COVID-19 Vaccination and Children

Last revised: October 18, 2022

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⚠ The Province of Ontario has expanded eligibility for COVID-19 booster doses. Children 5 to 11 years old in Ontario are now eligible for a booster dose of a COVID-19 vaccine 6 months after their primary series. Appointments at Ottawa Public Health clinics can be booked via the provincial booking system.

 Parents and caregivers of children aged six months to under five years are now able to book appointments for the paediatric COVID-19 vaccine.

Learn how to get a vaccine

New - What information is available on the Pfizer vaccine for children six months to four years?

Health Canada has approved the Pfizer-BioNTech COVID-19 vaccine (3mcg) for children six months to four years of age. 

The vaccine is a 3-dose primary series.  The recommended interval between doses is two months (56 days) between dose one and two, and two months (56 days) between dose two and three.  

For children who start their primary series with the Pfizer-BioNTech COVID-19 (3 mcg dose), they must also get a Pfizer-BioNTech COVID-19 product for their second and third doses. There is no mixing of COVID-19 vaccine products from different manufacturers for children six months to five years; however, if a child turns five and has not completed the series, they will be provided with the higher dose product appropriate for their age. 

Children six months to under five years of age getting a COVID-19 vaccine (either Pfizer or Moderna) should not routinely get a non-COVID-19 vaccine at the same time. A COVID-19 vaccine should be administered at least 14 days before or after getting a non-COVID vaccine (e.g., influenza vaccine). 

Why should my 6 months to 5-year-old get the COVID-19 vaccine?

Vaccination is the best and safest way to give an extra layer of protection for all children, including those aged six months to under five years.  

Not all children have only mild symptoms when they are sick with COVID-19. 

Even if your child has been infected with COVID-19, they should still be vaccinated. Studies in adults show that vaccination following infection provides stronger and longer-lasting protection. Vaccination is one of the best ways for individuals to protect themselves, their families and their communities against severe outcomes from COVID-19. 

I have questions about the COVID-19 vaccine for my child. Who can I talk to?

The SickKids COVID-19 Vaccine Consult Service is a by-appointment phone service that provides a safe, judgment-free space to have an open conversation about the COVID-19 vaccine.  

Learn more about Ottawa Public Health's plan to offer COVID-19 vaccines to children ages six months to 11 years old

For children aged six months to under five years, OPH recommends a vaccine appointment, to make sure the proper dose is available.

Getting your vaccination will give you greater protection against serious illness and hospitalization from COVID-19.

There are two different mRNA vaccines available to children six months of age and older. The vaccine your child gets will depend on availability and supply.

Children aged six months to four years may be offered the Pfizer BioNTech 3mcg COVID-19 vaccine. This vaccine is a 3-dose primary series. Each dose is given at least two months (56 days) apart. 

Children aged six months to four years may be offered the Moderna Spikevax (25 microgram [mcg]) dose. This is a 2-dose primary series. Each dose is given 2 months (56 days) apart.

Children aged five to 11 years of age will be offered the 10-mcg dose of the Pfizer-BioNTech COVID-19 vaccine to start their vaccine series.

Children who started a Moderna Spikevax 25 mcg vaccine series will generally complete the primary series with a second Moderna Spikevax dose. The Pfizer-BioNTech Comirnaty 10 mcg vaccine can be considered interchangeable with Moderna Spikevax 25 mcg to complete a primary series if it is authorized in the child’s age group (i.e., age five to 11 years old). This means, that is safe for a child to start their series with a Moderna Spikevax dose and finish their series with a Pfizer-BioNTech Comirnaty dose.

Children aged five to 11 years:

Per the Ministry of Health, the Pfizer-BioNTech COVID-19 vaccine 10-mcg dose is preferred to start the primary series in children this age over the Moderna (Spikevax) vaccine. This recommendation from the National Advisory Committee on Immunization is out of an abundance of precaution and is based on the higher number of adolescents and young adults who experienced myocarditis/pericarditis after receiving the Moderna COVID-19 vaccine (100 mcg dose) versus with the Pfizer-BioNTech COVID-19 vaccine (30mcg dose).

For children five years of age starting their COVID-19 vaccine (the age group in which both the Moderna Spikevax (25 mcg) and the Pfizer-BioNTech Comirnaty (10 mcg) COVID-19 vaccine primary series are authorized): Moderna Spikevax (25 mcg) may be offered to children five years of age instead of the Pfizer-BioNTech Comirnaty (10 mcg); however, the use of Pfizer-BioNTech Comirnaty (10 mcg) is preferred to Moderna Spikevax (25 mcg).

For children six to 11 years of age: The Moderna Spikevax COVID-19 vaccine will be available upon request at Ottawa Public Health clinic, with informed consent, as an alternative to the Pfizer-BioNTech COVID-19 vaccine to start or continue the series in children aged six to 11 years of age.

PLEASE NOTE:Masks are encouraged at all Ottawa Public Health Vaccination clinics.

Booking a vaccine appointment

Everyone aged six months and older at the time of their appointment is currently eligible to receive a COVID-19 vaccine.

