We have had many calls asking about the timing of vaccines this fall. As clinical pharmacists working at Charlton Health, we are happy to answer any questions regarding vaccines and the timing of medications. There is no need to separate the COVID-19 bivalent booster doses from other vaccines including the influenza vaccine. Many vaccines can be given on the same day. As the newest pneumonia vaccine, Prevnar 20 was released this summer, many people are also upgrading to this lifelong protection against 20 strains of bacterial pneumonia. It can also be given at the same time as other vaccines. Shingrix for shingles protection is offered in two doses, usually 2 months apart, and can also be given with other vaccines. So when getting vaccinated, consider other vaccines that you may require.

Kunal Bhatt, RPh, PharmD, HBSc is a staff pharmacist for Charlton Health. As a 2020 PharmD graduate from the University of Toronto, Kunal possesses a diverse range of experiences from working in hospital and community pharmacy settings. Since January 2021, Kunal was heavily invested in contributing to the efforts against COVID-19 by administering upwards of 5000 COVID-19 vaccines at William Osler Health System’s vaccination clinics. 

Atopic Dermatitis is commonly referred to as eczema. The foundation of the condition is skin barrier dysfunction, whereby allergens and infectious organisms can penetrate below the skin. This results in the release of histamine and other inflammatory chemicals causing redness of the skin and a frequent intense itch. Scratching the skin causes further irritation, making the inflammation and itch even worse. About 85% of people with atopic dermatitis experience their first flare before age 5. Approximately 25% of pediatric patients have recurrent symptoms into adulthood. 

Regular moisturizing is vital to maintain a healthy skin barrier along with avoiding triggers such as perfumes, air fresheners, candles, and smoking. Using soapless cleansers and shampoos, stress reduction, and avoiding curtains and carpets to reduce pollen, dander, and dust mites can all be beneficial. Although most people have mild to moderate symptoms that can be managed with these strategies and prescription creams, about 10% of people have moderate to severe symptoms that may require advanced therapies that reduce the immune response. Some of these advanced therapies include biologic treatments composed of protein, typically given as an injection.  However, there are some newer targeted treatments made available in tablet form. The latest addition to the list of oral targeted treatments for atopic dermatitis is called Abrocitinib, marketed as CIBINQO. It joins another medication in the same family, upadacitinib (Rinvoq) which is also approved for atopic dermatitis. Both medications are swallowed once a day and prevent immune cells from generating excess inflammation. Charlton Health is pleased to offer advanced therapies for many conditions, and we welcome this new addition to our treatment offerings.

Carolyn Whiskin is the Pharmacy Manager for Charlton Health. Carolyn specializes in the treatment of autoimmune diseases, pharmaceutical compounding, women’s health, pain, and smoking cessation. Carolyn has won provincial and national awards for her commitment to patient care and public service.

Kunal Bhatt, RPh, PharmD, HBSc is a staff pharmacist for Charlton Health. As a 2020 PharmD graduate from the University of Toronto, Kunal possesses a diverse range of experiences from working in hospital and community pharmacy settings. Since January 2021, Kunal was heavily invested in contributing to the efforts against COVID-19 by administering upwards of 5000 COVID-19 vaccines at William Osler Health System’s vaccination clinics. 

Health Canada has approved Evusheld as a preventative treatment for COVID-19. It is not intended to replace COVID-19 vaccinations, but rather to add another layer of protection in patients who are predicted to have a poor antibody response to the vaccine. It is a biologic therapy composed of 150mg of Tixagevimab and 150mg of Cilgavimab. These proteins are antibodies that are designed to block the entrance of the virus into human cells. The treatment is given as a set of two injections given in the buttocks. Over the last several months this preventative treatment has been made available to oncology and transplant patients. As of October 2022, Evusheld is also being made available to individuals receiving intravenous medications rituximab (commonly used in rheumatology) and ocrelizumab (widely used in the treatment of Multiple Sclerosis). A prescription is required, and injections are being offered through many clinics throughout the province and in some physician offices.

If you are receiving either of these medications, you can contact your prescriber to see if this therapy is appropriate for you. In the event that you contract COVID-19, antiviral treatment should be initiated as soon as possible to further decrease the risk of developing severe outcomes from the virus.

As a reference, we have provided a document to share some general information about this treatment made available by Ontario Health.

Carolyn Whiskin is the Pharmacy Manager for Charlton Health. Carolyn specializes in the treatment of autoimmune diseases, pharmaceutical compounding, women’s health, pain, and smoking cessation. Carolyn has won provincial and national awards for her commitment to patient care and public service.

