General Information
mRNA COVID-19 vaccines now contain one strain, XBB.1.5.
- General Eligibility
- mRNA COVID-19 XBB.1.5 vaccine is available to all individuals 6 months and older.
- It is highly recommended that the following populations receive this vaccine:
- individuals 50 years and older
- residents of long-term care and other congregate living settings, including personal care homes and shelters
- individuals 6 months and older with underlying medical conditions that place them at higher risk of severe COVID-19 (see Vulnerable Populations→ Underlying Medical Conditions below)
- pregnant individuals
- Indigenous peoples and those living in northern and remote communities
- health care workers, first responders, caregivers, and other essential service workers
- Individuals 5 years and older who are not immunocompromised may receive one dose, regardless of number and type of previous COVID-19 vaccines. The dose may be administered at least 6 months (minimum 3 months) following last COVID-19 vaccine dose or SARS-CoV-2 infection, whichever is later.
- For the purposes of vaccinating those living in personal care homes, long term care and other senior congregate living facilities (i.e., assisted living facilities), the vaccine can be administered less than 3 months (no minimum interval) after the last dose or infection.
- The number of doses varies for those 5 years and older who are moderately to severely immunocompromised based on number of previous doses received. See respective vaccine information in Details of COVID-19 Vaccines Available in SK for number of doses and intervals.
- The dose should be chosen according to vaccine recipient's age at presentation.
- Exception: Children who turn 5 during a series seeking Pfizer-BioNTech Comirnaty® should be referred to Public Health for the 3 mcg dose.
- Pharmacy professionals are permitted to immunize those 5 years and older.
- Refer out-of-province individuals or those who do not have valid Saskatchewan health services card to Public Health.
- The eHR Viewer needs to be checked for all individuals to confirm vaccine status.
Details of COVID-19 Vaccines Available in SK
- Moderna Spikevax® XBB.1.5 ≥ 6 Months (Royal Blue Cap, Coral Blue Font)
Indication
- Health Canada: immunization against COVID-19 in those 6 months of age and older.
- Pharmacy professionals are not permitted to provide immunizations to children under 5 years of age.
Administration
- Give doses IM (deltoid)
Dose and Interval
Dose
- ≥ 12 Years
- 0.5 mL (50 mcg mRNA)
- 0.5 mL (50 mcg mRNA)
- ≥ 5 Years to < 12 Years
- 0.25 mL (25 mcg mRNA)
- Children who transition from 4 to 5 years between doses should complete the series as per the ≥ 6 month to < 5 years schedule, according to vaccination history. Age-appropriate Spikevax® XBB.1.5 or Comirnaty® Omicron XBB.1.5 can be used to complete the series; the number of doses required to complete the series varies based on the brand(s) of vaccine previously received. See the Saskatchewan Immunization Manual - Chapter 10 → XBB.1.5 COVID-19 Vaccine Schedules for details.
- ≥ 6 Months to < 5 Years
- 0.25 mL (25 mcg mRNA)
- Pharmacy professionals are not permitted to immunize those under 5 years of age.
Number of Doses and Interval
Table 1: Number of Doses and Interval of Moderna Spikevax® XBB.1.5 for Non-Immunocompromised Individuals 5 Years and Older (Regardless of Number and Type of Previous COVID-19 Vaccine Received) Age Number of XBB.1.5
Doses RequiredInterval ≥ 12 Years 1 ≥ 6 months (minimum 3 months)
from last COVID-19 vaccine dose or
SARS-CoV-2 infection, whichever is later.†≥ 5 Years¥ to < 12 Years ¥ Children who transition from 4 to 5 years old between Moderna Spikevax® XBB.1.5 doses should complete the series as per the ≥ 6 month to < 5 years schedule, according to vaccination history. See the Saskatchewan Immunization Manual - Chapter 10 → XBB.1.5 COVID-19 Vaccine Schedules for details.
