COVID-19 Vaccines

• Children six-months to under five-years old are recommended to receive XBB vaccine to initiate or complete a primary series.
• Children must be at least six-months old at the time of vaccination.
• These vaccines are two-dose or three-dose series.
• The recommended interval between the two doses is 56 days as this time period provides a stronger immune response and may reduce the risk of myocarditis or pericarditis.

• Children five to 11-years old who have not been previously vaccinated against COVID-19, are recommended to receive an XBB vaccine. This vaccine is a one-dose series for this age group.
• Regardless of which product is offered to start a vaccine series, the previous dose should be counted, and the series need not be restarted.

• Individuals 12-years of age and older who have not been previously vaccinated against COVID-19, are recommended to receive an XBB vaccine. This vaccine is a one-dose series for this age group.
• Regardless of which product is offered to start a vaccine series, the previous dose should be counted, and the series need not be restarted.
• Individuals 12-years of age and older who are not able or willing to receive an mRNA COVID-19 vaccine can receive Novavax to initiate or complete their primary series. An XBB formulation of Novavax COVID-19 vaccine is expected later this fall.

Immunocompromised individuals who have been previously vaccinated are strongly recommended to receive an XBB COVID-19 vaccine this fall if it has been six months since a previous dose or confirmed SARS-CoV2 infection.

Who: Individuals six months of age and older (must be at least six months of age at the time of vaccination) with one of the medical conditions listed below:

• Individuals receiving dialysis (hemodialysis or peritoneal dialysis).
• Individuals receiving active treatment (e.g., chemotherapy, targeted therapies, immunotherapy) for solid tumour or hematologic malignancies. Active treatment includes patients who have completed treatment within 3 months.
• Recipients of solid-organ transplant and taking immunosuppressive therapy.
• Recipients of chimeric antigen receptor (CAR)-T-cell therapy or hematopoietic stem cell transplant (within 2 years of transplantation or taking immunosuppression therapy).
• Individuals with moderate to severe primary immunodeficiency (e.g., DiGeorge syndrome, Wiskott-Aldrich syndrome).
• Individuals with HIV with prior AIDS defining illness or prior CD4 count ≤ 200/mm3 or prior CD4 fraction ≤ 15% or (in children six months to 11-years old) perinatally acquired HIV infection.

First, second and third dose interval: Minimum 56 days between each dose.

Proof of eligibility requirement: Verbally attest to have a listed medical condition.

How to receive vaccine: Before vaccination, these individuals should discuss their vaccine plans with their health care providers to check if it will affect their treatment.

Who: Individuals five years of age and older (must be at least five years of age at time of immunization) receiving active treatment with the following categories of immunosuppressive therapies: anti-B cell therapies* (monoclonal antibodies targeting CD19, CD20 and CD22), high-dose systemic corticosteroids (refer to the CIG for suggested definition of high dose steroids), alkylating agents, antimetabolites, or tumor-necrosis factor (TNF) inhibitors and other biologic agents that are significantly immunosuppressive.

*Active treatment for patients receiving B-cell depleting therapy includes patients who have completed treatment within 12 months.

First, second and third dose interval: Minimum 56 days between each dose.

Proof of eligibility requirement: Verbally attest to receiving listed immunosuppressant medications or therapies.

How to receive vaccine: Before vaccination, these individuals should discuss their vaccine plans with their health care providers to check if it will affect their treatment.

See information on what is considered fully vaccinated in Ontario.

Individuals should receive all recommended doses (including booster doses) to stay up to date with their COVID 19 vaccines. See our frequently asked questions for more information.

An enhanced vaccine certificate with QR code is required as proof of vaccination

• Individuals with a green photo health card can download or print a vaccine certificate, with QR code by visiting the COVID-19 Vaccination Portal.
• If you do not have computer, a photo health card, or need help, call the Provincial Vaccine Contact Centre at 1-833-943-3900 to request a copy of your vaccine certificate by email or mail.

For more information visit the COVID-19 Vaccination Portal.

Not all children have only mild symptoms. Vaccination is the preferred and safest method to provide additional protection for all children, including those six-months to under five-years old. Having children vaccinated also provides further protection to their family members, especially if they have family members who are at risk for more severe illness.

Even if a child has already had COVID-19, vaccination is still important. While infection alone provides some protection, vaccination after infection helps further improve the immune response.

COVID-19 vaccines, like all medicines can cause side effects, although not everyone may experience them. The most frequently reported short-term side effects for children following the COVID-19 vaccine include redness and pain at injection site, fatigue, headache, chills, muscle aches and loss of appetite. These side effects are typically mild to moderate and on average did not last longer than three days.

We know it’s normal for kids to be anxious about getting needles. Here are some tips:

Before the appointment:

• Talk about what to expect (explain that the needle might feel like a pinch that only lasts a few seconds).
• Explain why the vaccine is important (to them, to their family, to school mates, etc.).
• Talk to them about what might work best for them. Is it a favourite stuffy? Do they need to listen to music or play a game on your phone/table to help keep them distracted?

