Health Care Providers COVID-19 Vaccine Information

COVID-19 Vaccine Resources

COVID-19 Vaccine Guidance (Ministry of Health and Long-Term Care)

Guidance on the use of COVID-19 vaccines in the fall of 2023 (National Advisory Committee on Immunization)

Child and Youth Vaccination

Individuals aged five years and older should consider delaying their COVID-19 booster until Fall, 2023, to maximize protection against COVID-19 outcomes when peak circulation of the virus is expected.

For guidance, see Tables 1 and 2 in the Ontario Ministry of Health's COVID-19 Vaccine Guidance document.

Additional:

CARD System for Coping with Vaccinations (SickKids)
Immunization Pain Management (clinician focus) (Immunize Canada)
Vaccine Hesitancy and First Nations, Inuit and Métis Populations – Potential Implications During COVID-19 (National Collaborating Centre for Infectious Diseases)
Vaccine Hesitancy Guide – Developed by Clinicians Across Canada (School of Public Policy – University of Calgary)

mRNA Vaccines

Public Health Ontario: COVID-19: What You Need to Know about mRNA Vaccines

Public Health Ontario: COVID-19 Vaccines: mRNA Vaccines

Protein Subunit Vaccines

The Novavax NuvaxovidTM vaccine is an adjuvanted vaccine containing recombinant COVID-19 spike protein fragments. For more information on the vaccine, please see the WHO Vaccine Explainer on protein subunit vaccines.

We recommend eligible individuals receive an mRNA vaccine, such as Moderna or Pfizer. However, we will offer the Novavax vaccine to those who meet the following criteria:

Are 12 years of age or older;
Live, work, or attend school in the Nipissing or Parry Sound district;
Do NOT have a confirmed allergy to any of the vaccine components or its container (the vial stopper is bromobutyl rubber, which is latex free). Please see Health Canada for a full list of vaccine ingredients;
Are not able to receive an mRNA vaccine due to contraindications, or would prefer not to receive an mRNA vaccine.

The safety and efficacy of Novavax have not been established in individuals who are immunocompromised due to disease or treatment. Informed consent for use of the vaccine in this population should include discussion that there is currently limited evidence on the use of Novavax in this population, while there is evidence on the safety profile and effectiveness of mRNA COVID-19 vaccines in these populations based on real world use with large numbers of individuals (CIG, 2022).

For more information or to arrange an appointment for Novavax, contact us at 1-800-563-2808.

Viral Vector Vaccines

Astra Zeneca, Medicago and Janssen COVID-19 vaccines are no longer being used in Ontario.

Vaccine Recommendations for Specific Health Conditions

Pregnancy and Breastfeeding

Since the beginning of the COVID-19 pandemic, evidence has evolved to indicate that pregnancy is a risk factor for severe outcomes of COVID-19, so it is especially for these individuals to stay up to date with COVID-19 vaccination.

A COVID-19 vaccine may be offered at any stage of the pregnancy (i.e., in any trimester).
COVID-19 vaccines may be co-administered with other vaccines recommended during pregnancy or while breastfeeding.
NACI strongly recommends that individuals who are pregnant or breastfeeding who have not yet begun or completed the primary series should be offered the recommended doses to complete the primary series.
Pregnant and breastfeeding individuals are also encouraged to be up to date with booster doses.

Immunocompromised Individuals

For moderately and severely immunocompromised individuals, a primary COVID-19 vaccines series comprises three doses.

Individuals 6 months and older who are moderately to severely immunocompromised may benefit from a primary series with bivalent Moderna (25 mcg in 6 months-11 years and 50mcg in those 12 years and older) compared to bivalent Pfizer (10 mcg in 5-11 years and 30 mcg in those 12 years and older).

For individuals 12-29 years of age, the bivalent Pfizer (30mcg) vaccine is preferred due to the lower risk of myocarditis and/or pericarditis, however, for some moderately to severely immunocompromised individuals, administration of the bivalent Moderna (50 mcg) may be considered based on the individual clinician judgement and informed consent.

