Planning guidance for immunization clinics for COVID-19 vaccines: Recommended schedules by age, health status and product

Download in Word format the primary series and booster dose vaccine recommendations by age, health status, and product.

Primary series

General notes for the primary series:

For the primary series, the recommended products are the monovalent original formulations of mRNA vaccines.
Immunocompromised refers to those who are moderately to severely immunocompromised.
Those who are moderately to severely immunocompromised are recommended to receive an additional dose in the primary series, with each dose being administered 4 to 8 weeks apart.
More details about vaccine schedules and intervals can be found in the Canadian Immunization Guide based on the National Advisory Committee on Immunization (NACI) recommendations.

Pfizer-BioNTech Comirnaty COVID-19 primary series
Primary series (age or health status)	NACI recommendations	Pfizer-BioNTech Comirnaty Original Monovalent 3 mcg per 0.2 mL dose Maroon cap / label 6 months to 4 years 2.2 mL of diluent	Pfizer-BioNTech Comirnaty Original Monovalent 10 mcg per 0.2 mL dose Orange cap / label 5 to 11 years 1.3 mL of diluent	Pfizer-BioNTech Comirnaty Original Monovalent 30 mcg per 0.3 mL dose Grey cap / label ≥ 12 years No diluent
6 months to 4 years of age (less than 5 years of age)
Not immunocompromised	May be offered	3 doses of 0.2 mL (3 mcg). At least 8 weeks apart. 6 months to 4 years.	no data	no data
Immunocompromised	May be offered Moderna preferred^{Table 1 Footnote a}	4 doses of 0.2 mL (3 mcg). 4 to 8 weeks apart. 6 months to 4 years.	no data	no data
5 years of age
Not immunocompromised	Should be offered Pfizer-BioNTech preferred^{Table 1 Footnote b}	no data	2 doses of 0.2 mL (10 mcg). At least 8 weeks apart. 5 to 11 years.	no data
Immunocompromised	Should be offered Pfizer-BioNTech preferred^{Table 1 Footnote b}; however Moderna may be considered due to potential benefit of inducing higher immune response and more durable protection^{Table 1 Footnote c}	no data	3 doses of 0.2 mL (10 mcg). 4 to 8 weeks apart. 5 to 11 years.	no data
6 to 11 years of age
Not immunocompromised	Should be offered Pfizer-BioNTech preferred^{Table 1 Footnote b}	no data	2 doses of 0.2 mL (10 mcg). At least 8 weeks apart. 5 to 11 years.	no data
Immunocompromised	Should be offered Pfizer-BioNTech preferred^{Table 1 Footnote b}; however Moderna may be considered due to potential benefit of inducing higher immune response and more durable protection^{Table 1 Footnote c}	no data	3 doses of 0.2 mL (10 mcg). 4 to 8 weeks apart. 5 to 11 years.	no data
12 to 17 years of age
Not immunocompromised	Should be offered Pfizer-BioNTech preferred^{Table 1 Footnote b}	no data	no data	2 doses of 0.3 mL (30 mcg). 8 weeks apart.
Immunocompromised	Should be offered Pfizer-BioNTech preferred^{Table 1 Footnote b}; however Moderna may be considered due to potential benefit of inducing higher immune response and more durable protection^{Table 1 Footnote c}	no data	no data	3 doses of 0.3 mL (30 mcg). 4 to 8 weeks apart.
18 years of age and over
Not immunocompromised	Should be offered Pfizer-BioNTech preferred for 18 to 29 years of age^{Table 1 Footnote b}	no data	no data	2 doses of 0.3 mL (30 mcg). 8 weeks apart.
Immunocompromised	Should be offered Pfizer-BioNTech preferred for 18 to 29 years of age^{Table 1 Footnote b}; however Moderna may be considered due to potential benefit of inducing higher immune response and more durable protection^{Table 1 Footnote c}	no data	no data	3 doses of 0.3 mL (30 mcg). 4 to 8 weeks apart.
Table 1 - Footnote a Moderna Spikevax is the preferred product for the primary series for children 6 months to less than 5 years of age who are moderately to severely immunocompromised as it is a 3-dose series as compared to 4-dose series with Pfizer-BioNTech Comirnaty. Return to Table 1 Footnote a referrer Table 1 - Footnote b Pfizer-BioNTech Comirnaty is the preferred product for the primary series in those 5 to 29 years of age because it has been shown to have a lower risk of myocarditis/pericarditis in adolescents and adults compared to Moderna Spikevax. Return to Table 1 Footnote b referrer Table 1 - Footnote c This consideration is based on data from adult populations (≥ 18 years of age) with original mRNA COVID-19 vaccines that suggests that Moderna Spikevax original (100 mcg) may result in higher vaccine effectiveness after a 2-dose primary series compared to Pfizer-BioNTech Comirnaty original (30 mcg) and is associated with a higher seroconversion rate among adult immunocompromised patients. Return to Table 1 Footnote c referrer

