Primary Series

Pediatric Pfizer-BioNTech Comirnaty™ 5-11 Years

The dose should be chosen according to vaccine recipient’s age at presentation.
  • For children who received the Pediatric vaccine for their first dose and who have turned 12 years old by the time the second dose is due, complete the series with the 30 mcg mRNA Pfizer-BioNTech COVID-19 vaccine that is authorized for individuals aged 12 years and older. 
Non-Immunocompromised Individuals
  • 2 doses of 0.2 mL (10 mcg mRNA)
    • See "Interval" below for information about timing of 2nd dose.
Moderately to Severely Immunocompromised Individuals
  • 3 doses of 0.2 mL (10 mcg mRNA)
    • See “Eligibility” below for included individuals.
    • See “Interval” below for information about timing of 2nd and 3rd doses.
References
Last Updated

28 Jan 2022

General Eligibility
  • All Saskatchewan residents ages 5 to 11 years without contraindications to the vaccine.
    • Individuals ≥12 years old on day of presentation are not eligible for Pediatric Pfizer-BioNTech Comirnaty™ and are to receive a vaccine approved for their age.
    • For children who are receiving their primary COVID-19 vaccine series and both Moderna Spikevax™ and Pediatric Pfizer-BioNTech Comirnaty™ are readily available, Comirnaty™ is the preferred vaccine as there is a lower risk of myocarditis compared to Spikevax™.
    • For moderately to severely immunocompromised children ages 6 to 11 years who are receiving their primary COVID-19 vaccine series and both Moderna Spikevax™ and Pediatric Pfizer-BioNTech Comirnaty™ are readily available, Spikevax™ may be preferred due to potentially greater immune response (based on adult data).
  • 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.

  • Residents who received immunization in a different jurisdiction will be eligible to receive subsequent dose(s) in Saskatchewan. Individuals in this scenario will need to have documentation of their dose(s) from the jurisdiction in which they were received. 
Immunocompromised Individuals for 3rd Dose in Primary Series

Includes moderately to severely immunocompromised individuals with the following conditions:

  • Recipients of active treatment for solid tumour or hematologic malignancies
  • Recipients of solid-organ transplant and taking immunosuppressive therapy
  • Recipients of of chimeric antigen receptor (CAR)-T-cell therapy or hematopoietic stem cell transplant (within 2 years of transplantation or taking immunosuppression therapy)
  • Moderate to severe primary immunodeficiency with associated humoral and/or cell-mediated immunodeficiency or immune dysregulation
  • HIV with prior AIDS defining illness OR prior CD4 count ≤ 200/mm3 OR prior CD4 fraction ≤ 15% OR perinatally acquired HIV infection
  • Recipients of active 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 ≥ 40 mg per day for more than 1 week)
    • alkylating agents, antimetabolites, or tumor-necrosis factor (TNF) inhibitors and other biologic agents that are significantly immunosuppressive 
References
Last Updated

18 Mar 2022

NOTE: If the interval is longer than recommended, there is no reason to restart the series. Provide the next dose as soon as possible.

Non-Immunocompromised Individuals
  • Dose 1: Day 0
  • Dose 2: 8 weeks (optimal interval)
    • 8 weeks is recommended, but dose can be provided at a shorter interval (≥ 21 days) if chosen.
      • NACI recommends an interval of 8 weeks in immunocompetent children 5-11 years of age even while the Omicron variant circulates. This longer interval is expected to provide a greater and more durable immune response as well as reduce the risk of myocarditis or pericarditis; severe outcomes from the Omicron variant are expected to remain low in these children during the time between doses.
    • Based on NACI recommendation, the minimum interval is 19 days between doses (any doses provided at an earlier interval would be considered invalid and need to be repeated).
      • This interval is not a recommended interval and should only be used to determine dose validity.
Moderately to Severely Immunocompromised Individuals

See "Eligibility” above for included individuals.

  • Dose 1: Day 0
  • Dose 2: 4 to 8 weeks after 1st dose
    • 4 to 8 weeks is recommended, but dose can be provided ≥ 21 days after 1st dose if chosen.
    • Based on NACI recommendation, the minimum interval is 19 days between doses (any doses provided at an earlier interval would be considered invalid and need to be repeated).
      • This interval is not a recommended interval and should only be used to determine dose validity.
  • Dose 3: 4 to 8 weeks after 2nd dose
  • Moderately to severely immunocompromised individuals who have previously received two doses should be offered a 3rd dose 4 to 8 weeks after the 2nd dose.
  • An interval of 8 weeks is expected to provide a greater and more durable immune response compared to shorter intervals; however, the benefits of this longer interval need to be weighed against the immunocompromised child’s risks of exposure and severe outcomes between doses.
References
Last Updated

28 Jan 2022

Pfizer-BioNTech Comirnaty™ ≥12 Years

The dose should be chosen according to vaccine recipient’s age at presentation.

