COVID-19 vaccine guidance for the fall 2023

Advisory Alert

October 5, 2023

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To: Local Health System Partners

FOR IMMEDIATE ATTENTION

COVID-19 vaccine guidance for the fall 2023 respiratory season.

Health system partners are reminded of the importance of advising patients of health protection measures this respiratory virus season. Critical among these measures is immunization, including against COVID-19, respiratory syncytial virus (RSV), and influenza.

This Advisory Alert provides information on updated COVID-19 vaccine recommendations and product availability, priority populations, and vaccination opportunities available through Public Health Sudbury & Districts for the fall vaccination campaign.

COVID-19 vaccine recommendations and product availability

Health Canada recently authorized two vaccines that target the Omicron XBB.1.5 subvariant for individuals aged six months and older:

Moderna Spikevax® XBB.1.5 monovalent andusomeran mRNA vaccine.
Pfizer-BioNTech Comirnaty® Omicron XBB.1.5 monovalent mRNA vaccine.

Individuals vaccinated with the updated XBB.1.5-containing vaccine are expected to benefit from a better immune response against currently circulating strains, compared to earlier formulations. Data from Moderna and Pfizer have shown that the BA.4/5 bivalent vaccines do generate immune responses against the XBB.1.5 subvariant and subvariants that are descendants of XBB; however, the new XBB.1.5 vaccine formulation generates a stronger immune response to these more recent subvariants.

Upcoming guidance from the National Advisory Committee on Immunization (NACI) is expected to provide additional XBB vaccine guidance that has already been released, including Pfizer-BioNTech-specific information and guidance for individuals with compromised immune systems.

As per current NACI recommendations, the Ministry of Health recommends a dose of the XBB.1.5-containing COVID-19 mRNA vaccine this fall for individuals 6 months of age and older in accordance with age and previous COVID-19 vaccination history or confirmed SARS-CoV-2 infection. The schedule is outlined in Table 1 below.

Table 1

Population	Vaccination History	Recommendations
5 years of age and older	At least one previous dose of a COVID-19 vaccine	1 dose of XBB.1.5-containing vaccine if it has been 6 months (minimum 3 months) since last dose or previous infection. ^A
5 years of age and older	No previous doses of a COVID-19 vaccine	1 dose of XBB.1.5-containing vaccine if it has been 56 days since previous infection^{A, D} (28 days for immunocompromised persons).
6 months to 4 years of age	Previously immunized with: 2 doses of Moderna	1 dose of XBB.1.5-containing vaccine if it has been 6 months (minimum 3 months) since last dose or previous infection.^A
6 months to 4 years of age	3 doses of Pfizer- BioNTech	1 dose of XBB.1.5-containing vaccine if it has been 6 months (minimum 3 months) since last dose or previous infection.^A
6 months to 4 years of age	1 dose of Moderna	1 dose of Moderna XBB.1.5 vaccine^B in accordance with product specific intervals^C and interval from previous infection.^{A, D}
6 months to 4 years of age	1 dose of Pfizer-BioNTech	2 doses of Pfizer XBB.1.5 vaccine^B in accordance with product specific intervals^C and interval from previous infection.^{A, D}
6 months to 4 years of age	2 doses of Pfizer-BioNTech	1 dose of Pfizer XBB.1.5 vaccine^B in accordance with product specific intervals^C and interval from previous infection.^{A, D}
6 months to 4 years of age	No previous doses of a COVID-19 vaccine	2 doses of Moderna XBB.1.5B in accordance with product specific intervals^C and interval from previous infection.^{A, D} OR 3 doses of Pfizer-BioNTech XBB.1.5 vaccine^B in accordance with product specific intervals^C and interval from previous infection.^{A, D}

^AConfirmed infection via testing or symptomatic disease and a household exposure to a confirmed case.

^BUse of the same vaccine product (Pfizer or Moderna) as previous dose(s) where possible and a three dose series is recommended when children are receiving a mixed schedule involving both products.

^C Product intervals: Moderna: recommended 56 days/minimum 28 days between doses; Pfizer: recommended 56 days/minimum 21 days between the first two doses and 56 days (recommended and minimum) between the second and third doses.

