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Toronto Public Health's Physician e-Newsletter

October 9, 2020

From:
Dr. Eileen de Villa
Medical Officer of Health
Toronto Public Health

In this issue:

  • NEW: TPH Updates COVID-19 Community Case and Contact Management Process
  • UPDATE: Flu Vaccine Delivery for Toronto Providers
  • REMINDER: High-dose TIV Preferred for Adults 65+
  • REMINDER: QIV for pregnant patients
  • UPDATE: PHO Respiratory Virus Testing Update
  • NEW: Publicly Funded Shingles Vaccine Changing to Shingrix®
  • UPDATE: Ministry of Health COVID-19 Guidelines
  • UPDATE: COVID-19 Screening Guidance for Schools and Child Care
  • NEW: COVID-19 Back to School Confirmation Form

Key Points

  1. To focus on the highest risk scenarios, Toronto Public Health (TPH) is implementing a temporary strategic re-prioritization of community case and contact management. More information
  2. Toronto providers will receive their first auto-shipment of flu vaccines between October 5 and 19. More information.
  3. TPH would like to remind health care providers that high-dose TIV is the preferential vaccine for adults 65 years and older without contraindications. More information.
  4. TPH would like to remind health care providers that pregnant patients can receive any QIV vaccine as long as there are no contraindications. More information.
  5. Public Health Ontario published the October 2020 Labstract: Respiratory Virus Testing Update. More information.
  6. Beginning mid-October, Ontario's publicly funded shingles program will change vaccine to Shingrix®. More information.
  7. The Ministry of Health has updated COVID-19 guidance documents. More information.
  8. In consultation with the Chief Medical Officer of Health, the Ontario government updated the COVID-19 school and child care screening guidance. More information.
  9. Toronto health care providers may wish to share the new Back to School Confirmation Form with patients. More information.

NEW: TPH Updates COVID-19 Community Case and Contact Management Process


To focus on the highest risk scenarios, Toronto Public Health (TPH) has implemented a temporary strategic re-prioritization of community case and contact management. 
  • TPH’s primary focus at this time is to continue to contact people with laboratory-confirmed COVID-19. 
  • TPH intends to return to their previous protocols for case and contact management once additional public health measures are able to drive case counts down.
TPH will continue to contact people diagnosed with COVID-19 to:
  • Confirm their positive COVID-19 lab test results;
  • Assess their signs and symptoms, and determine symptom onset;
  • Assess and confirm the person's ability to safely self-isolate, and make a referral to the Toronto Voluntary Isolation Centre if they cannot isolate safely at home; and
  • Provide instructions to the person to notify their close contacts.
TPH will not be collecting or referring high-risk close contacts to other public health departments, or following up with contacts from other local public health departments, at this time.

UPDATE: Flu Vaccine Delivery for Toronto Providers


Toronto providers will receive their first auto-shipment of flu vaccines between October 5 and 19.
  • Vaccine will be shipped on your regular scheduled delivery day.
  • It takes OGPMSS approximately 2 weeks to distribute vaccine orders across Toronto to all participating healthcare providers.
  • If you did not receive the vaccine this week, it will arrive next week.
  • Plan larger clinics for after the week of October 26, 2020.
Ordering Additional Vaccine:
  • Once the first shipment has been received, additional flu vaccine orders can be placed after October 19th for delivery on the week of October 26th.
  • Please do not submit your second order before October 19th as you will be asked to re-submit your order again.
Flu Vaccine Pick Up from OGPMSS:
  • Toronto providers can pick up their flu vaccine orders at OGPMSS, BY APPOINTMENT ONLY.
    • Ensure your vaccine order is submitted before the weekly cut-off date
    • Schedule an appointment with OGPMSS, at least two days before pick-up
    • Schedule your pick-up at least one day before your regular delivery date
    • Pick-up times are between 10 am to 12 noon; or 1 pm to 3 pm
    • You must have your cooler and requisition number ready for pick-up
    • Follow COVID-19 guidelines, screening and wear a mask
For more information on vaccine orders or pick-up, please call 416-327-0837 or email OGPMSS@ontario.ca.

More Information:

REMINDER: High-dose TIV Preferred for Adults 65+

TPH would like to remind health care providers that high dose trivalent inactivated influenza vaccine (HD TIV) is the preferential vaccine for adults 65 years and older without contraindications, for the following reasons:

  • Older adults have a higher burden of illness from influenza A(H3N2) and the high-dose vaccine provides a better effectiveness against A(H3N2) than the standard dose vaccine
  • Stronger protection against the A(H3N2) strain in the vaccine is more beneficial for older adults compared to getting two B-strains in a quadrivalent inactivated influenza vaccine (QIV)
  • There may also be some cross protection against B lineages in the trivalent inactivated influenza vaccine, so HD TIV may afford some protection against the B lineage not included in that vaccine
  • Don't delay an opportunity to vaccinate – if HD TIV is not available, provide the standard dose QIV to older adults

Back to Key Points

REMINDER: QIV for pregnant patients


TPH would like to remind health care providers that pregnant patients can receive any quadrivalent inactivated influenza (QIV) vaccine as long as there are no contraindications.

