COVID-19 Update: Third Doses

Posted Thursday October 21, 2021

Posted By: Michelle Goulet

Category: General

To: Ottawa Physicians and Nurse Practitioners
Date:October 21, 2021
From: Dr. Trevor Arnason, Associate Medical Officer of Health

Dear Colleagues,
The purpose of this memo is to provide an update regarding the Provincial guidance on third dose administration for COVID-19 vaccines.

COVID-19 Vaccines – Third Dose Eligibility

The Province recently announced an expansion of the eligibility criteria for third doses of COVID-19 vaccine. A complete two-dose COVID-19 vaccine series provides strong protection against COVID-19. Third doses are only offered to specific high-risk groups to increase protection based on data showing waning of immune response and an increased risk of COVID-19 infection in these groups. 

At this time third doses of COVID-19 vaccine may be offered to the following eligible populations:

  • Individuals receiving active treatment (e.g., chemotherapy, targeted therapies, immunotherapy) 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). Individuals with moderate to severe primary immunodeficiency (e.g., DiGeorge syndrome, Wiskott-Aldrich syndrome).
  • Individuals with stage 3 or advanced untreated HIV infection and those with acquired immunodeficiency syndrome.
  • Individuals receiving active treatment with the following categories of immunosuppressive therapies: anti-B cell therapies (monoclonal antibodies targeting CD19, CD20 and CD22), high-dose systemic corticosteroids (refer to the Canadian Immunization Guide (CIG) for suggested definition of high dose steroids), alkylating agents, antimetabolites, or tumor-necrosis factor (TNF) inhibitors and other biologic agents that are significantly immunosuppressive.
  • Residents of Long-Term Care Homes, Retirement Homes, Elder Care Lodges, and congregate settings serving seniors.

Provincially Recommended Interval

  • For medically eligible individuals (immune compromised, listed above), the recommended interval between the last dose of a primary two-dose series of COVID-19 vaccine and the third dose is at least two months (8 weeks)
  • For residents of Long-Term Care Homes, Retirement Homes, Elder Care Lodges, and congregate settings serving seniors the recommended interval between second and third doses in Ontario is 5 months.

While the majority of individuals eligible for a third dose of COVID-19 vaccine in the community have a specialist directly associated with a hospital program, there are certain immunosuppressant medications that may be prescribed outside of a hospital setting. The province has provided a list of immunosuppressant medications that would make an individual eligible for a third dose of COVID-19 vaccine. This list may not be exhaustive and health care providers may identify patients on other medications that are significantly immunosuppressive.

For additional guidance information and to access the list of immunosuppressant medications, please see the provincial guidance document COVID-19 Vaccine Third Dose Recommendations (PDF).

Template Letter 

Physicians and nurse practitioners may want to assist eligible individuals to receive a third dose in Ottawa using the attached template letter. The template letter includes all the considerations and information that may be needed to administer a third dose at the appropriate interval for the individual. Eligible patients may present a completed copy of this template letter at any of the community clinics, neighbourhood vaccine hubs or
pharmacies to receive a third dose. The template letter must be completed by a treating physician or nurse practitioner Primary care physicians in rostered Patient Enrollment models may be eligible to bill Code Q007 for assisting with access to vaccination for the 3rd dose if not previously billed for the patient. More information regarding the code can be found in a previous Public Health Alert.

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