MEMO: UPDATE - COVID-19 Vaccines: Phase 2

TO: Health Care Professionals in the Niagara region

FROM: Pandemic Response Division, Niagara Region Public Health

REFERENCE: UPDATE - COVID-19 Vaccines: Phase 2

DATE: April 22, 2021

This memo is in follow-up to the communications issued on April 14: COVID-19 Vaccines – Phase 2. Please see changes to the chart below:

Patients with Medical Exceptions to Extended Dose Interval – Highest Risk

From “Highest Risk” populations, the following patients are eligible to receive the COVID-19 vaccine at the shortened dose interval of 26 days (for both Moderna and Pfizer-BioNTech COVID-19 Vaccines) or 12 weeks for AstraZeneca. Essential caregivers will not be eligible for the shortened second dose interval. The duration between doses will remain at 16 weeks (4 months).

Transplant recipients (including solid organ transplants and hematopoietic stem cell transplants)
Individual with malignant hematologic disorder receiving active treatment (specifically chemotherapy, target therapies of immunotherapy)
Individual with non-hematologic malignant solid tumor receiving active treatment (specifically chemotherapy, target therapies of immunotherapy)

In order to receive vaccine at the shortened dose interval at Niagara’s vaccination clinics, the patient will require a letter or a completed form (please see Niagara Health’s webpage on exceptions to extended dose intervals) from their clinician to confirm that they are eligible to get a second dose appointment at shortened dose interval, identifying the reason for the exception. Patients are to bring the letter to their first appointment which allows the booking in COVax to go to 26 days and then they bring it again to the second appointment as proof again that they are eligible for that second dose.

Guidelines for Use of AstraZeneca

If you are offering AstraZeneca vaccine to patients in your office, please prioritize vaccine to patients in the “high risk” followed by the “at risk” categories.

There are currently three (3) bodies of guidance around use of the AstraZeneca COVID-19 vaccine. Please use your clinical judgement based on patient diagnosis, risk factors and vaccine availability when determining appropriate use of AstraZeneca vaccine for your patient.

Health Canada: Health Canada has authorized the use of the AstraZeneca vaccine for anyone 18 years of age and older, and reaffirmed that it meets thresholds of safety in those populations despite the rare observed incidence of vaccine-induced immune thrombotic thrombocytopenia (VITT).
The National Advisory Committee for Immunization (NACI): NACI sets best practice recommendations, and their current recommendation is to use the vaccine only in those 55 years of age and older where VITT is of lowest risk. NACI continues to review data for AstraZeneca vaccine and are working on updated recommendations for the near future.
Ontario: Here in Ontario – the province, given the state of the pandemic, given Health Canada’s reaffirmation of safety, and given that VITT risk decreases with age, has approved 40 years of age and older as the eligibility criteria to get AstraZeneca. However, if someone has eligibility criteria to receive COVID-19 vaccine other than age (e.g. a health care worker, underlying illness) they are eligible to receive the vaccine as long as the person is over the age of 18.

This is dynamic situation and guidance is constantly changing. As more information is made available we will provide an update. Please review the Ministry’s guidance for health care providers prior to administering the vaccine to patients.

Age-Eligibility

As a reminder, patients living in Niagara 60 years of age and older, as well as those from the identified COVID-19 “hot spot” 50 years of age and older with postal code L2G, are eligible to book vaccine appointments through the Provincial Booking Tool or by calling the Provincial Vaccine Booking Line number at 1-833-943-3900.

More Information

For links to further COVID-19 vaccine information in Niagara, please see Niagara Region Public Health’s COVID-19 Vaccinations website. For links to further COVID-19 vaccine-relevant information and planning resources, please see the Ministry of Health’s website.

Thank you again for your commitment to Ontario’s COVID-19 vaccine campaign.