Dr. Danielle Zerr is medical director of infection prevention at Seattle Children’s.

Is vaccination underway at Seattle Children’s?

Dr. Zerr: Yes. We are pleased to say that Seattle Children’s began vaccinating its workforce for COVID-19 on Dec. 16, 2020. To date, we have received four shipments of the Pfizer vaccine (975 doses each) .  We expect the vaccine supply allocated to us by the Washington State Department of Health to arrive in weekly shipments. Like other healthcare systems in Washington, Seattle Children’s has limited information at this time about the types and quantities of vaccines we will receive in the near future. As we learn more, we will share.

We rely on information from the CDC’s Advisory Committee on Immunization Practices (ACIP) and state and local public health authorities to guide our decisions on safe and equitable distribution of our vaccine supply.

Who is receiving vaccines at Seattle Children’s?

Dr. Zerr: Due to limited availability, we are prioritizing timing of vaccination in accordance with recommendations from our multidisciplinary Vaccine Task Force and federal and regional guidance. First, healthcare personnel at the highest risk of exposure will be offered the vaccine in an effort to maintain medical surge response capacity.

Here is how we are currently allocating vaccines:

First is phase 1A, the frontline workforce members and community providers. They are divided into three groups.

Phase 1A, Group 1 — Workforce members who have direct patient contact and the highest risk of exposure, including the following:

  • Work in COVID-19 acute care/PICU SIU
  • Work in ED (direct patient care and support services)
  • Work in urgent care centers
  • Work in SARS-CoV-2 testing sites/labs handling potentially COVID-19-positive samples
  • COVID-19 vaccination staff
  • COVID-19 screeners who swab workforce members and families for COVID-19, safety officers/security
  • Pediatric residents based at Seattle Children’s
  • Fellows working in the above high-risk areas
  • Other trainees working in the above high-risk areas
  • Team members who perform high-risk AGPs in the airway (anesthesiologists, pulmonary and otolaryngology providers, dental, respiratory therapists)

Phase 1A, Groups 2 and 3

  • Group 2: Includes active community medical staff with privileges and other inpatient providers with privileges.
  • Group 3: Includes active community medical staff without privileges. We will contact this group directly via email once we have more information to share about timing and scheduling. We don’t expect to begin offering vaccines to this group until late winter but the timing could be sooner or later depending on our future vaccine allotments.

Community providers employed by other health systems should obtain their vaccination from their home institution.

Future vaccine phases in 2021 will include more of our Seattle Children’s workforce members, patients and community healthcare partners. We will rely on federal and regional guidelines to prioritize within these groups.

Is Seattle Children’s requiring its workforce to be vaccinated?

Dr. Zerr: No, but everyone is strongly encouraged to get the vaccine. Getting vaccinated will help maintain a safe work environment, allow our healthcare workers to continue to safely care for patients during this surge, and decrease their risk of getting COVID-19 or potentially exposing others to it, including family, friends and the community.

Is there a cost for workforce members to get the vaccine?

Dr. Zerr: No, vaccines are free to all Seattle Children’s workforce members.

Who will be receiving the 20% of the vaccine Seattle Children’s received designated for “the community”?

Dr. Zerr: Our active community medical staff will be offered the vaccine, as detailed above, as well as students and trainees who are at Seattle Children’s. We are also identifying community and vendor partners who may be able to receive their vaccines at our sites.

Can my clinic staff receive the vaccine from Seattle Children’s? What about locums providers who work in community practices? 

Dr. Zerr: Not at this time. We are following state and local public health guidelines to prioritize groups for vaccination. If vaccine becomes available for clinic staff and/or locum providers, we will announce it. Please be sure you are subscribed to Provider News to ensure you hear from us.

If healthcare providers and their staff can’t get the vaccine at Seattle Children’s, where else can they get it?

Dr. Zerr: It’s not clear yet. You can ask your primary care provider if and when they will be offering a vaccine, and if you are employed by a healthcare organization, you can ask your employer when they will offer vaccines. However, it is likely they will not know yet.  You can also check with local public health agencies and the Washington State Department of Health for information about when vaccines will be more widely available.

As Moderna and others ramp up production of their vaccines that don’t require extreme cold storage like Pfizer’s, vaccine availability should greatly improve.

Information for independent, non-hospital associated practices:

How will I receive communication from Seattle Children’s about scheduling a vaccine?