Learn how to get a vaccine

Appointments and drop-ins:  

To support children's access to the vaccine, most appointments available through Ottawa Public Health will be protected in the booking system for children aged six months and older.   

Additionally, our recommendation is to book an appointment for each child or family member who is eligible for a vaccine. Anyone who does not have a scheduled appointment will be considered a drop-in. If members of the same family have appointments at different times, on the same day or different days, they can all be vaccinated together at the time of the earliest appointment. 

Who can receive first, second or third doses of the vaccine? 

If your child does not have a valid health card but is eligible for a vaccine, please call Ottawa Public Health at 613-691-5505 to book an appointment.

Who can receive first, second or third doses of the vaccine?

Who can receive a COVID-19 vaccine?

• Everyone six months or older at the time of their appointment is currently eligible to receive a COVID-19 vaccine.

• Children aged 6 months to 4 years getting the Pfizer-BioNTech pediatric COVID-19 vaccine, require 3 doses to complete a primary series.

• All residents are encouraged to get vaccinated as soon as they can, and to receive further doses as soon as they are eligible to ensure maximum protection against    COVID-19.

How can individuals access the Novavax (Nuvaxovid) COVID-19 vaccine?

You cannot book through the provincial portal. Booking will be through your local public health unit. Use this online form to register for a Novavax COVID-19 vaccine.

Visit our frequently asked questions about COVID-19 vaccination web page to learn more about the Novavax (Nuvaxovid) COVID-19 vaccine.

Who can receive a three dose primary series?

A ‘three-dose’ primary series refers to a series of three doses of the COVID-19 vaccine to make up a primary series offered to those who are immunocompromised or vulnerable. A third dose is added to the standard two-dose “primary vaccine series” to improve the immune response and establish an adequate level of protection for those who did not develop immunity or did not develop an optimal immune response after a 2-dose primary series.
Some individuals who are immunocompromised can get a third dose of the COVID-19 vaccine eight weeks after their second dose as part of an extended primary series. Note that in some cases the interval may be shortened as advised by your health care provider or specialist.
Please see COVID-19 Vaccine Guidance (gov.on.ca) for more information on eligibility for a three-dose primary series.
The third dose of vaccine will be given at least two months (eight weeks) after the second dose.
Ottawa residents who meet these criteria must present one of the following to receive their third dose:

  • A letter from their specialist or hospital program; or
  • Current prescription package, label or pharmacy receipt of an immunosuppressant medication listed by the Ontario government. The prescription must clearly label: patient name, name of medication, date of dispensing, and name of prescribing doctor.
Who can receive a booster?

Vaccination and practising public health measures like masking, avoiding gatherings, and staying homewhen sick, remain our strongest defense against COVID-19.

OPH recommends booster doses of COVID-19 vaccine for those who are eligible. Use the provincial Booster Dose Eligibility Tool to find out if you are eligible.

Booster eligibility:

  • Booster doses of an mRNA COVID-19 vaccine are recommended in Ontario for anyone aged 5 years and older if at least 168 days (approximately six months) have passed since their previous dose or COVID-19 infection.
    • Individuals must be at least five years old on the day they receive the vaccine.
    • Children aged 5 to 11 years are only eligible for one booster dose following the primary series, at this time. They will receive the Pediatric Pfizer-BioNTech vaccine.
  • As of October 17, 2022, all Ontarians aged 12 years and older are eligible for a bivalent COVID-19 booster dose.
  • Individuals can receive the bivalent booster at the recommended interval of at least six months from their previous dose, regardless of how many boosters they have already received.
  • Individuals may choose to receive a booster dose as early as three months (84 days) after their previous dose with informed consent.
  • As per the National Advisory Committee on Immunization, longer intervals between doses has shown to result in better immune response and somewhat better vaccine effectiveness than shorter intervals. Consult your health care provider for individual recommendations and to assess personal risks and benefits of receiving vaccination earlier.
  • Residents are encouraged to make an appointment or drop-in to one of the community clinics.
  • Eligible individuals can book an appointment through the COVID-19 vaccination portal or by calling the Provincial Vaccine Contact Centre at 1-833-943-3900.
  • Appointments can also be made with local pharmacies. Some primary care physicians are also providing booster doses.

The National Advisory Committee on Immunization (NACI) recommends that all individuals 65 years of age and older and individuals 12 years of age and older who are at increased risk of severe illness from COVID-19 should be offered a fall COVID-19 vaccine booster dose, regardless of the number of booster doses previously received. All other individuals 12 to 64 years of age may be offered a fall COVID-19 vaccine booster dose, regardless of the number of booster doses previously received.

