COVID-19 Strategic Action Framework: Routine Immunizations During COVID-19

Page updated on Aug 11, 2020 at 10:49 PM

This document is congruent with Alexandria Health Department’s (AHD) Strategic Action Framework and is one of a series of frameworks outlining AHD’s COVID-19 Pandemic Response


Eliminate vaccine-preventable illnesses, including seasonal influenza, and save infant, child, adolescent and adult lives by increasing immunization rates.


  • Reduce the incidence of illnesses, hospitalizations, and deaths due to vaccine-preventable diseases.
  • Inform all Alexandrians of the importance of vaccines, including seasonal influenza vaccine, in the prevention of disease outbreaks that would worsen the impact of COVID-19.
  • Disseminate messaging on how Alexandrians can safely obtain their immunizations in the midst of the COVID-19 pandemic.

Key Context

This is a living document and changes will be made based on updates in public health’s understanding of COVID-19, updated Centers for Disease Control (CDC) and Virginia Department of Health (VDH) guidance, and Alexandria Health Department (AHD) resources and prioritizations.

This document is consistent with the CDC’s Advisory Committee on Immunization Practices (ACIP) recommendations for children, adolescents 18 years old and younger, and adults.

The Code of Virginia requires immunizations to register for school; this requirement includes students who will be registering for virtual learning - see FAQ from the Virginia Department of Education. 


Support schools and school nurses as they communicate and enforce vaccine requirements for students starting school in the fall.

  • Provide ongoing educational support to school nurses who may have questions on catch up timing of routine vaccines and the efficacy of seasonal influenza vaccine.
  • Schedule an educational meeting between an Alexandria Health Department (AHD) immunization nurse and school nurses to go over FAQ’s and common errors in calculating timing of vaccines.
  • Collaborate with schools in their communications to parents regarding school vaccine entry requirements.
    • Encourage schools to announce back-to-school vaccine requirements through their normal channels (email, website, etc.). 
    • Emphasize that requirement compliance will be closely tracked and strictly enforced, explicitly stating the sanctions (e.g. inability to register and attend, including exclusion from virtual learning).
  • Provide schools with handouts to families, including a letter from AHD leadership, about the trio of adolescent vaccines required and recommended at the start of 7th grade (Tdap, HPV, and Meningococcal).
  • Work with the schools’ health services and school nurses to refer children without Tdap, Meningococcal, and HPV vaccines to their medical home or AHD.
  • Discuss school vaccination tracking policies as it relates to the timing of vaccine reporting, and establish a reminder plan for all schools to submit their Student Information Survey (SIS) report 30 days after the start of school to help AHD monitor vaccine completion rates.
  • Offer MRC volunteer assistance to schools for vaccine review of schools’ student records to assist with immunization catch-up and compliance with Code of Virginia.

Form and strengthen relationships with local providers.

  • Provide comprehensive, practice-specific support to providers, according to their stated needs, to ensure practices have the full capacity for routine immunizations.
    • Solicit feedback from clinician professional organizations on barriers to immunizations.
      • Post information and solicit input through professional listservs to reach clinicians.
    • Provide technical guidance on immunizing patients while adhering to COVID-19 mitigation strategies
    • Provide practices Personal Protective Equipment (PPE), as requested and available, to support their immunization efforts
  • Form relationships with the Virginia Chapter of the American Academy of Pediatrics (VA-AAP) and collaborate on the AAP Visiting Immunization Expert Initiative.

Support the establishment of medical homes for all children and adults, and continue to serve as a safety net for immunizations for families without a medical home.

  • Assess whether patients have a medical home during every AHD immunization visit and refer those without medical homes to appropriate resources.
  • Advocate for the trio of adolescent vaccines to be given during the initial adolescent visit.
  • Reinforce to parents that routine healthcare, including immunizations, is as important for their teenagers and young adults as it is for their infants and young children.
  • Provide needed immunizations, including influenza, to all clients seen in AHD public health specialty clinics and refer patients to get established with primary care providers.

Assess the rate of missed immunizations among AHD patients and in the City and perform targeted outreach.

  • Obtain Alexandria-specific Virginia Immunization Information System (VIIS) data to inform public messaging campaigns that will be developed in partnership with Fairfax County as part of VDH’s immunization funding grant.
  • Identify and contact AHD patients who are due for immunizations.
  • Assess for immunization needs at every clinic visit to leverage opportunities for vaccination and to reinforce their importance to patients and their parents.
  • Continue to strengthen AHD’s partnership with Neighborhood Health to maximize referrals to the Baby Care Program that serves infants and toddlers under 2 years old.
  • Analyze data to identify “pockets of under-immunization” for focused assessment of community-specific barriers and interventions. 
  • Promote age-appropriate immunizations through daycare centers.

Craft and disseminate clear, evidence-based, compelling flu vaccination messaging.

  • Develop public messaging campaigns to combat influenza vaccine hesitancy as part of the media campaign initiative in partnership with Fairfax County.
    • Prioritize communities experiencing a high burden of health disparities.
  • Distribute educational materials promoting the importance of influenza vaccine at AHD clinic visits, WIC appointments, and case management visits.
  • Promote influenza vaccination Points of Distribution (PODs) through advertising campaigns.

Encourage the development of a broad-based advocacy agenda to support immunization priorities.

  • Identify opportunities for AHD to promote and strengthen support for immunizations.
    • Form alliances with other governmental leaders and representatives and propose policy changes
  • Support Immunize Virginia at the local health department level.