Â
Considered immune if 2 documented doses of vaccine or positive serologyÂ
Contraindicated if plan to start therapy in < 4 weeks. Contraindicated in pregnancy.
When rapid protection is required, a minimum interval of 4 weeks between the 2 doses is acceptable.
Contraindicated.
Contraindicated if plan to start therapy in < 4 weeks. Contraindicated in pregnancy.
When rapid protection is required, a minimum interval of 4 weeks between the 2 doses is acceptable.
Contraindicated.
Persons who have had shingles in the last year are considered immune.
This vaccine is no longer available and has been replaced by the non-live herpes zoster (Shingrix®) vaccine.
Not recommended. Use inactivated vaccine.
Not recommended. Use inactivated vaccine. Â
Note: The non-live herpes zoster (Shingrix®) vaccine is suggested for all IBD patients who are immunosuppressed age 18 years and older, and strongly recommended for all IBD patients age 50 and older, whether immunosuppressed or not.
Not applicable
Contraindicated (use inactivated vaccine)
Contraindicated.
Not applicable
Contraindicated
Contraindicated. Click here for more details on special populations.
Not applicable. In the context of an active mpox outbreak, vaccination using Imvamune® should be offered to individuals/groups considered at high-risk of mpox.
Individuals receiving pre-exposure vaccination should be offered Imvamune® as a two-dose primary series, with at least 28 days between first and second 0.5 mL sub-cutaneous doses. Individuals considered moderately to severely immunocompromised and eligible for pre-exposure vaccination should be prioritized to receive two doses of Imvamune® administered at the authorized interval (28 days between doses).
Naturally occurring smallpox has been eradicated worldwide and smallpox vaccination is associated with the risk of significant morbidity and even mortality. The overall risk-benefit analysis supports the recommendation to not routinely immunize the general Canadian population against smallpox. As a result, smallpox vaccination is highly restricted.
Not recommended
Considered safe. Pre-exposure prophylaxis can be considered if travelling to high-risk areas. Given possible suboptimal response to vaccine if immunosuppressed, post-exposure prophylaxis with both vaccine and immunoglobulin should be considered in the event of exposure.
Contraindicated if immunosuppressed. Consider injectable inactivated form if indicated.
Contraindicated if immunosuppressed. If travelling to a yellow fever area, consult infectious disease specialist.
RECENT BLOOD TRANSFUSION/IMMUNE GLOBULIN
For travel vaccinations, it is recommended that you consult a travel medicine specialist about immunization questions specific to your destination. Please notify the travel medicine clinic of current medications prescribed.
No
Tetanus diphtheria (Td absorbed) / Tetanus diphtheria acellular pertussis / Tetanus diphtheria acellular pertussis and inactivated polioÂ
(Td/Tdap or DTaP/DTaP-IPV-Hib)
No
Give according to routine schedule.
Tdap booster every 10 years; with Tdap used instead of Td at 14 to 16 years of age.1
Pregnant women should be offered Tdap vaccine to be given at 27 to 32 weeks’ gestation during every pregnancy, irrespective of previous immunization history.
No
No
No
Annual vaccine. Timing of administration should balance nadir of immunosuppression and the need to deliver vaccine prior to the onset of influenza season (usually mid-December).
No
Give according to routine schedule§
In adults, if no prior pneumococcal vaccine:
*PCV-13, PCV-15 and PPSV-23 should not be routinely used in patients at increased risk of invasive pneumococcal disease (IPD) unless PCV-20 is not available (or not funded by the provincial/territorial public health vaccination program)
*Pneu-C-20 should be the product of choice for routine and catch-up immunization in children less than 5 years of age who are at increased risk of IPD. Please refer to Canadian Immunization Guide for recommended schedules.
No
Give according to routine schedule§
In adults, if no prior pneumococcal vaccine:
One-time booster after 5 years (if first vaccine was given at > 10 years of age) or 3 years (if first vaccine given at ≤ 10 years) and immunosuppressed.
*PCV-13, PCV-15 and PPSV-23 should not be routinely used in patients at increased risk of invasive pneumococcal disease (IPD) unless PCV-20 is not available (or not funded by the provincial/territorial public health vaccination program)
*Pneu-C-20 should be the product of choice for routine and catch-up immunization in children less than 5 years of age who are at increased risk of IPD. Please refer to Canadian Immunization Guide for recommended schedules.
No
One-time dose in patients 2 years and older:A
Pneu-C-20 should be the product of choice for routine and catch-up immunization in children less than 5 years of age who are at increased risk of invasive pneumococcal disease (IPD). Please refer to Canadian Immunization Guide for recommended schedules.
