Mixed Vaccines

[tazlover]

5 minutes ago, broberts said:

 

I believe there is in some circumstances a a concern if the two doses are more than 42 days apart.

If this is really the case, we are screwed for travel. My DH had his first AstraZeneca in April, and his second Pfizer was mid June. 73 days apart. But we had no choice in Southern Ontario. 

 

[Vancouver-Cruiser]

18 minutes ago, tazlover said:

If this is really the case, we are screwed for travel. My DH had his first AstraZeneca in April, and his second Pfizer was mid June. 73 days apart. But we had no choice in Southern Ontario. 

 

I think he’s fine assuming you are cruising from outside of the US. You have 12 weeks maximum between doses. 

[K_e_short]

13 minutes ago, Vancouver-Cruiser said:

I think he’s fine assuming you are cruising from outside of the US. You have 12 weeks maximum between doses. 

 

Careful. There are no rules about the interval between doses when mixing.

 

The CDC and WHO and manufacturers intervals are all based on not mixing doses.

 

 

[Vancouver-Cruiser]

1 minute ago, K_e_short said:

 

Careful. There are no rules about the interval between doses when mixing.

 

The CDC and WHO and manufacturers intervals are all based on not mixing doses.

 

 

True. One must be careful. I was just going by Royal Caribbean’s policy, which they said was based on the CDC’s clarification. Basically no mixing for US cruises and for international, 42 days for mRNA mixes, 84 days Astra/mRNA mixes. 

[K_e_short]

38 minutes ago, tazlover said:

If this is really the case, we are screwed for travel. My DH had his first AstraZeneca in April, and his second Pfizer was mid June. 73 days apart. But we had no choice in Southern Ontario. 

 

 

2 minutes ago, Vancouver-Cruiser said:

True. One must be careful. I was just going by Royal Caribbean’s policy, which they said was based on the CDC’s clarification. Basically no mixing for US cruises and for international, 42 days for mRNA mixes, 84 days Astra/mRNA mixes. 

 

Thank you for posting about the 84 days for AZ/mRNA mixes. I've only been looking at Carnival and Cunard so hadn't seen rccl policy.

Of course the CDC isn't in charge of non US ports so even more confusion as to why it's 84 days for mixing 🙂

[Vancouver-Cruiser]

From Royal Caribbean’s website:

 

For Cruises Departing from U.S. Ports 

The U.S. CDC has clarified their position regarding mixed vaccinations and provided updated guidance to Royal Caribbean. Currently, the CDC does not recognize any mixed combination of COVID-19 vaccines as fully vaccinated.

 

For Cruises Departing from Ports Outside of the U.S. 

For cruises departing from ports outside of the U.S., we will accept guests who are vaccinated with a mixed regimen consisting of 2 shots of the following manufacturer combinations: Pfizer and Moderna, or AstraZeneca with either Pfizer or Moderna. The doses must be separated by at least 28 days and not more than 42 days for mixes of Pfizer and Moderna, and separated by at least 4 weeks and not more than 12 weeks for combinations of AstraZeneca with Pfizer or Moderna.

[Vancouver-Cruiser]

1 minute ago, K_e_short said:

 

 

Thank you for posting about the 84 days for AZ/mRNA mixes. I've only been looking at Carnival and Cunard so hadn't seen rccl policy.

Of course the CDC isn't in charge of non US ports so even more confusion as to why it's 84 days for mixing 🙂

I think everyone needs to check their own cruise line’s policies on a regular basis. The changes are hard to keep up with!

 

My wife and I will be careful to get the “right” type of third dose when we are even allowed in British Columbia. Or drive across the line and get one, when the border opens.

[Fouremco]

Returning to the question of what documentation you need to provide and leaving aside the question of why, Celebrity requires paperwork for each dose. For US residents, that's on a single card. For Ontario and most Canadian residents, that's two separate documents, one for each shot. Remember, while the document for the second shot indicates that you've had "two valid dose(s)", it provides no information with respect to the first does. Don't make it complicated, just print both and take them with you.

[gnome12]

2 hours ago, K_e_short said:

 

 

Thank you for posting about the 84 days for AZ/mRNA mixes. I've only been looking at Carnival and Cunard so hadn't seen rccl policy.

Of course the CDC isn't in charge of non US ports so even more confusion as to why it's 84 days for mixing 🙂

AstraZeneca does not have the same dosing schedule as Pfizer or Moderna. The recommended interval between 2 AstraZeneca doses is 8-12 weeks, and results from the UK showed that the longer interval provided better protection. I think that is why the timing for mixing AZ with another vaccine is longer.

