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COVID-19 and Routine Vaccination

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COVID-19 and Routine Vaccination

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COVID-19 and Routine Vaccination
What does CDC advise about routine immunization services during the COVID-19 pandemic?
CDC is clear: Routine vaccination is an essential preventive care service for children, adolescents, and adults (including pregnant women) that should not be delayed because of the COVID-19 pandemic.
The complete CDC Interim Guidance for Immunization Services During the COVID-19 Pandemic is at this link: www.cdc.gov/vaccines/pandemic-guidance/index.html.
What does CDC advise about administering recommended immunizations to children and teens when COVID-19 is circulating?
It is important to assess the vaccination status of all children and adolescents at each patient visit to avoid missed opportunities for vaccination and ensure timely vaccine catch-up. All vaccines due or overdue should be administered according to the recommended CDC immunization schedules during that visit, unless a specific contraindication exists, to provide protection as soon as possible and minimize the number of healthcare visits needed to complete vaccination.
Due to COVID-19 in my community, many children in my practice missed well-child visits or were seen only on a telemedicine visit and need to be caught up on recommended vaccinations. How do we tackle this problem?
Begin by identifying children who have missed well-child visits and/or recommended vaccinations and contact them to schedule in person appointments. Consider starting with newborns, infants up to 24 months, young children and extending through adolescence. Consider the following strategies:
Use a reminder/recall system or other vaccination assessment tools in your state immunization information system (IIS) or electronic health record to identify and notify children in need of catch-up vaccination
Assess immunization status at every visit and provide all vaccinations due or overdue
Consider standing orders to simplify the process of vaccination. Templates are available here: www.immunize.org/standing-orders
Follow the CDC catch-up schedule to get children up to date on vaccination as efficiently as possible: www.cdc.gov/vaccines/schedules/hcp/imz/catchup.html#guidance
Should infants born to women with hepatitis B virus infection (hepatitis B surface antigen-positive [HBsAg+]) be treated differently during the COVID-19 pandemic?
No. The prevention of mother-to-child transmission of hepatitis B virus infection requires timely vaccination and administration of hepatitis B immune globulin (HBIG) at birth, followed by completion of the hepatitis B vaccine series and post-vaccination serologic testing.
Prenatal care providers should ensure that HBsAg-positive pregnant women are able to advocate for the proper care of their infants in case labor and delivery occurs at an unplanned facility or is attended by staff that are not knowledgeable about managing HBV-exposed infants. HBsAg-positive mothers should be educated about the importance of proper preventive care for their infant, supplied with documentation of their HBsAg laboratory results and instructed to provide this documentation to labor and delivery staff at the time of delivery.
Every effort should be made to ensure HBV-exposed infants complete the hepatitis B vaccine series following the ACIP recommendations (see www.cdc.gov/mmwr/volumes/67/rr/rr6701a1.htm).
CDC has posted additional information here: www.cdc.gov/vaccines/pandemic-guidance/index.html.
 
An infant in my practice is due for vaccinations but just tested positive for SARS-CoV-2 infection (the virus that causes COVID-19). She has no symptoms. Should we keep her vaccination appointment?
No. CDC recommends deferring vaccination of people while infected with SARS-CoV-2, regardless of symptoms, until they meet the criteria to discontinue isolation. Although mild illness is not a contraindication to vaccination, vaccination is deferred to avoid exposing healthcare personnel or other patients to SARS-CoV-2.
 
What does CDC advise about administering immunizations to adults when COVID-19 is circulating?
Healthcare providers, whether they administer vaccines or not, should take steps to ensure that their patients continue to receive all recommended vaccines. All providers should assess, recommend, administer (or refer) and document vaccination or vaccine counseling. Older adults and adults with underlying medical conditions are particularly at risk for preventable disease and complications if vaccination is deferred.
Vaccination of pregnant women with recommended maternal vaccines (tetanus toxoid, diphtheria toxoid, and acellular pertussis (Tdap) and influenza) is important for maternal and infant health. If vaccination has been delayed because of reduced or deferred in-person prenatal care visits, pregnant women should be scheduled for follow-up and vaccination during the next in-person appointment.
 
When COVID-19 is circulating, if I have the opportunity to vaccinate a child, teen, or an adult, should I administer only high priority vaccines, or should I administer all vaccines that are due at that visit?
You should continue to follow CDCís best practice guidelines and administer all recommended vaccines simultaneously when no specific contraindications exist at the time of the visit. By administering all vaccines due at the visit, you will reduce the total number of healthcare encounters necessary for the patient to be fully vaccinated.
How do I safely deliver vaccination services during the COVID-19 pandemic?
People infected with the virus that causes COVID-19 can transmit the infection even if they show no signs of illness. For this reason, it is important to apply good infection prevention practices to encounters with all patients. You should review carefully the detailed guidance on safe vaccination practices here: www.cdc.gov/vaccines/pandemic-guidance/index.html.
In general, vaccination in a medical home is preferred, but may not always be feasible. Primary care practices in communities affected by COVID-19 should continue to use strategies to separate well visits from sick visits.
Examples could include:
Scheduling sick visits and well visits during different times of the day
Reducing crowding in waiting rooms, by asking patients to remain outside (e.g., stay in their vehicles) until they are called in, or setting up triage booths to screen patients safely
Collaborating with other healthcare providers in the community to identify separate locations for providing routine well visits for children
How should we approach influenza vaccination when COVID-19 is or may be circulating during influenza season?
During the COVID-19 pandemic, reducing the overall burden of respiratory illnesses is important to protect vulnerable populations at risk for severe illness, the healthcare system, and other critical infrastructure. It is more critical than ever to use every opportunity during the influenza vaccination season to administer influenza vaccines to everyone who needs it. Influenza vaccination is recommended for all people age 6 months and older.
Some patients develop flu-like symptoms or fever after vaccination with recombinant zoster vaccine (RZV, Shingrix; GSK). Should I defer Shingrix vaccination because such a reaction might be confused with COVID-19?
No. If you have an opportunity to vaccinate a patient age 50 years or older who is due for dose 1 or dose 2 of Shingrix, proceed with vaccination as usual. It is important to counsel the patient about the risk of self-limited side effects, including local reactions, such as redness, pain, or swelling at the injection site, and systemic reactions, which include fever, chills, headache, and body aches. If they occur, such side effects normally resolve within 72 hours after vaccination.
Because of concerns about COVID-19, if a vaccine recipient develops fever after vaccination, they should stay home until it resolves. Shingrix vaccination does not cause respiratory symptoms common in COVID-19, such as cough or shortness of breath. If the vaccine recipient develops new symptoms of cough or shortness of breath, or if fever does not resolve within 72 hours of vaccination, the recipient should contact their healthcare provider.
Due to COVID-19 circulation in my community, I am delivering more patient care via telemedicine. Does that mean I can do nothing about vaccinations?
No. You can consider conducting your immunization assessment and counseling during the telemedicine visit and scheduling the patient for a brief vaccination-only encounter at an appropriate time and location.
This page was updated on June 11, 2020.
This page was reviewed on June 11, 2020.
 
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