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FAQ: The COVID-19 Vaccine and Migrant, Immigrant, and Food & Farm Worker Patients

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FAQ: The COVID-19 Vaccine and Migrant, Immigrant, and Food and Farm Worker Patients

Migrant Clinicians Network continues to receive questions from our clinical network on COVID-19 and vaccines for migrant, immigrant, and farmworker communities. While vaccines are available for all in the US, ages 5 and up, in reality, COVID-19 vaccines remain less accessible for many people, for a variety of reasons, including fear over immigration status, misinformation, lack of information in a preferred language, and lack of vaccination infrastructure. The dynamic situation does not belie the underlying mantra: everybody deserves a chance to get vaccinated against COVID-19. Vaccination is critical and efforts need to continue to make it fully accessible, with culturally appropriate education and conversation available in the language of the patient to answer their questions and build trust.

Until everyone is vaccinated, we will continue to see new variants emerge. Worldwide equitable vaccination is essential to end the pandemic.

This FAQ was last revised January 4, 2022. Information and data are changing very rapidly. For more updated information, please visit our blog:

A patient came in very fearful of the Omicron variant. What should I tell him?

As the Omicron variant is so still relatively new, there is very little data on its dangers, transmission rates, are being gathered. What is clear is that Omicron is highly contagious. 

In the meantime, stress what we know very well, that regardless of the variant, our tools to fight against all variants of COVID-19 remain the same: vaccination, mask wearing, sanitation, ventilation, and distance. Up-to-date vaccination, including a booster shot for vaccinated people ages 12 and up, is critical, and efforts need to continue to make it fully accessible, with education and conversation available in the language of the patient to answer their questions and build trust. While Omicron is vastly more contagious than Delta, efforts to mitigate the spread should continue or be increased. While we are unsure presently how effective our earlier recommendations are against Omicron, please continue to encourage vaccination is matched by ventilation, sanitation, personal protective equipment like respirators, and physical distancing efforts. Patients should be encouraged to continue mask wearing in public or crowded spaces.

Read the CDC’s official advisory on Omicron here.


What are the current recommendations if a patient is exposed to COVID?

In December 2021, the CDC once again revised it recommendations regarding isolation and quarantine, and may do so again, so please visit the CDC for the most up-to-date information.

  • If the patient is up to date on vaccinations, the patient should:
    • Wear a mask for 10 days. MCN additionally recommends the use of high-quality KN95 or N95 respirators over cloth or surgical masks.
    • Test on day five, if possible.
  • If the patient is unvaccinated or is not up to date on vaccinations (has not received a booster but is eligible), the patient should:
    • Quarantine for five days.
    • Wear a mask for the next five days. MCN additionally recommends the use of high-quality KN95 or N95 respirators over cloth or surgical masks when feasible and appropriate.
    • Test on day five, if possible.

These CDC recommendations can be especially difficult to complete for migrant and immigrant patients, who may have housing situations that make quarantine difficult, or may have informal work situations that make time off to quarantine or to get tested very difficult. Voice these concerns with patients and help them develop a plan to quarantine and keep themselves and the community safe. Earlier in the pandemic, many community health clinics partnered with hotels and other locations to ensure migrants have safe places to isolate or quarantine, with food and other essentials delivered to the location. As Omicron continues to spike, these partnerships and processes become critically important once again.

What are the current recommendations relating to isolation if a patient contracts COVID?

In December 2021, the CDC once again revised it recommendations regarding isolation and quarantine, and may do so again, so please visit the CDC for the most up-to-date information. 

Regardless of vaccination status, a patient who is positive for COVID-19 should stay home for five days. If the patient is asymptomatic or symptoms have resolved by day five, the patient may leave the house and must wear a mask for the next five days. MCN additionally recommends the use of high-quality KN95 or N95 respirators over cloth or surgical masks when feasible and appropriate. 

These CDC recommendations can be especially difficult to complete for migrant and immigrant patients, who may have housing situations that make isolation difficult, or may have informal work situations that make time off to isolate or to get tested very difficult. Voice these concerns with patients and help them develop a plan to isolate and keep themselves and the community safe. Earlier in the pandemic, many community health clinics partnered with hotels and other locations to ensure migrants have safe places to isolate or quarantine, with food and other essentials delivered to the location. As Omicron continues to spike, these partnerships and processes become critically important once again.

What changes to Pfizer booster recommendations occurred this month?

The CDC updated their Pfizer booster recommendations in early January 2022:

  • For all patients, the Pfizer booster is recommended five months after the second dose, instead of the previous recommendation of six.
  • Children ages 5 to 11 who are immunocompromised are advised to get the Pfizer booster shot 28 days after the second dose.

Remember that our understanding of the effectiveness of the vaccines over time continues to develop as we receive more data, and, consequently, recommendations may change. Please continue to check back here for updates and from other trusted sources like the CDC.