Kunal Bhatt, RPh, PharmD, HBSc is a staff pharmacist for Charlton Health. As a 2020 PharmD graduate from the University of Toronto, Kunal possesses a diverse range of experiences from working in hospital and community pharmacy settings. Since January 2021, Kunal was heavily invested in contributing to the efforts against COVID-19 by administering upwards of 5000 COVID-19 vaccines at William Osler Health System’s vaccination clinics. 

At Charlton Health, a center specializing in advanced treatments including biologic therapies, we are often excited when additional treatment options are made available for patients with autoimmune diseases. Recently, Rinvoq^© (upadacitinib), an oral treatment option for Rheumatoid Arthritis, Psoriatic Arthritis and Atopic Dermatitis was also approved to help treat Ankylosing Spondylitis.

Rinvoq^© (upadacitinib) is in a class of medications called JAK inhibitors.  Other medications in this class include Xeljanz^© (tofacitinib) and Olumiant^© (baricitinib).  In Canada, Rinvoq^© is the first of this class, to be used for Ankylosing Spondylitis (AS). This is amazing news for our patients living with AS, because their advanced treatment options consisted of only injections or infusions. If appropriate, for those patients who may not be comfortable self-injecting at home or be able to periodically attend a clinic for an infusion, Rinvoq^© (Upadacitinib) may be a convenient option to be taken as one tablet by mouth every day.  

 Interestingly, another medication, Sotyktu^© (deucravacitinib), within a similar class of medications as Rinvoq^©, was recently approved for treating moderate to severe plaque psoriasis in the United States. Currently, it is under review for approval by Health Canada and if approved, patients with psoriasis may also benefit in the future with the additional availability of an oral treatment option. 

Kunal Bhatt, RPh, PharmD, HBSc is a staff pharmacist for Charlton Health. As a 2020 PharmD graduate from the University of Toronto, Kunal possesses a diverse range of experiences from working in hospital and community pharmacy settings. Since January 2021, Kunal was heavily invested in contributing to the efforts against COVID-19 by administering upwards of 5000 COVID-19 vaccines at William Osler Health System’s vaccination clinics. 

With updated COVID-19 vaccines becoming available as booster doses to offer better protection against variants of the SARS-COV-2 virus, it is important to be aware of who is eligible to receive them. 

At Charlton Health, we continue to serve immunocompromised patients who are being treated for a variety of autoimmune diseases. We recognize and acknowledge the value that these new vaccines bring to better protect our patients. Currently, in Canada, one new bivalent vaccine (manufactured by Moderna) can be given as a booster dose for individuals who have completed the primary series of COVID-19 vaccines. 

As of September 12, 2022, Ontario’s Ministry of Health has recognized the following high-risk individuals to be eligible for the new COVID-19 bivalent Moderna booster vaccine dose (regardless of how many booster doses the individual had received in the past):

1. 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
2. Individuals aged 70 years and older
3. Individuals who are 12 years and older with moderately to severely immunocompromising conditions
   • For those between the age of 12-17 years of age with moderately to severely immunocompromising conditions, a booster dose of the bivalent Moderna COVID-19 vaccine may be offered off-label based on clinical discretion
4. Individuals that are 18 years and older who identify as First Nations, Inuit, or Metis and their non-Indigenous household members aged 18 years and older  
5. Pregnant individuals that are 18 years and older
6. Healthcare workers that are 18 years and older 

As of September 26, 2022, all individuals 18 years and older will be eligible to receive a fall COVID-19 bivalent (Moderna) booster dose (regardless of how many booster doses the individual had received in the past).

Table 2 from the COVID-19 Vaccine Guidance published by Ontario’s Ministry of Health provides the recommended timing interval between the primary series and booster doses of COVID-19 vaccines. It is important to highlight that for those individuals who are moderately and severely immunocompromised individuals, a primary series consists of 3 vaccine doses. The guidance also highlights the timing of the vaccine doses relative to previous infections, which would be important information for individuals who may have recently contracted COVID-19 and want added protection from the booster doses. 

For more information on these updates, you can review the guidance here.

**Please note that this is only the latest information as of September 9, 2022. As more information on the growing topic becomes available, the guidance will likely also be updated. 

Kunal Bhatt, RPh, PharmD, HBSc is a staff pharmacist for Charlton Health. As a 2020 PharmD graduate from the University of Toronto, Kunal possesses a diverse range of experiences from working in hospital and community pharmacy settings. Since January 2021, Kunal was heavily invested in contributing to the efforts against COVID-19 by administering upwards of 5000 COVID-19 vaccines at William Osler Health System’s vaccination clinics. 

