Health Professionals Update – Vol. 18, No. 29

From: 
Hetal Patel, MD, MPH, CCFP, FRCPC  
Associate Medical Officer of Health

In this issue

• Supplementary RSV clinical guidance for health care providers.
• Regulatory update: RSV monoclonal antibody (BEYFORTUS) is now authorized for midwifery practice
• MMRV vaccine shortage.
• Vaccine storage and handling reminders.

Key message

• The Provincial RSV Advisory Group has created supplementary clinical guidance to support Ontario’s RSV Prevention Program.
• RSV monoclonal antibody (BEYFORTUS) is now authorized for midwifery practice.
• There is currently a provincial shortage of MMRV vaccine. MMR and Varicella vaccines may be given separately at the same visit.
• PENTACEL (DTaP-IPV-HIB) must be reconstituted with liquid QUADRACEL (DTaP-IPV) and freeze-dried Act-HIB (HIB).
• Products that require reconstitution (e.g., VARILRIX, PENTACEL) must be reconstituted using the specific diluent provided by the same manufacturer.
• Multi-dose vials must be handled and disposed of according to the product monograph.

Supplementary RSV clinical guidance for health care providers

The Provincial RSV Advisory Group has developed Supplementary Clinical Guidance for Health Care Providers designed to answer frequently asked questions and support best practices in the implementation of Ontario’s Infant and High-Risk Children RSV Prevention Program, complementing the Ontario MOH guidance.

Guidance highlights:

• Additional program eligibility and accessibility considerations
• Timing of the RSV Season and the Infant RSV Program
• Considerations for children with complex medical conditions
• Other program and vaccine administration considerations

Regulatory update: RSV Monoclonal antibody (BEYFORTUS) is now authorized for midwifery practice

On October 31, 2025, the Ontario government amended O. Reg 188/24 under the Midwifery Act, 1991, expanding the scope of practice for midwives. The amendment authorizes midwives to prescribe and administer the RSV monoclonal antibody (BEYFORTUS). This regulatory change aligns with current public health efforts to reduce RSV-related morbidity in infants and supports broader access to immunization through midwifery-led care. BEYFORTUS can be ordered on the Peel Health Professionals Portal.

MMRV vaccine shortage

The combined measles, mumps, rubella, varicella (MMRV) vaccine (PRIORIX TETRA / PROQUAD) is not currently available for order through Peel Public Health due to a provincial shortage. Supply is expected to be available as early as December.

In place of the MMRV vaccine, you may administer separate MMR (MMR II / PRIORIX) and Varicella (VARIVAX / VARILRIX) vaccine products. MMR and Varicella vaccines can be co-administered during the same visit.

Reminder: When multiple immunizations are to be given at the same visit, separate limbs should be used if possible. Alternatively, the injections may be administered into the same limb separated by at least 2.5 cm (1”) apart. Different immunization equipment (needle and syringe) must be used for each immunization.

MMR (MMR II / PRIORIX) and Varicella (VARIVAX / VARILRIX) products are available to order via the Peel Health Professionals Portal. The online order portal will be updated once the MMRV product becomes available.

Vaccine storage and handling reminders

PENTACEL reconstitution

Important reminders on how to prepare and administer PENTACEL:

• PENTACEL (DTaP-IPV-HIB) protects against diphtheria, tetanus, pertussis, polio and Haemophilus influenzae type b (HIB).
• It comes in two vials:
  • One vial with freeze-dried Act-HIB (HIB)
  • One vial with 0.5 mL liquid QUADRACEL (DTaP-IPV)
• The liquid QUADRACEL vial must be used to reconstitute the freeze-dried Act-HIB vial.
• After reconstitution of the two components, PENTACEL can be administered.

Healthcare providers are encouraged to review the Product Monograph before administering PENTACEL.

Note: QUADRACEL (DTaP-IPV) should not be used as an alternative to BOOSTRIX-POLIO or ADACEL-POLIO (Tdap-IPV). Please ensureappropriate product selection when completing catch-up schedules. A DTaP-IPV-HIB vs. Tdap-IPV Decision Tool - Catch-up schedule for children under 7 years is available to support your practice.

Use of appropriate diluent supplied by manufacturer

Products that require reconstitution (e.g., VARILRIX, PENTACEL) must be reconstituted using the specific diluent provided by the same manufacturer. Vaccine products supplied by Peel Public Health that require reconstitution are packaged with the appropriate diluent from the respective manufacturers. Using a different diluent may compromise the vaccine’s integrity and effectiveness to protect against disease.

Multi-dose vials

Multi-dose vials (e.g., influenza, TUBERSOL) must be handled according to the product monograph. Once punctured, these vials must be kept in their original packaging and clearly labeled to indicate the date and time of first use, ensuring proper tracking and adherence to storage and usage guidelines. Discard as per manufacturer’s instructions or within 28 days, whichever is shorter.

Contact us

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