What options currently are recommended for treating COVID?

Clinicians are encouraged to emphasize to patients that our treatment options remain limited, and staying up to date on vaccination and consistently practicing preventative techniques are our best methods to prevent severe disease and death. 

In late 2021, the FDA approved two antiviral pills to be delivered at the onset of COVID symptoms. These pills are rolling out in very limited quantities. 

Some monoclonal antibody treatments that were used effectively against Delta variant infections are proving less effective against Omicron infection, and highlights the need for testing to distinguish between the variants. Testing of various monoclonal antibody treatments effective against Omicron are being tested presently.

Convalescent plasma, a promising treatment earlier in the pandemic, is presently not recommended because of inconsistency in the efficacy. Efforts to reintroduce convalescent plasma are ongoing.

A patient seems to have long COVID. What are the best practices for treating long COVID?

An estimated 15 million people may have symptoms after recovery from acute COVID, called long COVID. Some people who were asymptomatic with COVID may still develop long COVID. Because COVID can affect organs throughout the body, long COVID symptoms vary widely. Fatigue, brain fog, and blood clots in legs (DVT) and lungs (PE) are possible symptoms. The American Academy of Physical Medicine and Rehabilitation has developed three initial guidance statements on fatigue, breathing discomfort, and cognitive symptoms, and plan to continue to roll out guidance statements in the coming months. Primary care teams can address concerns about blood clots by prescribing blood thinners following infection, and ensuring that patients know the symptoms of blood clots.


A patient came in and we weren’t sure if she had COVID or the flu, so we ordered a complete viral panel. She had both COVID and the flu. Is this common?

We have insufficient evidence to determine how widespread this problem is. However, Omicron appears to be presenting similarly to the flu; the loss of smell and taste are presenting less frequently than with Delta. Consequently, more clinicians are ordering viral panels and discovering co-infections. Influenza is circulating throughout the country, and clinics and hospitals may need to consider a third isolation area for patients with COVID and influenza, to ensure that patients with COVID aren’t exposed to the flu, and vice versa.


A patient decided to wait to get a booster (because of concern that it might not work for Omicron, because of confusion over future boosters, or because of misinformation on its effectiveness). What should I say?

Encourage the patient to get the booster – it’s the strongest defense we have against contraction of disease, hospitalization, or death from COVID-19. Please stress that many hospitals around the country are strained or overwhelmed with COVID-19 cases from both Delta and Omicron. We have strong evidence that the COVID-19 vaccine booster increases immunity for patients and protects them against COVID variants.

While we do not have enough data to say for sure how well it protect patients from Omicron, we know that regardless of the variant, vaccination is our strongest tool against severe cases of or death from COVID-19. Please continue to stress that it is important for all eligible people – from ages 5 and up – should get vaccinated, and those age 12 and up should get a booster.

Who should get a booster dose of a vaccine?

As of January 2022, the CDC actively advises all vaccinated adults age 18 and up to get a COVID-19 booster shot. the CDC actively advises all vaccinated adults age 18 and up to get a COVID-19 booster shot. Children ages 12 to 17 and immunocompromised children ages 5 to 11 are also now eligible for a booster. See the CDC page for specifics on timing for each type of vaccine. Those who have received booster shots have reduced odds of contracting COVID-19, which indicates that the boosters are working to increase immunity after a period of waning immunity after initial vaccination. This is an updated recommendation and supersedes previous recommendations. The CDC may again change recommendations as more data are available.

It is critical to continue to voice that initial vaccinations with two doses of mRNA remain very highly effective against severe disease, hospitalizations, and death. Most deaths from COVID-19 continue to be among those who are unvaccinated. Getting initially vaccinated remains critically important to prevent severe disease, hospitalizations, and deaths.

Some vulnerable populations like migrants, immigrants, and refugees continue to have poor vaccine and booster access, because of fear of exposing documentation status, lack of transportation, lack of educational materials in the language of their choice, lack of childcare, concern after hearing misinformation, etc. It is critical that clinics, health departments, and other vaccine provision locations continue to connect with the historically marginalized and isolated members of their communities to facilitate vaccine access, with health fairs, mobile clinics, and partnerships with churches, farmers’ markets, and other local community groups.

Worldwide vaccine access is highly inequitable. Outside of the US, many frontline providers still lack access to a first dose, leaving them at high risk for infection. Additionally, oxygen supplies are hard to secure and/or transport throughout the Global South, leaving those with severe disease without access to a lifesaving intervention. Efforts like are working to address this ongoing health injustice by pushing for better worldwide access to first doses while we in the US begin the path to third doses.

Remember that our understanding of the effectiveness of the vaccines over time continues to develop as we receive more data, and, consequently, recommendations may change. Please continue to check back here for updates and from other trusted sources like the CDC.

How does the booster shot affect vaccine mandates?

