Primary Series

Pfizer-BioNTech Comirnaty™ ≥ 5 to < 12 Years (Orange Cap)

The dose should be chosen according to vaccine recipient’s age at presentation.
  • For children who received Pfizer-BioNTech Comirnaty™ 10 mcg for their first dose and who have turned 12 years old by the time the second dose is due, complete the series with Pfizer-BioNTech Comirnaty™ 30 mcg (Purple or Grey Cap). 
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

08 Aug 2022

General Eligibility
  • All Saskatchewan residents ages ≥ 5 to < 12 years without contraindications to the vaccine.
    • Individuals ≥12 years old on day of presentation are not eligible for Pfizer-BioNTech Comirnaty™ 10 mcg (Orange Cap) and are to receive a vaccine approved for their age.
    • For children ≥ 5 years of age who are receiving their primary COVID-19 vaccine series and both age-appropriate formulations of Moderna Spikevax™ and Pfizer-BioNTech Comirnaty™ are readily available, Comirnaty™ is the preferred vaccine by NACI and the Ministry of Health as there may be a lower risk of myocarditis and/or pericarditis compared to Spikevax™ based on data from adolescents and young adults, in whom higher doses were used. It is unknown if this difference in risk of myocarditis and/or pericarditis exists in children < 12 years.
    • For immunocompromised children ages ≥ 5 to < 12 years who are receiving their primary COVID-19 vaccine series and both age-appropriate formulations of Moderna Spikevax™  and Pfizer-BioNTech Comirnaty™ are readily available, Spikevax™ may be preferred due to potentially greater immune response (based on adult data).
    • Vaccines available for other age groups:
      • Moderna Spikevax™ (Royal Blue Cap): children ≥ 6 months to < 6 years of age; this vaccine is not offered in Saskatchewan pharmacies
      • Moderna Spikevax™ 50 mcg (Red Cap): individuals ≥ 6 years of age
      • Pfizer-BioNTech Comirnaty™ (Purple or Grey Cap): individuals ≥ 12 years of age  
      • Other vaccines for individuals ≥ 18 years of age are available through the Saskatchewan Health Authority
  • 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 eligibility and appropriate interval.

  • 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 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 
    • A list of immunosuppressive medications is available here.
  • Individuals on dialysis or with chronic kidney disease (stage 5)* 

* Individuals on dialysis or with chronic kidney disease (stage 5) were added to this definition July 2022. These individuals may be eligible for further COVID-19 vaccine doses as their primary series is to be 3 doses with booster doses according to eligibility. 

References
Last Updated

08 Aug 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 4 to 8 weeks in non-immunocompromised individuals 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
  • 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

08 Aug 2022

Pfizer-BioNTech Comirnaty™ ≥ 12 Years (Purple or Grey Cap)

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

  • For children who received Pfizer-BioNTech Comirnaty™ 10 mcg (Orange Cap) for their first dose and who have turned 12 years old by the time the second dose is due, complete the series with Pfizer-BioNTech Comirnaty™ 30 mcg (Purple or Grey Cap).
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.
    • For individuals 12 to < 30 years of age who are receiving their primary COVID-19 vaccine series and both age-appropriate formulations of Moderna Spikevax™ and Pfizer-BioNTech Comirnaty™ are readily available, Comirnaty™ is the preferred vaccine as there is a lower risk of myocarditis and/or pericarditis compared to Spikevax™.
    • For immunocompromised individuals who are receiving their primary COVID-19 vaccine series and both age-appropriate formulations of Moderna Spikevax™ and Pfizer-BioNTech Comirnaty™ are readily available, Spikevax™ may provide a greater immune response (based on adult data). However, the Ministry of Health recommends Pfizer-BioNTech Comirnaty™ for individuals < 30 years as indicated above.
    •  Vaccines available for other age groups:
      • Moderna Spikevax™ (Royal Blue Cap): children ≥ 6 months to < 6 years of age; this vaccine is not offered in Saskatchewan pharmacies.
      • Moderna Spikevax™ (Red Cap): children ≥ 6 years of age
      • Pfizer-BioNTech Comirnaty™ (Orange Cap): children ≥ 5 to < 12 years of age
      • Other vaccines for individuals ≥ 18 years of age are available through the Saskatchewan Health Authority
  • 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 eligibility and appropriate interval.

  • 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 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 
    • A list of immunosuppressive medications is available here.
  • Individuals on dialysis or with chronic kidney disease (stage 5)*

* Individuals on dialysis or with chronic kidney disease (stage 5) were added to this definition July 2022. These individuals may be eligible for further COVID-19 vaccine doses as their primary series is to be 3 doses (or 2 doses if first dose was Janssen Jcovden™) with booster doses as eligible.

