Booster dose for high-risk adolescents only, NACI issues “off-label” recommendation for 12 to 17 age group

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In a recent update on its COVID-19 vaccine guidance, NACI has made an “off-label” recommendation that only high-risk adolescents be given a booster dose.

At this time, Health Canada has not received a submission or clinical trial data from vaccine manufacturers for authorization of a COVID-19 booster dose for people under
18 years of age. Therefore, recommendations made for the use of booster doses in adolescents are currently considered off-label, NACI said in a statement posted on Friday.

The advisory body outlined three categories of 12 to 17-year-olds who are eligible for an additional jab.

This includes those who have an underlying medical condition that may put them at high risk of severe illness due to COVID-19, like those suffering from cancer, as well as those who are immunocompromised and who have already received a three-dose primary series (for adolescents who are immunocompromised, a booster dose would be their fourth dose).

Residents of congregate living settings, including shelters, group homes, quarters for migrant workers, correctional facilities are also considered high-risk and eligible for a booster.

Adolescents who belong to racialized or marginalized communities disproportionately affected by COVID-19 can also be given an additional dose of the Pfizer COVID-19 vaccine.

The use of the Pfizer-BioNTech mRNA booster dose (30 mcg) is preferred to the use of the Moderna mRNA booster dose (50 mcg dose) in adolescents to further minimize the rare risk of myocarditis and/or pericarditis following vaccination in this age group, stated NACI.

NACI recommends an interval of at least 6 months between the final dose of a primary series and a booster dose as evidence in adults suggests that longer intervals result in a
stronger immune response that is expected to be longer lasting and may be associated with a lower risk of myocarditis and/or pericarditis in adolescents and young adults.

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