Presently, the federal vaccine mandate does not include language around booster shots, meaning to be "fully vaccinated" means completion of the initial vaccination series (either one dose for J&J or two doses for Pfizer or Moderna). Individual companies with vaccine mandates may choose to require a booster shot if they desire. See OSHA’s website for more including example signage for employers. MCN strongly encourages everyone to stay up to date with their COVID vaccinations, regardless of vaccine mandates.

What does an H2-A worker or other immigrant need in order to enter the US?

As of December 6, 2021, all air passengers, including those who are vaccinated, must show a negative COVID-19 test taken no more than one day before travel to the United States.

All non-US citizen, non-US immigrant visitors to the US, including H2-A workers, must be vaccinated with a US-approved vaccine. The current list of US-approved vaccines for entry into the US are: Johnson & Johnson, Pfizer-BioNTech, Moderna, AstraZeneca, Covaxin, Covishield, BIBP/Sinopharm, and Sinovac.  Visit this CDC website to learn more

“Fully vaccinated” presently means more than 2 weeks after the last dose. As of December 6, 2021, a booster shot is not required to be considered “fully vaccinated” but that may change over time. Refer to the CDC website for any updates

My patient has concerns about getting their child vaccinated. How do I approach this conversation?

Hesitancy around vaccination for children must be approached in a similar way to hesitation for the self:

Spend time listening to the parent’s concerns; 

  • Reflect back and validate those concerns without judgment; 
  • Ask questions to get specific about their concerns; 
  • Provide the information we have and be up front about the information we don’t have;
  • Provide an open and safe space for discussion.

For many parents – including many who have been vaccinated themselves – the vaccine still seems too new. Some have heard misinformation about the vaccines potentially affecting fertility (of which there is no evidence); others are concerned that the vaccine may result in myocarditis in adolescent boys. (See question about myocarditis, below.) Hearing out their specific concerns, affirming their concerns, and providing the evidence we have that point to the safety of available vaccines is a start. Then, reaffirming why vaccination is important in the family and community – to protect the abuelos from hospitalization, to prevent more deaths in the community, to avoid future dangerous mutations, and to ensure that school, prom, and hangouts with friends aren’t interrupted again – can help reframe the conversation in a positive light. 

What do I say to parents who refuse the vaccine on the grounds that children rarely get very sick from COVID-19? 

In addition to building trust and confidence using the strategies outlined above, clinicians can provide some basic facts and figures to parents:

  • Vaccines reduce community spread: Asymptomatic and symptomatic children with COVID-19 carry high quantities of the disease, independent of disease severity, according to a recent study. Children who are up to date with their COVID vaccines have a lower risk of becoming infected. The best way to reduce community spread – to protect those among us who likely will get very ill with COVID, if they get infected – is to vaccinate our children.
  • Some children do get very ill: It is accurate to say that the risk of serious disease among children is low. However, presently, COVID-19 is estimated to be the sixth-largest killer of children in the US.  The risk is low, but many children are still going to the hospital and dying, more so since the Delta variant has become dominant.
  • Delta is more transmissible: The increase in pediatric cases, hospitalizations, and death are believed to be the result of the Delta variant's higher rate of contagion, not an increase in its severity among children.
  • The benefits greatly outweigh the very low risks of vaccination: Millions of children ages 12 – 17 have received the COVID-19 vaccine across the world.  Many children experience side effects – pain at injection site, fever, headache. There is a low risk of myocarditis. (See next question.)


Do teenage boys who get vaccinated have a higher risk of myocarditis?

It’s important to first note that there is a greater risk of myocarditis from a COVID-19 infection than from the COVID-19 vaccine.

Vaccine-related occurrence: There has been an increase of cases of myocarditis (inflammation of the heart muscle) and pericarditis (inflammation of the lining of the heart) after vaccination with an mRNA COVID-19 vaccine (Pfizer and Moderna), particularly among male adolescents. Myocarditis is commonly triggered by viral infections, and the inflammation after vaccination may be similarly triggered. As of October 27 2021, VAERS has received 1,784 reports of myocarditis or pericarditis among people ages 30 and younger who received COVID-19 vaccine. Parents should know that male adolescents are at higher risk than other groups, and more often after the second dose. Symptoms include chest pain, shortness of breath, and a feeling of a fluttering heart. Read more on this CDC webpage.

Infection-related occurrence: What is very critical to express to parents is that a child's risk of myocarditis as a result of COVID-19 infection is much higher than the risk of myocarditis from the vaccine.  From March 2020 to January 2021, the CDC found that patients infected with COVID-19 had nearly 16 times the risk for myocarditis compared to those who were not infected. The same study found that the myocarditis risk is 37 times higher for infected children under the age of 16, compared to that of children without COVID-19 infection. The best way to avoid infection is through vaccination.

