MEDICAL ADVISORY: Two New COVID-19 Administration Recommendations

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

Effective immediately, the National Advisory Committee on Immunization (NACI) and the Ministry of Health have issued two recommendations regarding the administration of COVID-19 vaccines.

Recommendation #1: Concomitant Administration of COVID-19 Vaccine with other Vaccines  

On September 28, 2021, the National Advisory Committee on Immunization (NACI) released an updated recommendation on the timing of COVID-19 and non-COVID vaccines administration.

NACI Recommendation  

NACI recommends that COVID-19 vaccines may be given at the same time as, or any time before or after, other vaccines, including live, non-live, adjuvanted or unadjuvanted vaccines.

Additional Information on Recommendation

• There have been no specific safety concerns identified when routine vaccines are given at the same time or within days of each other; however there is a possibility of increased temporary side effects when a COVID-19 vaccine and another vaccine are administered at the same time or within days of each other
• Vaccines administered during the same visit should be administered at different injection sites
• As with other vaccines, when possible, administration on the same day is preferred to vaccines being given within a few days of each other

Recommendation #2: Preferential Use of Pfizer for Individuals 12-24 years

Out of an abundance of caution, the Ministry of Health is issuing a preferential recommendation of the use of Pfizer-BioNTech vaccine (Cominarty) for individuals aged 12-24 years old. Effective immediately, Pfizer-BioNTech COVID-19 Vaccine (Cominarty) is the preferred vaccine for individuals under 25 years of age. However, Moderna’s Spikevax COVID-19 vaccine remains licensed by Health Canada as safe and effective to use in this population if that is patient preference, or if only Moderna’s vaccine is available.

Rationale

This recommendation is based on an observed increase in Ontario of myocarditis/pericarditis following vaccination with Moderna’s Spikevax compared to Pfizer-BioNTech’s Cominarty in the 18 to 24 year age group, particularly among males.

Additional Information on Recommendation

• The majority of reported cases have been mild with individuals recovering quickly, normally with anti-inflammatory medication. Typically, symptoms have been reported one week after vaccination, more commonly after the second dose.
• Of note, both myocarditis and pericarditis are more common after COVID-19 illness than after vaccination
• The National Advisory Committee on Immunization continues to
• Strongly recommend that a complete series with an mRNA vaccine be offered to all eligible individuals 12 years of age and older who do not have contraindications
• Recommend a precautionary measure for individuals who have experienced myocarditis or pericarditis following vaccination with a first dose of an mRNA COVID-19 vaccine to defer their second dose in the vaccination series until more information is available. NACI continues to review information as it becomes available and will take appropriate action as needed.

More Information

• NACI Recommendation on the use of COVID-19 vaccines
• Summary of updated NACI statement: September 28, 2021
• Ontario Recommends the use of Pfizer-BioNTech COVID-19 Vaccine for Individuals Aged 18-24 Years Old (news release)
• MEMO: COVID-19 Vaccine Contraindications and Medical Exemptions
• 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.
• Remind your patients to visit Public Health’s COVID-19 vaccination webpage for up-to-date information