This guide is to be used in conjunction with the medSask COVID-19 Vaccine Screening and Consent Form. It is intended to provide guidance and management of patients during the screening process.

14 Jul 2021
  • Q1a
    • Information added regarding pericarditis or myocarditis following mRNA vaccine.
  • Q2a
    • Clarifications regarding monoclonal antibodies added.
07 Jul 2021
  • Q1a
    • Instructions regarding reporting AEFIs to 2nd doses added.
30 Jun 2021
  • Form
    • Q1 has been separated into 1 and 1a. 
    • Capillary leak syndrome has been added to Q9.

  • Q1
    • Q1 is now Q1 and Q1a so that side effects from the first dose can be addressed separately.

  • Q9
    • Added capillary leak syndrome as a contraindication to AstraZeneca/COVISHIELD vaccines as per Health Canada.
22 Jun 2021
  • Q1 Previous COVID-19 Vaccine
    • Intervals between vaccine doses updated.
    • Wording regarding interchanging between mRNA vaccines updated.
08 Jun 2021
  • Q4 Pregnancy; Q5 Breastfeeding; Q6 Autoimmune Conditions; Q7  Immunosuppression
    • Changes to reflect that NACI now has the same recommendations for these individuals as for the general adult population based on emerging safety and immunogenicity data.
    • Algorithms and Benefit-Risk Information links have been removed as they are no longer in use/available within SHA.
04 Jun 2021
  • Q1 Previous COVID-19 Vaccine
    • Information added regarding minimum intervals between doses when vaccine for 2nd dose differs from vaccine received for 1st dose.
    • Clarification regarding interchanging mRNA vaccines.
02 Jun 2021
  • Q1 Previous COVID-19 Vaccine
    • Updated with interchangeability information for second dose.
21 May 2021
  • Q4 Pregnancy
    • As of May 21, 2021, only mRNA vaccines are to be routinely offered to pregnant individuals. Be sure to read the information in the tab for more details and nuances.
17 May 2021
  • Do you work in a healthcare facility or live in a personal care home?
    • PCH residents have been added to those to enter in the Vaccine Risk Factor Portal

  • Q1 Previous COVID-19 Vaccine
    • Many points added including:
      • Ensuring minimum intervals met and individual is eligible
      • Ensuring the recipient will be receiving the same vaccine as the first dose
      • Managing adverse events to first dose

  • Q2 Previous COVID-19 Infection
    • Added information regarding when to administer doses in those who tested positive for COVID-19 after their first dose.

  • Q3 Severe allergies
    • Information added regarding how to proceed if individual reports allergic reaction to first dose.

  • Q4 Pregnancy
    • Added guidance to those becoming pregnant after the first dose.

  • Q9 Vaccine-induced Immune Thrombotic Thrombocytopenia (VITT) related
    • Added history of thrombosis with thrombocytopenia after first dose of AstraZeneca/COVISHIELD to list of those who should not receive AstraZeneca/COVISHIELD as second dose.
14 May 2021
  • Age
    • Added some information regarding informed consent for mature minors.

  • Q2 Previous COVID-19 Infection
    • Direction has changed from the Ministry of Health such that no delay is required to receive COVID-19 vaccination following COVID-19 infection so long as the individual has recovered and no longer needs to follow isolation requirements.
11 May 2021
  • Age
    • Changed note to indicate pharmacies are authorized to provide Pfizer-BioNTech vaccine to eligible individuals ≥ 12 years old.
08 May 2021
  • Q4 Pregnancy
  • Q6 Autoimmune Conditions
    • Removed: "Patients with ANY autoimmune condition that involves the NEUROLOGICAL SYSTEM - other than Multiple Sclerosis - must discuss with the primary physician / specialist before immunization is provided."
05 May 2021
  • Age
    • Changed approved age for Pfizer ≥ 12 years old. Added note that pharmacies are not yet authorized to provide the vaccine to individuals <16 years of age). (See 11 May update.)

  • Q9
    • Added history of cerebral venous sinus thrombosis (CVST) associated with thrombocytopenia as per AstraZeneca product monograph.