References
Last Updated

08 Aug 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: 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 intervalis 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 third dose 4 to 8 weeks after the second 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

23 Nov 2021

Moderna Spikevax™ ≥ 6 Years (Red Cap)

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

≥ 6 to < 12 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

  • 3 doses of 0.5 mL (100 mcg mRNA) 

≥ 6 to < 12 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.
    • For individuals 6 to < 30 years of age who are receiving their primary COVID-19 vaccine series and both age-appropriate formulations of Moderna Spikevax™ and Pfizer-BioNTech Comirnaty™ are readily available, Comirnaty™ is the preferred vaccine as there is a lower risk of myocarditis and/or pericarditis compared to Spikevax™ in adolescents and young adults. 
      • Individuals (and/or caregivers of individuals) 12 to < 30 years old opting to receive Spikevax™ should be informed of the increased risk of myocarditis/pericarditis compared to receiving Comirnaty™. 
      • It is unknown if this difference in risk of myocarditis and/or pericarditis exists in children < 12 years; however, Comirnaty™ is also the preferred vaccine in this age group.
    • For immunocompromised individuals who are receiving their primary COVID-19 vaccine series and both age-appropriate formulations of Moderna Spikevax™ and Pfizer-BioNTech Comirnaty™ are readily available, Spikevax™ may provide a greater immune response (based on adult data). However, the Ministry of Health recommends Pfizer-BioNTech Comirnaty™ for individuals < 30 years as indicated above.
    • Vaccines available for other age groups:
      • Moderna Spikevax™ (Royal Blue Cap): children ≥ 6 months to < 6 years of age; this vaccine is not offered in Saskatchewan pharmacies.
      • Pfizer-BioNTech Comirnaty™ (Orange Cap): children ≥ 5 to < 12 years of age
      • Pfizer-BioNTech Comirnaty™ (Purple or Grey Cap): individuals ≥ 12 years of age
      • Other vaccines for individuals ≥ 18 years of age are available through the Saskatchewan Health Authority
  • 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 eligibility and appropriate interval. 
      •  
  • 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 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 
  • Individuals on dialysis or with chronic kidney disease (stage 5)* 

*Individuals on dialysis or with chronic kidney disease (stage 5) were added to this definition July 2022. These individuals may be eligible for further COVID-19 vaccine doses as their primary series is to be 3 doses (or 2 doses if first dose was Janssen Jcovden™) with booster doses as eligible.

References
Last Updated

08 Aug 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: 4 to 8 weeks after 1st dose recommended (≥ 28 days)
    • Based on NACI recommendation, the minimum interval is 21 days between doses 1 & 2 (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 recommended (≥ 28 days)
  • Moderately to severely immunocompromised individuals who have previously received two doses should be offered a third dose 4 to 8 weeks after the second 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

22 Jul 2022

Booster Doses

Dose

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

For individuals ≥ 5 to < 12 years, Pfizer-BioNTech Comirnaty™ (Orange Cap) is the only vaccine to be used for booster doses.

Booster Dose
  • 0.2 mL (10 mcg mRNA)
References
Last Updated 

31 Aug 2022

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

  • In Saskatchewan, Pfizer-BioNTech Comirnaty™ is preferred to Moderna Spikevax™ for those 12 to < 30 years when both age-appropriate formulations of the vaccines are readily available.
    • NACI recommends Comirnaty™ in those 12 to 17 based on amount of available data.
Booster Doses
  • 0.3 mL (30 mcg mRNA)   
References
Last Updated

01 Sep 2022

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

  • Moderna Spikevax™ (Red Cap) is indicated for individuals ≥ 6 years for primary series doses. Moderna Spikevax™ (any formulation) is not to be used for booster doses in children < 12 years.
  • In Saskatchewan, Pfizer-BioNTech Comirnaty™ is preferred to Moderna Spikevax™ for those 12 to < 30 years when both age-appropriate formulations of the vaccines are readily available.
    • NACI recommends Comirnaty™ in those 12 to 17 based on amount of available 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 Seniors' Assisted Living residents, 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

01 Sep 2022

  • Moderna Spikevax™ Bivalent Original / Omicron BA.1 is indicated for individuals ≥ 18 years as a booster dose only in those who have completed a primary series (with any COVID-19 vaccine).  Moderna Spikevax™ Bivalent is not to be used for primary series doses.
  • In Saskatchewan, bivalent vaccine eligibility will prioritize those at highest risk from the current COVID-19 Omicron variant
Booster Dose
  • 0.5 mL (50 mcg mRNA) containing 25 mcg original and 25 mcg Omicron BA.1 variant
References
  • Moderna
  • Saskatchewan Immunization Manual
  • Directive from Dr. Saqib Shahab, Chief Medical Health Officer
    • Provision of Moderna Spikevax™ Bivalent Original/Omicron Vaccine; 08 Sept 2022
Last Updated