During the appointment:

• Stay calm yourself! Children see and feel what their parents are doing. Speak in a positive, normal voice to help calm your child. Demonstrate a calm optimistic presence. Take slow breaths before, during and after the needle together.
• If your child is small enough, you can hold them on your lap while they get their vaccine.
• Practice deep breathing exercises together. For example - try square breathing. Picture a square. Each inhale lasts four seconds and is one side of the square, moving clockwise and alternating.
• If using distraction, choose a distraction that involves multiple senses (sight, hearing and touch).

The Health Department also encourages you to look at the CARD system to help your children through the vaccine process. Comfort Ask Relax and Distract. Get more information from the Government of Ontario's resource Nervous About Getting Needles? Immunizers at our clinics are familiar with the CARD system.

• Children with severe food, insect bite and medication allergies should receive the COVID-19 vaccine and will be monitored for a longer period at the clinic after getting their vaccine.
• COVID-19 vaccines do not contain preservatives, antibiotics, adjuvants, common food allergens, human materials, and animal derived materials.

Up to two thirds of children experience some type of fear of needles. Some tips for parents and caregivers to help reduce pain and fear of needles include:

• Preparing your child before the appointment.
• Use of topical anesthetics prior to vaccination (discuss application with your child’s pharmacist or health care provider).
• Your presence as a parent or caregiver to offer support during vaccination.
• Letting your child sit on your lap if possible.
• Distraction such as toy, singing, special object, counting or electronic device.
• Being honest. For example., Instead of saying, "the needle won’t hurt", you could say, "some people feel pressure or a pinch".
• Encouraging your child to relax their arm and be still
• Remaining calm and positive

Please speak to your child’s health care provider if you have questions or concerns about pain management and needle fear.

If your child has a high fever (over 40°C or 104°F) or side effects that are worrying you or do not seem to be going away after a few days, contact your child’s health care provider or seek medical attention.

Go to the nearest emergency department or call 911 if they have serious drowsiness, seizures/convulsions, hives, swelling of the face, throat or mouth, trouble breathing or other serious symptoms.

Seek medical attention if your child develops any of the following symptoms after receiving the vaccine: chest pain, shortness of breath and/or palpitations (pounding or racing heart) or feeling of a rapid or abnormal heart rhythm. These may be symptoms of myocarditis (inflammation of the heart muscle) or pericarditis (inflammation of the sac of the heart), which is very rare and treatable.

• The Ontario Ministry of Health recommends a dose of the XBB containing COVID-19 mRNA vaccine for individuals six-months and older who have been previously vaccinated against COVID-19, if it has been six months from the previous COVID-19 vaccine dose or known SARS-CoV-2infection. Individuals who have not been previously vaccinated, may use the XBB containing COVID-19 vaccine to initiate the series.
• Data has shown the new XBB vaccine formulation generates a stronger immune response to these more recent variants.
• The Novavax vaccine may be offered to eligible individuals who are not able or not willing to receive an mRNA COVID-19 vaccine.

A limited amount of Novavax vaccine is available for eligible adults. An XBB.1.5 formulation of Novavax COVID-19 vaccine is expected later this fall.

• Who is eligible: Individuals 12 years and older who are not able or not willing to receive an mRNA COVID-19 vaccine.
• How to book: Call the Health Department’s call center at 1-888-444-5113 to book an appointment.

Online appointment booking and walk-ins for the Novavax COVID-19 vaccine are not available.

Some people may experience side effects from the vaccine, but these will likely be mild and resolve after a few days. Some of the symptoms are part of the body's response to developing immunity.

Common side effects reported in clinical trials for these vaccines include:

• Pain, tenderness, itchiness, redness or swelling at the injection site
• Headache
• Tiredness or feeling unwell
• Muscle or joint pain
• Fever or chills
• Nausea
• Swelling or tenderness under the armpit (Moderna only)
• Vomiting or diarrhea

In rare cases, serious allergic reactions (anaphylaxis) can occur. Seek immediate medical attention if you have trouble breathing, have hives, or swelling of the face and throat.

Rare cases of myocarditis (inflammation of the heart muscle) and/or pericarditis (inflammation of the lining around the heart) have been reported following vaccination with COVID-19 mRNA vaccines.

If you have a reaction to the vaccine, contact your health care provider who will report the side effect directly to the health department. The health department will keep track of the reported side effects to make sure the vaccine continues to be safe.

mRNA vaccines (Pfizer and Moderna)

• Yes, the National Advisory Committee on Immunization (NACI) recommends that regardless of which product is offered to start a primary series, the series can be safely completed with another mRNA vaccine.
• Vaccine interchangeability can apply to XBB containing COVID-19 vaccines if used to complete a vaccine series started with a different formulation (either original monovalent or bivalent vaccine).
• Mixing COVID-19 vaccines is safe, effective, and enables Ontarians to benefit from the protection of a booster dose.

Novavax Nuvaxovid®

Individuals may receive mixed doses of Novavax Nuvaxovid® and mRNA vaccines. If receiving a mixed primary series or additional booster doses with the Novavax vaccine, informed consent should include a discussion of the benefits and potential risks given the currently limited data on the effectiveness and safety of mixed schedules with the Novavax vaccine.

