COVID-19 Vaccination of Healthcare Personnel: Updated SHEA Recommendations

December 09, 2020

SHEA has updated its recommendations for COVID-19 vaccination in healthcare settings.

The SHEA statement was authored by experts Drs. Marci Drees, Grace Lee, Deborah Yokoe, and David Weber. The statement was first published in October, and this update incorporates recent developments.

Below, we’ve highlighted the main points in the statement, which are discussed further by Dr. Grace Lee in her presentation on the SHEA Dec. 6 Town Hall and in the slide deck by Dr. Weber.

  • Shipments: 
    • The first vaccines may reach Phase 1a. recipients by mid-Dec. based on timing for the FDA authorization meetings and plans for rapid turnaround by CDC’s ACIP and distribution task force.
    • Facilities must coordinate with local public health offices, who will receive initial vaccine allotments. 
    • Facilities and individual recipients likely will not be able to select the vaccine they prefer
    • Pfizer/BioNTech vaccines will be shipped in dry ice boxes with 1,000 doses per box to maintain requirement for –70°C storage 
    • Initial shipments may not be evenly distributed across the US in order to address areas in greatest need; however, subsequent shipments are expected to arrive rapidly and facilities should plan from the start to administer all available doses.
  • HCP Policies:
    • Pfizer/BioNTech and Moderna vaccines are expected to be approved under Emergency Use Authorization; therefore, SHEA: 
      • Does NOT recommend the COVID-19 vaccine be mandatory or condition-of-employment 
      • DOES recommend utilization of an informed consent process 
      • DOES recommend that serious adverse events be covered under workers’ compensation
  • Prioritization: 
    • Individuals included in ACIP-identified prioritization Phases 1a.-1c. will overlap.  
    • Facilities can move from one phase to the next once demand for vaccines is saturated. The goal is to ensure all doses are used expeditiously so that vaccine does not sit on shelves.  
    • Phase 1a. encompasses HCP in all settings and roles, and long-term care residents. The SHEA COVID-19 Vaccine Statement provides prioritization guidance for HCP, applying ACIP’s ethical principles: maximizing benefits, minimizing harms, promoting justice, mitigating health inequities, and promoting transparency.  
    • Vaccination of pregnant or lactating women will depend on the exact language used in the EUA (see SHEA COVID-19 Vaccine Statement).  
    • Phase 1b. includes essential personnel outside of healthcare.   
    • Phase 1c. includes adults with underlying medical conditions and those over 65.  
    • Under the current EUA submission, there is insufficient information about children under 16 years of age; therefore, children will not be included in the initial EUA.
  • Administration:  
    • Stagger vaccination in departments/units/roles to prevent staffing shortages: 
      • A portion of recipients of the Pfizer/BioNTech and Moderna vaccines will experience systemic reactions, some with fever.  
      • Reactions to the second dose are stronger than the first.  
      • Consider encouraging individuals to be vaccinated just before planned time off, if feasible.   
    • Both vaccines will be administered using multidose vials:  
      • Most HCP have limited familiarity with multidose vials.   
      • Consider adding a pharmacy technician or other staff member to prepare vaccine doses for the nurse or vaccinator.   
      • Competency in safe handling of multidose vials is essential.   
    • Both vaccines require 2 doses, 21 or 28 days apart: 
      • Vaccine doses are NOT interchangeable by manufacturer.  
      • Vaccinators should provide reminders for second doses and means for patients to track the type, lot, and date of their vaccine.  
      • Facilities must have a process to ensure second doses are available at the proper time for those who have received the first dose.   
    • Both Pfizer/BioNTech and Moderna’s vaccines must be administered within 6 hours once reconstituted or once a vial is entered. They have a shelf life of 5 days and 2 weeks if unconstituted, respectively.
  • Tracking:  
    • Healthcare systems will be required to report all vaccines administered (type, dose number, etc.) to state or local authorities via the state immunization registry or another tool.   
    • Facilities, including nursing homes, will report weekly to NHSN (module available mid-Dec.) the aggregate vaccines administered to HCP.
  • Safety Monitoring:  
    • Safety surveillance systems will include: VAERS, VSD, NHSN, and CMS  
    • V-SAFE is a new surveillance system for smartphone users.   
      • Vaccinators should advise all smartphone users to sign up for V-SAFE. 
      • V-SAFE will text recipients at 7 days post-vaccine, weekly for 6 weeks, and then periodically for up to 1 year. V-SAFE will correspond with VAERS upon any reported serious adverse event.
  • Some HCP may be hesitant to receive the COVID-19 vaccine. Facility or health system leadership can help foster confidence by being vaccinated publicly. Facilities should develop a communications plan for HCP COVID-19 vaccination (see SHEA Statement). 

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