Moderna Spikevax and Novavax Nuvaxovid COVID-19 primary series
Primary series (age or health status)	NACI recommendations	Moderna Spikevax Original Monovalent 0.1 mg per mL dose Royal blue cap and purple label border 6 months to 11 years No diluent	Moderna Spikevax Original Monovalent 0.2 mg per mL dose Red cap and light blue label border ≥ 6 years No diluent	Novavax Nuvaxovid 5 mcg per 0.5 mL dose ≥ 12 years No diluent Only recommended if not able or willing to receive mRNA vaccine^{Table 2 Footnote a}
6 months to 4 years of age (less than 5 years of age)
Not immunocompromised	May be offered	2 doses of 0.25 mL (25 mcg). At least 8 weeks apart. 6 months to 5 years.	no data	no data
Immunocompromised	May be offered Moderna preferred^{Table 2 Footnote b}	3 doses of 0.25 mL (25 mcg). 4 to 8 weeks apart. 6 months to 5 years.	no data	no data
5 years of age
Not immunocompromised	Should be offered Pfizer-BioNTech preferred^{Table 2 Footnote c}	2 doses of 0.25 mL (25 mcg). At least 8 weeks apart. 6 months to 5 years.	no data	no data
Immunocompromised	Should be offered Pfizer-BioNTech preferred^{Table 2 Footnote c}; however Moderna may be considered due to potential benefit of inducing higher immune response and more durable protection^{Table 2 Footnote d}	3 doses of 0.25 mL (25 mcg). 4 to 8 weeks apart. 6 months to 5 years.	no data	no data
6 to 11 years of age
Not immunocompromised	Should be offered Pfizer-BioNTech preferred^{Table 2 Footnote c}	2 doses of 0.5 mL (50 mcg). At least 8 weeks apart. 6 to 11 years.	2 doses of 0.25 mL (50 mcg). At least 8 weeks apart. 6 to 11 years.	no data
Immunocompromised	Should be offered Pfizer-BioNTech preferred^{Table 2 Footnote c}; however Moderna may be considered due to potential benefit of inducing higher immune response and more durable protection^{Table 2 Footnote d}	3 doses of 0.5 mL (50 mcg). 4 to 8 weeks apart. 6 to 11 years.	3 doses of 0.25 mL (50 mcg). 4 to 8 weeks apart. 6 to 11 years.	no data
12 to 17 years of age
Not immunocompromised	Should be offered Pfizer-BioNTech preferred^{Table 2 Footnote c}	no data	2 doses of 0.5 mL (100 mcg). 8 weeks apart.	2 doses of 0.5 mL (5 mcg). 8 weeks apart. Not yet reviewed by NACI.
Immunocompromised	Should be offered Pfizer-BioNTech preferred^{Table 2 Footnote c}; however Moderna may be considered due to potential benefit of inducing higher immune response and more durable protection^{Table 2 Footnote d}	no data	3 doses of 0.5 mL (100 mcg). 4 to 8 weeks apart.	2 to 3 doses of 0.5 mL (5 mcg). 4 to 8 weeks apart. Not yet reviewed by NACI.
18 years of age and over
Not immunocompromised	Should be offered Pfizer-BioNTech preferred for 18 to 29 years of age^{Table 2 Footnote c}	no data	2 doses of 0.5 mL (100 mcg). 8 weeks apart.	2 doses of 0.5 mL (5 mcg). 8 weeks apart.
Immunocompromised	Should be offered Pfizer-BioNTech preferred for 18 to 29 years of age^{Table 2 Footnote c}; however Moderna may be considered due to potential benefit of inducing higher immune response and more durable protection^{Table 2 Footnote d}	no data	3 doses of 0.5 mL (100 mcg). 4 to 8 weeks apart.	2 to 3 doses of 0.5 mL (5 mcg). 4 to 8 weeks apart.
Table 2 - Footnote a The National Advisory Committee on Immunization (NACI) preferentially recommends mRNA vaccines due to their demonstrated high efficacy and effectiveness and favourable safety profile. Return to Table 2 Footnote a referrer Table 2 - Footnote b Moderna Spikevax is the preferred product for the primary series for children 6 months to less than 5 years of age who are moderately to severely immunocompromised as it is a 3-dose series as compared to 4-dose series with Pfizer-BioNTech Comirnaty. Return to Table 2 Footnote b referrer Table 2 - Footnote c Pfizer-BioNTech Comirnaty is the preferred product for the primary series in those 5 to 29 years of age because it has been shown to have a lower risk of myocarditis/pericarditis in adolescents and adults compared to Moderna Spikevax. Return to Table 2 Footnote c referrer Table 2 - Footnote d This consideration is based on data from adult populations (≥ 18 years of age) with original mRNA COVID-19 vaccines that suggests that Moderna Spikevax original (100 mcg) may result in higher vaccine effectiveness after a 2-dose primary series compared to Pfizer-BioNTech Comirnaty original (30 mcg) and is associated with a higher seroconversion rate among adult immunocompromised patients. Return to Table 2 Footnote d referrer