† For the purposes of vaccinating those living in personal care homes, long term care and other senior congregate living facilities (i.e. assisted living facilities), the vaccine can be administered less than 3 months (no minimum interval) after the last dose or infectionTable 2: Number of Doses and Interval of Moderna Spikevax® XBB.1.5 for Moderately to Severely Immunocompromised Individuals 5 Years and Older¥,† COVID-19 Vaccine History
(original monovalent and/or bivalent vaccinesNumber of XBB.1.5 Doses Required Interval Between Last Dose and First XBB.1.5 Dose* Interval Between XBB.1.5 Doses* 0 doses 3 Not applicable 4-8 weeks 1 dose 2 4-8 weeks 4-8 weeks 2 doses 1 4-8 weeks Not applicable 3 or more doses 1 6 months (min 3 months) Not applicable ¥ Children who transition from 4 to 5 years old between Moderna XBB.1.5 doses should complete the series as per the ≥ 6 month to < 5 years schedule, according to vaccination history. See the Saskatchewan Immunization Manual - Chapter 10 → XBB.1.5 COVID-19 Vaccine Schedules for details.
† Additional considerations apply to candidates and recipients of solid organ transplants and hematopoietic stem cell transplants. Refer to COVID-19 Vaccine Contraindications and Precautions Background Document or Vulnerable Populations → HSCT / SOT.
*An interval of 6 months (minimum 3 months) is recommended from previous SARS-CoV-2 infection. For the purposes of vaccinating those living in personal care homes, long term care and other senior congregate living facilities (i.e. assisted living facilities), the vaccine can be administered less than 3 months (no minimum interval) after the last dose or infection.
Adverse Events
- Clinical information is from a booster dose study of Spikevax® XBB.1.5 in individuals 18 years and older as well as earlier formulations as primary series and booster doses in individuals 6 months and older.
- Common adverse events (≥ 10%)
- local reactions (pain, axillary swelling/tenderness, redness)
- "COVID arm” is a local delayed (≥ 7 days) reaction with these symptoms; it is an expected reaction that resolves within 7 -10 days. This does not need to be reported as an AEFI/AESI.
- fatigue
- headache
- myalgia
- arthralgia
- chills
- fever
- nausea/vomiting
- decreased appetite
- enlarged lymph nodes
- hypoaesthesia (decreased sense of touch or sensation, numbness) or paraesthesia (tingling, itching or pricking sensation)
- dizziness
- local reactions (pain, axillary swelling/tenderness, redness)
- Rare adverse events
- Anyone experiencing symptoms associated with the conditions below should seek medical attention.
- Myocarditis and pericarditis are less frequent in children < 12 years old and were not reported in clinical trials.
- Symptoms may include chest pain, shortness of breath, irregular or fast/pounding heartbeat.
- Anaphylaxis is very rare but has been reported, in most cases, within 30 minutes of vaccination.
- Symptoms may include hives; swelling of face, tongue, or throat; difficulty breathing.
- Bell's palsy has been reported in a small number of adults; symptoms typically resolve within a month.
- Symptoms may include weakness or paralysis on one side of the face.
- Myocarditis and pericarditis are less frequent in children < 12 years old and were not reported in clinical trials.
- Anyone experiencing symptoms associated with the conditions below should seek medical attention.
Product Information
- Product monograph: Spikevax® XBB.1.5
Non-medicinal Ingredients
- acetic acid
- cholesterol
- DSPC (1,2-distearoyl-sn-glycero-3-phosphocholine)
- Lipid SM-102
- PEG2000-DMG (1,2-dimyristoyl-rac-glycerol,methoxy-polyethyleneglycol)
- sodium acetate trihydrate
- sucrose
- trometamol
- trometamol hydrochloride
- water for injection
Polyethylene glycol (PEG) and trometamol (tromethamine) are potentially allergenic ingredients.
Specific Reference
- Moderna
Last Updated: 01 Nov 2023
- Health Canada: immunization against COVID-19 in those 6 months of age and older.
- Pfizer BioNTech Comirnaty® Omicron XBB.1.5 ≥ 5 Years to < 12 Years (Blue Cap, Blue Label)
Indication
- Health Canada: immunization against COVID-19 in those ≥ 5 years to < 12 years
Administration
- Give doses IM (deltoid)
Dose
- 0.3 mL (10 mcg mRNA)
- Note: the dose volume to deliver 10 mcg is different from previous formulations of Pfizer BioNTech Comirnaty® vaccine for this age group.
Interval
Non-Immunocompromised Individuals
- ≥ 6 months (minimum 3 months) from last COVID-19 vaccine dose or SARS-CoV-2 infection, whichever is later.
