COVID-19 VACCINE TOOLKIT

FOR MONTGOMERY COUNTY PHYSICIANS

About this toolkit

This toolkit contains information related to the Pfizer-BioNTech, Moderna, and Janssen COVID-19 vaccines. Montgomery County physicians were among the first to receive the vaccine, as well as administer it to patients. While guidance continues to evolve and additional details are released, the MCMS Immunization Task Force has created this toolkit to provide updates on COVID-19 vaccination distribution in Montgomery County, collate guidance on vaccine handling and storage, promote strong vaccination recommendations to patients, and answer frequently asked questions from physician members.

Jump to a toolkit section: Local Resources - Preparing to Administer the Vaccine - CDC Guidance & AMA Resources - Frequently Asked Questions

Children 12-15 Now Eligible for Boosters

The Maryland Department of Health updated Maryland's vaccination plan to allow children aged 12-15 to seek booster shots 5 months after their first series as of January 6, 2022. It has also been promoted to patients directly on state websites and by the Governor during a recent press conference.

Travis Gayles, M.D., PhD, MoCo County Health Officer

Lawrence Green, M.D., MCMS Immediate Past President

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Pfizer Vaccines for Children 5-11

Children 5 years and older can get the Pfizer-BioNTech COVID-19 Vaccine. Children 5 through 11 years old will receive a separate vaccine formulation denoted with an orange cap of the Pfizer-BioNTech COVID-19 Vaccine that has one-third the dose given to adolescents and adults, and will receive the vaccine with a smaller needle. An overview of the description of the differences in the adult/adolescent formulation and pediatric formulationpdf icon is available.

Children between the ages of 2 and 4 years old, other unvaccinated children 5 years or older and adults should continue to wear a mask in public spaces and around people they don’t live with.

Third Dose & Booster Updates from CDC - 10.21.21

On Thursday, October 21, 2021, CDC published new recommendations for booster shots of all three COVID-19 vaccines.

For individuals who received a Pfizer-BioNTech or Moderna COVID-19 vaccine, the following groups are eligible for a booster shot at 6 months or more after their initial series:

65 years and older
Age 18+ who live in long-term care settings
Age 18+ who have underlying medical conditions
Age 18+ who work or live in high-risk settings

For the nearly 15 million people who got the Johnson & Johnson COVID-19 vaccine, booster shots are also recommended for those who are 18 and older and who were vaccinated two or more months ago.

There are now booster recommendations for all three available COVID-19 vaccines in the United States. Eligible individuals may choose which vaccine they receive as a booster dose. Some people may have a preference for the vaccine type that they originally received and others, may prefer to get a different booster. CDC’s recommendations now allow for this type of mix and match dosing for booster shots.

Where can patients access booster shots in Maryland?

To access a list of booster shots near you, visit the state of Maryland's Vaccine Finder and enter your address. The state's listing includes state vaccination sites, county-sponsored clinics, and local pharmacies.

Key Local Resources for Physicians

Montgomery County COVID-19 Vaccine Portal

MDH COVID-19 Physician Calls

ImmuNet COVID-19 Vaccine Registration

Six Steps to Prepare for COVID-19 Vaccine Distribution in Your Medical Practice

1. Register with ImmuNet.

Maryland physicians interested in providing the vaccine to patients in their practice will have to take two steps:

1A. Onboard with ImmuNet to report vaccination data (enrollment form available here).

You do not have to have integration of your EHR to ImmuNet to give the vaccine. You need to be signed up with ImmuNet and have access to ImmuNet via their website OR your EHR. If you are a part of MDPCP Program, please reach out to your State Practice Coach for more information and assistance.

1B. Register with ImmuNet as a vaccine provider in order to receive and administer the vaccine.

This guide will assist potential COVID-19 vaccinators with registration and ordering in ImmuNet. Only one registration is needed per location. Note that practices with multiple locations must register each location (that plans to order and have vaccines shipped to and stored at that location) separately.

