For some health care professionals, one of our responsibilities is administering vaccines. Many facilities also find themselves participating in vaccination efforts, whether that’s organization vaccination clinics for the public or offering vaccinations directly to patients and staff.
With the new COVID-19 vaccines, this will be the first time many of us will be handling a vaccine that isn’t the flu shot or part of the standard vaccination schedule. This is also the first time mRNA vaccines have been licensed for public use.
As we begin the long vaccination process to end the pandemic, here’s what we currently know about administering the COVID-19 vaccines.
General COVID-19 Vaccine Guidelines
Currently, all COVID-19 vaccines that have been approved or are likely to be approved soon in the United States require a two-dose course with several weeks in between each dose. Be aware of the following considerations:
- Do not mix vaccines, such as giving one dose of the Pfizer-BioNTech vaccine for the first dose and a dose of the Moderna vaccine as the second dose.
- Do not get another vaccine 14 days before or after you get the COVID-19 vaccine.
- People who have had confirmed COVID-19, whether symptomatic or asymptomatic, should still be offered the vaccine.
- You don’t need to be tested for COVID-19 in order to be offered the vaccine, but you must be fully recovered if you have a current infection and are no longer under isolation.
- There is no minimum time you must wait between recovering from COVID-19 and getting vaccinated, but it’s suggested that you can wait 90 days after infection, as you likely won’t be able to be reinfected.
- Wait 90 days after you’ve received passive antibody therapy (like monoclonal antibodies or convalescent plasma) to treat COVID-19.
Severe Allergic Reactions
Pfizer-BioNTech and Moderna currently recommend that anyone with a known history of having severe allergic reactions to any ingredient in their vaccines should avoid getting the vaccine.
Currently, the CDC considers those with a health history of a severe allergic reaction to any other vaccine or any injectable therapy a precaution but not a contraindication. That means that the CDC recommends that these people can still get the vaccine, but they need additional observation after being vaccinated.
If someone with this health history still wants to get the vaccine, you need to observe them after vaccination:
- 30 minutes if they have a history of anaphylaxis for any reason
- 15 minutes for everyone else.
Vaccination Guidelines for Special Populations
The clinical trials for the COVID-19 vaccines included many special populations in order to determine the vaccine’s safety across a wide range of the public. However, as the vaccines are still new and there are many special populations, we don’t have complete data for certain demographics yet.
With what we know so far, here are the suggested vaccination guidelines for certain high-risk special populations:
- The vaccine is just as safe for those who have underlying medical conditions as it is for those who don’t. Those who have no contraindications that would prevent them from getting vaccinated have had similar safety and efficacy trial results as those without any comorbidities.
- People who are immunocompromised, whether from disease or medication, can get the vaccine unless they have other contraindications to consider. However, there isn’t any data on how safe and efficient the vaccine is for this population.
- Pregnant people may choose to be vaccinated. However, we also don’t have much data yet on the vaccine’s safety for this population, and studies are ongoing.
- Breastfeeding or lactating women may also choose to be vaccinated, but there is also no data yet on the vaccine’s safety for this population.
- Currently, the vaccines are not approved for use in children.
Before You Give the Vaccine
Just as with any vaccine, the person you’re administering it to should know and understand the full risks associated with getting a vaccine, and that’s especially important with the COVID-19 vaccines.
In addition to fact sheets, here are some things to consider telling a vaccine recipient before you give them the vaccine:
- Explain the potential and expected symptoms that may come after vaccination. This includes soreness or redness at the injection site or flu-like symptoms (chills, fever, body aches) in the days following the dose. Explain that this is normal and a good sign that the vaccine and your immune system are working correctly.
- Emphasize how important it is that they get the second dose on time. Their immunity is not complete or guaranteed until after the second dose.
- Instruct them to continue following precautionary measures, such as social distancing, wearing a mask, quarantine after exposure, and washing their hands often, even after completing the full course. It takes one to two weeks after the second dose for immunity. Additionally, we’re still learning about the disease and the vaccine, and immunity is not guaranteed, even once they’re vaccinated.
- Remind them that no vaccine is 100% effective.
The Pfizer-BioNTech Vaccine
These vaccines come in vials that have enough for multiple doses per vials, and you’ll need to dilute the doses before you administer them. This vaccine should not be given to anyone younger than 16 years old.
Each person who gets this COVID-19 vaccine needs two doses of 30 micrograms (0.3 ml) each administered intramuscularly, 21 days apart.
There’s a 4-day grace period for the second dose, meaning that someone can get the second dose starting at day 17 after the first dose. If they miss getting the second dose before day 21, they should get it as soon as possible, but they won’t need to repeat the doses.
Storage and Handling
The vials must be kept frozen between -80 degrees Celsius and -60 degrees Celsius and protected from light.
