The Dalglish Family 22q Clinic

Our Clinic recommends that all individuals with 22q as well as their family members receive all the vaccine doses (including boosters) for which they are eligible.

1. All individuals with 22q should receive the vaccine - the three doses protect very well against the worst effects of the virus.
   • All individuals in Ontario aged 60 and over can receive their fourth dose. The recommended interval is 5 months (140 days) after the third dose, but the interval can be as short as three months (84 days).
   • All individuals in Ontario aged 18 and over can receive their third dose at least 3 months (84 days) after their second dose.
   • All individuals aged 12 to 17 can receive their third dose at least 6 months (168 days) after their second dose. This interval may be associated with a lower risk of myocarditis with or without pericarditis. With informed consent, individuals 12-17 years of age may receive a booster dose at a minimum of 3 months (84 days) after completion of a primary COVID-19 vaccine series.
   • Residents in long term care homes can receive their fourth dose at least 3 months (84 days) after their third dose.
   • See the Government of Ontario’s webpage on booster doses
2. Individuals with moderate to severe primary immunodeficiency should receive additional doses:
   • Third dose (as part of an “extended primary series”) at least 8 weeks (56 days) after the second dose.
   • Fourth dose (booster):
     • At least 3 months (84 days) after the third dose for individuals 18 years and older
     • At least 6 months (168 days) after the third dose for individuals 12 to 17 years old
   • Eligible individuals will need to provide their prescription, prescription vial or a referral from a health care professional at the time of their appointment.
   • See the Government of Ontario’s webpage on booster doses
3. All close contacts (e.g., immediate family members) of individuals with 22q should also receive the vaccine, in order to protect the person in the family likely to be most in danger of getting very sick from the virus (that is, the person with 22q).
   • All essential care partners must show their proof of vaccination against COVID-19 when they enter the Toronto General Hospital and other UHN sites.
4. Individuals who have recovered from a COVID-19 infection should still receive the COVID-19 vaccine.
   • Based on data from Kentucky, USA, if you remain unvaccinated, you are more than twice as likely as fully vaccinated people to get COVID-19 again.
   • Based on data from February 6^th, 2022 in Ontario, unvaccinated individuals are 2.5 times more likely to catch COVID-19, 6 times more likely to need to be hospitalized, and over 12 times more likely to end up in the ICU due to COVID-19 compared to fully vaccinated people.
5. Women who are breastfeeding, or planning a pregnancy should get the COVID-19 vaccines.
   • Data
     • Canadian data have shown that those who get COVID-19 while pregnant have a higher chance of needing a C-section or having a preterm birth. Pregnant women who get COVID-19 are also more likely to be admitted to an ICU than women who are not pregnant.
     • A study by CDC in US (and reported by CBC) showed that there is no link between COVID-19 vaccination and preterm delivery or underweight newborns
   • More information
     • COVID-19 Vaccines for women who are pregnant, breastfeeding or planning a pregnancy
     • I am pregnant or breastfeeding. Should I get the COVID-19 vaccine?
6. People who experienced severe, immediate allergic reactions after a first dose of COVID-19 can safely receive future doses after consulting with an appropriate physician, and that the optimal interval between COVID-19 mRNA vaccines appears to be 8 weeks.

Please note that there are very few acceptable medical exemptions to the COVID-19 vaccination.

For more information and to book your vaccination appointment, please visit the Ontario Government’s Getting the COVID-19 vaccine page.

All the COVID-19 vaccines approved by Health Canada give excellent protection against the COVID-19 disease. None of them contain any live virus. They cannot cause disease. So they are safe for people with immune deficiencies, just as they are for everyone else in the general population. Even for people who don’t make antibodies very well, the vaccine will help protect against the COVID-19 disease.

If you have any concerns, please check with your doctor. You can also call the VaxFacts Clinic of the Scarborough Health Network to book a phone appointment. VaxFacts is an opportunity for a one-to-one, judgement-free phone call with a physician, to address any questions or concerns about the COVID-19 vaccines. They have successfully counselled hundreds of patients in the past couple of months and have now opened up to all of Canada.

