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New Brunswick COVID-19 Vaccine Clinic Guide for Immunizers

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New Brunswick COVID-19 Vaccine Clinic Guide for Immunizers New Brunswick COVID-19 Vaccine Clinic Guide for Immunizers Department of Health Public Health New Brunswick September 17, 2021 Public Health New Brunswick New Brunswick Department of Health PO Box 5100 Fredericton, New Brunswick, E3B 5G8 Canada This report is available online: www.gnb.ca/publichealth Ce document est aussi disponible en français sur le titre «Guide sur la vaccination contre la COVID-19 pour les Vaccinateurs du Nouveau-Brunswick ». TABLE OF CONTENTS NEW BRUNSWICK COVID-19 CLINIC GUIDE FOR IMMUNIZERS .......................................................... 1 1.0. PURPOSE ....................................................................................................................................... 1 2.0. VACCINE SOP ON TRANSPORTATION AND RECEIPT ............................................................. 1 Vaccines – storage and handling and maintaining cold chain to prevent temperature excursions (portable freezers and refrigeration) .......................................................... 2 3.0. SCHEDULES, DOSES AND ADMINISTRATION OF COVID-19 VACCINES ............................... 3 Carton Labelling of COVID-19 Vaccines ........................................................................ 4 4.0. REDUCING UNNECESSARY VACCINE WASTAGE .................................................................... 4 Context .............................................................................................................................. 4 Planning and prioritizing individual vaccination over wastage .................................. 5 Extra doses; mixing and pooling of vials ...................................................................... 5 Reporting Wastage .......................................................................................................... 6 5.0. HEALTH CANADA APPROVED AND NON-APPROVED VACCINES FOR COVID-19 ............... 7 6.0. VACCINE INTERCHANGEABILITY ............................................................................................... 7 7.0. NB RECOMMENDED INTERVAL FOR COVID-19 VACCINES APPROVED BY HEALTH CANADA ......................................................................................................................................... 8 8.0. CONSENT FOR SECOND DOSES ................................................................................................ 9 9.0. REPORTING ADMINISTERED DOSES .......................................................................................10 10.0. VACCINE AGE ELIGIBILITY AND PAYMENT FOR SERVICES ................................................11 mRNA Vaccine Age ........................................................................................................ 11 Payment for services ..................................................................................................... 11 11.0. TIMING OF COVID-19 VACCINES WITH OTHER VACCINES AND IMMUNOLOGICAL PRODUCTS ...................................................................................................................................11 Timing of COVID-19 Vaccines with Other Vaccines: NACI’s Recommendations ... 11 Timing of COVID-19 vaccines with monoclonal antibodies or convalescent plasma .............................................................................................................................12 12.0. VACCINATION OF PEOPLE WITH PREVIOUS SARS-COV-2 INFECTION ..............................12 13.0. VACCINATION OF PEOPLE WITH VACCINE PHOBIAS, FEARS OR ANXIETIES ..................12 Vaccine Phobia, Fears or Anxiety Causes: ................................................................. 12 Strategies in Reducing Vaccine Pain, Fears and Anxiety ......................................... 13 Special Clinics for People with Vaccine Phobia, Fears or Anxiety........................... 13 14.0. CONTRAINDICATIONS AND PRECAUTIONS ............................................................................14 15.0. ANAPHYLAXIS MANAGEMENT ..................................................................................................16 Anaphylaxis Contraindication ...................................................................................... 16 Vaccine Allergy Risk Assessment process ................................................................ 17 Medical Directive for Obtaining Consent, Administering Vaccine and to Manage Anaphylaxis .................................................................................................................... 18 Management of Anaphylaxis ........................................................................................ 