Health Care Providers COVID-19 Vaccine Information

Child and Youth Vaccination

Infants and children aged six months and older are eligible for vaccination.

For infants aged six months to four years, Moderna Spikevax (25 mcg) is available. It is a two-dose series, with a recommended interval of eight weeks between doses.
For children aged five years, both Moderna Spikevax (25 mcg) as well as Pediatric Pfizer BioNTech Comirnaty (10 mcg) vaccine are available. They are both two-dose series vaccines, with a recommended interval of eight weeks between doses. Pediatric Pfizer BioNTech Comirnaty (10 mcg) vaccine is the preferred vaccine to be offered at this age.
For children aged 6 to 11, Moderna Spikevax (50 mcg) as well as Pediatric Pfizer BioNTech Comirnaty (10 mcg) vaccine are recommended. They are both two-dose series vaccines, with a recommended interval of eight weeks between doses.
For youth aged 12 to 17, vaccination is recommended. Pfizer BioNTech Comirnaty (30 mcg) vaccine is preferred over Moderna Spikevax (100 mcg) because of the lower risk of myocarditis/pericarditis. The primary series is a two-dose series, with an eight week interval recommended between doses. Please look at the “Fall 2022 Booster Eligibility” tab for information on booster dose eligibility in this age group.

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:

We have developed Frequently Asked Questions: COVID-19 mRNA Vaccines for Children to support parents and guardians using expert medical advice and scientific research.
The Canadian Paediatric Society has provided a directory of resources for paediatricians to help health professionals educate families on COVID-19 vaccines. They have also established resources on childhood immunizations and working with vaccine hesitant parents.
The Ontario Ministry of Health has created a website for health care providers that includes all guidance and recommendations related to the COVID-19 vaccine.
The Government of Canada provides information on available vaccines, clinical trials and guidance on vaccinating children and youth, including recommendations on the use of COVID-19 vaccines.

Additional:

Behavioural Science-Informed Strategies for Increasing COVID-19 Vaccine Uptake in Children and Youth (Ontario COVID-19 Science Advisory Table)
CARD System for Coping with Vaccinations (SickKids)
COVID-19 Vaccination for People with Disabilities (Ontario COVID-19 Science Advisory Table)
Immunization Pain Management (clinician focus) (Immunize Canada)
Maintaining Immunizations for School-Age Children During COVID-19: Expert and Stakeholders Roundtable Report (Dalla Lana School of Public Health – University of Toronto; Michael G. Degroote School of Medicine – McMaster University)
Rapid Review: What is Known about Parents’ Considerations for Vaccine Uptake for Children and Adolescents? (School of Nursing - McMaster University; National Collaborating Centre for Methods and Tools)
Resources for Health and Social Service Providers (Kids Health)
Supporting Conversations with Youth about the COVID-19 Vaccine (Ontario Association of Children’s Aid Societies)
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)
Community of Practice Sessions: COVID-19 Vaccination in Children Age 5 to 11 years - Part 1 and 2 (Ontario College of Family Physicians) – Worth 1 MainPro+ CME Credits

COVID-19 Vaccine Resources

COVID-19 Vaccine Information Sheet for Youth (age 12-17) in English (Ministry of Health, July 19, 2021)
COVID-19 Vaccine Information Sheet for Youth (age 12-17) in French (Ministry of Health, July 19, 2021)
COVID-19 Vaccine Information Sheet in English (Ministry of Health, July 19, 2021)
COVID-19 Vaccine Information Sheet in French (Ministry of Health, July 19, 2021)
Tool Kit for Healthcare Providers (Public Health Agency of Canada)
COVID-19 Vaccine Tool Kit: Communications Resources for Indigenous Communities and Organizations (Government of Canada)
VaxFacts Clinic (Scarborough Health Network)
COVID-19 Vaccination Recommendations for Special Populations (Ontario Ministry of Health)
COVID-19 Vaccines Tool (CEP)
Vaccines at a Glance Summary (CEP)
Weekly reports of provincial rates of Adverse Events Following Immunization (AEFIs) can be found on the Public Health Ontario COVID-19 Vaccines Webpage
Youth Vaccination Resources (Ministry of Health)

mRNA Vaccines

Patient Information

PHO: COVID-19: What You Need to Know about mRNA Vaccines

Health Care Provider Resources

PHO: COVID-19 Vaccines: mRNA Vaccines
Communique to Health Practitioners: Report of myocarditis/pericarditis following COVID-19 vaccination (PHAC, June 2021)
Guide to Addressing Moderna Vaccine Hesitancy (CEP, June 2021)
Q&A for Health Care Providers on Mixed COVID-19 mRNA Vaccine Schedules (Ministry of Health, June 18, 2021)

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.”

Protein Subunit Vaccines

The Novavax Nuvaxovid^TM 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 18 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 our COVID-19 Call Centre at 1-844-478-1400.

Viral Vector Vaccines

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.

Vaccine Recommendations Regarding 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.

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 Individuals

There 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/Pericarditis

Individuals 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.

Addressing Vaccine Hesitancy

National Institutes of Health: Health Communicator’s Tip Sheet: The Do's and Don'ts for COVID-19 Vaccine Conversations
This Is Our Shot – FAQ for the general public on COVID-19 vaccination
Building Confidence in Vaccines (PHO)
The SickKids Vaccine Confidence Support Resource List

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

Fall 2022 Booster Eligibility

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 Vaccine

Bivalent 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:

Older adults (≥65 years of age);
Residents of long-term care facilities or congregate living settings for seniors;
Individuals 12 years of age and older with an underlying medical condition that places them at high risk of severe COVID-19;
Adults in or from First Nations, Métis, or Inuit communities, where infection can have disproportionate consequences;
Adults in racialized communities and/or marginalized communities (e.g. people living with disabilities) disproportionately affected by COVID-19;
Residents of other congregate living settings (e.g., quarters for migrant workers, shelters, correctional facilities, group homes) who are 12 years of age and older.

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.

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 do I get involved in working in a COVID-19 mass immunization clinic as a physician, nurse practitioner, or pharmacist?

If you're interested in getting involved in vaccinating at a mass immunization clinic, please contact us at covax@healthunit.ca for information.

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. 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.

Emerging Research

PHO provides, and regularly updates, synopses of key research articles related to COVID-19:

Emerging Topics: Synopsis of COVID-19 Key Research Articles

COVID-19 Serology

COVID-19 Antibody (Serology) Testing Summary for Clinicians

Medical Exemptions to COVID-19 Vaccines

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