- Promote COVID-19 vaccine among people who are pregnant, lactating or who may become pregnant. Only 31% of pregnant people in the U.S. are fully vaccinated. In 2021, 97% of pregnant people hospitalized for COVID-19 illness or labor and delivery with active infection were unvaccinated. Educate patients on the safety and effectiveness of COVID-19 vaccine during pregnancy.
- Be aware, the U.S. is experiencing a shortage of BinaxNOW antigen test kits, straining the entire testing system. Washington State Department of Health (DOH) is working with the manufacturer, Abbott, and the federal government to increase the supply in Washington. However, supplies will likely remain low for the next month or two.
- Help families navigate the K-12 testing requirements to return to school for students with COVID-19-like illness (CLI). Children with CLI need a PCR test before returning to school. Over-the-counter antigen tests do not offer proof of testing.
COVID-19 vaccine for pregnant and lactating people
On Sept. 29, the Centers for Disease Control and Prevention (CDC) released a Health Alert Network (HAN) advisory recommending urgent action to increase COVID-19 vaccination among people who are pregnant, recently pregnant, lactating, trying to become pregnant or who may become pregnant. CDC strongly recommends COVID-19 vaccine before or during pregnancy because the benefits of vaccine outweigh known or potential risks.
As of Sept. 27, more than 125,000 lab-confirmed COVID-19 cases are in pregnant people, including more than 22,000 hospitalizations and 161 deaths. The highest number of COVID-19-related deaths in pregnant people (n=22) in one month happened August 2021. National surveillance data shows about 97% of pregnant people hospitalized for illness or labor and delivery with active infection were unvaccinated.
In addition to the risks of severe illness and death for pregnant and recently pregnant people, they are also at increased risk for adverse pregnancy and neonatal outcomes, including preterm birth and admission of their neonate(s) to an intensive care unit (ICU). Other adverse pregnancy outcomes, like stillbirth, have been reported.
Despite the known risks of COVID-19, as of Sept. 18, 31.0% of pregnant people were fully vaccinated before or during their pregnancy. Additionally, there are racial and ethnic disparities in vaccination coverage for pregnant people.
Healthcare providers should communicate the risks of COVID-19, the benefits of vaccine, and the safety and effectiveness of COVID-19 vaccine during pregnancy. Healthcare providers should strongly recommend people who are pregnant, recently pregnant, lactating, trying to become pregnant or who may become pregnant get COVID-19 vaccine as soon as possible.
- Ensure all clinical staff are aware of the recommendation for vaccination of people before and during pregnancy and the serious risks of COVID-19 to pregnant and recently pregnant people and their fetuses/infants.
- Increase outreach efforts to encourage, recommend and offer vaccination to people who are pregnant, recently pregnant, lactating, trying to become pregnant or may become pregnant. A strong recommendation from a healthcare provider is a critical factor in COVID-19 vaccine acceptance and can make a meaningful difference to protect the health of pregnant and recently pregnant people and their fetuses/infants.
- For healthcare providers who see patients who are pregnant, recently pregnant, lactating, trying to become pregnant or who may become pregnant:
- Review patients’ COVID-19 vaccination status at each pre- and post-natal visit and discuss COVID-19 vaccine with those who are unvaccinated.
- Reach out to your patients with messages encouraging and recommending the critical need for vaccination.
- Remind patients that vaccine is recommended for those with prior COVID-19 infection. Studies show vaccination provides increased protection in people who have recovered from COVID-19.
- Support efforts to ensure people who get the first dose of an mRNA COVID-19 vaccine (i.e., Pfizer-BioNTech, Moderna) return for their second dose to complete the series as close as possible to the recommended interval.
- Consider a booster dose for eligible pregnant people.
- Communicate accurate information about COVID-19 vaccines and confront misinformation with evidence-based messaging from credible sources. For example, currently no evidence shows any vaccine, including COVID-19 vaccine, causes fertility problems in women or men.
- Become a COVID-19 vaccine provider and vaccinate patients during their visit. Learn how to enroll as a COVID-19 vaccine provider.
- Interim clinical considerations for use of COVID-19 vaccines currently approved or authorized in the U.S.
- COVID-19 vaccines while pregnant or breastfeeding.
- COVID-19 vaccines for people who would like to have a baby.
- COVID-19 among pregnant and recently pregnant people.
- COVID data tracker:
- Toolkit for pregnant people and new parents.
- Building confidence in COVID-19 vaccines.
Following a Sept. 23 vote by the Advisory Committee on Immunization Practices (ACIP), on Sept. 24 CDC recommended a single booster dose of Pfizer-BioNTech (Comirnaty) vaccine to certain high-risk populations at least 6 months after their primary series under the FDA’s expanded EUA:
- All Pfizer recipients 65 years or older or who live in long-term care facilities should receive a booster dose.
