Vaccination Guide for
Immunosuppressed Patients with IBD

COVID-19

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For individuals who have previously been vaccinated with a complete primary series that did not include an XBB.1.5 COVID-19 vaccine, a dose of XBB.1.5 COVID-19 vaccine is recommended 6 months following previous COVID-19 vaccination or SARS-CoV-2 infection (whichever is later). Shorter intervals (i.e., 3 months to less than 6 months) following previous vaccination or infection have also not been shown to pose a safety risk (see Table 2).

Individuals whose primary series includes the XBB.1.5 COVID-19 vaccine do not require further doses at this time once the series is complete.

An mRNA COVID-19 vaccine dose is preferred for those previously vaccinated. However, Novavax Nuvaxovid XBB.1.5 should be offered to individuals 12 years of age and older who are not able or willing to receive an mRNA COVID-19 vaccine. Preference of mRNA vaccines over the protein subunit vaccine is due to the availability of more data with regard to the benefits and risks of mRNA vaccines compared to the protein subunit vaccine. Recommendations regarding the use of the protein subunit vaccine are currently under review by NACI. Both the original mRNA vaccines and Novavax Nuvaxovid original have been associated with a rare risk of myocarditis/pericarditis. Data is not yet available for XBB.1.5 vaccines.

For information on the management of errors and deviations, see PHAC’s resource: Quick reference guide on the use of COVID-19 vaccines: Managing vaccine administration errors or deviations for additional guidance.

Table 2. Summary of number of recommended XBB.1.5 mRNA COVID-19 vaccine doses based on previous non-XBB.1.5 vaccination history (i.e., previously received original monovalent or BA.1 bivalent or BA.4/5 bivalent vaccines (non-XBB.1.5)A
AgePrevious vaccination with only non-XBB.1.5 mRNA COVID-19 vaccinesNumber of doses and interval of XBB.1.5 mRNA COVID-19 vaccines to be administered
Moderna Spikevax XBB.1.5 scheduleBPfizer-BioNTech Comirnaty Omicron XBB.1.5 scheduleC
For those not moderately to severely immunocompromised
6 months to under 5 yearsD3 or more dosesSee 2 or more doses

1 dose

6 months from last dose

Shorter intervals (i.e., 3 months to less than 6 months) have also not been shown to pose a safety risk

2 or more doses

1 dose

6 months from last dose

Shorter intervals (i.e., 3 months to less than 6 months) have also not been shown to pose a safety risk

See 2 doses or 3 or more doses, as applicable
2 dosesSee 2 or more doses

1 dose

8 weeks from last dose

1 dose

1 dose

8 weeks from last dose

2 doses

8 weeks from last dose and between doses

5 years of age and older2 or more doses

1 dose

6 months from last dose

Shorter intervals (i.e., 3 months to less than 6 months) have also not been shown to pose a safety risk

1 doseE

6 months from last dose

Shorter intervals (i.e., 3 months to less than 6 months) have also not been shown to pose a safety risk

1 dose

1 dose

8 weeks from last dose

1 dose

8 weeks from last dose

For those who are moderately to severely immunocompromised
6 months to under 5 yearsF4 or more dosesSee 3 or more doses

1 dose

6 months from last dose

Shorter intervals (i.e., 3 months to less than 6 months) have also not been shown to pose a safety risk

3 or more doses

1 dose

6 months from last dose

Shorter intervals (i.e., 3 months to less than 6 months) have also not been shown to pose a safety risk

See 3 doses or 4 or more doses, as applicable
3 dosesSee 3 or more doses

1 dose

4 to 8 weeks from last dose

2 doses

1 dose

4 to 8 weeks from last dose

Moderna is preferredF

2 doses

4 to 8 weeks from last dose and between doses

1 dose

2 doses

4 to 8 weeks from last dose and between doses

Moderna is preferredF

3 doses

4 to 8 weeks from last dose and between doses

5 years of age and olderH3 or more doses

1 dose

6 months from last dose

Shorter intervals (i.e., 3 months to less than 6 months) have also not been shown to pose a safety riskH

1 doseE,G

6 months from last doseG

Shorter intervals (i.e., 3 months to less than 6 months) have also not been shown to pose a safety risk

2 doses

1 dose

4 to 8 weeks from last dose

1 doseG

4 to 8 weeks from last dose

1 dose

2 doses

4 to 8 weeks from last dose and between doses

2 doses

4 to 8 weeks from last dose and between doses

A  Further details on the recommendations on the use of the XBB.1.5-containing COVID-19 vaccines in previously vaccinated individuals are available in the NACI Guidance on the use of COVID-19 vaccines in the fall of 2023 and the subsequent Addendum to the guidance on the use of COVID-19 vaccines in the fall of 2023.

 


B
  Note for the primary series for children 6 months to under 5 years of age: Follow this column if all past vaccine doses have been Moderna Spikevax vaccines and now also administering Moderna Spikevax XBB.1.5.

 

C  Note for the primary series for children 6 months to under 5 years of age: Follow this column if now administering Pfizer-BioNTech Comirnaty Omicron XBB.1.5, or if one or more past vaccine doses have been Pfizer-BioNTech Comirnaty vaccines (whether giving Pfizer-BioNTech Comirnaty Omicron XBB.1.5 or Moderna Spikevax XBB.1.5 now).

 

D  Children 6 months to under 5 years of age who are at high risk for severe illness due to COVID-19 should be vaccinated against COVID-19 with a primary series and other children in this age group may be vaccinated.

 

E  Children who are not immunocompromised and started their primary series with 2 doses of a non-XBB.1.5 Pfizer-BioNTech product when they were less than 5 years of age and are completing their primary series at 5 years of age or older, are recommended to receive a total of 3 doses of COVID-19 vaccine in their primary series.

 

F  For those 6 months to under 5 years of age who are moderately to severely immunocompromised, Moderna Spikevax is preferred because it requires only 3 doses, while Pfizer-BioNTech Comirnaty requires 4 doses.

 

G  Children who are moderately to severely immunocompromised and started their primary series with 2 or 3 doses of a non-XBB.1.5 Pfizer-BioNTech product (not the preferred product) when they were less than 5 years of age and are completing their primary series at 5 years of age or older, are recommended to receive a total of 4 doses of COVID-19 vaccine in their primary series.

 

H If the primary series was started with non-XBB1.5 COVID-19 vaccine(s), those 5 years of age and older who are moderately to severely immunocompromised are recommended to receive a total of 3 doses of COVID-19 vaccines for the primary series.