Ottawa Public Health strongly recommends that the following vulnerable groups book a bivalent COVID-19 booster appointment as soon as possible (at the shortened interval of three months) to protect themselves this fall as more people spend time indoors: 

  • individuals aged 65 and over; 
  • residents of long-term care homes, retirement homes, Elder Care Lodges and individuals living in other congregate settings that provide assisted-living and health services; 
  • First Nation, Inuit and Métis individuals and their non-Indigenous household members aged 18 and over; 
  • Individuals 12 years of age and older with an underlying medical condition that places them at high risk of severe COVID-19 including moderately to severely immunocompromised individuals; 
  • pregnant individuals aged 18 and over; and 
  • health care workers aged 18 and over.
  • For more information see: 

Ontario Government: All Ontarians Aged 12+ Eligible for Bivalent Booster

The National Advisory Committee on Immunization: An Advisory Committee Statement (ACS) National Advisory Committee on Immunization (NACI) Updated guidance on COVID-19 vaccine booster doses in Canada

Public Health Agency of Canada: SUMMARY OF NATIONAL ADVISORY COMMITTEEON IMMUNIZATION (NACI) STATEMENT OF OCTOBER 7, 2022 Updated guidance on COVID-19 vaccine booster doses in Canada

 

If your child does not have a valid health card but is eligible for a vaccine, please call Ottawa Public Health at 613-691-5505 to book an appointment.

What is the optimal interval between the first and second dose for 2-dose COVID-19 vaccines for children?

The optimal interval between doses of an mRNA COVID-19 vaccine is two months or eight weeks. This interval applies to two and three dose primary series.

Children aged six months to four years:

  • Pfizer BioNTech Comirnaty 3mcg dose is a 3-dose primary series. Each dose is given two months (56 days) apart.
  • Caregivers may choose, with informed consent to follow a shorter interval between the 1st and 2nd doses. The shorter interval is 21 days. The shortest interval between the second and third dose is 56 days. 

Children aged six months to under five years:

Moderna Spikevax 25 mcg dose:

  • NACI recommends at least eight weeks between the first and second dose. What we know is that a longer interval between doses can provide better protection overall.
  • In older age groups, longer vaccine intervals have shown to reduce the risk of myocarditis/pericarditis. (To note: in study participants six months to five years, no cases of myocarditis/pericarditis occurred)
  • Caregivers may choose, with informed consent, to follow a shorter interval between dose one and two. The shorter interval could be as early as 28 days after the first dose.

Children aged five to 11 years:

  • More data has become available that suggests that protection can be improved upon when the interval between the first and second dose are extended beyond the original manufacturer’s recommended interval (e.g., 21 days between first and second dose of a Comirnaty/Pfizer-BioNTech COVID-19 vaccine; 28 days between first and second doses of a Moderna Spikevax COVID-19 vaccine for children aged 6-11).
  • As per NACI, an eight week interval helps balance optimal protection while simultaneously minimizing the time at risk of infection due to having protection from only one dose. There is emerging safety data that suggest that a longer interval between dose one and two may reduce the risk of myocarditis/pericarditis after the second dose of an mRNA COVID-19 vaccine. 
  • Individuals may choose to speak with their primary care provider about what interval is best for them considering the local transmission of COVID-19 and the degree of individual risk of exposure.
  • The authorized interval may still be used with informed parental consent.
    • You can get your child’s second dose of Pfizer-BioNTech 10 mcg as early as 21 days after their first by providing informed consent at one of our clinics or by calling the province at 1-833-943-3900.
    • You can get your child’s second dose of a Moderna Spikevax vaccine as early as 28 days after their first by providing informed consent at one of our clinics and upon request
  • Interruption of a vaccine series resulting in a greater interval between doses than recommended does not require re-starting the series.

References 

National Advisory Committee on Immunization (2022). Recommendations on the use of Moderna Spikevax COVID-19 vaccine in children 6 months to 5 years of age 

National Advisory Committee on Immunization (2021). Recommendations on the use of COVID-19 vaccines. 

Ministry of Health (2022). COVID-19 Vaccine Guidance, Version 3.1

If my child has symptoms or was told to self-isolate can they still go to their vaccine appointment?

No. If your child any has COVID-19 symptoms of illness or has been told to self-isolate then their COVID-19 vaccination appointment should be rescheduled to a later date. Screening for our vaccine clinics is the same as for schools and daycares in Ottawa. In other words, if your child is permitted to go to school or daycare, then they can attend their vaccine appointment. If you are still unsure if they can attend, please complete the COVID-19 screening tool for school or child care.

Reducing pain during vaccination

Needles can be scary (and not just for parents). Here are some helpful ways to help reduce pain for your child when they get their vaccine.

Babies:

  • Hold your baby cradled in your arms, or sitting on your lap   

  • You can breast/chest or bottle feed your baby during and after the injection   

  • Offer a pacifier before, during and after to help with pain   

  • You can offer your baby a sucrose solution (6 months to 2 years) 1 to 2 min before the vaccine, see: Reducing pain with Sucrolose: https://www.aboutkidshealth.ca/article?contentid=3628&language=english

  • You can use a numbing patch or cream, like EMLA, or AMETOP. Apply it to the upper, outer thigh for babies 6 months to 12 months 30-60 minutes before the appointment. Follow manufacturer instructions. 

Image of where an intramuscular (IM) vaccine is given to children under 1 year of age

  • Stay calm and use a normal speaking voice. Do not threaten or punish, it will only make them more afraid.  
  • After the vaccine, give comfort (hugs, cuddles) and lots of praise!

