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1. Pneumococcal vaccine and coronavirus (COVID-19)
2. Vaccination clinic implmentation during COVID-19 response
3. Drive-in immunisation clinics: Advice for providers during COVID-19

Pneumococcal vaccine and coronavirus (COVID-19)

Pneumococcal vaccines (Pneumovax 23 and Prevenar 13) protect against disease such as pneumonia caused specifically by the bacterium pneumococcus. Pneumococcal vaccines will not provide protection against COVID-19. There is currently no evidence to suggest that pneumococcal vaccines provide protection against COVID-19 associated pneumonia.

Pneumococcal vaccination is not recommended for healthy adolescents and adults due to their low disease risk. Government funded vaccine should only be used for those particularly vulnerable to pneumococcal infection. These include all:

• young children at 6 weeks, 4 months and 12 months of age, medically at risk children should receive an additional dose at 6 months of age
• Aboriginal people 15 - 49 years with underlying risk conditions associated with pneumococcal disease.
• Aboriginal people 50 years and over
• older adults 65 years and over.

Vaccination clinic implementation during COVID-19 response

The following advice has been provided by NSW Health and is being provided to assist you with planning and managing vaccination clinics which is coinciding with the COVID-19 response (also available in PDF format). Immunisation providers should continue to offer immunisation services with enhanced infection control measures. Therefore you must take all possible steps to reduce the risk of transmission to your staff and clients attending vaccination clinics. This document recommends procedures based on current advice to minimise risk. Vaccination providers will have to consider their operational process based on staffing, physical layout of venues, fittings and resources. Additional information on COVID-19 is available from NSW Government - COVID-19.

Immunisation services must continue

Now more than ever, it is important to maintain high vaccination coverage levels to prevent outbreaks of vaccine preventable diseases in the community. It is therefore essential that immunisation services continue, in particular for:

• infant and early childhood immunisation sessions providing the National Immunisation Program (NIP) schedule vaccines
• adolescent vaccination for catch-up of NIP vaccines
• Winter Influenza Vaccination Program
• adult vaccination for provision of NIP vaccines
• provision of additional recommended vaccines as required.

Recommendations for venues

It is recommended that signage be displayed at the entrances of all vaccination clinics. Such signage should include:

• due to the ongoing coronavirus (COVID-19) pandemic, our clinic is taking measures to protect the community. It is vital that all instructions are followed
• only one parent/guardian should accompany a child into the session
• people must not attend the session if they or their child have symptoms of a respiratory infection (such as fever, or a sore throat, or a runny nose, or shortness of breath or a cough) or have returned from overseas in the past 14 days or have been told to self-isolate
• wash hands or use hand sanitiser provided at the entrance to the reception or waiting area
• consideration should be given to the translation of all signage and messaging into other key community languages.

Physical distancing measures

Remind staff that if they are unwell they must not attend work.

• Send reminders to eligible patients that they can receive their vaccinations including the influenza vaccine and include advice that they should call in advance if they are not feeling well.
• Ensure that a process is available to undertake a phone assessment and re-schedule the appointment if required.
• Ask patients not to arrive in advance of their appointment to minimise the number of people that are in the clinic.
• Make a staff member available to monitor queueing. This is extremely important to ensure physical distancing and maintain the order and flow into the administration area if multiple patients arrive at the same time. Options may include an appointment system for vaccinations, families waiting outside (if safe to do so) or in their cars before and after vaccination (as long as they can be monitored for an adverse event following immunisation). Patients could be phoned when it’s time to come into the clinic.
• Ensure administration, clinical and patient areas are wiped down frequently (and between patient encounters) using a sodium hyperchlorite based solution. Refer to the Clinical Excellence Commission’s advice.

Clinic set up

Arrange a process and a checklist to assess each patient as they arrive for their vaccination prior to entering the practice. This could include keeping doors locked and ask patients to call once they are outside.

• Ensure there is a process to keep well patients separated from patients who are suspected of COVID-19.
• Minimise patient movement through the clinic as much as possible.
• Make alcohol hand rub or hand washing facilities available at the entrance to your practice/clinic area and ensure patients use these on entry and when leaving.
• Designate specific times throughout the week for vaccination clinics to ensure that only well patients are in the clinic during those times.
• Ensure that seating and standing queuing areas meet the current recommendations of physical distancing. If standing, mark each standing position with an ‘X’. If seated, chairs must be spaced appropriately to maintain physical distancing and cleaned between use.
• Sit clients 1.5 metres from administration staff desk on check in and 1.5 metres from other clients at the nurse’s table.
• Remove all toys and magazines from your waiting room.
• Use alternative entrance/exit (where available) to avoid patients walking through the administration area.

Vaccination process

• Minimise physical contact with client record documents.
• Limit the vaccine process to one adult with the child/minor being vaccinated (unless there are extenuating circumstances).
• Consider the size of the clinic area and apply the principles of physical distancing to determine the number of patients that can attend the clinic at any one time.
• Consider a separate room for clients to wait post vaccination dependant on numbers at each session.
• Consider PPE requirements. There are no additional PPE requirements for your routine immunisation service. Standard and transmission based precautions should be utilised as appropriate.
• Use PPE when vaccinating patients with symptoms consistent with coronavirus where there is a much higher risk of transmission (provided they are well enough to be vaccinated). More advice can be found on the NSW COVID-19 website.
• Ensure that hand hygiene is performed between each patient.
• Use a single use pre-immunisation checklist for each client rather than a laminated re-useable version. Consider displaying a large pre-vaccination checklist in the queuing area.
• Use a separate pen supply for patients to sign their consent form, cleaning appropriately between use.

Consider alternate models

• Alternate locations for influenza vaccination clinics may also be considered if practicable such as an outdoor area
  e.g. practice car park (refer to NSW Health guidance for drive-in clinics). Conducting vaccination clinics in an alternate location could also include combining and sharing resources and staff with other practices in your local area. Points to consider for alternate models include:
  • maintain physical distancing and enhanced infection control requirements
  • patient and staff safety and comfort e.g. consideration of the weather and nearby traffic
  • requirements to maintain confidentiality and undertake pre-vaccination assessments
  • appropriate cold chain management
  • pre-vaccination waiting and post vaccination observation areas that provide physical distancing
  • facilities/area to manage adverse events
  • maintaining vaccination records
  • bathroom and break facilities for staff
  • messaging to patients.

As always, please contact your local public health unit on 1300 066 055 for all immunisation queries.

Drive-in immunisation clinics: Advice for providers during COVID-19

NSW Health has developed guidance for GP practices considering vehicle-based influenza vaccination clinics.