Clinical Information for COVID-19 Vaccine Providers

Training for COVID-19 Vaccine Providers

The Centers for Disease Control and Prevention (CDC) has several training programs related to vaccine administration. You can use this to help you prepare to administer the vaccine.

Training

Training Related to Pediatric Patients

State Webinars

Clinical Resources

Standing Orders

Vaccine Approval Process and Standing Order Requirements: How To Know When to Start Administering New Vaccines

Step-By-Step Guide

Step 1: Vaccine manufacturer submits new vaccine data to FDA

Step 2: New vaccine data is reviewed by the FDA, ACIP, and the Western States Scientific Safety Review Workgroup (WSSSRW)

Step 3: Approval by the FDA, ACIP, and the WSSSRW

Step 4: Standing orders are updated at provider offices for administration of vaccine based on new recommendations

  • Provider locations offering COVID-19 vaccines may wait for Centers for Disease Control and Prevention (CDC) to update their standing orders or for Washington State signed standing orders, before they’re able to administer the vaccine based off the new recommendation.

Step 5: Vaccine recipients use Vaccine Locator to determine where the new updated vaccine recommendation is being offered or contact the provider location prior to their appointment to check on availability

What Are Standing Orders?

Standing orders are protocols that allow non provider clinical staff such as nurses and medical assistants to administer certain vaccines without examination or direct order from the attending provider. Under state law, nurses and medical assistance may administer vaccines only under prescription of certain kinds of prescribers such as a physician. Standing orders allow physicians to approve vaccination for all eligible patients in a given healthcare setting at once, without needing to individually prescribe vaccines to each patient. The use of standing orders for vaccination is recommended by the CDC, the Advisory Committee on Immunization Practices because it can save time and reduce missed opportunities for vaccination.

Additional Considerations

The ACIP may not always address a new vaccine recommendation right away. In these cases, providers can update standing order recommendations after approval from the Western States Scientific Review Workgroup.

The Department has rescinded the Janssen COVID-19 Vaccine (Johnson & Johnson) Statewide Standing Orders for Administering Vaccine to Persons 18 Years of Age and Older, dated April 8, 2022, effective May 6, 2022.

Frequently Asked Questions

Should I administer extra vaccine doses to my patients?

An additional dose is for patients who completed the initial vaccine series but didn't have a strong enough immune response. A booster dose is for patients when it's likely that their immunity after the initial vaccine series waned over time.

The Centers for Disease Control and Prevention (CDC) and the Western States Scientific Review Workgroup recommend a booster dose for everyone 12 years and older.

CDC also recommended an additional dose of mRNA (Pfizer-BioNTech or Moderna) COVID-19 vaccines for certain immunocompromised groups. These patients may also get a booster (fourth) dose after getting the additional (third) dose.

  Who Gets It When to Get It

Additional dose

People who are immunocompromised and got a two-dose mRNA COVID-19 vaccine.*

See the Centers for Disease Control and Prevention's (CDC) interim clinical considerations for a list of immunocompromising conditions.

At least 28 days after your second dose of mRNA COVID-19 vaccine.

Booster dose

People 18 years and older who got the Johnson & Johnson COVID-19 vaccine as their primary series. At least two months after your first dose.

People 12 years and older who got the Pfizer-BioNTech COVID-19 vaccine as their primary series.

At least five months after your second dose.**

For patients who are moderately to severely immunocompromised, at least five months after the patient's additional (third) dose.

People 18 years and older who got the Moderna COVID-19 vaccine as their primary series.

At least five months after your second dose.**

For patients who are moderately to severely immunocompromised, at least five months after the patient's additional (third) dose.

*Use the same vaccine brand as the patient's initial vaccine series, if possible. If you don't have it available, the other mRNA vaccine brand may be used.

**For booster doses, patients 18 years and older can get the same or a different vaccine for their booster dose than they received for their primary series. However, people ages 17 and younger may only get the Pfizer COVID-19 vaccine for their booster dose.

Please do not administer any doses of vaccine beyond the doses recommended by CDC, even if your patient requests it. Also, please do not administer any doses of vaccine to someone outside of the recommended age range for that vaccine or dose.

Who should get an additional dose of the COVID-19 vaccines?

The Centers for Disease Control and Prevention (CDC) recommends an additional dose of the Pfizer-BioNTech or Moderna COVID-19 vaccines only to certain immunocompromised groups, including patients who have:

  • Been receiving active cancer treatment for tumors or cancers of the blood
  • Received an organ transplant and are taking medicine to suppress their immune system
  • Received a stem cell transplant in the last two years or are taking medicine to suppress their immune system
  • Moderate or severe primary immunodeficiency (such as DiGeorge syndrome or Wiskott-Aldrich syndrome)
  • Advanced or untreated HIV infection
  • Been receiving active treatment with high-dose corticosteroids or other drugs that may suppress your immune system

You can find more information on additional doses for immunocompromised people in CDC's interim clinical considerations for COVID-19 vaccines.