 

AEFI = Adverse Event Following Immunization
AESI = Adverse Events of Special Interest
DPEBB = Drug Plan & Extended Benefits Branch
HIV= Human Immunodeficiency Virus
LTC = Long-Term Care
MHO = Medical Health Officer
NACI = National Advisory Committee on Immunization
PCH = Personal Care Home
SCA = Saskatchewan Cancer Agency
SHA = Saskatchewan Health Authority
SIM = Saskatchewan Immunization Manual
SOGC = Society of Obstetricians and Gynecologists of Canada

Vaccine Recipient Information

Ensure the vaccine recipient is within the authorized age group of the vaccine being provided.
  • AstraZeneca/COVISHIELD: ≥ 18 years old
  • Moderna: ≥ 18 years old
  • Pfizer-BioNTech: ≥ 12 years old (Note: as of 11 May 2021, authorized immunizers may administer vaccine to eligible persons 12 years and older.)

NOTE: Whether individuals in an age group are eligible for vaccination at any given time in SK will depend on the phased rollout. 

Informed Consent of Minors (<18 years old)

  • See SIM Chapter 3 for further details if needed.
  • FAQs and examples of different scenarios (e.g. mature minor who wants to be vaccinated but parents object) can be found here.
  • All doses administered in pharmacy require informed consent, regardless of consent that may have been obtained through other programs (e.g. school-based clinics).

Mature Minors (ages 13-17 years)

  • Individuals ages 13-17 are considered to be mature minors. Children aged 13 years and older can legally consent to, refuse and revoke immunizations on their own behalf if they demonstrate capability and understanding of the standard information. It is up to the individual health care provider to use their professional judgement to assess the patient to determine whether the patient has demonstrated the capacity to make that decision. 
  • If the health care provider does not deem them to be a mature minor, then they would fall into the same category and consent requirements as a child (ages 12 and under), which would require consent from a parent/legal guardian. 

Minors 12 Years and Younger

  • Consent must be obtained from a parent/legal guardian.
  • All biological and adoptive parents have the authority to give, refuse and revoke informed
    consent for their children’s immunizations, except when their decision-making rights have been
    legally revoked and another legal guardian has been appointed (e.g., social worker).
References 
Last updated

04 Jun 2021

  • Individuals who work in healthcare facilities will need to be documented via the Vaccine Risk Factor Portal. The DPEBB guide to this portal is available here.

  • To register for login access, phone the CGI Help Desk: 1-800-667-6080 or 306-761-4286

  • The information MUST be entered into the portal BEFORE entering the prescription and billing to DPEBB.

  • The categories of healthcare workers that can be flagged on the form are:
    • SHA (i.e. staff employed by the SHA)
    • SHA LTC (i.e. staff working at a LTC facility operated by the SHA)
    • Non-SHA (e.g. dentist, nurse at a private physician clinic, community pharmacists) 
    • Non-SHA LTC (i.e. staff working at privately operated or SHA affiliated LTC facilities)
    • PCH (i.e. staff working at a personal care home)
    • PCH resident

  • For more specific information regarding eligibility, non-SHA professions, as well as other groups such as teachers, pharmacists can refer to the government eligibility lists. 
     
  • This table outlines Vaccine Eligibility Groups, as well as information regarding proof of employment/eligibility and is also posted on the website above.
Last Updated

17 May 2021

Screening Questions

General Information
  • The eHR Viewer needs to be checked for all individuals.
  • Ensure the vaccine recipient is eligible for first or second dose.
    • All residents 12 years and older are eligible for the first dose.
    • All residents who have received their first dose of vaccine are eligible to receive their second dose following a 28-day interval.
      • NOTE: As a general vaccination principle, interruption of a vaccine series resulting in an extended interval between doses does not require restarting the vaccine series, regardless of the interval between doses. Should an eligible individual present for the 2nd dose beyond 16 weeks (the current extended interval), provide the dose as soon as possible and consider the series complete.
  • Residents who received their first dose in a different jurisdiction will be eligible to receive their second dose in Saskatchewan and in alignment with Saskatchewan’s current interval. Individuals in this scenario will need to have documentation of their first dose from the jurisdiction they received it in.
Vaccine Used for 2nd Dose
  • As of June 1, 2021, based on NACI recommendation, Saskatchewan is adopting the following strategy for vaccine to use as 2nd dose:
    • Anyone who received AstraZeneca for their first dose is eligible to receive AstraZeneca, Pfizer-BioNTech or Moderna for the 2nd dose, as preferred, unless contraindicated.
    • mRNA vaccines (Pfizer-BioNTech or Moderna) are considered interchangeable. Anyone who received an mRNA vaccine for the 1st dose should take whichever of these two vaccines is available to them for their 2nd dose, rather than waiting for the same brand of vaccine. This will provide residents with more options to be immunized sooner.
    • Currently there are limited data regarding safety and efficacy of interchangeability of COVID-19 vaccines. For a review of the current available evidence and to support informed decision making, refer to NACI Interchangeability of Authorized COVID-19 Vaccines Rapid Response full report or summary
Minimum Intervals Between COVID-19 Vaccine Doses
Vaccine Brand 1st Dose Vaccine Brand 2nd Dose Interval*
Pfizer-BioNTech Pfizer-BioNTech Minimum 28 days^
Moderna Moderna Minimum 28 days
Pfizer-BioNTech Moderna Minimum 28 days
Moderna Pfizer Minimum 28 days
AstraZeneca AstraZeneca Minimum 28 days
AstraZeneca Pfizer-BioNTech Minimum 28 days
AstraZeneca Moderna Minimum 28 days