Comparing vaccine- or infection-related risks: Those cases of vaccine-associated myocarditis have resulted in rapid recovery (weeks) as opposed to COVID infection-associated myocarditis which can remain long term and adversely affect the efficiency of the heart’s pumping ability (left ventricular ejection fraction). It does not appear that any cases of myocarditis reported after COVID-19 vaccine (whether linked to the vaccine or not) have resulted in death.

Misinformation: A pre-print study was retracted when the risk of myocarditis after vaccination was grossly overstated. Unfortunately, this pre-print study was shared widely on social media before it was retracted, which is affecting parents’ understanding of the risk of myocarditis after vaccination.


Many places are requiring parents to be present when children receive their vaccinations. This is posing a barrier to many of my immigrant and migrant patients who need to work. What suggestions do you have to address this?

Rules vary greatly according to state, and some states are changing their laws because of the COVID-19 vaccines. Presently, medical consent laws in 40 states require parental approval for children under 18 to receive a vaccine. Some states are moving to reduce barriers for teens to receive COVID-19 shots; others are pushing for greater stringency to block teens from acting without parental consent. Additionally, some counties have their own consent laws that override state laws. The website provides guidance on minor consent laws by state and by county if applicable. The website also offers materials to help teens discuss vaccination with their parents.  We recommend that clinicians check their states’ laws to determine whether parent presence is required.

In areas where parents are required to be present, some parents encounter a barrier to vaccination. Many health centers and health departments are offering after-hours and weekend clinics to increase access to COVID-19 vaccines. If your patient is unable to attend available vaccination clinics, it is likely that that patient is not the only one in the community with limited access. It is highly recommended to coordinate vaccination clinics that cater to the needs of the migrant and immigrant community, taking into account work schedules, mobility, language and cultural barriers, and fear of immigration status. Mobile vaccination clinics that go to farmworker housing, and pop-up clinics in popular locations like grocery stores, flea markets, and churches, are critical avenues to increase access. Culturally relevant vaccination materials are also important. (See “Practical Resources from MCN” below for materials.)

What considerations should I make for migrant and immigrant workers getting the COVID-19 vaccine, now that there is a federal vaccine mandate as well as the potential for mandates in other workplaces?

Because of vaccine mandates, the vaccine card is no longer just a health document, but is now a required employment document. Many migrants and immigrants work under an alias. It is critical that clinicians discuss with the patient whether the patient will need the card in the patient’s real name or in their alias name. The patient may need two cards, and the clinician may explore putting the worker’s name and alias (“AKA”) name in the state’s vaccine database. This is an updated recommendation and supersedes previous recommendations.

A worker got vaccinated under his own name. He uses an alias at work. Now, there’s a vaccine mandate at his work, but his vaccine card doesn’t match his work name. What should he do?

Because of vaccine mandates, the vaccine card is no longer just a health document, but is now a required employment document. We recommend that the clinician issue a second card with the alias name. If possible, the clinician is encouraged to include the alias (“AKA”) in the state’s vaccine database if possible, so that both cards hold information that is verifiable in the database that is accessible only to health care providers. This is an updated recommendation and supersedes previous recommendations.

A worker got vaccinated under his name, but uses an alias at work. Because of the new workplace mandate, his workplace had a mandatory vaccine clinic for those who couldn’t show proof of vaccination, so he got vaccinated a second time. What are the health implications of double vaccination?

There are limited data on patients who have received more vaccinations than is recommended.

Initial data from the CDC about people who have received a third dose showed similar or more mild side effects to those of the two-shot series. These side effects include short-term fever, chills, and other flu-like symptoms.

A community member asked me about Ivermectin to treat COVID-19. What should I say in response? 

Unfortunately, a lot of misinformation/disinformation about Ivermectin is circulating on the internet, claiming that it is an effective cure for COVID-19. Here are some basic facts to share:

  • Ivermectin is primarily a deworming medicine for animals. It has limited use for humans, against a number of health concerns like worms, lice, and onchocerciasis. It is not approved for use in humans against COVID-19.
  • The reason it isn’t approved for use in humans against COVID-19 is because there is insufficient evidence that it works against COVID-19.
  • One of the largest clinical trials to assess whether Ivermectin is effective against COVID-19 was halted because it was showing no benefit over placebo, according to the New York Times.
  • One of the journal articles that purportedly demonstrated benefit was retracted.
  • The NIH reported on each of the completed studies, their findings, and their limitations, on their COVID-19 Treatment Guidelines page. The panel reviewing the findings determined that “There is insufficient evidence for the COVID-19 Treatment Guidelines Panel (the Panel) to recommend either for or against the use of ivermectin for the treatment of COVID-19. Results from adequately powered, well-designed, and well-conducted clinical trials are needed to provide more specific, evidence-based guidance on the role of ivermectin in the treatment of COVID-19.”
  • Some people are getting sick from using Ivermectin. Calls to Poison Control for Ivermectin have increased significantly. Side effects include dizziness, pruritis, nausea, and diarrhea.
  • Remind patients how science works: that if well-conducted clinical trials show any indication that a drug works against COVID-19, that will be headline news. Such trials would be followed by additional studies to confirm its effectiveness and study side effects. In this way, scientists gather sufficient data to make sure a drug is both effective and safe for use. Unfortunately, at present, the clinical trials that have been completed have significant limitations, and most do not show positive benefits of Ivermectin. Consequently, we continue to lack sufficient data to show that Ivermectin works against COVID-19 and cannot recommend it.


