Primary Series

Note: Neither Moderna Spikevax Bivalent nor Pfizer-BioNTech Comirnaty® Original & Omicron BA.4/BA.5 are authorized to be used as a primary COVID-19 immunization series. However, the SK Ministry of Health supports permissive administration of either bivalent vaccine for this purpose with informed consent if an individual requests to start or complete their COVID-19 primary series with bivalent vaccine.

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

The dose should be chosen according to vaccine recipient’s age at presentation, which means some children may receive different doses to complete the series.
  • For example, a child who is 11 years old at the first dose and turns 12 years old before the next dose, would receive 10 mcg (Orange cap) and 30 mcg (Purple or Grey cap), respectively, of Pfizer-BioNTech Comirnaty®.   
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.

*To complete a primary series started with Pfizer-BioNTech Comirnaty® 3 mcg (Maroon cap), children require 3 doses (if immune competent) or 4 doses (if immunocompromised). If the child transitions from 4 years old to 5 years old during the vaccine series, they should still receive the number of doses recommended as part of their initial primary series.  This also applies to mixed vaccine series (i.e. at least one Moderna Spikevax™ 25 mcg dose given as a dose in the primary series). 

  • E.g. Immunocompromised child received 2 doses of Pfizer-BioNTech Comirnaty® 3 mcg (Maroon cap) and turns 5 years old before the 3rd dose. Based on the initial schedule when they started the series, and because they are immunocompromised, their primary series would consist of four doses. Therefore, TWO doses of Pfizer-BioNTech Comirnaty® 10 mcg (Orange cap) will be required to complete the primary series. The Contraindications and Precautions Background Document includes more examples.

Note: Pfizer-BioNTech Comirnaty® 10 mcg (Orange cap) is the preferred vaccine for 5-year olds, but the primary series may also be completed with Moderna Spikevax™ 25 mcg (Royal Blue cap). 

References
Last Updated

28 Oct 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 authorized for their age.
    • For children ≥ 5 to < 12 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. 
    • 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).
    • Other vaccines available:
      • 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® (Maroon Cap): individuals ≥ 6 months to < 5 years; this vaccine is not offered in Saskatchewan pharmacies.
      • 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

02 Nov 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. 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.
  • Dose 3 (if primary series started with Pfizer-BioNTech Comirnaty® 3 mcg): 8 weeks after 2nd dose
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
  • Dose 4 (if primary series started with Pfizer-BioNTech Comirnaty® 3 mcg): 4 to 8 weeks after 3rd 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 Oct 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 29 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). 
    • For those 12 to 29 years who are moderately to severely immunocompromised and both Spikevax™ and Comirnaty® are available, consider:
      • patient values
      • risks of myocarditis/pericarditis
        • males
        • 2nd dose, especially at shorter intervals (at least 8 weeks preferred)
      • risks of acquiring COVID-19 infection
        • vaccination status and/or recent COVID-19 infection
        • degree of immune suppression
        • levels of SARS-CoV-2 circulating
        • characteristics of circulating variant(s)
        • level of exposure to SARS-CoV-2 (e.g. level of interaction with the public, personal protection measures taken)
        • comorbidities
    •  Other vaccines available:
      • 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® (Maroon Cap): individuals ≥ 6 months to < 5 years; this vaccine is not offered in Saskatchewan pharmacies.
      • 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

02 Nov 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
    • 4 to 8 weeks Is recommended, but dose can be provided ≥ 21 days after 2nd dose if chosen.
  • 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 12 to 29 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 29 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 by NACI.
    • 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). 
    • For those 12 to 29 years who are moderately to severely immunocompromised and both Spikevax™ and Comirnaty® are available, consider:
      • patient values
      • risks of myocarditis/pericarditis
        • males
        • 2nd dose, especially at shorter intervals (at least 8 weeks preferred)
      • risks of acquiring COVID-19 infection
        • vaccination status and/or recent COVID-19 infection
        • degree of immune suppression
        • levels of SARS-CoV-2 circulating
        • characteristics of circulating variant(s)
        • level of exposure to SARS-CoV-2 (e.g. level of interaction with the public, personal protection measures taken)
        • comorbidities
    • Other vaccines available:
      • Moderna Spikevax™ (Royal Blue Cap): children ≥ 6 months to < 6 years of age; this vaccine is not offered in Saskatchewan pharmacies.
      • Pfizer-BioNTech Comirnaty® (Maroon Cap): individuals ≥ 6 months to < 5 years; 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

02 Nov 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

  • For individuals ≥ 5 to < 12 years, Pfizer-BioNTech Comirnaty® (Orange Cap) is the only vaccine to be used for booster doses.
  • See primary series for first 3 doses in moderately to severely immunocompromised individuals.
Booster Dose
  • 0.2 mL (10 mcg mRNA)
References
Last Updated 