*Previous information suggested 8-12 weeks between doses is optimal; however, with the Delta variant circulating in Saskatchewan, it's recommended that all residents receive second dose vaccinations as soon as eligible.
^21 days is the minimum interval authorized by Health Canada;19 days is included in NACI recommendations based on the per-protocol design for the Pfizer-BioNTech clinical trial that was 19-23 days. The province is adopting a 28 day interval for all vaccines. 
†28 days is the minimum interval authorized by Health Canada; 21 days is included in NACI recommendations based on the majority of participants in the Moderna COVID-19 vaccine clinical trial received the second dose 21 to 42 days after the first, as per the pre-defined window.

References
Last Updated

30 Jun 2021

Reaction to previous COVID-19 vaccine
  • Note: asking about side effects to the first vaccine is included to prompt a conversation with the vaccine recipient (e.g. any concerns, what to expect from second dose, how to manage side effects). Expected side effects are not to be reported and it is not necessary they be documented on this form.

  • If an AEFI was submitted, communication from the MHO should have been received by whomever submitted the AEFI as to whether or not to proceed with the second dose. The individual should have been provided this information. At this time it is unclear how pharmacy can access the direction provided by the MHO if the individual does not know/remember.

  • If an AEFI has not been submitted, gather as many details as possible, submit an AEFI and wait for MHO communication. Pharmacies are to submit AEFIs to their local Public Health Office.

  • Ensure Adverse Events of Special Interest (AESIs) have been reported, including thrombotic events, hemorrhagic disease/bleeding disorders, thrombocytopenia and other coagulation/blood disorders. More details available here.

  • If the reaction did not warrant AEFI submission, provide reassurance of the safety of the second dose and proceed with consent. Guidance as to which reactions are considered expected and which should be reported is available here.

  • AstraZeneca/COVISHIELD (only), is contraindicated in individuals who have experienced any of the following after a viral vector COVID-19 vaccine:
    • venous or arterial thrombosis with thrombocytopenia 
    • capillary leak syndrome

  • mRNA vaccines (Pfizer-BioNTech, Moderna) only - Individuals who developed myocarditis or pericarditis following their first dose of mRNA vaccine:
    • It is unclear if people who developed myocarditis or pericarditis after a first dose of an mRNA COVID-19 vaccine may be at increased risk of further adverse cardiac effects following a second dose of the vaccine. As a precautionary measure, the second dose in the mRNA COVID-19 vaccination series should be deferred in individuals who developed myocarditis or pericarditis following the first dose of an mRNA COVID-19 vaccine as an adverse event until more information is available. NACI will continue to monitor the evidence and update recommendations as needed.
    • Administration of the second dose of an mRNA COVID-19 vaccine series may be considered in certain circumstances upon consultation with the individual’s specialist(s). Considerations for second dose administration may include:
      • Personal risk of severe acute COVID-19 (e.g., age, underlying conditions).
      • Level of COVID-19 community transmission and personal risk of infection.
    • These individuals should be informed of the risks of myocarditis and pericarditis following a second mRNA COVID-19 vaccine dose and advised to seek medical attention if they develop symptoms including chest pain, shortness of breath or palpitations.

  • Reactions to 2nd dose - Reporting AEFIs
    • When completing an AEFI form for a second dose (or future immunizations/boosters) of a COVID-19 vaccine, include the following for the previous dose(s) of COVID-19 immunization(s) in the table in Section 4b. Medical history of the revised National AEFI Form*:
      • Date of previoius COVID-19 immunization;
      • Dose number; 
      • Vaccine trade name; and
      • Vaccine manufacturer
*Until the National AEFI Form is revised, enter this information in the Supplementary Information Section (10). The revised form will include a table in Section 4b for this information.
 