An extended primary series is recommended for the following populations:

Individuals receiving dialysis (hemodialysis or peritoneal dialysis)
Recipients of solid-organ transplant and taking immunosuppressive therapy
Individuals receiving active treatment (e.g., chemotherapy, targeted therapies, immunotherapy) for solid tumour or hematologic malignancies.
Recipients of chimeric antigen receptor (CAR)-T-cell therapy or hematopoietic stem cell transplant (within 2 years of transplantation or taking immunosuppression therapy)
Individuals with moderate to severe primary immunodeficiency (e.g., DiGeorge syndrome, Wiskott-Aldrich syndrome)
HIV and AIDS-defining illness in last 12 months before starting vaccine series, or severe immune compromise with CD4 count <200 cells/uL or CD4 percentage <15%, or without HIV viral suppression.
Individuals receiving active treatment with the following categories of immunosuppressive therapies: anti-B cell therapies (monoclonal antibodies targeting CD19, CD20 and CD22), high-dose systemic corticosteroids.

Myocarditis/Pericarditis

There have been Canadian and international reports of myocarditis and pericarditis following vaccination with COVID-19 mRNA vaccines. The majority of cases have responded well to conservative therapy and tend to recover quickly.

Symptoms have typically been reported to start within one week after vaccination.
Cases of myocarditis/pericarditis following COVID-19 mRNA vaccination occur more commonly in adolescents and young adults (12-29 years), more often after the second dose and more often in males than females.

NACI continues to strongly recommend that a complete series with an mRNA COVID-19 vaccine be offered to all eligible individuals in Canada including those 5 years and older.

The benefits of vaccination with COVID-19 vaccines continue to outweigh the risks of COVID-19 illness and related, possibly severe outcomes for all age groups.

Anyone receiving an authorized mRNA COVID-19 vaccine should be informed of the risk of myocarditis and pericarditis, and advised to seek medical attention if they develop symptoms including chest pain, shortness of breath, palpitations, or feeling of rapid or abnormal heart rhythm.

In most circumstances, and as a precautionary measure until more information is available, individuals with a diagnosed episode of myocarditis within 6 weeks of receipt of a previous dose of an mRNA COVID-19 vaccine should defer further doses of the vaccine. This includes any person who had an abnormal cardiac investigation including electrocardiogram, elevated troponins, echocardiogram or cardiac MRI after a dose of an mRNA vaccine.

This is a precaution based on recommendations issued by NACI, CIG, PHO, and MOH.

In situations where there is uncertainty regarding myocarditis diagnosis, discussion should occur with an appropriate health care provider on potential options for (re) immunization with the same or alternative COVID-19 vaccine, including a risk-benefit analysis for the individual.

Those with a history compatible with pericarditis and who either had no cardiac work or had normal cardiac investigations, can receive the next dose once they are symptom free and at least 90 days has passed since vaccination.

Some people with confirmed myocarditis with or without pericarditis may choose to receive another dose of vaccine after discussing the risks and benefits with their health care provider.

Individuals can be offered the next dose once they are symptom free and at least 90 days has passed since vaccination.
If another dose of vaccine is offered, they should be offered the bivalent Pfizer-BioNTech (30 mcg) vaccine due to the lower reported rate of myocarditis and/or pericarditis when offered as part of e primary series.
Informed consent should include discussion about the unknown risk of recurrence of myocarditis and/or pericarditis following receipt of additional doses, as well as the need to seek immediate medical assessment and care should symptoms develop.

Multi-Inflammatory Syndrome in Children or in Adults (MIS-C/Afollowing vaccination with an mRNA COVID-19 vaccine

Children and adolescents with SARS-CoV-2 infection are at risk of MIS-C in children, a rare but serious syndrome that can occur several weeks following SARS-CoV-2 infection. Very rare cases of MIS-C/A have been reported following vaccination with COVID-19 mRNA vaccines in Canada and internationally among individuals aged 12 years and older.

For children or adults with a previous history of multisystem inflammatory syndrome (MIS-C/A), unrelated to any previous COVID-19 vaccination, vaccination should be postponed until clinical recovery has been achieved or until it has been greater than 90 days since diagnosis, whichever is longer.