- For the purposes of vaccinating those living in personal care homes, long term care and other senior congregate living facilities (i.e., assisted living facilities), the vaccine can be administered less than 3 months (no minimum interval) after the last dose or infection.
- Children who transition from 4 to 5 years old between doses should complete the series as per the ≥ 6 month to < 5 years schedule, depending on vaccination history. See the Saskatchewan Immunization Manual - Chapter 10 → XBB.1.5 COVID-19 Vaccine Schedules for details.
- The series can be completed using either the Comirnaty® Omicron XBB.1.5 3 mcg (maroon cap, > 6 months to < 5 years) or Spikevax® XBB.1.5 25 mcg (0.25ml) vaccines.
- The schedule (number of doses required) for the vaccine initially used needs to be followed (i.e., if age transition occurs during Comirnaty® vaccination series, follow the Comirnaty® schedule to complete series using either vaccine).
- Pfizer 3 mcg maroon cap is only available through Public Health.
- The series can be completed using either the Comirnaty® Omicron XBB.1.5 3 mcg (maroon cap, > 6 months to < 5 years) or Spikevax® XBB.1.5 25 mcg (0.25ml) vaccines.
Moderately to Severely Immunocompromised Individuals
Table 1: Number of Doses and Interval of Pfizer-BioNTech Comirnaty® Omicron XBB.1.5 for Moderately to Severely Immunocompromised Individuals 5 Years and Older¥,† COVID-19 Vaccine History
(original monovalent
and/or bivalent vaccines)Number of XBB.1.5 Doses Required Interval Between Last Dose and First XBB.1.5 Dose* Interval Between XBB.1.5 Doses* 0 doses 3 Not applicable 4-8 weeks 1 dose 2 4-8 weeks 4-8 weeks 2 doses 1 4-8 weeks Not applicable 3 or more doses 1 6 months (min 3 months) Not applicable ¥ Children who transition from 4 to 5 years old between doses should complete the series as per the ≥ 6 month to < 5 years schedule, depending on vaccination history See the Saskatchewan Immunization Manual - Chapter 10 → XBB.1.5 COVID-19 Vaccine Schedules for details.
- The series can be completed using either the Comirnaty® Omicron XBB.1.5 3 mcg (maroon cap, > 6 months to < 5 years) or Spikevax® XBB.1.5 25 mcg (0.25ml) vaccines.
- The schedule (number of doses required) for the vaccine initially used needs to be followed (i.e., if age transition occurs during Comirnaty® vaccination series, follow the Comirnaty® schedule to complete series using either vaccine).
- Pfizer 3 mcg maroon cap is only available through Public Health.
† Additional considerations apply to candidates and recipients of solid organ transplants and hematopoietic stem cell transplants. Refer to COVID-19 Vaccine Contraindications and Precautions Background Document or Vulnerable Populations → HSCT / SOT.*An interval of 6 months (minimum 3 months) is recommended from previous SARS-CoV-2 infection. For the purposes of vaccinating those living in personal care homes, long term care and other senior congregate living facilities (i.e., assisted living facilities), the vaccine can be administered less than 3 months (no minimum interval) after the last dose or infection.
Adverse Events
- Clinical data are based on monovalent and bivalent Pfizer-BioNTech Comirnaty® formulations.
- Common adverse events included:
- More common
- local reactions: pain at injection site, redness, and swelling
- “COVID arm” is a local delayed (≥ 7 days) reaction with these symptoms; it is an expected reaction that resolves within 7-10 days. This does not need to be reported as an AEFI/AESI.
- fatigue
- headache
- muscle pain
- chills
- fever
- joint pain
- diarrhea
- nausea
- vomiting
- enlarged lymph nodes
- local reactions: pain at injection site, redness, and swelling
- Less common (<10%) adverse events
- excessive sweating
- night sweats
- malaise
- Rare adverse events
- Anyone experiencing symptoms associated with the conditions below should seek medical attention.
- Myocarditis and pericarditis are less frequent in children < 12 years old and were not reported in clinical trials.
- Symptoms may include chest pain, shortness of breath, irregular or fast/pounding heartbeat.
- Anaphylaxis is very rare but has been reported, in most cases, within 30 minutes of vaccination.
- Symptoms may include hives; swelling of face, tongue, or throat; difficulty breathing.
- Bell’s palsy has been reported in a small number of adults; symptoms typically resolve within a month.
