1. Coronavirus (COVID-19)
  2. Vaccine
  3. Immunocompromised

Coronavirus (COVID-19): immunocompromised

If you’re moderately or severely immunocompromised or are taking medications that can substantially affect your immune system, you may be eligible to receive an additional dose of an mRNA COVID-19 vaccine.

Active treatment for cancer

If you’re receiving cancer treatment or have received cancer treatment in the past 12 months you may be able to receive an additional dose of an mRNA COVID-19 vaccine.

People receiving chemotherapy or immunotherapy and targeted agents are eligible for an additional dose.

People who are only receiving hormonal agents, radiation therapy or surgery are not eligible for an additional dose.

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.

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

Human Immunodeficiency Virus (HIV)

If you have stage 3 or advanced untreated HIV infection or acquired immunodeficiency syndrome (AIDS) with a Cluster of Differentiation 4 (CD4) of less than 200, you’re able to receive an additional dose of an mRNA 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 (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)