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 an mRNA vaccine 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.
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.
The Janssen COVID-19 vaccine is a viral vector single dose vaccine that is offered to individuals 18 years and older ONLY if you are not eligible to receive any of the other available COVID-19 vaccines. Contact your health care provider to find out if you are eligible.
For immunocompetent individuals
Individuals aged 5 years and older receiving an mRNA vaccine (Pfizer-BioNTech or Moderna Spikevax) will require two doses to complete their primary series.
If Moderna Spikevax is used for children under 5, then two doses are required to complete their primary series. If Pfizer-BioNTech is used for children under 5, then three doses are required to complete their primary series. See Table 2
Like mRNA vaccines, Novavax Nuvaxovid is a 2-dose primary series.
For immunocompromised individuals
Individuals aged 6 months or older who are moderately to severely immunocompromised (Government of Ontario, PDF, pages 7-9) are recommended to receive a three-dose primary series to provide better immunity.
If Pfizer-BioNTech Comirnaty is used for children under 5, then four doses are required to complete the primary series.
Below are 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
- 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 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 Guide for suggested definition of high dose steroids), alkylating agents, antimetabolites, or tumor-necrosis factor (TNF) inhibitors and other biologic agents that are significantly immunosuppressive.
Table 1:COVID-19 Vaccine Preferences for Primary Series The National Advisory Committee on Immunization (NACI) preferentially recommends receipt of monovalent mRNA COVID-19 vaccines to complete a primary series for all individuals 6 months and older, without contraindications to the vaccine.
Age | Indication | Vaccine Product | Recommendation |
---|---|---|---|
6 months to 4 years | Immunocompetent Immunocompromised | Monovalent Moderna Spikevax 25 mcg OR Pfizer BioNTech Comirnaty 3 mcg Monovalent Moderna Spikevax 25 mcg OR Pfizer BioNTech Comirnaty 3 mcg | Recommended without preference. While two mRNA vaccines have been approved for this age group, it is not recommended that they are interchanged. Once an immunization series is initiated, the same product should be continued until the primary series is complete. This is particularly important for this population due to the difference in the number of doses that comprise the primary series. Moderna Spikevax recommended preferentially for program related reasons (fewer doses for the client), see above note. Do not interchange products when possible and where age indications allow. |
Children age 5 | Immunocompetent and immunocompromised | Monovalent Moderna Spikevax 25 mcg OR Pfizer BioNTech Comirnaty 3 mcg | Moderna Spikevax recommended preferentially for program related reasons (fewer doses for the client), see above note. Do not interchange products when possible and where age indications allow. |
Children 6 to 11 years | Immunocompetent and immunocompromised | Monovalent Moderna Spikevax 50 mcg OR Pfizer BioNTech Comirnaty 10 mcg | Moderna Spikevax may be offered with informed consent. Pfizer BioNTech preferred. |
Adolescents and young adults 12 to 29 years | Immunocompetent and immunocompromised | Monovalent Moderna Spikevax 100 mcg OR Pfizer BioNTech Comirnaty 30 mcg | Recommended without preference. |
Adults ≥ 30 years | Immunocompetent and immunocompromised | Monovalent Moderna Spikevax 100 mcg OR Pfizer BioNTech Comirnaty 30 mcg | Recommended without preference. |
Table 2: COVID-19 Primary Series Eligibility for Immunocompetent Individuals by Product and Age (Monovalent Moderna Spikevax)
