MEMO: Expanded Third Dose Eligibility – Immunosuppressant Medications

TO: Pharmacy and Health Care Professionals in Niagara

FROM: Pandemic Response Division, Niagara Region Public Health

REFERENCE: Expanded Third Dose Eligibility – Immunosuppressant Medications

DATE: Oct. 25, 2021

This Memo provides and update on third dose eligibility for individuals who are moderately to severely immunocompromised, expanding on the third dose eligibility Memos from September 21 and August 31.

The Ministry of Health has released a list of new immunosuppressant medications for third dose eligibility. To see the classes of medication, generic names and brand names, please refer to the Ministry of Health Third Dose Recommendations guidance document, page 5. There is no change to the eligibility for a third dose for previously announced groups.

Dose Interval for Eligible Patients

As a reminder, the Ontario recommended interval between the last dose of the initial primary series and the third dose for moderately to severely immunocompromised individuals is at least two months (8 weeks)
As per the National Advisory Committee on Immunization (NACI), the minimum interval should be 28 days; however, an interval longer than the minimum 28 days between doses is likely to result in a better immune response
Risk factors for exposure and severe disease should be considered when deciding on the appropriate interval
- If you are referring eligible patients to a Public Health clinic, please note patients should not be referred until they’ve met these intervals
Additionally, residents of Long-Term Care Homes, Retirement Homes, Elder Care Lodges, and elderly living in other congregate settings (e.g. assisted-living facilities, chronic care hospitals, naturally occurring congregate retirement settings/congregate senior’s apartment buildings, etc.) are also eligible for a third dose in Ontario
- Per NACI, these individuals should receive their third dose at a recommended interval of at least six months after their second dose

Process for Vaccinating Eligible Individuals

There is no change in terms of the process for vaccinating eligible individuals with a third dose as to what was originally outlined in our August 31 Memo
As a reminder, patients referred to a vaccination clinic for their third dose must be provided with a medical letter to present at the clinic that states the condition that makes them eligible for a third dose of COVID-19 vaccine. The medical letter must include
- Date, and be on letterhead
- Contact information for the clinic, physician, pharmacist, specialist or medical practice of individual completing the letter
- Patient’s name (typed/generic letters will not be accepted)
- Patient’s eligible condition (or medication) for third dose
If you are administering the COVID-19 vaccine at your office, you may also provide third doses to your eligible patients. Please note eligible patients should not be given a third dose until they meet the time interval for a third dose as specified above.

More Information

Call the COVID-19 Primary Care Info-Line at 905-688-8248 (press 7, then 1 for physicians). The info-line is open Monday to Friday, 8:30 a.m. to 4:15 p.m.