COVID-19: Vaccines

Recommendations for fall/winter 2024-2025 COVID-19 Vaccination

It is recommended anyone 6 months of age and older receive an updated COVID-19 vaccine this fall/winter to provide protection against strains that are spreading.

The National Advisory Committee on Immunization (NACI) recommend individuals who are at higher risk of getting very sick from a COVID-19 infection should be vaccinated with an updated COVID-19 vaccine this fall including:

• Adults 65 years of age or older
• Individuals 6 months of age and older who are/have:
  • Residents of long-term care homes and other congregate living settings
  • Pregnant Individuals*
  • From First Nations, Métis and Inuit communities
  • Members of racialized and other equity-deserving communities
  • Underlying medical conditions that places them at higher risk of severe COVID-19, including children with complex health needs
  • Provide essential community services including health care workers and first responders.

*COVID-19 vaccine may be offered at any stage of the pregnancy (i.e., in any trimester) and while breastfeeding.

NACI also recommends that all individuals 6 months of age and over not listed above may receive an updated vaccine beginning in the fall of 2024.

Available COVID-19 Vaccines fall/winter 2024

Publicly funded COVID-19 vaccines are made available by the Ontario Ministry of Health.

The COVID-19 vaccines available in Ontario for fall/winter 2024:

• Moderna KP.2 for those 6 months of age and older
• Pfizer KP.2 for those 12 years of age and older

Note: The Novavax vaccine will not be available in Ontario for 2024/25. Individuals who are unable to receive an mRNA vaccine, should speak with their health care provider about treatment options, including the use of Paxlovid, to reduce the duration and severity of illness.

Both Moderna and Pfizer vaccines can be used interchangeably, as long as the vaccine provided is the vaccine approved by age.

When to Receive an Updated COVID-19 Vaccine

Beginning in October, those who are at high-risk of getting very sick from COVID-19 should receive their vaccine.

In addition, the following priority populations can receive their vaccine in October:

• Children 6 month to 4 years of age
• Health care workers
• First responders
• Individuals with significant exposure to birds and mammals (such as poultry, livestock, slaughterhouse and processing plant workers, wildlife officers/researchers, and veterinarians)

Beginning October 28, 2024, everyone 6 months of age and older can receive a COVID-19 vaccine.

Recommended Interval for Fall/Winter Dose with Updated Vaccine

For previously vaccinated individuals the recommended interval is 6 months from the last COVID-19 vaccine dose, and a minimum of 3 months from the last dose may be used. See schedules below.

For recent COVID-19 infection: Individuals may consider delaying COVID-19 immunization by 3 to 6 months if someone had a recent test-confirmed COVID-19 infection and were previously vaccinated.

Children 6 months to 4 years of age and moderately to severely immunocompromised individuals may need additional doses at different intervals. See schedule below.

Vaccine Use by Age

Immunization schedule for fall/winter 2024-25 – Children 6 months to 4 years of age.

Current Age	Health Status	Vaccination History	# of Does of Moderna to give	Interval between doses
6 months to 4 years	Immunocompetent	0 does	2 doses	8 weeks
		1 dose Moderna	1 dose	8 weeks
		1 dose Pfizer	2 doses	8 weeks
		2 doses with ≥1 doses Pfizer	1 dose	8 weeks
		2 doses both Moderna	1 dose	6 months°
		≥3 doses, any product	1 dose	6 months°

°For previously vaccinated individuals, the recommended interval is 6 months from the last COVID-19 vaccine dose, and a minimum of 3 months from the last dose may be used.

Immunization schedule for fall/winter 2024-25 – Immunocompetent Children ages 5 years and older

Current Age	Health Status	Vaccination History	# of Doses of Moderna or Pfizer to give	Interval between Doses
5 years^ +	Immunocompetent	0 doses	1 dose	–
		≥1 dose, any product	1 dose	6 months°

^ Children who started the primary series at less than 5 years of age and turn 5 years of age before completing the series, should get 1 dose this fall/winter with a minimum 8-week interval after their last dose.

Vaccination if Immunocompromised

Receiving a vaccine is important for individuals who are moderately to severely immunocompromised and at increased risk of severe illness from COVID-19.

Moderately to severely immunocompromised individuals who are 6 months to 4 years of age who have not been previously vaccinated should receive an additional dose of vaccine to be fully protected.

Moderately to severely immunocompromised individuals who are 5 years of age and older should receive an additional COVID-19 vaccine.

