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Practice management during respiratory season New

This resource shares strategies for fall preparedness that may be helpful for primary care practices in Ontario. It draws on ideas, information, and resources from various types of primary care practice models across Ontario. You are encouraged to select and adapt strategies that best fit your own context.  

Planning and proactive strategies 

Proactive patient outreach (EO; OCFP checklist, 2023)
  • Encourage annual immunizations for all eligible patients. Use multiple channels to maximize engagement. 
    • Email campaigns and social media posts that include a booking link or front-desk contact details. 
    • Signage displayed in waiting rooms as seasonal reminders. 
    • Printed letters or direct calls to patients without email access, especially older adults. 
  • Identify high-risk patients, e.g., age 5 and under, age 65 and older, comorbidities, chronic disease, COPD, and asthma. 
  • Reach out to high-risk patients about testing and antiviral options proactively. 
  • Consider hosting a dedicated ‘Vaccine Day’ to administer the flu shot and other recommended respiratory illnesses vaccines. 
  • Direct patients living farther away to community pharmacies for vaccinations, if needed.
Patient communication and education (EO)
  • Share educational messages and resources to help patients make informed decisions (e.g., when to seek in-person care vs self-manage symptoms). 
Infection prevention and control (IPAC) (EO; OCFP checklist 2023)
  • Plan and review IPAC procedures for your office. 
  • Ensure PPE inventory is adequate. 
  • Consider implementing masking protocols, including any signage reminders to wear a mask. 
  • Make masks available for symptomatic patients (fever, cough, cold) upon entry to reduce exposure in the waiting and examination rooms. 
  • Consider installing plexiglass barriers in the office (e.g., front desk). 
  • If feasible, designate separate waiting areas for symptomatic patients. Use rooms that are easy to clean and sanitize regularly (e.g., remove high-touch items such magazines and toys). 

Effective teamwork and workflow strategies

Teamwork and coordination ((Expert opinion, PHAC, 2021; PHAC, 2024; PHAC, 2025; Lyons et al., 2024; Stratoberdha et al., 2022)

Leverage the care team according to each member’s scope of practice, and provide training as needed, to optimize efficiency and patient-centered care.

  • Ensure nurses are integrated into vaccination planning and delivery. See nurse contributions during the COVID-19 pandemic for ideas.
  • Consider implementing instant messaging tools to facilitate communication with staff.
  • Hold regular clinical and staff meetings to share learnings from webinars, review workflows, and discuss challenges.

  • Consider employing the following strategies to involve other team members in vaccination efforts. See table below. 

Strategy

Practical application

Engage nurses & pharmacists as educators & administrators 

Leverage trusted relationships to provide vaccine education, address hesitancy and administer seasonal vaccines. 

Target outreach efforts 

Assign nurses or allied staff (e.g., social workers) to reach high-risk or underserved populations through reminder calls, community clinics or home visits. 

Embed vaccine promotion within care 

Incorporate seasonal immunization discussions into routine visits for chronic disease management, wellness checks and follow-ups. 

Integrate team-based planning 

Involve social workers, pharmacists, administrative staff, and allied health professionals in scheduling, coordinating patient communications and documentation management. 

Managing patient access (EO)
  • If feasible, have multiple staff members answer incoming calls to improve responsiveness. 
  • Encourage patients to see other clinicians in the same clinic if their regular clinician is unavailable. 
  • Schedule symptomatic patients at the end of the day to minimize exposure. 
  • If feasible, offer expanded weekday evening and weekend hours to increase accessibility when demand is high. 
  • If feasible, double-up appointments to maximize efficiency. 
  • If feasible, reserve 30 minutes daily for same-day appointments, with flexibility to increase this when demand is high. 
  • Consult OMA’s scheduling tips to help improve scheduling efficiency. 
Documentation and EMR efficiency (EO)
Optimizing workflows (EO)
  • Use public health prevalence data to guide clinical identification of illnesses. 
  • Train front office team members to screen incoming calls to assess priority, severity, and whether the appointment should be in-person or virtual. 
  • Example flow chart: screening for respiratory illness (OCFP) 
  • Leverage virtual visits where appropriate to manage patient volume. 
  • Provide COVID-19 testing kits and ask patients to self-swab in their car to reduce staff workload and enhance clinic efficiency. 
  • Use direct EMR-based email communication (e.g., sending requisitions) to patients, without adding to staff workload. 
Referrals and transitions in care (EO)

Seasonal and respiratory immunizations New

Pneumococcal 

  • IPD is more common in winter and spring 
  • Recommended for: 
    • Infants and children (routine for those aged 6 weeks to 4 years) 
    • Adults (recommended) 
    • Older adults (routine for those aged 65 years and older) 
    • Those at increased risk of invasive pneumococcal disease (for those aged 6 weeks and older with certain medical or non-medical conditions who are at high risk for IPD) 
Available products and indications (PHAC, 2025)

Type of vaccine

Vaccine name and eligible groups in Ontario

Pneumococcal conjugate (Pneu-C) 

  • Prevnar 13 (Pneu-C-13): No longer publicly funded. Individuals previously eligible should receive either Pneu-C-15 or Pneu-C-20 depending on risk for IPD. 
  • Vaxneuvance (Pneu-C-15): Children 6 weeks to 4 years of age at low risk for IPD. 
  • Prevnar 20 (Pneu-C-20): Individuals ≥6 weeks of age and older at high risk for IPD and individuals ≥65 years of age at low risk for IPD.  

