Immunization Information for Healthcare Providers

This section is intended for healthcare professionals who order vaccines from the Middlesex-London Health Unit, and provide immunizations within their office. General and updated information will be highlighted here.

Click here for more information on the Pneumococcal Vaccine Program Transition

The Canadian Immunization Guide is a comprehensive resource about immunizations, developed for health professionals. Information from the Public Health Agency of Canada as well as vaccine details, schedules, doses, stats, research and general information are searchable on this site.

Vaccine Information

• Vaccines are available at Middlesex-London Health Unit Immunization Clinics for specific individuals.
• To qualify for an appointment, individuals must be within one of the following categories:
• are under the age of 18 years old and do not have health care coverage in Ontario (i.e. Health Card) OR
• are under the age of 18 years old and recently arrived in Canada within the last 12 months and do not have a primary health care provider OR
• require post-exposure prophylaxis vaccine related to a vaccine preventable disease case or community outbreak OR
• missed receiving doses of vaccines at grade 7 school clinics (Hepatitis-B, HPV and Meningococcal ACYW-135 vaccines) OR
• are under risk for imminent suspension from school (have received yellow letter) and are not able to receive vaccines at another health care provider
• Ontario Ministry of Health and Long Term Care - Immunization fact sheets and information
• Public Health Agency of Canada - Fact sheets and vaccine information
• Public Health Ontario - Vaccine safety information, research and reports
• A Guide to Measles, Mumps, Rubella and Varicella Vaccines (PDF)
• A Guide to Tetanus-Containing Combination Vaccines (PDF)
• A Guide to Meningococcal Vaccines (PDF)

Pneumococcal Vaccine Program Transition

As of July 2, 2024, Ontario’s publicly funded pneumococcal vaccine program transitioned to the following new pneumococcal vaccines:

• Pneumococcal 15-valent conjugate (Pneu-C-15), VAXNEUVANCE – this replaces Pneu-C-13 (PREVNAR-13)
• Pneumococcal 20-valent conjugate (Pneu-C-20), PREVNAR-20 – this replaces Pneu-P-23 (PNEUMOVAX)

These two new pneumococcal conjugate vaccines will provide broader protection against invasive pneumococcal disease (IPD) compared to Pneu-C-13 and longer-term protection than Pneu-P-23. Previous pneumococcal vaccines are to be replaced and returned to the health unit through the regular vaccines return process. 

Ministry Link for Pneumococcal Vaccine Transition Information (includes fact sheets, healthcare provider resources and other links).

RSV Vaccine Program

Ontario now has two RSV publicly funded programs – one for high-risk adults, and one for infants. Healthcare providers can order these vaccines through PHOS, based on their patient’s eligibility. The Ontario 2024-25 Respiratory Syncytial Virus (RSV) prophylaxis program information has been updated. As the respiratory season is coming to a close in the spring of 2025, the following changes will be initiated.

Eligibility: High Risk Older Adult - RSV Vaccine Program

Ontario will continue the high-risk older adult RSV vaccine program that was introduced in 2023. The 2024-25 adult RSV program will continue into the spring. Individuals who meet eligibility criteria only require one dose, with no boosters recommended at this time.

The program includes individuals who are 60 years of age and older and who are also:

• residents of long-term care homes, Elder Care Lodges, or retirement homes including similar settings (e.g., co-located facilities)
• patients in hospital receiving alternate level of care (ALC) including similar settings (for example, complex continuing care, hospital transitional programs)
• patients receiving hemodialysis or peritoneal dialysis
• recipients of solid organ or hematopoietic stem cell transplants
• individuals experiencing homelessness
• individuals who identify as First Nations, Inuit, or Métis

*Currently, only a single dose of RSV vaccine is recommended by Health Canada and the National Advisory Committee on Immunization. Studies show multi-year protection and timing for subsequent doses is unknown at this time. Studies are ongoing to determine the duration of protection. 

Vaccines

Two vaccine products are authorized for individuals 60 years of age and older:

• Arexvy
• Abrysvo

Individuals who do not qualify for a publicly funded dose may be able to purchase it at a pharmacy.

Publicly funded vaccines for those who are eligible continue to be available to order through Public Health Ordering System (PHOS).

Infant and High-Risk Children RSV Prevention Program:

The 2024-25 RSV prevention program has ended for infants, high-risk children and pregnant individuals.

• Therefore, doses of Beyfortus and Abrysvo should no longer be administered.
• It is recommended that children receive their dose of Beyfortus in the fall, as it will provide 6 months of protection through the next RSV season.
• Pregnant individuals will also be eligible at that time, between 32-36 weeks of pregnancy prior to their baby being born during RSV season.

