Coadministration of COVID-19 Vaccines with Other Vaccines and Updates on Third Dose Eligibility in Ontario

With flu shot season just around the corner, the National Advisory Committee on Immunization’s (NACI), updated recommendations regarding the coadministration of COVID-19 vaccines with other vaccines have arrived in a timely manner. Previously, NACI had recommended that the COVID-19 vaccines be administered at least 14 days after or 28 days before other vaccines, as a precautionary measure. However, considering previous experience of giving other vaccines at or around the same time along with the emerging evidence on the COVID-19 vaccines, NACI has now recommended that the COVID-19 vaccines can be given at the same time as, or any time before or after, other vaccines. This includes live and non-live vaccines.

Also, as the third COVID-19 vaccine dose eligibility for Ontario residents continues to expand, we’ve provided the list below regarding who may be eligible as per the most recent recommendations from Ontario’s Ministry of Health, released on October 7, 2021.

When receiving your third dose, you will be asked to show the prescription receipt from one of the listed medications OR the labelled medication container. Some people on medications beyond those listed below, may still be eligible to receive third doses, as the list may not be complete. These individuals will require a referral form/letter from their healthcare provider for a third dose of the COVID-19 vaccine. The recommended timing of the third dose remains the same as previously established, at least 8 weeks since the second dose.

Table of Medications Considered Highly Immunosuppressive for Third Doses (Adapted from: Ministry of Health, COVID-19 Vaccine Third Dose, Recommendations, Version 2.0 October 7, 2021)

Class	Generic Name	Brand Name
Steroids (greater than 20 mg/day of prednisone or equivalent for more than 2 weeks)	Prednisone
	Dexamethasone	Decadron
	Methylprednisolone	SoluMedrol DepoMedrol Medrol
Antimetabolites	Cyclophosphamide	Procytox
	Leflunomide	Arava
	Methotrexate	Trexall Metoject Otrexup Rasuvo Rheumatrex
	Azathioprine	Imuran
	6-Mercaptopurine	Purinethol
	Mycophenolic Acid	Myfortic
	Mycophenolate Mofetil	CellCept
Calcineurin Inhibitors/mTOR Kinase Inhibitor	Tacrolimus	Prograf Advagraf Envarsus PA
	Cyclosporine	Neoral Gengraf Sandimmune
	Sirolimus	Rapamune
JAK (Janus Kinase) Inhibitors	Baricitinib	Olumiant
	Tofacitinib	Xeljanz
	Upadacitinib	Rinvoq
Anti-TNFα (Tumour Necrosis Factor)	Adalimumab	Humira Amgevita Hadlima Hulio Hyrimoz Idacio
	Golimumab	Simponi
	Certolizumab Pegol	Cimzia
	Etanercept	Enbrel Brenzys Erelzi
	Infliximab	Remicade Avsola Inflectra Remsima Renflexis
Anti-Inflammatory	Sulfasalazine	Salazopyrin Azulfidine
	5-Aminosalicylic Acid/Mesalamine	Pentasa
Anti-CD20	Rituximab	Rituxan Ruxience Riximiyo Truxima Riabni
	Ocrelizumab	Ocrevus
IL-1 RA (Interleukin 1 receptor antagonist)	Anakinra	Kineret
	Canakinumab	Ilaris
Anti-IL 6	Tocilizumab	Actemra
	Sarilumab	Kevzara
Anti-IL 12/23	Ustekinumab	Stelara
Anti-IL 17	Secukinumab	Cosentyx
	Ixekizumab	Taltz
Anti-IL17 R	Brodalumab	Siliq
Anti-BLyS	Belimumab	Benlysta
Anti-IL 23	Guselkumab	Tremfya
	Rizankizumab	Skyrizi
Selective T cell Costimulation Blocker	Abatacept	Orencia
	Fingolimod	Gilenya
S1PR (Sphingosine 1-phosphate receptor agonist)	Siponimod	Mayzent
	Ozanimod	Zeposia
Phosphodiesterase Inhibitors	Apremilast	Otezla

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.

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