No. The COVID-19 vaccines do not contain mercury, formaldehyde, aluminum or fetal cells.

• In rare instances where the risks of COVID-19 vaccine administration outweigh the benefits, a medical exemption may be warranted. This occurs in consultation with your health care provider.
• Generally, few actual contraindications to COVID-19 vaccines qualify as medial exemptions, and most individuals can safely receive COVID-19 vaccines.
• As of March 1, 2022, Ontario no longer requires businesses and organizations to check for proof of vaccination or medical exemption. Individual businesses and organizations may choose to require proof of vaccination upon entry.
• Consult your health care provider (physician or nurse practitioner) to assess your need for a medical exemption. If the health care provider determines there is a need, they will submit information directly to the Health Department for review.
• Exemptions will only be accepted from practitioners licenced to practice in Ontario.
• If you would like to obtain a QR code, contact your health care provider as submission to the Health Department is required to obtain a QR code.
• Your consent is required for the collection, use and disclosure of your personal health information with the Health Department.
• Learn more about medical exemptions, including who qualifies.

In most circumstances, further doses of mRNA COVID-19 vaccines should be deferred for people who experienced myocarditis (with or without pericarditis) within six weeks of receiving a previous dose of an mRNA COVID-19 vaccine.

Individuals with a history of pericarditis and who either had no cardiac investigation or normal cardiac investigations, can receive the next dose once they are symptom free and at least 90 days has passed since vaccination.

The National Advisory Committee on Immunization (NACI), Public Health Ontario (PHO), and the Ontario Ministry of Health (MOH) are following this closely and will update this recommendation as more evidence becomes available.

Since all Health Canada authorized COVID-19 vaccines are not live vaccines, they are considered safe in autoimmune conditions and immunocompromised persons (due to disease or treatment), however there is limited data on efficacy.

Individuals who were immunocompromised due to disease or treatment were excluded from some of the Phase III trials for COVID-19 vaccines available at present and those with autoimmune conditions had very small representation.

A three-dose primary series is recommended for moderately to severely immunocompromised individuals with the aim of enhancing the immune response and establishing an adequate level of protection.

Third doses and booster doses strengthen the protection of those who may have a weaker immune response after two doses and are at higher risk of serious complications from COVID-19.

Some immunocompromised individuals may be eligible for additional dose(s) following a discussion with your health care provider.

For more information, visit three-dose primary series and boosters for individuals who are immunocompromised.

Although pregnant and breastfeeding people were not a part of clinical trials for any of the vaccines, real world evidence shows that mRNA vaccines (Moderna or Pfizer) are safe for this population. A review following vaccination of over 35,000 pregnant women in the United States demonstrated that these women developed strong immunity without safety issues.

The National Advisory Committee on Immunization (NACI) strongly recommends that pregnant or breastfeeding individuals receive a complete mRNA vaccine series.

See the COVID-19 vaccines in pregnancy website for more information about vaccination during pregnancy and while breastfeeding.

There is no need to avoid pregnancy following vaccination with mRNA vaccines.

The Scarborough Health Network’s VaxFacts Clinic, in partnership with Scarborough Health Network’s VaxFacts, is available to support people who are pregnant, breastfeeding or planning to conceive. Book a 1:1 appointment to discuss your questions or concerns related to the COVID-19 vaccine.

COVID-19 Vaccination in Pregnancy and Breastfeeding Clinical Support Tool

1. If you have a history of significant allergic reactions and/or anaphylaxis to any food, drug, venom, latex, or other allergens not related to mRNA vaccines, you can be vaccinated with and will be asked to wait 30 minutes for observation after you receive your vaccine.

2. If you have allergy issues such as allergic rhinitis, asthma or eczema, you can be vaccinated, and will be asked to wait 15 to 30 minutes after your vaccine for observation.

3. If you have had an allergic reaction and/or anaphylaxis that occurred after a vaccine, an investigation will need to be done by your local health department. If you have a history of a reaction to a vaccine outside of the normal side effects, please phone the Durham Health Connection Line to have them initiate an investigation.

4. If you have had an allergic reaction including anaphylaxis to a component of a COVID-19 mRNA vaccine, you should not receive any COVID-19 mRNA vaccine in a general vaccine clinic. Please contact your health care provider to assess your need to receive a COVID-19 mRNA vaccine in a controlled setting.
   
   If you experienced an allergic reaction including anaphylaxis following a COVID-19 mRNA vaccine, an investigation will need to be completed by your local health department. Please phone the phone the Durham Health Connection Line to have them initiate an investigation. Contact your health care provider to assess your need for a medical exemption.

Seek medical attention if you have trouble breathing, develop hives, or develop swelling of the face and throat. As with all vaccines, vaccine side effects will continue to be monitored as people receive the vaccine.

If you develop a reaction to the vaccine, contact your health care provider. Please phone the Durham Health Connection Line to have them initiate an investigation. Public health will keep track of the reported side effects to make sure the vaccine continues to be safe.