Fourth Dose (Second booster) Recommendations

NEW: April 6, 2022

Based on recommendations from the National Advisory Committee on Immunization, the following individuals are eligible to receive a second booster dose of COVID-19 vaccine:

• residents of personal care homes and elderly persons housing congregate living sites (such as supportive housing and assisted living) with no age limit;
• individuals aged 70 or older who live in the community; and
• First Nations, Inuit and Metis people aged 50 or older, regardless of where they live.

The second booster should be Pfizer or Moderna and given at least six months after their last booster dose.

For most people, the second booster dose will be their fourth dose of vaccine. However, for immunocompromised people who received an initial series of three vaccine doses to offer stronger protection against COVID-19, the second booster would be their fifth dose. This dose should also be given six months after their first booster.

Who should get the COVID-19 mRNA vaccine and which vaccine should I get?

Children aged 5 to 11 should receive the pediatric Pfizer vaccine.

All adolescents and young adults between the ages of 12 and 29 are recommended to receive Pfizer for all doses, due to a lower risk of myocarditis/pericarditis with this vaccine as compared to Moderna in this age group.

Adults aged 30 years and older can get either mRNA vaccine (Pfizer or Moderna). It is recommended to get the same mRNA vaccine for dose 1 and dose 2, if available. However, getting a combination of mRNA vaccines is both safe and effective, and either (Pfizer or Moderna) can be offered if:

• the same mRNA vaccine is not available
• your previous dose was with a non-mRNA vaccine (e.g. AstraZeneca, Janssen)
• the last dose is unknown

Adults aged 30 years and older can get either mRNA vaccine (Pfizer or Moderna) for the booster dose (regardless of the COVID-19 vaccines previously given).

Recommendations for individuals who are moderately to severely immunocompromised:

• Individuals 12 years and older with a weakened immune system are recommended to receive a total of four doses. Individuals aged 12 to 29 years are recommended to receive Pfizer.
• Adults 30 years and older should get the same mRNA vaccine for dose 1, dose 2 and dose 3, if available. The booster dose (dose 4) can be given with either mRNA vaccine (Pfizer or Moderna), regardless of the COVID-19 vaccine given previously. Talk to your doctor about which vaccine might be right for you, as some evidence suggests that Moderna (100 mcg) may produce a better immune response among people who are immunocompromised.

Who is severely Immunocompromised?

People who are moderately to severely immunocompromised due to a medical condition and/or treatment include those who:

• are receiving active chemotherapy (or immunotherapy) for cancer;
• have received a solid organ transplant and are currently receiving chemotherapy or other immunosuppressive therapy;
• were born with moderate or severe dysfunction of their immune system;
• are living with untreated or advanced HIV-AIDS; or
• are taking certain medications that severely affect the immune system.  

The following people should talk to their doctor about the risks and benefits of an additional dose:

• receiving hemodialysis or peritoneal dialysis;
• on the list to receive a solid organ transplant; or
• have a ventricular assist device (VAD).   

Medical exemptions

For the vast majority of people, the COVID-19 vaccine is a safe and effective way to protect themselves and others against the virus. It is recommended that all eligible individuals who live, work or study in Manitoba be fully vaccinated against COVID-19. However, there are a very small number of people who can’t or shouldn’t be immunized, or need to delay vaccination, due to their medical history.

Only people who qualify and have had their medical situation confirmed by a specialist can receive an exemption. These are the only medical conditions or situations that are eligible to be considered:

• diagnosed with myocarditis or pericarditis within seven days of an mRNA COVID-19 vaccine, confirmed by a licensed cardiologist;
• diagnosed with Guillain-Barré syndrome within 42 days of COVID-19 vaccination, confirmed by a licensed neurologist;
• experienced a serious adverse event following immunization after a dose of COVID-19 vaccine where a licensed provincial medical officer of health has recommended against further vaccination, confirmed by a licensed provincial medical officer of health;
• acute diagnosis of vaccine-induced immune thrombotic thrombocytopenia confirmed by a CancerCare Manitoba (CCMB) hematologist, where another viral vector COVID-19 vaccine should not be provided but an mRNA COVID-19 vaccine may be feasible, approved by a CCMB hematologist;
• CAR-T therapy for cancer within the last three months, confirmed by a CCMB hematologist or oncologist;
• stem cell transplant within the last three months, confirmed by a CCMB hematologist  or oncologist;
• solid organ transplant recipients, including those who within two weeks of transplant or one month post-transplant, confirmed by the licensed specialist supervising the transplant;
• actively receiving anti-cancer drug therapy, which may mean there is a benefit to deferring vaccination to a later date, though this should be weighed against the risks of the person being infected by COVID-19, as directed by a CCMB oncologist or hematologist;
• taking one or more of the following medications within the last six months: alemtuzumab, anti-thymocyte globulin (ATG)/thymoglobulin, basiliximab, blinatumomab, obinatuzuamb, ocrelizumab, ofatumumab, cyclophosphamide or rituximab which may mean there is a benefit to deferring vaccination to a later date, though this should be weighed against the risks of the person being infected by COVID-19, as directed by a CCMB oncologist or hematologist; or
• severe allergy or anaphylactic reaction to a previous dose of a COVID-19 vaccine or any of its components that cannot be mitigated, confirmed by a licensed allergist at the Health Sciences Centre Allergy Clinic.

If you feel you may qualify based on this list, schedule an appointment with your health care provider and/or your specialist. They will review the exemption criteria with you to determine if you qualify. Only a medical specialist (physician) can request a medical exemption from the province. Do not contact or request a referral to a specialist unless you meet one of the criteria listed.

Exemptions can only be made by specialists who are:

• registered with the College of Physicians and Surgeons of Manitoba; and,
• certified by and in good standing with the Royal College of Physicians and Surgeons of Canada in the relevant specialty.

Individuals cannot submit their own requests for exemption.

Once an exemption is submitted, information about the exemption will be entered into the provincial immunization database, including whether the exemption is permanent or temporary.

You will be able to request your digital or physical Manitoba immunization card approximately seven to 14 business days after your exemption is submitted. The card and the display shown after scanning the QR code will be identical to those currently used by fully immunized people.

This will help protect your private health information, while also keeping a simple, consistent process for venues and events that must validate immunization status. For more information, visit: Province of Manitoba | For Residents.

Manitoba’s exemption process only applies within the province, for events and venues that may require proof of immunization to attend or participate. It does not apply to any immunization requirements set by the Government of Canada, including for travel on planes, trains and cruises. For Government of Canada immunization requirements, please visit COVID-19: Proof of vaccination in Canada and for international travel for Canadians - Canada.ca or COVID-19 Boarding flights and trains in Canada - Travel.gc.ca