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COVID-19 vaccine clinic toolkit for long-term care facilities

Last updated March 29, 2024.

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Summary of recent changes

On Feb. 28, 2024, the Advisory Committee on Immunization Practices (ACIP) and Centers for Disease Control and Prevention (CDC) recommended that all people aged 65 years and older receive one additional dose of any updated 2023–2024 COVID-19 vaccine (Moderna, Novavax, or Pfizer-BioNTech) at least four months following the previous dose of an updated 2023-2024 COVID-19 vaccine.

People who have never been vaccinated against COVID-19 before and start with the Novavax vaccine need to complete a two-dose series (three weeks apart) before receiving an additional dose.  Pfizer and Moderna’s updated 2023-2024 COVID-19 vaccines are both single-dose initial series.

People aged 65 years and older have the highest COVID-19 hospitalization rates. Hospitalization rates increase with age. Vaccination with an updated 2023-2024 COVID-19 vaccine provides increased protection against symptomatic SARS-CoV-2 infection, as well as COVID-19-associated emergency department and urgent care visits and hospitalizations, compared to people without an updated vaccine. Updated 2023-2024 COVID-19 vaccines provide protection against JN.1 and other currently circulating variants. 

To view all updates, visit CDC’s Interim Clinical Considerations for Use of COVID-19 Vaccines in the United States.

 

 

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What you need to know

All people aged 65 years and older should receive one additional dose of any updated (2023–2024 formula) COVID-19 vaccine (Moderna, Novavax, or Pfizer-BioNTech) at least four months following the previous dose of an updated 2023-2024 COVID-19 vaccine.

People aged 6 months through 64 years who have not yet received an updated (2023-2024 formula) COVID-19 vaccine should receive an updated dose now.

Children aged 6 months through 4 years should complete a multi-dose initial series (two doses of Moderna or three doses of Pfizer mRNA COVID-19 vaccine) with at least one dose of 2023-2024 COVID-19 vaccine.

People who are moderately or severely immunocompromised should complete a two- or three-dose initial series with at least one dose of the 2023-2024 COVID-19 vaccine and may receive one or more additional 2023-2024 COVID-19 vaccine doses, informed by the clinical judgment of a health care provider and personal preference and circumstances. Any further additional doses should be administered at least two months after the last updated 2023–­2024 COVID-19 vaccine dose. 

None of the updated 2023-2024 COVID-19 vaccines is preferred over another.

Bivalent mRNA Moderna and Pfizer-BioNTech COVID-19 vaccines and the original (ancestral) Novavax vaccine are no longer authorized for use in the United States.

An alternative to mRNA COVID-19 vaccines remains available for people who cannot or will not receive an mRNA vaccine. FDA authorized and CDC approved an updated Novavax COVID-19 vaccine. Novavax is authorized as:

  • A two-dose primary series to people aged 12 years and older who have not previously gotten any COVID-19 vaccine doses and choose to get the Novavax vaccine.
  • A single dose given at least two months after receipt of the last previous dose of COVID-19 vaccine in people previously vaccinated with any COVID-19 vaccine.

Johnson & Johnson COVID-19 vaccine is not available in the United States.

COVID-19 vaccine recommendations will be updated as needed.

 

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The Colorado Department of Public Health and Environment is committed to ensuring that residents and staff in long-term care settings, such as nursing homes, assisted living residences, residential care communities, group homes, and senior housing, have access to COVID-19 vaccines. 

The emergence and transmission of new COVID-19 variants highlight the continued need for residents and staff to stay up to date with COVID-19 vaccines. Current vaccines protect against severe illness, hospitalizations, and deaths. However, breakthrough infections in people who are vaccinated may occur.

Residents and health care workers who are vaccinated should get all doses recommended for their age and immune status as soon as they can. Unvaccinated residents and health care workers should get vaccinated with an updated 2023-2024 COVID-19 vaccine as soon as they can. These updated COVID-19 vaccines have been formulated to more closely target currently circulating variants and provide better protection against serious consequences of COVID-19, including hospitalization and death. Staying up to date with your COVID-19 vaccines reduces your chance of getting seriously sick, needing to be hospitalized, developing Long COVID, or dying due to COVID-19.

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Guidance for vaccination

Get vaccinated and stay up to date with your COVID-19 vaccines

COVID-19 vaccines available in the United States are effective at protecting people from getting seriously ill, needing to be hospitalized, and dying. Three safe and effective COVID-19 vaccines are available. There are two updated 2023-2024 mRNA COVID-19 vaccines, one manufactured by Pfizer-BioNTech and another by Moderna. An updated 2023-2024 Novavax COVID-19 vaccine is also available. 

As with vaccines for other diseases, people who are up to date have the highest level of protection. CDC recommends that everyone aged 6 months and older receive a COVID-19 vaccine. People aged 6 months and older should receive all doses recommended for them for the highest level of protection. COVID-19 vaccines require multiple doses to build the highest level of protection. Many long-standing, routine vaccines work the same way. 

 

What does it mean to be up to date?

People aged 5-64 years

You are up to date when you get one updated 2023-2024 COVID-19 vaccine.

