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.

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 is accessible 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 the 0-18 year old age range, AND be in one of the following categories: a newcomer within the last 12 months, not have Ontario health coverage (ie OHIP) or require a vaccine that only MLHU can provide.
• 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)

RSV Vaccine

The RSV vaccine (Arexvy) has been authorized for use in Canada for adults 60 years of age and older and will be publicly funded in Ontario for individuals that live in long-term care homes, Elder Care Lodges and some retirement homes. 

Arexvy is given as a single dose. A 14-day period is required between receiving Arexvy and another vaccine, such as COVID-19 and influenza. This is to better identify and manage any adverse effects following the vaccination.

Primary care providers may discuss the option to privately purchase Arexvy with their patients who are 60 years of age and older that do not qualify for the publicly funded vaccine. Pharmacies are now able to order the vaccine at an approximate cost of $250.00 (pharmacies do not have access to the publicly funded RSV vaccine).

NOTE: The Arexvy vaccine is not available at MLHU clinics.

Update for Spring 2024: As RSV disease incidence is currently decreasing after respiratory season, doses of RSV vaccine are not currently indicated unless a healthcare provider recommends a dose for an individual due to assessed risk. Please watch for Fall 2024 recommendations for the vaccine coming soon. 

Vaccine Schedules 

We promote and follow the Ontario Immunization schedule for vaccines:

• Publicly Funded Immunization Schedules for Ontario - 2022
• Information about mandatory vaccines for school attendance (ISPA)

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 date. The vaccine also needs to be wasted in the COVAXon system by the site's superuser.