2. Determine your practice’s storage capacity and protocol for the Moderna or Jannsen vaccine(s).

Each vaccine with an EUA has different storage requirements.

Moderna

The Moderna COVID-19 vaccine may be stored in the refrigerator
between 2°C and 8°C (36°F and 46°F) for up to 30 days before vials are punctured, or in a freezer adjusted to the proper temperature range.

CDC Summary for Storage & Handling,
CDC storage and handling labels and temperature logs under "storage and handling resources"

Jannsen/J&J

The Jannsen COVID-19 vaccine may be stored in the refrigerator between 2°C and 8°C (36°F and 46°F) until the expiration date before vials are punctured. After puncturing the multidose vial seal, store vaccine in the refrigerator between 2°C and 8°C (36°F and 46°F) for up to 6 hours or at room temperature (up to 25°C/77°F) for 2 hours.

CDC Summary for Storage & Handling
CDC storage and handling labels and temperature logs under "storage and handling resources"

For more information on the Pfizer-BioNTech COVID-19 Vaccine, which requires ultra-cold storage (or to be refrigerated and administered within 5 days), visit the CDC's overview.

3. Prepare your staff for vaccine administration.

Ensure your staff has reviewed the vaccine administration guidelines and is trained to give vaccines. You may find the following resources helpful:

4. Evaluate and plan workflows for appointment scheduling and administration.

Evaluate your practice’s ability to schedule vaccine appointments and the follow-up appointment. Consider that the Moderna vaccine doses should be at least 28 days apart (thought second doses administered up to 4 days before the recommended date are considered valid), both doses should be Moderna vaccine, and always administer the vaccine series alone (wait a minimum of 14 days before or after administration of any other vaccine). More detail is available in the vaccine's standing orders.

Determine whether your practice will offer vaccine clinic days instead of mixing regular patients with vaccine-only patients. Here are some considerations for planning curbside or drive-through clinics.

Evaluate workflows to ensure that there are appropriate workflow changes to accommodate the administration of the vaccine, including an area for an observation period, space allocated to ensure no gathering in the areas, etc. The CDC has provided a preparation and administration summary.

When administering vaccine, clinicians should screen recipients for contraindications and precautions, even on the second dose. The recipient’s health condition or recommendations regarding contraindications and precautions for vaccination may change from one visit to the next. To assess patients correctly and consistently, vaccination clinicians should use a standardized, comprehensive screening tool.

5. Stratify your patient population and educate patients about the vaccine.

6. When ImmuNet reaches out to you, be prepared to respond to how many patients fit the categories for vaccination within a 2-week period.

CDC Guidance & AMA Resources: Preparing for COVID-19 Vaccination

Training and Educational Materials

Understanding & Explaining COVID-19 Vaccines

Vaccine Storage and Handling Toolkit

COVID-19 Vaccine Training Module For HCPs

CDC COVID-19 Vaccination Training Programs and Reference Materials for Healthcare Professionals

AMA COVID-19 Vaccine Physician FAQs

Complimentary COVID-19 Vaccine CME

Pfizer's Full Approval from the FDA

Talking to Patients

MoCo DHHS FAQ for Patients

Talking to Patients about COVID-19 Vaccines

Making a Strong Recommendation for COVID-19 Vaccination

Answering Patients’ Questions

Patient-Facing FAQs

AMA COVID-19 Vaccine Patient FAQs

Explaining mRNA COVID-19 Vaccines

COVID-19 Vaccination Communication Toolkit

Getting Started

Fact Sheets and FAQs

Posters

Stickers

Social Media

AMA's Guide to Messaging

Frequently Asked Questions from Physician Members

Where and when can physicians and practice staff in Montgomery County get a vaccine?

The Montgomery County Health Department is coordinating clinics and a listing of clinics run by other organizations in the community (hospitals, pharmacies, etc.) The health department has sole authority over appointment scheduling, follow-up, and clinic locations. MCMS is dedicated to serving physicians in our community by providing timely communication of information provided to us by the county health department. If you or a patient-facing member of your staff is seeking the vaccine, please contact us. To learn more about vaccine access for members of the public, visit the Montgomery County Health Department.