PCV20 is currently only covered by private insurance. Coverage may vary based on province
*minimum interval of 8 weeks if rapid completion of series is required
No
Give according to routine schedule.
Vaccinate at-risk patients if none previously.
No
Vaccinate at-risk patients (asplenia, HIV, congenital immunodeficiency).
Â
No
Two doses required: give at 0, 6 to 12 months; or 0, 6 to 18 months.â€
If vaccinated during an immunosuppressed period and patient is in an at-risk group, consider booster when no longer immunosuppressed.
Recommended for at-risk groups (e.g., liver disease such as PSC, travellers, MSM).
Yes
Yes
May be given instead of HAV and HBV individually. Give according to routine schedule.
Â
No
The non-live herpes zoster (Shingrix®) vaccine is suggested for all IBD patients who are immunosuppressed, age 18 years and older and is strongly recommended for all IBD patients age 50 and older, whether immunosuppressed or not.
Adults 50 years of age or older:
Â
There is no information on the use of Shingrix® in pregnant or breast-feeding women. Providers should consider delaying vaccination.
Shingrix® can be given concomitantly with unadjuvanted seasonal influenza vaccine, 23-valent pneumococcal polysaccharide vaccine (PPV23), or reduced antigen diphtheria-tetanus-acellular pertussis vaccine (Tdap).
MSM: males who have sex with males, PSC: primary sclerosing cholangitis, HIV: human immunodeficiency virus
*CDC now recommends 2 doses of HPV vaccine for people starting the vaccination series before the 15th birthday. Three doses of HPV vaccine are recommended for people starting the vaccination series on or after the 15th birthday and for people with certain immunocompromising conditions (CDC October 2016)
§In patients ≥ 5 years where pneumococcal polysaccharide vaccine is indicated, some experts recommend the use of conjugate vaccine prior to administration of polysaccharide vaccine in immunosuppressed patients (regardless of age) to enhance immune response. In these cases, the polysaccharide vaccine should be given at least 8 weeks after the conjugate, wait 5 years then one time revaccination with Pneumovax® 23 booster dose (NACI 2012). Prevnar® 13 is currently not licensed in patients ≥ 5 years of age, although its use is still recommended in high-risk patients. NACI. Update on the Use of Conjugate Pneumococcal Vaccines in Childhood.; 2010. NACI. Statement on the Use of Conjugate Pneumococcal Vaccine – 13 Valent in Adults (Pneu-C-13), 2013.
†The dosage schedule for hepatitis A and hepatitis B vaccines depend on the vaccine used. See vaccine product monograph for instructions. Accelerated schedules are available for some vaccines.
Two (2) doses of Moderna Spikevax XBB.1.5 or 3 doses of Pfizer-BioNTech Comirnaty XBB.1.5 are recommended, with an 8-week interval between doses. An additional dose is recommended for individuals who are moderately to severely immunocompromised, with an interval of 4 to 8 weeks between each dose (see Table 1 for schedules and dosages).
The 8-week interval is longer than the authorized interval and is recommended as a better immune response has been associated with a longer interval between doses. For those who are moderately to severely immunocompromised, the 4 to 8-week interval between doses needs to balance a potentially better immune response with longer intervals with the need for earlier protection due to risk of exposure from circulating SARS-CoV-2 and the risk of severe COVID-19 disease.
Those who are moderately to severely immunocompromised are recommended to receive an additional dose in the primary series compared to those who are not immunocompromised in order to help improve the immune response and vaccine effectiveness in this group (based on data from adults). Those who are moderately to severely immunocompromised generally respond less well to COVID-19 vaccines and are at higher risk for severe illness.
If children 6 months to under 5 years of age started the primary series with a non-XBB.1.5 vaccine (i.e., original monovalent, BA.1 bivalent or BA.4/5 bivalent) but did not complete the series, they should complete the primary series with an XBB.1.5 vaccine (see Table 2).
For children 6 months to under 5 years of age who are moderately to severely immunocompromised, a 3-dose series of the Moderna Spikevax (25 mcg) vaccine is preferred over 4 doses of Pfizer-BioNTech Comirnaty (3 mcg) because there is likely higher acceptability and more feasible implementation due to fewer doses in the schedule using Moderna Spikevax.
A mixed product schedule using vaccines from different manufacturers can be offered for the primary series, however if both Pfizer-BioNTech Comirnaty and Moderna Spikevax vaccine products are used in the same primary series for an individual 6 months to under 5 years of age, the total number of doses in the series should follow the Pfizer-BioNTech Comirnaty schedule (see Table 2).
