MEDICAL ADVISORY: COVID-19 Vaccination Information

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

Since receiving COVID-19 vaccine on January 12, Niagara Region Public Health and Emergency Services (NRPH&ES) administered the first doses of vaccination to long-term care residents in only nine days. This is a major milestone, since this group is suffering the greatest burden of the pandemic. In only the last month there have been 113 deaths of long-term care and retirement home residents in Niagara. Vaccination will hopefully begin to put an end to this tragedy.

NRPH&ES is currently completing vaccination of high-risk retirement home residents now. Unfortunately, with the slow-down in vaccine shipments to Canada, administering second doses to these residents is likely to exhaust most of our vaccine supply in upcoming weeks. Vaccination of long-term care home and high-risk retirement home staff is going to be delayed. Vaccination of other health care works and additional priority groups is likewise on hold. Niagara Health has needed to suspend its hospital-based clinics for healthcare workers at this time.

Future vaccination planning is well underway, but much of the details depend on uncertain dose delivery timelines. In particular, we do not have a timeline on when vaccine might be available to primary care, but expect it is at least a couple of months away. For more information about the province’s current plans, please visit the COVID-19 Vaccination Update: Technical Briefing.

Implications for Your Practice

With the highly anticipated arrival of the Pfizer vaccine in Niagara, we recognize that your office may already be getting calls from patients about their medical and immunization history in advance of their COVID-19 vaccination.

As is to be expected, there is a great deal of anxiety around specific groups and the safety of the vaccine. Individuals are looking to their health care provider to answer their questions. We would like to support your preparation to help the following patient groups make an informed decision around receiving the COVID-19 vaccine when they call.

Children

• The National Advisory Committee on Immunization (NACI) recommends that individuals under 16 years old should not be offered COVID-19 vaccination at this time, with the possible exception of adolescents 12 to 15 years of age receiving the Pfizer-BioNTech vaccine after a risk assessment

The following excerpts are from the Ministry of Health COVID-19 Vaccination Recommendations for Special Populations [Version 1.1 January 8, 2021]:

Breastfeeding

• COVID-19 mRNA vaccines are not live vaccines and, based on their biologic mechanism of action, mRNA vaccines are not hypothesized to be a risk to the breastfeeding infant
• For any individuals who are breastfeeding, the COVID-19 vaccine should be offered after recognizing the insufficiency of evidence for the use of COVID-19 vaccine in the breastfeeding population

Pregnant

• Pregnant individuals in the authorized age group may choose to receive the vaccine after informed counselling and consent that includes
  1. A review of the risks and benefits of the vaccine,
  2. A review of the potential risks /consequences of a COVID infection in pregnancy,
  3. A review of the risk of acquiring a COVID infection in pregnancy, and
  4. An acknowledgment of the insufficiency of evidence for the use of current COVID-19 vaccines in the pregnant population.
• If after this counselling by their treating provider, the pregnant individual feels the potential benefits of vaccination outweigh the potential harms, they should be able to access the vaccine

Allergies

Refer to the chart below to determine how to advise a patient with allergies:

Autoimmune conditions and immunocompromised due to disease or treatment

• Individuals in the authorized age group with autoimmune conditions, immunodeficiency conditions or those immunosuppressed due to disease or treatment may choose to receive the vaccine after informed counselling and consent that includes:
  1. A review of the risks and benefits of the vaccine,
  2. A review of the potential risks /consequences of a COVID infection,
  3. A review of the risk of acquiring a COVID infection, and
  4. An acknowledgment of the insufficiency of the evidence for the use of currently available COVID-19 vaccines in these populations and in view of possible decreased vaccine effectiveness with the use of immunosuppressive therapy.
• Individuals receiving stem cell therapy, CAR-T therapy, chemotherapy, immune checkpoint inhibitors, monoclonal antibodies (e.g. rituximab) and other targeted agents (e.g. CD4/6 inhibitors, PARP inhibitors, etc.) should be offered vaccine after informed counselling and consent by their treating provider

Adverse Reactions Following Immunization

• If someone experiences an adverse event following immunization, they should report it to a healthcare professional, such as a family doctor.  Healthcare professionals are asked to report adverse events to Public Health.
• Public Health surveillance of adverse events following immunizations is important for timely detecting of rare vaccine safety issues.  Expected side effects for each vaccine product are listed on the vaccine product monograph.

Additional Guidance Available

New resources are available to help you make recommendations and answer patient questions regarding COVID-19 vaccination. As guidance changes often, please visit these webpages frequently to confirm you are accessing the latest version.

• NRPH&ES has added 'COVID-19 vaccines' as a section to the FAQs
• NACI has released recommendations on the use of COVID-19 vaccines
• The Ministry of Health has created a COVID-19 Vaccine-Relevant Information and Planning Resources webpage for health care providers. The most relevant resources for your practice include:
  • COVID-19 Vaccine Recommendations for Special Populations. This document contains recommendations based on the best available evidence for COVID-19 vaccination in special populations and expert clinician advice. 
  • COVID-19: About Vaccines. This document contains useful information to answer general questions from patients such as: how vaccination works, potential side effects, details on the Pfizer-BioNTech and Moderna mRNA COVID-19 vaccines, and responses to several FAQs.
  • Managing Health Care Workers with Symptoms within 48 Hours of Receiving COVID-19 Vaccine. This document includes actions to take prior to vaccination for health care workers as well as post-vaccine symptom assessment.

Prioritization

Niagara Health, the Community Coordination Task Force for COVID-19 Vaccination formed by Regional Council, and NRPH&ES are working together on the region’s vaccination plan, starting with priority populations identified by the Ontario government for Phase 1 of COVID-19 vaccinations. We will continue to follow the province’s ethical framework for COVID-19 vaccine distribution as more vaccine arrives in Niagara. NRPH&ES will update the COVID-19 Vaccination webpage regularly as we receive information on when priority groups are to be vaccinated and how they will be notified when it is their turn.  Phase 3 (vaccinating the general population) could begin as early as August 2021, pending availability of vaccines.

NRPH&ES has asked that residents refrain from calling Public Health or their health care provider to ask about COVID-19 vaccine clinic information or being put on a wait list for the time being. Some offices have chosen to send an email communication to their patients including the following key messages:

• Directing patients to visit:
  • Niagara Health’s website for news updates on the status of COVID-19 vaccination in Niagara
  • Public Health’s COVID-19 Vaccination webpage for up-to-date information
• Highlighting Ontario’s three-phase vaccine distribution plan
• Asking patients not to call the office or Public Health to ask about clinic information or being put on a wait list
• Reminding patients to continue following public health measures

If You Need to Call Public Health

• We continue to be available to answer questions from health care professionals. If you have questions, please call our COVID-19 Primary Care Info Line (905-688-8248, press 7 then press 1). Please note the new hours of operation are Monday to Friday, 9:15 a.m. to 4:30 p.m. (previously 7:30 p.m.)
• Questions about COVID-19 vaccination are challenging for us to answer at this point as the provincial government is leading the vaccine program rollout
• COVID-19 vaccination in Niagara is evolving based on vaccine supply, and we will continue to update you as we receive information from the province