Child and Youth Vaccination |
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Infants and children aged six months and older are eligible for vaccination.
Please look at NACI’s age-specific recommendations for further information. Key Sources of Information on Child/Youth COVID-19 mRNA Vaccines for Health Care Providers:
Additional:
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COVID-19 Vaccine Resources |
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mRNA Vaccines |
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Patient InformationHealth Care Provider Resources
Statement from the National Advisory Committee on Immunization (NACI, June 17, 2021): “Individuals who received a first dose of an mRNA vaccine (Pfizer-BioNTech, Moderna) should be offered the same mRNA product for their second dose. If the same product is not readily available, or the product used for the first dose is unknown, another mRNA vaccine is considered interchangeable and should be used to complete the series.” |
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Protein Subunit Vaccines |
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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:
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 our COVID-19 Call Centre at 1-844-478-1400. |
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Viral Vector Vaccines |
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Upon request, or for individuals who have an allergy to mRNA vaccines (like Pfizer or Moderna), can get Johnson & Johnson (Janssen); informed consent is required, and this vaccine can be requested by clients by calling us at 1-844-478-1400. A single dose of this vaccine meets requirements for full vaccination, although a booster shot is recommended after 84 days. |
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Vaccine Recommendations Regarding Specific Health Conditions |
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Pregnancy and BreastfeedingSince 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. It is recommended that a complete vaccine series should be offered to individuals who are pregnant or breastfeeding. Also, pregnant or recently pregnant adults are recommended to receive a booster dose of COVID-19 vaccine (at the appropriate interval) if they have not already received one since the start of fall 2022. An mRNA vaccine is preferred due to reassuring published data on the safety of these vaccines in pregnancy, and specifically, bivalent vaccines being the preferred vaccine for booster doses. It is recommended that an authorized protein subunit COVID-19 vaccine (Novavax Nuvaxovid) or virus-like particle COVID-19 vaccine (Medicago Covifenz) may be offered to individuals in the authorized age group without contraindications to the vaccine who are not able or willing to receive an mRNA COVID-19 vaccine. Safety and efficacy data in individuals who are pregnant or breastfeeding following vaccination with a protein subunit COVID-19 vaccine or a virus-like particle COVID-19 vaccine are not available. Immunocompromised IndividualsThere is emerging evidence on the safety and immunogenicity following a third dose of a COVID-19 vaccine for those that have not seroconverted following their second dose in select immunocompromised populations. For moderately and severely immunocompromised individuals, a primary COVID-19 vaccines series comprises three doses. Moderately to severely immunocompromised individuals aged five and older are recommended to receive a booster dose of COVID-19 vaccine (at the appropriate interval) if they have not already received one since the start of fall 2022. An mRNA vaccine and specifically, a bivalent vaccine is the preferred vaccine for booster doses. Myocarditis/PericarditisIndividuals who have a history of myocarditis unrelated to mRNA COVID-19 vaccination should consult their clinical team for individual considerations and recommendations. Individuals previously diagnosed with myocarditis, whose diagnosis is considered remote and are no longer followed clinically by a medical professional for cardiac issues should receive the vaccine. This guidance is issued by the National Advisory Committee on Immunization (NACI). A medical exemption may be issued only if discussion has occurred with an appropriate physician or nurse practitioner regarding potential options for immunization with an mRNA COVID-19 vaccine or alternative, and the physician or nurse practitioner has determined that the individual cannot receive any COVID-19 vaccine. A medical exemption may be issued if myocarditis/pericarditis was diagnosed after medical evaluation (e.g., ER physician, relevant specialist). In most circumstances, and as a precautionary measure until more information is available, individuals with a diagnosed episode of myocarditis/pericarditis within six 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 (ECG), elevated troponins, echocardiogram or cardiac MRI after a dose of an mRNA vaccine. This is a precaution based on recommendations issued by the National Advisory Committee on Immunization (NACI). NACI, Public Health Ontario (PHO), and the Ontario Ministry of Health (MOH) are following this closely and will update this recommendation as more evidence becomes available. In situations where there is uncertainty regarding myocarditis diagnosis, discussion should occur with an appropriate physician or nurse practitioner on potential options for (re)immunization with the same or alternative COVID-19 vaccine, including a risk-benefit analysis for the individual. The individual qualifies for a medical exemption if the physician or nurse practitioner has determined the individual is unable to receive any COVID-19 vaccine. Those with a history compatible with pericarditis and who either had no cardiac workup or had normal cardiac investigations, can be re(immunized) once they are symptom free and at least 90 days has passed since vaccination. Some people with confirmed myocarditis and/or pericarditis may choose to receive another dose of vaccine after discussing the risks and benefits with their healthcare provider. Individuals can be revaccinated 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 Pfizer-BioNTech 30 mcg vaccine due to the lower reported rate of myocarditis and/or pericarditis following the Pfizer-BioNTech 30 mcg vaccine compared to the Moderna 100 mcg vaccine. Informed consent should include discussion about the unknown risk of recurrence of myocarditis and/or pericarditis following receipt of additional doses of Pfizer-BioNTech COVID-19 vaccine in individuals with a history of confirmed myocarditis and/or pericarditis after a previous dose of mRNA COVID-19 vaccine, as well as the need to seek immediate medical assessment and care should symptoms develop. |
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Addressing Vaccine Hesitancy |
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Fall 2022 Booster Eligibility |
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All individuals aged five years of age or older are eligible for a fall booster if it has been six months since their last dose. A shorter interval of at least three months may be warranted when considering individual risks and circumstances. Not all individuals eligible for a fall booster are currently eligible to receive the bivalent vaccine. We will be administering the bivalent vaccine as per Ministry of Health eligibility criteria. Individuals not eligible for the bivalent vaccine will be offered an appropriate monovalent vaccine for their fall booster. Bivalent VaccineBivalent COVID-19 vaccines are available in Ontario. These vaccines are approved by Health Canada for use as a booster dose for individuals who have completed a primary series. Bivalent vaccines target both the original COVID-19 virus strain and the Omicron subvariants. All Ontarians aged 5 and over are now eligible to receive bivalent vaccine. Those who are at higher risk of severe illness from COVID-19 are particularly encouraged to receive a bivalent vaccine this fall. Individuals at higher risk of severe illness from COVID-19 include:
Booster doses will be offered at a recommended interval of six months (168 days), or a minimum interval of three months (84 days), since the last dose received or since the most recent COVID-19 infection. Individuals at higher risk as outlined above are strongly recommended to receive their bivalent booster as soon as they can (i.e., at 84 days since previous dose or last COVID-19 diagnosis), to protect themselves this fall as people spend more time indoors. There is no current recommendation for individuals to receive an additional bivalent dose if they have received any COVID-19 booster dose (monovalent or bivalent) on or after September 1, 2022. NACI has issued recommendations on the use of bivalent Omicron-containing mRNA COVID-19 vaccines as well as recommendations on the use of COVID-19 vaccine booster doses in children 5-11 years of age which highlight some of the evidence and rationale they considered in their approval decision. |
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COVAXon Basics for Health Care Providers |
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Emerging Research |
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PHO provides, and regularly updates, synopses of key research articles related to COVID-19: |
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COVID-19 Serology |
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Medical Exemptions to COVID-19 Vaccines |
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Medical Exemptions to COVID-19 Vaccination (Ministry of Health) Medical Exemptions to COVID-19 Vaccination and New Clinical Trial Exemption Process Physician and Nurse Practitioner offices needing to request a Medical Exemption Form please email vpd@healthunit.ca |
See also: COVID-19 Information for Healthcare Providers, Hospitals and Long-Term Care