Population | Primary Series Schedule | 1st Dose | 2nd Dose and interval |
---|---|---|---|
Age 6 months to 4 years | 2 doses | 25mcg/0.25 mL IM | 0.25 mL IM Recommended: 8 weeks/56 days after 1st dose Minimum: 28 days after 1st dose with informed consent |
Age 5 – with informed consent | 2 doses | 25mcg/0.25 mL IM | 0.25 mL IM Recommended: 8 weeks/56 days after 1st dose Minimum: 28 days after 1st dose with informed consent |
Population | Primary Series Schedule | Product Formulation | 1st Dose | 2nd Dose and interval |
---|---|---|---|---|
Age 6 to 11 Years with informed consent | 2 doses | 50 mcg/0.25 ml 25 mcg/0.25 mL | 0.25 mL IM 0.5 mL IM | 0.25 mL IM Recommended: 8 weeks/56 days after 1st dose Minimum: 28 days after 1st dose with informed consent 0.5 mL IM Recommended: 8 weeks/56 days after 1st dose Minimum: 28 days after 1st dose with informed consent 0.5 mL IM Recommended: 8 weeks/56 days after 1st dose Minimum: 28 days after 1st dose with informed consent |
Population | Primary Series Schedule | Product Formulation | 1st Dose | 2nd Dose and Interval |
---|---|---|---|---|
Age ≥ 12 Years | 2 dose primary series | 50 mcg/0.25 mL | 100 mcg (0.5 mL) IM | 100 mcg (0.5 mL) IM Recommended: 8 weeks/56 days after second dose Minimum: 28 days after second dose with informed consent |
Table 3: COVID-19 Vaccine Eligibility for immunocompetent individuals by product and age (Monovalent Pfizer Bio-NTech)
Population | Primary Series Schedule | 1st Dose | 2nd Dose | 3rd Dose |
---|---|---|---|---|
Age 6 months to 4 years | 3 doses | 3 mcg IM 0.2 mL | 3 mcg IM 0.2 mL Recommended: 8 weeks/56 days after 1st dose Minimum: 21 days after 1st dose with informed consent | 3 mcg IM 0.2 mL Recommended: 8 weeks/56 days after second dose Minimum: 56 days after second dose |
Population | Primary Series Schedule | 1st Dose | 2nd Dose and interval |
---|---|---|---|
Age 5 years to 11 years | 2 doses | 10 mcg 0.2 mL IM | 10 mcg 0.2 mL IM Recommended: 8 weeks/56 days after 1st dose Minimum: 28 days after 1st dose with informed consent |
Population | Primary Series Schedule | 1st Dose | 2nd Dose and interval |
---|---|---|---|
Age ≥ 12 Years | 2 doses | 30 mcg 0.3 mL IM | 30 mcg 0.3 mL IM Recommended: 8 weeks/56 days after 1st dose Minimum: 28 days after 1st dose with informed consent |
Table 4: COVID-19 Primary Series Eligibility for Immunocompetent Individuals by Product and Age (Novavax Nuvaxovid)
Population | Primary Series Schedule | Product Formulation | 1st Dose | 2nd Dose and Interval |
---|---|---|---|---|
Age ≥ 18 Years | 2 dose primary series | 5 mcg/0.5 mL | 5 mcg (0.5 mL) IM | 5 mcg (0.5 mL) IM Recommended: 4 weeks (28 days) after 1st dose. Minimum: 3 weeks (21 days) with informed consent |
Table 5: COVID-19 Primary Series Eligibility for Immunocompromised Individuals by Product and Age (Monovalent Moderna Spikevax)
Population | Primary Series Schedule | 1st Dose | 2nd Dose | 3rd Dose |
---|---|---|---|---|
Age 6 months to 4 years | 3 doses | 25 mcg 0.25 mL IM | 0.25 mL IM Recommended: 8 weeks/56 days after 1st dose Minimum: 28 days after 1st dose with informed consent | 0.25 mL IM Recommended: 8 weeks/56 days after second dose Minimum: 28 days after second dose with informed consent |
Age 5 – with informed consent*see note below | 3 doses | 25 mcg 0.25 mL IM | 0.25 mL IM Recommended: 8 weeks/56 days after 1st dose Minimum: 28 days after 1st dose with informed consent | 0.25 mL IM Recommended: 8 weeks/56 days after second dose Minimum: 28 days after second dose with informed consent |
Population | Primary Series Schedule | Product Formulation | 1st Dose | 2nd Dose and interval | 3rd Dose and interval |
---|---|---|---|---|---|