NACI recommends inactivated influenza vaccine in every pregnancy due to increased risk for severe illness from the flu.

UPDATE: PHO Respiratory Virus Testing Update

Public Health Ontario published the October 2020 Labstract: Respiratory Virus Testing Update.

New this year:

  • On November 2, 2020 PHO’s laboratory will implement a new laboratory developed multiplex respiratory virus PCR panel, “FLUVID”, consisting of targets for influenza A, influenza B, SARS-CoV-2, and respiratory syncytial virus (A + B).
  • See the Labstract for a summary of eligibility criteria for respiratory virus testing available at PHO’s laboratory by patient setting and outbreak status. 

Back to Key Points

NEW: Publicly Funded Shingles Vaccine Changing to Shingrix®

Beginning mid-October, Ontario's publicly funded shingles program will change vaccine to Shingrix®.

  • Current supplies of publicly funded live attenuated zoster vaccine (LZV) (Zostavax®II) expire in October 2020.
  • Recombinant Zoster Vaccine (RZV) (Shingrix®) is safe and effective for the prevention of shingles and its complications. The RZV efficacy remains higher and appears to decline more slowly, in all age groups, compared with LZV.

NACI recommends:

  • Adults who were previously vaccinated with LZV should re-vaccinate with two doses of RZV at least one year after receiving LZV.
  • For individuals with a previous episode of herpes zoster disease: provide two doses of RZV at least one year after herpes zoster episode.
  • RZV may be considered for immunocompromised individuals, on a case-by-case assessment of the benefits vs risks.

For more information, including details regarding when RZV is publicly funded and for whom, see TPH's Vaccine Alert.

Back to Key Points

UPDATE: Ministry of Health COVID-19 Guidelines


The Ministry of Health has recently updated the following COVID-19 guidance documents:
  • COVID-19 Provincial Testing Guidance Update (September 24, 2020)
    • Significant change includes: Low risk, asymptomatic individuals should not be considered for testing.
    • NOTE: for details on who should be tested at a COVID-19 Assessment Centre vs a Pharmacy, see TPH's COVID-19 Testing Webpage
  • Quick Reference Public Health Guidance on Testing and Clearance (October 1, 2020)
    • Significant change includes moving from a 14-day clearance period for all COVID-19 cases, to a 10-day clearance period for cases with mild to moderate illness and a 20-day clearance period for cases with severe illness (requiring ICU-level support) or with immune compromise (see Approaches to Clearing Cases in the document).
    • Contacts who have had a high-risk exposure to a case must self-isolate for 14 days from their last exposure.

UPDATE: COVID-19 Screening Guidance for Schools and Child Care

In consultation with the Chief Medical Officer of Health, the Ontario government updated the COVID-19 school and child care screening guidance. This additional information will help parents determine when it is most appropriate for students, children and their families to seek a test for COVID-19.

In addition, TPH developed Follow up Instructions for School Students, Staff and Visitors Tested for COVID-19 which includes details regarding when to return to school after a COVID-19 test and corresponding guidance for household members.

Back to Key Points

NEW: COVID-19 Back to School Confirmation Form

As outlined in the September 23rd Communique article: School Reopening Guidance for Toronto Health Care Providers:

  • Health care providers should avoid providing notes or statements attesting to a clinical assessment that COVID-19 has been “ruled out” as a cause of colds or respiratory symptoms, if a COVID-19 test was not completed.
  • Medical notes or proof of negative tests are not required for staff or students to return to school following an illness or a high-risk contact.
Toronto health care providers may wish to share the new Back to School Confirmation Form with patients.
  • This form is for parents to complete to confirm that their child is healthy and able to return to school.
  • NOTE: TPH has shared this form with Toronto school boards, however, some schools may be following their own processes for return to school.
Toronto Public Health | 416.338.7600 | toronto.ca/health
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Contact Information

To give us your comments: healthprofessionals@toronto.ca

To report communicable diseases:
Communicable Disease Surveillance Unit,
277 Victoria St., 10th Floor, Toronto, ON  M5B 1W2
Phone: 416-392-7411, After hours: 311,
Fax: 416-392-0047

To order Hepatitis A or B vaccines for high risk clients: 416-338-7790

To report vaccine adverse events: 416-338-2030

For information about STIs or to order medications for treatment: 416-338-2373

For information about TB or to order medications for treatment: 416-338-7600

Communique Editors: Dr. Christine Navarro, Dr. Irene Armstrong

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