Bell’s palsy following vaccination with an mRNA COVID-19 vaccine

Very rare cases of Bell’s palsy have been reported following vaccination with COVID-19 mRNA vaccines in Canada and internationally among individuals 12 years and older. Bell’s palsy is an episode of facial muscle weakness or paralysis. The condition is typically temporary. Symptoms appear suddenly and generally start to improve after a few weeks.

Symptoms of Bell’s palsy may include:

Uncoordinated movement of the muscles that control facial expressions, such as smiling, squinting, blinking or closing the eyelid
Loss of feeling in the face
Headache
Tearing from the eye
Drooling
Lost sense of taste on the front two-thirds of the tongue
Hypersensitivity to sound in the one ear
Inability to close an eye on one side of the face

Health care professionals should submit an adverse event following immunization (AEFI) when Bell’s Palsy has occurred following immunization.

History of Allergies

People who experienced a severe immediate allergic reaction after a dose of an mRNA COVID-19 vaccine can safely receive future doses of the same or another mRNA COVID-19 vaccine after consulting with an allergist/immunologist or another appropriate physician.
Individuals with a suspected history of adverse reactions to tromethamine, including suspected history of systemic allergic reactions to radiocontrast media and ketorolac, may receive vaccines containing tromethamine.
Individuals with known allergies to components of the vaccines may speak with an appropriate physician or nurse practitioner for evaluation and creation of a vaccination care plan.

Symptoms either current or displayed recently, of chest pain or shortness of breath

Vaccine should not be offered to persons displaying current or recent history of chest pain or shortness of breath.

Those with symptoms should contact their health care provider or should be directed to the emergency department or instructed to call 911.

Addressing Vaccine Hesitancy

Conversations in Vaccine Confidence, a Guide and Toolkit (OCAD University, VaxFacts Clinic, Scarborough Health Network, Fall 2021)
VaxFacts Poster
SickKids COVID-19 Vaccine Consult Service Poster

Booster Dose Recommendations and Staying-Up-to-Date

Booster Doses

Individuals 5 years and older should consider delaying receipt of a COVID-19 vaccine booster until Fall 2023.

Receiving a booster dose in the Fall, as respiratory season commences, will maximize protection against COVID-19 when peak circulation of the virus is expected.

The decision to receive a booster dose prior to Fall 2023 may be appropriate for certain individuals based on their unique health status and personal situation.

Staying Up-to-Date

For those 6 months – 4 years, up-to-date means having a completed primary series. Booster doses are not currently recommended for this age group.

For those 5 years and older, up-to-date means completion of the primary series and receipt of the currently recommended booster dose.

COVAXon Basics for Health Care Providers

Getting Involved in COVID-19 Vaccine Administration

How do I order COVID-19 vaccine for my practice/clinic?

If you're interested in ordering COVID-19 vaccine for your practice and/or clinic, please contact us at covidinventory@healthunit.ca.

In order to provide COVID-19 vaccine in the province of Ontario, you must have access to the Covax documentation system.

We can request access to Covax for you and/or your staff and can provide a brief virtual orientation session to Covax and the COVID-19 vaccine ordering process. Please contact the Health Unit at covax@healthunit.ca for more information.

If you are a pharmacy and would like to start offering the COVID-19 vaccine, you must contact the Ontario Pharmacists Association for further direction on how to get involved in the COVID-19 vaccine roll-out.

COVID-19 vaccine allocation is provided to pharmacies directly from the Ministry of Health in partnership with the Ontario Pharmacists Association.

Pharmacies use Covax for documentation and can reach out to us for further information and/or training related to Covax.

How to Request Access to Covax

Covax is the provincial documentation system for the COVID-19 vaccine. In order to provide vaccination in Ontario, you must have a profile in the Covax.

We can request access to Covax for you and/or your staff and can provide orientation to Covax and the COVID-19 vaccine ordering process. Please contact us at covax@healthunit.ca for further information.

How to Set a Password

You will receive an email from Salesforce, which contains a link. When you click on this link it will provide you with prompts to successfully set up your password. The link found in the email is only active for a 24-hour period. You can contact us or call or Covax Support at 1-888-333-0640 to request a password reset if the link is no longer active.

