COVID-19 Vaccination Update: policies for high-risk settings; third dose recommendations for vulnerable groups; youth born in 2009 now eligible.
August 18, 2021
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To: Health Care Providers
FOR IMMEDIATE ATTENTION
Policies required for high-risk settings and third doses now recommended for vulnerable groups
The purpose of this Advisory Alert is threefold. First, to inform of policy expectations for high-risk settings; second, to share recommendations on third doses for vulnerable groups; and third, to advise on eligibility of youth born in 2009. For more detailed information, read the government of Ontario’s news release: Ontario makes COVID-19 vaccination policies mandatory for high-risk settings.
COVID-19 vaccination policy for high-risk settings
On August 17, 2021, Ontario’s Chief Medical Officer of Health issued Directive 6 (Ministry of Health) mandating hospitals and home and community care service providers to have a COVID-19 vaccination policy for employees, staff, contractors, students and volunteers, and for ambulance services to have a COVID-19 vaccination policy for paramedics. Policies for these high-risk settings must take effect by September 7, 2021.
Policies will be similar to those of Ontario’s long-term care homes which came into effect earlier this summer. It will require proof of full vaccination against COVID-19, or proof of medical exemption, or if declined, completion of an education session on the COVID-19 vaccine. Educational sessions must be approved by the organization. Employees, volunteers and students who do not provide proof of full vaccination must complete regular antigen point of care testing and provide proof of negative results at minimum every seven days. Hospital policies will apply to any business or organization operating on the hospital site. Note that an organization may decide to remove the option for education and require proof of vaccination or medical exemption.
Your continued support of COVID-19 vaccination within your practice is highly valued. Please consider how you will implement a COVID-19 vaccination policy in your practice to help protect those most at risk.
To assist patients who may be reluctant for specific reasons, this Vaccine Hesitancy Guide www.vhguide.ca addresses hesitancies related to the COVID-19 vaccine, providing user-friendly prompts and ways to engage, affirm, ask, share, and evoke, using motivational interviewing principles.
COVID-19 vaccination policies expected for other high-risk settings
It is expected that vaccination policies will also be implemented in other high-risk settings such as post-secondary institutions, licenced retirement homes, women’s shelters, as well as congregate group homes and day programs for adults with developmental disabilities, children’s treatment centres, and other services for children with special needs, and licensed children’s residential settings. This will support a consistent and persistent approach within Ontario. The Ministry of Education intends to introduce a vaccination disclosure policy for all publicly funded school board employees, and staff in private schools, as well as for all staff in licensed childcare settings for the 2021-22 school year in support of the return to school plan.
Individuals (e.g. employees, staff, contractors, students and volunteers) working in vulnerable settings will be required to provide one of the following:
- Proof of full vaccination against COVID-19
- A medical reason for not being vaccinated against COVID-19; or
- Completion of a COVID-19 vaccination educational session.
Individuals who do not provide proof of full vaccination against COVID-19 will be required to undertake regular antigen testing, similarly to the vaccination policy requirements currently in place for long-term care homes.
Recommendations for a third dose in vulnerable groups
Select groups at highest-risk will be eligible for a third dose of the COVID-19 vaccine based on the recommendation of the Chief Medical Officer of Health and other health experts. A third dose will provide these vulnerable groups with an extra layer of protection against the Delta variant. A third dose of a COVID-19 vaccine is recommended for select vulnerable populations:
- Transplant recipients (including solid organ transplant and hematopoietic stem cell transplants)
- Individuals receiving active treatment (chemotherapy, targeted therapies, immunotherapy) for malignant hematologic disorders (e.g. acute myeloid leukemia, chronic myeloid leukemia, acute lymphoblastic leukemia, chronic lymphocytic leukemia)
- Individuals receiving treatment with an anti-CD20 agent (e.g. rituximab, ocrelizumab, ofatumumab), commonly used for conditions such as multiple sclerosis, rheumatoid arthritis, leukemias/lymphoma etc.
Vulnerable elderly in high-risk congregate settings:
- Residents of long-term care homes, high-risk retirement homes and elder care lodges
A third dose will help to provide individuals in these groups with an improved immune response.
Individuals who are transplant recipients, patients with hematological cancers (examples include lymphoma, myeloma, leukemia) on active treatment (chemotherapy, targeted therapies, immunotherapy) for malignant hematologic disorders, and recipients of an anti-CD20 agent (e.g. rituximab, ocrelizumab, ofatumumab) can receive their third dose at a minimum of eight weeks following their second dose. Planning discussions are underway with acute care partners to determine how and when health care providers will notify eligible patients.
Individuals who reside in high-risk congregate settings including long-term care homes, higher-risk licensed retirement homes (as defined by the Ministry of Health), and First Nations elder care lodges will be offered a third dose at a minimum of five months following their second dose. Residents will be notified of vaccination opportunities once eligible.
The Ministry of Health will be providing further direction on where third doses can and will be administered. Specialists are asked to assist with the identification of patients who are eligible for a third dose. To support system navigation, health care providers can also inform their patients of third dose eligibility. The Ministry of Health COVID-19 Vaccine Information Sheet has been updated to reflect most recent third dose recommendations and can be used to guide patient conversations.
Health care providers who would like to be onboarded to the vaccination program as a primary care site should notify Public Health Sudbury & Districts at PHSD_COVIDemail@example.com.
Children born in 2009
Beginning August 18, 2021, all children turning 12 years old before the end of 2021 will be eligible to receive their first dose of COVID-19 vaccine, without having to wait until they turn 12. This will further support a safer return to school by ensuring more children and youth can benefit from the protection offered by the vaccine. Please continue to advise patients of their eligibility and support their informed decision-making.
Options for vaccination
With efforts in place to make vaccination accessible to all, current options include pop-up clinics and mobile clinics at various locations throughout our area, in addition to mass immunization clinics and some pharmacy and primary care locations. Vaccination to client is also a possibility for those who are homebound.
Anyone can visit our Vaccination Clinics for COVID-19 webpage for information on clinic dates, times, and locations. Clients can also book an appointment online at covid-19.ontario.ca/book-vaccine or by calling 705.674.2299 (toll-free: 1.800.708.2505), between 8 a.m. and 8 p.m., seven days a week. Individuals or organizations can also request pop-up or mobile bus vaccination opportunities at their event or place of work by contacting PHSD_COVIDfirstname.lastname@example.org. All requests will be assessed for feasibility.
For additional information on the COVID-19 vaccines, as well as for specific answers to your frequently asked questions, visit our FAQ web page or call Public Health Sudbury & Districts at 705.522.9200 (toll-free 1.866.522.9200).
Original Signed By
Dr. Penny Sutcliffe
Medical Officer of Health and Chief Executive Officer
NOTE: All Advisory Alerts are found on our website.
This item was last modified on August 18, 2021