The National Advisory Committee on Immunization (NACI) has recommended that patients with moderate to severe immunocompromise due to disease or treatment be offered an additional fourth dose at least 6 months following their third dose. Following direction from the OCPHO, NTHSSA is offering 4th doses to patients who are eligible due to certain conditions or treatments, as long as at least 6 months have passed since the 3rd dose.
This fourth dose is intended to restore protection that may have decreased over time in individuals who have certain conditions putting them at very high risk for severe disease.
For the same reason, NACI also recommends that youths aged 5-15 years old who are severely immunocompromised should receive a 3rd dose 4-8 weeks after their second dose.
Members of the public are being asked to accurately self-identify if they meet the following criteria.
At this time, eligible patients (all ages) include those with the following:
- Active treatment of cancer or other hematologic malignancy
- Recipient of solid-organ transplant and taking immunosuppressive therapy
- Treatment of leukemia with T cell therapy, or had a stem cell transplant within the last two years
- Moderate to severe primary B or T cell immunodeficiency (e.g.: Di George Syndrome or Wiskott-Alrich Syndrome)
- Stage 3 or advanced untreated HIV infection or diagnosis of Acquired Immune Deficiency Syndrome (AIDS)
- Active treatment of active disease (neurological, autoimmune, neoplastic) with any of the following immune suppressive therapies:
- Corticosteroids at doses equivalent to or greater than prednisone 20mg/day for greater than 14 days
- Anti-B cell therapy (e.g.: rituximab/Rituxan, belimumab/Benlysta, etanercept/Enbrel, tocilizumab/Actemra)
- Alkylating agent therapy (e.g.: carboplatin, chlorambucil, cisplatin, cyclophosphamide)
- Systemic antimetabolite therapy (e.g.: 6-mercaptopurine, 5-fluorouracil, gemcitabine, cytarabine, pemetrexed, methotrexate)
- Tumour necrosis factor (TNF) inhibitor therapy (e.g.: infliximab/Remicade, etanercept/Enbrel, adalimumab/Humira)
- Other biologic therapy (e.g.: ustekinumab/Stelara)
The following are examples of conditions or treatments which are currently NOT considered eligible for fourth dose immunization under the new guidance:
- Other autoimmune conditions (e.g.: lupus, rheumatoid arthritis, psoriasis, etc.) unless they also have a condition or treatment listed above
- Treated and well-controlled HIV infection
- Previous cancer on suppressive therapy (e.g.: tamoxifen, leuprolide)
- Systemic corticosteroid therapy at less than prednisone equivalent of 20mg/day or for less than 14 days
- Corticosteroid therapy administered topically, by inhalation (e.g.: Flovent, Flonase, Budesonide), or by local injection (e.g.: joint injection)
- Physiologic replacement therapy (e.g.: hormone replacement therapy, thyroid replacement therapy)
Please book vaccination appointments through your local health centre or online in Yellowknife. Individuals will be assessed by a nurse at the time of immunization to confirm eligibility. Further updates regarding recommendations for vaccinations will be provided in accordance with directions received from the Public Health Agency of Canada and the OCPHO as they become available.