Moderately to Severely Immunocompromised Individuals

As indicated by NACI, the following individuals are considered to be moderately to severely immunocompromised and are recommended to receive additional dose(s) as detailed in the immunization schedules section above:

• Solid tumor or hematologic malignancies or treatments for these conditions.
• Solid-organ transplant and taking immunosuppressive therapy.
  Hematopoietic stem cell transplant (HSCT) (within 2 years of transplantation or taking immunosuppression therapy).
• Immunocompromise due to chimeric antigen receptor (CAR) T cell therapy targeting lymphocytes.
• Moderate to severe primary immunodeficiency with associated humoral and/or cell-mediated immunodeficiency or immune dysregulation.
• HIV with AIDS-defining illness or TB diagnosis in last 12 months before starting vaccine series, or severe immune compromise with CD4 < 200 cells/μL or CD4 <1 5%, or without HIV viral suppression.
• Recent treatment with the following categories of immunosuppressive therapies: anti-B cell therapies (monoclonal antibodies targeting CD19, CD20 and CD22), high-dose systemic corticosteroids, alkylating agents, antimetabolites, or tumor- necrosis factor (TNF) inhibitors and other biologic agents that are significantly immunosuppressive.
• Chronic kidney disease on dialysis

Please refer to Ministry of Health guidance for more information and schedules below.

Immunization schedule for fall/winter 2024-25 – Moderate to Severely immunocompromised Children 6 months to 4 years of age

Current Age	Health Status	Vaccination History	# of Additional Doses Recommended	Interval between Doses
6 months to 4 years	Immunocompromised	0 doses	3 doses	4 to 8 weeks
		1 dose Moderna	2 doses	4 to 8 weeks
		1 dose Pfizer	3 doses	4 to 8 weeks
		2 doses both Moderna	1 dose	4 to 8 weeks
		2 doses with ≥1 doses Pfizer	2 doses	4 to 8 weeks
		3 doses with ≥1 doses Pfizer	1 dose	4 to 8 weeks
		3 doses all Moderna	1 dose	6 months°
		≥4 doses, any product	1 dose	6 months°

Immunization schedule for fall/winter 2024-25 – Moderate to Severely immunocompromised 5 years of age and older

Current Age	Health Status	Vaccination History	# of Additional Doses Recommended	Interval Between Doses
5 years^ +	Immuno-compromised (IC)	0 doses	2 doses	4 to 8 weeks
		1 dose XBB or KP.2	1 dose¥	4 to 8 weeks
		1 dose non-XBB/non-KP.2	2 doses¥	4 to 8 weeks
		2 doses with ≥1 doses non-XBB/non-KP.2	1 dose¥	4 to 8 weeks
		2 doses, XBB	1 dose	6 months°
		≥3 doses, any product	1 dose	6 months°
	IC: HSCT recipient or CAR T cell therapy	1 dose XBB or KP.2	2 doses	4 to 8 weeks
		2 doses XBB and/or KP.2	1 dose	4 to 8 weeks
		≥3 doses XBB	1 dose	6 months°

¥ An additional dose may also be offered if recommended by the client’s healthcare provider.
^ Immunocompromised children who started the primary series at less than 5 years of age and turn 5 years of age before completing the series, should continue the primary series schedule that was initiated (i.e., continue schedule as if child is under 5 years of age.)

Immunization schedule for fall/winter 2024-25 – Moderate to Severely immunocompromised HSCT, CAR T cell therapy – 5 years of age and older

Current Age	Health Status	Vaccination History	# of Additional Doses Recommended	Interval between Doses
5 years +	IC: HSCT recipient or CAR T cell therapy	0 doses	3 doses	4 to 8 weeks
		1 dose XBB or KP.2	2 doses	4 to 8 weeks
		2 doses XBB and/or KP.2	1 dose	4 to 8 weeks
		≥3 doses XBB	1 dose	6 months°

New hematopoietic stem cell transplantation (HSCT) recipients and chimeric antigen receptor (CAR) T cell therapy are considered immunologically naïve and should be vaccinated with 3 doses beginning at 3 to 6 months post-HSCT/CAR T-cell therapy, regardless of previous vaccination history, with 4 to 8 weeks between doses.

Co-administration of Vaccines

Moderna and Pfizer vaccines may be given at the same time with other vaccines, or at any time before or after other non-COVID-19 vaccines (live or non-live vaccines), including influenza vaccine, respiratory syncytial virus (RSV) vaccine and/or the RSV monoclonal antibody, Beyfortus®.

Residents Without OHIP Cards

Learn more on where people without OHIP cards can get vaccinated.

If You Received a Vaccine Outside of Ontario/Canada

Everyone six months of age and older who has been vaccinated outside of Canada with one or more vaccine(s) not approved by Health Canada can receive a dose of the updated COVID-19 vaccine if it has been at least six months since the last COVID-19 vaccine.