[hancogran]

4 hours ago, K_e_short said:

 

Careful. There are no rules about the interval between doses when mixing.

 

The CDC and WHO and manufacturers intervals are all based on not mixing doses.

 

 

We are also from Ontario and have received mixed mrna vaccines (first Pfizer  in April and then Moderna in June).  I actually emailed the CDC asking them what we should be doing in order to be considered fully vaccinated and able to cruise.

 

I received a reply back and here is what they say regarding the interval between mixed doses:  (no mention of a maximum time)

 

In exceptional situations in which the vaccine product given for the first dose cannot be determined or is no longer available, any available mRNA COVID-19 vaccine may be administered at a minimum interval of 28 days between doses to complete the mRNA COVID-19 vaccination series.

 

 

Edited August 25, 2021 by hancogran

[mabt]

5 hours ago, K_e_short said:

 

 

Thank you for posting about the 84 days for AZ/mRNA mixes. I've only been looking at Carnival and Cunard so hadn't seen rccl policy.

Of course the CDC isn't in charge of non US ports so even more confusion as to why it's 84 days for mixing 🙂

 

The short answer to that is that Royal Caribbean is making it up.

 

I assume that it is roughly based on manufacturer's recommended intervals, but they're not enforcing the same recommendations for same-manufacturer doses, and the manufacturer's recommendations don't apply to mixed doses anyway, so... it's basically arbitrary.

 

But pointing this out to them does not seem to have had any effect, so we're rolling with it.  🙃

[broberts]

55 minutes ago, hancogran said:

We are also from Ontario and have received mixed mrna vaccines (first Pfizer  in April and then Moderna in June).  I actually emailed the CDC asking them what we should be doing in order to be considered fully vaccinated and able to cruise.

 

I received a reply back and here is what they say regarding the interval between mixed doses:  (no mention of a maximum time)

 

In exceptional situations in which the vaccine product given for the first dose cannot be determined or is no longer available, any available mRNA COVID-19 vaccine may be administered at a minimum interval of 28 days between doses to complete the mRNA COVID-19 vaccination series.

 

 

 

I don't believe any cruise line is accepting mixed mRNA vaccinations, despite what the CDC has said. Possibly because some ports do not accept mixed mRNA.

[K_e_short]

3 hours ago, hancogran said:

We are also from Ontario and have received mixed mrna vaccines (first Pfizer  in April and then Moderna in June).  I actually emailed the CDC asking them what we should be doing in order to be considered fully vaccinated and able to cruise.

 

I received a reply back and here is what they say regarding the interval between mixed doses:  (no mention of a maximum time)

 

In exceptional situations in which the vaccine product given for the first dose cannot be determined or is no longer available, any available mRNA COVID-19 vaccine may be administered at a minimum interval of 28 days between doses to complete the mRNA COVID-19 vaccination series.

 

 

 

Sorry I will explain that I do not consider Moderna and Pfizer as a mixed dose. It is the same type of vaccine and other then the time between doses you can cruise.

 

Right now it is those with AZ and Moderna/Pfizer that have no option other then getting a 3rd dose.

 

[Vancouver-Cruiser]

12 minutes ago, K_e_short said:

 

Sorry I will explain that I do not consider Moderna and Pfizer as a mixed dose. It is the same type of vaccine and other then the time between doses you can cruise.

 

Right now it is those with AZ and Moderna/Pfizer that have no option other then getting a 3rd dose.

 

Unfortunately, the CDC doesn’t agree with you. 

[mabt]

3 hours ago, broberts said:

 

I don't believe any cruise line is accepting mixed mRNA vaccinations, despite what the CDC has said. Possibly because some ports do not accept mixed mRNA.

 

It varies.

 

DCL is explicit: "Guests who have received one dose of Moderna and one dose of Pfizer are considered fully vaccinated, per CDC guidelines."

 

(Funny how Royal Caribbean cites those very same guidelines as the reason they don't accept mixed mRNA doses, but I digress.)

 

Princess also considers mixed mRNA to be fully vaccinated.

 

NCL and RCCL say no to mixed mRNA for US departures, but yes for non-US departures, with the caveat on Royal of specific allowable intervals that seems to be RCCL's very own made-up requirement.

 

Haven't checked the others.

 

[mabt]

21 minutes ago, Vancouver-Cruiser said:

Unfortunately, the CDC doesn’t agree with you. 

 

Well, the CDC actually does agree that mixed mRNA doses are to be considered fully vaccinated.  They are quite clear about that in their clinical considerations guidelines.