Please Note:

• Publicly funded Abrysvo and Beyfortus can be kept in fridges at healthcare provider offices until the next RSV season, pending expiry date.
• Please do NOT return these vaccines to MLHU unless they have expired.
• Consider putting a notation on the boxes to not administer doses until the dates and eligibility for the 2025-26 season has been announced.
• Beyfortus will not be available to order at this time.

Vaccine Schedules 

The Middlesex-London Health Unit promotes and follows the Ontario Immunization schedule for vaccines:

• Publicly Funded Immunization Schedules for Ontario - 2022

Vaccine Medical Exemptions

Sometimes there are medical reasons for individuals not being able to be immunized with mandatory vaccines. This can include a serious immunocompromising condition, severe past reaction including anaphylaxis, and allergies to components of a particular vaccine.

Another medical exemption this form is used for is varicella disease. If a child born in 2010 or after was diagnosed with chicken pox disease, a medical exemption form needs to be filled out by the healthcare provider who diagnosed the disease, to exempt the child from the required varicella vaccines. This form must be filled out by the healthcare provider and sent to the health unit. Varicella titres showing immunity can also be used instead of the medical exemption form.

Medical Exemption form for child care: Children aged 0-4 yrs

Medical Exemption form for school attendance: Children aged 4-17 yrs

Vaccine Ordering and Returns

Vaccine Ordering

Middlesex-London healthcare providers who have passed their annual fridge inspection may order publicly funded vaccines from the Middlesex-London Health Unit. New healthcare providers who have not yet had a public health fridge inspection, should review the vaccine storage and handling guidelines for more information and preparation.

How to order vaccine:

1. Obtain an inventory of your current vaccines in your fridge and ensure you are only ordering a one-month supply of vaccine.
2. Include your last 4 weeks of fridge temperature logs with your order request.
3. Submit your order request through the online Public Health Ordering System (PHOS). If you have yet to register for PHOS, please have your organization's primary contact complete the online registration form. Orders placed via fax or email are no longer being processed.

Please allow 72 hours (3 business days) for orders to be filled. You will be notified when your order is ready for pick-up. Please wait until you receive a confirmation before picking up your vaccine order. You will need to pick up vaccines from the Middlesex-London Health Unit receiving zone located in the Citi Plaza loading dock at 355 Wellington St., London. Please inquire at vaccineorders@mlhu.on.ca for detailed instructions about how to access the loading dock.

All office staff or couriers MUST arrive prepared with a conditioned insulated container that contains cold ice packs, packing material and a working min-max thermometer that is reading temperatures within +2 to +8 ⁰C. Large vaccine orders may require more than one conditioned insulated container. Vaccine will not be released without this requirement.

IMPORTANT: Please carefully review Vaccine Transport and Insulated Containers information for instructions on preparing your cooler for picking up vaccine. Vaccine orders will not be released to couriers or office staff who do not bring proper vaccine packing materials and a conditioned cooler to the Health Unit for vaccine pick up.

When ordering school immunization program vaccines (HPV, Hepatitis B and Meningococcal ACYW-135), you will be required to provide patient information. Once these doses are administered, ALL doses must be reported back to the Health Unit on the paperwork provided with the vaccine.

Vaccine Returns

1. Vaccines should be returned to the Middlesex-London Health Unit if:
   • They are expired (this includes all vaccines except for COVID-19 vaccine)*
   • A cold chain incident has occurred, and public health has provided you with the direction to return the spoiled vaccine
2. Complete the Vaccine Return Form. This form is REQUIRED for all vaccine returns. Returns without this form will not be accepted.
   Vaccine Return Form (PDF)
3. Place the vaccine you are returning in a bag and write “Vaccines – DO NOT USE” on the bag. Do NOT leave expired or spoiled vaccines in your fridge.
4. Attach the Vaccine Return Form to the bag or place the form inside the bag and label the outside of the bag with the health care provider/office name
5. Vaccine diluent does not need to be returned to the Middlesex-London Health Unit and can be disposed of as directed by your waste disposal company
6. Do not return other medications or medical products that were not distributed by the Vaccine Distribution program.
7. Expired or wasted vaccine returns do not need to be returned in a conditioned cooler as the vaccine will not be re-used.
8. The bag can be dropped at the Health Unit receiving zone located in the Citi Plaza loading dock at 355 Wellington St., London. Please enquire at vaccineorders@mlhu.on.ca for detailed instructions about how to access the loading dock.
9. Returns are accepted during regular business hours.
10. Vaccines are expensive biological agents. You can work to prevent the need for returning vaccine by ordering only a one-month supply at a time and taking care of your vaccine properly.

*COVID-19 vaccine needs to be wasted at the site it is being provided at, when it expires by date or by freezer-to-fridge expiry date. The vaccine also needs to be wasted in the COVAXon system by the site's superuser.