MEDICAL ADVISORY: Updated guidance on COVID-19 vaccinations
Issued by: Azim Kasmani, MD, FRCPC, Associate Medical Officer of Health
Over the next few weeks, the Government of Ontario has
indicated that it will begin to change COVID-19 restrictions across the province. Vaccination remains the strongest protection against severe illness, hospitalization and death from COVID-19 and remains critical to protecting individuals and society. Please continue to encourage COVID-19 vaccination (first, second and third doses/booster doses) among your patients.
COVID-19 Vaccine Recommendations for Children five to 11 years of age
- Currently in the Niagara region, 47% of children between the ages of five to 11 have received their first dose of COVID-19 vaccine and 21% have received a second dose. The National Advisory Committee on Immunization (NACI) has recently strengthened its recommendation for vaccination of children five to 11 years of age against COVID-19.
- NACI recommends that a complete series (two doses) with a Pfizer-BioNTech Comirnaty vaccine (10 mcg) should be offered to children five to 11 years of age who do not have contraindications.
- An eight-week interval between the first and second dose is recommended.
- A three dose primary series of the Pfizer-BioNTech Comirnaty (10 mcg) is recommended for children five to 11 years of age who are moderately to severely immunocompromised
- An interval of eight weeks between each dose is recommended, with a minimum interval of 28 days
COVID-19 Vaccine Third and Booster Doses for Youth aged 12 to 17
To date, 83% of adolescents 12 to 17 years of age in Niagara region have received two doses of a COVID-19 vaccine. Beginning on Feb. 18, 2022, Ontario has expanded booster dose eligibility to youth aged 12 to 17. Booster doses should be given six months (168 days) following a second dose, however a booster dose may be given as early as 84 days following a second dose, after consultation with a healthcare provider. Youth must be 12 years or older at the time of vaccination in order to be eligible for the booster dose.
NACI has prioritized booster doses in adolescents 12 to 17 years of age who may be
at high risk of severe COVID-19 outcomes due to underlying medical conditions or living conditions, or who belong to racialized or marginalized communities disproportionately affected by COVID-19.
- NACI recommends a booster dose of an mRNA COVID-19 vaccine may be offered at least 6 months after the completion of a primary COVID-19 vaccine series to adolescents 12 to 17 years of age who
- Have an underlying medical condition that may put them at high risk of severe illness due to COVID-19, including those who are immunocompromised and who have already received a 3-dose primary series (for adolescents who are immunocompromised, a booster dose would be their fourth dose);
- Are residents of congregate living settings, including shelters, group homes, quarters for migrant workers, correctional facilities;
- Belong to racialized or marginalized communities disproportionately affected by COVID-19.
- Adolescents 12 to 17 years of age who are moderately to severely immunocompromised should be offered a
three-dose primary series of an mRNA COVID-19 vaccine
- For those individuals who previously received a two-dose COVID-19 vaccine series (with a homologous or heterologous schedule using mRNA vaccines), it is recommended that an additional dose of an mRNA COVID-19 vaccine should be offered
- The use of the Pfizer-BioNTech mRNA booster dose (30 mcg) is preferred to the use of the Moderna mRNA booster dose (50 mcg dose) in adolescents to further minimize the rare risk of myocarditis and/or pericarditis following vaccination in this age group
Vaccination Intervals for Individuals Previously Infected with SARS-CoV-2
On Feb. 4, 2022, NACI released updated guidance on COVID-19 vaccination timing for individuals previously infected with SARS-CoV-2. NACI continues to recommend that COVID-19 vaccines should be offered to individuals with previous SARS-CoV-2 infection without contraindications to the vaccine. While infection alone may provide some protection, vaccination following infection is expected to strengthen the immune response and to provide a more robust and longer-lasting protection against COVID-19.
Infection prior to initiation or completion of primary vaccine series (e.g. before the first dose, or after receiving a first dose but before receiving the second dose)
- Individuals five years of age and older
- NACI’s recommended interval for the next dose is eight weeks after symptom onset or positive test (if asymptomatic)
- Individuals five years of age and older who are moderately to severely immunocompromised (with no previous history of MIS-C)
- NACI’s recommended interval the next dose is four to eight weeks after symptom onset or positive test (if asymptomatic)
- Individuals five years of age and older with a previous history of MIS-C (regardless of immunocompromised status)
- NACI’s recommended interval the next dose is when clinical recovery has been achieved or ≥90 days since the onset of MIS-C, whichever is longer
- The minimum interval for all
individuals is once a client’s isolation period is completed and symptoms are mostly resolved, provided the minimum interval for the primary series doses has been met
Infection after primary series and before booster dose (e.g. after the second dose for most individuals)
- Individuals eligible for a booster dose
- NACI recommends the booster dose three months after symptom onset or positive test (if asymptomatic) and at least six months from completion of primary series
- The minimum interval for the booster is once client’s isolation period is completed and symptoms are mostly resolved, provided it has been six months since completing the primary series
Previous Infection of COVID-19 defined as
- Confirmed by a molecular (e.g. PCR) or Health Canada-approved antigen detection-based (e.g. RAT) test; or
- Symptomatic disease compatible with COVID-19 AND household exposure to a confirmed COVID-19 case
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