  • For children who received the Pediatric vaccine for their first dose and who have turned 12 years old by the time the second dose is due, complete the series with the 30 mcg mRNA Pfizer-BioNTech COVID-19 vaccine that is authorized for individuals aged 12 years and older.
Non-Immunocompromised Individuals
  • 2 doses of 0.3 mL (30 mcg mRNA) 
    • See "Interval" below for information about timing of 2nd dose. 
Moderately to Severely Immunocompromised Individuals
  • 3 doses of 0.3 mL (30 mcg mRNA)
    • See “Eligibility” below for included individuals.
    • See "Interval" below for information about timing of 2nd and 3rd doses. 
References
Last Updated

23 Nov 2021

General Eligibility
  • All Saskatchewan residents ≥ 12 years of age without contraindications to the vaccine.
    • Children 5 years old are to receive Pediatric Pfizer-BioNTech Comirnaty™.
    • Children 6 to 11 years old are to receive Pediatric Pfizer-BioNTech Comirnaty™ or Moderna Spikevax™ (50 mcg).
    • For individuals 30 years and younger who are receiving their primary COVID-19 vaccine series and both Moderna Spikevax™ and Pfizer-BioNTech Comirnaty™ are readily available, Comirnaty™ is the preferred vaccine as there is a lower risk of myocarditis compared to Spikevax™.
    • For immunocompromised individuals who are receiving their primary COVID-19 vaccine series and both Moderna Spikevax™ and Pfizer-BioNTech Comirnaty™ are readily available, Spikevax™ may be preferred due to potentially greater immune response.
  • 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.

  • Residents who received immunization in a different jurisdiction will be eligible to receive subsequent dose(s) in Saskatchewan. Individuals in this scenario will need to have documentation of their dose(s) from the jurisdiction in which they were received. 

  • Doses to complete a series in recipients of non-Health Canada authorized vaccines received out of country
    • Residents who received one or two doses of a non-Health Canada authorized COVID-19 vaccine should be offered one additional dose based on the Public Health Agency of Canada’s guidance document.
    • Non-residents who received one or two doses of a non-Health Canada authorized COVID-19 vaccine and are planning to stay in Canada for longer periods of time (i.e. to live, work or study in Canada) should be offered one additional dose based on the Public Health Agency of Canada’s guidance document.
Eligibility for Immunocompromised Individuals to Receive 3rd Dose of Primary Series

Includes moderately to severely immunocompromised individuals with the following conditions:

  • Recipients of active treatment for solid tumour or hematologic malignancies
  • Recipients of solid-organ transplant and taking immunosuppressive therapy
  • Recipients of of chimeric antigen receptor (CAR)-T-cell therapy or hematopoietic stem cell transplant (within 2 years of transplantation or taking immunosuppression therapy)
  • Moderate to severe primary immunodeficiency with associated humoral and/or cell-mediated immunodeficiency or immune dysregulation
  • HIV with prior AIDS defining illness OR prior CD4 count ≤ 200/mm3 OR prior CD4 fraction ≤ 15% OR perinatally acquired HIV infection
  • Recipients of active 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 ≥ 40 mg per day for more than 1 week)
    • alkylating agents, antimetabolites, or tumor-necrosis factor (TNF) inhibitors and other biologic agents that are significantly immunosuppressive 
References
Last Updated

18 Mar 2022

NOTE: If the interval is longer than recommended, there is no reason to restart the series. Provide the next dose as soon as possible.

Non-Immunocompromised Individuals
  • Dose 1: Day 0
  • Dose 2: 8 weeks (optimal interval)
    • 8 weeks is recommended, but dose can be provided at a shorter interval if chosen.
      • ≥ 21 days if first dose was Comirnaty™
      • ≥ 28 days if first dose was a different COVID-19 vaccine
    • Based on NACI recommendation, the minimum interval is 19 days between doses (any doses provided at an earlier interval would be considered invalid and need to be repeated).
      • This interval is not a recommended interval and should only be used to determine dose validity.  
Moderately to Severely Immunocompromised Individuals

See “Eligibility” above for included individuals.

  • Dose 1: Day 0
  • Dose 2: ≥ 28 days after 1st dose
  • Dose 3: ≥ 28 days after 2nd dose

NOTE: An interval longer than 28 days (e.g. two to three months) is likely to result in a better immune response; however, delaying the dose leaves the individual vulnerable to infection. When deciding the interval, consider:

  • individual’s risk of COVID-19 infection, including comorbidities and level of immunosuppression
  • individual's level of exposure to COVID-19, including level of SARS-CoV-2 virus circulating in the community
References
Last Updated

23 Nov 2021

Moderna Spikevax™ ≥ 6 Years

Non-Immunocompromised Individuals
12 years and older
  • 2 doses of 0.5 mL (100 mcg mRNA) 

6 to 11 years

  • 2 doses of 0.25 mL (50 mcg mRNA)

See "Interval" below for information about timing of 2nd dose. 

Moderately to Severely Immunocompromised Individuals

12 years and older

  • 3 doses of 0.5 mL (100 mcg mRNA) 

6 to 11 years

  • 3 doses of 0.25 mL (50 mcg mRNA)

See “Eligibility” below for included individuals.
See "Interval" below for information about timing of 2nd and 3rd doses.