Young children:

  • Consider using a topical anesthetic like EMLA or AMETOP. Apply to upper arm (over the deltoid) about 30-60 minutes before the appointment time. Follow manufacturer instructions.  

 (Image of where an intramuscular injection is given in the deltoid muscle)

  • Prepare your child ahead of time by reading stories about what to expect. Be honest and use language they will understand (i.e., it will feel like a pinch).
  • Tell your child what they can do to ease the pain (for example, sit still, breathe deeply, relax the arm like jello).

  • Sit them on your lap (for smaller children).  The immunizer will instruct you on how to position them and talk you through the injection.
  •  Bring your child’s favourite stuffy or blanket for comfort.

  •  Stay calm and distract your child by talking to them and giving encouragement. Do not threaten or punish as this will only make them more afraid. Sing a song, tell a joke or a story.

  •  Give lots of praise once the injection is done!

Older children (six years of age and older):

  • Consider using an anesthetic cream like EMLA or AMETOP (see above section for instructions). 
  • Prepare your child on what to expect, a day or two before the appointment.
  • Stay calm and encourage your child during the injection. Using threats or punishment only makes the situation more stressful.
  • Distract them by telling stories, jokes or practicing deep breathing together.
  • If your child is moving a lot, ask the immunizer to assist you with proper holding techniques that are safest for your older child.

Following the vaccine

Your child may feel minor pain at the injection site or feel unwell 24 to 48 hours following their vaccine. You can give Acetaminophen to help with pain. For any unexpected side effects please contact their family care provider, consult your post vaccine care handout and the After your COVID-19 vaccine (Ministry of Health) handout.  

Take a tour of our COVID-19 vaccination clinic

How to prepare for your vaccination appointment

Why should children get vaccinated?

Importance of vaccination

English: Deciding to vaccinate your child against COVID-19 - Help from an Ottawa paediatric doctor - YouTube 

Français (French) : Décidez-vous de vacciner votre enfant contre la COVID-19? - L'aide d'une pédiatre d'Ottawa - YouTube

Arabic: You tube - تحتاج أن تقرر بخصوص تلقيح طفلك ضد كوفيد-۱۹ ؟ شاهد هذا الفيديو لأخصائية أطفال بأوتاوا

Farsi: You tube - هستید COVID-19 چنانچه در حال تصمیم گیری برای انجام واکسیناسیون کودک خود در مقابل

Español (Spanish): Decidir a vacunar a su hijo contra el COVID-19 – Ayuda de una pediatra de Ottawa - YouTube

Five to 11 COVID-19 Vaccination – Parent testimonials

English: Why I chose to vaccinated my five to 11-year-old child against COVID-19 - Rana's story

English: Why we chose to vaccinate our children - Anita and Michael's story

Français : Pourquoi j'ai choisi de vacciner mon enfant de cinq à 11 ans - L’histoire de Nenette

Somali: Maxaa aan utallalay ilmayhaga 5 ilaa 11 jirka ah - Marian's story

English and Nigerian: Why we been decide make we vaccinate our pikin - Anita and Michael's story

Lingala: Ponanini nazuaki likanisi yako mema bana na ngai ya 5 to 11 bazua mangwele - Nenette's story

لماذا اخترت تطعيم طفلي

The health impacts that COVID-19 has on children

COVID-19 affects children differently than adults. There is a lower percentage of COVID related hospitalizations, ICU admissions, deaths, and severe complications/outcomes with children.

The impact of COVID-19 infection may be lesser, but the mental impact on children has shown to be very significant. COVID-19 has resulted in loss of in-person school and reduced social interactions with peers meaning increased stress and negative mental health for children.

Vaccination is a means to ensuring children can continue their routines of daily life and not miss out on important things.

What is the difference between ‘natural immunity’ and ‘vaccine induced immunity’? Should I still get my child vaccinated if they have already had a COVID-19 infection?

Natural immunity (immunity from exposure) is when the body creates protection against a virus once your body has been exposed or infected by it. Natural immunity means the body has some form of defence against a virus due to exposure or infection – not due to a vaccine. With COVID-19 exposure or infection, natural immunity can protect you, but we don’t know how well or for how long. We do know that whatever protection the body has gained weakens over time.

Vaccine induced immunity (immunity from a vaccine) is the body’s defence against a virus after getting a vaccine. This is a more controlled way (through clinic trials, testing and surveillance) to provide immunity against a virus without the harmful risks of being infected. This is especially true with COVID-19 infection which can cause serious and long-term illness and death.

Getting a COVID-19 infection can be very risky, even for children (see post-COVID symptoms). Being infected means you can spread it to others, and some people will develop serious illness, complications or require hospitalization from COVID-19. There is still much we don’t know about this virus and its long-term effects on the body.

COVID-19 is still present in our community, and variants like Omicron are very contagious, causing a lot of illness in our homes, schools, and child care settings. Choosing to get vaccinated as soon as your child is eligible (including booster doses) will provide the best protection from serious illness and complications from COVID-19.