References
Last Updated

14 Jul 2021

  • If the individual tested positive or has had previous COVID-19 disease, the individual should receive vaccination when otherwise appropriate (e.g. for 2nd dose, at least 28 days following the 1st dose) as long as they have recovered and no longer need to follow isolation requirements.

  • A complete vaccination series is required for everyone, regardless of past COVID-19 infection.
References
Last Updated

17 May 2021

  • Answers “Yes”: Based on expert opinion, vaccination with either first or second dose of COVID-19 vaccine should be delayed for at least 90 days after treatment with anti-SARS-CoV-2 monoclonal antibodies or convalescent plasma as these therapies may interfere with and delay response to the COVID-19 vaccine. The period of 90 days is based on the half-life of the therapies.
    • Anti-SARS-CoV-2 monoclonal antibodies approved in Canada include:
      • bamlanivimab  
      • casirivimab and imdevimab 
    • The deferral does not apply to non-SARS-CoV-2 monoclonal antibodies that may be used for treatment of SARS-CoV-2 infection such as sarilumab and tocilizumab.

  • Answers “No”: Proceed with vaccination.

  • Answers “I don’t know”: If individual had COVID-19 infection and did not receive intravenous treatment, proceed with vaccination. If intravenous treatment for COVID-19 was received in the previous 90 days, or the individual is unsure, refer to primary care provider.
References
Last Updated

14 Jul 2021

  • Individuals can be asked if they have been seen by an allergy specialist; if so, allergies may be confirmed, allergens identified, and advice provided by allergist regarding future exposures/what to avoid.

  • COVID-19 vaccine should not be offered to individuals with a proven severe allergic reaction (e.g., anaphylaxis) to any component of the specific COVID-19 vaccine or its container. Refer to Public Health.
    Product Monographs: Pfizer-BioNTech, Moderna, AstraZeneca, COVIDSHIELD 

  • Allergens of particular concern:
    • Polyethylene glycol: avoid Pfizer-BioNTech, Moderna – found in over-the-counter (e.g. cough syrup, laxatives), and prescription medications, medical bowel preparation products for colonoscopy, skin care products, dermal fillers, cosmetics, contact lens care solutions, products such as ultrasound gel.
    • Tromethamine: avoid Moderna  - found in contrast media, oral and parenteral medications.
    • Polysorbate 80: avoid AstraZeneca/COVISHIELD, Janssen – found in medical preparations (e.g., vitamin oils, tablets, and anticancer agents), cosmetics.

  • If this is the second dose and individual reports an allergic reaction to the first dose:
    • If an AEFI was submitted, communication from the MHO should have been received by whomever submitted the AEFI as to whether or not to proceed with the second dose. The individual should have been provided this information. If the individual does not know/ remember, there should be a note in the eHR viewer.
    • If an AEFI has not been submitted, the immunizer who administered the first dose will need to submit an AEFI and wait for MHO communication. Pharmacies are to submit AEFIs to their local Public Health Office.
    • If the reaction was an expected reaction and did not warrant AEFI submission, provide reassurance of the safety of the second dose and proceed with consent. Guidance as to reactions to report is available here.

 

Reference
Last Updated

17 May 2021

  • Pregnancy is not a contraindication to any of the COVID-19 vaccines.
    • Receiving COVID-19 vaccine (including AstraZeneca/COVISHIELD) is not a reason to terminate pregnancy.

  • As of May 21, 2021 only mRNA vaccine (i.e. Pfizer-BioNTech and Moderna) are to be routinely offered to pregnant individuals
    • Viral vector vaccines (i.e. AstraZeneca or COVISHIELD) can be offered if: 
      • allergy to any of the mRNA vaccine components, or
      • mRNA vaccine is not readily available
    • The reasons for this recommendation:
      • concern about increased complexity in medical care if Vaccine-induced Immune Thrombotic Thrombocytopenia (VITT) were to occur following a viral vector vaccine
      • the majority of safety data are from mRNA vaccines
    • Those who received AstraZeneca for the first dose can receive Pfizer-BioNTech or Moderna for the second dose. See Q1.

  • Based on real world data indicating COVID-19 vaccines are safe in pregnancy, NACI’s recommendations for COVID-19 vaccination in pregnant individuals are now the same as those for the general adult population.