- Pfizer recipients between 50 and 64 years old with underlying medical conditions should receive a booster dose.
- Pfizer recipients between 18 and 49 years old with underlying medical conditions may receive a booster dose based on their individual risks and benefits.
- Pfizer recipients between 18 and 64 years old in an occupational or institutional setting where the burden of disease and risk of infection are high may receive a booster dose based on their individual risks and benefits.
Recent CDC and FDA decisions about booster doses do not change the definition of full vaccination. Booster doses are not required where vaccine mandates are in place.
A Clinician Outreach and Communication Activity (COCA) call on Sept. 28, 2021 covered what clinicians needs to know about administering booster doses.
COVID-19 vaccine resources
- Help patients access their vaccine records and explain the different ways to show vaccination status.
- EUA fact sheets for recipients and caregivers:
- COVID-19 vaccine locator, DOH.
- COVID-19 vaccine for providers
- COVID-19 vaccine provider toolkit and resources, DOH.
- COVID-19 vaccination for providers, CDC.
- Clinical considerations for COVID-19 vaccination and guidance for managing anaphylaxis, CDC.
- COVID-19 vaccine quick reference guide for healthcare professionals, CDC.
- COVID-19 vaccine training module on best practices for providers, CDC.
- Association of J&J with thrombotic thrombocytopenia after vaccination:
- J&J vaccine health alert, CDC.
- Vaccine-induced immune thrombotic thrombocytopenia frequently asked questions, American Society of Hematology (ASH).
- Diagnosis and management of vaccine-induced immune thrombotic thrombocytopenia webinar, ASH and CDC.
- April 15, 2021 Clinician Outreach and Communication Activity (COCA) call: J&J COVID-19 vaccine and cerebral venous sinus thrombosis with thrombocytopenia update for clinicians on early detection and treatment, CDC.
- Association of mRNA vaccines with myocarditis and pericarditis after vaccination:
- Information for healthcare providers: myocarditis and mRNA vaccines, DOH
- Follow-up of patients with myocarditis, consult recommendations, American Heart Association and the American College of Cardiology.
- Clinical considerations: Myocarditis and pericarditis after receipt of mRNA COVID-19 vaccines among adolescents and young adults, CDC.
- Overview of myocarditis and pericarditis, ACIP COVID-19 Vaccines Work Group, June 23, 2021, CDC.
- COVID-19 subcommittee of the World Health Organization (WHO) Global Advisory Committee on Vaccine Safety (GACVS) reviews cases of mild myocarditis reported with COVID-19 mRNA vaccines, WHO news release, May 26, 2021.
- Myocarditis and pericarditis following mRNA COVID-19 vaccination, CDC.
- Selected adverse events reported after COVID-19 vaccination, CDC.
- Myocarditis and pericarditis resources for the public, CDC.
COVID-19 test supply shortage
The U.S. is experiencing a shortage of BinaxNOW antigen test kits, straining the entire testing system. DOHis working with the manufacturer, Abbott, and the federal government to increase the supply to Washington. However, supplies will likely remain low over the next month or two. If you need test kits, we have alternative options.
Abbott Laboratories extended all BinaxNOW tests’ shelf life to 12 months. See Abbott’s BinaxNOW COVID-19 ag card product expiry update for new expiration dates by lot number.
Testing in schools
As in-person learning resumes at schools, families need help navigating the K-12 testing requirements to return to school when a student has CLI. Children with CLI need a PCR test before they return to school. Over-the-counter antigen tests do not offer proof of testing.
- If a person with COVID-19 symptoms tests negative for SARS-CoV-2 with a molecular test, they may return to school following existing school illness management policies as long as they are not a close contact of someone with COVID-19 and subject to quarantine.
- If a person with COVID-19 symptoms tests negative for SARS-CoV-2 with an antigen test, per CDC antigen testing guidance, a confirmatory lab-based molecular test is recommended.
- Anyone symptomatic who receives a negative antigen test should seek a confirmatory PCR test. An alternative to confirmatory nucleic acid amplification testing (NAAT) is serial antigen testing performed every 3-7 days for 14 days.
COVID-19 test processing
Labs report varying amounts of time to process COVID-19 tests. To support faster turnaround, we encourage providers to use in-state labs. The table below shows COVID-19 test processing times for in-state private labs.
|LAB||TIME TO PROCESS TEST||TESTS PROCESSED DAILY|
|Northwest Pathology||24-48 hours||20,000|
|UW Virology||24-48 hours||7,000-9,000|
|Atlas Genomic||24-48 hours||10,000|
Share the following 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 COVID-19 symptoms and have not been tested or exposed.