Children who started the primary series with a non-XBB.1.5 vaccine at less than 5 years of age and turn 5 years of age before completing the series, should receive the number of XBB.1.5 vaccine doses recommended as per Table 2 for those 5 years of age and older (including relevant footnotes). Children who started a primary series with an XBB.1.5 vaccine at less than 5 years of age and turn 5 years of age before completing the primary series, should receive the following with the age-appropriate dosage for their current age:
One dose of XBB.1.5 vaccine is recommended as per the authorized schedule in the product monograph. An additional dose is recommended for individuals who are moderately to severely immunocompromised, with an interval of 4 to 8 weeks between the two doses (see Table 1 for schedules and dosages).
Those who are moderately to severely immunocompromised are recommended to receive an additional dose in the primary series compared to those who are not immunocompromised in order to help improve the immune response and vaccine effectiveness in this group. Those who are moderately to severely immunocompromised generally respond less well to COVID-19 vaccines and are at higher risk for severe illness.
The 4 to 8-week interval for those who are moderately to severely immunocompromised needs to balance a potentially better immune response with the longer interval with the need for earlier protection due to risk of exposure from circulating SARS-CoV-2 and the risk of severe disease. As well, the risk of myocarditis/pericarditis following the second dose has been determined to be lower with longer intervals between doses.
If a person 5 years of age and over started the primary series with a non-XBB.1.5 vaccine (i.e., original monovalent, BA.1 bivalent or BA.4/5 bivalent) but did not complete the series, they should complete the primary series with an XBB.1.5 vaccine based on the total number doses previously recommended (i.e., they should receive a total of 2 COVID-19 vaccine doses in the primary series if not immunocompromised and 3 doses in the primary series if they are immunocompromised) (see Table 2).
For children who started a primary series at less than 5 years of age and turn 5 years of age before completing the primary series, see guidance above for Children 6 months to under 5 years of age.
There is no longer a product preference between Moderna Spikevax and Pfizer-BioNTech Comirnaty with the use of XBB.1.5 COVID-19 vaccines for unvaccinated individuals 12 to 29 years of age. Previously, Pfizer-BioNTech Comirnaty had been preferred over Moderna Spikevax for the primary series among individuals 12 and 29 years of age due to the higher risk of myocarditis/pericarditis observed following the Moderna Spikevax 100 mcg original monovalent vaccine primary series (especially after the second dose). This product preference has now been removed. As compared to the original monovalent primary series, the risk of myocarditis/pericarditis is now expected to be lower due to the use of a 1-dose schedule in most individuals and potentially due to a lower dosage of the available Moderna Spikevax vaccine (50 mcg in the XBB.1.5 formulation compared to 100 mcg in the original monovalent formulation).
mRNA vaccines are the preferred products. It is recommended that a primary series of the authorized protein subunit COVID-19 vaccine (Novavax Nuvaxovid XBB.1.5) should be offered to those 12 year 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.
When offering Novavax Nuvaxovid XBB.1.5 as a primary series to those 12 years of age and older who are moderately to severely immunocompromised, it should be noted that the safety and efficacy has not been established in these individuals. Informed consent for use of Novavax Nuvaxovid XBB.1.5 for those who are moderately to severely immunocompromised should include the above information, and the well- documented evidence on the safety profile and effectiveness of mRNA COVID-19 vaccines in these populations based on real world use with large numbers of individuals.
Age group | Immunization scheduleA | Products | Recommended intervalB |
---|---|---|---|
Schedule for those not moderately or severely immunocompromised | |||
6 months to under 5 years of age |
|
| 8 weeks |
5 years of age and older |
| Moderna Spikevax
Pfizer-BioNTech Comirnaty
| Not applicable |
Schedule for individuals who are moderately to severely immunocompromised | |||
6 months to under 5 years of age |
| As above | 4 to 8 weeks |
5 years of age and older |
| 4 to 8 weeks | |
|
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:Â Managing vaccine administration errors or deviations for additional guidance.
Age | Previous vaccination with only non-XBB.1.5 mRNA COVID-19 vaccines | Number of doses and interval of XBB.1.5 mRNA COVID-19 vaccines to be administered | |
---|---|---|---|
Moderna Spikevax XBB.1.5 scheduleB | Pfizer-BioNTech Comirnaty Omicron XBB.1.5 scheduleC | ||
For those not moderately to severely immunocompromised | |||
6 months to under 5 yearsD | 3 or more doses | See 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 doses | See 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 older | 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 | 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 yearsF | 4 or more doses | See 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 doses | See 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 olderH | 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 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 | |
|
Compared to non-pregnant persons, SARS-CoV-2 infection in pregnancy is associated with increased risk of hospitalization and admission to an intensive care unit (ICU). SARS-CoV-2 infection during pregnancy is also associated with an increased risk in the neonate of preterm birth, low birth weight, and admission to a neonatal intensive care unit (NICU). Vaccination helps to protect the person who is pregnant and vaccination during pregnancy also lowers the risk of hospitalization for their newborn.
