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COVID-19 Health Care Staff Vaccination IFC-6
On Friday November 5, 2021, the Centers for Medicare and Medicaid Services (CMS) published a rule requiring all health care facilities certified under Medicare and Medicaid to ensure their staff have received COVID-19 vaccination. The rule is effective immediately. The first compliance deadline is December 6, 2021, and all covered staff must have received all shots for full vaccination by January 4, 2022. CMS has several resources available, including an infographic, a webinar recording and slide deck, and frequently asked questions (FAQs). CHA has provided a summary of the rule for members (member login required). 

Also on November 5, 2021, the Occupational Safety and Health Administration released its COVID-19 Employer Emergency Temporary Standard (OSHA ETS) for facilities with 100 or more employees. In general, if facilities are subject to the CMS rule then that rule takes priority. The CMS FAQs have more information on how the CMS rule interacts with the OSHA ETS and state law requirements.
 

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Pediatricians address parents' fears about COVID vaccines for kids

September 15, 2021

By JULIE MINDA

As of Aug. 31, 47% of people aged 12-17 had been partially or fully inoculated against COVID-19 — the lowest percentage of any age group eligible for vaccination, according to data analysis from The Washington Post.

Girl celebrating
Arin Cuvala celebrates after getting her first COVID-19 vaccine dose at Saint Alphonsus Health System in Boise, Idaho. Arin is 12, and a seventh grader at Lewis and Clark Middle School in Meridian, Idaho. She got the vaccine within the first week of eligibility and said she is excited to keep herself, her family and friends safe from COVID-19.

Surveying reported Aug. 11 by the Kaiser Family Foundation indicates that 23% of parents of kids in this age range want to wait to see how the COVID vaccines are working before inoculating their kids, 9% say they'll only vaccinate them if mandated to do so and 20% say they will definitely not vaccinate their kids against COVID.

Dr. Sreeramya Kanumilli, a pediatrician with the Facey Medical Group in Burbank, California, says, "With the delta variant of COVID being much more transmissible to kids, and with school starting, we're starting to see increasing infections, increasing symptoms. The vaccine is the best way to protect people, and so I ask in every patient visit" about openness to vaccination.

Kanumilli is among a sampling of ministry-affiliated pediatricians and pediatric practice leaders who say they are deeply concerned about youth who are eligible for the shots but unvaccinated. They are working to dispel the fears of teens and their vaccine-hesitant parents. Ministry systems too are sending pro-vaccine messages directly to parents of teens and promoting teen vaccination in mass media, on social media and in community forums.

Doctor with a mother and her child
Dr. Diana M. Roukoz, a Mercy Clinic Pediatrics pediatrician, treats Maggie Lorentz, 9, and Elaina Lorentz, 6, at her suburban St. Louis office. Roukoz spoke with their mom Rebecca Lorentz, second from left, about when the COVID vaccine may be approved for use in children ages 5 to 12. Lorentz plans to have the girls inoculated. The girls' two older brothers already have been.

The Kaiser survey found that parents' top concern about vaccinating their teens had to do with safety and side effects. Almost 90% of the vaccine-hesitant respondents say not enough is known about the long-term side effects in children. Kaiser's research summary says that nearly 75% of vaccine-hesitant parents cite fears the drug may negatively impact their child's future fertility even though the Centers for Disease Control and Prevention says there is no evidence that any of the COVID vaccines, or any vaccines for that matter, cause female or male infertility.

"Our biggest role as providers is to establish ourselves as a source that can be trusted and that is open and honest," says Kanumilli, whose medical group is affiliated with Providence St. Joseph Health. "I encourage patients to ask questions, and I dispel myths."

Kids aren't little adults
In December, the Food and Drug Administration granted emergency use authorization of the Pfizer coronavirus vaccine to people ages 16 and up. In mid-May the agency broadened its emergency use authorization again, this time to approve the use of the Pfizer vaccine in people ages 12-15. Moderna has a pending FDA application for an emergency use authorization to allow its vaccine to be used in those 12 to 18. (In August, Pfizer became the first vaccine maker to gain full FDA approval for use of its COVID vaccine in people 16 and older.)

Doctor holding a sign
Dr. Sreeramya Kanumilli, a pediatrician with the Facey Medical Group in Burbank, California, is an enthusiastic promoter of vaccination for all who are eligible. Facey is affiliated with Providence St. Joseph Health.