More Information about COVID 19 Vaccines

Everyone

To book your vaccination appointment, please visit the Ontario Government’s Getting the COVID-19 vaccine page. You can see our tip sheet for more information.

Toronto’s City Immunization Clinics accept walk-in visits for COVID-19 vaccinations, while continuing with booked appointments.

You can also get your vaccine at a GO-VAXX mobile vaccine clinic, which are modified from GO buses. Please check their schedule to see when these clinics will come to your community.

Individuals with anxiety or needle phobia

The Centre for Addiction and Mental Health (CAMH) in Toronto offers a vaccination clinic that can accommodate their needs on specific days. If you have needle anxiety or a fear of needles and would like accommodations during your appointment, please do not schedule through their booking site and email them instead to schedule your appointment.

Individuals who had a COVID-19 infection

• Any vaccinated Canadian who got a COVID-19 infection should wait 3 months before getting a COVID-19 booster shot.
• Those who had a COVID-19 infection before starting or completing their primary COVID-19 vaccine series may receive their next dose 8 weeks after symptoms started or after testing positive.
• See the CBC article for more information.

Individuals with moderate to severe primary immunodeficiency

Government recommendations for the third dose uses the term “DiGeorge syndrome”, which is an older name for 22q11.2 deletion syndrome (22q).

• Individuals with moderate to severe primary immunodeficiency should receive additional doses:
  • Third dose (as part of an “extended primary series”) at least 8 weeks (56 days) after the second dose.
  • Fourth dose (booster):
    • At least 3 months (84 days) after the third dose for individuals 18 years and older
    • At least 6 months (168 days) after the third dose for individuals 12 to 17 years old
• Eligible individuals will need to provide their prescription, prescription vial, or a referral from a health care professional at the time of their appointment.
• See the Government of Ontario’s webpage on booster doses

Individuals who have received some vaccine doses outside of Ontario

Please see the Government of Ontario’s COVID-19 Guidance for Individuals Vaccinated outside of Ontario/Canada.

Additional Notes

If you need help booking a vaccination appointment, please call us at (416) 340-5145 or email us at 22q@uhn.ca.

Updated March 2^nd, 2022: Even though many places no longer ask for a proof of COVID-19 vaccination, Toronto General Hospital still requires that essential care partners who bring patients to medical appointments be vaccinated.

Where to get your proof of vaccination

• Please visit the Government of Ontario’s Proof of COVID-19 vaccination site. [Help]
• Individuals who have received some vaccine doses outside of Ontario should consult the Government of Ontario’s COVID-19 Guidance for Individuals Vaccinated outside of Ontario/Canada.

Our Clinic recommends that all individuals with 22q as well as their family members receive all the vaccine doses (including boosters) for which they are eligible. For more information, please see our section on COVID-19 vaccination.

If you have any questions or concerns, please speak with your healthcare provider.

COVID-19 is a respiratory disease caused by a new coronavirus called SARS-CoV-2.

COVID-19 symptoms and treatment (Government of Canada website)

Self assessment (Government of Ontario website)

Is it COVID or a cold? How to know as Omicron cases rise (CBC Article)

Although this disease has been spreading quickly around the world, there are a few things you can do to avoid catching it.

• Avoid being very near another person
  • “Social distance” means keeping about 6 feet apart (2 metres, or 3 big steps)
• Wash your hands properly and frequently using soap and water
  • Video: How to wash your hands properly
• If soap and water are not available, use an alcohol-based hand sanitizer.
• Video: How to use hand sanitizers properly
• Wear a mask as an added layer of protection
  • Video: How to put on and take off a mask properly
  • Avoid masks with graphene
  • In Ontario, masks are required in the following settings:
    • public transit
    • long-term care and retirement homes
    • hospitals
    • shelters
    • jails
    • congregate care and living settings
  • Avoid touching your eyes, nose, and mouth with your hands
  • Sneeze or cough into your sleeve or a tissue and wash your clothes often
  • Disinfect spaces regularly, especially phones, door handles, etc.
  • Improve the ventilation of your home
    • Guidance for multi-family homes (apartments) and long-term care homes

PCR Test

Updated April 11^th, 2022

The following individuals are eligible for COVID-19 PCR testing and assessment for the use of specific antiviral medications.

