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

• COVID-19 vaccine training module (CDC)
• List of COVID-19 vaccination training programs and reference materials (CDC), including vaccine administration resources
• You Call the Shots web-based training course (CDC)
• Training for vaccine management processes
• Communicating about Vaccines - COVID-19 & More (Children's Hospital of Philadelphia Vaccine Education Center)
• Vaccine Confidence Training and Toolkit (The American College of Obstetricians and Gynecologists) a 90-minute online course covering topics such as motivational interviewing and addressing misinformation. Accessed through an easy to create ACOG account.

Training Related to Pediatric Patients

• February 10, 2022 - COVID-19 Updates: What Clinicians Need to Know About Multisystem Inflammatory Syndrome in Children
• February 25, 2022 - Management of COVID-19 Vaccination of Pediatric Patients Webinar
• March 16, 2022 – Approving COVID-19 Vaccines for Children: When Do We Know Enough?

State Webinars

• Immunization training
• Webinar series on how to incorporate COVID-19 vaccines into your practice workflow and on effective strategies to engage patients in conversations about the vaccine (DOH and Washington State Medical Association)
• December 7, 2021 – COVID-19 Vaccination and Counseling Billing Presentation (YouTube)
  • Slides (PDF) | Q&A Document (PDF)
• November 18, 2021 – COVID-19 Vaccine Safety and VAERS Reporting webinar
• November 8, 2021 – COVID-19 Vaccine Updates webinar

Clinical Resources

• COVID-19 Vaccine Immunization Schedule (PDF) (CDC)
• COVID-19 Vaccine Product Characteristics Chart (PDF)
• About the vaccines
• July 6, 2021 - Morbidity and Mortality Weekly Report (MMWR), mRNA COVID-19 vaccines and myocarditis
• Myocarditis and mRNA vaccines (PDF)
• Vaccine administration errors (PDF)
• VAERS System and Reporting (YouTube)
• COVID-19 clinical FAQs (CDC)
• COVID-19 vaccine product information (CDC)
• Interim clinical considerations for use of COVID-19 vaccines (CDC)
• Summary document for interim clinical considerations (PDF) (CDC)
• Pre-vaccination checklist for COVID-19 vaccines (PDF) (CDC)
• Additional languages: Arabic | French | Korean | Simplified Chinese | Spanish | Vietnamese
• ID Snapshot: How to reduce pain during vaccination (American Academy of Pediatrics)
• Vaccinating homebound persons with COVID-19 vaccine (CDC)
• Vaccine Storage and Handling toolkit, including a new COVID-19 Vaccine Addendum (CDC)
• Epidemiology and Prevention of Vaccine-Preventable Diseases (CDC)
• COVID-19 mRNA vaccines: what clinic personnel need to know (Immunization Action Coalition)
• Childhood Vaccine Program Transition Flyer (PDF)

Standing Orders

• Centers for Disease Control and Prevention (CDC) standing orders template for:
  • Novavax, 12 years and older (PDF)
  • Pfizer, 6 months–4 years of age
  • Pfizer, 5 years of age and older
  • Moderna, 6 months–4 years of age
  • Moderna, 5 years of age and older
     

Frequently Asked Questions

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

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

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.

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

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
• Novavax: 12 years and older

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. The Novavax vaccine is available for ages 12+ under an EUA. 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. Find more resources for you and your patients with the Pregnancy and COVID-19 Vaccine Toolkit.

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)

Novavax

• The Novavax vaccine currently should not be given:
• To anyone under the age of 12 years old until further research can support its use in that age category. 
• Outside the appropriate age dose.
• To anyone with a history of myocarditis or pericarditis.

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.

Additionally, if people are found to be extremely allergic, making COVID-19 vaccine too risky to give, providers should consider offering EVUSHELD.

In June of 2022 the U.S. Food and Drug Administration authorized revisions to Evusheld dosing. 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 regard to timing of most other routine vaccines.

People, particularly adolescent or young adult males, might consider waiting 4 weeks after orthopoxvirus vaccination (either JYNNEOS or ACAM2000) before receiving a Moderna, Novavax, or Pfizer-BioNTech COVID-19 vaccine because of the observed risk for myocarditis and pericarditis after receipt of ACAM2000 orthopoxvirus vaccine and mRNA (i.e., Moderna and Pfizer-BioNTech) and Novavax COVID-19 vaccines and the unknown risk for myocarditis and pericarditis after JYNNEOS.

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.