COVID-19 Vaccine Update: Booster doses for all individuals 12 to 17 years of age and updated vaccination timing following COVID-19 infection

February 18, 2022

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To: Local Health System Partners

FOR IMMEDIATE ATTENTION

New booster dose eligibility for individuals aged 12 to 17 and updated recommendations for vaccination post infection

This Advisory Alert updates that of February 9, 2022 and outlines guidance from the Ontario Ministry of Health regarding booster dose eligibility for individuals 12 to 17 years of age, online booking updates, and recommendations for vaccination intervals following COVID-19 infection. All updates are aligned with the Ministry of Health COVID-19 Vaccine Third Dose Recommendations (PDF) (see attachment, link active following posting to Ministry website).

Booster dose eligibility and interval recommendations for individuals aged 12 to 17

Eligibility

Effective February 18, 2022, eligibility for COVID-19 vaccine booster dose is expanded to include all individuals aged 12 to 17 years who have completed their primary vaccine series (whether a two-dose or three-dose primary series).

Interval

As of February 18, 2022, all individuals 12 to 17 years of age who have completed their primary series are eligible for their booster dose 168 days (6 months) following the completion of their primary series. Note that this includes those with a two-dose primary series and those with a three-dose primary series (i.e. moderately to severely immunocompromised). Individuals 12 to 17 years of age who were previously eligible for a booster dose, (those with underlying medical conditions, select health care workers, and First Nations, Inuit, and Métis) are also now recommended to receive their booster dose at the 168-day (6 month) interval.

The six month or 168-day interval for those 12 to 17 years of age may be associated with a lower risk of myocarditis with or without pericarditis. With informed consent, individuals 12 to 17 years old will be able to book their booster dose appointment at 3 months (84 days) after the completion of a primary COVID-19 vaccine series. See below for booking details.

Additional information

The intent of the booster dose is to restore protection that may have decreased over time with the goal of enhancing immune response. Emerging evidence shows that the ≥ 6 months (168 days) interval, after completion of a primary COVID-19 vaccine series, may be associated with a lower risk of myocarditis with or without pericarditis. Eligible individuals who are immunocompromised should consult their health care provider for guidance on specific timing of booster dose vaccination if they have questions regarding timing of vaccination in alignment with their treatment schedule.

Individuals 12 to 29 years of age are preferentially recommended to receive Pfizer-BioNTech Comirnaty (30mcg) but may receive Moderna Spikevax with informed consent. Recommendation for booster dose following myocarditis and pericarditis after primary vaccinations remain as outlined in the January 18, 2022, Advisory Alert.

Booking

All eligible individuals seeking a booster dose can attend a walk-in vaccination clinic or book an appointment by calling 705.674.2299 (toll‑free: 1.800.708.2505), between 8 a.m. and 6 p.m., Monday to Friday. Online booking is currently only open to individuals who completed a two-dose primary vaccine series and are seeking a third dose for their booster as well as those 18 years of age and older who completed a three-dose primary series and are seeking a booster dose appointment.

As of March 1, 2022, online booking for booster doses (fourth doses) will be available to individuals 12 to 17 years of age who are moderately to severely immunocompromised and to any eligible individual who had any of the following three-dose combinations:

one or two doses of a COVID-19 vaccine not authorized by Health Canada, followed by one dose of a COVID-19 mRNA vaccine authorized by Health Canada, OR
three doses of a COVID-19 vaccine not authorized by Health Canada.

These individuals are eligible to book their fourth dose appointment for an mRNA COVID-19 vaccine at recommended interval of at least six months (168 days) for those 12 to 17 years of age and three months (84 days) for those 18 years of age and older.

Individuals 12 to 17 years of age wishing to book a booster dose appointment at a minimum of 3 months (84 days) after completion of a primary COVID-19 vaccine series, and with informed consent, must call 705.674.2299 (toll‑free: 1.800.708.2505) to book an appointment or attend a walk-in vaccination clinic. Online booking is not available for individuals 12 to 17 years of age seeking a shorter interval than the recommended 168 days.

Recommendations for vaccination dose intervals for those with previous COVID-19 infection*

As per the National Advisory Committee on Immunization (NACI), emerging evidence indicates that a longer interval between SARS-CoV-2 infection and vaccination is associated with improved antibody responses to COVID-19 vaccines. Recommendations for vaccination intervals are dependent on the timing of infection, and are outlined as follows:

Primary series

If infection with SARS-CoV-2 occurs before first dose of vaccination (no vaccination completed) or between dose one and dose two (only one dose administered), the following recommendations apply as per Ministry of Health COVID-19 Vaccine Third Dose Recommendations (PDF) and Ministry of Health COVID-19 Vaccine Administration guidance (PDF) (link active following posting to Ministry website):
- Individuals who are not considered moderately to severely immunocompromised should receive the vaccine 8 weeks after symptom onset or positive test (if asymptomatic).
- Individuals who are moderately to severely immunocompromised are recommended to receive the vaccine 4 to 8 weeks after symptom onset or positive test (if asymptomatic).
- Individuals with a history of multisystem inflammatory syndrome in children (MIS-C) are recommended to receive the vaccine dose when clinical recovery has been achieved or ≥ 90 days since the onset of MIS-C, whichever is longer.

Booster dose

If COVID-19 infection occurs after completion of the primary series but before the booster dose, individuals 12 years of age and older are recommended to receive their booster dose 3 months after symptom onset or positive test (if asymptomatic) once they are eligible as defined above.

*Previous infection of SARS-CoV-2 is defined as:

A COVID-19 case confirmed by a molecular (for example, PCR) or rapid antigen test; OR
Symptomatic AND a household contact of a confirmed COVID-19 case.

Recommendations are regularly re-examined and issued as new evidence becomes available. For more information on vaccination intervals following infection, review the Ministry of Health COVID-19 Vaccine Third Dose Recommendations (PDF) and Ministry of Health COVID-19 Vaccine Administration guidance (PDF) (link active following posting to Ministry website).

Local vaccination opportunities

Please visit our Vaccination clinics for COVID-19 webpage for information on clinic dates, times, and locations. Clients can attend a walk-in vaccination clinic or book an appointment online at covid-19.ontario.ca/book-vaccine or by calling 705.674.2299 (toll‑free: 1.800.708.2505), between 8 a.m. and 6 p.m., Monday to Friday. Clients can also contact a local participating pharmacy or primary care provider.

Sincerely,

Original Signed By

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

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This item was last modified on February 18, 2022