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State of California—Health and Human Services Agency
California Department of Public Health

AFL 23-33
November 13, 2023

General Acute Care Hospitals (GACHs)
Acute Psychiatric Hospitals (APHs)

Coronavirus Disease 2019 (COVID-19) Vaccine Recommendations for Eligible Individuals Prior to Discharge
(This AFL supersedes AFL 21-20.2)

​All F​acilities Letter (AFL) Summary

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


Ongoing morbidity and mortality from evolving variants of SARS-CoV-2 underscore the continued importance of COVID-19 vaccines and related measures, including testing and masking, to protect patients, staff, and the community from COVID-19. Older adults and persons with weakened immune systems are at highest risk for severe illness. Additionally, children and adults with no underlying medical conditions can still experience severe illness due to 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 updated COVID-19 vaccinations to eligible patients, especially those at highest risk from severe 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 ​

Overview of COVID-19 Vaccination

COVID-19 vaccination is recommended for everyone ages 6 months and older in the United States for the prevention of COVID-19. There is no preferential recommendation for the use of any one COVID-19 vaccine over another when more than one recommended and age-appropriate vaccine is available.

The 2023–2024 formulation for all COVID-19 vaccines licensed or authorized in the United States (Moderna, Novavax, and Pfizer-BioNTech) has been updated to a monovalent vaccine based on the Omicron XBB.1.5 sublineage of SARS-CoV-2. The Original monovalent and bivalent (Original and Omicron BA.4/BA.5) formulations should no longer be used.

Everyone 6 months and older should stay up to date with COVID-19 vaccines:

  • Everyone 5 years of age and older is recommended to receive a single updated dose as long as it has been at least 2 months since their last dose.
  • Young children 6 months through 4 years are recommended to receive 2–3 updated doses, while those who have received prior doses are recommended for 1–2 additional doses.
  • Everyone 6 months of age and older who is immunocompromised may receive additional updated doses.

Refer to CDC Interim Clinical Considerations for Use of COVID-19 Vaccines for more details.

Hospitals can purchase vaccines directly from COVID-19 vaccine manufacturers or wholesale distributors. Hospitals serving uninsured patients can inquire about participation in the Vaccines for Children Program or the Bridge Access Program for adults.

Please direct patients to consult their primary care provider or to the MyTurn or CDC Vaccines websites for assistance in obtaining future doses recommended beyond the dose administered before discharge at your hospital.

If you have any questions about COVID-19 vaccines, please contact the Provider COVID-19 Call Center by email at or by phone at (833) 502-1245 Monday – Friday from 8 AM–5 PM.



Original signed by Cassie Dunham

Cassie Dunham

Deputy Director


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