BCHHS Public Health Provider Alert: COVID-19 vaccine updates & Governor's new Exec Order

May 18, 2021

Governor Cooper’s Executive Order 215

  • As of May 14th at 1:30pm, in NC there is no more statewide mask mandate, no mandatory mass gathering limits, no mandatory capacity limits, and no mandatory social distancing limits.
  • There are some exceptions where masks must continue to be worn, including K-12 schools, childcare facilities, children’s day and overnight camps, healthcare settings, public transportation, detention facilities and homeless shelters. Employers, business owners and local governments may require face coverings and social distancing.
  • FAQs about this order can be found here.
  • With regard to healthcare settings:
    • Section 3.3 in Executive Order 215 states that, “all residents, workers, and visitors in health care settings including hospitals, outpatient healthcare settings, Long Term Care ("LTC") Facilities, skilled nursing facilities ("SNF"), and intermediate care facilities for individuals with intellectual disabilities ("ICFIID"), must follow the requirements in the CDC Healthcare Infection and Prevention Control Recommendations in Response to COVID-19 Vaccination. Per this CDC guidance, "in general, fully vaccinated healthcare personnel (HCP) should continue to wear source control while at work. However, fully vaccinated HCP could dine and socialize together in break rooms and conduct in-person meetings without source control or physical distancing. If unvaccinated HCP are present, everyone should wear source control and unvaccinated HCP should physically distance from others."
    • Based on other CDC guidance, visitors to clinics should still wear face coverings, be screened for symptoms & exposure, and maintain physical distancing.

Updated CDC Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Authorized in the United States

  • I strongly encourage you to review the May 14th updates to this document, which include:
    • Updated information for authorized age groups to include vaccination of adolescents ages 12–15 years with Pfizer-BioNTech COVID-19 vaccine.
    • Updated information on coadministration of COVID-19 vaccines with other vaccines.
      • COVID-19 vaccines and other vaccines may now be administered without regard to timing. This includes simultaneous administration of COVID-19 vaccines and other vaccines on the same day, as well as coadministration within 14 days.
      • It is unknown whether reactogenicity of COVID-19 vaccine is increased with coadministration, including with other vaccines known to be more reactogenic, such as adjuvanted vaccines or live vaccines. When deciding whether to coadminister another vaccine(s) with COVID-19 vaccines, providers should consider whether the patient is behind or at risk of becoming behind on recommended vaccines, their risk of vaccine-preventable disease (e.g., during an outbreak or occupational exposures), and the reactogenicity profile of the vaccines.
      • If multiple vaccines are administered at a single visit, administer each injection in a different injection site.
        • For adolescents and adults, the deltoid muscle can be used for more than one intramuscular injection.
        • Separate injection sites by 1 inch or more, if possible.
        • Administer the COVID-19 vaccines and vaccines that may be more likely to cause a local reaction (e.g., tetanus-toxoid-containing and adjuvanted vaccines) in different limbs, if possible.
      • Per the CDC, these updated coadministration recommendations may facilitate catch-up on routine vaccination of adolescents.
        • As of May 2, 2021, overall Vaccines for Children provider orders (other than influenza) were down by 11.7 million doses compared with 2019. This gap is largest in vaccines primarily given to adolescents.
          • Tdap down 18.9%
          • HPV down 19.3%
          • Meningococcal conjugate vaccine down 15.1%
    • A new section on persons with a history of multisystem inflammatory syndrome added to considerations for vaccination of people with certain underlying medical conditions.
    • Updated recommendation for timing of COVID-19 vaccine administration in persons with a history of heparin-induced thrombocytopenia.
    • Updated information on vaccination of children and adolescents.
  • The CDC’s pre-vaccination checklist has not yet been updated with these changes.
  • The slides and a recording of the May 14th CDC COCA call “What Clinicians Need to Know About Pfizer-BioNTech COVID-19 Vaccination of Adolescents” can be found here.

Please become a COVID-19 vaccine provider!

  • NCDHHS and BCHHS encourage all pediatric and adult primary care providers to enroll with NCDHHS as COVID-19 vaccine providers.
    • It is important to make vaccines easily accessible to individuals in settings they trust, such as in your clinics. (See graph below.) Having vaccine onsite will increase the chance that your patients will get vaccinated after you’ve addressed any remaining concerns or questions they may have.
      • For our local pediatricians:  We have heard from a pediatrician in another part of the state that their office has enjoyed vaccinating adults alongside their adolescent children & grandchildren. They estimated that ~40% of their COVID vaccines in the last week were to adult caregivers, including elderly grandparents and Spanish-speaking-only parents.
      • Please consider offering COVID vaccine to anyone who accompanies your patients!
    • We know that using every dose in a vial before it expires can be challenging when accommodating walk-ins or administering vaccine in smaller settings. But giving people easy and convenient options to be vaccinated should be prioritized over ensuring that every dose is used in an open vial.
    • BCHHS Public Health staff are available to answer your questions about handling and storage of the vaccine, and will work with you to transfer small allotments of vaccine to meet your clinic’s needs.
    • To learn more about enrolling, see the information here, as well as this roadmap of the state’s provider enrollment process.
    • Info on Moderna vaccine storage & handling:  https://www.cdc.gov/vaccines/covid-19/info-by-product/moderna/downloads/storage-summary.pdf  
    • Info on Pfizer vaccine storage & handling:  https://www.cdc.gov/vaccines/covid-19/info-by-product/pfizer/downloads/storage-summary.pdf  
    • Info on Johnson & Johnson vaccine storage & handling:  https://www.cdc.gov/vaccines/covid-19/info-by-product/janssen/downloads/janssen-storage-handling-summary.pdf