To: Residential care facilities (nursing homes, assisted living facilities, group homes, and intermediate care facilities) The Colorado Department of Public Health and Environment (CDPHE) would like to provide an update on changes at the federal level regarding COVID-19 vaccine dose recommendations, as well as a reminder of the Public Health Order (PHO 20- 20), and Residential Care Facility (RCF) Mitigation Guidance requirement to offer vaccine clinics within your facility to ensure continued access to vaccination for residents and staff.
On Sept. 1, Centers for Disease Control and Prevention (CDC) recommended the bivalent COVID-19 mRNA booster dose authorized by U.S. Food and Drug Administration (FDA) on August 31, 2022.The Pfizer bivalent vaccine is recommended for people aged 12 years and older. The Moderna bivalent vaccine is recommended for people aged 18 years and older. The prior (original) vaccines, still used for primary series vaccination, are referred to below as monovalent vaccines. For the new doses, an omicron BA.4/BA.5 spike protein component has been added to the monovalent (original) Pfizer and Moderna mRNA COVID-19 vaccines to create a bivalent vaccine, also known as an omicron dose. These doses are designed to protect against both the original strain of the COVID-19 virus and the BA.4 and BA.5 subvariants of the omicron strain that are currently predominant in Colorado. Receiving all recommended doses of COVID-19 vaccine is critical to protect both staff and residents from getting seriously ill, needing to be hospitalized, and dying. Getting an omicron dose will also help prepare for potential fall and winter surges of COVID-19. Current COVID-19 vaccine recommendations are available in the Interim Clinical Considerations for Use of COVID-19 Vaccines CDC. The bivalent COVID-19 vaccine is a single dose administered at least two months after: - Completion of primary vaccination with any authorized or approved monovalent (original) COVID-19 vaccine, or
- Receipt of the most recent booster dose with any authorized or approved monovalent (original) COVID-19 vaccine.
Additional bivalent recommendations and updates - Everyone aged 12 years and older should get one age-appropriate bivalent mRNA dose after completion of any FDA-approved or FDA-authorized monovalent (original) primary series or last monovalent (original) booster dose.
- People cannot get a bivalent booster dose without first completing at least a primary series.
- Age-appropriate mix-and-match booster doses are allowed. There is no preference for Moderna or Pfizer as a booster dose, regardless of the type of primary series.
- The bivalent recommendation replaces previous booster recommendations for people aged 12 years and older.
- Monovalent (original) mRNA COVID-19 vaccines are NO LONGER authorized as booster doses for people aged 12 years and older.
- With both influenza (flu) and COVID-19 circulating, getting both vaccines is important for the prevention of severe disease, hospitalization, and death. Getting both vaccines at the same visit increases the chance that a person will be up to date with their vaccinations.
- At a minimum, defer any COVID-19 vaccination at least until recovery from acute COVID-19 infection/illness and criteria to discontinue isolation have been met.
CDC definitions used by CDPHE when referring to COVID-19 vaccinated persons - Up to date with your COVID-19 vaccines means you completed a COVID-19 vaccine primary series and received the most recent booster dose recommended for you by CDC.
- If you completed your primary series, but are not yet eligible for a booster, you are also considered up to date.
Reference: CDC: Stay Up to Date with Your COVID-19 Vaccines RCF COVID-19 Mitigation Guidance temporary allowance for up-to-date - Residents and staff who meet the criteria below will be considered “up to date” for the purposes of the mitigation strategies listed in the RCF Mitigation Guidance until September 30, 2022 to allow time for facilities to acquire and administer the new omicron (bivalent) dose currently recommended by CDC.
- Have completed a primary COVID-19 series and are not yet eligible for a booster dose.
- Have completed their primary COVID-19 series and ALL booster doses (as recommended for them by CDC as of August 31, 2022) or any booster dose in the last two months.
- Residents and staff who meet the criteria below will continue to be considered “not up to date” for the purposes of the mitigation strategies listed in the RCF Mitigation Guidance.
- Have not completed a primary COVID-19 series.