- Symptoms may include weakness or paralysis on one side of the face.
- Myocarditis and pericarditis are less frequent in children < 12 years old and were not reported in clinical trials.
- Anyone experiencing symptoms associated with the conditions below should seek medical attention.
- More common
Product Information
- Product monograph: Comirnaty® Omicron XBB.1.5
Non-Medicinal Ingredients
- ALC-0315 = ((4-hydroxybutyl) azanediyl)bis (hexane-6,1-diyl)bis(2-hexyldecanoate)
- ALC-0159 = 2-[(polyethylene glycol)-2000]-N,N-ditetradecylacetamide
- Cholesterol
- DSPC = 1,2-distearoyl-sn-glycero-3-phosphocholine
- sucrose
- tromethamine
- tromethamine hydrochloride
- water for injection
Polyethylene glycol (PEG) and tromethamine are potentially allergenic ingredients.
Specific Reference
- Pfizer-BioNTech
Last updated: 01 Nov 2023
- Pfizer BioNTech Comirnaty® Omicron XBB.1.5 ≥ 12 Years (Grey Cap, Grey Label)
Indication
- Health Canada: immunization against COVID-19 in those ≥ 12 years
Administration
- Give doses IM (deltoid)
Dose
- 0.3 mL (30 mcg mRNA)
Interval
Non-Immunocompromised Individuals
- ≥ 6 months (minimum 3 months) from last COVID-19 vaccine dose or SARS-CoV-2 infection, whichever is later.
- For the purposes of vaccinating those living in personal care homes, long term care and other senior congregate living facilities (i.e., assisted living facilities), the vaccine can be administered less than 3 months (no minimum interval) after the last dose or infection.
Moderately to Severely Immunocompromised Individuals
Table 1: Number of Doses and Interval of Pfizer-BioNTech Comirnaty® Omicron XBB.1.5 for Moderately to Severely Immunocompromised Individuals 12 Years and Older† Interval Between XBB.1.5 Doses*(original monovalent and/or bivalent vaccines) Number of XBB.1.5 Doses Required Interval Between Last Dose and First XBB.1.5 Dose* Interval Between XBB.1.5 Doses* 0 doses 3 Not applicable 4-8 weeks 1 dose 2 4-8 weeks 4-8 weeks 2 doses 1 4-8 weeks Not applicable 3 or more doses 1 6 months (min 3 months) Not applicable † Additional considerations apply to candidates and recipients of solid organ transplants and hematopoietic stem cell transplants. Refer to the COVID-19 Vaccine Contraindications and Precautions Background Document or Vulnerable Populations → HSCT / SOT.
*An interval of 6 months (minimum 3 months) is recommended from previous SARS-CoV-2 infection. For the purposes of vaccinating those living in personal care homes, long term care and other senior congregate living facilities (i.e., assisted living facilities), the vaccine can be administered less than 3 months (no minimum interval) after the last dose or infection.
Adverse Events
- Clinical data are based on monovalent and bivalent Pfizer-BioNTech Comirnaty® formulations.
- Common (≥ 10%) adverse events
- local reactions: pain at injection site, redness, and swelling)
- COVID arm” is a local delayed (≥ 7 days) reaction with these symptoms; it is an expected reaction that resolves within 7-10 days. This does not need to be reported as an AEFI/AESI.
- fatigue
- headache
- myalgia
- chills
- arthralgia
- chills
- fever
- joint pain
- diarrhea
- nausea
- vomiting
- enlarged lymph nodes
- local reactions: pain at injection site, redness, and swelling)
- Less common (<10%) adverse events
- excessive sweating
- night sweats
- malaise
- Rare adverse events
- Anyone experiencing symptoms associated with the conditions below should seek medical attention.
- Myocarditis and pericarditis have been reported in a small number of people. Most cases followed vaccination with second doses of monovalent mRNA COVID-19 vaccine and occurred more often in males, and in those 12 to 29 years of age.
- Symptoms may include chest pain, shortness of breath, irregular or fast/pounding heartbeat.
- Anaphylaxis is very rare but has been reported, in most cases, within 30 minutes of vaccination.
- Symptoms may include hives; swelling of face, tongue, or throat; difficulty breathing.
- Bell’s palsy has been reported in a small number of adults; symptoms typically resolve within a month.