If you live in Toronto and got COVID-19 vaccines outside of Ontario or Canada, learn more about how to document any dose(s) received outside of Ontario or Canada by visiting COVID-19: Proof of Vaccination.

Further information:

To support with vaccine information, VaxFacts+  is helping community members and families to get the most accurate information.

How COVID-19 Vaccines Work

COVID-19 vaccines teach our immune system to make antibodies that protect against COVID-19. These antibodies can recognize and attack the virus when it enters the body.

The vaccine is given using a needle in your upper arm. It takes at least two weeks after getting a vaccine dose to be protected. It is safe to get the vaccine at the same time with other vaccines, or at any time before or after other non-COVID-19 vaccines (live or non-live vaccines), including influenza vaccine, respiratory syncytial virus (RSV) vaccine and/or the RSV monoclonal antibody, Beyfortus®.

mRNA vaccines, like the Pfizer-BioNTech Comirnaty and Moderna Spikevax vaccines, provide your body with instructions (mRNA) to make antibodies. The COVID-19 vaccine is the first vaccine using mRNA technology to be approved for use, but it was in development for many years prior to the COVID-19 pandemic.

Protein subunit vaccines, like Novavax, contain harmless and purified pieces (proteins) of the virus which have been specifically selected for their ability to trigger immunity. Your body then uses these to make its own instructions to make antibodies.

Novavax vaccine will not be available in Ontario for 2024/25. Individuals who are unable to receive an mRNA vaccine, should speak with their health care provider about treatment options, including the use of Paxlovid, to reduce the duration and severity of illness.

Note: Novavax vaccine will not be available in Ontario for 2024/25. Individuals who are unable to receive an mRNA vaccine, should speak with their health care provider about treatment options, including the use of Paxlovid, to reduce the duration and severity of illness.

If unable to receive an mRNA vaccine

Novavax vaccine will not be available in Ontario for 2024/25.
Individuals who are unable to receive an mRNA vaccine, should:

• Speak with their health care provider about treatment options, including the use of Paxlovid, to reduce the duration and severity of illness.
• Layer other personal preventive measures to reduce the risk of infection from COVID-19.
• Take some steps to protect yourself and others during respiratory illness season include:
  • consider wearing a tight-fitting, well-constructed mask in indoor public settings, especially if you are at higher risk of severe infection
  • wash your hands often
  • cover your mouth when you cough or sneeze
  • regularly clean high touch surfaces
  • optimize indoor air quality

For more information visit Protection from COVID 19 and other respiratory illnesses | ontario.ca

Vaccine Safety

Health Canada has approved COVID-19 vaccines as safe and effective. They meet quality standards, and the benefits of the vaccines outweigh the risks of a COVID-19 infection. 

Health Canada and Public Health Agency of Canada continue to monitor the safety of all COVID-19 vaccines approved in Canada and will take appropriate action as needed. 

Potential Side Effects and When to Get Medical Attention

Most vaccine side effects are mild and last for one to three days. Common side effects include: 

• Sore arm near the injection site 
• Feeling tired 
• Headache 
• Achy muscles or joints 
• Fever and chills 

Severe side effects are rare. Get medical attention right away if you develop any of these symptoms after getting a vaccine: 

• Signs and symptoms of severe allergic reaction, including hives, swelling of the mouth or throat or trouble breathing, hoarseness or wheezing.
• High fever (over 40°C)
• Seizures
• Other serious reactions

Report any severe reactions to the COVID-19 vaccine to your health care provider. Health care providers are required to report Adverse Events Following Immunizations (AEFIs) to Toronto Public Health.

Vaccine Allergies

COVID-19 vaccines do not contain eggs, gelatin (pork), gluten, latex, preservatives, antibiotics or aluminum. 

People with allergies, including serious allergies to food, medications, and insect bites can get the COVID-19 vaccine. Allergic reactions can be treated and are usually temporary. People are monitored for 15 minutes after vaccination for any reactions. 

People with severe allergies to any of the vaccine ingredients should speak with their physician/allergist about getting the vaccine. Some people with allergies to an ingredient can still be safely vaccinated. 

If you get a serious reaction after your first dose, talk to your health care provider about future vaccinations. Sometimes you can still be safely vaccinated or can received a different vaccine. 

Resources

• Vaccine Data on COVID-19 Pandemic Archived Dashboards
• Archived: COVID-19 Pandemic City Immunization Strategies
• Adverse Events Following Immunization
• Adverse Events Following Immunization (AEFIs) for COVID-19 in Ontario
• Reported Side Effects Following COVID-19 Vaccination in Canada
• Vaccine Injury Support Program