  • Informed consent in this population may include the following considerations:
    • the individual’s risk of COVID-19 including comorbidities
    • the individual’s level of exposure to COVID-19
    • the potential risks of COVID-19 infection in pregnancy
    • the emerging safety and immunogenicity data of COVID-19 vaccinations in pregnancy
      • There are now real world data emerging in which no maternal or neonatal safety signals have been raised. These data have been derived from:
        • international immunization registries
        • preliminary analyses of > 35,000 pregnant women in the US who received mRNA vaccine
      • Data are available indicating mRNA vaccination in pregnant individuals results in comparable antibody titres to those generated following mRNA vaccination in non-pregnant individuals.
      • Maternal IgG humoral response to mRNA COVID-19 vaccines transfers across the placenta to the fetus, leading to a significant and potentially protective, antibody titre in the neonatal bloodstream one week after the second dose. 

  • This SOGC statement may help guide the informed consent conversation.
References
Last Updated

08 Jun 2021 

  • Based on real world data indicating COVID-19 vaccines are safe during breastfeeding, NACI’s recommendations for COVID-19 vaccination in breastfeeding individuals are now the same as those for the general adult population, which is to receive a complete mRNA series. In SK, those who received AstraZeneca as their first dose have the option of AstraZeneca or mRNA for their second dose. See Q1.


  • Informed consent in this population may include the following considerations:
    • the individual’s risk of COVID-19 including comorbidities
    • the individual’s level of exposure to COVID-19
    • the emerging safety data of COVID-19 vaccinations in breastfeeding individuals
      • Early studies consistently show that both anti-spike IgG and IgA are present in breastmilk after maternal vaccination with mRNA vaccines.
      • In one small cohort study, mRNA from COVID-19 vaccines was undetectable in breastmilk 4-48 hours post-vaccination.
    •  
  • Receipt of the COVID-19 vaccine is not a reason to stop breastfeeding.

  • An SOGC statement discusses COVID-19 vaccines in pregnancy and breastfeeding; it focuses on pregnancy but may have some information to help guide the informed consent conversation with a breastfeeding individual.

References
Last Updated

08 Jun 2021

  • See table at end for common autoimmune conditions (not comprehensive).

  • For AstraZeneca/COVISHIELD COVID-19 Vaccine only: individuals with a previous history of thrombosis associated  with lupus anticoagulant (thrombotic anti-phospholipid syndrome) should not receive this vaccine due to very rare reports of a combination of blood clots and low levels of blood platelets following immunization.

  • Preferably patients discuss the vaccine with their primary care provider/specialist prior to presenting. Document details if they report having the discussion. However:
    • If they have not discussed vaccination with their primary care provider/specialist AND their condition is UNSTABLE, refer to PCP/specialist.
    • If they have not discussed vaccination with their primary care provider/specialist AND their condition is STABLE, consider immunization. Timing of the vaccine and dosing of some disease-specific drugs and a patient's immune status may need to be considered and warrant referral to a specialist (see below).
    • Refer recipients of stem cell transplants to specialist.

  • Based on real world data indicating COVID-19 vaccines are safe in those with autoimmune conditions, NACI’s recommendations for COVID-19 vaccination in these individuals are now the same as those for the general adult population, which is to receive a complete mRNA series. In SK, those who received AstraZeneca as their first dose have the option of AstraZeneca or mRNA for their second dose. See Q1.

  • Informed consent in this population may include the following considerations:
    • the individual's risk of COVID-19 including comorbidities and level (if any) of immunosuppression,
    • the individual's level of exposure to COVID-19,
    • current stability/control of the autoimmune condition,
    • emerging real-world data regarding safety and immunogenicity
      • data from primarily mRNA COVID-19 vaccine indicates the safety (frequency and severity of adverse effects) in those with autoimmune conditions is comparable to those without autoimmune conditions,
      • efficacy and effectiveness data (i.e. effect on illness/hospitalizations/death) are not available but data from observational trials indicate immune responses to mRNA or AstraZeneca COVID-19 vaccines were only diminished in those on immunosuppressive therapy,
        • the vaccine antibody response in individuals with autoimmune conditions who take immunosuppressive therapy may not be as strong as the immune response in individuals not taking these therapies; immunized individuals still need to take precautions against COVID–19 disease

  • Examples of medications that may be immunosuppressive can be found here

  • Little information is available regarding the best time to administer COVID-19 vaccine in relation to dosing of immunomodulators to elicit the maximal vaccine response. As such, preference is to have patients discuss vaccination timing with prescriber/specialist.   