Booster doses

General notes for the booster dose:

For the booster dose, the recommended products are the mRNA bivalent formulations (containing mRNA encoding for the original strain and either Omicron BA.1 or BA.4/BA.5). The original products may be offered as a booster to those unwilling to receive a bivalent product but are not summarized here.
Booster doses are offered at least 6 months from the completion of the primary series, a previous booster dose or a COVID-19 infection, whichever is later.
More details can be found in the Canadian Immunization Guide based on the NACI recommendations.

Pfizer-BioNTech Comirnaty COVID-19 booster dose
Booster dose (age or risk status)	NACI recommendations	Pfizer-BioNTech Comirnaty Bivalent BA.4/BA.5 5 mcg of original and 5 mcg of Omicron BA.4/BA.5 per 0.2 mL dose Orange cap / label 5 to 11 years 1.3 mL of diluent	Pfizer-BioNTech Comirnaty Bivalent BA.4/BA.5 15 mcg of original and 15 mcg of Omicron BA.4/BA.5 per 0.3 mL dose Grey cap / label ≥ 12 years No diluent
6 months to 4 years of age (less than 5 years of age)
All	Not recommended No authorized product	no data	no data
5 years of age
Not at increased risk for severe disease^{Table 3 Footnote a}	May be offered one booster Only Pfizer-BioNTech is authorized	0.2 mL (5 mcg of original and 5 mcg of Omicron BA.4/BA.5). 5 to 11 years.	no data
At increased risk for severe disease^{Table 3 Footnote a}	Should be offered one booster^{Table 2 Footnote b} Only Pfizer-BioNTech is authorized	0.2 mL (5 mcg of original and 5 mcg of Omicron BA.4/BA.5). 5 to 11 years.	no data
6 to 11 years of age
Not at increased risk for severe disease^{Table 3 Footnote a}	May be offered one booster	0.2 mL (5 mcg of original and 5 mcg of Omicron BA.4/BA.5). 5 to 11 years.	no data
At increased risk for severe disease^{Table 3 Footnote a}	Should be offered one booster^{Table 2 Footnote b}	0.2 mL (5 mcg of original and 5 mcg of Omicron BA.4/BA.5). 5 to 11 years.	no data
12 to 17 years of age
Not at increased risk for severe disease^{Table 3 Footnote a}	If have not received a booster since the start of fall of 2022, a booster may be offered^{Table 2 Footnote c}	no data	0.3 mL (15 mcg of original and 15 mcg of Omicron BA.4/BA.5).
At increased risk for severe disease^{Table 3 Footnote a}	If have not received a booster since the start of fall of 2022, a booster should be offered^{Table 2 Footnote c}	no data	0.3 mL (15 mcg of original and 15 mcg of Omicron BA.4/BA.5).
18 to 64 years of age
Not at increased risk for severe disease^{Table 3 Footnote a}	Should be offered at least one booster. In addition, if previously received a booster, may be offered a booster if one has not yet been received since the start of fall of 2022^{Table 2 Footnote c}.	no data	0.3 mL (15 mcg of original and 15 mcg of Omicron BA.4/BA.5).
At increased risk for severe disease^{Table 3 Footnote a}	If have not received a booster since the start of fall of 2022, a booster should be offered^{Table 2 Footnote c}. In addition, those who are moderately to severely immunocompromised may also be offered a booster starting in the spring 2023.	no data	0.3 mL (15 mcg of original and 15 mcg of Omicron BA.4/BA.5).
65 years of age and over
All	If have not received a booster since the start of fall of 2022, a booster should be offered^{Table 2 Footnote c}. In addition, may also be offered a booster starting in the spring 2023.	no data	0.3 mL (15 mcg of original and 15 mcg of Omicron BA.4/BA.5).
Table 3 - Footnote a Those at increased risk for severe disease include those with underlying medical conditions (including those who are moderately to severely immunocompromised), and racialized and marginalized populations who have been disproportionately affected due to a number of intersecting equity factors. Other groups considered at increased risk are identified in the Interim guidance on planning considerations for a fall 2022 COVID-19 vaccine booster program in Canada. Return to Table 3 Footnote a referrer Table 3 - Footnote b Children 5 to 11 years of age who already received a booster dose with an original COVID-19 mRNA vaccine are not recommended to receive a bivalent Omicron-containing booster. However, at the provider's discretion, a bivalent booster dose (as per recommended interval) could be offered to children considered at high risk of severe COVID-19 who have previously received a booster dose with the original Pfizer-BioNTech Comirnaty mRNA vaccine. Return to Table 3 Footnote b referrer Table 3 - Footnote c The start of the fall 2022 booster program varied across Canadian jurisdictions from August to September 2022. If a booster dose has not been received since the start of fall 2022, it should or may be offered as per the recommended interval, as per the recommendation above. Return to Table 3 Footnote c referrer

