Primary Series Recommendations
Primary series recommendations are based on multiple factors including age and health status (for example, immunocompetent or immunocompromised). Being immunocompetent means that your body can produce a normal immune response. Being immunocompromised means that your body’s immune system is weaker and may need help fighting infections such as COVID-19.
All individuals 6 months and older are currently eligible to receive a COVID-19 vaccine.
Eligible individuals are recommended to receive a bivalent mRNA for their primary series due to the excellent protection they provide against severe illness and hospitalization, and their well-known safety profiles. Pfizer-BioNTech Comirnaty and Moderna Spikevax are examples of mRNA COVID-19 vaccines. All individuals are recommended to complete their primary series as soon as possible and plan to receive a booster dose in the fall of 2023.
Novavax Nuvaxovid is a non-mRNA COVID-19 vaccine. It is available for people 18 years of age and older who are not willing to receive an mRNA vaccine or who have not been able to accept an mRNA COVID-19 vaccine due to symptoms or conditions. Eligible individuals may request an appointment to receive Novavax Nuvaxovid by calling Public Health & Sudbury Districts.
Please note that Janssen Inc. previously offered a viral vector single dose COVID-19 vaccine; however, on June 28, 2023, submitted a voluntary recall to Health Canada for the product because of a business decision and not as the result of any health or safety concerns related to the vaccine. As such, the JCOVDEN (Janssen) COVID-19 vaccine is no longer available. Clients are encouraged to contact Public Health or speak with their health care provider to discuss non-mRNA vaccine options.
For immunocompetent individuals
Individuals aged 5 years and older receiving an mRNA vaccine (Pfizer-BioNTech Comirnaty or Moderna Spikevax) will require two doses to complete their primary series. Like mRNA vaccines, Novavax Nuvaxovid is also a 2-dose primary series.
If Moderna Spikevax is used for children under 5, then two doses are required to complete their primary series. If Pfizer-BioNTech comirnaty is used for children under 5, then three doses are required to complete their primary series.
For immunocompromised individuals
Individuals aged 6 months and older who are moderately to severely immunocompromised are recommended to receive a three-dose primary series to provide better immunity.
If Pfizer-BioNTech Comirnaty is used for children under 5 years of age, then four doses are required to complete the primary series.
All immunocompromised individuals are recommended to complete their primary series as soon as possible and plan to receive a booster dose in the fall of 2023.
The safety and efficacy of Novavax Nuvaxovid has not been established in individuals who are immunocompromised due to disease and treatment. Individuals must provide informed consent to receive a 3 dose primary series understanding that there is currently limited evidence of these vaccines in this population.
Below is a list of medical conditions and treatments that could classify an individual as immunocompromised. Click here for a more comprehensive list of medications, and conditions.
Immunocompromised Persons (Moderate to Severely)
- Individuals receiving dialysis (hemodialysis or peritoneal dialysis)
- Recipients of solid-organ transplant and taking immunosuppressive therapy
- Individuals receiving active treatment (for example, chemotherapy, targeted therapies and immunotherapy) for solid tumour or hematologic malignancies
- 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 (for example, DiGeorge syndrome and Wiskott-Aldrich syndrome)
- HIV with AIDS-defining illness in the last 12 months before starting vaccine series, or severe immune compromise with CD4 count <200 cells/uL or CD4 percentage <15%, or without HIV viral suppression
- 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 Guidefor suggested definition of high dose steroids), alkylating agents, antimetabolites, or tumor-necrosis factor (TNF) inhibitors and other biologic agents that are significantly immunosuppressive.
Booster doses
Booster dose(s) are recommended based on the ongoing risk of infection, the risk of severe illness from COVID-19, and the impacts on health system capacity from the COVID-19 pandemic. Only individuals who have completed their primary series are eligible for booster doses.
Booster doses improve the immune response and provide better and longer-lasting protection.
Like the primary series, individuals are recommended to receive a bivalent mRNA vaccine for their booster dose(s). Bivalent vaccines target both the original SARS Co-V-2 virus and specified Omicron variants. The bivalent mRNA vaccines provide improved protection against circulating Omicron variants.
