MEMO: Interim Guidance for Well Child Visits & Immunization ServicesTO: Health Care Professionals in the Niagara Region FROM: Healthy Babies Healthy Children & Vaccine Preventable Disease programs, Niagara Region Public Health & Emergency
Services REFERENCE: Interim Guidance for Well Child Visits & Immunization Services DATE: April 2020
As information around COVID-19 continues to evolve, we wanted to thank you for your efforts to keep up with the steady stream of changes and your hard work on the front lines. The continuity and prioritization of immunization programs for the most vulnerable in our community must be carefully considered in order to avoid unintentional consequences such as unimmunized cohorts and increases in vaccine preventable diseases. Furthermore, newborn and well child visits are critical now more than ever, given the various restrictions and challenges during the pandemic. This memo summarizes updated interim guidance for well child visits and immunization services. We recognize that during this time there are added barriers around providing care safely. We
previously provided recommendations on how to protect yourself, your staff and your patients during essential appointments (please see “Providing Preventive Care during COVID-19”). If you are running short on personal protective equipment, please continue placing orders with your regular suppliers or sourcing locally. Interim Guidance for Well Child Visits - We have heard that families are experiencing challenges accessing newborn and well baby assessment and supports
for weight, immunization, postpartum adjustment and infant feeding
- The World Health Organization’s operational guidance around maintaining essential health services during an outbreak, identifies the care of vulnerable populations such as infants as a high-priority
- The Canadian Pediatric Society guidance for COVID-19 recommends that routine immunizations for infants and children should be kept up to date
- We strongly support the Interim Schedule for Children and Pregnant Women during the COVID-19 Pandemic on the Canadian Family Physician’s website for well child visits that recommends
- In-person appointments at:
- 0-2 weeks to assess weight, feeding issues and jaundice
- 1 month if there are concerns necessitating an in person assessment
- 2, 4, 6, 12, and 15 months for well baby, growth and development and vaccines
- 18 months for developmental assessment and vaccines
- Virtual appointments at:
- 1 month (provided there are no concerns)
- 9 months
- This guidance recommends considering postponing the 4-6 year old well child visit. Immunizations should be still given on schedule, but this visit may be deferred until the child is close to becoming overdue (at 7 years of age).
Parenting Support - The need to redeploy Public Health
staff for the pandemic response has resulted in service disruptions to our family health programs:
- Breastfeeding support is being offered through phone and video
- Prenatal Classes, Baby Talk and Well Baby Clinics have been cancelled
- Home visiting services are presently being offered by phone/video
- We encourage you to inform your patients that Niagara Parents is available to answer questions and provide reliable advice about pregnancy, newborn care, infant feeding, child or parental mental health concerns, and community
supports
- Patients can connect with a nurse at Niagara Parents Monday – Friday, 8:30 a.m. – 4:15 p.m. at 905-688-8248 or 1-888-505-6074 ext. 7555.
When to Consider Delivering Immunizations to your Patients The following patients are priority for vaccinations: - Children up to seven years of age as per the interim guidance above
- Health care providers and those working in health care settings: Provide immunization according to the Canadian Immunization Guide’s (CIG) recommended immunization for health care workers
- Child care educators: Provide vaccines as directed by the
Medical Officer of Health
- Post-exposure prophylaxis including hepatitis B vaccination to newborns of carrier mothers, and outbreak control as a prevention and management strategy should not be delayed or deferred
If you are already seeing the following patients for urgent health issues or other necessary visits, use this opportunity to provide immunizations: - Adolescents / Adults: Provide immunization according to the Publicly Funded Immunization Schedules for Ontario
- Seniors: Pneumococcal
vaccine if eligible (a booster of Pneumovax 23 is only recommended in certain situations as per the CIG)
- Pregnant women (see National Advisory Committee on Immunization statement), family members or caregivers of infants and young children: Tdap booster following recommendations for use and eligibility
Delayed and Catch-Up Immunization Schedules - Most routine vaccines, if delayed, can be given at the earliest opportunity
- For vaccines that are given as part of a series, subsequent doses can be adjusted accordingly. One exception is the vaccine that provides protection against rotavirus, as the schedule includes a minimum and maximum age
- The CIG states that in general, “regardless of the time between doses, interruption of a vaccine series does not require restarting the series as delays between doses do not result in a reduction in final antibody concentrations for most multi-dose products,” with the exception of cholera and rabies
vaccine
- Maximum protection is generally not attained until the complete vaccine series has been administered
- Administration of multiple vaccines at the same visit is one strategy for ensuring catch-up immunization
Additional Information - For up-to-date information about providing preventive care during COVID-19, please see the list of Frequently Asked
Questions
- If you have questions about this memo, please call Public Health Monday to Friday, 8:30 a.m. to 4:15 p.m. at 905-688-8248 or 1-888-505-6074 and:
- Ext. 7555 to connect with a nurse at Niagara Parents
- Ext. 7396 for immunizations or to request to receive an electronic copy of the Ministry of Health’s “Guidance for Immunization Service Providers During COVID-19” Memorandum.
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