Immunization Delivery during COVID-19
Routine vaccination is an essential service. Immunization can prevent illnesses that lead to unnecessary medical visits, hospitalizations and further strain to the health care system. It's important to provide routine immunizations as best as possible despite the circulation of COVID-19.
The Ministry of Health has provided guidance for immunization services during COVID-19. We'll update this information as new guidance becomes available.
Immunization Planning
Ensure adequate assessment and vaccine inventory so that each patient receives all indicated vaccines, minimizing the need for additional health care visits.
Groups Requiring Immunization
Anyone who is:
- Due for any vaccine
- At increased risk for acquiring and / or transmitting vaccine preventable diseases
- At risk of vaccine preventable disease complications
- Missing vaccine doses
When to Immunize
- Take all opportunities to immunize and offer vaccines when combined with other visits
- More than one vaccine product can be administered safely in the same visit and will not affect vaccine efficacy. For full details on exceptions to this, consult the Canadian Immunization Guide.
- Administer post-exposure prophylaxis (measles, hepatitis A, hepatitis B, rabies, meningococcus and varicella) for probable or confirmed cases of COVID-19 or their close contacts without delay
Vaccine Eligibility for Missed Doses
| Vaccine | Eligibility | Impacted Cohort | Remains eligible for missed doses until |
|---|---|---|---|
| Hep B (Recombivax or Engerix) | Grades 7 to 8 | Grade 9 students in the 2020 / 21 school year (born in 2006) | Aug. 31, 2021 (must complete series) |
| HPV-9 (Gardasil 9) | Females: Grades 7 to 12 Males: Grades 7 to 11 |
Female students who graduated in the 2019 / 20 school year (born in 2002) | Aug. 31, 2021 (must complete series) |
| Men-C-ACYW-135 (Nimenrix) | Grades 7 to 12 and those born in or after 1997 | Not applicable, but vaccination is required under the Immunization of School Pupils Act | Remains eligible until vaccine is received |
| HZ (Shingrix) | 65 to 70 years old | 70 year olds turning 71 in 2020 or 2021 (born in 1949 or 1950) | Dec. 31, 2021 |
Catch-Up Vaccines for Missed Doses
Use the product monographs and tables 4 to 21 in the Publicly Funded Immunization Schedules for Ontario to help with determining intervals between doses that are delayed or off-schedule.
Most vaccines are generally straightforward when providing catch-up doses, such as provide the dose at the earliest opportunity with no need to restart a series. There are some exceptions:
- The interrupted schedules for vaccines that contain tetanus, diphtheria, pertussis, polio, and Hib, as well as the pneumococcal conjugate vaccine are complex when the schedule has been interrupted
- The recommended and minimum interval table for the rotavirus vaccine
Tables for these immunization schedules have been provided on pages 7-9 in the Ministry of Health guidance:
Tdap-IPV, Td and IPV, and / or Td schedule for individuals 7 years of age and older who have not completed their series
DTaP-IPV-[Hib] indicates the use of DTaP-IPV-Hib or DTaP-IPV depending on the age of the child.
| Number of DTaP-IPV-[Hib] doses received at age <7 years | Individual’s current age | Continue with the following number of Tdap-IPV, Td and IPV, and/or Td doses to complete series (recommended intervals) |
|---|---|---|
| 1 dose | 7 to 17 years |
|
| 1 dose | 18 years or older |
|
| 2 doses | 7 to 17 years |
|
| 2 doses | 18 years or older |
|
| 3 doses | 7 years or older |
|
| 4 doses received at <4 years | 7 years or older |
|
Pneu-C-13 schedule for children <5 years of age who have not completed their series
Pneu-C-13 is not recommended for healthy children beyond 5 years of age (60 months). Children 5 years of age and older who missed any previous doses of Pneu-C-13 do not require further catch-up doses.
For high risk individuals, refer to Ontario's high-risk immunization schedules for Pneu-C-13 immunization.
| Child’s age | Applies to | Number of Pneu-C-13 doses received previously | Number of Pneu-C-13 doses required to complete series and recommended intervals |
|---|---|---|---|
| 2 to 6 months | Healthy | 1 dose (1st dose) |
|
| 2 to 6 months | Healthy | 2 doses (1st and 2nd dose) |
|
| 2 to 6 months | High risk | 1 dose (1st dose) |
|
| 2 to 6 months | High risk | 2 doses (1st and 2nd dose) |
|
| 7 to 11 months | All | 1 dose (1st dose) |
|
| 7 to 11 months | All | 2 doses (1st and 2nd dose) |
|
| 12 to 23 months | All | 1 dose (1st dose) at age <12 months |
|
| 12 to 23 months | All | 1 dose (1st dose) at age 12 months or older |
|
| 12 to 23 months | All | 1 dose (1st dose) at age <12 months and 1 dose (2nd dose) at age 12 months or older |
|
| 12 to 23 months | All | 2 or more doses at age <12 months |
|
| 24 to 59 months | All | Any incomplete series |
|
Rot-5 Immunization Series for Infants <32 Weeks of Age
If an incomplete dose is administered for any reason, for example, infant spits the vaccine, a replacement dose should NOT be administered.
Vaccination should not be initiated in infants 15 weeks of age or older, as the safety of providing the first dose of Rot-5 in older infants is not known. If Rot-5 is inadvertently administered at 15 weeks of age or older, the rest of the series should be completed with a minimum of four weeks between each dose and all doses should be administered before 32 weeks of age.
Recommended Intervals
- 1st dose between 2 months and 15 weeks of age
- 2nd dose, 2 months after 1st dose
- 3rd dose, 2 months after 2nd dose and before 32 weeks
Minimum Intervals
- 1st dose between ages 6 and 15 weeks
- 2nd dose, 4 weeks after 1st dose
- 3rd dose, 4 weeks after 2nd dose and before 32 weeks
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