Update on criteria for medical exemption to COVID-19 vaccination

Advisory Alert

September 22, 2021

*Cette information est seulement disponible en anglais.

To: Local Health Care Providers

FOR IMMEDIATE ATTENTION

Medical exemptions to COVID-19 vaccination

In follow up to an Advisory Alert issued on September 17, 2021, this Advisory Alert provides further information pertaining to evaluating contraindications or precautions to COVID-19 vaccination that may warrant a medical exemption. This Advisory Alert also outlines provincial consultation requirements for individuals seeking medical exemption due to severe allergic reaction or anaphylaxis and shares a sample medical exemption form for use in your practice.

Contraindications and precautions that may require medical exemptions

Please refer to the Ministry of Health’s Medical Exemptions to COVID-19 Vaccination (PDF) document for guidance to assist physicians/specialists and nurse practitioners in evaluating contraindications or precautions to COVID-19 vaccination that may warrant a medical exemption.

As noted in this resource, there are very few actual contraindications to available COVID-19 vaccines that would qualify as medical exemptions and most individuals can safely receive COVID-19 vaccines.

The following is a summary only of conditions and/or adverse events following immunization that may qualify for a medical exemption to COVID-19 vaccination. See the above-noted Ministry of Health document for further details including requirements for specialist consultation.

1.     Pre-existing condition(s)

• Severe allergic reaction or anaphylaxis to a component of a COVID-19 vaccine.
• Myocarditis prior to initiating an mRNA COVID-19 vaccine series (individuals aged 12-17 years old).

2.     Contraindications to initiating an AstraZeneca/COVISHIELD COVID-19 vaccine series

• History of capillary leak syndrome (CLS)
• History of cerebral venous sinus thrombosis (CVST) with thrombocytopenia
• History of heparin-induced thrombocytopenia (HIT)
• History of major venous and/or arterial thrombosis with thrombocytopenia following any vaccine.

3.     Adverse events following COVID-19 immunization

• Severe allergic reaction or anaphylaxis following a COVID-19 vaccine.
• Thrombosis with thrombocytopenia syndrome (TTS)/VITT4 following the Astra Zeneca/COVISHIELD COVID-19 vaccine.
• Myocarditis or pericarditis following a mRNA COVID-19 vaccine.
• Serious adverse event following COVID-19 immunization (e.g. results in hospitalization, persistent or significant disability/incapacity).

4.     Actively receiving monoclonal antibody therapy OR convalescent plasma therapy for the treatment or prevention of COVID-19

• Patient qualifies for time-limited medical exemption while they are actively receiving therapy

Additional consultation required for severe allergic reaction or anaphylaxis

Patients with pre-existing allergies to a component of the COVID-19 vaccine or those who have experienced a severe allergic reaction to a previous dose of a COVID-19 vaccine should not routinely be offered a COVID-19 vaccine of the same vaccine platform. An assessment from an allergist/immunologist to determine whether the vaccine is contraindicated or can be safely administered and a method for possible safe (re)administration is advised.

A medical exemption in these circumstances may be issued only if:

• The allergy was documented and evaluated by allergist/immunologist; AND
• A discussion occurred with the allergist/immunologist on potential options for immunization with the same or alternative COVID-19 vaccine; AND
• The allergist/immunologist has determined that the individual is unable to receive any COVID-19 vaccine.

Consultation with an allergist/immunologist

In situations where the patient seeking a medical exemption has an allergist or immunologist, they should seek guidance from this specialist provider.

An alternative resource for clinicians in the event that a patient does not have an allergist or immunologist is the Ontario eConsult Centre or Excellence online COVID-19 – Allergy/Immunology BASE™ Managed Specialty Group. This group allows physicians and nurse practitioners to ask COVID-19 vaccine allergy related questions to Allergy and Clinical Immunology specialists electronically. Health care providers seeking response to COVID-19 allergy specific questions, may sign-up for the eConsult service by visiting www.otnhub.ca or completing the Intake Form.

Completing a medical exemption form

This templated proof of medical exemption form (English, French) can be used to issue a medical exemption. The template meets the documentation requirements of the Ontario Government and is based on the provincial government sample (Government of Ontario, PDF).

More information about medical exemptions can be found in the Vaccine Information Sheets and Special Populations Document (PDF) available on the Ministry of Health’s website. Also, the College of Physician’s and Surgeons website contains COVID-19 FAQs for physicians to guide your practice. Medical exemptions are expected to be infrequent and should be supported by expert consultation.

Additional information

For more 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).

Sincerely,

Original Signed By

Dr. Penny Sutcliffe
Medical Officer of Health and Chief Executive Officer

NOTE: All Advisory Alerts are found on our website.

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This item was last modified on September 23, 2021