It is recommended to be vaccinated even after a COVID-19 infection. Children should wait at least eight weeks after symptoms began or, a positive test result if there were no symptoms before receiving a primary series dose and 6 months before receiving a booster dose. A booster can be administered at a shortened interval of 3 months with informed consent.

Find out where to get your child vaccinated.

Vaccine safety, approval and myths

How do I know that vaccines are safe?

Health Canada has one of the most rigorous scientific review systems in the world and only approves a vaccine if it is safe, works, and meets the highest manufacturing and quality standards.

Vaccines undergo a comprehensive review of their safety, quality and efficacy (how well they work) before they are approved and can be used in Canada. After approval, vaccines are continually monitored through a “vaccine safety surveillance” to ensure their safety.

Ottawa Public Health is involved in this surveillance process by investigating all reports of Adverse Events Following Immunization (AEFIs) and reporting them to Public Health Ontario.

An AEFI is a serious or unexpected reaction that happens after someone receives a vaccine, which may or may not be caused by the vaccine. In Ontario, health professionals like nurses and doctors are required to report AEFIs to their local public health unit like Ottawa Public Health. For more information on this process you can visit Public Health Ontario’s website.

How the vaccines are studied and tested for children and youth

Health Canada evaluates drugs and vaccines before they can be sold in Canada. They also monitor real-world evidence while they are on the market.

When a company decides it would like to sell a drug or vaccine in Canada, it files a submission with Health Canada. A new drug submission contains detailed scientific information about the drug's safety, efficacy and quality.

Health Canada scientific reviewers evaluate data to assess the potential benefits and risks of a drug or vaccine. They also review the information that will be provided to health care practitioners and consumers about the product. After the review, they may authorize the drug or vaccine for sale in Canada only if the benefits of the product outweigh the potential risks.

Learn more about the drug and vaccine authorizations for COVID-19 on Health Canada's website.

What are the side-effects of the vaccine in kids and how can I support my child to deal with them?

Pfizer- BioNTech Comirnaty COVID-19 vaccine (3 mcg) for children six months to four years:

The most commonly reported side effects were:

  • Irritability/crying
  • Pain
  • Loss of appetite
  • Fever and Headache (aged two to four years)

Moderna Spikevax COVID-19 Vaccine (25 mcg) for children six months to five years: 

The most commonly reported side effects were: 

  • Irritability/crying 

  • Pain  

  • Sleepiness 

  • Loss of appetite  

  • Fatigue (37 months to five years) 

Children did well with the vaccine overall. There were no major safety concerns noted in study participants. 

Pfizer-BioNTech COVID-19 vaccine (10 mcg) for children aged five to 11 years  

There were no serious side effects related to the vaccine reported in this age group. Local reactions including pain, redness and swelling at the injection site were very common. They were mostly mild to moderate in severity. The local reactions generally started about one to two days after receiving the vaccine and lasted about one to two days.   

Other reactions included:  

  • fatigue,   

  • headaches,   

  • muscle pain,   

  • chills,   

  • fever, and   

  • joint pain   

These reactions occurred more frequently after the second dose and were mild to moderate in severity. They generally started about one to four days after either dose of the vaccine and lasted about one day. Find more information about Reducing pain during vaccination

The Moderna Spikevax COVID-19 Vaccine (50 mcg) for children six to 11 years: 

According to NACI, interim findings from Phase 2/3 clinical trial conducted in the US and Canada did not indicate any safety concerns. However, any rare adverse events would not be known due to the size of the trial. Per the Ministry of Health and in accordance with NACI, the Pfizer-BioNTech COVID-19 vaccine is preferentially recommended in this age group.  

It is common to have temporary side effects following vaccination. Local reaction at the injection site include redness, soreness and swelling. The local reactions generally started one to two days after receiving the vaccine and lasted about three days. Other reactions include: 

  • chills 

  • fatigue 

  • joint pain 

  • headache 

  • mild fever 

  • muscle aches 

  • nausea 

  • vomiting 

If someone experiences an adverse event following immunization (AEFI), they should report it to a healthcare professional (e.g., family doctor). An AEFI is an unwanted or unexpected health effect that happens after someone receives a vaccine, which may or may not be caused by the vaccine. There is a safety system to monitor for AEFIs and to investigate them. You can find more information on what is done if someone develops an adverse reaction here: If a person develops an adverse reaction, what should be done?  

For more information, please visit:  

What is Hybrid Immunity?

Hybrid immunity is when you have been sick with COVID-19 and have also had the COVID-19 vaccine.

Hybrid immunity gives stronger protection than having the vaccine alone or just being infected with the virus.

Many children have been sick with COVID-19 while Omicron has been the main circulating COVID-19 variant. Children can better protect themselves, even if they have been sick with COVID-19, by getting a full vaccination series – including booster doses when eligible.

Children 6 months to 5 years of age who are sick with COVID-19, should wait 8 weeks after the symptoms start (or after a positive test if no symptoms) to get a COVID-19 vaccine.