- Symptoms may include weakness or paralysis on one side of the face.
- Myocarditis and pericarditis have been reported in a small number of people. Most cases followed vaccination with second doses of monovalent mRNA COVID-19 vaccine and occurred more often in males, and in those 12 to 29 years of age.
- Anyone experiencing symptoms associated with the conditions below should seek medical attention.
Product Information
- Product monograph: Comirnaty® Omicron XBB.1.5
Non-Medicinal Ingredients
- ALC-0315 = ((4-hydroxybutyl) azanediyl)bis (hexane-6,1-diyl)bis(2-hexyldecanoate)
- ALC-0159 = 2-[(polyethylene glycol)-2000]-N,N-ditetradecylacetamide
- Cholesterol
- DSPC = 1,2-distearoyl-sn-glycero-3-phosphocholine
- sucrose
- tromethamine
- tromethamine hydrochloride
- water for injection
Polyethylene glycol (PEG) and tromethamine are potentially allergenic ingredients.
Specific Reference
- Pfizer-BioNTech
Last updated: 10 Oct 2023
- Product Comparison Table of COVID-19 Vaccines Available in SK Pharmacies
The following table includes characteristics of the mRNA COVID-19 vaccines available in Saskatchewan pharmacies.
For more details about the included vaccines and/or information regarding COVID-19 vaccines only available through Public Health, see the Saskatchewan Immunization Manual and COVID-19 Vaccine Contraindications and Precautions Background Document.
Moderna Spikevax® XBB.1.5
Royal Blue Cap, Coral Blue Font
Pfizer-BioNTech Comirnaty® Omicron XBB.1.5
Grey Cap, Grey BorderPfizer-BioNTech Comirnaty® Omicron XBB.1.5
Blue Cap, Blue BorderDO NOT DILUTE DO NOT DILUTE DO NOT DILUTE Health Canada-
Authorized Age≥ 6 months ≥ 12 years ≥ 5 years to < 12 years Concentration 50 mcg / 0.5 mL 30 mcg/0.3 mL 10 mcg/0.3 mL DIN 02541270 02541823 02541858 Packaging Multidose preservative-free 2.5 mL vials
Cartons of 10 vials
Royal blue cap; coral blue font on label
Multidose preservative-free 2.25 mL vials
Cartons of 10 vials
Grey cap; grey border
Multidose preservative-free 2.25 mL vials
Cartons of 10 vials
Blue cap; blue border
Storage/Stability
Moderna Spikevax® XBB.1.5
Royal Blue Cap, Coral Blue FontPfizer-BioNTech Comirnaty® Omicron XBB.1.5
Grey Cap, Grey Border
Pfizer-BioNTech Comirnaty® Omicron XBB.1.5
Blue Cap, Blue Border
Stability in Freezer Store at -50°C to -15°C (freezer) until the expiry date printed on the label.a Store at -90°C to -60°C (ultrafreezer) until the expiry date printed on the label. Thawing Thaw in fridge (takes 2 hours)
or
Thaw at room temperature (takes 45 minutes)After thawing, let stand at room temperature for 15 minutes before administering.
Do not refreeze thawed vials
Thaw in fridge (takes up to 6 hours)
or
Thaw at room temperature (takes ~30 minutes)
Do not refreeze thawed vialsStability in Refrigerator
(2°C to 8°C)Up to 30 days prior to first use Up to 10 weeks prior to first use Dilution DO NOT DILUTE Stability at Room Temperature
(up to 25°C)No more than 24 cumulative hours at room temperature.
Vials can be returned to fridge (whether before or after puncture) but time spent at room temperature must be tracked. Time at room temperature (punctured and unpunctured) must not exceed 24 hours total.
Prior to puncture, no more than 12 cumulative hours at room temperature. Vials can be returned to fridge (whether before or after puncture) but time spent at room temperature must be tracked.
After puncture, use within 12 hours.
Stability after
1st PunctureUp to 24 hours at 2°C to 25°C. Discard after 24 hours.
The duration of time an unpunctured vial was stored at room temperature (if any) must be factored into time at room temperature after puncture.
Vials can be returned to fridge but the time at room temperature (punctured and unpunctured) is cumulative and must not exceed 24 hours total.Up to 12 hours at 2°C to 25°C Protect from Light Store in original carton.
