Health Advisory
INTERIM GUIDANCE FOR IMMUNIZATION SERVICES DURING THE COVID-19 PANDEMIC

Summary

The Delaware Division of Public Health (DPH) is issuing this Health Advisory to inform medical providers of the Centers for Disease Control and Prevention's (CDC) "Interim Guidance for Immunization Services During the COVID-19 Pandemic" released on June 9, 2020. The guidance, which is primarily focused on the pediatric population, serves to assist immunization providers in a variety of clinical and alternative settings in planning for the safe administration of vaccines during the COVID-19 pandemic.

Background

The COVID-19 pandemic has caused healthcare providers to change how they operate to continue to provide essential services to patients. Ensuring that immunization services are maintained or re-initiated is essential for protecting individuals and communities from vaccine-preventable diseases and outbreaks and reducing the burden of respiratory illness during the upcoming influenza season. This guidance will be continually reassessed and updated based on the evolving epidemiology of COVID-19 in the United States.

Stay-at home and shelter-in-place orders have resulted in a decline in outpatient pediatric visits and fewer vaccine doses being administered, leaving children at risk of vaccine preventable diseases. A recent review of Delaware immunization data showed a significant decline in immunization completion rates across all childhood vaccines starting in March 2020. This decline is attributable to changes in provider operations and client behavior due to the pandemic.

Recommendations

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.

• Healthcare providers should identify children who have missed well-child visits and/or recommended vaccinations and contact parents to schedule in-person appointments, starting with newborns, infants and children up to 24 months, young children, and then adolescents.
• 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 due or overdue vaccines should be administered during the visit according to the recommended CDC immunization schedules, unless specifically contraindicated. This practice provides immunization protection as soon as possible and minimizes the number of healthcare visits needed to complete vaccination.

Providers should continue to use strategies to separate well visits from sick visits. Examples might include:

• Scheduling sick visits and well-child visits during different times of the day
• Reducing crowding in waiting rooms by asking patients to remain outside (e.g., stay in their vehicles, if applicable) until they are called into the facility for their appointment, or setting up triage booths to screen patients safely
• Collaborating with health care providers in the community to identify separate locations for providing well visits for children

DPH Communicable Disease Regulations mandate that all immunizations administered in the State of Delaware must be reported to the Immunization Information System also known as DelVAX. For assistance with vaccine reporting, contact the Immunization Program at 302-744-1050 or 1-800-282-8672 or visit http://www.dhss.delaware.gov/dph/dpc/immunize.html

Resources

• CDC Guidance "Interim Guidance for Immunization Services During the COVID-19 Pandemic":
  https://www.cdc.gov/vaccines/pandemic-guidance/index.html.

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