Covax is web-browser sensitive and the following web-browsers are recommended:

Safari
Edge
Mozilla Firefox
Chrome

2-Step Authentication

Each time you log on to Covax, you will need to validate your identity using Two-factor Authentication (2FA), (often referred to as 2-step authentication) which adds a second layer of security.

You will need to download the free Salesforce Authenticator App on your personal cell phone at the same time as you set up your Covax account.

You will be prompted to use the 2-factor authentication each time you sign into Covax, and will need your cell phone each time you log on.

How to Log On and Off

Open a new tab in your web browser and go to covaxon.my.salesforce.com.

Log on with your username and password. You will then be prompted to the 2-factor authentication using your personal cell phone.

You can contact the provincial COVAXon support services desk at 1-888-333-0640 if you are having any difficulty logging on.

Log off can be found in the top right-hand corner of the Covax screen when you click on the little creature in the circle.

Covax is web-browser sensitive and the following web-browsers are recommended:

Safari
Edge
Mozilla Firefox
Chrome

How to Request a Password Reset

Why my account isn't working (30 day de-activation) and how to resolve

Covax accounts are disabled after a 30-day period with no activity.

We are able to reactivate your Covax account. Please contact us at covax@healthunit.ca to request a reactivation of your account.

How to Search for Clients

Using the tabs on the top of the Covax page, click on the ‘Client Search’ tab. This will open a window requesting the client's Ontario Health Card Number. Enter the Health Card number.

If the client has been entered into Covax, the search will generate a result.
If the client has not been entered into Covax, you will be prompted to search for the client using different parameters such as First Name, Last Name, Date of Birth, etc. If no client is found with these additional identifiers, it will prompt you to search the Ontario Health Card Provincial registry using the health card number.
If client has an Ontario Health Card number they will be found in the provincial registry, even if the client has an expired health card or an older red and white health card.
If a client has an Ontario Health Card and are not found in the system, please contact the COVaxon Support Desk Services for support. Do not create a new client record for client unless directed by the support desk.

In Ontario, we provide free vaccine to all people, regardless of whether they are a permanent resident of Ontario. In the instance of vaccinating a client who does not have an Ontario Health Card, they will not be in the provincial registry and you may have to create the client.

If this is the client's second dose of vaccine in Ontario, they will be in Covax. If this is the first dose of vaccine in Ontario, they may not be in Covax.

Select the ‘HCN unavailable’ box and use other search parameters to attempt to search for client in Covax. If not found, create a new client record for client.

New Immunization

This function is found in the upper right-hand corner of the client file. Once a client is connected to the correct vaccination event, you are able to click on the New Immunization function to document that the client has received the vaccine and send the vaccine receipt to client via email.

Contact us at covax@healthunit.ca if you are having any difficulty using these functions in Covax, finding the correct vaccination event, or finding active inventory in the vaccination event.

Vaccination Events

A vaccination event is a clinic and/or location that a client is receiving a vaccine. The vaccination event is created by the Health Unit when a vaccination order is made and will be reused for all future vaccine orders from your organization.

When the vaccine is physically allocated to different locations the vaccination event is virtually allocated the vaccine. All clients who are vaccinated at a specific location need to be connected to the vaccination event in order to have their dose documented.

Contact the Health Unit at covax@healthunit.ca if you are having difficulty finding the correct vaccination event, or finding active inventory in the vaccination event.

Note: Vaccination events can represent a mobile clinic, and are not necessarily physical locations.

Inventory Reconciliation

Complete the inventory form after each day that COVID-19 vaccine doses have been administered.

Offices can monitor their own inventory at the vaccination event level. At the end of each day that your office/clinic/practice administers vaccine, ensure that your physical inventory matches the Covax inventory.

Covax automatically adjusts inventory for all doses administered; however, all wastage, extra doses, or clients who do not provide consent will need to be adjusted manually. For more information on how to make these adjustments to the virtual inventory, the Health Unit can provide a 15-minute virtual live demonstration on how to make the adjustments.