More Resources:

FDA’s Why You Should Not Use Ivermectin to Treat or Prevent COVID-19

AMA, APhA, ASHP Call for Immediate End to Prescribing, Dispensing, and Use of Ivermectin to Prevent or Treat COVID-19 Outside Clinical Trials

Considering that the flu didn’t circulate much last year, should I still recommend a flu shot?  

Yes. All patients aged six months and older are encouraged to get the flu vaccine. It is very important that community members are given culturally competent information on how and why to get it. 

As hospitals and intensive care units continue to be filled with COVID-19 patients, it becomes urgently important that community members are protected as much as possible from the flu to reduce the likelihood of overwhelmed hospital systems.

This lifesaving vaccine can protect those like young children and the elderly who die every year from influenza. It is worth noting that, with children back to school and many people back at work, our day-to-day situation is quite different than during last year’s flu season. The pandemic is not a good reason to skip the flu shot.

What is different about the flu vaccine this year? What about COVID and the flu?   

The CDC’s new guidance for the flu shot highlights some changes. Clinicians are encouraged to review the CDC's guidance in its entirety. All patients aged 6 months and older are encouraged to get the flu vaccine.

For those who have COVID-19: At present, there are no data to inform optimal timing of influenza vaccination for vaccine effectiveness in persons with COVID-19 or who are recovering from COVID-19, according to the CDC. Patients without contraindications or allergies are encouraged to get both the COVID-19 and flu vaccines as soon as possible to protect themselves, their families, and their communities.

For those who wish to get the COVID-19 vaccine and the flu vaccine: It is safe to administer a COVID-19 vaccine and a flu shot on the same day. Migrant patients and others who have reduced access to health care and limited time to put toward recovery are particularly encouraged to receive the flu and COVID-19 vaccinations at the same time. This is an updated recommendation and supersedes previous recommendations.

What does the approval of the Pfizer vaccine mean for migrants, immigrants, and refugees? 

In late August, the Pfizer vaccine received full approval from the FDA for patients ages 16 and up. Emergency Use Authorizations remain in effect for the Moderna and J&J vaccines, as well as for Pfizer for patients ages 12 to 15.  These vaccine manufacturers, however, are in process to receive full approval from the FDA.

Many people expressed hesitancy to get the vaccine because of its lack of full FDA approval. This may prompt new conversations with patients. The FDA’s approval further establishes the Pfizer vaccine’s efficacy and safety.

Full approval paves the way for vaccine mandates, which may be issued for vaccines that are not under emergency use authorization. MCN supports vaccine mandates as long as they are accompanied by efforts to implement them in an equitable way and are preceded by strategies to mitigate the spread in the workplace and keep workers safe. It is worth noting that many workers in the US, including many food and farmworkers, still lack access to COVID-19 vaccines because of numerous barriers, including lack of culturally relevant and low-literacy information and education in the language of their choice.

Is it safe for a person to get vaccinated during pregnancy, while breastfeeding, or when planning to get pregnant? 

As of late August, more than 139,000 pregnant people have been vaccinated against COVID-19. Of that cohort, no unexpected pregnancy or fetal problems have occurred. There have been no reports of any increased risk of pregnancy loss, growth problems, or birth defects. As a reminder, the COVID-19 vaccines are not live vaccines, and pregnant women and their babies cannot get COVID-19 from the vaccine. It is also believed that some immunity is conferred by the vaccinated mother to the newborn.

With this data, the CDC has strongly recommended vaccination for pregnant women as of August 2021.



How do I talk to women who are pregnant or breastfeeding about getting vaccinated?  

Women who are pregnant or breastfeeding will have many questions and hesitancies because of their concern over the health of their babies. It is very important to share with pregnant women why it is so critical for them to get vaccinated.

Women who get COVID-19 during pregnancy:

  • Are three times more likely to need ICU care;
  • Are two to three times more likely to need advanced life support and a breathing tube;
  • Have a small increased risk of dying from COVID-19;
  • May be at an increased risk of stillbirth and preterm birth;
  • May pass antibodies to their babies.

It is worth pointing out that COVID causes hypoxia (lack of sufficient oxygen) and hypoxia so severe that it requires ICU care or advanced life support for a pregnant mother is dangerous for a developing fetus. The COVID-19 vaccine is the best way to protect the fetus and the mother from serious disease, hospitalization, and death.

