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

AFL 23-34
November 13, 2023

All Facilities

Coronavirus Disease 2019 (COVID-19) Vaccine Recommendations for Clinically Eligible Individuals
(This AFL supersedes AFL 22-09.1)

​All Facilities Letter (AFL) Summary

  • The California Department of Public Health (CDPH) recommends facilities offer COVID-19 vaccinations to clinically eligible individuals.
  • This revision includes information related to updated (2023-2024 Formulation) COVID-19 vaccines.


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, residents, staff, and the community from COVID-19.

This AFL reminds facilities of the importance of offering and encouraging COVID-19 vaccinations to clinically eligible individuals, especially those at highest risk of morbidity and mortality, at all interactions across the healthcare continuum.  

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.

Other Resources

For assistance in obtaining COVID-19 vaccinations, please direct patients to consult their primary care provider or to the MyTurn or CDC Vaccines websites.​​

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


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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