| COVID-19 and Routine Vaccination |
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| What does CDC
advise about routine immunization services
during the COVID-19 pandemic? |
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| 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. |
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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. |
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| What does CDC
advise about administering recommended
immunizations to children and teens when COVID-19 is circulating? |
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| 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. |
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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? |
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| 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: |
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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 |
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Assess immunization
status at every visit and provide all
vaccinations due or overdue |
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Consider standing orders
to simplify the process of vaccination.
Templates are available here:
www.immunize.org/standing-orders |
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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 |
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Should infants born to women with hepatitis B
virus infection (hepatitis B surface
antigen-positive [HBsAg+]) be treated
differently during the COVID-19 pandemic? |
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| 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. |
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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. |
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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). |
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CDC has posted additional information here:
www.cdc.gov/vaccines/pandemic-guidance/index.html. |
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| 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? |
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| 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. |
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| What does CDC
advise about administering immunizations to
adults when COVID-19 is circulating? |
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| 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. |
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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. |
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| 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? |
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| You should
continue to follow CDC’s 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. |
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| How do I
safely deliver vaccination services during the
COVID-19 pandemic? |
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| 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. |
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| 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. |
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Examples could include: |
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Scheduling sick visits and well visits
during different times of the day |
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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 |
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Collaborating with other healthcare
providers in the community to identify
separate locations for providing routine
well visits for children |
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| How should we
approach influenza vaccination when COVID-19
is or may be circulating during influenza
season? |
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| 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. |
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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? |
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| 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. |
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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. |
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| 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? |
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| 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. |
ACIP Recommendations
Vaccine Information Statements 