Common Autoimmune Conditions* (not an exhaustive list)

Addison's Erythema nodosum Lupus Psoriatic arthritis
Alopecia areata Fibromyalgia Meniere's disease Raynaud's syndrome
Amyloidosis Graves' disease Multiple Sclerosis Restless legs syndrome
Ankylosing spondylitis Guillain-Barre syndrome Myasthenia gravis Rheumatoid arthritis
Celiac disease Hashimoto's thyroiditis Neutropenia Sarcoidosis
Crohn's disease Hemolytic anemia Henoch-Schonlein purpura Scleroderma
Diabetes Type 1 Juvenile arthritis Optic neuritis Thrombocytopenia  purpura
Endometriosis Kawasaki disease Psoriasis Ulcerative colitis
References
Last Updated

08 Jun 2021

  • As applicable, also see:
    • 7(i) Medications
    • 7(ii) Cancer
    • 7(iii) Transplant
    • 7(iv) HIV

  • Individuals may be immunosuppressed/ immunocompromised because of medications/ treatments and/or their condition(s). It is preferred all such individuals discuss the vaccine with their primary care provider /specialist prior to presenting. The main concern is diminished response to the vaccine.

  • Individuals who MUST consult with their primary care provider/specialist include those:
    • with cancer being treated with immune checkpoint inhibitors (pembrolizumab, nivolumab, atezolizumab)
    • with cancer being treated with chimeric antigen receptor (CAR)-T therapy
    • being treated with blood and bone marrow stem cell transplant (autologous or allogeneic) (pre and post)
  • For other immunosuppressed/immunocompromised patients, it is preferred that the vaccine be discussed with the primary care provider/specialist prior to presenting. Document details if they report having the discussion. However: 
    • If they have not discussed vaccination with their primary care provider/specialist AND their condition is UNSTABLE, refer to PCP/specialist.
    • If they have not discussed vaccination with their primary care provider/specialist AND their condition is STABLE, consider immunization. Timing of the vaccine and dosing of some disease-specific drugs and a patient's immune status may need to be considered and warrant referral to a specialist. See 7(i) Medications; 7(ii) Cancer; 7 (iii) Transplant; and/or 7(iv) HIV as applicable.

  • Based on real world data indicating COVID-19 vaccines are safe in those who are immunosuppressed, NACI’s recommendations for COVID-19 vaccination in these individuals are now the same as those for the general adult population, which is to receive a complete mRNA series. In SK, those who received AstraZeneca as their first dose have the option of AstraZeneca or mRNA for their second dose. See Q1.

  • Informed consent in this population may include the following considerations:
    • the individual’s risk of COVID-19 including level of immunosuppression and comorbidities,
    • the individual’s level of exposure to COVID-19,
    • emerging real-world data regarding safety and immunogenicity
      • data from primarily mRNA COVID-19 vaccine indicates the safety (frequency and severity of adverse effects) in those who are immunosuppressed is comparable to those who are not immunosuppressed
      • efficacy and effectiveness data (i.e. effect on illness/hospitalizations/death) are not available but data from observational trials indicate immune responses to mRNA or AstraZeneca COVID-19 vaccines were diminished or delayed in those on immunosuppressive therapy
        • immunized individuals who are immunosuppressed still need to take precautions against COVID-19 infection.
References
Last Updated

08 Jun 2021

  • Also see 7 - Information for all

  • As applicable, also see:
    • 7(ii) Cancer
    • 7(iii) Transplant
    • 7(iv) HIV

  • Examples of medications that may be immunosuppressive can be found here

  • Little information is available regarding the best time to administer COVID-19 vaccine in relation to dosing of immunomodulators to elicit the maximal vaccine response. As such, preference is to have patients discuss vaccination timing with prescriber/specialist. 
References
Last Updated

05 May 2021

  • Also see 7 - Information for all

  • See the SCA documents: Cancer Patients and the COVID-19 Vaccine and COVID-19 Vaccine Information for Patients

  • Cancer survivors should be offered vaccination.

  • Most patients being treated for cancer should be offered vaccination, though the timing around treatment needs to be considered.