When you’re preparing to use the vials, thaw in a fridge with temperatures between 2 degrees Celsius and 8 degrees Celsius for up to 5 days (120 hours). It’ll take up to 2 to 3 hours to thaw a carton of vials, but fewer vials may need less time to thaw.
When you’re ready to use the vials, thaw them at room temperature up to 25 degrees Celsius for 30 minutes at normal room lighting. The vials must reach room temperature before you can dilute the doses.
Once an undiluted vial has been thawed, you can keep it in a fridge for five days or at room temperature for no more than 2 hours. Once a vial has been both thawed and diluted, then it must be stored between 2 degrees Celsius and 25 degrees Celsius, and you have only 6 hours from when you diluted it before you must throw it away.
Before you can give the vaccine, you must dilute the dose. You have to dilute the vial within two hours after it’s reached room temperature.
Dilute each vial with 1.8 milliliters of 0.9% Sodium Chloride Injections, USP (preservative-free normal saline). This is the only approved liquid for dilution. Do not use anything else.
Vials should not be shaken, only swirled gently. Shaken vials must be disposed of immediately.
The Moderna Vaccine
The Moderna vaccine is the second mRNA vaccine to be authorized for public use.
As with the Pfizer-BioNTech vaccine, each vial continues multiple doses, but unlike the Pfizer-BioNTech vaccine, vials do not need to be diluted before use. This vaccine is approved for use in adults 18 years old and older.
Each person who gets this COVID-19 vaccine needs two doses of 100 micrograms (0.5 ml) each administered intramuscularly, 28 days apart.
As with the Pfizer-BioNTech vaccine, there is a 4-day grace period for the second dose, meaning that recipients can get the second dose starting on day 24. If the recipient doesn’t get the second dose before the 28-day mark, they should get it as soon as possible, and the first dose does not need to be repeated.
Storage and Handling
The vials must be kept at -20 degrees Celsius for transportation and long-term storage.
They can be stored either in a freezer between -25 degrees Celsius and -15 degrees Celsius for 6 months or up to the expiration date, or they can be stored in a refrigerator between 2 degrees Celsius and 8 degrees Celsius for up to 30 days before they are first used.
When you’re preparing to use the vials, you can thaw them one of two ways:
- Thaw in a fridge with temperatures between 2 degrees Celsius and 8 degrees Celsius for 2 hours and 30 minutes.
- Thaw at room temperature between 15 degrees Celsius and 25 degrees Celsius for 1 hour.
Do not refreeze thawed vials.
When you’re ready to use the vaccine, it can be kept out at room temperature for up to 12 hours.
After Giving the Vaccine
There are several instructions that vaccine recipients need to know after getting vaccinated, which you will need to give each recipient an after-vaccination handout for the specific vaccine they received.
Among other details, the handout details common side effects that they might experience, such as pain or swelling at the injection site and flu-like symptoms, such as a fever, chills, or headache.
The handout should also instruct recipients to report any adverse reactions directly to the vaccine developer, such as through the Pfizer-BioNTech safety reporting website.
Encourage vaccine recipients to closely follow all post-vaccination instructions. It can take up to two weeks after the second dose of the vaccine before the body is immunized against COVID-19, and we don’t know yet if immunized people can still spread the virus.
Instruct recipients to continue practicing precautionary measures, including wearing a mask, social distancing, and washing their hands, even after they’ve received their second dose. These recommendations are likely to continue until the majority of people are vaccinated.
For pregnant people who choose to be vaccinated, if they develop a fever as a side effect of the vaccine, they should be encouraged to take acetaminophen to treat the fever to prevent potential issues with the pregnancy.
For Vaccine Administrators
As a vaccine administrator, you are required to report any adverse events that happen to any recipient after vaccination through the Vaccine Adverse Events Reporting System (VAERS). Events include the following:
- Administration errors
- Cases of multisystem inflammatory syndrome
- Cases of COVID-19 that results in hospitalization or death after vaccination
- Other significant adverse events.
For Facilities and Their Staff
The CDC has outlined various considerations for facilities once their staff is vaccinated. In addition to continuing to use infection prevention measures, like using protective personal equipment, the CDC recommends vaccination health care professionals with the following considerations:
- Vaccinate a staff member directly before they have one or two days off of work.
- Stagger vaccination among the staff so that not everyone in a single department or unit gets the vaccine at the same time.
- Offer nonpunitive sick leave in the event of post-vaccination symptoms to encourage reporting.
- Develop a system to quickly assess any post-vaccination signs or symptoms in staff members.
The COVID-19 vaccines are a new and exciting step for ending the pandemic, but with their arrival comes a number of new challenges that will constantly evolve as we learn more about the vaccine and COVID-19.
As health care professionals on the frontlines for vaccination, stay in close contact with your local health departments and government organizations, so we can distribute the vaccine to critical populations quickly and safely.