COVID-19 vaccination plans in correctional facilities should include considerations for how to sub-prioritize vaccination in the event there is not enough vaccine at a given time. Sub-prioritization planning for vaccination may occur at the facility level, individual level, or both, and should be coordinated with state and local health departments. Sub-prioritization decisions can be guided by facility- and individual-level data and should take into consideration the feasibility of subpopulation vaccination across multiple facilities versus facility-based vaccination. Jurisdictions are encouraged to consider vaccination of both staff and incarcerated/detained persons of correctional or detention facilities at the same time because of their shared increased risk of disease and the efficiency of vaccinating more people in the same place.

Facility-level indicators that may be helpful for vaccination sub-prioritization include:

  1. the number of staff and incarcerated/detained persons;
  2. proportion of older staff and incarcerated/detained persons with high-risk medical conditions that increase the risk of COVID-19 morbidity and mortality;
  3. baseline healthcare infrastructure;
  4. facility ventilation;
  5. ease of access by vaccination teams;
  6. ability to continue normal operations in the event of staff quarantine after exposures; and
  7. ability to isolate and quarantine incarcerated/detained persons if an outbreak occurs.

Individual-level factors that may be helpful for vaccination sub-prioritization include older age, high-risk medical conditions, recent COVID-19 in the past 90 days, and risk of exposure to other incarcerated/detained persons who have COVID-19.

The risk for severe illness increases with age, with older adults at highest risk. Adults of any age with certain underlying medical conditions are also at increased risk for severe illness from COVID-19. As such, according to the Advisory Committee on Immunization Practices (ACIP) updated interim vaccine allocation recommendations, COVID-19 vaccines should be offered to frontline workers and adults who are 75 years of age or older (Phase 1b), as well as persons aged 65–74 years and persons aged 16–64 years with medical conditions that increase risk of severe illness due to COVID-19 (phase 1c). Correctional and detention facilities, especially those with geriatric and medical units, should coordinate with state/local health officials on how to sub-prioritize staff and incarcerated/detained persons that fall into these two sub-categories when it is not feasible to vaccinate all incarcerated/detained persons and staff at the same time.

CDC has published a companion guide to assist state, tribal, local, and territorial immunization programs and other immunization partners in planning for vaccination of populations recommended to receive initial doses of COVD-19 vaccine.

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