31 Aug 2022

  • For individuals 12 years and older, Omicron-containing bivalent COVID-19 vaccines are recommended for booster doses, however Pfizer-BioNTech Comirnaty® original may be used if requested or if bivalent vaccine is not available.
  • See primary series for first 3 doses in moderately to severely immunocompromised individuals.
Booster Doses
  • 0.3 mL (30 mcg mRNA)   
References
Last Updated

02 Nov 2022

  • For individuals 12 years and older, Omicron-containing bivalent COVID-19 vaccines are recommended for booster doses, however Moderna Spikevax™ original may be used if requested or if bivalent vaccine is not available.
  • Moderna Spikevax™ (Red Cap) can be used for individuals ≥ 6 years for primary series doses and for individuals ≥ 12 years for booster doses.  
  • See primary series for first 3 doses in moderately to severely immunocompromised individuals.
 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

02 Nov 2022

  • Moderna Spikevax™ Bivalent is:
    • indicated for individuals ≥ 18 years as a booster dose for those previously immunized with a COVID-19 vaccine series.  
    • not authorized to be used as a primary COVID-19 immunization series. However, the Ministry of Health supports permissive administration of this bivalent vaccine for this purpose with informed consent if an individual requests to start or complete their COVID-19 primary series with bivalent vaccine.
    • the preferred mRNA Omicron-containing bivalent vaccine brand in SK for those 12 years and older who are moderately to severely immunocompromised. Use in adolescents < 18 years old is off-label.
Booster Dose
  • 0.5 mL (50 mcg mRNA) containing 25 mcg original and 25 mcg Omicron BA.1 variant
References
Last Updated

28 Oct 2022

  • Pfizer-BioNTech Comirnaty® Original & Omicron BA.4/BA.5 (Bivalent BA.4/BA.5) has been authorized by Health Canada for individuals ≥ 12 years as a booster dose for those previously immunized with a COVID-19 vaccine primary series.
  • The Pfizer Comirnaty® bivalent vaccine is not authorized to be used as a primary COVID-19 immunization series. However, the Ministry of Health supports permissive administration of this bivalent vaccine for this purpose with informed consent if an individual requests to start or complete their COVID-19 primary series with bivalent vaccine.
  • Moderna Spikevax™ Bivalent is the preferred mRNA Omicron-containing bivalent vaccine brand in SK for those 12 years and older who are moderately to severely immunocompromised. Use of Moderna Spikevax™ Bivalent in adolescents < 18 years is off-label
Booster Dose
  • 0.3 mL (30 mcg mRNA) containing 15 mcg original and 15 mcg Omicron BA.4/BA.5 variant
References
Last Updated

17 Oct 2022

Eligibility and Interval

eligibility-table-part1.png
eligibility-table-part2.1.png

  1. See Individuals Who Are Moderately to Severely Immunocompromised tab for definition of moderately to severely immune compromised.
  2. 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.
  3. mRNA vaccines are preferred as booster doses, but alternatives (e.g. Novavax Nuvaxovid, Janssen Jcovden) are available through Public Health.
  4. 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.
  5. There are no clinical data of Pfizer-BioNTech Comirnaty bivalent vaccine containing the BA.4/BA.5 variant. Authorization was based on preclinical data (antibody response) of this vaccine as well as indirect clinical data of Pfizer-BioNTech Comirnaty bivalent vaccine containing the BA.1 variant.
  6. There are limited adult data indicating potentially greater immune response from Moderna Spikevax original compared to Pfizer-BioNTech Comirnaty original. This recommendation is based on expert opinion.
  7. 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
  8. There are limited data on use of Moderna Spikevax original in those 12-17 years of age and no data on Moderna Spikevax Bivalent in <18 years of age; recommendation based on expert opinion.
  9. There are no data of bivalent mRNA vaccines in adolescents 12-17. Use of Pfizer-BioNTech Comirnaty Original & Omicron BA.4/BA.5 in this age group has been authorized based on extensive experience and post-market safety data with the same dose (30 mcg) of Pfizer-BioNTech Comirnaty (original).
  10. Janssen Jcovden is only approved for individuals 18 years and older.
  11. For individuals who are moderately to severely immunocompromised who received Janssen Jcovden, the interval to the 2nd dose (mRNA preferred), is at least 28 days from the Jcovden dose. 
References
Last Updated