People who are pregnant or breastfeeding are recommended to be vaccinated as per the Recommendation for use section, with COVID-19 vaccination recommended for those 5 years of age and older who have not been previously vaccinated. Pregnancy is included in the group of previously vaccinated individuals for whom COVID-19 vaccination is particularly important.
An mRNA vaccine is preferred due to reassuring published data on the safety of these vaccines in pregnancy. COVID-19 vaccines can be given at any stage of pregnancy.
Pregnant or breastfeeding individuals were excluded from COVID-19 vaccine clinical trials. However, analysis of data collected through international COVID-19 immunization registries to date have not revealed any maternal or neonatal safety signals.
Informed consent should include discussion that there is real-world evidence on the safety profile and effectiveness of mRNA vaccination with large numbers of individuals who are pregnant or breastfeeding, but that there is currently limited evidence on the use of the protein subunit vaccine.
Rates of adverse effects are similar in people who are pregnant or breastfeeding and those who are not pregnant or breastfeeding. Studies have not found any impacts of mRNA COVID-19 vaccination on the infant/child being fed human milk or on milk production or excretion. Vaccination during pregnancy does not increase risk for adverse pregnancy/birth outcomes, including miscarriage, stillbirth, low birth weight, preterm birth, and NICU admission.
Evidence suggests that COVID-19 mRNA vaccination during pregnancy results in comparable antibody titres to those generated in non-pregnant women. Maternal IgG humoral response to mRNA COVID-19 vaccines transfers across the placenta to the fetus, leading to a significant and potentially protective antibody titre in the neonatal bloodstream 1 week after the second dose. Infants of people who received the second dose of a primary series or a booster dose during pregnancy had a lower risk of hospitalization with COVID-19 (including Omicron) compared to infants born to individuals who were unvaccinated.
The effect was greater with the booster dose than the second dose in a primary series and if the dose was given later in the pregnancy as opposed to earlier. The protection from maternal vaccination against infant hospitalization decreases over time since birth.
Observational studies consistently show that both anti-spike IgG and IgA are present in breastmilk for at least 6 weeks after maternal vaccination with mRNA vaccines. The protection against disease as a result of breastfeeding is currently unknown.
Individuals who have received a COVID-19 vaccine during pregnancy are encouraged to enroll in a COVID-19 vaccine pregnancy registry (see Table 2).
There is a Canadian COVID-19 Vaccine Registry for Pregnant and Lactating Individuals, hosted at the University of British Columbia and supported by the COVID-19 Immunity Task Force (CITF) to assess the safety and effectiveness of COVID-19 vaccines.
Vaccine product | Registry information |
---|---|
Pfizer-BioNTech Comirnaty® COVID-19 vaccines | Pfizer-BioNTech does not have a vaccine registry for pregnant persons. Individuals who are vaccinated with the Pfizer-BioNTech COVID-19 vaccine during pregnancy are encouraged to enroll into the Canadian COVID-19 Vaccine Registry for Pregnant and Lactating Individuals described above. |
Moderna Spikevax® COVID-19 vaccines | There is a vaccine registry that monitors pregnancy outcomes in persons vaccinated with the Moderna COVID-19 vaccine during pregnancy. Individuals who are vaccinated with the Moderna COVID-19 vaccine during pregnancy are encouraged to enroll in the registry by calling 1-866-MODERNA (1-866-663-3762). |
Novavax Nuvaxovidâ„¢ COVID-19 vaccines | There is a vaccine registry that monitors pregnancy outcomes in persons vaccinated with NUVAXOVID during pregnancy. Individuals who are vaccinated with NUVAXOVID during pregnancy are encouraged to enroll in the registry by visiting C-VIPER: COVID-19 Vaccines International Pregnancy Exposure Registry. |
Yes
Safe to give to family members.
Yes
Approximately 5% of vaccinated patients develop a vesicular rash. Immunosuppressed persons should avoid contact with the family member when the rash is present. Post-exposure prophylaxis (see below) is recommended, as it is not possible to differentiate between rash from vaccine and true varicella infection.
Yes
Limited data on excretion of live rotavirus in stool after vaccination but the inoculum is likely less than with active infection. Need to consider risks and benefits. If vaccine is given to family members, good hand hygiene should be practised to prevent theoretical transmission.
Yes
Oral typhoid vaccine is not known to result in live vaccine-strain typhoid being shed in the stool of healthy subjects and there is no documented secondary transmission.
Yes
Safe to give to family members.