Infants aged 6 months to 4 years are not currently eligible for a booster dose. Individuals aged 5 years and older are eligible and recommended to receive a booster dose of the bivalent Pfizer-BioNTech Comirnaty COVID-19 vaccine or the bivalent Moderna Spikevax vaccine. The type and dose will be dependent of the age of the client.
Effective July 7, 2023, individuals 5 years and older should consider delaying receipt of a COVID-19 vaccine booster until fall 2023. Receiving a booster dose in the fall, as the respiratory season commences, will maximize protection against COVID-19 when peak circulation of the virus is expected. The decision to receive a booster dose prior to fall 2023 may be appropriate for certain individuals based on their unique health status and personal situation. Individuals are encouraged to speak with their health care provider before booking an appointment in the summer.
The recommended interval for this booster dose is 6 months after your last dose or confirmed SARS-Co-V-2 infection.
Novavax Nuvaxovid is authorized for use as a booster dose for individuals 18 years and older who have not been able, due to contraindications, or not willing to, receive an mRNA COVID-19 vaccine. Individuals should be made aware of the limited long-term effectiveness and safety data for this product as a booster dose.
Vaccination after COVID-19 infection
COVID-19 vaccination is still recommended regardless of if you have had a COVID-19 infection. Your body will build natural antibodies to help fight COVID-19 after being infected, however, after time your natural immunity will wane and you can be re-infected with COVID-19.
*It is important to note that the longer interval between infection and vaccination may result in a better immune response.
Table 1: Recommended Intervals Between Previous SARS-CoV-2 Infection and COVID-19 Vaccination
| Infection Timing Relative to COVID-19 Vaccination | Population | Recommended Interval Between Infection** and Vaccination |
|---|---|---|
| Infection prior to completion or initiation of primary vaccination series. | Individuals 6 months of age and older who are not considered moderately to severely immunocompromised with no previous history of multisystem inflammatory syndrome in children and adults (MIS-C and MIS-A). Individuals 6 months of age and older who are moderately to severely immunocompromised and with no previous history of multisystem inflammatory syndrome (MIS-C) Individuals 6 months of age and older with a previous history of multisystem inflammatory syndrome MIS-C and MIS-A (regardless of immunocompromised status) | Receive the vaccine 2 months (56 days) after symptom onset or positive test (if asymptomatic). Receive the vaccine dose 1 to 2 months (28 to 56 days) after symptom onset or positive test (if asymptomatic) Receive the vaccine dose when clinical recovery has been achieved or ≥ 90 days since the onset of MIS-C and MIS-A, whichever is longer |
| Infection after primary series | Individuals currently eligible for booster dose(s) | A minimum of 6 months (168 days) after previous COVID-19 infection characterized by positive test or after having symptoms post contact with someone who had a positive test. |
If you have received a vaccine outside of Ontario/Canada
Please report your COVID-19 vaccination(s) in the provincial database (COVaxON) or contact Public Health Sudbury & Districts to have your immunization record updated. We will require proof of vaccination, for example, an immunization record or proof of vaccine certificate (PVC). Please contact us at 705.522.9200 (toll-free 1.866.522.9200). Once we have updated your immunization record and reviewed the details of the specific vaccine you received, you will be able to book your next vaccine appointment via telephone or online.
Post-transplant re-vaccination
Re-vaccination is recommended (Government of Ontario, PDF) with a new three-dose primary series and booster dose of the of the COVID-19 vaccine given the loss of immunity following:
- hematopoietic stem cell transplant (HSCT)
- hematopoietic cell transplants (HCT) (autologous or allogeneic)
- CAR-T-cell therapy
Contact your health care provider if any of the above conditions apply to you after your COVID-19 vaccination. You may be recommended to be re-vaccinated due to loss of immunity following therapy or transplant. This is determined in consultation with your clinical team. If it is determined that you need to restart your primary series, bring a copy of the referral form to your vaccination appointments, indicating that you are restarting your primary series.
Learn more about the vaccines, vaccine eligibility by age, and where to get vaccinated.