Who should get a booster COVID-19 dose?

The Centers for Disease Control and Prevention (CDC) and the Western States Scientific Safety Review Workgroup recommend a booster dose for everyone 5 years and older.

What do I do for patients vaccinated outside of the United States?

We don't know the safety or efficacy of giving someone a COVID-19 vaccine authorized or approved in the United States after they received a COVID-19 vaccine not authorized or approved by the U.S. Food and Drug Administration (FDA).

Although they are not authorized by the FDA, the Centers for Disease Control and Prevention (CDC) does not recommend revaccinating patients who completed a COVID-19 vaccine series authorized by the World Health Organization (WHO). However, CDC recommends providers offer an FDA authorized or approved COVID-19 vaccine to patients who:

  • Partially completed a COVID-19 vaccine series authorized by WHO
  • Partially completed or completed a COVID-19 vaccine series not authorized by the FDA or WHO

For more information, see the interim clinical considerations for COVID-19 vaccines.

What do I do for patients vaccinated as part of a clinical trial?

You may have patients who completed a COVID-19 vaccine series as part of a U.S.-based clinical trial involving a COVID-19 vaccine not currently authorized by the U.S. Food and Drug Administration (FDA).

Patient vaccinated with a clinical trial COVID-19 vaccine not authorized or approved by the FDA but listed for emergency use by the World Health Organization (WHO), such as the AstraZeneca COVID-19 vaccine. Active vaccine

Do not give the patient any additional doses.

Considered fully vaccinated two weeks after completing the series.

Placebo

Not considered fully vaccinated.

Offer an FDA-authorized or FDA-approved COVID-19 vaccine. Encourage patients to follow current prevention measures.

Patient vaccinated with a clinical trial COVID-19 vaccine not authorized or approved by FDA or listed by WHO, such as the Novavax COVID-19 vaccine. Active vaccine

Check if an independent group (e.g., a data and safety monitoring board) confirmed the vaccine's efficacy.

If confirmed, your patient is considered fully vaccinated two weeks after completing the series. Do not give the patient any additional doses.

Placebo

Not considered fully vaccinated.

Offer an FDA-authorized or FDA-approved COVID-19 vaccine series. Encourage patients to follow current prevention measures.

For more information, please see the Centers for Disease Control and Prevention's (CDC) clinical considerations for COVID-19 vaccines.

Is the Johnson & Johnson vaccine available to use again?

On May 6, 2022, the U.S. Food and Drug Administration limited the authorized use of the Johnson & Johnson (Janssen) COVID-19 vaccine.

Read their full statement.

DOH has rescinded standing orders for J&J. There may still be situations where this is the best option for vaccination. Please review the FDA guidance for further details.

If you wish to still administer J&J, you must do so under your internal ordering process, which could include your own standing orders.

Should patients get a titer or blood test prior to getting vaccinated?

No, the Advisory Committee on Immunization Practices (ACIP) does not recommend titer testing before vaccination

Do patients have to receive the same vaccine for their second and third doses?

You should use the same vaccine brand to administer additional doses to immunocompromised patients. However, if you don't have the same brand available, the other mRNA vaccine brand may be used.

For booster doses, patients 18 years and older can get the same or a different vaccine brand than they received for their primary series. However, people ages 17 and younger may only get the Pfizer COVID-19 vaccine for their booster dose because it's currently the only vaccine authorized for this age group.

What ages are the vaccines recommended for?

The Advisory Committee on Immunization Practices (ACIP) recommended the following age groups to receive vaccine:

  • Pfizer-BioNTech vaccine: 6 months and older
  • Moderna vaccine: 6 months and older
  • Johnson & Johnson – Janssen vaccine: 18 years and older

The Pfizer and Moderna vaccines are recommended over the J&J vaccine due to the rare risk of TTS (Thrombosis with Thrombocytopenia Syndrome), a condition in which a low blood platelet level interferes with the formation of blood clots, and GBS (Guillain-Barré Syndrome), an autoimmune disorder which can result in permanent nerve damage.

Can people under age 18 get the vaccine?

Yes, the Pfizer-BioNTech (Pfizer) vaccine and Moderna COVID-19 vaccine brands are authorized for children ages 6 months and older. Youth who are under 18 years of age may need consent from a parent or guardian to get the vaccine, unless they are legally emancipated.

If you have questions about what you can accept as parental consent, please consult your legal counsel. If your office or organization already has guidance on this for other vaccines, you may wish to consult those as well. You can use this sample consent for minor vaccination as a starting point.

Can people who are pregnant, lactating, or planning to become pregnant get the vaccine?