References
Last Updated

18 Mar 2022

General Eligibility
  • All Saskatchewan residents ≥ 6 years of age without contraindications to the vaccine.
    • Children 5 years old are to receive Pediatric Pfizer-BioNTech Comirnaty™.
    • For individuals 30 years and younger who are receiving their primary COVID-19 vaccine series and both Moderna Spikevax™ and Pfizer-BioNTech Comirnaty™ are readily available, Comirnaty™ is the preferred vaccine as there is a lower risk of myocarditis compared to Spikevax™.
      • Individuals (and/or caregivers of individuals) 6 to 30 years old opting to receive Spikevax™ shall be informed of the increased risk of myocarditis/pericarditis compared to receiving Comirnaty™.
    • For immunocompromised individuals who are receiving their primary COVID-19 vaccine series and both Moderna Spikevax™ and the age-appropriate Pfizer-BioNTech Comirnaty™ are readily available, Spikevax™ may be preferred due to potentially greater immune response (based on adult data).
  • 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. 
      •  
  • Residents who received immunization in a different jurisdiction will be eligible to receive subsequent dose(s) in Saskatchewan. Individuals in this scenario will need to have documentation of their dose(s) from the jurisdiction in which they were received. 

  • Doses to complete a series in recipients of non-Health Canada authorized vaccines received out of country
    • Residents who received one or two doses of a non-Health Canada authorized COVID-19 vaccine should be offered one additional dose based on the Public Health Agency of Canada’s guidance document.
    • Non-residents who received one or two doses of a non-Health Canada authorized COVID-19 vaccine and are planning to stay in Canada for longer periods of time (i.e. to live, work or study in Canada) should be offered one additional dose based on the Public Health Agency of Canada’s guidance document.
Eligibility for Immunocompromised Individuals to Receive 3rd Dose of Primary Series

Includes moderately to severely immunocompromised individuals with the following conditions:

  • Recipients of active treatment for solid tumour or hematologic malignancies
  • Recipients of solid-organ transplant and taking immunosuppressive therapy
  • Recipients of of chimeric antigen receptor (CAR)-T-cell therapy or hematopoietic stem cell transplant (within 2 years of transplantation or taking immunosuppression therapy)
  • Moderate to severe primary immunodeficiency with associated humoral and/or cell-mediated immunodeficiency or immune dysregulation
  • HIV with prior AIDS defining illness OR prior CD4 count ≤ 200/mm3 OR prior CD4 fraction ≤ 15% OR perinatally acquired HIV infection
  • Recipients of active 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 ≥ 40 mg per day for more than 1 week)
    • alkylating agents, antimetabolites, or tumor-necrosis factor (TNF) inhibitors and other biologic agents that are significantly immunosuppressive 
References
Last Updated

18 Mar 2022

NOTE: If the interval is longer than recommended, there is no reason to restart the series. Provide the next dose as soon as possible.

Non-Immunocompromised Individuals
  • Dose 1: Day 0
  • Dose 2: 8 weeks (optimal interval)
    • 8 weeks is recommended, but dose can be provided at a shorter interval (≥ 28 days) if chosen.
    • Based on NACI recommendation, the minimum interval is 21 days between doses (any doses provided at an earlier interval would be considered invalid and need to be repeated).
      • This interval is not a recommended interval and should only be used to determine dose validity.  
Moderately to Severely Immunocompromised Individuals

See “Eligibility” above for included individuals.

  • Dose 1: Day 0
  • Dose 2: ≥ 28 days after 1st dose
  • Dose 3: ≥ 28 days after 2nd dose

NOTE: An interval longer than 28 days (e.g. two to three months) is likely to result in a better immune response; however, delaying the dose leaves the individual vulnerable to infection. When deciding the interval, consider:

  • individual’s risk of COVID-19 infection, including comorbidities and level of immunosuppression
  • individual's level of exposure to COVID-19, including level of SARS-CoV-2 virus circulating in the community
References
Last Updated

23 Nov 2021

Additional/Booster Doses

There are currently no additional/booster doses authorized for children 5-11 years.

Dose

See primary series for first 3 doses in moderately to severely immunocompromised individuals.

For individuals 12 to 30 years, Pfizer-BioNTech Comirnaty™ is preferred to Moderna Spikevax™ as a precaution when both vaccines are readily available. There has been a lower reported rate of myocarditis/pericarditis following Pfizer-BioNTech Comirnaty™ compared to Moderna Spikevax™.

For immunocompromised individuals eligible for a booster, Moderna Spikevax™ may be preferred to Pfizer-BioNTech Comirnaty™ when both vaccines are readily available, due to potentially greater immune response (based on adult data).

Booster Doses
  • 0.3 mL (30 mcg mRNA)   
References
Last Updated

18 Mar 2022

See primary series for first 3 doses in moderately to severely immunocompromised individuals.

For individuals 12 to 30 years, Pfizer-BioNTech Comirnaty™ is preferred to Moderna Spikevax™ as a precaution when both vaccines are readily available. There has been a lower reported rate of myocarditis/pericarditis following Pfizer-BioNTech Comirnaty™ compared to Moderna Spikevax™. Individuals in this age group opting to receive Moderna Spikevax™ should be informed of the increased risk of myocarditis/pericarditis compared to Pfizer-BioNTech Comirnaty™.

For immunocompromised individuals eligible for a booster, Moderna Spikevax™ may be preferred to Pfizer-BioNTech Comirnaty™ when both vaccines are readily available, due to potentially greater immune response (based on adult data).

