COVID-19 VACCINES

A number of vaccines have been authorized and recommended to prevent COVID-19. They each require multiple doses (primary and booster) over varying time periods, depending on the product, and the individual’s age and immune status. Approved vaccines include:

• Moderna (for ages 6 months and older)
• Novovax (for ages 18 years and older)
• Pfizer-BioNTech (for ages 6 months and older)
• Janssen (Johnson & Johnson) (for ages 18 and older)
  (CDC, 2022y)

Detailed and up-to-date information on these vaccines, including vaccination schedules for children, adults, and immunocompromised individuals are available on the CDC website (see “Resources” at the end of this course).

Who Should and Should Not Receive a COVID-19 Vaccine

The CDC (2022bb) recommends everyone stay up to date with COVID-19 vaccination, including all primary series doses and boosters for their age group:

• People ages 6 months through 4 years should get all COVID-19 primary series doses.
• People ages 5 years and older should get all primary series doses, and the booster dose recommended for them by CDC, if eligible.
  • People ages 5–11 years are recommended to get the original (monovalent) booster.
  • People ages 12 years and older are recommended to receive one updated Pfizer or Moderna (bivalent) booster.
    • This includes people who have received all primary series doses and people who have previously received one or more original (monovalent) boosters.
    • At this time, people ages 12–17 years can only receive the updated Pfizer bivalent booster.

According to the World Health Organization (WHO, 2022), people who should not receive a COVID-19 vaccine include those with:

• A history of severe allergic reaction/anaphylaxis to any of the ingredients of the COVID-19 vaccine
• A fever over 101 °F (38.5 °C)
• Currently confirmed or suspected COVID-19 infection (in which case they should wait to obtain the vaccine until after the mandated isolation period is concluded and acute symptoms have subsided)

It typically takes several weeks after each dose of COVID-19 vaccine to develop maximum levels of immunity. The exact length of time a vaccine provides protection is unknown. However, most people have strong protection against serious illness and death for at least six months (WHO, 2022).

Coadministration of COVID-19 Vaccines with Other Vaccines

According to the CDC, COVID vaccines may be administered without regard to timing of other vaccines. This includes simultaneous administration of the COVID-19 vaccine and other vaccines on the same day. However, administration of an orthopoxvirus vaccine with a COVID-19 vaccine requires additional considerations, which are detailed on the CDC website.

When administering multiple injections:

• Each syringe should be labeled with the name and dosage of the vaccine, lot number, initials of the preparer, and exact beyond-use time, if applicable.
• Each injection should be administered in a different injection site. These sites should be separated by one inch or more, if possible.
• When administering the COVID-19 vaccine and vaccines that may be more likely to cause a local reaction, injections should be given in different limbs, if possible.
  (CDC, 2022z)

Safe Administration of Vaccines during the COVID-19 Pandemic

The potential for asymptomatic transmission of the SARS-CoV-2 virus that causes COVID-19 requires meticulous attention to infection prevention practices during all patient encounters, including physical distancing, respiratory and hand hygiene, surface decontamination, and source control while in a healthcare facility (CDC, 2021j).

REDUCING EXPOSURE

To help ensure the safe delivery of care during influenza vaccination visits, providers should minimize chances for exposures, including:

• Screening for symptoms of COVID-19 in persons with possible COVID-19, prior to and upon arrival at the facility
• Isolating symptomatic patients as soon as possible
• Limiting and monitoring points of entry to the facility and installing barriers, such as clear plastic sneeze guards, to limit physical contact with patients at triage
• Implementing policies for the use of a cloth face covering in persons over the age of 2 years (if tolerated)
• Ensuring adherence to respiratory hygiene, cough etiquette, and hand hygiene
  (CDC, 2021k)

INFECTION CONTROL

All healthcare facility staff should adhere to recommended infection prevention and control procedures, including:

• Following Standard Precautions, which includes guidance for hand hygiene and cleaning the environment between patients
• Wearing a medical facemask at all times
• Using eye protection based on level of community transmission
  (CDC, 2021k)

VACCINE ADMINISTRATION

When administering all types of vaccines:

• Reduce crowding in waiting areas by asking patients to remain outside (e.g., stay in their vehicles, if applicable) until they are called into the facility for their appointment.
• Ensure that physical-distancing measures, with separation of at least 6 feet between patients and visitors, are maintained during all aspects of the visit, including check-in, checkout, screening procedures, and postvaccination monitoring, using strategies such as physical barriers, signs, ropes, and floor markings.
• Utilize electronic communications as much as possible (e.g., filling out needed paperwork online in advance) to minimize time in the office as well as reuse of materials (e.g., clipboards, pens).

When administering intranasal or oral vaccines:

• Wear gloves when administering intranasal or oral vaccines.
• Change gloves between patients in addition to performing hand hygiene.
• Wear masks according to guidelines.

For intramuscular or subcutaneous vaccines:

• Change gloves between patients in addition to performing hand hygiene.

(CDC, 2022x)