MEMO: Publicly Funded Immunization Appointments are Essential during the COVID-19 Pandemic

TO:  Health care professionals in the Niagara region

FROM: Vaccine Preventable Disease program, Niagara Region Public Health & Emergency Services

REFERENCE: Publicly Funded Immunization Appointments are Essential during the COVID-19 Pandemic

DATE:  March 2020

Our Sincere Gratitude for Keeping Niagara Residents Healthy

Thank you for your ongoing work to support our community’s response to the COVID-19 pandemic. These are challenging times and we appreciate everything you are doing in your practices. 

Immunization Program Changes at Public Health

The COVID-19 pandemic has made it necessary for us to change our service delivery model that will have implications for both your practice and Niagara residents. Here is what you need know:

Student suspension is cancelled

• All students who have an outstanding Order for Suspension from Attendance at School pursuant to the Immunization of Schools Pupils Act will have the Order rescinded for this current school year. This means that all students who do not have up-to-date vaccination information on file with Public Health will not be suspended from school this year. 
• Public Health is recommending that parents keep their child’s vaccine record up-to-date and continue to report these vaccines to Public Health

Public Health is not immunizing at this time

• Public Health staff have been redeployed to address the COVID-19 pandemic.  Therefore, we do not have the capacity to maintain our vaccination clinics. As such, we are not immunizing anyone. 
• Please do not refer your patients to Public Health for immunizations at this time.  Our vaccination clinics are cancelled.

Public Health will continue to fill vaccine orders and deliver vaccines directly to your office

• You can continue to order vaccines as per the usual process. 
• All vaccine pick-up has been cancelled. Instead, we will deliver the vaccines directly to your office according to the vaccine delivery schedule. However, if you have an urgent or time sensitive vaccine request, please let us know. Tell us at the time of ordering if your office hours have changed as this may impact vaccine deliveries.

Publicly Funded Immunizations are Essential Appointments

As per our Novel Coronavirus (COVID-19) Update #9, Public Health is asking physicians to continue to provide medical care that addresses the urgent and emergent needs of their patients. We consider on time immunization to be an essential service that can mitigate adverse patient outcomes. With our vaccination clinics cancelled, Niagara residents will be relying on community based health care providers for immunization services.

Consider this:

• Globally - according to the World Health Organization, many countries around the world have been experiencing measles outbreaks in the past year
• The Centre for Disease Control considers pertussis to be an endemic disease in the United States. In 2018, there were 15,609 reported cases.
• Provincially, there were 388 pertussis cases requiring 34 hospitalizations in 2018. This resulted in three deaths.
• With Public Health staff redeployed, immunization records will not be reviewed for overdue status this year; decreasing vaccine coverage rates would threaten the ability to maintain Niagara’s community immunity

We strongly encourage you to complete all publicly funded immunizations on time for children up to 2 years of age, as per the Publicly Funded Immunization Schedules for Ontario. The schedule allows for some flexibility in terms of when the 4-6 year old vaccinations are administered. You may consider postponing these vaccinations until your patients are close to being overdue (7 years of age.)

Logistical Considerations around Providing Immunizations during the COVID-19 Pandemic

Your office will need to determine the best internal office logistics to provide essential immunization appointments

• Personal Protective Equipment (PPE). We understand the face-to-face nature of immunizing at a time of physical distancing may be uncomfortable as you deliberate the safety of your staff and patients
  • Please refer to the Ministry of Health COVID-19 Guidance: Primary Care Providers in a Community Setting for information on how to protect you and your staff when seeing patients at this time
  • If you are in need of PPE, contact Jill Croteau at jill.croteau@niagararegion.ca and she will direct you appropriately
• Let your patients know that vaccination appointments are available. If capacity is an issue, start with infant vaccinations, then reach out to other high priority patients for publicly funded immunizations (e.g. patients overdue for vaccination, patients who meet high-risk criteria). 
  • It is important to note that one adult lifetime booster with Tdap is publicly funded for adults 18 and older. However, the Tdap is recommended for every pregnancy and, any family member or caregiver of an infant or young child. As such, Tdap boosters for these populations are also considered essential immunization appointments, even if they are not publicly funded.
• Conduct over the phone screening before scheduling immunization appointments and screening upon entry
  • Follow the Ministry of Health COVID-19 Guidance: Primary Care Providers in a Community Setting for specifics
  • Ensure a Novel Coronavirus (COVID-19) Screening Poster for Health Care Professional is posted; copies can be ordered under "Infection Prevention and Control"
  • The Ontario College of Family Physicians have provided a sample message for patients that you can use on their COVID-19: Tips for Family Doctors web page
• If your patient fails the screening, call Public Health and a nurse will work with you to determine if your patient qualifies for testing.
  • ​Defer immunization until the patient is out of isolation.
• Ask patients to plan ahead for pain management.
  • Refer them to the HELP Eliminate Pain in Kids & Adults website 
• Determine how to facilitate physical distancing for immunization appointments. Suggestions include:
  • Permit only one caregiver to accompany the individual being immunized when necessary
  • Space out immunization appointments so patients do not cross paths
  • Ask patients to wait in their car to avoid being in the waiting room. Have your staff text or call to let them know when they are ready to be seen for their immunization.
• Follow environmental cleaning and disinfecting recommendations for COVID-19 for health care settings
  • Consider making immunization appointments for the first hour of the day after disinfecting the office overnight for patients that are more vulnerable
  • If space or layout permits, consider having patients coming in for immunizations use a separate entrance and go to a room strictly maintained for immunizations

For More Information

• Visit the Ontario College of Family Physicians website to access Guidance for Family Physicians: In-Person Visits When Phone/Video Isn’t Enough
• For immunization questions, please call the Vaccine Preventable Disease program at 905-688-8248 or 1-888-505-6074 ext. 7396
• To access COVID-19 information and resources call 905-688-8248 and follow the prompts
  • Calls are answered Monday to Friday, 9:15 a.m. to 7:30 p.m., and Saturday and Sunday, 9:15 a.m. to 4:15 p.m.
  • Visit the Health Care Professionals Website for a list of Frequently Asked Questions, to order signage, and more