 Booster Doses
  • The following individuals are to receive a dose of 0.5 mL (100 mcg mRNA):
    • Residents of Long-Term Care (Special Care Homes), Personal Care Homes and Other Congregate Living Settings that provide care for seniors, regardless of age
    • Individuals 70 years and older
    • Moderately to severely immunocompromised individuals (those who received a 3-dose primary series)

  • All other individuals eligible for a booster are to receive a dose of 0.25 mL (50 mcg mRNA)^.

^Regardless of type of vaccine used for the primary series.

References
Last Updated

18 Mar 2022

Eligibility and Interval

Eligibility and Intervals for each population are found in the Summary Table. More details regarding populations are provided in the tabs. 

Population Moderately to Severely Immunocompromised? # Doses in Primary Series Minimum Interval to Booster 1    Minimum Interval to Booster 2   
Adults 18 Years and Older in Long-Term Care, Personal Care Homes or Other Congregate Living Settings that Provide Care for Seniors Yes 3* 3 months 4 months
No 2 4 months 4 months
Individuals 50 Years and Older Living in the Community Yes 3* 3 months 4 months
No 2 4 months 4 months
Individuals 12 -49 Years Living in the Community Yes 3* 3 months N/A
No 2 4 months N/A
Recipients of 1 Dose of Janssen (Johnson & Johnson)  Yes (mRNA preferred) 2^ 2 months N/A (unless also among groups eligible for Booster 2 above)
No 1 2 months
Individuals Who Have Received 3 or More Doses No See tab “Who Have Received 3 or More Doses” N/A (unless also among groups eligible for Booster 2 above)

‡ See “Individuals Who Are Moderately to Severely Immunocompromised” tab for definition of moderately to severely immunocompromised.
* For individuals who are moderately to severely immunocompromised who received 2 doses made up of mRNA and/or AstraZeneca Vaxzevria™, the interval to the 3rd dose is at least 28 days from the 2nd dose. 
^ For individuals who are moderately to severely immunocompromised who received Janssen, the interval to the 2nd dose, which is mRNA, is at least 28 days from the Janssen dose.
N/A= Not applicable; these individuals are not eligible.

"Months" refer to calendar months. For example, if an individual received a dose January 5, 2022 and is eligible for another dose at 4 months, the dose can be provided May 5, 2022 or later. 

References
Last Updated

06 May 2022

Moderately to severely immunocompromised individuals include those with the following conditions:
  • Recipients of active treatment for solid tumour or hematologic malignancies
  • 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)
  • Moderate to severe primary immunodeficiency with associated humoral and/or cell-mediated immunodeficiency or immune dysregulation
  • HIV with prior AIDS defining illness OR prior CD4 count ≤ 200/mm3 OR prior CD4 fraction ≤ 15% OR perinatally acquired HIV infection
  • Recipients of active 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 ≥ 40 mg per day for more than 1 week)
    • alkylating agents, antimetabolites, or tumor-necrosis factor (TNF) inhibitors and other biologic agents that are significantly immunosuppressive

Reminder: primary series is 3 doses; 3rd dose at least 28 days following 2nd dose

Other Important Information 

  • As of January 6, 2022, immunocompromised individuals are no longer required to present a letter of eligibility.

  • Those who were immunized with their primary series and received a booster when they were previously immunocompetent and are currently moderately to severely immunosuppressed, do not qualify for another booster dose unless the booster dose was administered less than 3 months after the last dose in their primary series.

  • Those who received a primary series while immunocompromised but are currently not considered moderately to severely immunocompromised, may receive a booster/fourth dose at least 3 months after the last dose of their primary series.

  • New individuals who meet the criteria receive a 3-dose primary series (minimum 28 days between each dose) and Booster 1 at least 3 months following their last dose. When eligible by age criteria, individuals receive Booster 2 at least 4 months following Booster 1.

  • Health Canada has not authorized booster doses for individuals younger than 18 years. Booster doses are off-label in these individuals. 
    • NACI recommends a booster dose should be offered to moderately to severely immunocompromised individuals 12 to 17 years of age. 
References
Last Updated

26 Apr 2022

 

This population encompasses all non-immunocompromised individuals including those:
  • Living in the community
  • Living in First Nations & Metis communities and the Northern Service Administration District (NSAD)- Far North in SK
  • Who are healthcare workers
  • Living in congregate living settings including:
    • homeless and other emergency shelters
    • group homes
    • mental health residential care
    • correctional institutions
  • Belonging to racialized and/or marginalized communities disproportionately affected by COVID-19
  • Who have underlying health conditions and are clinically extremely vulnerable including:
    • Individuals with severe respiratory conditions, including all cystic fibrosis, severe asthma and severe chronic obstructive pulmonary disease (COPD)
    • Individuals with rare diseases that significantly increase the risk of infections (such as homozygous sickle cell disease)
    • Individuals who had their spleen removed
    • Individuals with very significant developmental disabilities that increase risk (such as Down’s syndrome)
    • Individuals on dialysis or with chronic kidney disease (stage 5)
    • Individuals with significant neuromuscular conditions requiring respiratory support
    • Individuals with diabetes (any type)

Individuals 12 to 17 Years

No COVID-19 vaccines have received Health Canada authorization for booster doses in children 12 to 17 years old. NACI has reviewed evidence regarding: the primary series in children 12-17 years old; booster doses in adults 18 years and older; limited real-world data of booster doses in children 12-17 years old; waning vaccine protection from the primary series; and effectiveness of the primary series against Omicron.