 

But for some reason some (not all) of the cruise lines seem to have gotten a different memo.

[Vancouver-Cruiser]

19 minutes ago, mabt said:

 

Well, the CDC actually does agree that mixed mRNA doses are to be considered fully vaccinated.  They are quite clear about that in their clinical considerations guidelines.

 

But for some reason some (not all) of the cruise lines seem to have gotten a different memo.

From the CDC site:

 

“However, COVID-19 vaccines are not interchangeable.

mRNA COVID-19 vaccines (Pfizer-BioNTech and Moderna)

Data on the safety and efficacy of a mixed-product series have not been evaluated. Both doses of the series should be completed with the same product.”
 

They consider you fully vaccinated with mixed mRNA only if you meet a couple of exceptions. Good luck trying to convince a cruise line that you meet those exceptions. 

[K_e_short]

45 minutes ago, Vancouver-Cruiser said:

From the CDC site:

 

“However, COVID-19 vaccines are not interchangeable.

mRNA COVID-19 vaccines (Pfizer-BioNTech and Moderna)

Data on the safety and efficacy of a mixed-product series have not been evaluated. Both doses of the series should be completed with the same product.”
 

They consider you fully vaccinated with mixed mRNA only if you meet a couple of exceptions. Good luck trying to convince a cruise line that you meet those exceptions. 

 

The issue is not "convincing" the cruise line that you are vaccinated.

 

I mean I would love to call Carnival and tell them that mixing a vector with a Mrna vaccine has shown to increase my immunity since its two types of vaccine, but I know they won't care.

 

The issue is that each cruiseline is interpreting the CDC rules just a bit differently.

 

For those with Pfizer/Moderna mixes they have options for certain cruise lines cruising out of the U.S.

Those with AZ and Pfizer/Moderna have no option cruising out of the U.S.

 

[broberts]

2 hours ago, K_e_short said:

 

Sorry I will explain that I do not consider Moderna and Pfizer as a mixed dose. It is the same type of vaccine ....

 

The vaccines use the same technology but are quite different. 

[mabt]

3 hours ago, Vancouver-Cruiser said:

From the CDC site:

 

“However, COVID-19 vaccines are not interchangeable.

mRNA COVID-19 vaccines (Pfizer-BioNTech and Moderna)

Data on the safety and efficacy of a mixed-product series have not been evaluated. Both doses of the series should be completed with the same product.”
 

They consider you fully vaccinated with mixed mRNA only if you meet a couple of exceptions. Good luck trying to convince a cruise line that you meet those exceptions. 

 

No.  There are a couple of "exceptional situations" in which they recommend proceeding with mixed mRNA doses.  The exception conditions, for what little it's worth, are exactly the conditions under which most Canadians received mixed mRNA doses (namely, the unavailability of a second dose of the original product leading to a vaccination interval longer than 48 days).

 

 

Regardless of the reason why you've received mixed doses, you're considered fully vaccinated.  You can't just quote the first sentence of the paragraph and then go on to ignore the rest.

 

"If two doses of different mRNA COVID-19 vaccine products are administered in these situations (or inadvertently), no additional doses of either product are recommended at this time. Such persons are considered fully vaccinated against COVID-19 ≥2 weeks after receipt of the second dose of an mRNA vaccine."

 

These guidelines were not written to inform public policy.  If you're an American vaccine administrator following the CDC clinical guidelines, which is the intended audience, then the described situations or "inadvertent" cover all possible scenarios.  You're either following the guidelines, or you're not.  If you're not, then the document is moot.  The point is that if someone shows up in your clinic and has already has two different mRNA doses, regardless of the reason, they are considered "fully vaccinated", clinically speaking, and you shouldn't give them another dose.

 

At this point it's all kind of irrelevant in the context of the cruise lines' policies though.  They are all pointing to the same set of guidelines, and drawing different conclusions, or somehow getting different answers from the CDC.

 

Probably the same as when we ask the cruise lines to clarify their policies and the answers are all over the place.  The answer depends on when, how, and to whom the question is asked.

 

 

Edited August 26, 2021 by mabt

[paf225]

7 hours ago, broberts said:

 

I don't believe any cruise line is accepting mixed mRNA vaccinations, despite what the CDC has said. Possibly because some ports do not accept mixed mRNA.

 

Both Azamara and Crystal view passengers with mixed mRNA vaccines as being fully vaccinated.  I've highlighted the pertinent sentences in excerpts from their posted vaccination policies.