Moderna Spikevax and Novavax Nuvaxovid COVID-19 booster dose
Booster dose (age or risk status)	NACI recommendations	Moderna Spikevax Bivalent BA.1 0.1 mg per mL 25 mcg of original and 25 mcg of Omicron BA.1 per 0.5 mL dose Royal blue cap and green label border ≥ 6 years No diluent	Moderna Spikevax Bivalent BA.4/BA.5 0.1 mg per mL 25 mcg of original and 25 mcg of Omicron BA.4/BA.5 per 0.5 mL dose Royal blue cap and grey label border ≥ 18 years No diluent	Novavax Nuvaxovid 5 mcg per 0.5 mL dose ≥ 18 years No diluent Only recommended if not able or willing to receive mRNA vaccine^{Table 4 Footnote a}
6 months to 4 years of age (less than 5 years of age)
All	Not recommended No authorized product	no data	no data	no data
5 years of age
Not at increased risk for severe disease^{Table 4 Footnote b}	May be offered one booster Only Pfizer-BioNTech is authorized	no data	no data	no data
At increased risk for severe disease^{Table 4 Footnote b}	Should be offered one booster^{Table 4 Footnote c} Only Pfizer-BioNTech is authorized	no data	no data	no data
6 to 11 years of age
Not at increased risk for severe disease^{Table 4 Footnote b}	May be offered one booster	0.25 mL (12.5 mcg of original and 12.5 mcg of Omicron BA.1). 6 to 11 years.	no data	no data
At increased risk for severe disease^{Table 4 Footnote b}	Should be offered one booster^{Table 4 Footnote c}	0.25 mL (12.5 mcg of original and 12.5 mcg of Omicron BA.1). 6 to 11 years.	no data	no data
12 to 17 years of age
Not at increased risk for severe disease^{Table 4 Footnote b}	If have not received a booster since the start of fall of 2022, a booster may be offered^{Table 4 Footnote d}	0.5 mL (25 mcg of original and 25 mcg of Omicron BA.1).	no data	no data
At increased risk for severe disease^{Table 4 Footnote b}	If have not received a booster since the start of fall of 2022, a booster should be offered^{Table 4 Footnote d}	0.5 mL (25 mcg of original and 25 mcg of Omicron BA.1).	0.5 mL (25 mcg of original and 25 mcg of Omicron BA.4/BA.5). Off label^{Table 4 Footnote e}.	no data
18 to 64 years of age
Not at increased risk for severe disease^{Table 4 Footnote b}	Should be offered at least one booster. In addition, if previously received a booster, may be offered a booster if one has not yet been received since the start of fall of 2022^{Table 4 Footnote d}.	0.5 mL (25 mcg of original and 25 mcg of Omicron BA.1).	0.5 mL (25 mcg of original and 25 mcg of Omicron BA.4/BA.5).	0.5 mL (5 mcg). Not yet reviewed by NACI.
At increased risk for severe disease^{Table 4 Footnote b}	If have not received a booster since the start of fall of 2022, a booster should be offered^{Table 4 Footnote d}. In addition, those who are moderately to severely immunocompromised may also be offered a booster starting in the spring 2023.	0.5 mL (25 mcg of original and 25 mcg of Omicron BA.1).	0.5 mL (25 mcg of original and 25 mcg of Omicron BA.4/BA.5).	0.5 mL (5 mcg). Not yet reviewed by NACI.