To learn more about vaccination after a COVID-19 infection, see: Can children who have already tested positive for COVID-19 get a COVID-19 vaccine

What is the risk of myocarditis/pericarditis from the COVID-19 vaccine vs from COVID-19 Infection for children?  

COVID-19 affects children differently than adults. There is a lower percentage of COVID-19 related hospitalizations, ICU admissions, deaths, and severe complications/outcomes with children. But children with COVID-19 infection are at risk of MIS-C (multisystem inflammatory syndrome). MIS-C is a rare but serious syndrome that can occur several weeks after a COVID-19 infection. Myocarditis and pericarditis can also occur as a complication of COVID-19 infection in children, but this is rare.

In Canada, there have been reported cases of myocarditis and pericarditis in people 12 years and over who received the 30mcg dose of the Pfizer-BioNTech COVID-19 vaccine or the 100mcg dose of the Moderna COVID-19 vaccine. It is important to note that the risk is rare. In adolescents and young adults the risk of myocarditis/pericarditis with Moderna Spikevax (100 mcg) was higher than with Pfizer-BioNTech Comirnaty (30mcg).

Currently, the risk of myocarditis/pericarditis in children six months to 11 years, following immunization is unknown.

Based on the studies done so far, myocarditis and/or pericarditis were not detected. Safety surveillance data from individuals aged 12 and older does not suggest the risk of myocarditis/pericarditis following mRNA COVID-19 vaccination would be greater in children aged five to 11 years compared to older populations. Also, data from older age groups also suggests that an extended interval between the first and second dose (at least eight weeks) may also be associated with a reduced risk of myocarditis/pericarditis following a second dose of an mRNA COVID-19 vaccine.

Please seek medical attention if your child develops symptoms including chest pain, shortness of breath, or palpitations following immunization.

Health Canada, the Public Health Agency of Canada and NACI (National Advisory Committee on Immunization) will continue to monitor and review the emerging evidence on the safety and effectiveness of the vaccine. They will update their recommendation, as well as its strength, as the evidence base evolves.

For more information, please read: 

Can my child get their COVID-19 vaccine if they have recently received another vaccine or will be getting one soon? 

Children six months to under five years of age getting a COVID-19 vaccine (either Pfizer or Moderna) should not routinely get a non-COVID-19 vaccine at the same time. A COVID-19 vaccine should be administered at least 14 days before or after getting a non-COVID vaccine (e.g., influenza vaccine). This means that when your child receives their COVID-19 vaccine, they will not be given other vaccines at the same time.

This is a precaution to help to determine if a side effect that is due to the COVID-19 vaccine or another vaccine. There may be circumstances when a dose of a COVID-19 vaccine and another vaccine need to be given at the same time. A healthcare provider can help with this decision.

For children aged five years and older, COVID-19 vaccines may be given at the same time, or before or after a non COVID-19 vaccine. This is done with informed consent. There are no specific safety concerns when routine vaccines are given at the same time or within days of each other. There could be stronger, temporary side effects when a COVID-19 vaccine and another vaccine are given at the same time or within days of each other.

My child is 5 years old. Should they receive the Moderna Spikevax 25mcg dose? Or the Pfizer Comirnaty 10mcg dose?

Children five years of age are recommended to start the primary vaccine series with the Pfizer BioNTech Comirnaty (10mcg dose) vaccine.

Children who start a Moderna Spikevax (25mcg) vaccine series should generally complete the primary series with a second Moderna Spikevax dose appropriate for their age, at an interval of at least eight weeks.

As per the National Advisory Committee on Immunization (NACI): “If readily available (i.e., easily available at the time of vaccination without delay or vaccine wastage), the same mRNA COVID-19 vaccine product should be offered for the subsequent dose in a vaccine series started with a specific mRNA COVID-19 vaccine.

However, when the same mRNA vaccine product is not readily available, is unknown, or is no longer authorized for the age group (e.g., once a child has turned 6 years of age), another mRNA COVID-19 vaccine product recommended in that age group can be considered interchangeable.”

Can children who have already tested positive for COVID-19 get a COVID-19 vaccine?

Yes. According to the NACI Updated guidance on COVID-19 vaccination timing for individuals previously infected with SARS-CoV-2 children with a previous COVID-19 infection may be offered two doses of the vaccine.

For individuals six months and older with a previous COVID-19 infection, it is suggested, they can receive the vaccine eight weeks after symptoms began, or after positive test result (if no symptoms). This interval applies to an infection before a first and second dose of the COVID-19 vaccine.

For individuals five to 11 years of age who are eligible to receive a booster dose, it is suggested, they can receive their booster dose six months after symptoms began, or after positive test result (if no symptoms). Individuals may receive their vaccine (first, second or booster dose) when they have completed their isolation and no longer have symptoms with informed consent.

New evidence shows that a longer interval between a COVID-19 infection and vaccination is associated with improved antibody responses to COVID-19 vaccines.

Children with a history of MIS-C (multisystem inflammatory syndrome) may be vaccinated once they have recovered or once it has been more than 90 days since diagnosis, whichever is longer. There is no information that suggests that antibodies from a recent COVID-19 infection would interfere with vaccine efficacy.