When encountering resistance from pregnant women:

  • Build trust with women over time.
  • Listen with respect. Show empathy and support: “I understand your concerns and it’s good that you’re being careful regarding the health of your baby. It is important to protect your baby.”
  • Then provide the facts: “These studies provide evidence that this vaccine is a way to protect your baby.”
  • Tell stories, about other patients, about your own COVID-19 vaccination, or about colleagues or friends, that may be relevant. 
  • If the patient remains concerned, ask them to talk with another trusted source like a doctor or midwife.
  • It may take more than one conversation to help a mother through hesitancy.

What special concerns should I be looking for among migrants, immigrants, and refugees?  

Frontline clinicians are reporting that some patients, particularly otherwise young and healthy patients, who are very or severely ill with COVID-19 have been found to have uncontrolled and undiagnosed diabetes. Diabetes remains a serious health concern among migrant, immigrant, and refugee communities, who lack access to health care and oftentimes struggle to implement and maintain strategies for healthy living. Clinicians who serve these populations are encouraged to increase outreach to these communities and screen patients for diabetes. Read more about diabetes and access resources on MCN’s Diabetes page. 

What is considered a breakthrough case?  

A breakthrough case is a positive COVID-19 case that occurs two weeks or more after the last dose of the COVID-19 vaccine is administered. This case may be symptomatic or asymptomatic. It is important to note that as more people are fully vaccinated, it is natural to expect a rise in the number of fully vaccinated people who are hospitalized – especially those who were already immunocompromised. Breakthrough cases among people who are up to date on their COVID vaccines are more common with Omicron, although early data suggest that, as with Delta, very few of these cases result in hospitalization or death. More data are needed for a conclusive picture on breakthrough infections and Omicron.

Should vaccinated patients who have been exposed to COVID-19 get a COVID-19 test if they are not experiencing symptoms?  


If a vaccinated patient has a known exposure, the patient does not have to quarantine, but should get tested five to seven days after exposure, even if they do not have symptoms. They should also wear a mask for 14 days following exposure. Read more on the CDC’s Quarantine page. 


What do I do if a patient is partially vaccinated with a non-FDA approved vaccine, like AstraZeneca or Synovax?

Some migrant patients are arriving in the US with partial vaccination. AstraZeneca and Synovax are two vaccines that are not available in the US, but are widely used in other countries. Both require two vaccinations. If a patient arrives with documentation indicating only one vaccination of the two has been administered, MCN recommends the following.

For migrant women between the ages of 18 and 60, and if Pfizer or Moderna are available, MCN recommends that the patient begin the Pfizer or Moderna two-shot series. (Learn more about why MCN recommends this here.)

For migrant women over the age of 60 and migrant men of any age, MCN recommends the administration of one dose of J&J if available. 

Read the CDC’s recommendations here.

What do I tell a patient about post-vaccination mask wearing and distance?

It's very important that vaccinated people continue to wear masks and maintain physical distance in public. As of July 27, 2021, the CDC again recommends that vaccinated individuals in areas with high COVID-19 transmission wear masks when in indoor public spaces. Vaccinated individuals may contract the virus in some rare cases (see the question about “breakthrough cases,” below.) Most COVID-19 cases among vaccinated individuals are mild and do not require hospitalization. However, these individuals can still spread the virus to unvaccinated people, who now make up about 97% of severe cases, hospitalizations, and deaths. Additionally, the continued spreading of the virus is dangerous for everyone – vaccinated and unvaccinated alike – as it may result in new and more dangerous variants.

How do I talk to my migrant patients about the Johnson & Johnson/Janssen (J&J) vaccine?

Migrant Clinicians Network recommends the J&J vaccine to male migrant patients as well as female migrant patients over the age of 60. (Please see the next question for more.) If a patient was already feeling hesitant toward vaccinations, the pause on this vaccine that occurred in April 2021 and the July 2021 FDA addition of a warning around Guillain-Barre syndrome may worry patients and further their hesitation.

  • Validate patients’ concerns. Reassure them that it is normal to have such concerns.
  • Update patients if needed on the CDC and FDA’s decision to make the pause and to resume the distribution and use of the J&J.
  • Make sure all their questions are answered to the best of your ability.
  • Be honest about the unknowns.
  • Point out the benefits of the pause and the warning.
    • Efficacy of public health and vaccine safety systems.
      • On the pause: “The public health authorities were able to track six people out of 6.8 million as of April 2021 who had an adverse outcome, one to three weeks after the J&J vaccination. This is a very rare reaction, affecting much less than one percent of those who received the vaccine.”
      • On the warning: “Public health authorities reviewed reports of about 100 out of 13 million people as of July 2021 who have received the J&J vaccination. Most were reported in older men, about two weeks after vaccination. This, too, is a very rare reaction, also affecting far less than one percent of those who received the vaccine. The increase in Guillain-Barré after vaccination is similar to the increase seen after the seasonal flu shot. The shingles vaccine may also increase the risk of the syndrome.”
      • On the system’s effectivity: “It is remarkable that the systems could pick up such a small percentage of adverse reactions.”
  • Migrant women require specific considerations. See the following question.