65 years of age and over
All	If have not received a booster since the start of fall of 2022, a booster should be offered^{Table 4 Footnote d}. In addition, may also be offered a booster starting in the spring 2023.	0.5 mL (25 mcg of original and 25 mcg of Omicron BA.1).	0.5 mL (25 mcg of original and 25 mcg of Omicron BA.4/BA.5).	0.5 mL (5 mcg). Not yet reviewed by NACI.
Table 4 - Footnote a The National Advisory Committee on Immunization (NACI) preferentially recommends mRNA vaccines due to their demonstrated high efficacy and effectiveness and favourable safety profile. Return to Table 4 Footnote a referrer Table 4 - Footnote b Those at increased risk for severe disease include those with underlying medical conditions (including those who are moderately to severely immunocompromised), and racialized and marginalized populations who have been disproportionately affected due to a number of intersecting equity factors. Other groups considered at increased risk are identified in the Interim guidance on planning considerations for a fall 2022 COVID-19 vaccine booster program in Canada. Return to Table 4 Footnote b referrer Table 4 - Footnote c Children 5 to 11 years of age who already received a booster dose with an original COVID-19 mRNA vaccine are not recommended to receive a bivalent Omicron-containing booster. However, at the provider's discretion, a bivalent booster dose (as per recommended interval) could be offered to children considered at high risk of severe COVID-19 who have previously received a booster dose with the original Pfizer-BioNTech Comirnaty mRNA vaccine. Return to Table 4 Footnote c referrer Table 4 - Footnote d The start of the fall 2022 booster program varied across Canadian jurisdictions from August to September 2022. If a booster dose has not been received since the start of fall 2022, it should or may be offered as per the recommended interval, as per the recommendation above. Return to Table 4 Footnote d referrer Table 4 - Footnote e Moderna Spikevax bivalent BA.4/BA.5 is off label for 12 to 17 years of age but may be considered for those who are moderately to severely immunocompromised as Moderna Spikevax original (50 mcg) as booster may have somewhat higher vaccine effectiveness compared to Pfizer-BioNTech Comirnaty original (30 mcg) as a booster based on a study in adults conducted during the Delta and early Omicron periods. Return to Table 4 Footnote e referrer

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Date modified:: 2023-03-06

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Planning guidance for immunization clinics for COVID-19 vaccines: Recommended schedules by age, health status and product

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