Vaccination continues to be very important, as individuals previously infected with COVID-19 may remain at risk of Omicron infection. Numerous reports have documented the risk of reinfection with Omicron is higher than risk of reinfection with previous variants.

My child is 11 years old. Should I wait until they are 12 years old and get the ‘larger’ dose, or get the dose that is available to them now?

No, you should not wait until your child is 12 to get the ‘larger’/adult dose. Children should get the first COVID-19 vaccine that is available to them. At Ottawa Public Health clinics, children who are 11 at the time of their appointment will receive the 10-mcg dose of the Pfizer-BioNTech COVID-19 vaccine. The 10-mcg pediatric Pfizer-BioNTech formulation of the vaccine has been assessed for safety in the five to 11 year old population in clinical trials and these trials did not indicate any serious safety concerns. 

Alternatively, eligible children 11 years can receive the pediatric Moderna Spikevax 50 mcg dose. According to NACI, the use of Pfizer-BioNTech Comirnaty (10 mcg dose) is preferred to start or continue the primary vaccine series.

The 10 micrograms (mcg) Pfizer-BioNTech COVID-19 vaccine is approved for use in children aged five to 11 years, compared to the 30-mcg vaccine which is approved for adolescents and adults 12 years of age and older.

The Moderna Spikevax 50 mcg dose is approved for use in children aged 6 to 11 years, compared to the 100 mcg dose approved for adolescents and adults 12 years of age and older.

According to the National Advisory Committee on Immunization (NACI), clinical trial data indicates the pediatric formulation of the Pfizer-BioNTech COVID-19 vaccine (10 mcg) produces a good immune response in children 5-11 years of age, similar to the response seen in young adults 16 to 25 years of age who receive the adolescent/adult dose (30 mcg). 

Health Canada has authorized the use of Moderna (Spikevax) 50 mcg vaccine for children aged six to 11 years. Individuals aged 6 to 29 years of age can request Moderna (Spikevax). It can be accessed with informed consent, acknowledging that the Pfizer COVID-19 vaccine is preferentially recommended due to the elevated risk of myocarditis/pericarditis associated with the Moderna (Spikevax) vaccine.

Can I ask that a smaller dose be given to my child if they are smaller for their age or a larger dose if they are bigger for their age?   

Ottawa Public Health will be following the vaccine recommendation based on age and not weight in their clinics.

This approach is based on their training and how the companies are saying vaccines should work. The 10 micrograms (mcg) Pfizer-BioNTech Comirnaty vaccine is approved for use in children aged five to 11 years, compared to the 30-mcg vaccine which is approved for adolescents and adults 12 years of age and older.  

The Moderna Spikevax 50 mcg dose is approved for use in children aged six to 11 years, compared to the 100 mcg dose approved for adolescents and adults 12 years of age and older.

If you have a particular concern about your child, please talk to your family doctor and/or a health practitioner.  

What vaccine should my child get if they are 11 years old for the first dose and they turn 12 when they are eligible for the second dose?  

Your child can get the 10 microgram (mcg) dose of the Pfizer-BioNTech Comirnaty COVID-19 vaccine for their first dose then receive the 30-mcg dose of the adolescent/adult vaccine for their second dose when they turn 12.

Alternatively, your child can get the 50 mcg dose of the Moderna Spikevax COVID-19 for their first dose and receive the 100 mcg dose of the adolescent/ adult vaccine for their second dose when they are 12.

It is important to note that, according to NACI, the use of Pfizer-BioNTech Comirnaty (10 mcg dose) is preferred to Moderna Spikevax (50 mcg dose) to start or continue the primary vaccine series.

According to NACI, children who receive the pediatric formulation of the Pfizer-BioNTech COVID-19 vaccine (10 mcg) for their first dose who turn 12 by the time of their second dose will receive the adolescent/adult formulation of the Pfizer-BioNTech COVID-19 vaccine (30 mcg) to complete their primary series. 

For more information: See the FAQ:  My child is 11 years old. Should I wait until they are 12 years old and get the ‘larger’ dose, or get the dose that is available to them now?  

Health Canada has authorized the use of Moderna (Spikevax) 50 mcg vaccine for children aged six to 11 years. Individuals aged 6 to 29 years of age can request Moderna (Spikevax). It can be accessed with informed consent, acknowledging that the Pfizer COVID-19 vaccine is preferentially recommended due to the elevated risk of myocarditis/pericarditis associated with the Moderna (Spikevax) vaccine. 

Vaccine myths

Vaccine confidence is an important focus for Ottawa Public Health. Vaccine misinformation is widespread and can be a deterrent to vaccine confidence. We are here to provide trustworthy, science-based information to help you understand why Ottawa Public Health promotes vaccines as an important, reliable and safe way of protecting you and your loved ones from vaccine preventable diseases.