Dr. Joseph Kahn, president of Mercy Kids, the pediatric practice of Mercy, says that FDA emergency use authorization could come in late fall or early winter for children ages 5-11 and in the spring for those younger than 5. The Pfizer vaccine likely would be the first available to these age groups.

The pediatricians and practice leaders from Mercy, Hospital Sisters Health System, Providence St. Joseph Health and Trinity Health who spoke to Catholic Health World say many of their eligible adolescent patients are receiving their inoculations in the large, centralized vaccination centers these systems established early this year, including drive-thru centers set up by HSHS. Some systems, including HSHS and Trinity Health, have been offering vaccinations in their primary care and pediatric clinics on a limited basis.

Kahn notes Mercy is already thinking about how it can efficiently inoculate large numbers of young children in pediatric offices once the FDA gives the go ahead.

Some of the COVID vaccines expire fairly quicky — within six hours of opening a vial — and since young children almost surely will be administered smaller doses than adults, there will be more doses available per vial. Kahn said it will be challenging to minimize vaccine waste. Thru-put is another concern. Mercy may enlist Child Life specialists to calm children who fear needle sticks.

Rushing in or holding out
More than one-third of parents of children ages 5-11 who responded to the Kaiser survey published in August say they will only vaccinate their child if required to do so or that they will definitely not vaccinate. Forty percent of parents of children under 5 said this.

Hulyalkar
Hulyalkar

Dr. Manasi Hulyalkar, a pediatrician with HSHS Medical Group in Jacksonville, Illinois, says roughly half of her patients' parents are very enthusiastic about vaccination and about half are hesitant.

Kanumilli says many of her patients in Southern California want their kids vaccinated as soon as they are eligible.

Dr. Diana M. Roukoz, a Mercy Clinic Pediatrics pediatrician practicing in suburban St. Louis, says she has had some parents so eager to vaccinate their kids under 12 that they've asked if they can fib about their age, but others are resistant.

Roukoz
Roukoz

Some of her teen patients work to persuade their vaccine-hesitant parents to OK the inoculation. She says she's been brought to tears by socially minded teens who tell her of their desire to get the shots so they can protect others.

Dr. Sanjay Garg, a pediatrician with HSHS Medical Group in Decatur, Illinois, says his patients' parents are about evenly split between the vaccine-enthusiastic and the vaccine-hesitant. The latter group includes parents worried about how fast the vaccines were approved, concerns he counters by explaining the rigorous process of vaccine development and testing.

Garg
Garg

Kanumilli says parents also worry about myocarditis, a potentially serious but rare complication of mRNA vaccinations.

Hulyalkar says some parents say since the overwhelming majority of kids infected with COVID thus far have mild symptoms, it's a low-risk proposition to hold off on vaccination. But, she says, as caseloads rise locally, so too do parental fears and interest in vaccinating their children.

In conversations with parents, the doctors say they emphasize that while children are at lower risk of serious side effects and death from COVID, as compared with older populations, they still can require hospitalization and endure long-lasting health consequences from the virus.

Open door
All the pediatricians say they are focused on being transparent, fact-based and nonjudgmental in communicating with parents and youth about vaccines. They're encouraging them to rely on trusted health professionals rather than social media in making medical decisions.

"Our message is: 'We are on your side,'" Hulyalkar says.

Roth
Roth

Dr. Dan Roth, Trinity Health executive vice president and chief clinical officer, says vaccine hesitancy is not a novel issue. A percentage of parents long have been concerned with — and resistant to — pediatric inoculations. Trinity Health pediatricians reach out to parents whose kids are behind on pediatric vaccinations and other preventive care. They likely will contact parents of youth not vaccinated for COVID too.

Kahn says Mercy's marketing department is amplifying its pro-vaccination messages and education through traditional and social media. Two Mercy pediatricians who practice in central Missouri's Laclede County have created podcasts on the vaccination topic. According to The New York Times tracker, Laclede County has a vaccination rate of 29%.

Kanumilli fields questions about pediatric vaccination in online community forums. Her message to vaccine-hesitant parents is: "The vaccines are a wonderful gift from God, and we need to rally together, accept this gift and be on the same page."

 

Copyright © 2021 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3490.