MEDICAL ADVISORY: New COVID-19 Vaccine Products for Children and Other Updates

Issued by: M. Mustafa Hirji, MD, MPH, FRCPC, Medical Officer of Health & Commissioner (Acting)

Date: January 11, 2023

On Dec. 9, 2022, Health Canada authorized the Pfizer-BioNTech Comirnaty bivalent (10 mcg) mRNA COVID-19 vaccine for use as a booster dose in children five to 11 years of age. Starting Dec. 21, children five to 11 years of age are eligible to book a bivalent booster dose.

NACI recommends only ONE booster dose after the primary series for children 5 to 11. Eligibility for booster doses is based on the interval since a patient’s last dose:

• Patients five years of age and older are recommended to get their booster dose six months after their last dose of COVID-19 vaccine or COVID-19 infection
• Patients at high risk of severe COVID-19 illness are strongly recommended to get their booster at a three-month interval, during the fall/winter respiratory illness season
• If a patient has already received a booster dose (monovalent or bivalent) since Sept. 1, they are up-to-date. Additional booster doses are not recommended at this time.

Although not recommended, if a provider wishes to offer a bivalent vaccine “off-label” as a second booster dose to children 5-11 years, it should be done only for children who are high risk for severe outcomes, and only after a 6-month interval.

Infant Pfizer now available

• Infant Pfizer-BioNTech Comirnaty (six months to four years of age) is available to order for practices that have joined the COVID-19 vaccine administration program
  • Please note that all immunocompetent children must receive three doses, each 8 weeks apart, to complete their primary series
  • The Moderna Spikevax product for this age group remains a two dose series
  • For immunocompromised children, a three dose series of Moderna Spikevax is recommended over a four dose series of Pfizer-BioNTech Comirnaty.

COVID-19 vaccines may be given at the same time as, or any time before or after, other vaccines, for all age groups.

Janssen Update

• Janssen may be offered through Niagara Region Public Health clinics to patients who call to book AND are 18 years and older, only when all other authorized COVID-19 vaccines are contraindicated (mRNA and Novavax)

Storage and Handling of Pfizer-BioNTech Comirnaty’s COVID-19 Vaccines 

• For practices that have joined the COVID-19 vaccine administration program, Pfizer-BioNTech Comirnaty recommends that all of their multi-dose COVID-19 vaccine products be discarded 12 hours after first puncture.
• Vaccine waste may be unavoidable when trying to provide patients with every possible opportunity to be vaccinated. Do not hesitate to puncture a vial for patients who may be vaccine hesitant or unlikely to return for vaccination. Given the low demand for vaccination and secure supply, some level of wastage is likely to occur despite best efforts.

Health Care Provider Action

• Strongly recommend all eligible patients and staff receive the bivalent booster
• If your practice does not administer COVID-19 vaccines, please let your patients know where they can get vaccinated in Niagara 
• Encourage parents with questions about vaccinating their child to contact the SickKids COVID-19 Vaccine Consult Service or the VAXFacts Clinic

More information

• Updated recommendations on the use of COVID-19 vaccine booster doses in children 5 to 11 years of age and concurrent vaccine administration, NACI
• COVID-19 Vaccine Guidance, Ministry of Health
• Increasing Booster Uptake: Getting a Person from No to Yes, MDBriefCase
• Waning immunity, variants, and COVID-19 boosters, PHAC podcast