Health Advisory: Immunizations and COVID-19 Updates for Providers

Published Aug. 4, 2020

Requested actions

• Start planning for school-related immunizations.
• Be aware of the State Board of Health immunization rule change. Anticipate increased requests and demand.
• Be aware of the new guidelines regarding Tdap in schools.
• Provide students with medically verified immunization records for schools. Students must have their records by the first day of school.
• Follow CDC guidance to safely immunize children in your healthcare facility during COVID-19.
• Contact and request families who have missed well-child visits and vaccinations to come in for an appointment.


We anticipate children will return to some version of school in the upcoming school year. These congregate settings pose an increased risk of disease outbreak and transmission. An outbreak of a vaccine preventable disease on top of the ongoing COVID-19 pandemic would place a large strain on our healthcare system. Even if schools do not return in an in-person setting, students are still required to be up to date on school required vaccines on the first day of school.

Updated vaccine rules are in effect.

Washington State Board of Health’s change to Washington Administrative Code Chapter 246-105 is in effect for the 2020-2021 school year. These changes may spur an increased demand for well-child visits. The change has 3 components:

Medically verified immunization records are required for school and childcare entry.
• The state has clarified the definition of conditional status. Students must have all school required vaccines or exemptions and all paperwork on the first day of school.
• The Tdap requirement has changed from 6th-12th grades to 7th-12th grades. All students entering 7th grade must have a Tdap on or after their 10th birthday. Students in 8th-12th grades must have a Tdap dose on or after their 7th birthday based on the previous guidelines.

Prepare children for school.

• Make sure students are up to date on their vaccines by the first day of school.
• Provide families with immunization records or encourage them to use MyIR to print the Certificate of Immunization Status. Each school needs the immunization records for all students for attendance.
• Ensure school orders and medical authorizations are up to date. Students need them to safely attend school. Pay extra attention to life-saving medications like inhalers and epi-pens.

  • Specify whether students can carry inhalers and/or epi-pens. This is especially important for students in afterschool activities.
  • Consider using PCMS forms.

• Complete sports physicals for student-athletes

Resources to safely provide in-person services

Providing pediatric well-care during COVID-19—American Academy of Pediatrics.
Critical updates on COVID-19—American Academy of Pediatrics.
Health supervision of infants, children and adolescents, 4th edition—Bright Futures.
Information for pediatric healthcare providers—CDC.

Additional resources

Please continue vaccinating patients during COVID-19—Washington State Department of Health.
Vaccination guidance during a pandemic—CDC.
Guiding principles for immunization activities during the COVID-19 pandemic—World Health Organization.

Immediately report COVID-19

  • To report a notifiable condition, call (360) 414-5599 x 6431 during business hours, (360) 636-9595 after hours or use the Reportable Disease Fax Form.
  • Cases in the following people—call (360) 414-5599 x 6431
    • Healthcare workers (e.g., EMS, medical, nursing, any healthcare facility employee).
    • Public safety workers (e.g., law enforcement, firefighter).
    • Staff or resident of long-term care facilities, senior living centers, permanent supportive housing or similar congregate settings (e.g., shelter, correctional facility).
    • Anyone who dies with COVID-19.
    • Anyone with suspected MIS-C.

Patient communication

Share these materials with patients.

• What to do if you have COVID-19.
• What to do if you may have been exposed to COVID-19.
• What to do if you have symptoms of COVID-19 and haven’t been exposed or tested.

Additional resources

• Washington State COVID-19 risk assessment dashboard.
• CDC guidance for healthcare providers and facilities.
• DOH COVID-19 data dashboard.
• DOH COVID-19 page.
• CDC COVID-19 page.