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 of Tdap-IPV, 2 months after DTaP-IPV-[Hib] dose
  • 1 dose of Tdap, 2 months after 1st Tdap-IPV dose
  • 1 dose of Tdap-IPV, 6-12 months after Tdap dose
1 dose

18 years or older

  • 1 dose of Tdap-IPV
  • 1 dose of Td dose, 2 months after Tdap-IPV dose
  • 1 dose of Td and IPV, 6-12 months after Td dose
2 doses 7 to 17 years
  • 1 dose of Tdap-IPV, 6-12 months after DTaP-IPV-[Hib] dose
  • 1 dose of Tdap, 6-12 months after 1st Tdap-IPV dose
2 doses 18 years or older
  • 1 dose of Tdap-IPV
  • 1 dose of Td, 6-12 months after Tdap-IPV dose
3 doses 7 years or older
  • 1 dose of Tdap-IPV, 6-12 months after DTaP-IPV-[Hib] dose
4 doses received at <4 years 7 years or older
  • 1 dose of Tdap-IPV

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)
  • 2nd dose, 2 months after 1st dose
  • 3rd dose, 2 months after 2nd dose and at age 12 months or older
2 to 6 months Healthy 2 doses (1st and 2nd dose)
  • 3rd dose, 2 months after 2nd dose and at age 12 months or older
2 to 6 months High risk

1 dose (1st dose)

  • 2nd dose, 2 months after 1st dose
  • 3rd dose, 2 months and after 2nd dose
  • 4th dose, 2 months after 3rd dose and at age 12 months or older
2 to 6 months High risk 2 doses (1st and 2nd dose)
  • 3rd dose, 2 months and after 2nd dose
  • 4th dose, 2 months after 3rd dose and at age 12 months or older
7 to 11 months All 1 dose (1st dose)
  • 2nd dose, 2 months after 1st dose
  • 3rd dose, 2 months after 2nd dose and at age 12 months or older
7 to 11 months All 2 doses (1st and 2nd dose)
  • 3rd dose, 2 months after 2nd dose and at age 12 months or older
12 to 23 months All 1 dose (1st dose) at age <12 months
  • 2nd dose, 2 months after 1st dose
  • 3rd dose, 2 months after 2nd dose
12 to 23 months All 1 dose (1st dose) at age 12 months or older
  • 2nd dose, 2 months after 1st dose
12 to 23 months All 1 dose (1st dose) at age <12 months and 1 dose (2nd dose) at age 12 months or older
  • 3rd dose, 2 months after 2nd dose
12 to 23 months All 2 or more doses at age <12 months
  • 1 dose, 2 months after most recent dose
24 to 59 months All Any incomplete series
  • 1 dose, 2 months after more recent dose

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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