• Individuals aged 18 and over who are immunocompromised (have an immune system that is weakened by a health condition or medications);
• Individuals aged 70 and over;
• Individuals aged 60 and over with fewer than three vaccine doses; and
• Individuals aged 18 and over with fewer than three vaccine doses and at least one risk condition

Please read this news release to see if you are eligible for testing before you book an appointment.

Rapid Antigen Tests

Individuals in Ontario can obtain free rapid antigen tests (RATs) at grocery stores and pharmacies. To find out where to get a test and how to use it, please visit the government’s website on Rapid testing for at-home use.

Rapid antigen tests using nasal samples are less sensitive for the Omicron variant compared to the Delta variant. In order to receive a reliable result, individuals should collect oral-nasal samples. Please have a look at:

• Instructions for swabbing (pdf)
• Video instructions for swabbing (adults)
• Video instructions for swabbing (children)

This CBC article contains the following information:

• When should I use a rapid test?
• What does a negative result mean?
• Should I use a rapid test before an event?
• What’s the best technique for taking a test?
• How many test kits should I keep at home?
• Where to find a free rapid test in your province or territory

Avoid non-essential travel outside Canada, regardless of your vaccination status. However, if you must travel, please visit the Government of Canada’s website on Travel, testing and borders. Travelers who are fully vaccinated follow a different set of rules compared to those who are not.

There is a lot of information on the Internet about the current pandemic, but not everything is accurate.

Please visit the following websites for the most up-to-date and reliable information:

• Videos from the Immune Deficiency Foundation
• Confused About COVID? Family Doctors Answer Your Questions
• University Health Network (UHN) - COVID-19 Info/Policies
• City of Toronto
• Public Health Ontario
• Government of Canada - includes outbreak updates, symptoms, prevention, travel, preparation

Please do not come to the Clinic if you have any of the symptoms. Depending on your situation, you may be able to have your appointment remotely.

Please see our section on Clinic operations and hospital restrictions during COVID-19.

Please note that Toronto General Hospital has a Universal Masking Policy.

• Cloth masks are not permitted at UHN.
• Everyone entering UHN must wear a medical mask. If you are wearing a mask from home, screening staff will give you a medical mask to wear instead.
• UHN physicians and Nurse Practitioners are the only two healthcare providers who can approve a patient face mask exemption, and must provide exempt patients with a completed Face Mask Exemption Form. Please contact our Clinic at least 1 week before your appointment if you would like a mask exemption. Even with an exemption, you will be required to wear a face shield while at UHN which will be provided at our screening entrances. You will also receive a ‘mask exemption sticker’.

If you need to see a doctor for a problem that is very urgent but not life-threatening, and if you are unable to book an appointment with your family doctor, you can book an appointment with Toronto’s Virtual Emergency Department. You can receive care by phone, smartphone, tablet or computer. Please watch the video on their website to see the types of health issues that they can help you with.

While there are support services and financial assistance available, we urge you to be very careful about possible scams. Please visit the Government of Canada’s Slam the scam website to learn how to protect yourself.

Support

• The Center for Disease Control’s page on Stress and Coping

• Connectability Resources for people with Intellectual Disabilities

• Toronto Drop-In Network

• Pooran Law’s COVID-19 Resource Centre

Financial assistance

• Ontario Works (OW)

• Ontario Disability Support Program (ODSP)

• Passport funding

• Canada’s COVID-19 Economic Response Plan