Should migrant women take the J&J vaccine?

MCN recommends that migrant women between 18 and 60 avoid the J&J if an alternative (Pfizer or Moderna) is available. This eliminates the risk of TTS, as both Pfizer and Moderna, as mRNA vaccines, do not share the same vaccine mechanisms as the J&J or AstraZeneca that have the TTS risk. Migrant women in particular have serious barriers to access health care, including transportation, language barriers, work limitations, rural and isolated locations, and limited integration into their new communities to understand health care options. These barriers may make access to emergency care needed for TTS even more difficult.

Most cases of TTS have been seen in women between 18 and 49, with a small number in women between ages 50 and 58. In an abundance of caution, MCN is recommending the avoidance of J&J for migrant women up to age 60.

If a migrant woman prefers the J&J or if the J&J is the only vaccine available, make sure the patient knows the signs and symptoms of TTS and typical window of onset of symptoms.

For women 58 and over and for men of any age, MCN recommends to get vaccinated with the vaccine that is available in their area, whenever they first have the opportunity to do so. Do not delay vaccination.

Read more about these recommendations on Johnson & Johnson COVID-19 Vaccine: Care for Migrant Women Requires Adjusted Approach.

How do I respond to my patients’ basic questions about the safety of vaccines?

This critical basic question is very important to answer fully, with respect and patience, and in a culturally competent manner. 

It is important to remember that some vulnerable populations who would best benefit from the COVID-19 vaccine are also the populations that have been grossly mistreated historically during vaccine trials or forced into state-sponsored medical procedures without consent.  The racist underpinnings of our public health systems continue to traumatize our patients today.

Some basic points to consider:

  • Since its release, almost 50 percent of the US population, including millions of health care workers, leading scientists, politicians, and community leaders, have received the shot themselves. Many of your doctors, nurses, and health care staff, those who work tirelessly to care for you, have taken the shots to protect themselves and in turn their communities, showing another vote of confidence in the safety of the vaccines.
  • Like all vaccinations, there is a risk of minor side effects, most commonly pain at the site of injection, fatigue, muscle or joint pain, and headaches, all of which clear up in a matter of days.
  • The J&J vaccine may cause a very rare but serious effect of cerebral venous sinus thrombosis combined with thrombocytopenia. (See the first question in this FAQ.)
  • Side effects remain very low, while the risk of developing severe disease and death without the protection of the vaccine continues to be high.


Practical Resources from MCN


Other Resources

When will farmworkers and their children get access to a vaccine or booster?

Thousands of farmworkers and their families around the country have already received their vaccine where they have been prioritized. In other areas, vaccines remain inaccessible to historically marginalized people who encounter barriers (including technological, linguistic, transportation, immigration status-related, and work-related) to schedule an appointment and/or to attend a vaccine appointment.

  • Marginalized communities need your continued advocacy. Clinicians need to loudly and regularly speak up on behalf of their patients. Make connections, build connections and trust with communty leaders, and insert yourself into the discussions on distribution.
  • Develop a health center team to coordinate vaccination for marginalized communities, particularly for BIPOC children who are at a greater risk of severe COVID-19 than their white peers. Create a detailed workplan and workflow to clearly prepare for all aspects of vaccinations, from paperwork burdens to appointment confirmations to the vaccination provision itself. Include community advocates. Be prepared for poor distribution and interruptions in deliveries by preparing and executing a transparent communication plan with your community, that anticipates the many bumps and hiccups in vaccine provision and distribution. Build in flexibility and contingency plans when possible, recognizing the changes in populations like among farmworker families as the seasons progress.

The Moderna and Pfizer-BioNTech vaccines require two shots. What if a patient is moving? Should the patient wait to get the one-shot vaccine when/if it is again available, or to get a two-shot vaccine in the next location?

We recommend that farmworkers get vaccinated when they have the opportunity to do so.  Encourage you’re the patient to take a photo of the vaccination card and to send that photo to a family member or trusted person, so that if the card is lost (or even the phone), there is evidence of the first dose of vaccination.

If a patient isn’t sure if they can make a second appointment, sign them up with Health Network.  Migrant Clinicians Network operates Health Network, a virtual case management system that assists migrants with ongoing health needs in finding health care at their next destination. Clinicians are strongly encouraged to enroll patients who may need to migrate before they can receive the second vaccination. After enrollment, a Health Network Associate will follow up with the patient and assist in finding a health facility in the migrant’s next location so the patient can access the correct second dose. Health Network’s services are without cost to the health facilities or patients.

Learn more about Health Network here:

Learn more about Health Network enrollment here: 

Contact Theressa Lyons-Clampitt for more information:

What patients should I be particularly concerned about?