18 16.0. MANAGING COVID-19 VACCINATION ADMINISTRATION ERRORS ......................................18 Vaccine Error Prevention .............................................................................................. 18 Inadvertent Vaccine Administration Errors ................................................................. 19 Guidance for Vaccine Administration Errors .............................................................. 20 17.0. ADVERSE EVENTS FOLLOWING IMMUNIZATION (AEFI) .......................................................24 Side Effects Post COVID-19 Vaccination ..................................................................... 24 Reporting Adverse Events ............................................................................................ 26 New Brunswick COVID-19 Vaccine Clinic Guide for Immunizers 18.0. VACCINE INJURY SUPPORT PROGRAM (VISP) ...................................................................... 26 19.0. RESOURCES ................................................................................................................................ 26 APPENDIX A – CLINIC CHEAT SHEET TABLE FOR IMMUNIZERS ..................................................... 27 APPENDIX B – COVID-19 VACCINE ALLERGY RISK ASSESSMENT FORM ..................................... 29 APPENDIX C – AEFI PROCESS MAP ...................................................................................................... 31 ii New Brunswick COVID-19 Vaccine Clinic Guide for Immunizers NEW BRUNSWICK COVID-19 CLINIC GUIDE FOR IMMUNIZERS • Addition of link to Federal Portal for regulatory information on COVID-19 vaccines • Amended carton labeling to include products from EU. • Section 5.0: New guidance for Non-Health Canada approved vaccines • Section 6.0: Amended guidance regarding vaccine interchangeability • Section 8.0 o 8.1 Added guidance regarding timing of COVID-19 vaccines with other vaccines o 8.2 Added guidance regarding COVID-19 and immunological products o 8.3 Added guidance regarding timing of TB Testing • Section 10.0 o Table 2.0 Added: Managing Contraindications and possible Allergic Reactions (Previously in the Cheat Sheet for Immunizers) • Section 11.0 o Table 3.0 Added: Potential Allergens in Health Canada Approved COVID-19 vaccines. (Previously in the Cheat Sheet for Immunizers) o Section 11.2 Added Allergy Risk Assessment Process o 11.4 Added guidance regarding Second dose after Anaphylaxis • Section 13.0 o New section added on vaccination of people with vaccine phobias, fears or anxieties • Section 14.0 o 14.1 Amended age eligibility for mRNA vaccine • Section 15.0 Title Change o 15.3 Updated guidance for vaccine administration errors for Age • Appendix A Cheat Sheet Table revised • Appendix B Added “Allergy Risk Asssement Form” 1.0. PURPOSE The purpose of this document is to provide clinical guidance about COVID-19 vaccination in New Brunswick. The primary target audience for this document are all Health and Allied Health Care Practitionners who are immunizing with COVID-19 vaccines and are referred to as “Immunizers” throughout this Guide. For information on how to plan a community immunization clinic, pop up clinic or other alternate immunization clinic sites, please refer to the New Brunswick COVID-19 Community Clinic Planning Guide which was adapted from the Public Health Agency of Canada (PHAC). This clinical guide is meant to complement and does not replace information provided in the New Brunswick Immunization guide, NACI’s Recommendation on the Use of COVID-19 vaccines or the vaccine Product Monograph. General healthcare professional COVID-19 resources can be found on the GNB Vaccines website. 2.0. VACCINE SOP ON TRANSPORTATION AND RECEIPT It is important that clinic sites are equipped to ensure the integrity and effectiveness of the vaccine (i.e. cold chain and other procedures). Please refer to Standard Operating Procedures on Transportation of COVID-19 Vaccines and the National Vaccine Storage and Handling Guidelines for Immunization Providers – 2015 for information on how to properly handle and transport vaccines. September 17, 2021 1 New Brunswick COVID-19 Vaccine Clinic Guide for Immunizers Once frozen, thawed mRNA or viral vector vaccines are received at the site, they must immediately be stored in a ultra-low freezer, freezer or refrigerator suitable for vaccine storage for the product. A purpose-built vaccine storage unit (i.e. ultra-low freezer, freezer, pharmacy, lab-style or laboratory-grade refrigerator) is the standard for storage of vaccines. Domestic refrigerators are not designed to meet the requirements for vaccine storage. For information on temperature excursions, please refer to the product monographs on GNB’s Website: Vaccine Resources for Healthcare Professionals. If there is a risk of a temperature excursion or if any interruption in cold chain occurs contact the Vaccine Operation
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