MEDICAL ADVISORY: Fall Respiratory Vaccinations

Issued by: Dr. Azim Kasmani, MD MSc FRCPC, Medical Officer of Health

Date: November 9, 2023

The Ministry of Health has announced that everyone can get their flu and XBB COVID-19 vaccines at participating pharmacies and primary care providers.

Niagara Region Public Health encourages you to protect your eligible staff and patients by offering COVID-19 vaccination in your office. Public Health continues to offer COVID-19 vaccination to eligible individuals six months of age and older at our clinics.

Updated Guidance for Moderna and Pfizer XBB COVID-19 Vaccines

• The Ministry of Health updated their COVID-19 Vaccine Guidance since our Sept. 29 Medical Advisory to reflect both Moderna XBB and Pfizer XBB COVID-19 vaccines. The following are updated recommendations when counseling patients or administering COVID-19 vaccination:
  • All patients six months and older. The recommendation for this age group is to get an XBB COVID-19 vaccine if it has been six months since they were last vaccinated or infected with COVID-19.  The Ministry has updated the vaccine schedule based on immunization history and immune status. Refer to Table 1 on pages 5-7 of the Ministry of Health’s COVID-19 Vaccine Guidance.
  • Previously unvaccinated patients who are 12 to 29 years old. These individuals may receive either the Pfizer or Moderna XBB COVID-19 vaccine. The Pfizer COVID-19 vaccine is no longer preferred over the Moderna COVID-19 vaccine.
  • Immunocompromised patients. Guidance for the appropriate immunization schedule based on the number of previous doses received is now available. Refer to Table 1 on pages 6-7 of the Ministry of Health’s COVID-19 Vaccine Guidance.
  • Patients six months of age and older vaccinated with one or more non-Health Canada approved vaccine(s). The recommended number of XBB COVID-19 vaccine dose(s) depends on how many previous dose(s) the individual received and their immune status. Refer to Table 1 on pages 5-7 of the Ministry of Health’s COVID-19 Vaccine Guidance.
• Pfizer XBB product monograph is now available
• An XBB formulation of Novavax COVID-19 Vaccine is expected but is still under review  by Health Canada

RSV Vaccine

• Most deaths from RSV in Ontario have occurred in those aged 60 years and older
• The RSV vaccine is 94.1% effective against severe RSV-related lower respiratory tract disease and 71.7% effective against RSV-related acute respiratory infection

Publicly Funded RSV Vaccine

• RSV vaccine is publicly funded for residents of Long-Term Care Homes, Elder Care Lodges and Retirement Homes licensed to provide dementia care services
• Other individuals over the age of 60 years may receive RSV vaccine fee-for-service from a primary care physician. It is anticipated that pharmacies will soon be able to offer it for a fee as well.
• Public Health is managing the local distribution of RSV vaccine as per Ministry guidelines but will not be offering RSV vaccine at our clinics

Not Publicly Funded RSV Vaccine

• Primary care providers can prescribe RSV vaccine to anyone 60 years of age and older who don’t meet the criteria for publicly funded RSV vaccine. Patients will need to purchase the vaccine from a pharmacy and take it back to their primary care provider to get vaccinated.
  • For administration information, follow the Arexvy product monograph
  • It is encouraged to wait at least two weeks before or after the administration of RSV vaccine before administering other vaccinations in order to better monitor adverse events. However, given there are no safety or efficacy concerns with co-administration, in some scenarios co-administration may be considered by a provider, for example:
    • If community activity of COVID-19, influenza and / or RSV is high and increasing
    • When there is a risk that the individual otherwise will not receive the recommended vaccine
  • The adverse event reporting process is the same for the RSV vaccine
  • The need for future doses, or booster doses of RSV vaccine is unknown at this time
• Pharmacists can’t administer RSV vaccine yet, but there are pending regulatory amendments to enable them to do so
• Additional RSV vaccines are expected to be authorized in the Canadian market in the coming year

RSV Information for Patients

Health care providers can direct patients to the Ministry of Health’s RSV website. The following fact sheets are also available:

• How to protect yourself and others from respiratory viruses (Public Health Ontario)
• Respiratory Syncytial Virus (RSV) (Ministry of Health)

More Information

• Ontario Respiratory Virus Tool
• Public Health Ontario Rounds: Updates on Influenza, COVID-19 and RSV for the 2023-24 Season (presentation)
  • Public Health Ontario’s short-term projections of SARS-CoV-2, influenza, and respiratory syncytial virus (RSV) activity, and risk of related severe disease among pediatric and general adult population groups (surveillance report)
• Seasonal Influenza
• Call the Vaccine Preventable Disease program at 905-688-8248 or 1-888-505-6074 ext. 7396