Publicly Funded Immunization Program Updates
Pneumococcal Vaccine Program
In July 2024, Ontario’s publicly funded pneumococcal vaccine program transitioned to the following pneumococcal vaccine products:
- 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 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.
On July 2, 2025, the following eligibility enhancement was announced for infants and children:
- Children aged 6 weeks to 17 years who are at high risk of invasive pneumococcal disease (IPD) who have completed their Pneu-C-13 immunization series are now eligible for one dose of Pneu-C-20 vaccine.
For more information on the provincial Pneumococcal Vaccine Program, including healthcare provider factsheets, visit this Ministry of Health webpage.
RSV Vaccine Program
Ontario 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. For more Information, Ministry of Health Respiratory Syncytial Virus (RSV) prevention programs.
The 2025/2026 Older Adult High-Risk RSV Vaccine Program
The RSV adult immunization eligibility has now expanded, to protect more Ontarians when they are vulnerable to RSV illness.
Eligibility:
- All individuals aged 75 and older (new for the 2025-2026 season)
- Individuals 60 to 74 years of age 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 levels of care including similar settings (e.g., complex continuing care, hospital transitional programs).
- patients with glomerulonephritis who are moderately to severely immunocompromised
- 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.
If an individual has previously received a dose of RSV vaccine, they do not need to receive another dose this season, as booster doses are not recommended for any adults at this time.
Vaccines
Two vaccine products are available for adults:
The 2025/2026 Infant and High-Risk Children RSV Prevention Program
Under Ontario’s infant RSV program, two publicly funded products are available for the prevention of disease during the RSV season:
- Nirsevimab (Beyfortus) can be given to infants less than 8 months of age, as well as high-risk children from 8 up to 24 months of age.
- During RSV season, this product can be administered shortly after birth.
- This is a monoclonal antibody immunizing product.
- This product does not provide long-term immunity to RSV disease but helps protect infants when they are most at risk of severe RSV disease.
- • Abrysvo may be given to pregnant individuals to protect their infants who will be born during RSV season.
- This vaccine provides infants with passive maternal antibodies that helps to protect them from severe RSV illness for up to 6 months after birth.
- • Administration of both the vaccine to the pregnant individual and a monoclonal antibody to the infant is NOT recommended except under specific circumstances:
- infants born less than 14 days after administration of Abrysvo OR
- Infants who meet the medical criteria for increased risk of severe RSV disease:
- All premature infants (i.e.,
NOTE: Giving the monoclonal antibody to an infant is the recommended approach over vaccination in pregnancy to protect infants, based on recommendations from the National Advisory Committee on Immunization (NACI).
Eligibility:
Due to the seasonality of the RSV virus and to ensure optimal protection, Nirsevimab (Beyfortus) or Abrysvo should be administered shortly before and during the active RSV season (November 1 to March 31, peaking in December), with regional variation across Ontario and between years.
As of October 1, 2025, monoclonal antibody immunization is publicly funded for RSV prevention in infants and children who are residents of Ontario and meet any of the following criteria:
- infants born on or after April 1,2025 and aged less than 8 months at the time of immunization, within their first RSV season
- children up to 24 months of age who meet the following high-risk criteria for severe RSV disease through their second RSV season:
- chronic lung disease (CLD), including bronchopulmonary dysplasia/chronic lung disease
- hemodynamically significant congenital heart disease (CHD)
- severe immunodeficiency
- Down Syndrome/Trisomy 21
- cystic fibrosis with respiratory involvement and/or growth delay
- neuromuscular disease impairing clearing of respiratory secretions
- severe congenital airway anomalies impairing the clearing of respiratory secretions
Dosage – Administration Guidelines for Infants and Children
There are two different doses of Nirsevimab (Beyfortus), dependent on weight:
| Category |
Weight |
Dose |
Timing |
| Infants born during the current RSV season |
|
50 mg in 0.5 mL
(100 mg/mL) |
100 mg in 1.0 mL
(100 mg/mL) |
|
| Administration from birth |
| Administration from birth |
|
| Infants born on or after April 1st, less than 8 months of age up to end of their 1st RSV season |
|
50 mg in 0.5 mL
(100 mg/mL) |
100 mg in 1.0 mL
(100 mg/mL) |
|
| Shortly before the start of the RSV season |
| Shortly before the start of the RSV season |
|
| Children up to 24 months of age and at continued high-risk from RSV infection during second RSV season |
N/A |
200 mg (two separate 1.0 mL injections of 100 mg/mL) |
Shortly before the start of their second RSV season |
Note: Syringes cannot be combined or split to obtain the proper dose required. See Ministry fact sheet for HCP for dosing for children undergoing cardiac surgery with cardiopulmonary bypass.
As of October 1, 2025 publicly funded Abrysvo vaccine is available to:
- pregnant individuals who are between 32-36 weeks gestation, who are not planning on immunizing their infant with Nirsevimab (Beyfortus). See note above pertaining to NACI recommendations for infant immunization preference.
- NOTE: the RSV vaccine Arexvy should NOT be given to pregnant individuals
Please Note:
- Pharmacies will not have access to publicly funded RSV vaccine. Individuals who are eligible should not be sent to a pharmacy to pick up or receive the vaccine(s) there. Adults who do not qualify for a free dose may obtain the vaccine at a pharmacy with a prescription from their primary care provider and will be required to pay out of pocket or through their health insurance.
- The adult and pregnancy vaccines are not administered at Middlesex-London Health Unit clinics. Beyfortus for infants is available at select clinics for those who cannot receive the product elsewhere.
- Publicly funded vaccine cannot be used for individuals who do not meet the eligibility criteria.
- Ministry of Health Infant and High-risk Children Respiratory Syncytial Virus (RSV) Prevention Program Factsheet for Health Care Providers.