Migrant patients encounter numerous and overlapping barriers to accessing health care. This results in some migrants experiencing ongoing health concerns that go unaddressed. Some of these health concerns, including asthma and diabetes, increase the patients’ risk of severe COVID-19 disease, if they become infected with the virus. Indeed, clinicians in our network have encountered the results of unaddressed diabetes in the hospital. “If I have a seemingly healthy young person in the ICU with COVID-19, more often than not, they have an underlying but unaddressed concern like uncontrolled diabetes. One patient’s A1c was 13 – and I had to tell him, ‘you’re not just struggling with COVID-19. You have diabetes,’” said Laszlo Madaras, MD, MPH, MCN’s Chief Medical Officer.

More than ever, outreach workers, community health workers, and other clinicians working closely within migrant and immigrant communities need to reach out to community members who may be overlooked and make sure their underlying health needs are being met.

Read more about the link between diabetes and severe COVID-19 on this FAQ from the American Diabetes Association.

Utilize MCN’s low literacy Spanish language comic book, available to print and download: Mi salud es mi tesoro.

What if a patient who has received one shot of the Pfizer or Moderna (and therefore is only partially vaccinated) has contracted COVID-19?

Patients who fall ill after their first vaccination must follow all precautions as those without any vaccination: get tested and isolate while waiting for results. After recovering from COVID, patients should discuss the timing of the introduction of the second dose with their physician. A second vaccination sooner than 90 days after infection may give increased side effects, compared to severity of side effects in those who did not contract COVID-19 after the first vaccination.

If a patient had COVID-19, do they still need to be vaccinated?

The CDC says that patients who are sick with COVID-19 should wait until they have recovered before getting the vaccination or receiving a booster shot. This is in contrast to earlier recommendations of 90 days after infection. People who have recovered from a COVID-19 infection do not have to wait a certain amount of time before getting vaccinated or receiving a booster shot.

What do I do if a patient has lost the vaccination card?

Patients who say they have already received a vaccine but do not have evidence may need assistance in contacting the location of their vaccination to verify their vaccination status – social workers and outreach workers may be helpful here. If the patient has migrated since they got vaccinated, determine any details the patient remembers – location, time and date, type of vaccination – and contact the vaccination site. Each location has a different process in terms of recording and providing vaccine records to the local health department. Each state has a vaccination registry that contains records of all vaccinations provided in the state. Depending on the location, the patient’s information may already be registered with the state. The CDC’s Immunization Information Systems gives contact information for each state here.

Should a patient get a mammogram after getting the COVID-19 vaccine?

It is recommended to wait at least two weeks after the provision of a COVID-19 vaccine before receiving a mammogram or other diagnostic imaging exam. This is because the COVID-19 vaccines may cause swollen lymph nodes, which may be interpreted as cancer in such imaging exams. Read more here. As a precaution, if the patient is not migrating and can delay the imaging exam, clinicians may recommend that the patient wait six to ten weeks after the second COVID-19 dose. If a patient needs to move before that six to ten week period is over, clinicians can enroll the patient in Health Network, and we can assist in guiding the patient in the new health system in their next location to schedule a mammogram or other diagnostic imaging exam.

What do I do if my patient or my patient’s community is encountering misinformation about the vaccine?

Patients are concerned about the safety of the vaccine and much misinformation is circulating around. Help the patient understand the safety of the vaccine and how to deconstruct conflicting or confusing health messages that may be misinformation through our interactive guide, “Deconstructing Health Misinformation”.

Interactive Prezi version:

Single-page handout version:

How can I help my fellow clinicians be informed?

It is clear that some clinicians continue to be concerned about the safety of the COVID-19 vaccines – not just the larger community. Considering the speed of their development and the limited communication efforts, this hesitancy is expected. Thousands of clinicians – many within our network – have shared their COVID-19 vaccination selfies on social media, many with notes on their elation of having the opportunity to be vaccinated. This message is important for both clinical colleagues and the larger community to see. Sharing clinician-centered resources to better inform colleagues may also help ameliorate concerns:


Q&A: What PCPs Need to Know about COVID-19 Vaccines, article co-written by MCN’s Chief Medical Officer, Laszlo Madaras, MD, MPH

CHA Healthcare’s video, COVID Primer for Primary Care

The New Vaccines, Attitudes Toward Vaccination, and the Biden COVID-19 Task Force, Grand Rounds from UCSF

CDC’s Clinical Resources for Each COVID-19 Vaccine

How can I keep track of vaccination in my region?

Vaccination dashboards are developing. Resources vary in each community. Here are some early national resources:


Johns Hopkins provides a vaccine dashboard:

MCN is part of a new initiative, Resilient American Communities, which is just getting off the ground and will be a resource to watch:

Other Resources

MCN has upcoming online seminars specifically on COVID-19 vaccinations. Watch our Upcoming Webinars page for registration when new seminars are announced:




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