Here are some common myths about COVID-19 vaccines

Can the mRNA vaccine alter a person’s DNA?
No. mRNA is not able to alter or modify a person’s genetic makeup (DNA). The mRNA from a COVID-19 vaccine never enters the nucleus of the cell, which is where our DNA are kept. This means the mRNA does not affect or interact with our DNA in any way. Instead, COVID-19 vaccines that use mRNA work with the body’s natural defenses to safely develop protection (immunity) to disease.
Can the COVID-19 vaccine cause a COVID-19 infection?

No. None of the COVID-19 vaccines currently approved for use in Canada use the live virus that causes COVID-19. There are several different types of vaccines in development. The goal of each of the vaccines is to teach the immune system how to recognize and fight the virus that causes COVID-19. Sometimes this process can cause symptoms, such as fever. These symptoms are normal and are a sign of the immune response to vaccine.

It usually takes the body a few weeks to build immunity after receiving a vaccine. It is possible that someone could become infected with the COVID-19 virus before or just after getting the vaccine and get sick. This happens because the vaccine has not had enough time to provide protection in the body. Learn more about COVID-19.

How do I know if the vaccine is halal?

Many companies are making vaccines and the COVID-19 vaccines that are approved in Canada are from Pfizer-BioNTech, Moderna, AstraZeneca and Janssen do not contain gelatin or pork products.

Vaccines that may become available later may include gelatin or pork products and as more information becomes available for these, consult with religious leaders about which specific vaccines are recommended. It is important to know there are approved vaccines in Canada that do not contain gelatin or pork products.

Is it true that the COVID-19 vaccines contain elements from a human fetus?

No. Many researchers use what are called ‘cell lines’ to develop vaccines. Cell lines are cultures of human or animal cells that can be grown in a lab for long periods of time. Most cells will eventually stop dividing and die, but some cell lines, called immortal cell lines, never stop dividing. These cell lines are especially useful for vaccine work. The viral-vector vaccines currently approved for use in Canada were produced using cell lines from human embryos that were electively aborted many years ago*. Scientists used these cell lines to grow the harmless virus needed to create an immune response against COVID-19. Cell lines from elective abortions are called fetal cell lines. Fetal cell lines have been used in medicine for years. Many of the vaccines that are widely used today were developed using fetal cell lines. These include some of the vaccines used to prevent rubella, hepatitis A and chickenpox. Although human cell cultures may have been used in the process of developing these vaccines, the vaccines do not contain any human cells or tissue.

Each of the COVID-19 vaccines being used in Canada have been approved and are safe and effective.

*The viral vector vaccines (AstraZeneca and Janssen) used fetal cell lines in the production of the final vaccine product. The mRNA vaccines (Pfizer and Moderna), used fetal cell lines in the research phase but not in the production:

  • AstraZeneca uses the HEK-293 cell line for the development, testing and production of the vaccine.
  • Janssen (J&J) uses PER.c6 cell line for the development, testing and production of the vaccine. This cell line was developed from retinal cells of an 18-week-old fetus aborted in 1985.
  • Pfizer was developed using genetic sequencing on computers without fetal cells. The HEK-293 abortion-related cell line was used in research related to the vaccine. It was not used for testing or the ongoing production.
  • Moderna does not need aborted fetal cell lines for production. But, aborted fetal cell line was used in both development and testing in the initial stage.

Can someone who has been vaccinated ‘shed the virus’ and put others at risk?

No. Viral shedding occurs after an individual gets infected by a viable (living) virus.

Vaccinated people do not shed any virus because the vaccines do not contain whole, living viruses. The vaccines also do not cause whole viruses to be created. The current vaccines approved for use in Canada do not contain live SARS-CoV-2 virus.

There are two classes of approved COVID-19 vaccines in Canada: mRNA vaccines, and viral vector-based vaccines.

mRNA vaccines

Both mRNA vaccines approved for use in Canada (Pfizer and Moderna) use synthetic mRNA. Synthetic mRNA is made to contain instructions for the spike protein found on the coronavirus. Once given to someone, the mRNA is delivered to the vaccinated person’s cells. The cell uses this to make copies of this spike protein, not whole viruses, which allow the body’s immune system to recognize and fight the coronavirus.

Viral vector-based vaccines

The COVID-19 viral vector-based vaccines (AstraZeneca and Janssen) use a harmless, weakened adenovirus as a vector (a shell). When the vaccine is made, DNA coding for the SARS-CoV-2 spike protein is put into this adenoviral vector (or shell). The vector acts as a delivery system to bring the SARS-CoV-2 spike protein code to human cells. The vector (not SARS-CoV-2) will enter a cell in the body to deliver the instructions.  Then the instructions from inside the vector use the cell’s machinery to produce the spike protein and bring it to the surface of the cell. A vaccinated person’s immune system will recognize that the protein doesn’t belong there and train the body’s immune system to attack the coronavirus in the future. However, the spike protein doesn’t infect the recipient with SARS-CoV-2. It cannot cause the infection because it is not a whole virus.

Both mRNA COVID-19 and viral vector-based vaccines cannot cause infection with SARS-CoV-2, and therefore cannot cause viral shedding of SARS-CoV-2.

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