  • NACI recommends a booster dose should be offered to children 12-17 years old who:
    • are moderately to severely immunocompromised
    • are at high risk of severe illness due to COVID-19 because of an underlying medical condition
    • live in congregate living settings
    • belong to racialized and/or marginalized communities disproportionately affected by COVID-19
  • NACI recommends a booster dose may be offered to all other children 12-17 years old.
  • As per Summary Table, children 12-17 years in Saskatchewan are eligible for Booster 1.
References
Last Updated

26 Apr 2022

While mRNA vaccines are preferred for all individuals, doses of viral vector vaccines are valid. In individuals who received additional mRNA doses (e.g., for travel), some of the doses may be considered booster doses. See "Individuals Who have Received 3 or More Doses (E.g., Travel Doses)" tab for details. 

Individuals who received a Janssen (Johnson & Johnson) dose:

  • It is recommended these individuals receive an mRNA booster vaccine at least 2 months after receiving the Janssen dose. This is considered Booster 1.
    • Booster 2 can be received at least 4 months after Booster 1 in those who are eligible.
  • Viral vector vaccines are not recommended for immunocompromised individuals. However, if an immunocompromised individual receives a Janssen dose, NACI recommends an mRNA dose be provided at least 28 days following the Janssen dose to complete the primary series. Booster doses would then apply as above. 

"Months" refer to calendar months. For example, if an individual received a dose January 5, 2022 and is eligible for another dose at 2 months, the dose can be provided Nar 5, 2022 or later.

References
Last Updated

26 Apr 2022

Up to two additional doses had been provided to some individuals to complete a homologous mRNA series. An example when this may have happened is those travelling to jurisdictions in which their vaccine series was not recognized.

Now that booster doses are being provided, some of these additional doses may be considered Booster 1. This will depend on the number of doses, the intervals between doses, and the immune status of the individual.

Note that the criteria used to assess what additional doses constitute booster doses changed May 5, 2022. Now, no previously received additional doses are considered Booster 2. Assess to determine if any of the additional doses are considered Booster 1.

Steps to Determine if Additional Dose is a Booster Dose
1. Verify type, dose, and date of each vaccine given.
2. Determine the immune status of the individual.
3. Confirm the minimum intervals were met for the primary series doses (longer than recommended intervals are acceptable).
4. Calculate the interval between doses. For previously given doses, any additional dose given ≥ 3 months from a previous dose is considered a valid booster dose.
5. Determine if individual is eligible for additional booster doses.

Use the printable algorithm below to determine if doses are considered valid booster doses for moderately to severely immunocompromised or non-immunocompromised individuals who have received 3 or 4 doses of a combination of Pfizer BioNTech Comirnaty™, Moderna Spikevax™, and/or AstraZeneca Vaxzevria™.

travel-doses-algorithm.png

Printable tables are also available, which provide:

  • Information and example scenarios for: 
    • non-immunocompromised (including clinically vulnerable) individuals who have received 3 or 4 doses of a combination of Pfizer BioNTech Comirnaty™, Moderna Spikevax™, and/or AstraZeneca Vaxzevria™ (examples also below)
    • moderately to severely immunocompromised individuals who have received 3 or 4 doses of a combination of Pfizer BioNTech Comirnaty™, Moderna Spikevax™, and/or AstraZeneca Vaxzevria™
    • non-immunocompromised (including clinically vulnerable) individuals who have received Janssen (Johnson & Johnson) vaccine
    • non-immunocompromised (including clinically vulnerable) individuals who have received non-Health Canada authorized vaccines  
  • Details of what is considered a booster dose (also below)
  • Definitions of moderately to severely immunocompromised and clinically vulnerable 
Table: Example Scenarios for Determining 1st Booster Dose Eligibility Based on Interval Between Previously Received Doses

The examples in this table are based on a 2-dose (mRNA, AstraZeneca Vaxzevria™) primary series for non-immunocompromised (including clinically vulnerable) individuals. See printable tables for more scenarios.

Individual Has Received Three Doses
Dose 1 Dose 2 Dose 3  Dose 4 Considered to Have 
Booster 1? 
May 15 Jun 20 Sep 10
(< 3 months after Dose 2)
N/A No
Give Booster 1 ≥ 4 months after Dose 3
When eligible‡, give Booster 2 ≥ 4 months after Booster 1
May 15 Jun 20 Sep 30
(≥3 months after Dose 2)
N/A

Yes
When eligible‡, give Booster 2 ≥ 4 months after last dose

Individual Has Received Four Doses
Jun 15 Jul 20 Aug 20
(< 3 months after Dose 2)
Oct 10
(< 3 months after Dose 2)
No
Give Booster 1 ≥ 4 months after Dose 4
When eligible‡, give Booster 2 ≥ 4 months after Booster 1
Apr 15 May 20 Aug 30
(≥ 3 months after Dose 2)
Oct 30
(< 3 months after Dose 3)
Yes
When eligible‡, give Booster 2 ≥ 4 months after last dose   
Jun 15 Jul 20 Aug 20
(< 3 months after Dose 2)
Oct 30
(≥ 3 months after Dose 2)
Apr 15 Jun 20 Aug 20
(< 3 months after Dose 2)
Nov 30
(≥ 3 months after Dose 3)
Apr 15 May 20 Aug 20
(≥ 3 months after Dose 2)
Nov 30
(≥ 3 months after Dose 3)
‡ Eligibility criteria are outlined in the Summary Table.
Details of What is Considered a Booster Dose 

This information is also included with the printable tables. "Months" refers to calendar months. For example, if an individual received a dose January 5, 2022 and is eligible for another dose at 3 months, the dose can be provided April 5, 2022 or later.