 

From Azamara's website;

• Will I be considered fully vaccinated if my first dose of the Covid-19 vaccine is from one manufacturer and the second dose is from another?

  Following CDC guidelines, Azamara will consider a guest fully vaccinated with proof of vaccination that can include mixed doses of the Pfizer and Moderna mRNA vaccines. Guests sailing on Azamara Quest sailing from Athens can have mixed doses that include AstraZeneca as long as the AstraZeneca dose is administered first, and then either the Pfizer or Moderna dose within 8-12 weeks. No other mixed vaccine doses will be accepted

   

  From Crystal's website;

   

  A DECLARATION OF SAFETY

  Your promise to us is your Declaration of Safety via Crystal’s secure, online portal, Priority Check-In and Planning Center (PCPC). When you sign your Declaration of Safety, you're giving us a true picture of your health and telling Crystal exactly what you need to travel in confidence and safety.

   

  • All guests 12 years or older will be required to be fully inoculated with a COVID-19 vaccine (both doses if recommended by manufacturer) at least 14 days prior to boarding any Crystal ship.  Vaccines must be accepted by the country Crystal guests are entering if it requires one.

  Mixed Vaccines: Guests who have received one single dose of a vector vaccine (e.g. AstraZeneca) and one single dose of a mRNA vaccine (e.g. Pfizer/BioNTech, Moderna) will not be considered fully vaccinated. Guests who have received two single doses of mixed vaccines that are the same type (e.g., both are mRNA or Johnson & Johnson) will be considered fully vaccinated and will be permitted to sail, so long as the final dose is received at least 14 days prior to the beginning of the cruise.

  Verified documentation and/or evidence of vaccination will be required at the time of boarding and failure to provide this documentation will result in denial of boarding. 

[ilovetotravel1977]

There is hope for folks:

 

https://news.paxeditions.com/news/buzz/wttc-urges-us-govt-speed-approval-uk-astrazeneca-vaccine

[Vancouver-Cruiser]

8 hours ago, mabt said:

 

No.  There are a couple of "exceptional situations" in which they recommend proceeding with mixed mRNA doses.  The exception conditions, for what little it's worth, are exactly the conditions under which most Canadians received mixed mRNA doses (namely, the unavailability of a second dose of the original product leading to a vaccination interval longer than 48 days).

 

 

Regardless of the reason why you've received mixed doses, you're considered fully vaccinated.  You can't just quote the first sentence of the paragraph and then go on to ignore the rest.

 

"If two doses of different mRNA COVID-19 vaccine products are administered in these situations (or inadvertently), no additional doses of either product are recommended at this time. Such persons are considered fully vaccinated against COVID-19 ≥2 weeks after receipt of the second dose of an mRNA vaccine."

 

These guidelines were not written to inform public policy.  If you're an American vaccine administrator following the CDC clinical guidelines, which is the intended audience, then the described situations or "inadvertent" cover all possible scenarios.  You're either following the guidelines, or you're not.  If you're not, then the document is moot.  The point is that if someone shows up in your clinic and has already has two different mRNA doses, regardless of the reason, they are considered "fully vaccinated", clinically speaking, and you shouldn't give them another dose.

 

At this point it's all kind of irrelevant in the context of the cruise lines' policies though.  They are all pointing to the same set of guidelines, and drawing different conclusions, or somehow getting different answers from the CDC.

 

Probably the same as when we ask the cruise lines to clarify their policies and the answers are all over the place.  The answer depends on when, how, and to whom the question is asked.

 

 

Yes, I referred to the exceptions. I ignored nothing. I’m simply pointing out that it’s reasonable that some cruise lines follow a strict interpretation and prohibit any mixed doses. Otherwise they might be in a position to ask if one meets the exceptions. It’s the CDC that is being unreasonable. 

[mabt]

11 minutes ago, Vancouver-Cruiser said:

Yes, I referred to the exceptions. I ignored nothing. I’m simply pointing out that it’s reasonable that some cruise lines follow a strict interpretation and prohibit any mixed doses. Otherwise they might be in a position to ask if one meets the exceptions. It’s the CDC that is being unreasonable. 

 

Agree to disagree.

[broberts]

1 hour ago, Vancouver-Cruiser said:

Yes, I referred to the exceptions. I ignored nothing. I’m simply pointing out that it’s reasonable that some cruise lines follow a strict interpretation and prohibit any mixed doses. Otherwise they might be in a position to ask if one meets the exceptions. It’s the CDC that is being unreasonable. 

 

Is your definition  of unreasonable "it won't do what I want"?