Respiratory Illness: Tools and Resources for Doctors

Updated respiratory illness resources:

• Clinical Updates for Family Physicians (OCFP PDF, updated October 2024)
• Common Respiratory Illnesses in Children: Tip Sheet for Family Doctors (OCFP PDF, updated October 2024)
• Screening tool (PDF) to help front office identify patients at high risk for serious illness/outcomes from respiratory illness (OCFP, updated October 2024)
• Ontario Respiratory Virus Tool (external link) – epidemiological information on virus activity, including COVID-19, flu, RSV and other respiratory viruses (PHO)

Updates on vaccination, testing and treatment:

Vaccines

• The updated COVID-19 vaccine is available widely.

• Age indications for vaccines: Moderna (Spikevax) vaccine for ages six months and older; Pfizer (Comirnaty) for ages 12 years and older.
  • No preference between vaccines for ages 12+.
  • The vaccine may be given at the same time, or at any time before or after any other vaccine.
  • Unless contraindicated, previously vaccinated individuals can receive a dose if it has been at least three months since their last dose. Note that children younger than four with no previous COVID-19 vaccine may require a two-dose series.
  • One’s history of COVID-19 infection does not affect when to get vaccinated, (i.e., same principle as for flu and other vaccines).
• Vaccination available primarily at participating pharmacies (external link) and public health units (PHUs). If you are vaccinating, continue to order vaccines from your local PHU.

Testing

• Test to treat – publicly funded testing is available for those eligible for treatment (i.e., at higher risk of severe illness)
  • They are, in general:
    • 65 years of age or older;
    • 18 years of age or older and immunocompromised;
    • living in some high-risk or congregate settings;
• Continue to order rapid antigen tests (RATs) via the PPE Supply Portal to provide to eligible patients.
• PCR tests may be requested for eligible patients through Public Health Ontario.
• Patients may also access testing, including PCR for eligible patients, via participating community pharmacies and some local Public Health Units.

Treatment

• Use clinical discretion in prescribing antiviral medications.
• Consider treatment with Paxlovid (first-line therapy) or, if contraindicated/not feasible, with remdesivir; usually treatment must begin within 5-7 days of symptoms starting or a positive test result.
• Paxlovid is covered under the Ontario Drug Benefit plan for eligible patients and may also be covered by private insurance plans.
• Advise patients with Paxlovid prescription to reach out to their community pharmacy about availability.

Resources:

• Recommendations for Antiviral Therapy for Adults with Mild to Moderate COVID-19 (PDF), including treatment algorithm (Ontario Health, April 2024)
• COVID-19 testing and treatment (MOH External link) | Find COVID-19 PCR testing locations (External link)
• COVID-19 vaccine – find participating Ontario pharmacies (External link)
• PPE supply portal for healthcare providers (External link – register for Provincial Antigen Testing Program to sign in)
• PCR test requisition form (PHO PDF, August 2024)
• Access to remdesivir in the community,(PDF) including downloadable referral form (Ontario Health atHome, June 2024)

Highlights of Ontario’s RSV program:

• Publicly funded prevention programs are focused on infants and high-risk adults aged 60 years or older.
  • Monoclonal antibody Beyfortus® is recommended for universal immunization of newborns and high-risk infants up to 24 months old.
  • Infants born during RSV season (November 2024-April 2025) are to be immunized before hospital discharge; infants born in 2024 out of RSV season or outside hospital may be immunized in primary care, hospital clinics, or through local Public Heath Units.
  • High-risk older adults (including residents of any retirement home aged 60+) are eligible to receive the Abrysvo® or Arexvy® vaccine. Studies show multi-year protection from vaccination – those who received a dose last RSV season do not require a dose this season.
  • Counsel pregnant individuals about the effectiveness of Beyfortus® in prevention – Abrysvo® may be offered in pregnancy if Beyfortus® is declined.
• RSV immunization may be given at the same time or at any time before or after other vaccines.
• Order Beyfortus® through your local Public Health Unit. Timelines for availability of 100 mg infant doses may vary.

Resources:

• Summary of RSV prevention programs (PDF) including eligibility, products and dosing (OCFP, September 2024)
• Summary of the RSV immunization program (external link), including billing information (OMA)
• 2024-2025 RSV Prevention Program for infants in Ontario (external link), including sample script for a letter to patients (CEP, September 2024)
• Provider factsheet: Protecting Infants and High-Risk Children during RSV Season (Provincial Council for Maternal and Child Health PDF, 2024)
• Older Adult High-Risk Respiratory Syncytial Virus (RSV) Vaccine Program Fact Sheet – Vaccine Recipients (MOH PDF, August 2024)

Key Updates:

• Individuals aged six months and older who have no contraindications or precautions can receive any age-appropriate quadrivalent or trivalent vaccine.
• For children, there is no preference for quadrivalent over trivalent flu vaccine formulations (new NACI recommendation– external link).
• Adults aged 65+ should get an enhanced flu vaccine – high-dose or adjuvanted are considered equivalent. If not available, offer any available age-appropriate vaccine.
• Children six months to nine years old who have not previously received a seasonal flu vaccine should receive two doses, at least four weeks apart.

Resources:

• 2024-25 Universal Influenza Immunization Program (MOH external link)
• Health Care Provider Fact Sheet: Influenza Immunization for Individuals 6 months to 64 years of age (MOH PDF, September 2024)
• Health Care Provider Fact Sheet: Influenza Immunization for Individuals ≥65 years of age (MOH PDF, September 2024)
• Antiviral Medications for Seasonal Influenza in 2024-25: Public Health Considerations (PHO PDF, September 2024)

Brief summary of changes to Pneumococcal Vaccine program:

• Pneu-C-15 (Vaxneuvance®) and Pneu-C-20 (Prevnar 20®) vaccines have replaced Pneu-C-13 (Prevnar 13®) and Pneu-P-23 (Pneumovax®)
• PCV-15 is recommended for low-risk children, and PCV-20 is recommended for all other eligible populations (high-risk children, high-risk adults and adults over 65).
• There are no changes to eligibility and dosing schedule; individuals with completed vaccine series are not part of the product transition.

Resources:

• Changes to Ontario’s Publicly Funded Pneumococcal Vaccine Program(PDF), including timing and age cohorts (OCFP, August 2024)

Key information:

• High number of cases in 2024 may be attributed to waning immunity/missed doses.
• Tdap doses at:
  • ages two, four and six months.
  • ages four years and 14 years.
  • every pregnancy, one dose ideally between 27 and 32 weeks of gestation.

Resources:

• Publicly funded Immunization Schedules for Ontario (MOH PDF, June 2022)
• DFCM-OCFP Community of Practice sessions:
  • Sept. 6, 2024 (external link – discussion starts at 36:34); Preparing for Fall and Practice Management
  • Sept. 20, 2024 (external link – discussion starts at 46:47) Managing Respiratory Illness in Kids & COPD

Key information:

• Masking policies are set by individual practices – continue to take steps needed to minimize transmission risk.
• Continue to order PPE from the PPE Supply Portal. (External link)

Resources:

• Safely providing in-person care for community-based practices (a summary of PHO comprehensive guidance, OMA PDF, August 2024)
• Printable office signs (PDF) to encourage masking in clinic (OCFP)

Resources to share with patients:

• Family Doctor Tips on Caring for Children with Respiratory Symptoms (OCFP PDF, updated October 2024)
• If You Get Sick: Managing Colds, Flus, RSV and COVID-19 (OCFP PDF, updated October 2024)
• Protection from COVID‑19 and other respiratory illnesses (Ministry of Health external link)