^DInterval from previous infection: 56 days after symptom onset (28 days for immunocompromised persons). With special consideration to those with MIS-C/MIS-A as outlined in Table 2 of the current guidance.

The updated COVID-19 Vaccine Administration Guidance document is available on the Ministry of Health website. At this time, one non-mRNA XBB.1.5 vaccine is currently awaiting Health Canada approval. Further information will be provided once the product is authorized and recommendations have been received for its use.

Groups for which COVID-19 vaccine is highly recommended

Immunization is particularly important for those at increased risk for influenza and/or COVID-19 related complications or hospitalization. Initial doses of COVID-19 vaccine received by public health units have been prioritized for hospitalized individuals and hospital staff, long-term care home and Elder Care Lodge residents, staff, and caregivers.

As vaccine becomes available to primary care providers, please prioritize vaccination of your patients who are in the following high-risk groups:

Residents and staff of congregate living settings.
Pregnant individuals.
Individuals 65 years of age and older.
All children 6 months to 4 years of age (due to influenza risk).
Individuals 6 months of age and older with underlying health conditions.
Individuals who are from a First Nation, Inuit, or Metis community and/or who self-identify as First Nation, Inuit or Metis, and their household members.
Members of racialized and other equity-deserving communities.
Health care workers and first responders.

Concurrent administration of COVID-19 and other vaccines

Coadministration of influenza and COVID-19 vaccines is recommended wherever feasible to ensure optimal and timely protection.

For individuals 6 months of age and older, COVID-19 vaccines may be given at the same time as, or any time before or after, other vaccines, including live, non-live, adjuvanted, or unadjuvanted vaccines with the exception of Imvamune vaccine and RSV vaccine (Arexvy®) at this time.

Imvamune®: If vaccine timing can be planned, it is recommended to delay the administration of the COVID-19 vaccine for a period of at least 4 weeks before or after the administration of Imvamune®.

Arexvy®: It is recommended to delay the administration of COVID-19 vaccine for a period of at least 2 weeks before or after administration of the RSV vaccine. Refer to the recent Ontario Immunization Advisory Committee Recommendations: Clinical Considerations for the Co-Administration of RSV, COVID-19 and Influenza Vaccines Among Older Adults in Long-term Care Facilities for further information.

If different vaccines are co-administered, immunization on separate limbs is recommended to minimize the risk of interaction.

Current vaccination opportunities through Public Health Sudbury & Districts

Beginning the week of October 2, 2023, COVID-19 vaccination opportunities will be available through Public Health Sudbury & Districts for persons at increased risk for influenza and/or COVID-19 related complications or hospitalization. A list of scheduled clinics can be found at phsd.ca/COVID-19/vaccine-clinics.

Ordering COVID-19 vaccine

The XBB.1.5 formulation of COVID-19 vaccines is available to order through your normal ordering practices. Bivalent COVID-19 vaccine remains available for ordering for individuals who decline the XBB.1.5 formulation.

New resources to support COVID-19 vaccine administration in your clinical practice

Your participation and support for the COVID-19 vaccine program is critical as we collectively respond to the ongoing circulation of the SARS-CoV-2 virus as well as other respiratory diseases preventable by vaccination. New processes have streamlined the requirements for COVID-19 vaccine program implementation and new resources are available to aid with onboarding for providers who wish to offer COVID-19 vaccine in their offices. COVID-19 vaccine can now be picked up along with other publicly funded vaccines through Public Health Sudbury & Districts.

Vaccination is a key health protection strategy. Please consider integrating the administration of COVID-19 vaccines into your routine practice.

Health care providers are encouraged to visit our COVID-19 Vaccine Clinic Communications in a Box webpage for information on how to offer a COVID-19 vaccine to their patient population. If you have questions or require onboarding or support in the implementation of the COVID-19 vaccine program in your office setting please contact, Taylor McCharles, Program Manager at mccharlest@phsd.ca or by calling 705.522.9200, ext. 3021 (toll-free: 1.866.522.9200).

Thank you for you ongoing support in protecting and promoting health in our communities.

Sincerely,

Original Signed By

Dr. Penny Sutcliffe
Medical Officer of Health and Chief Executive Officer

This item was last modified on December 3, 2024