Age 6 to 11 Years with informed consent | 3doses | 50 mcg/0.25 mL 25 mcg/0.25 mL | 0.25 mL IM 0.5 mL IM | 0.25 mL IM Recommended: 8 weeks/56 days after 1st dose Minimum: 28 days after 1st dose with informed consent 0.5 mL IM Recommended: 8 weeks/56 days after 1st dose Minimum: 28 days after 1st dose with informed consent | 0.25 mL IM Recommended: 8 weeks/56 days after second dose Minimum: 28 days after second dose with informed consent 0.5 mL IM Recommended: 8 weeks/56 days after second dose Minimum: 28 days after second dose with informed consent |
Population | Primary Series Schedule | Product Formulation | 1st Dose | 2nd Dose and interval | 3rd Dose and Interval |
---|---|---|---|---|---|
Age ≥ 12 Years | 3 dose primary series | 50 mcg/0.25 mL | 100 mcg (0.5 mL) IM | 100 mcg (0.5 mL) IM Recommended: 8 weeks/56 days after second dose Minimum: 28 days after second dose with informed consent | 100 mcg (0.5 mL) IM Recommended: 8 weeks/56 days after second dose Minimum: 28 days after second dose with informed consent |
Table 6: COVID-19 Primary Series Eligibility for Immunocompromised Individuals by Product and Age (Monovalent Pfizer Bio-NTech)
Population | Primary Series Schedule | 1st Dose | 2nd Dose | 3rd Dose | 4th Dose |
---|---|---|---|---|---|
Age 6 months to 4 years - Immunocompromised | 4 doses | 3 mcg IM 0.2 mL | 3 mcg IM 0.2 mL Recommended: 8 weeks/56 days after 1st dose Minimum: 21 days after 1st dose with informed consent | 3 mcg IM 0.2 mL Recommended: 8 weeks/56 days after second dose Minimum: 56 days after second dose | 3 mcg IM 0.2 mL Recommended: 8 weeks/56 days after third dose Minimum: 56 days after second dose |
Population | Primary Series Schedule | 1st Dose | 2nd Dose | 3rd Dose |
---|---|---|---|---|
Age 5 years to 11 years | 3 doses | 10 mcg 0.2 mL IM | 10 mcg 0.2 mL IM Recommended: 8 weeks/56 days after 1st dose Minimum: 28 days after 1st dose with informed consent | 10 mcg 0.2 mL IM Recommended: 8 weeks/56 days after second dose Minimum: 28 days after second dose with informed consent |
Population | Primary Series Schedule | 1st Dose | 2nd Dose | 3rd Dose |
---|---|---|---|---|
Age ≥ 12 Years | 3 doses | 30 mcg 0.3 mL IM | 30 mcg 0.3 mL IM Recommended: 8 weeks/56 days after 1st dose Minimum: 28 days after 1st dose with informed consent | 30 mcg 0.3 mL IM Recommended: 8 weeks/56 days after second dose Minimum: 28 days after second dose with informed consent |
Table 7: COVID-19 Primary Series Eligibility for Immunocompromised Individuals by Product and Age (Novavax Nuvaxovid)
Please note that the efficacy of Novavax for immunocompromised individuals has not yet been established. Individuals must provide informed consent to receive a 3 dose primary series.
Population | Primary Series Schedule | Product Formulation | 1st Dose | 2nd Dose | 3rd Dose |
---|---|---|---|---|---|
Age ≥ 12 Years | 3 dose primary series | 5 mcg/0.5 mL | 5 mcg (0.5 mL) IM | 5 mcg (0.5 mL) IM Recommended: 4 weeks (28 days) after 1st dose. Minimum: 3 weeks (21 days) with informed consent | 5mcg (0.5mL) IM Recommended: 8 weeks (56 days) after 1st dose. Minimum: 4 weeks (28 days) with informed consent |
Important To Note
Although individuals can receive their second doses of their COVID-19 vaccine at a three-month minimal interval, waiting until the recommended interval period allows for a more robust and durable immune response and greater vaccine effectiveness. Waiting is also associated with decreased cases of myocarditis and pericarditis.
All individuals over 6 months of age can receive their COVID-19 vaccines simultaneously with any other non-covid vaccines.
For information about COVID-19 vaccines for children and youth, please see Child and Youth Vaccination Toolkit.
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.
Individuals are recommended to receive an mRNA vaccine for their primary series and their booster dose(s). mRNA vaccines are either monovalent (one strain of COVID-19) or bivalent (two strains of COVID-19). 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. The Bivalent mRNA vaccines are the recommended vaccines for a booster dose.
