Coronavirus Disease 2019 (COVID-19) Vaccine Recommendations for Eligible Individuals Prior to Discharge

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AFL 21-20.1 From the California Department of Public Health

February 7, 2022

TO: General Acute Care Hospitals (GACHs)
Acute Psychiatric Hospitals (APHs)
SUBJECT: Coronavirus Disease 2019 (COVID-19) Vaccine Recommendations for Eligible Individuals Prior to Discharge
(This AFL supersedes AFL 21-20)

All Facilities Letter (AFL) Summary

This AFL recommends GACHs and APHs offer COVID-19 vaccinations and booster doses to eligible individuals prior to discharge. This AFL provides technical assistance on options and resources to assist GACHs and APHs vaccinate their patients.

The circulation of more transmissible recent variants of the SARS-CoV-2 virus has led to surges in COVID-19 cases. The majority of COVID-19 hospitalizations and deaths are occurring in unvaccinated individuals. The emergence of the Omicron variant further demonstrates the importance of vaccination, boosters, and other prevention efforts, including testing and masking, to protect patients, staff, and the community from  COVID-19.

To reduce the spread of COVID-19, CDPH recommends that prior to discharge from the hospital, 24-hour observation, or emergency department, GACHs and APHs offer COVID-19 vaccinations, including booster doses, to eligible patients, especially those at highest risk of morbidity and mortality from COVID-19, such as:  

  • Patients age 65 years or older
  • Psychiatric patients
  • Patients being discharged to congregate care or residential settings, such as: post-acute medical facilities, skilled nursing facilities, residential care facilities for the elderly, correctional facilities, behavioral health facilities, and homeless shelters

Primary series vaccines should be administered to unvaccinated patients or patients that have not completed the primary vaccine series. Boosters should be administered when clinically appropriate, based on when the primary vaccine series was administered and the medical condition that required hospitalization. Boosters are especially urgent for those at higher risk of severe disease, such as those listed above. COVID-19 boosters help broaden and strengthen the protection against the Omicron variant.

Three vaccines are authorized  for use in the United States to prevent COVID-19. The COVID-19 mRNA vaccines from Pfizer-BioNTech and Moderna are preferred over the Janssen (J&J) COVID-19 vaccine. However, vaccination should not be delayed in order to offer a specific product. 

If additional primary or booster doses are recommended after the dose administered before discharge at your hospital, please direct patients to the MyTurn or websites for assistance in obtaining future doses.  

Additionally, for any hospital not already providing COVID-19 vaccines that is interested in becoming a COVID-19 vaccine provider, please visit the California COVID-19 Vaccination Program website (myCAvax). For COVID-19 vaccine provider enrollment instructions, please visit the Vaccinate All 58 webpage.

If you have any questions about this AFL, please contact the Healthcare-Associated Infections Program at


Original signed by Cassie Dunham

Cassie Dunham

Acting Deputy Director