Dr. Zerr: If you are an active community medical staff member, with or without privileges at the hospital, you will receive direct communications from Seattle Children’s when the vaccine is available to you. If you are not a member of our active community medical staff, please subscribe to Provider News to receive future notification of vaccine availability.

Do I have to come to Seattle Children’s to get vaccinated?

Dr. Zerr: Yes. The hospital is currently the only location where we are offering the vaccine.

Which vaccine will I receive? Can I choose?

Dr. Zerr: The vaccine given on any particular date and time will depend on our supplies and logistics. A choice won’t be offered. We currently have only the Pfizer vaccine, which is given in two doses several weeks apart.  Other vaccines that we may receive in the future may also be given in two doses. Second doses will be the same type as the first, which means if you get a Pfizer vaccine in the first dose, your second dose will be Pfizer also.

Are there any precautions to receiving the vaccine for individuals on immunosuppressive therapies?

Dr. Zerr: We recommend following the guidance of the CDC’s ACIP on this matter. According to ACIP’s website on December 20, 2020 : “Persons with HIV infection or other immunocompromising conditions, or who take immunosuppressive medications or therapies might be at increased risk for severe COVID-19. Data are not currently available to establish vaccine safety and efficacy in these groups. Persons with stable HIV infection were included in mRNA COVID-19 vaccine clinical trials, though data remain limited. Immunocompromised individuals may still receive COVID-19 vaccination if they have no contraindications to vaccination. However, they should be counseled about the unknown vaccine safety profile and effectiveness in immunocompromised populations, as well as the potential for reduced immune responses and the need to continue to follow all current guidance to protect themselves against COVID-19…” (ACIP website, in the section “Vaccination of persons with underlying medical conditions”).

If I tested positive for COVID-19, do I still need to get the vaccine?

Dr. Zerr: Yes, you should still get a vaccine; however, if you are eligible to receive your vaccine at Seattle Children’s and you have tested positive for COVID-19 in the past 90 days, we require that you defer your vaccine to allow vaccination of other healthcare workers who remain susceptible to infection, as current evidence suggests reinfection is uncommon during the 90 days after initial infection. Other institutions may have different policies.

Can I get the vaccine if I have allergies?

Dr. Zerr: Most people who have allergies can receive the vaccine. The one exception is those who have had a severe allergic reaction to the vaccine itself or any of its components; this group should not receive the vaccine. People who have had severe allergic reactions to other vaccines or injected medications can receive the vaccine, but they should be monitored for 30 minutes. Food, environmental, and animal allergies are not restricted from receiving the vaccine in any way. Our COVID-19 vaccination clinic is prepared in the event a vaccine recipient develops symptoms of severe allergy during the 15- to 30-minute monitoring period.

Is it safe for pregnant and breastfeeding women to get the COVID-19 vaccine?

Dr. Zerr: While pregnant and breastfeeding women can get the vaccine, we encourage them to contact their healthcare provider before getting the vaccine. None of the clinical trials for the COVID-19 vaccine included pregnant or breastfeeding women.

The Society for Maternal Fetal Medicine and the American College of Obstetrics and Gynecology recommend that pregnant and breastfeeding women who are high-risk healthcare workers and first responders be offered and receive the COVID-19 vaccine. They also offer the following guidance and information and recommend that you consult with your care provider if you have questions:

  • Vaccine safety and efficacy have not been tested in pregnancy.
  • The risk of maternal or fetal harm from an mRNA vaccine is unknown, but thought to be low.
  • COVID-19 disease carries increased risk in pregnancy, particularly for patients with obesity or other medical conditions.
  • Receipt of the vaccine is a personal choice.
  • Pregnant women who have a history of significant allergy to any of the COVID-19 vaccine components should not receive the COVID-19 vaccine until there is a better understanding of anaphylactic reactions to the vaccine.

The University of Washington has established a registry to follow pregnant and breastfeeding women who receive the COVID vaccine. Learn more and register. Questions can be directed to covidvaccpreg@uw.edu.

What advice do you have for pediatric providers if they develop a reaction to the vaccine that mimics COVID-19 infection?

Dr. Zerr: You should be tested for COVID-19 if you experience COVID-19 symptoms such as respiratory issues, sore throat or cough that aren’t compatible with an expected vaccine side effect (local site reaction, fever, fatigue, myalgia, headache). If you experience symptoms such as fever, fatigue, myalgia or headache that could be either related to the vaccine or COVID-19 or another viral infection, then it is fine to wait and quarantine at home. If you are having a vaccine reaction, it should resolve in 24 to 48 hours. If symptoms don’t resolve by the end of the third day — day 1 being the day of the vaccine — then test for COVID-19.