Children aged 5 to 11 years are eligible to receive a booster dose of the Bivalent or Monovalent Pfizer-BioNTech Comirnaty COVID-19 vaccine. The recommended interval for this booster dose is 6 months after your last dose. No evidence suggests that children in this age group should have more than one booster dose regardless of if that dose was a monovalent or bivalent booster.
Those aged 12 years and older are eligible to receive a bivalent booster at the recommended interval of 6 months since their last COVID-19 vaccine dose, regardless of the number of booster doses received previously. For those 12 to 17 years old, bivalent Pfizer-BioNTech Comirnaty is the only authorized bivalent product. For those aged 18 years and older, either bivalent Moderna Spikevax or bivalent Pfizer-BioNTech Comirnaty may be used.
Individuals who are a member of a specified high-risk group will be recommended to make modifications to the booster dose intervals above.
Infants aged 6 months to 4 years are not currently eligible for a booster dose.
The Ontario Ministry of Health recommends individuals receive an mRNA booster dose due to the strong protection offered and well-established safety and effectiveness data.
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.
The Janssen COVID-19 Vaccine is approved as a booster dose for individuals 18 years and older ONLY if all other COVID-19 vaccinations are contradicted.
A bivalent booster dose is strongly recommended for the following high-risk groups at an interval of 3 months from their last dose:
- Residents of long-term care homes, retirement homes, Elder Care Lodges, and individuals living in other congregate settings that are 12 years and older
- Individuals aged 65 years and older
- Individuals who are12 years and older with moderately to severely immunocompromising conditions
- Individuals 12 years and older with an underlying medical condition(Government of Ontario, PDF, page 11) that places them at high risk of severe COVID-19 illness
- Adults who identify as First Nation, Inuit or Métis and their adult non-Indigenous household members
- Adults in racialized and/or marginalized communities disproportionately affected by COVID-19
- Pregnant individuals
- Health care workers
Table 8: mRNA COVID-19 Vaccine Product Preferences for Booster Doses
Age | Indication | Vaccine Product | Recommendation |
---|---|---|---|
Infants and children 6 months up to 4 years | NOT eligible for booster doses currently | ||
Children 5 to 11 years | Immunocompetent Immunocompromised IN THE CASE THAT BIVALENT VACCINE IS REFUSED | Bivalent Pfizer BioNTech 10 mcg Bivalent Pfizer BioNTech 10 mcg Pfizer BioNTech 10 mcg (monovalent) | Bivalent Pfizer BioNTech 10 mcg Bivalent Pfizer BioNTech 10 mcg Monovalent Pfizer BioNTech 10 mcg may be offered with informed consent |
Adolescents 12 to 17 | Immunocompetent Immunocompromised | Bivalent Pfizer BioNTech 30 mcg Not eligible for Bivalent Moderna Spikevax Vaccine Bivalent Pfizer BioNTech 30 mcg OR Bivalent Moderna Spikevax 50 mcg | Bivalent Pfizer BioNTech 30 mcg preferred Bivalent Pfizer BioNTech 30 mcg preferred Bivalent Moderna Spikevax 50 mcg may be offered with informed consent |
Adults ≥ 18 years | Immunocompetent and immunocompromised | Bivalent Pfizer BioNTech 30 mcg OR Bivalent Moderna Spikevax 50 mcg | Recommended without preference |
Table 9: Covid-19 Booster dose Intervals for individuals by Product, Age, and Health Status (Bivalent Moderna Spikevax and Monovalent Moderna Spikevax)
Moderna Spikevax vaccine is not authorized for booster doses in children 5 to 11 years of age
Population | Dosage | Interval |
---|---|---|
Age 12 to 17 Years – Immunocompromised or with medical/biological/social factors increasing risk | 50 mcg (0.5 mL) IM | Recommended: 3 months (84 days) after previous dose with informed consent. |
Age ≥ 18 Years Immunocompetent | 50 mcg (0.5 mL) IM | Recommended: 6 months (168 days) after previous dose Minimum: 3 months (84 days) after previous dose with informed consent |
Age ≥ 18 Years Immunocompromised and/or medical/biological/social factors increasing risk | 50 mcg (0.5 mL) IM | Recommended: 3 months (84 days) after previous dose |
Table 9: COVID-19 Booster dose Intervals for individuals by Product, Age, and Health Status (Bivalent Pfizer-BioNTech and Monovalent Pfizer-BioNTech)
Population | Dosage | Interval |
---|---|---|