The criteria used to assess what additional doses constitute booster doses changed May 5, 2022. Now, no previously received additional doses are considered Booster 2. Assess to determine if any of the doses are considered Booster 1.

  • If so, Booster 2 can be given, when eligible, at least 4 months after the last dose.
  • If none of the previously received additional doses constitute Booster 1, the next dose can be received  ≥ 4 months after the last dose and will be Booster 1.

2-Dose Vaccines - Non-Immunocompromised (Including Clinically Vulnerable)
(Pfizer BioNTech Comirnaty™, Moderna Spikevax™, AstraZeneca Vaxzevria™)

Those Who Have Received THREE Doses
AZ, mRNA, mRNA
AZ, AZ, mRNA
mRNA, mRNA, mRNA

  • If interval between Doses 2 and 3 is < 3 months, considered to have no booster. Next dose should be ≥ 4 months after last dose and will be Booster 1.
  • If interval between Doses 2 and 3 is ≥ 3 months, considered to have Booster 1. If eligible, next dose should be ≥ 4 months after last dose and will be Booster 2.

Those Who Have Received FOUR Doses
AZ, mRNA, mRNA, mRNA
AZ, AZ, mRNA, mRNA

  • If interval between Doses 2 and 4 is < 3 months, considered to have no booster. Next dose should be ≥ 4 months after last dose and will be Booster 1.
  • If interval between Doses 2 and 3 OR interval between Doses 3 and 4 OR interval between Doses 2 and 4 is ≥ 3 months, considered to have Booster 1. If eligible, next dose should be ≥ 4 months after last dose and will be Booster 2.

2-Dose Vaccines – Moderately to Severely Immunocompromised
(Pfizer BioNTech Comirnaty™, Moderna Spikevax™, AstraZeneca Vaxzevria™)

Current guidance recommends that AstraZeneca Vaxzevria™ is not a preferred vaccine for moderately to severely immunocompromised individuals; however, some of these individuals may have received this vaccine. Any doses received are valid if the minimum interval has been met.

Those Who Have Received THREE Doses
AZ, mRNA, mRNA
AZ, AZ, mRNA
mRNA, mRNA, mRNA

  • The primary series constitutes 3 doses, so these individuals are considered to have no boosters.
  • Booster 1 is given ≥ 3 months^ from the last dose.

    ^This interval is different from the interval to Booster 1 for non-immunocompromised (≥ 4 months) and is different from the interval to Booster 2 in non-immunocompromised and moderately to severely immunocompromised (both ≥ 4 months).

Those Who Have Received FOUR Doses
AZ, mRNA, mRNA, mRNA
AZ, AZ, mRNA, mRNA

  • If interval between Doses 3 and 4 is < 3 months, considered to have no booster. Next dose should be ≥ 3 months^ after last dose and will be Booster 1.
  • If interval between Doses 3 and 4 is ≥ 3 months, considered to have Booster 1. If eligible, next dose should be ≥ 4 months after last dose and will be Booster 2.

^ Note this interval is different from the interval to Booster 1 for non-immunocompromised (≥ 4 months) and is different from the interval to Booster 2 in non-immunocompromised and moderately to severely immunocompromised (both ≥ 4 months).

1-Dose Vaccine – Non-Immunocompromised (Including Clinically Vulnerable)
(Janssen [Johnson & Johnson])

In SK, it is recommended to provide an additional mRNA dose ≥ 2 months after the Janssen dose; this dose is considered Booster 1.

Those Who Have Received TWO Doses
Janssen, mRNA

  • If interval between Doses 1 and 2 is < 2 months, considered to have no booster. Next dose should be ≥ 2 months^ after last dose and will be Booster 1.
  • If interval between Doses 1 and 2 is ≥ 2 months, considered to have Booster 1. If eligible, next dose should be ≥ 4 months after last dose and will be Booster 2.

^ Note this interval is different from the interval to Booster 1 for all others.

Those Who Have Received THREE Doses
Janssen, mRNA, mRNA

  • If interval between Doses 1 and 3 is < 2 months, considered to have no booster. Next dose should be ≥ 2 months^ after last dose and will be Booster 1.
  • If interval between Doses 1 and 2 OR interval between Doses 2 and 3 OR interval between Doses 1 and 3 is ≥ 2 months, considered to have Booster 1. If eligible, next dose should be ≥ 4 months after last dose and will be Booster 2.

^ Note this interval is different from the interval to Booster 1 for all others.