- Have not received all booster doses recommended for them by the CDC as of August 31, 2022.
- Everyone will be considered “up to date” immediately upon receiving the new omicron (bivalent) dose, regardless of a prior booster vaccination.
RCF Comprehensive Mitigation Guidance requirements As the FDA authorizes and CDC recommends additional COVID-19 vaccine doses, facilities must: - Evaluate their residents' and staff's vaccination status and adhere to the new standards.
- Provide CDPHE-approved messaging to residents, resident decision-makers, and staff alerting them to updated COVID-19 vaccine recommendations and the importance of getting and staying up to date with all recommended doses.
- Make the vaccine available to staff and residents at their facility, within 60 days of any updates to CDC recommendations.
- Complete the required EMResource reporting as soon as possible within the reporting period the vaccine doses are administered.
- Communicate with CDPHE within three business days regarding the facility’s ability to provide a vaccination clinic and respond to CDPHE’s communication.
How to request a vaccine clinic from CDPHE CDPHE will provide one vaccine clinic before November 1, 2022 to facilities that are unable to provide a vaccine clinic on their own or use a community vaccine provider. Facilities must complete the following EMResource question during the first reporting period (by September 14, 2022). Facilities requesting CDPHE assistance to provide a vaccination clinic should complete the following EMResource question AND complete the Long Term Care Facility (LTCF) Booster Clinic Request Fall 2022 form as soon as possible to allow for clinic scheduling. Question: CDPHE COVID-19 Vaccine Clinic Assistance Definition: The RCF Comprehensive Mitigation Guidance requires that facilities offer a COVID-19 vaccine clinic to staff and residents inside their facility within 60 days of any update to CDC’s vaccine recommendations. CDC recommended COVID-19 omicron bivalent vaccine doses on September 1, 2022. CDPHE can assist with vaccination clinics for facilities that need it, but encourages all facilities to develop plans with community partners and document that information in the Ongoing COVID-19 Vaccination and Treatment Form. Does your facility require any CDPHE assistance to hold that clinic?
- No: The facility is responsible for providing its own vaccine clinic and should report the vaccine provider it will use in the comments section.
When your facility answers YES to this EMResource question AND completes the request form, a CDPHE representative will contact your facility to gather the necessary information to schedule the clinic. To prevent communication delays, ensure all contact information listed for your facility in the Colorado Health Facilities Interactive (COHFI) system is accurate. A designated facility representative needs to quickly connect with a CDPHE representative to begin this process. When CDPHE contacts your facility about your COVID-19 vaccination needs, answer or return the call as soon as possible. This clinic can be used by both residents and staff to provide bivalent and/or primary doses of COVID-19 vaccine. Begin gathering consent for COVID-19 vaccinations before your vaccine clinic by reviewing CDPHE’s COVID-19 vaccine screening and administration form (most recent version is dated 9/1/2022 or later). After the clinic is complete, facilities are expected to update EMResource with the date the vaccine clinic was completed that offered omicron bivalent booster vaccines, the number of residents who received the new omicron bivalent dose, as well as up-to-date, not up-to-date, and not vaccinated resident and staff. EMResource questions update EMResource has been updated with additional questions related to facility COVID-19 vaccine clinics and residents receiving the omicron bivalent doses. Question: COVID-19 Vaccine Clinic Date Definition: Since September 1, 2022, provide the most recent date that your facility offered a COVID-19 vaccine clinic to offer the omicron bivalent doses recommended by CDC on September 1, 2022. If your facility did not offer a vaccine clinic to provide the omicron bivalent doses, a comment for this question is needed. Question: Resident omicron doses Definition: Number of residents who got a COVID-19 omicron dose at any clinic(s) at your facility or outside of your facility from their primary care provider or another vaccine provider since September 1, 2022. CDC updated their COVID-19 vaccine recommendation to include omicron doses for those aged 12 years and older who completed a primary vaccination series if it has been at least two months after the second dose in the primary vaccination series or at least two months since the last booster dose. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html *The Resident Second Boosters question has been removed. Sources and resources:
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