Thawed vials and filled syringes can be handled in room light conditions.
Store in original carton.
Thawed vials can be handled in room light conditions.
Handling Swirl vial gently after thawing and between each withdrawal.
Do not shake.Before use, mix by inverting vaccine vial gently 10 times.
Do not shake.Appearance White to off-white dispersion—may contain white or translucent product-related particles; ensure no foreign particulate matter or discolouration. BEFORE inverting: may contain white to off-white opaque amorphous particles.
AFTER inverting: white to off-white suspension; ensure no visible particles/ discolouration.
a. Expiry dates have been extended for some lots. Use the Moderna Vial Expiration Checker or check the VDTS to verify dates.Specific References
- Moderna
- Pfizer-BioNTech
Last Updated: 10 oct 2023
- Novavax Nuvaxovid™ - Limited Information
This vaccine is not available at Saskatchewan pharmacies.
Indication
- Health Canada: Immunization against COVID-19 for individuals:
- 12 years and older (primary series - see Notes)
- 18 years and older (booster - see Notes)
Notes
- This is an adjuvanted recombinant protein subunit COVID-19 vaccine.
- mRNA COVID-19 vaccines are preferred, but this vaccine is an option for those who cannot take or choose not to take mRNA vaccines.
- In Saskatchewan, Nuvaxovid™ can be used an alternative to mRNA COVID-19 XBB vaccines in eligible individuals 12 years and older.
- Individuals should be made aware an XBB formulation of Nuvaxovid™ is forthcoming and an interval of 6 months (minimum 3 months) from previous COVID-19 vaccine dose will be required. However, when this new formulation will be available cannot be predicted.
Specific Reference
- Novavax
Last updated: 27 Sep 2023
- Health Canada: Immunization against COVID-19 for individuals:
Vulnerable Populations
- Definition of Moderately to Severely Immunocompromised
As per the Canadian Immunization Guide, moderately to severely immunocompromised individuals include those with the following conditions:
- Immunocompromised due to solid tumour or hematologic malignancies or treatments of these conditions
- Recipients of solid organ transplant and taking immunosuppressive therapy
- Additional considerations apply to candidates and recipients of solid organ transplants. Refer to COVID-19 Vaccine Contraindications and Precautions Background Document or Guide for the Vaccine Screening and Consent Form, Q4 Solid Organ Transplant.
- Recipients of hematopoietic stem cell transplant (within 2 years of transplantation or taking immunosuppressive therapy)
- Additional considerations apply to candidates and recipients of solid organ transplants. Refer to COVID-19 Vaccine Contraindications and Precautions Background Document or Guide for the Vaccine Screening and Consent Form, Q4 Cancer and HSCT.
- Recipients of chimeric antigen receptor (CAR)-T-cell therapy targeting lymphocytes
- Moderate to severe primary immunodeficiency with associated humoral and/or cell-mediated immunodeficiency or immune dysregulation
- HIV with AIDS-defining illness or TB diagnosis in last 12 months before starting vaccine series, or severe immune compromise with CD4 count < 200 cells/µL or CD4% <15%, or without HIV viral suppression
- Recipients of recent treatment with the following categories of immunosuppressive therapies:
- anti-B cell therapies (monoclonal antibodies targeting CD19, CD20 and CD22)
- high-dose systemic corticosteroids (prednisone equivalent of ≥ 2 mg/kg/day or 20 mg/day if weight > 10 kg, for ≥ 14 days)
- alkylating agents, antimetabolites, or tumor-necrosis factor (TNF) inhibitors and other biologic agents that are significantly immunosuppressive
- see list of Potentially Immunosuppressive Medications
- Chronic kidney disease on dialysis
Last updated: 27 Sep 2023
- Hematopoietic Stem Cell Transplant and Solid Organ Transplant
- Hematopoietic stem cell transplant and solid organ transplant recipients are considered moderately to severely immunocompromised and there are specific recommendations for COVID-19 vaccine schedules and timing.
- There are also some recommendations for transplant candidates.
Hematopoietic Stem Cell Transplant (HSCT)
- HSCT recipients MUST speak to their cancer care team / specialist.
- Pre-transplant
- If feasible, XBB.1.5 COVID-19 vaccine series should be administered at least 4 weeks prior to starting conditioning regimen.