Non-Health Canada Authorized Vaccines – Non-Immunocompromised (Including Clinically Vulnerable)

  • Individuals who have received 1 or 2 doses of a Non-Health Canada authorized vaccine should receive 1 mRNA dose to complete the primary series ≥ 28 days after the last dose.
    • Doses received after the 1st mRNA vaccine are assessed for eligibility as a booster dose.
  • Individuals who have received 3 doses of a Non-Health Canada authorized vaccine do not need further vaccines to complete the primary series. 
References
Last updated

06 May 2022

Supplementary Information

 

  • For individuals 12 to 30 years, Pfizer-BioNTech Comirnaty™ is preferred to Moderna Spikevax™ as a precaution. There has been a lower reported rate of myocarditis/pericarditis following Pfizer-BioNTech Comirnaty™ compared to Moderna Spikevax™. Individuals in this age group opting for Moderna Spikevax™ should be informed of the increased risk of myocarditis/pericarditis compared to Pfizer-BioNTech Comirnaty™. 

  • COVID-19 vaccination is recommended in those who have previous SARS-CoV-2 infection. See “NACI Interval Guidance” below for more information.
    • Safety and efficacy of Novavax Nuvaxovid™ have not been established in individuals with previous SARS-CoV-2 infection; this product may be used with informed consent.

  • No COVID-19 vaccines have received Health Canada authorization for booster doses in children 12 to 17 years old. NACI has reviewed evidence regarding: the primary series in children 12-17 years old; booster doses in adults 18 years and older; limited real-world data of booster doses in children 12-17 years old; waning vaccine protection from the primary series; and effectiveness of the primary series against Omicron. NACI recommends booster doses to children 12-17 years old who:
    • are moderately to severely immunocompromised
    • are at high risk of severe illness due to COVID-19 because of an underlying medical condition
    • are residents of congregate living settings
    • belong to racialized and/or marginalized communities disproportionately affected by COVID-19

  • Travel doses are no longer offered to individuals 18 years and older.
References
Last Updated

11 Apr 2022

This information outlines some differences between NACI guidance and Ministry of Health recommendations to help the informed consent process.

  • In general, reasons to choose shorter or longer intervals are similar whether considering intervals between COVID-19 vaccine doses or intervals between SARS-CoV-2 infection and COVID-19 vaccination.
  • A longer interval may produce a more robust and durable reaction compared to a shorter interval.
  • A shorter interval may be preferred:
    • when SARS-CoV-2 circulation is high, especially as seen with the Omicron variant
    • for those who are more susceptible to SARS-CoV-2 (e.g. immunocompromised) and/or those who are expected to have more severe outcomes from SARS-CoV-2 infection (e.g. underlying medical conditions)
    • health system capacity is limited
  • While some Ministry of Health interval recommendations may be shorter than those of NACI, Ministry of Health does not recommend against longer intervals. Recommendations have been made for the broader Saskatchewan population. On an individual level, risk factors (immune status, underlying conditions, SARS-CoV-2 exposure) should be considered to determine the best interval for that individual.

Intervals between COVID-19 vaccine doses

  • The intervals provided in this guide are those recommended by the Ministry of Health and represent minimum, or in some cases optimal, intervals between COVID-19 vaccine doses.
  • In some cases, NACI recommended intervals are longer than what is recommended in Saskatchewan.
  • NACI general recommended intervals between doses are below. See the COVID-19 Vaccine Chapter for details.
    • Primary series
      • Non-immunocompromised individuals
        • 1st and 2nd doses: 8 weeks (=optimal interval)
      • Moderately to severely immunocompromised individuals*
        • 1st and 2nd doses: minimum interval as determined by vaccine manufacturer
          • Optimal intervals are not provided.
        • 2nd and 3rd doses: at least 28 days
          • Optimal intervals are not provided.
          • While intervals >28 days are likely to result in better immune response, this needs to be balanced with the individual’s susceptibility to SARS-CoV-2 infection, risk of severe outcomes, and exposure risk.
    • Booster Dose
      • Last dose of primary series and booster dose: at least 6 months

*mRNA vaccination is recommended for all individuals. If the individual has received Janssen COVID-19 vaccine, the recommended minimum interval to the additional dose is 28 days. (2 months is recommended in Saskatchewan.)

Interval between SARS-CoV-2 infection and subsequent COVID-19 vaccine doses

  • Individuals infected with SARS-CO-V-2 should receive COVID-19 vaccination as vaccination provides more reliable and stronger immune protection.
  • Individuals need to wait at least until acute symptoms of COVID-19 have ceased and they are no longer infectious before receiving vaccination.
    • The reasons are to reduce transmission of COVID-19 to those at the vaccine clinic and to determine if any arising symptoms are due to infection or vaccination.
  • NACI suggests a longer interval as presented in the table below.