We are pleased to share the upcoming opening of the Charlton Digestive Disease Centre at 25 Charlton Ave. East in Hamilton. This will be an outpatient Gastroenterology clinic with a primary focus on exemplary patient experience. We have had the pleasure of working with the gastroenterologists that will be servicing the clinic. They are offering a comprehensive service of endoscopy and colonoscopy procedures, as well consultation and follow-up.

The clinic is committed to lowering the wait times that patients are experiencing with digestive health issues. If you are in need of such services, our referral form can be used by your family physician.

Any questions about the Centre and its services can be directed to Jennifer Heipel at 905-526-7002 ext 1104 or visit our website.

Jennifer Heipel has approximately 15 years of experience working as a hepatology nurse/clinical research coordinator for several gastroenterologists, hepatologists, infectious diseases and addiction specialists. She is trained in the treatment of Hepatitis B and C therapies as well as general hepatology and pre/post liver transplant follow up. Jennifer serves as Charlton Health’s full-time Hepatology Nurse and manages the Hepatology Program. She has worked and continues to work with Dr. Puglia at McMaster University and other area Gastroenterologists to develop a comprehensive, in-house Hepatology program and Hepatitis C program here at Charlton Health.

August is Psoriasis Action Month and at Charlton, we are happy to provide advanced therapies to many people living with psoriasis and to acknowledge Psoriasis Action Month. It is important that people without psoriasis are educated to reduce misconceptions they may have about the condition.  

Psoriasis is an autoimmune disease that showcases its symptoms on the skin and nails. There are different types of psoriasis that are diagnosed based on the type of rash and areas the rash presents.  

Below are common misconceptions about psoriasis, clarified. 

For more information about lifestyle and healthy skincare with psoriasis, please see our previous blog “Management of Psoriasis” posted on February 24, 2022. At the end of that blog are great links to resources to further educate yourself about psoriasis.  

World Hepatitis Day is July 28 and we want to help raise awareness for these diseases. They are a group of infectious diseases that affect the liver, known as hepatitis A, B, C, D and E.  

At Charlton Health we have a great team that specializes in hepatology and offer fibroscans for their patients. Fibroscan machines are special ultrasound machines that are used to scan your liver. The machine is looking for liver scarring or otherwise known as fibrosis. This information, along with blood tests, will give the doctor more information about a person’s liver disease.  

The different types of hepatitis have different ways of transmission. They also vary as some are short-term infections while others are long-term infections. The best way to protect your health is to prevent infection, the best ways to prevent the different hepatitis infections are listed in the table below. 

For further information about the details of hepatitis and prevention, visit the Center of Disease Control and Prevention (CDC) Website.

Marija Ilic is a Pharmacy Student from the University of Waterloo currently doing a rotation at Charlton Health as part of her final year of studies. Through Marija’s education, she has gained experience in both hospital and community pharmacy settings and hopes to find a specialized pharmacy role when she graduates. 

Jennifer Heipel has approximately 15 years of experience working as a hepatology nurse/clinical research coordinator for several gastroenterologists, hepatologists, infectious diseases and addiction specialists. She is trained in the treatment of Hepatitis B and C therapies as well as general hepatology and pre/post liver transplant follow up. Jennifer serves as Charlton Health’s full-time Hepatology Nurse and manages the Hepatology Program. She has worked and continues to work with Dr. Puglia at McMaster University and other area Gastroenterologists to develop a comprehensive, in-house Hepatology program and Hepatitis C program here at Charlton Health.

Vaccination to prevent bacterial pneumonia is suggested for all patients with either a medical condition or immunosuppressive treatment that increases their infection risk. Before starting on advanced therapies such as biologics, we suggest adults update their vaccines, which includes pneumonia protection. Prevnar 13 is a vaccine protecting against the main 13 types of bacterial pneumonia and one dose lasts for a person’s whole life.

Health Canada has just approved Prevnar 20, which is already available in the United States. This will provide lifelong protection against an additional 7 types of pneumonia and will likely replace Prevnar 13. It should be available for purchase by the end of July. It is our hope that it will be publicly funded for compromised adults over 50 as Prevnar 13 is currently.

If you have received Prevnar 13 in the past, you may consider upgrading to this enhanced protection when it is made available to you as long as it has been at least 6 months from the previous Prevnar 13 dose.

Carolyn Whiskin is the Pharmacy Manager for Charlton Health. Carolyn specializes in the treatment of autoimmune diseases, pharmaceutical compounding, women’s health, pain, and smoking cessation. Carolyn has won provincial and national awards for her commitment to patient care and public service.