Sept 2022

Topics

• Summary of Changes for COVID-19 Vaccine
• Up-to-date Definition and Bivalent Vaccine Availability 
• LTCF Vaccine Resources 
• Can the Updated Bivalent Booster be Given at the Same Time as the FLU Vaccine? 

Summary of Changes for COVID-19 Vaccine

• Current monovalent mRNA COVID-19 vaccines are no longer authorized for use as boosters in individuals 12 years and older.  
• The FDA authorized two bivalent COVID-19 vaccines for use as a booster dose; Moderna for 18+ and Pfizer-BioNTech for 12+.
• The bivalent vaccines contain an mRNA component from the original strain and mRNA component in between the more recent Omicron BA.4 and BA.5 variant. 
• A person is eligible to receive a bivalent booster if it has been at least two months since they have completed primary vaccination or have received the most recent booster dose with any authorized or approved monovalent COVID-19 vaccine.

Up-to-date Definition and Bivalent Vaccine Availability

DSHS Dear Admin Letter 9/13/22: https://www.dshs.wa.gov/sites/default/files/ALTSA/rcs/documents/multiple/022-09-13-1.pdf?utm_medium=email&utm_source=govdelivery
 
CDC is now recommending the new bivalent booster and discontinuing recommendations for giving monovalent vaccine as a booster shot, yet the bivalent booster is not yet widely available. There is concern about how to determine if someone in LTC is up-to-date. The interim guidance serves as a bridge during this period of the bivalent vaccine not being widely available and is temporary until the bivalent vaccine is more available.
 
Summary of the interim guidance:

• Residents in LTCFs may continue to be considered up to date if they have received all of their recommended doses of the monovalent vaccine boosters, IF the bivalent vaccines are currently not available to them.
• Facilities will have to document their efforts to obtain the bivalent vaccines in order to demonstrate that the bivalent vaccines are not yet available to them.

• Example: LTCFs, specially SNFS, who work with a LTC Pharmacy may document their coordinated efforts to access the bivalent vaccines for their community.

• If the bivalent vaccine is available to the facility through their pharmacy then they would need to receive the bivalent vaccine in order to be considered up-to-date. If the hospital can provide the bivalent vaccine before discharge and the resident refused then that resident would be not up-to-date and need to quarantine. If the hospital doesn’t have available vaccine and the new admit has all their prior doses then they are still up-to-date and do not need to quarantine. They would continue to be up-to-date until the vaccine is available to LTC facility through their pharmacy or LHJ.
• For staff up-to-date status and return to work after an exposure, it would seem fair to consider “available” as the facility is able to provide a vaccine clinic for staff.

If you have any questions or need assistance with guidance interpretation, please email us at [email protected]

LTCF Vaccine Resources

LTCF are responsible to coordinate vaccinations for their residents and staff.  We suggest that they do the following, in order;

• Facility checks with their LTCF pharmacy provider to arrange support
• Identify and follow up with any other local pharmacies
• Check with their LHJ
• LHJ will check with DOH, if appropriate

• Email to include name of facility, number of residents, and timeframe for request

Can the Updated Bivalent Booster be Given at the Same Time as the FLU Vaccine?

Yes!  It is safe to get the COVID-19 vaccine, including the updated bivalent booster, at the same time as the flu vaccine or any other vaccine.  It is important that everyone aged 6 months and older is up to date on their COVID-19 vaccines and receives an annual flu vaccine in the next few months. 
Studies show health care providers are the most trusted source of vaccine information.  According to the CDC, research also shows when a strong recommendation is given by a health care provider, a client is four to five times more likely to be vaccinated. 
Encourage clients to receive both at the same visit.  Taking a bundled, or presumptive, approach to vaccine recommendations may be helpful if you sense hesitancy.  For example, you can tell your client which vaccines they need, rather than ask them what they want. Bundling also helps if there is hesitancy about a particular vaccine but not others.  For example, "you are due for your Tdap, COVID-19 and annual flu vaccines."  Bundling the COVID-19 vaccine with Tdap and flu, which are routine, may put your client at ease.