Providers should refer to the CDC’s guidance on return to work.

Will a vaccine be tested in the pediatric population? When? How?

Dr. Zerr: Yes, pediatric testing of vaccines is already underway. Pfizer began testing in youth ages 12 to 17 in October. Moderna is slated to begin testing in the same age group shortly, and more vaccine makers are expected to begin pediatric trials once their drugs are approved for adult use. AstraZeneca is testing its vaccine in children, but so far only outside the United States.  We don’t know when the pediatric data will be available or when a vaccine will be approved for youth.

COVID-19 vaccines, like other drugs, will be tested in progressively lower age groups, starting with teens and proceeding to the youngest children last. Even though babies have been affected by COVID-19 at a higher rate than children 12 months and up, testing will likely not skip past the other kids’ age groups.

Pediatric testing is necessary because drugs sometimes work differently in the pediatric population than adults, and children may have stronger reactions (more fever, joint or muscle ache or fatigue) because their immune systems are more active.

Is there an opportunity for my patients to participate in COVID-19 vaccine trials?

Dr. Zerr: Pfizer is recruiting individuals ages 12 to 15 for its COVID-19 vaccine study. Children may be eligible if they have not participated in a previous trial for COVID-19 and have no history of COVID-19 infection or a positive COVID-19 test. Learn more.

When do you expect a vaccine for kids to be available?

Dr. Zerr: We don’t know and would not want to speculate. It depends on when the vaccine studies can demonstrate the results needed. There is no word on whether we’ll have a vaccine for kids by next fall. It’s certainly a good goal, and we’d like to see it happen. Our state is not presently requiring children and teens to have a COVID-19 vaccine in order for them to return to school.

What are the recommended pediatric priority groups to receive the vaccine?

Dr. Zerr: It is undetermined at this moment. We need to wait to receive guidance from the CDC’s Advisory Committee on Immunization Practices (ACIP). Stay tuned.

Are there any pediatric groups who should not receive the vaccine?

Dr. Zerr: We don’t know yet. We are looking to ACIP to make that determination.

What kind of side effects might we see in kids? Is it safe?

Dr. Zerr: We don’t know for sure. We can expect to see some of the same side effects we’ve seen in adults: fever, fatigue and achy muscles and joints. There’s no reason to believe what we’ve seen in adults will be different in kids, but the studies will let us know. Typically, if a vaccine is safe for adults, it is safe in kids.

Will the kids’ vaccine need to be repeated, like the adult one?  

Dr. Zerr: Yes. The vaccines for kids from Pfizer and Moderna will likely be two-part vaccines like their adult counterparts. Johnson & Johnson is working on a vaccine that is one dose. We will not know the exact dose and frequency of a pediatric vaccine until the data comes out.

Is Seattle Children’s participating in trials of the vaccine in kids?

Dr. Zerr: Not currently. According to clinicaltrials.gov, the only Seattle area institution currently participating in trials of a kids’ vaccine is the Benaroya Research Institute at Virginia Mason.

Most pediatric community clinics will not have capability to store the Pfizer vaccine. How will this be addressed?

Dr. Zerr: Pfizer’s vaccine requires unusually deep cold storage, which Seattle Children’s can provide but many clinics in the community cannot.  As more vaccines become available that don’t require nonstandard, deep cold storage like Pfizer’s, we expect to see improved availability of vaccines to community clinics.

Will Seattle Children’s vaccinate pediatric patients ages 16 to 18 since the vaccines are approved for that age group?

Dr. Zerr: We are waiting for ACIP to provide guidance on offering vaccines to patients ages 16 to 18.

Where can patients go to get vaccinated if their pediatric clinic isn’t offering it?

Dr. Zerr: It’s too soon to say. It’s possible Seattle Children’s will offer COVID-19 vaccinations at our regional clinics when more vaccines are available, but nothing is planned yet. Our best guess is that we will rely on clinics to distribute the Moderna or any other vaccine that they are able to properly store in their own refrigerated facilities.

Do you have suggestions on how to calm parent uneasiness about getting kids vaccinated?

Dr. Zerr: The CDC provides talking points and materials for providers to discuss the COVID-19 vaccine with patients and families. See “Talking to Recipients about COVID-19 Vaccines” on the CDC website, which includes these documents:


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