- Provincial Council for Maternal and Child Health (PCMCH) has developed a fact sheet for parents and expectant parents that is available in English, French and several additional languages.
- Indigenous Primary Health Care Council (IPHCC) and PCMCH have co-developed a tailored fact sheet for Indigenous parents, families and caregivers that is available in English, French and four Indigenous languages.
Ordering
- Beyfortus is now available to order for the 2025-26 respiratory season
- The exact date for pick-up will be confirmed by e-mail when the order is processed.
- Please do not send couriers prior to the date indicated.
- There may be delays due to product availability or the volume of orders.
- Please do NOT return vaccines to MLHU unless they have expired.
- All HCPs who order vaccines (excluding pharmacies) must use the online Public Health Ordering System (PHOS).
Immunization Information
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Middlesex-London Health Unit
- Alerts and eNewsletter for Healthcare Providers - sign-up, read past alerts and eNewsletters
- A Guide to Measles, Mumps Rubella and Varicella Vaccines (PDF)
- A Guide to Tetanus-Containing Combination Vaccines (PDF)
- A Guide to Meningococcal Vaccines (PDF)
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Ontario Ministry of Health
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Public Health Agency of Canada
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Public Health Ontario
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Immunization Schedules
Publicly Funded Immunization Schedules for Ontario - 2022 is intended primarily for health care providers who administer immunizations. It is to be used as a reference tool for immunizers and provided information regarding:
- The routine immunization schedule,
- Catch-up immunization schedules,
- High risk immunization programs and schedules,
- Eligibility criteria for all publicly funded immunizations, and
- Minimum and recommended intervals between doses for immunization series
Immunization Medical Exemptions
Under provincial legislation, children and students attending licensed child care, elementary or secondary school must either have proof of immunization, or have a valid medical or non-medical exemption.
The appropriate form must be completed by a physician or nurse practitioner and submitted to the Middlesex-London Health Unit for children who require a medical exemption.
In addition to being completed for children and students that are contraindicated for immunization, a medical exemption may be used to indicate immunity to a particular vaccine preventable disease (such as history of varicella disease). A lab report demonstrating immunity may replace the exemption form.
Statement of Medical Exemption Forms (*available in English and French)
*If PDF files do not open in the internet browser, download and open with Adobe Acrobat
**If a child attending child care still requires an exemption when they begin school, the appropriate school-age form must be completed. |
Instructions
1. Fill out the appropriate State of Medical Exemption Form
- Indicate which vaccine preventable disease(s) the individual is being exempt from receiving immunization for. Indicate whether the exemption is permanent or temporary. If temporary, include an end date.
2. Submit the form to the Middlesex-London Health Unit.
- The physician or nurse practitioner may submit the form by fax to 519-663-0416, OR
- The family can submit a copy of the form. If child attends child care, the child care centre will also require a copy of the form.
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Immunization Ordering and Returns
Healthcare providers in the Middlesex-London area who have passed their annual fridge inspection may order publicly funded vaccines from the Health Unit. Healthcare providers who have not yet had fridge inspected by public health and those wanting to learn more about immunization storage and handling should visit the Health Unit’s Immunization Storage and Handling webpage.
How to order publicly funded immunizations:
1. Review your current inventory of immunizations in your fridge.
- When submitting your order, you will be required to indicate how many of each immunization you currently have in your fridge.
- To minimize waste and loss in the event of a cold chain incident, you should not store more than a one-month supply of immunizations
2. Gather your fridge temperature logs from the last 4 weeks. These will need to be submitted with your order.
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 submitted via fax or email will not be processed.
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Other important information about ordering immunizations
- Allow 72 hours (3 business days) for orders to be filled. You will be notified by email when your order is ready for pick-up.
- All orders must be picked up from the Middlesex-London Health Unit receiving zone located in the Citi Plaza loading dock at 355 Wellington St., London. Instructions on accessing the loading dock will be sent by email with your order confirmation and are also available here.
- Healthcare providers, staff or couriers MUST arrive for order pick-up 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 orders may require more than one conditioned insulated container. For more information on immunization transportation and temporary storage, visit the Health Unit’s Immunization Storage and Handling webpage.
- When ordering school immunization program vaccines (HPV, Hepatitis B and Meningococcal ACYW-135), you may be required to provide patient information. Once you have administered these immunizations, healthcare providers must report back to the Health Unit using the form provided.
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Immunization Returns
Immunizations should be returned to the Middlesex-London Health Unit when:
- Expired (exception - *COVID-19 vaccine)*
- You have been instructed by a public health nurse to return immunization(s) following the investigation of a cold chain incident.
- *COVID-19 vaccine that has expired (by manufacture expiry freezer-to-fridge expiry date) should be wasted at the site where it is being stored. The wastage must be reported in the COVAXon system by the site's superuser.
How to return publicly funded immunizations:
- Complete the Vaccine Return Form. This form is REQUIRED for all immunization returns. Returns without this form will not be accepted. Vaccine Return Form (PDF)
- 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.
- Attach the Vaccine Return Form to the bag or place the form inside the bag and label the outside of the bag with the healthcare provider/office name.
- Drop the return off at the Middlesex-London Health Unit receiving zone located in the Citi Plaza loading dock at 355 Wellington St., London. Instructions on accessing the loading are available here. Returns are accepted during regular business hours.
- 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.
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Other important information regarding immunization returns:
- Diluent does not need to be returned and can be disposed of at your site.
- Do not return other medications or medical products that were not distributed by the Vaccine Distribution Program
- Immunizations that are expired or wasted do not need to be returned in a conditioned cooler as the vaccine will not be re-used.
- Immunizations are expensive biological agents. You can prevent waste by limiting ordering to a one-month supply.
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