Coronavirus (COVID-19): immunocompromised

Immunocompromised due to cancer or treatment for cancer

You’re able to receive an additional dose of an mRNA COVID-19 vaccine if you’re immunocompromised due to cancer or if you’re receiving treatment for cancer.

You're able to receive an additional dose of mRNA COVID-19 vaccine if you're receiving CAR-T therapy, received a stem cell transplant within 2 years or received a stem cell transplant and taking immunosuppressive medication.

Chronic kidney disease and receiving dialysis

People with chronic kidney disease who are receiving dialysis are able to receive an additional dose of an mRNA COVID-19 vaccine.

Received a solid organ transplant and are taking immunosuppressive medication

You’re able to receive an additional dose of an mRNA COVID-19 vaccine if you have received a solid organ transplant and are taking immunosuppressive medications.

Moderate to severe primary immunodeficiency

People with some moderate to severe primary immunodeficiencies that can cause immunosuppression severe enough to reduce vaccine effectiveness are able to receive an additional dose of an mRNA COVID-19 vaccine.

A full list of primary immunodeficiencies is available at Immunodeficiency Canada.

People with the following immunodeficiencies are not eligible to receive an additional dose:

• Glycogen Storage Disease
• Goodpasture Syndrome
• Hereditary angioedema
• Hyper-IgD Syndrome
• Immunodysregulation, Polyendocrinopathy and Enteropathy, X-linked
• Mannose Binding Lectin Deficiency
• Selective IgA deficiency
• Selective IgM deficiency
• Transient Hypogammaglobulinemia of Infancy
• Unspecified Hypogammaglobulinemia (people 17 and older)

Human Immunodeficiency Virus (HIV)

People with HIV who have been diagnosed with an AIDS-defining illness or a tuberculosis diagnosis in the last 12 months (before getting a first dose of COVID-19 vaccine) are able to receive an additional dose of an mRNA COVID-19 vaccine.

People with HIV without viral suppression are able to receive an additional dose of an mRNA COVID-19 vaccine.

People 6 and older with HIV infection and a Cluster of Differentiation 4 (CD4) of less than 200, or CD4 fraction less than 15% are able to receive an additional dose of an mRNA COVID-19 vaccine.

Children 1 to 5 with HIV infection and a Cluster of Differentiation 4 (CD4) of less than 500, or CD4 fraction less than 22% are able to receive an additional dose of COVID-19 vaccine.

Children 6 to 11 months with HIV infection and a Cluster of Differentiation 4 (CD4) of less than 750, or CD4 fraction less than 26% are able to receive an additional dose of COVID-19 vaccine.

Active treatment with certain immunosuppressive therapies

If you have a medical condition that requires one of the following immunosuppressive treatments, you’re able to receive an additional dose of an mRNA COVID-19 vaccine.

Anti-B cell therapies (CD19, CD20, CD22)

• Rituximab (Rituxan, Rituxan SC, Ruxience, Riabni, Riximyo, Truxima)
• Obinutuzumab (Gazyva)
• Ofatumumab (Kesimpta)
• Ocrelizumab (Ocrevus)

High-dose systemic corticosteroids 4

• Prednisone ≥ 20 mg for ≥ 14 days ( > 2 mg/kg/day for > 14 days for people < 10kg) (Winpred, Deltasone)
• Steroid Equivalencies for Prednisone 20mg
  • Hydrocortisone (cortisol) 80mg (Cortef, Solu-Cortef)
  • Cortisone acetate 100mg (Cortone)
  • Prednisolone 20mg (Pediapred)
  • Methylprednisolone 16mg (Solu-Medrol, Depo-Medrol, Medrol)
  • Triamcinolone 16mg (Aristocort)
  • Dexamethasone 3mg (Decadron)
  • Betamethasone 2.4mg (Betnesol)
  • Budesonide 1.5mg (Jorveza, Entocort)

Alkylating agents

• Busulfan [alkyl sulfonate] (Myleran, Busilvex)
• Chlorambucil [nitrogen mustard] (Leukeran)
• Cyclophosphamide [nitrogen mustard] (Procytox)
• Hydroxyurea (Hydrea)
• Melphalan [nitrogen mustard] (Alkeran)
• Treosulfan (Trecondvy)

Antimetabolites

• Azathioprine [purine antimetabolite] (Imuran)
• Cladribine [adenosine analogue] (Mavenclad)
• Mercaptopurine [purine analogue] (Purinethol; also called 6-MP)
• Methotrexate [folate analogue] (Rheumatrex, Metoject)
• Leflunomide [pyrimidine antimetabolite] (Arava)
• Teriflunomide (pyrimidine antimetabolite) (Aubagio)

Tumor-necrosis factor (TNF) inhibitors

• Adalimumab (Humira, Abrilada, Amgevita, Hadlima, Hulio, Hyrimoz, Idacio)
• Certolizuvmab pegol (Cimzia)
• Etanercept (Enbrel, Brenzys, Erelzi)
• Golimumab (Simponi)
• Infliximab (Remicade, Avsola, Inflectra, Omvyence, Remsima SC, Renflexis)

Other immunosuppressive biologic agents that significantly affect the immune system

• IL-1 inhibitor: Anakinra (Kineret), Canakinumab (Ilaris)
• IL-6 inhibitor: Tocilizumab (Actemra), Sarilumab (Kevzara), Siltuximab (Sylvant)
• IL-17 inhibitor: Secukinumab (Cosentyx), Ixekizumab (Taltz), Brodalumab (Siliq)
• IL 12/23 inhibitors: Ustekinumab (Stelara)
• IL 23 inhibitors: Guselkumab (Tremfya, Tremfya One-Press), Risankizumab (Skyrizi)
• Anti-integrin: Natalizumab (Tysabri), Vedolizumab (Entyvio)

Additional eligible immunosuppressive drug categories

• Anti B-cell: Belimumab (Benlysta)
• Anti-CD52 Monoclonal Antibody: Alemtuzumab (Lemtrada)
• Calcineurin Inhibitor: Cyclosporine (Neoral), Tacrolimus (Prograf, Advagraf, Envarsus)
• Inosine Monophosphate Dehydrogenase Inhibitor: Mycophenolate, Mycophenolate Mofetil, Mycophenolic Acid (CellCept, Myfortic)
• JAK Inhibitors: Baricitinib (Oluminant), Ruxolitinib (Jakavi), Tofacinitib (Xeljanz, Xeljanz XR), Upadacitinib (Rinvoq)
• mTOR Kinase Inhibitor: Sirolimus (Rapamune), Everolimus (Afinitor, Disperz, Certican)
• Nrf2 Pathway Activator: Dimethyl Fumarate (Tecfidera)
• S1P Antagonists: fingolimod (Gilenya), Siponimod (Mayzent), ozanimod (Zeposia)
• T-cell co-stimulation modulators: Abatacept (Orencia)