Children aged 6 months through 4 years

Children in this age group are up to date when they get all recommended doses, including at least one dose of updated 2023-2024 COVID-19 vaccine.

Everyone aged 65 years and older

You are up to date when you have received two updated 2023–2024 COVID-19 vaccine doses at least 4 months apart.

People aged 65 years and older who have not previously received any COVID-19 vaccine doses and choose to get Novavax should get two doses of the updated Novavax vaccine, followed by one additional dose of any updated 2023–2024 COVID-19 vaccine to be up to date.

People who previously received the Johnson & Johnson COVID-19 vaccine

You are up to date when you get one updated 2023-2024 COVID-19 vaccine.

Vaccine recommendations are based on your age, the vaccine you receive, and length of time since your last dose. People who are moderately or severely immunocompromised have different recommendations for COVID-19 vaccines.

References:

Receiving all recommended doses of COVID-19 vaccine is critical to protect staff and residents from getting seriously ill, being hospitalized, or dying.

Current COVID-19 vaccine recommendations are available in CDC’s Interim Clinical Considerations for Use of COVID-19 Vaccines.

 

COVID-19 vaccines: 2023–2024 updated, bivalent, and original

2023–2024 updated COVID-19 vaccines

Three updated 2023-2024 COVID-19 vaccines are available in the United States: Pfizer-BioNTech, Moderna, and Novavax.

The 2023–2024 updated COVID-19 vaccines more closely targets the XBB lineage of the omicron variant and could restore protection against severe COVID-19 that may have decreased over time. Data shows the updated vaccines are better at protecting recipients from currently circulating variants.

2022–2023 bivalent vaccines

As of September 11, 2023, the bivalent Pfizer-BioNTech and Moderna COVID-19 vaccines are no longer available for use in the United States.

The 2022–2023 bivalent vaccines were designed to protect against both the original virus that causes COVID-19 and the omicron variants BA.4 and BA.5. Two COVID-19 vaccine manufacturers, Pfizer-BioNTech and Moderna, developed bivalent COVID-19 vaccines.

Original vaccines

As of April 18, 2023, the original Pfizer-BioNTech and Moderna COVID-19 vaccines are no longer available for use in the United States.

As of October 3, 2023, the original Novavax vaccine is no longer available for use in the United States.

As of May 6, 2023, J&J/Janssen COVID-19 vaccine is no longer available for use in the United States.

Previous COVID-19 vaccines were called “original” because they were designed to protect against the original virus that causes COVID-19.

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Additional COVID-19 vaccination considerations

Vaccination during a COVID-19 outbreak 

Receiving a COVID-19 vaccination is critical to protect both staff and residents against COVID-19. Find onsite vaccination clinic guidance for residential care facilities

Vaccination after a previous or current COVID-19 (SARS-CoV-2) infection 

COVID-19 vaccination is recommended for everyone aged 6 months and older, regardless of a history of symptomatic or asymptomatic SARS-CoV-2 infection. This includes people with prolonged post COVID-19 symptoms and applies to all recommended COVID-19 vaccine doses. This recommendation also applies to people who experience SARS-CoV-2 infection before or after receiving any COVID-19 dose.

People with known current SARS-CoV-2 infection should defer any COVID-19 vaccination at least until recovery from the acute illness (if symptoms were present). For further information, see CDC’s Use of COVID-19 Vaccines in the United States webpage. 

Additionally, people who recently had COVID-19 may consider delaying their next vaccine dose by three months from when their symptoms started or, if they had no symptoms, when they first tested positive. Reinfection is less likely in the weeks to months after infection. However, certain factors, such as personal risk of severe disease, local COVID-19 hospital admission level (“What’s happening near you”), and the most common COVID-19 variant currently causing illness, could be reasons to get a vaccine sooner rather than later.

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Moderna vaccine materials

Pfizer vaccine materials

Novavax vaccine materials

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Infection prevention recommendations for vaccination clinics

Refer to the On-site Vaccine Clinics at Residential Care Facilities guidance for vaccination clinics conducted in residential care facilities. It is important to follow infection prevention recommendations to prevent transmission of COVID-19 within the facility.  

Colorado Immunization Information System (CIIS)

Immunization records are confidential, personal medical information. The Colorado Immunization Information System (CIIS) is a lifelong immunization record tracking system under the Colorado Immunization Registry Act of 2007.
CIIS has signed agreements with all participating sites that are authorized to provide information to or access information from CIIS. CIIS and all people and entities that access immunization records are required to maintain the confidentiality of those records.

This Colorado Immunization Information System | Department of Public Health & Environment website provides information about requesting a copy of your immunization records.

CDPHE encourages facilities to obtain CIIS access to view resident immunization records. The facility COVID-19 Vaccination Coordinator, Backup Coordinator or another facility representative must complete the Colorado Immunization Information System (CIIS) training to obtain access to the CIIS system by following these instructions. Additionally, see the CIIS Enrollment Requirement Presentation and this CDPHE CIIS General User Training page. Email the Colorado Immunization Information System (CIIS) team at cdphe.ciis@state.co.us.


Additional resources

COVID-19 vaccine resources 

Long-term care facility resources