Age 5 to 11 Years Immunocompetent | 10 mcg (0.2 mL) IM (bivalent product product) OR 10mcg (0.2ml) IM (monovalent pediatric Pfizer) | Recommended: 6 months (168 days) after last dose Minimum: 3 months (84 days) after last dose with informed consent |
Age 5 to 11 Years Immunocompromised and/or medical/biological/social factors increasing risk | 10 mcg (0.2 mL) IM (bivalent product) OR 10mcg (0.2ml) IM (monovalent pediatric Pfizer) | Recommended: 6 months (168 days) after last dose Minimum: 3 months (84 days) after last dose with informed5 consent |
Age ≥ 12 Years Immunocompetent | 30 mcg (0.3 mL) IM (Bivalent Pfizer-BioNTech) OR 30 mcg (0.3 mL) IM (monovalent Pfizer-BioNTech) | Recommended: 6 months (168 days) after last dose Minimum: 3 months (84 days) after last dose with informed consent |
Age ≥ 12 Years Immunocompromised and/or medical/biological/social factors increasing risk | 30 mcg (0.3 mL) IM (Bivalent Pfizer-BioNTech) OR 30 mcg (0.3 mL) IM (monovalent Pfizer-BioNTech) | Recommended: 3 months (84 days) after last dose |
Table 10: COVID-19 Booster dose Intervals for individuals by Product, Age, and Health Status (Novavax Nuvaxovid)
Population | Dosage | Interval |
---|---|---|
Age 18 + | 5 mcg (0.5 mL) IM | Recommended: 6 months (168 days) after last dose Minimum: 3 months (84 days) after last dose with informed consent |
It is important to keep your COVID-19 vaccinations up to date, which includes getting any booster dose when eligible. If you are eligible to receive your vaccine, book a vaccine appointment now.
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.
Individuals 6 months of age and older who are not considered moderately to severely immunocompromised that were infected with COVID-19 before starting or completing their primary series should wait 2 months (56 days) after symptom onset or positive test (if asymptomatic) before receiving their next dose.
Immunocompromised individuals should wait 1 to 2 months (28 to 56 days) before continuing their primary series and consult their primary care provider to determine the best timeline to continue vaccination.
Individuals 5 years and older infected with COVID-19 after their primary series should wait 6 months (168 days) to get their next booster dose.
Individuals 12 years and older that fall into the following categories are considered high risk individuals for transmitting or developing serious illness with COVID-19, and should receive their booster dost at a 3 month interval following infection.
- Residents of long-term care homes, retirement homes, Elder Care Lodges, and individuals living in other congregate settings that are 12 years and older
- Individuals aged 65 years and older
- Individuals who are 12 years and older with moderately to severely immunocompromising conditions
- Individuals 12 years and older with an underlying medical condition(Government of Ontario, PDF, page 11) that places them at high risk of severe COVID-19 illness
- Adults who identify as First Nation, Inuit or Métis and their adult non-Indigenous household members
- Adults in racialized and/or marginalized communities disproportionately affected by COVID-19
- Pregnant individuals
- Health care workers
*It is important to note that the longer interval between infection and vaccination may result in a better immune response.
Table 11: Recommended Intervals Between Previous SARS-CoV-2 Infection and COVID-19 Vaccination
Infection Timing Relative to COVID-19 Vaccination | Population | Suggested 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 (MIS-C). Individuals 6 months of age and older who are moderately to severely immunocompromised and with no history of multisystem inflammatory syndrome (MIS-C) Individuals 6 months of age and older with a previous history of multisystem inflammatory syndrome MIS-C (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, whichever is longer |
Infection after primary series but before first booster dose and/or second booster dose | Individuals currently eligible for booster dose(s) | A minimum of 3 months (84 days) after symptom onset or positive test (if asymptomatic); however, a 6-month (168 day) interval may provide a better immune response of product given. |
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.
For more information, read the COVID-19 Guidance for individuals vaccinated outside of Ontario / Canada (Government of Canada).
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.