- Post-transplant
- Postpone vaccination in severe, uncontrolled acute graft versus host disease (GVHD), grade 3-4.
- For previously immunized or unimmunized HSCT recipients, vaccination with XBB.1.5 can be initiated 4 months after HSCT (3 months post-autologous transplant for patients who will be started on maintenance therapy post-transplant).
- Vaccinated HSCT recipients should receive a booster dose 3 months after their previous vaccine dose.
- HSCT recipients with previous COVID-19 infection should defer vaccination for 3 months post-infection.
- The HSCT Program will provide a letter to recipients to take into their immunizer when they are eligible to start their COVID-19 vaccination series with schedule to return in 4 weeks, 8 weeks, then 3 months for booster.
- Pre-transplant
Solid Organ Transplant (SOT)
- Medically stable SOT recipients followed up by the Saskatchewan Transplant Program DO NOT NEED to consult their specialist prior to immunization with COVID-19 vaccines.
- Pre-transplant
- Unvaccinated SOT candidates should receive 3 doses (using min. 4-week intervals) of mRNA COVID-19 vaccine as a primary series, with the final dose given 1-2 weeks prior to transplantation whenever possible. If indicated, an additional dose given 3 months after the last vaccine dose may be recommended by the Transplant Program.
- Post-transplant
- Unvaccinated SOT recipients should receive 3 doses (using min. 4-week intervals) of mRNA vaccine as a primary series. If indicated, an additional dose given 3 months after the last vaccine dose may be recommended by the Transplant Program.
- Vaccinated SOT recipients should receive an additional dose given 3 months after their previous vaccine dose as recommended by the Transplant Program.
- All SOT recipients should wait at least 1 month post-transplant to continue vaccine series, regardless of induction therapy.
- SOT recipients undergoing active treatment for acute rejection should defer vaccination for 1 month.
- SOT recipients who have received rituximab should defer vaccination for at least 3 months.
- SOT recipients with previous COVID-19 infection should defer vaccination for 3 months post-infection.
- The Saskatchewan Transplant Program will provide a letter for recipients to take into their immunizer when they are eligible for their first dose and it will specify that the recipient return for a second dose 3 months later.
Last updated: 19 Oct 2023
- Hematopoietic stem cell transplant and solid organ transplant recipients are considered moderately to severely immunocompromised and there are specific recommendations for COVID-19 vaccine schedules and timing.
- Underlying Medical Conditions Associated with More Severe COVID-19 Disease
As per the Public Health Agency of Canada, individuals with the following medical conditions are at greater risk of more severe COVID-19 disease:
- Cancer
- Cerebrovascular disease
- Chronic kidney disease
- Chronic liver disease (limited to: cirrhosis, non-alcoholic fatty liver disease, alcoholic liver disease, and autoimmune hepatitis)
- Chronic lung disease (limited to: bronchiectasis, chronic obstructive pulmonary disease, interstitial lung disease, pulmonary hypertension, pulmonary embolism)
- Cystic fibrosis
- Diabetes mellitus, type 1 and type 2
- Disabilities (e.g., Down syndrome, learning, intellectual, or developmental disabilities; ADHD; cerebral palsy; congenital disabilities; spinal cord injuries)
- Heart conditions (e.g., cardiomyopathies, coronary artery disease, heart failure, etc.)
- HIV infection
- Mental health disorders (limited to: mood disorders, including depression; schizophrenia spectrum disorders)
- Obesity
- Pregnancy and recent pregnancy
- Primary immunodeficiency disease
- Smoking, current or former
- Solid organ or blood stem cell transplant
- Tuberculosis
- Use of corticosteroids or other immunosuppressive medication
Certain medical and/or social vulnerabilities, may make it more difficult for patients to recognize, clearly communicate, or act on symptoms' progression. Affected individuals may include: people experiencing intellectual, developmental, or cognitive disabilities; people who use substances regularly; people who live with mental health conditions; and persons experiencing homelessness or who are unhoused. These patients need closer attention and monitoring.
Last updated: 27 Sep 2023
References
- General References
- Saskatchewan Immunization Manual
- Chapter 10: Biological Products
- eHealth COVID-19 Immunization Manual
- Canadian Immunization Guide
- Public Health Agency of Canada
- SK Drug Plan and Extended Benefits Branch
- Saskatchewan Immunization Manual