12 Sep 2022

Eligibility and Interval

Population Moderately to Severely Immunocompromised? # Doses in Primary Series Minimum Interval to Booster 1    Minimum Interval to Booster 2¥   
≥ 18 Years Yes 3 months 4 months 
No 2 4 months  4 months 
≥ 12 Years to < 18 Years Yes 3 3 months N/A
No 2 4 months N/A
 ≥ 5 Years to < 12 Years Yes 3 4 months N/A
No 2 4 months N/A
Recipients of 1 Dose of Janssen Jcovden™ Yes
(mRNA preferred)
2^ 2 months 4 months
No 1 2 months 4 months

‡ See “Individuals Who Are Moderately to Severely Immunocompromised” tab for definition of moderately to severely immunocompromised.
¥ Intervals between previous doses and number of doses received do not need to be assessed. Person is eligible for booster if it has been at least 4 months since the last dose.

€ A minimum interval of three months can be used on a case-by-case basis in exceptional circumstances such as individual risk, travel, vaccine availability, and administration efficiency.
Janssen Jcovden™ is only approved for individuals 18 years and older. 
^ For individuals who are moderately to severely immunocompromised who received Janssen Jcovden™, the interval to the 2nd dose, which is mRNA, is at least 28 days from the JCovden™ dose.

N/A= Not applicable; these individuals are not eligible.

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

References
Last Updated

31 Aug 2022

  • Health Canada authorized the use of Moderna Spikevax Bivalent Original/Omicron BA.1 as a booster dose in individuals 18 years and older on September 1, 2022.

  • In Saskatchewan, bivalent vaccine eligibility will prioritize those at highest risk from the current COVID-19 Omicron variant.

  • Starting 12 Sept 2022, eligibility to receive Moderna Spikevax Bivalent vaccine as a booster dose includes:
    • individuals 18 years and older residing in long-term care and personal care homes and other congregate living facilities

  • Starting 19 Sept 2022, eligibility to receive Moderna Spikevax Bivalent vaccine as a booster dose includes:
    • individuals 18 years and older residing in long-term care and personal care homes and other congregate living facilities
    • individuals 70 years and older
    • Individuals 50 years and older in First Nation and Metis communities and those in the Northern Service Administration District (NSAD).

  • Eligible individuals should receive Moderna Spikevax Bivalent vaccine booster dose at least 4 months* following their last COVID-19 vaccination regardless of the number of COVID-19 doses previously received.

  • Individuals are eligible for ONE dose of Moderna Spikevax Bivalent vaccine as a booster dose.

  • Bivalent COVID-19 booster doses in Saskatchewan will be offered in a phased approach. As vaccine supply increases and system capacity allows, eligibility will expand to:
    • Individuals 18 years of age with immunocompromising conditions; and
    • Individuals 50 years of age and older living in the community; and eventually
    • All individuals 18 years of age to align with the annual influenza immunization campaign.

  • NACI recommends that the authorized dose of a bivalent Omicron-containing mRNA COVID-19 vaccine should be offered as a booster dose to the authorized age groups (≥18 years of age). If the bivalent Omicron-containing mRNA COVID-19 vaccine is not readily available, an original mRNA COVID-19 vaccine should be offered to ensure timely protection. Individuals eligible for a booster dose, particularly those in groups at a higher risk of severe outcomes from COVID-19, should not delay their planned vaccination in anticipation of a bivalent Omicron-containing vaccine.  Individuals choosing to delay a booster dose in anticipation of a new vaccine formulations should carefully assess their individual risks (risk of SARS-CoV-2 infection and severe outcomes from COVID-19) and benefits associated with deferring a booster dose.

* A minimum interval of three months can be used on a case-by-case basis in exceptional circumstances such as individual risk, travel, vaccine availability, and administration efficiency.

References
Last Updated

12 Sep 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
    • A list of immunosuppressive medications is available here.
  • Individuals on dialysis or with chronic kidney disease (stage 5)*
* Individuals on dialysis or with chronic kidney disease (stage 5) were added to this definition July 2022. These individuals may be eligible for further COVID-19 vaccine doses as their primary series is to be 3 doses (or 2 doses if first dose was Janssen Jcovden™) with booster doses as eligible.

Reminder: primary series is 3 doses of most vaccines†; 3rd dose at least 28 days following 2nd dose
†Viral vector vaccines are not recommended for immunocompromised individuals. However, if an immunocompromised individual receives Janssen Jcovden™, NACI recommends an mRNA dose be provided at least 28 days following the Jcovden™ dose to complete the primary series. Booster doses would then apply. 

