaviridae family. Further, both the Influenza and SARS-CoV-2 rely on different protein layers to initiate responses. Influenza uses two surface antigens, while SARS-CoV-2 uses spike proteins, so their immunization approaches are different.

However, it is important that you also consider getting the flu vaccine this year. In a typical year, more than 100,000 Missourians become sick from the flu and some are hospitalized. To ensure Missouri has the capacity to care for COVID-19 patients, we need to do whatever we can to prevent additional strains on our healthcare system.

Rumor: The COVID-19 vaccines will tamper with your DNA.

Fact: : That rumor is baseless. mRNA provides a set of instructions to your cells to create an immune response specific to COVID-19. Medical doctors independent of the vaccine development teams have verified that using mRNA will not alter the DNA of our body's cells. The COVID-19 vaccines were created through mRNA technology. They do not introduce DNA into your body.

This rumor is false even for the Janssen vaccine, which uses viral vector (carrier) technology aided by an modified adenovirus. The vector used in Janssen’s vaccine is a harmless adenovirus (like the common cold) that has been modified so it won’t be able to replicate or cause illness.

Rumor: The vaccine contains Syncytin-1, which is vital for the formulation of human placenta in women.

Fact: Medical professionals have called this “an utterly bizarre claim.” None of the COVID-19 vaccines contain Syncytin-1. Furthermore, there are no protein-based vaccines among the candidates in phase 3 clinical trials for COVID-19. Scientifically, there is no sequence homology between SARS-CoV-2 and Syncytin-1, so any immune response initiated by the vaccine against SARS-CoV-2 would not affect Syncytin-1.

Rumor: The vaccine was rushed for political reasons.
Fact: The approval process does not include approval from any elected official. Scientific data and information generated by large-scale clinical trials is reviewed by the U.S. FDA, medical and public health experts from the Advisory Committee on Immunization Practices and the CDC before a vaccine will be made available.The federal effort called Operation Warp Speed has no formal oversight of or control over the vaccine approval process that determines safety and efficacy.

Rumor: Bill & Melinda Gates will use the COVID-19 vaccine to collect human biometric data that will then be uploaded to a cloud environment and connected with cryptocurrency.
Fact: There is no tracking chip technology involved in the COVID-19 vaccine, or any vaccine. Although the Bill and Melinda Gates Foundation has been involved in philanthropy and public health for years, there is no truth in this rumor.

Rumor: Mercury will be present in the COVID-19 vaccines and is dangerous.

Fact: Pfizer and Moderna’s vaccines do not contain mercury. Also, mercury is not a confirmed ingredient in any other COVID-19 vaccines at this time, but has been safely used in extremely small amounts to prevent dangerous germs, like bacteria and fungi, from growing in multi-dose vaccine vials. By preventing that harmful bacteria growth, residents see fewer severe local reactions.

Mercury is a naturally occurring element in the world. There are two primary types of mercury that humans may come into contact with: methylmercury and ethylmercury. Methylmercury can be toxic to humans in high doses and is not used in vaccines. Ethylmercury is used in extremely small amounts to prevent harmful bacteria from growing in vaccines and is quickly cleared from the human body. The ethlymercury medical product Thimerosal has a record of being very safe. Data from many studies show no evidence of harm caused by the extremely small amounts used in vaccines.

Rumor: The government just wants to use me as a "guinea pig."
Fact: All residents that have participated in clinical studies thus far have volunteered to do so and residents who choose vaccination will not be considered a test subject. Vaccinators will be required to track severe reactions to the vaccine, which is standard protocol for all vaccines.

Rumor:The virus is a hoax.
Fact: COVID-19 is not a hoax and neither is the vaccine. It is recommended by medical professionals that you consider getting vaccinated.

Rumor: Microchip hardware will be used in a vaccine to track Americans.
Fact: There will not be any tracking mechanisms inside of a COVID-19 vaccine.

Rumor: Getting a COVID-19 vaccines will stop you from donating blood.
Fact: According to the American Red Cross, receiving the Pfizer, Moderna or Johnson & Johnson COVID-19 vaccines will not affect your eligibility to donate blood. You may donate blood, with no waiting period, even after you have been fully vaccinated. Individuals who have received a COVID-19 vaccine are not eligible to donate convalescent plasma for COVID-19 patients.