Health Canada has approved Moderna’s bivalent COVID-19 vaccine, which includes the original vaccine and protection against the Omicron BA.1 variant. This is the same booster authorized a few weeks ago in the U.K.
A limited initial shipment of doses should arrive in Manitoba next week, followed by more throughout September. Canada is expecting more than 10 million doses before the end of this month.
Public Health guidance is expected soon on this new booster option. In the meantime, we know the following from Health Canada’s regulatory decision and NACI’s updated recommendations:
The 50 microgram dose of the bivalent vaccine should be offered to individuals 18 years of age and older. If a bivalent vaccine is not available, an original mRNA booster should be offered to ensure timely protection.
For those 12 – 17 years of age who are moderately to severely immuno-compromised or who are at high risk of severe outcomes due to biological or social factors, they may be offered a bivalent vaccine booster “off-label.”
The evidence suggests that both the original and bivalent mRNA vaccines are effective as a booster to prevent severe disease.
NACI continues to recommend an additional booster this fall regardless of the number of previous boosters to all adults age 65+ and also all those age 12 – 65 who are at increases risk for severe disease. All others age 12 – 64 may also be offered an additional booster this fall too.
Pfizer’s BA.1 bivalent booster is still under review by Health Canada.
What about BA.4 and BA.5
BA.1 is no longer the most common variant circulating in Canada, but the Moderna booster approved today targets BA.1.
Earlier this week, the U.S. FDA authorized boosters that target BA.4 and BA.5. The CDC will review the evidence and recommend eligibility and prioritization. The FDA was able to “fast track” approvals for these variants based on animal tests alone rather than waiting for human studies.
Health Canada is expecting submissions from Pfizer and Moderna in the next few weeks for a BA.4 and BA.5 bivalent booster.
In the meantime, it is important to note that existing evidence suggests “a second booster with Spikevax (BA.1) Bivalent would provide a superior neutralizing antibody response against BA.4/5 compared to a second booster with Spikevax Original.”
What to do right now?
NACI recommends not waiting for a bivalent booster for those at higher risk who are eligible now for their first or second booster. “Individuals choosing to delay a booster dose in anticipation of a new vaccine should carefully consider their individual risk.”
Earlier this summer, Manitoba Public Health offered guidance for physicians in counselling patients about boosters, recommending those eligible for their first booster should proceed without delay. For those considering a second booster, the advice was to help patients weight the benefits and risks, including the potential to delay being eligible for a bivalent vaccine this fall.
We anticipate new guidance for physicians and your patients on this very soon.
Severe outcomes from COVID-19 increased compared to the previous week. There were 67 hospital admissions, up from 60 the week before. This includes 9ICU admissions, up from 8 the previous week. Weekly hospital admissions last peaked at 264 in the week ending April 16.
There were 6 deaths recorded, down from 9 the previous week. There have now been 2,115 deaths related to COVID-19.
There were 622 lab-confirmed cases reported in Manitoba over the last week, the highest number since mid-May and up significantly from 473 the previous week. The test positivity rate was 22.1%, down from 23.9 %.
Join us on September 27 for an exclusive webinar with Dr. Brent Roussin, Manitoba’s Chief Provincial Public Health Officer, for an update about COVID-19 and influenza this fall and winter. The event will be hosted by Doctors Manitoba President Dr. Candace Bradshaw.
Dr. Roussin will provide a briefing for physicians about public health’s monitoring and what to expect, how vaccines and other measures will be used this season to mitigate the risks, and advice for physicians to use in their practice. The webinar will also include a Q&A. You can submit your questions in advance, or ask them live during the webinar.
Earlier this week, we learned that health support workers represented by CUPE have reached a new tentative agreement with the health system, after being without a contract since 2017. We have heard from many physicians worried about health support workers’ well-being and vacancies, and we hope a new contract will help to address these concerns.
We also want all members to know our team have been monitoring this and all other public sector negotiations very closely as we prepare to negotiate the next Master Agreement, as the current Agreement expires in March 2023. The new CUPE contract, like other recently-settled public sector contracts for nurses and other workers, provides an average increase of about 1.4% per year.
Perhaps more significantly, we continuously monitor and evaluate physician remuneration and benefits in other provinces, which provides a benchmark that has proven to be the most important in ensuring physicians here in Manitoba are fairly and competitively remunerated. We’re also reviewing other factors, such as addressing the physician shortage, supporting a pandemic recovery, and the various economic pressures that are relevant in medical care. See this recent update from our President, Dr. Candace Bradshaw, about our preparations for negotiating your next Master Agreement.
Stay tuned for further updates this fall.
Physician Views Needed about H. Pylori
You are invited to share your views about testing and treatment for Helicobacter Pylori (H. Pylori).
A study led by Manitoba physicians Dr. Charles Bernstein, Dr. Seth Shaffer and Dr. Alexander Singer is exploring physicians’ current approaches to testing and treatment of H. pylori. The investigators are part of a larger team exploring the developing of metagenomics to determine H. pylori antibiotic resistance profiles.
No personal or identifying information will be collected and all information will be collated; no responses will be attributed to any one individual.
If you would like to complete the survey and/or have more information, please click here. The survey should take about 10 minutes to complete.
Health System Updates
Monkey Pox Update
As of August 29, Manitoba Health will be expanding eligibility to include pre-exposure prophylaxis for Manitobans who meet the specific eligibility criteria. Vaccination used for pre-exposure prophylaxis may help prevent the onset of the disease or make it less severe. At this time, due to the limited national and global vaccine supply, pre-exposure prophylaxis will consist of a single dose of vaccine. Post-exposure prophylaxis continues to be available for close contacts of a confirmed or probable monkeypox case. Individuals who have already received a dose of Imvamune for pre-exposure prophylaxis may be eligible for a second dose as post-exposure prophylaxis as determined in consultation with public health. To review eligibility criteria and learn how to book click here.
Poliovirus Prevention, Management and Control
In light of the recent case of polio in an unvaccinated adult in New York, Manitoba Health is reminding clinicians to be alert for all cases of poliovirus and acute flaccid paralysis (AFP), particularly if the individual:
Is unvaccinated or under-vaccinated against poliovirus;
Has recent travel in countries with ongoing polio transmission or in locations where cases have been recently reported and identified as a risk for further cases (e.g., Rockland County);
Was exposed to a person who travelled/resided in any of these areas.
The provincial polio protocol (updated in August 2019) provides information on the prevention, management and control of polio, with information on testing, treatment and case/contact management. You can find it here.
Ensure your patients are up to date on their polio (IPV) immunizations. The recommended immunization schedule for children previously unimmunized can be found here. Find NACI’s recommendations for adult immunization here. Find out more here.
First Nations people living off reserve (21%) were more likely than non-Indigenous people (15%) to report an unmet need for such services in the first year of the pandemic.
Almost half of First Nations people living off reserve (43%), Métis (42%) and Inuit (43%) who required health care services in the past year experienced problems with scheduling appointments. In comparison, 37% of non-Indigenous people experienced such problems.
Indigenous people report a lack of health services in their area and discrimination by health care professionals during the pandemic.