Other Important Information 

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

  • Individuals not previously immunocompromised but become moderately to severely immunocompromised receive a 3-dose primary series (minimum 28 days between each dose). The interval to Booster 1 in these individuals is at least 3 months for those who are 12 years and older and at least 4 months for those who are ≥ 5 years to < 12 years. Further booster doses can be received when eligible. 

  • NACI recommends that individuals eligible for a booster dose, particularly those in groups at higher risk of severe outcomes from COVID-19, should not delay their planned vaccination in anticipation of a bivalent Omicron containing mRNA COVID-19 vaccine.

  • Bivalent vaccine: At this time, eligibility for bivalent booster doses in Saskatchewan is being prioritized based on those at highest risk from the current COVID-19 Omicron variant.  Moderately to severely immunocompromised individuals are not eligible for a bivalent booster dose unless they meet the age and/or place of residence criteria as noted in Bivalent Vaccine Availability and Eligibility.  As vaccine supply increases and system capacity allows, individuals 18 years of age and older with immunocompromising conditions will be included in eligibility.
References
Last Updated

12 Sep 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.  

Individuals who received a Janssen Jcovden™ dose:

  • It is recommended these individuals receive an mRNA booster vaccine at least 2 months after receiving the Janssen Jcovden™ dose. This is considered Booster 1.
    • Booster 2 can be received at least 4 months after Booster 1 in those who are eligible (though a minimum interval of 3 months can be used on a case-by-case basis in exceptional circumstances such as travel).
  • Viral vector vaccines are not recommended for immunocompromised individuals. However, if an immunocompromised individual receives a Janssen Jcovden™ dose, NACI recommends an mRNA dose be provided at least 28 days following the JCovden™ 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 July 5, 2022 and is eligible for another dose at 2 months, the dose can be provided September 5, 2022 or later.

References
Last Updated

24 May 2022

Supplementary Information

 

Choice of Vaccine

  • mRNA vaccines are the recommended COVID-19 vaccine platform for everyone unless contraindicated.

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

  • Booster Doses in Individuals 5 Years to < 18 Years
    • Pfizer-BioNTech Comirnaty™ 10 mcg (Orange Cap) has been authorized for a first booster dose in individuals ≥ 5 years to <12 years.
    • Pfizer-BioNTech Comirnaty™ 30 mcg (Purple or Grey Cap) has been authorized for a first booster dose in individuals 16 years and older.
    • Moderna Spikevax™ has been authorized for a first booster dose in individuals 18 years and older.
    • 5 Years to < 12 Years
      • All individuals ≥ 5 years to < 12 years are eligible for Booster 1 with Pfizer-BioNTech Comirnaty™ in Saskatchewan at least 4 months following the last dose of the primary series.
      • NACI recommends a booster dose with Pfizer-BioNTech Comirnaty™ should be offered to individuals in this age group with underlying medical conditions that put them at high risk of severe illness due to COVID-19 and that a booster dose may be offered to all others in this age group. (See full NACI recommendation).
      • Moderna Spikevax™ is not to be used for booster doses in this age group.
    • 12 Years to < 18 Years
      • All individuals ≥ 12 years to < 18 years are eligible for Booster 1 in Saskatchewan at least 4 months following the last dose of the primary series.
      • NACI recommends a booster dose should be offered to individuals in this age group who are vulnerable/have risk factors and that a booster dose may be offered to all others in this age group. (See full NACI recommendation).
      • Pfizer-BioNTech Comirnaty™ is the preferred vaccine by NACI and the Ministry of Health. 
References
Last Updated

31 Aug 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 supports NACI's 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: minimum interval as authorized by Health Canada for the specific vaccine
          • Optimal interval: 8 weeks  
      • Moderately to severely immunocompromised individuals*
        • 1st and 2nd doses: minimum interval as authorized by Health Canada for the specific vaccine
          • Optimal interval: 4-8 weeks
        • 2nd and 3rd doses: ≥ 28 days
          • Optimal interval: 4-8 weeks
        • 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
      • 1st booster dose: ≥ 6 months after last dose of primary series
      • 2nd booster dose: 6 months from 1st booster, though this may need to be shorter depending on local epidemiology

*mRNA vaccination is recommended for all individuals. If the individual has received Janssen Jcovden™, 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)

 

 

No previous history of MIS-C or MIS-A following vaccination

Not moderately to severely immunocompromised

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

No previous history of MIS-C or MIS-A following vaccination

Moderately to severely immunocompromised

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

Previous history of MIS-C or MIS-A following vaccination

Regardless of immunocompromised status

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

Infection after primary series but before booster dose

Individuals 12 years and older currently eligible for a booster dose

6 months since previous infection, though may be as short as 3 months depending on epidemiological risk

MIS-A = multisystem inflammatory syndrome in adults; MIS-C = multisystem inflammatory syndrome in children

References
Last Updated

22 Sep 2022