  • Patients being treated for cancer with the following treatments can receive the vaccine at any time:
    • targeted and hormonal treatments
    • radiation therapy

  • Timing of vaccination around treatments may need to be considered for patients being treated for cancer with the following treatments and patients should consult their cancer care team:
    • immune checkpoint inhibitors (MUST consult)
    • hematopoietic stem cell transplant (MUST consult)
    • chemotherapy
    • B-cell directed therapy 
      • Anti CD20 antibodies (rituximab, afutuzumab)
      • Anti CD19 antibodies (blinatumomab)
      • Anti CD22 antibodies (inotuzumab ozogamicin)
      • BTK inhibitors (ibrutinib)
    • T-cell directed therapy
      • calcineurin inhibitors (cyclosporine)
      • ATG (antithymocyte globulin – rabbit and equine)
      • alemtuzumab
References
Last Updated

08 Jun 2021

  • Also see 7 - Information for all

  • Solid Organ Transplant Recipients
    • Medically stable solid organ transplant patients followed up by the Saskatchewan Transplant Program DO NOT NEED to consult their specialist prior to immunization with COVID-19 vaccines.
    • However, if the patient had a recent transplant (less than 1 month ago) or was recently (less than 1 month ago) treated for rejection or if the immunizer is unsure of the individual's eligibility, please ask the individual to contact the Saskatchewan Transplant Program to determine if and when they should receive the vaccine.

  • Hematopoietic Stem Cell Transplant (HSCT) recipients MUST speak to their cancer care team / specialist.
References
Last  Updated

08 Jun 2021 

  • Also see 7 - Information for all

  • Individuals living with HIV who are considered immunocompetent may be vaccinated at any time. If there is doubt regarding immunocompetency status, consult or refer to primary care provider/ specialist.
Reference
Last Updated

08 Jun 2021

  • Having an increased risk of bleeding due to condition or treatment is NOT a contraindication to vaccine administration. To reduce bleeding risk:
    • Apply direct pressure (without rubbing) to the injection site for 5 minutes or longer after injection to stop the bleeding.
References
Last Updated
12 Apr 2021
  • Note: this question applies to AstraZeneca/COVISHIELD vaccines only. Pharmacies offering Pfizer-BioNTech or Moderna vaccines do not need to ask this question.

  • AstraZeneca/COVISHIELD (only), is contraindicated in individuals with a history of: 
    • heparin-induced thrombocytopenia (HIT)
      • HIT antibody lingering might interfere with the lab assay to detect the Vaccine-induced Immune Thrombotic Thrombocytopenia (VITT) anibody and may complicate management.
    • thrombotic anti-phospholipid syndrome
    • venous or arterial thrombosis with thrombocytopenia following AstraZeneca/COVISHIELD vaccines
    • episodes of capillary leak syndrome, which is characterized by acute episodes of limb edema, hypotension, hemoconcentration and hypoalbuminemia

  • AstraZeneca/COVISHIELD (only), is to be used with caution in individuals with a history of cerebral venous sinus thrombosis (CVST) with thrombocytopenia.
    • It is recommended individuals with a history of CVST with thrombocytopenia only receive this vaccine if benefit outweighs risk; mRNA COVID-19 vaccine is preferred.
References
Last Updated

30 Jun 2021

  • Because of no data, to be prudent, simultaneous administration with other vaccines should be avoided to maximize benefits of COVID-19 vaccination while minimizing any risks of harm. Recommended intervals: 

    • ≥14 days after receiving another vaccine before receiving COVID-19 vaccines
      • The main reason for this recommendation is to avoid erroneously attributing AEFIs to a particular vaccine.
      • If an individual presents for COVID-19 vaccine prior to 14 days following another vaccine, they may be immunized with their informed consent.  
    • ≥ 28 days after receiving COVID-19 vaccine before receiving other vaccines
      • The main reason for this recommendation is the theoretical potential for interference of the immune response.
      • If an individual requires a vaccination as part of a post-exposure prophylaxis protocol, it should be administered regardless of timing of any COVID-19 vaccine doses.
      • If an individual presents for another vaccine prior to 28 days following COVID-19 vaccine, they may be immunized with their informed consent.  

 

  • There may be exceptions in consultation with a primary care provider.

  • If a vaccine(s) is administered within these time intervals (purposely or inadvertently), consider all vaccine doses valid.
References:
Last Updated

08 May 2021

No part of this work may be reproduced, distributed, or transmitted in any form or by any means unless authorized by medSask. For copyright permission requests, please contact druginfo@usask.ca.
Last updated: 14 Jul 2021