01 Nov 2022

  • Individuals 12 years and older are eligible for one dose of bivalent COVID-19 vaccine.  
    • Moderna Spikevax™ Bivalent is authorized in individuals 18 years and older
      • In SK, this is the preferred booster vaccine for those who are moderately to severely immunocompromised, including in those ≥ 12 years to < 18 years, in which case it is off-label.
    • Pfizer-BioNTech Comirnaty® Original & Omicron BA.4/BA.5 is authorized in individuals 12 years and older.
  • Eligible individuals should receive bivalent vaccine booster dose at least 4 months* following their last COVID-19 vaccination:
    • regardless of the number of COVID-19 doses previously received, as long as their primary series is complete, and
    • regardless of the previous COVID-19 vaccine brand(s) received in the past

  • Neither the Moderna Spikevax™ bivalent vaccine nor the Pfizer-BioNTech Comirnaty® bivalent vaccine are authorized to be used as a primary COVID-19 immunization series. However, the Ministry of Health supports permissive administration of either bivalent vaccine for this purpose with informed consent if an individual requests to start or complete their COVID-19 primary series with bivalent vaccine.

NACI and SK Recommendations

  • Bivalent Omicron-containing mRNA COVID-19 vaccines are preferred for booster doses in the authorized age groups.
  • If a bivalent Omicron-containing mRNA COVID-19 vaccine is not readily available or desired, an original mRNA COVID-19 vaccine may be offered to ensure timely protection. 
  • Those who have received a fall booster dose with an original or bivalent mRNA COVID-19 vaccine, do not require further doses at this time. All mRNA COVID-19 vaccines are likely to provide significant protection against hospitalization and severe disease.

* 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

17 Oct 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. 

  • In SK, Moderna Spikevax™ Bivalent is the preferred booster vaccine for those who are moderately to severely immunocompromised (off-label recommendation for ≥12 to <18 years).
References
Last Updated

01 Nov 2022

While mRNA vaccines are preferred for all individuals, doses of viral vector vaccines, including mixed doses (1 viral vector + 1 mRNA), are valid and constitute a primary series.  

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

17 Oct 2022

Supplementary Information

 

Choice of Vaccine
  • mRNA vaccines (original or bivalent) are the recommended COVID-19 vaccine platform for everyone unless contraindicated.
Primary Series
  • Individuals ≥5 Years to 29 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™.
    • NACI also recommends Comirnaty® over Spikevax™ for those ≥ 5 Years to < 12 Years, however the risk of myocarditis/pericarditis in this age group is lower. 
    • Individuals ≥12 to 29 years opting for Moderna Spikevax™ should be informed of the increased risk of myocarditis/pericarditis compared to Comirnaty®. 
Booster Doses
  • Individuals 5 Years to < 12 Years
    • Pfizer-BioNTech Comirnaty® 10 mcg (Orange Cap) is authorized as a booster dose in individuals ≥ 5 years to <12 years. This is the only vaccine to be used for booster doses in this age group.
    • 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.

  • Individuals ≥ 12 Years 
    • Health Canada Authorizations 
      • Pfizer-BioNTech Comirnaty® original 30 mcg (Purple or Grey Cap) is authorized for a first booster dose in individuals 16 years and older; in SK it can be used in those 12 years and older.
      • Moderna Spikevax™ original 50 mcg/100 mcg (Red Cap) is authorized for a first booster dose in individuals 18 years and older; in SK it can be used in those 12 years and older.
      • Moderna Spikevax™ Bivalent is authorized as a booster dose in individuals 18 years and older.
      • Pfizer-BioNTech Comirnaty® Original & Omicron BA.4/BA.5 is authorized as a booster dose in individuals 12 years and older.

    • SK/NACI Recommendations
      • In Saskatchewan, all individuals 12 years and older are eligible for a fall booster dose at least 4 months* following the last dose, as long as the primary series is complete. 
      • NACI and SK Ministry of Health recommend that the authorized dose of a bivalent Omicron-containing mRNA COVID-19 vaccine be offered as the booster dose to the authorized age groups.
        • If the bivalent Omicron-containing mRNA COVID-19 vaccine is not readily available or is requested, an original mRNA COVID-19 vaccine should be offered to ensure timely protection.
      • In SK, Moderna Spikevax™ Bivalent is the preferred booster vaccine for moderately to severely immunocompromised individuals 12 years and older. 
        • Use of Moderna Spikevax™ Bivalent in ≥12 to <18 years of age is off-label. 

*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.

Recipients of 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.
    • 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

02 Nov 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.
  • For individuals 5 years and older, the Ministry of Health recommends waiting at least 3 months post-infection before receiving COVID-19 vaccination to ensure a robust immune response is mounted.
    • If requested, vaccination can be provided before 3 months as long as symptoms have resolved.
  • NACI suggests a longer interval before booster doses 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

29 Sep 2022