Is there a local source of information about the vaccine I can refer patients to?

Who can administer the vaccine in Maryland?

The Department of Health issued an order allowing any individual to administer the COVID-19 vaccination, subject to the following:

The individual has successfully completed training on the administration of COVID-19 vaccines;
Qualified supervisory personnel at the vaccination site reasonably determine that the individual is able to administer COVID-19 vaccines under appropriate supervision; and
The individual administers the COVID-19 vaccine at the vaccination site under the reasonable supervision of qualified supervisory personnel.

What is the priority order for the vaccine in Maryland?

The State will follow the CDC’s prioritization plan, which calls for vaccinating health care workers, nursing home and assisted living residents first. This is Group 1A, which is believed to include about 800,00 people in Maryland.

Group 1B will include other “higher risk” individuals and first responders.

Group 2 will include people in “critical roles” including “essential infrastructure workers” and individuals who are moderately high risk.

Group 3 will include the general population.

How will vaccine ordering be administrated in Maryland?

What are the storage requirements for the vaccines?

How will the State promote vaccine confidence among Marylanders?

How can I best prepare to address patient questions about COVID-19 vaccines?

COVID-19 vaccines are new and questions from patients should be expected. Physicians are one of the most trusted sources of information for their patients on vaccines. Providing a strong recommendation is critical for vaccine acceptance. Physicians can share the importance of vaccines in protecting individual patient health as well as the health of loved ones or even discuss your personal plans as a health care professional to get vaccinated.

Examples:

“I strongly recommend you get a COVID-19 vaccine once it is widely available…”
“This vaccine is especially important for you because of your [job/underlying health condition].”
“I believe in this vaccine so strongly that I plan to get it as soon as it is available.”

The CDC has outlined answers to common patient questions, and the AMA also offers a helpful patient-facing FAQ handout.

Should pregnant and lactating women be vaccinated against COVID-19?

Questions on Vaccine Approval, Allocation, Distribution, Administration & Safety - Answers from the AMA

The American Medical Association (AMA) collated their most frequently asked questions about the COVID-19 vaccine and published answers to them. Access the FAQ now.

Included in this FAQ:

Vaccine Approval

What processes are in place to ensure vaccine safety and effectiveness?
What information does FDA require of manufacturers to issue an “Emergency Use Authorization”?
Are mRNA vaccines safe?

Vaccine allocation and distribution

Which populations will be prioritized to receive initial vaccine?
How will vaccine be allocated to jurisdictions and other entities (i.e., federal entities or tribal nations)?
How can I determine my states plan for vaccine operations and distribution?

Vaccine administration

What do physicians need to do to be eligible to administer COVID-19 vaccines?
What vaccine storage and handling requirements do physicians need to
be aware of?
What will be included in the vaccine ancillary supply kits?
Is there training available for health care professionals on COVID-19 vaccine administration?

Data Reporting: What are the reporting requirements that physicians will need to comply with?

Vaccine safety: What additional steps are being taken to ensure vaccine safety postauthorization?

Should individuals with a history of severe allergic reactions receive the COVID-19 vaccine?

The American College of Allergy, Asthma, and Immunology (AAAI) released guidance stating that mRNA COVID-19 vaccines should not be administered to individuals with a known history of a severe allergic reaction to any component of the vaccine. Although the specific vaccine component causing the anaphylaxis has not been identified, polyethylene glycol is one of its ingredients and has been known to cause anaphylaxis. AAAI emphasized that people with common allergies to medications, foods, inhalants, insects and latex are no more likely than the general public to have an allergic reaction to the mRNA COVID-19 vaccines. Those patients should be informed of the benefits of the vaccine versus its risks.

.The CDC released guidance on severe allergic reactions, recommending that patients experiencing a severe allergic reaction AFTER getting the first shot should not get the second shot. The CDC also says that doctors may refer these patients to a specialist in allergies and immunology to provide more care or advice.