Table: NACI Suggested Intervals Between Previous SARS-CoV-2 Infection and COVID-19 Vaccination

SARS-CoV-2 Infection Timing Relative to COVID-19 Vaccination

Population

Suggested Interval between SARS-CoV-2 Infection and Vaccination

Infection prior to initiation or completion of primary vaccination series

(Primary series for individuals moderately to severely immunocompromised is 3 doses)

 

 

Individuals 5 years and older

No previous history of MIS-C

Not moderately to severely immunocompromised

Vaccine dose 8 weeks after symptom onset or positive test (if asymptomatic)

Individuals 5 years and older

No previous history of MIS-C

Moderately to severely immunocompromised

Vaccine dose 4-8 weeks after symptom onset or positive test (if asymptomatic)

Individuals 5 years or older

Previous history of MIS-C

Regardless of immunocompromised status

Vaccine dose when recovered clinically or at least 90 days since onset of MIS-C, whichever is longer

Infection after primary series but before booster dose

Individuals 12 years and older currently eligible for a booster dose

3 months after symptom onset or positive test (if asymptomatic) so long as it is at least 6 months from completing primary series

MIS-C = multisystem inflammatory syndrome in children

References
Last Updated

11 Apr 2022

mRNA vaccines are preferred for additional doses unless contraindicated.

See table below for recommended vaccine to use for additional dose depending on first two doses.

  • If the individual received a mixed mRNA schedule for first and second doses, either mRNA product may be used for the additional dose.

  • It is advised to match mRNA vaccine brands for an individual’s immunization series, however if the mRNA vaccine brand an individual previously received is unavailable at the time of presentation for the booster dose, or the individual requests another mRNA vaccine brand, the other mRNA vaccine brand may be administered and is expected to provide strong protection against COVID-19.

  • Novavax Nuvaxovid™ is a protein subunit COVID-19 vaccine that may be used off-label as a booster dose in individuals 18 years and older for whom mRNA vaccines are contraindicated, inaccessible, or refused. Novavax Nuvaxovid™ is only available through public health clinics.
  • If the individual received an AstraZeneca Vaxzevria™ dose followed by an mRNA dose, the same mRNA vaccine should be used for the additional dose, when possible, to avoid potentially needing a fourth dose for travel purposes.

  • Any mRNA vaccine can be used after a two-dose AstraZeneca Vaxzevria™ series.

  • Recipients of a Janssen (Johnson & Johnson) one-dose vaccination are eligible for one mRNA vaccine dose.

  • Individuals who received one or two doses of a non-Health Canada authorized COVID-19 vaccine should be offered one additional dose (preferentially mRNA) at least 28 days after the last COVID-19 vaccine dose to complete the primary series.
    • Following the additional dose, booster doses can be provided to those who are eligible.

      Recommended COVID-19 Vaccines for Additional Doses to Increase Immunity
Dose 1 Dose 2 Dose 3
COVISHIELD COVISHIELD Pfizer-BioNTech Comirnaty™
COVISHIELD COVISHIELD Moderna Spikevax™
COVISHIELD AstraZeneca Vaxzevria™ Pfizer-BioNTech Comirnaty™
COVISHIELD AstraZeneca Vaxzevria™ Moderna Spikevax™
COVISHIELD Pfizer-BioNTech Comirnaty™ Pfizer-BioNTech Comirnaty™
COVISHIELD Moderna Spikevax™ Moderna Spikevax™
AstraZeneca Vaxzevria™ AstraZeneca Vaxzevria™ Pfizer-BioNTech Comirnaty™
AstraZeneca Vaxzevria™ AstraZeneca Vaxzevria™ Moderna Spikevax™
AstraZeneca Vaxzevria™ COVISHIELD Pfizer-BioNTech Comirnaty™
AstraZeneca Vaxzevria™ COVISHIELD Moderna Spikevax™
AstraZeneca Vaxzevria™ Pfizer-BioNTech Comirnaty™ Pfizer-BioNTech Comirnaty™
AstraZeneca Vaxzevria™ Moderna Spikevax™ Moderna Spikevax™
Pfizer-BioNTech Comirnaty™ Pfizer-BioNTech Comirnaty™ Pfizer-BioNTech Comirnaty™
Pfizer-BioNTech Comirnaty™ Moderna Spikevax™ Moderna Spikevax™
Pfizer-BioNTech Comirnaty™ Moderna Spikevax™ Pfizer-BioNTech Comirnaty™
Pfizer-BioNTech Comirnaty™ Pfizer-BioNTech Comirnaty™ Moderna Spikevax™
Pfizer-BioNTech Comirnaty™ AstraZeneca Vaxzevria™ Pfizer-BioNTech Comirnaty™
Pfizer-BioNTech Comirnaty™ COVISHIELD Pfizer-BioNTech Comirnaty™
Moderna Spikevax™ Moderna Spikevax™ Moderna Spikevax™
Moderna Spikevax™ Pfizer-BioNTech Comirnaty™ Pfizer-BioNTech Comirnaty™
Moderna Spikevax™ Pfizer-BioNTech Comirnaty™ Moderna Spikevax™
Moderna Spikevax™ Moderna Spikevax™ Pfizer-BioNTech Comirnaty™
Moderna Spikevax™ AstraZeneca Vaxzevria™ Moderna Spikevax™
Moderna Spikevax™ COVISHIELD Moderna Spikevax™
Janssen (Johnson & Johnson) Pfizer-BioNTech Comirnaty™ -
Janssen (Johnson & Johnson) Moderna Spikevax™ -

Novavax Nuvaxovid™ is available through Public Health and may be given to individual in whom mRNA vaccines are contraindicated, inaccessible, or refused.

References
Last Updated

11 Apr 2022