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 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)

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. For more Ministry Information, click here.

Eligibility: High Risk Adults

Ontario will continue the high-risk older adult RSV vaccine program that was introduced in 2023 with expanded eligibility in 2024-25. In order to be eligible for publicly funded vaccines, individuals must:

• Be 60 years of age or older; AND
• NOT have received a publicly funded dose of RSV vaccine during the 2023-2024 season*; AND
• Meet one of the following additional criteria:

• Residents of long-term care homes, Elder Care Lodges, or retirement homes
• Patients receiving alternative level of care (ALC) in hospitals or similar settings (e.g. complex continuing care, hospital transition 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

Eligibility: Pregnant Individuals, Infants and High-Risk Children
Ontario has expanded the publicly funded high-risk RSV prevention program beginning in 2024-25 for all infants and high-risk children up to 24 months of age. RSV protection can be provided in one of two ways:

• Providing RSV vaccine (Abrysvo) to pregnant individuals between 32-36 weeks gestation OR
• Providing the monoclonal antibody product Beyfortus (nirsevimab) to infants at birth
• Infant immunization is preferred over pregnancy administration (only one method of protection is recommended, not both)
• If mother did not receive Abrysvo, and the infant did not receive Beyfortus at birth, the infant remains eligible for a dose if born in 2024
• These products will only be provided during the current RSV season (typically November to April each year)
• High-risk children up to the age of 24 months can also receive a dose in a subsequent RSV season
• Dosing is available in three strengths: 50mg, 100mg and 200mg
• See Ministry information for eligibility and dosing requirements

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 do not have a health care provider.
• Publicly funded vaccine cannot be used for individuals who do not meet the eligibility criteria.

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.