Yes, data show that COVID-19 vaccines are safe during pregnancy. The Centers for Disease Control and Prevention (CDC), American College of Obstetricians and Gynecologists (ACOG), and Society for Maternal-Fetal Medicine (SMFM) recommend the COVID-19 vaccine for people who are pregnant, lactating, or planning to get pregnant. Some studies show that a vaccinated parent can even pass antibodies against COVID-19 along to their baby through pregnancy and lactation. Unvaccinated pregnant people who get COVID-19 are at increased risk of severe complications like preterm birth or stillbirth. In addition, people who get COVID-19 while pregnant are two to three times more likely to need advanced life support and a breathing tube.

You can read more about the recommendation from the American College of Obstetricians and Gynecologists (ACOG) and refer to resources on this list from ACOG. You can also use these talking points on reproductive health to answer patient questions.

Are there any restrictions on who can receive the vaccine?

Generally, the COVID-19 vaccines should not be given to anyone who is under the authorized age or has a history of severe allergic reactions to an ingredient or previous dose of the COVID-19 vaccines.

Pfizer-BioNTech

The Pfizer COVID-19 vaccine should not be given to anyone:

  • Under 6 months of age
  • Outside of the appropriate age dose
  • With a history of severe or immediate allergic reactions to an ingredient of the Pfizer-BioNTech vaccine, such as polyethylene glycol or polysorbate
  • Who had a severe or immediate allergic reaction to their first dose of an mRNA COVID-19 vaccine (Pfizer or Moderna)
Moderna

The Moderna COVID-19 vaccine should not be given to anyone:

  • Under 6 months of age
  • Outside of the appropriate age dose
  • With a history of severe or immediate allergic reactions to an ingredient of the Moderna vaccine, such as polyethylene glycol or polysorbate
  • Who had a severe or immediate allergic reaction to their first dose of an mRNA COVID-19 vaccine (Pfizer or Moderna)
Johnson & Johnson – Janssen

See the Advisory Committee on Immunization Practices' (ACIP) interim clinical considerations for COVID-19 vaccines for more information.

Should I administer the vaccine to patients with a history of allergies?

The COVID-19 vaccines should not be given to people with a known history of severe allergic reaction, such as anaphylaxis, to any ingredient or a previous dose of the COVID-19 vaccines.

People who have had a severe allergic reaction to other vaccines or injectable therapies may still be able to receive this vaccine. However, providers should do a risk assessment and counsel them about the potential risks. If the patient decides to get the vaccine, providers should observe them for 30 minutes to monitor for any immediate reactions. People who report having mild or childhood allergic reactions to medications or vaccines may still get the vaccine.

See the Advisory Committee on Immunization Practices' (ACIP) interim clinical considerations for COVID-19 vaccines for more information.

Can someone who has COVID-19 disease now get vaccinated?

People who currently have COVID-19 should wait to get vaccinated until they feel better and their isolation period is finished if possible. People recently infected with COVID-19 can choose to wait up to 90 days after their illness passes before getting vaccinated.

People who were recently exposed to COVID-19 should also wait to get the vaccine until after their quarantine period, if they are able to safely quarantine away from other people. If there is a high risk they could infect others, they may be vaccinated during their quarantine period to prevent spreading the disease. Providers should take steps to ensure the environment is safe to protect others during the vaccination.

Can someone who previously had COVID-19 disease get vaccinated?

Yes, the Advisory Committee on Immunization Practices (ACIP) recommends anyone who previously had COVID-19 to get the vaccine. A history of having COVID-19 doesn't affect the recommendation.

Can patients receive both COVID-19 and other routine vaccines at the same time on the same day?

Yes. The Advisory Committee on Immunization Practices (ACIP) changed their recommendations on May 12, 2021. You can now administer COVID-19 vaccines and other vaccines to patients without waiting 14 days.

Can you get a COVID-19 test after recently getting vaccinated?

Yes, you can still get a COVID-19 test after recently getting vaccinated. It will not affect the results of a SARS-CoV-2 nucleic acid amplification or antigen test.

Should patients delay their screening mammogram if they were recently vaccinated?

No, patients do not need to reschedule their screening mammogram if they were recently vaccinated. The COVID-19 vaccine may cause swollen lymph nodes, or unilateral lymphadenopathy, after administration and in some cases, it will be important to ensure further evaluation. You should:

  • Update your patient intake forms to ask if patients have received the COVID-19 vaccine, when they received it, and which arm they received it in.
  • Do a diagnostic work up for the swollen lymph nodes for people who received the COVID-19 vaccine in the last four weeks, but consider scheduling a follow-up exam in 4 to 12 weeks after they finish the COVID-19 vaccine series.
  • If it is possible and doesn't delay care, schedule the screening exam before the patient's first dose of a COVID-19 vaccination or four to six weeks after they finish the COVID-19 vaccine series.

You can read more about the recommendation from the Society of Breast Imaging.