Pneumococcal polysaccharide

(Pneu-P) 

  • Pneumovax 23 (Pneu-P-23): No longer publicly funded. Individuals previously eligible should receive Pneu-C-20.  

 

 
Vaccination schedule for those meeting the following high-risk criteria: (MOH, 2025)
  •  Chronic cardiac disease   
  • Chronic respiratory disease, excluding asthma, except those treated with high dose corticosteroid therapy 

Age

# of previously received  Pneu-P-23 doses 

# of Pneu-C-20 doses recommended (0.5ml/dose) 

18 to 64 years 

0 doses

1 dose

18 to 64 years

1 dose

0 doses

≥65 years 

0 to 1 doses

1 dose 

Pneu-C-20 should be given 1 year after last dose of Pneu-P-23   

≥65 years 

2 doses

0 doses

  • Pneu-C and Pneu-C: 8 weeks minimum
  • Pneu-P-23 and Pneu-C: 1 year minimum
  • Pneu-C-20 vaccines may be given at the same time with other vaccines, or at any time before or after other vaccines.  
  • A pneumococcal conjugate vaccine should not be given to: 
    • Individuals with a history of anaphylaxis after previous administration of the vaccine, and/or
    • Anaphylactic hypersensitivity to any component of the vaccine 
  • Only postpone administration of pneumococcal vaccine for individuals with severe acute illness.  

Influenza (annual seasonal vaccines, trivalent and quadrivalent preparations) 

  • Offer annually to anyone 6 months of age and older who does not have a contraindication to the vaccine. 
  • Particularly recommended for individuals at high risk of severe disease, influenza-related complications or hospitalization 
  • Individuals at greatest risk include adults and children with chronic health conditions, cardiac or pulmonary disorders (includes bronchopulmonary dysplasia, cystic fibrosis, and asthma) 
  • Influenza vaccines should not be given to: 
    • Individuals who have had an anaphylactic reaction to a specific influenza vaccine, or to any of the components (offer another influenza vaccine that does not contain that component) with the exception of egg; 
  • In addition, LAIV should not be given to: 
    • Individuals with severe asthma, active wheezing, or medically attended wheezing in the 7 days prior to the proposed date of vaccination 
    • LAIV is not contraindicated for individuals with a history of stable asthma or recurrent wheeze which is not active. 
    • Children less than 24 months of age 
    • Children 2 to 17 years of age currently receiving long-term aspirin or aspirin-containing therapy 
    • Pregnant individuals. Not contraindicated during breastfeeding (lactating). 
    • Individuals who are immunocompromised due to underlying disease and/or therapy.
  • Postpone in individuals with serious acute illnesses until their symptoms have improved. 
  • Individuals who have developed Guillain-Barré Syndrome (GBS) within 6 weeks of a previous influenza vaccination unless another cause was found for the GBS. 
  • For LAIV, NACI additional precautions include:
    • Significant nasal congestion or discharge  
    • For close contacts of individuals with severe immune compromising conditions 
    • When there is administration of antivirals active against influenza (e.g., oseltamivir, zanamivir). 

Parameter

Oseltamivir (Tamiflu®) 

Zanamivir (Relenza®) 

Dosage

  • Adults: 75mg twice daily for 5 days 
  • Dose adjust for renal impairment. 
  • Adults and pediatric patients ≥ 7 years: 10mg (2 inhalations; 5mg/inhalation) twice daily*, for 5 days (or longer if clinically indicated)  
  • *On first day of treatment, a second dose should be taken provided there is at least 2 hours between doses. On the remaining days, doses should be taken about 12 hours apart. 

Contraindications

N/A

  • Severe underlying airway conditions (e.g., chronic obstructive pulmonary disease or asthma). 
  • Allergy to milk protein 
Available products and indications (PHAC, 2025) 
  • Influenza vaccines should not be given to: 
    • Individuals who have had an anaphylactic reaction to a specific influenza vaccine, or to any of the components (offer another influenza vaccine that does not contain that component) with the exception of egg; 
  • In addition, LAIV should not be given to: 
    • Individuals with severe asthma, active wheezing, or medically attended wheezing in the 7 days prior to the proposed date of vaccination 
    • LAIV is not contraindicated for individuals with a history of stable asthma or recurrent wheeze which is not active. 
    • Children less than 24 months of age 
    • Children 2 to 17 years of age currently receiving long-term aspirin or aspirin-containing therapy 
    • Pregnant individuals. Not contraindicated during breastfeeding (lactating). 
    • Individuals who are immunocompromised due to underlying disease and/or therapy. 
  • Postpone in individuals with serious acute illnesses until their symptoms have improved. 
  • Individuals who have developed Guillain-Barré Syndrome (GBS) within 6 weeks of a previous influenza vaccination unless another cause was found for the GBS.
  • For LAIV, NACI additional precautions include:
    • Significant nasal congestion or discharge  
    • For close contacts of individuals with severe immune compromising conditions 
    • When there is administration of antivirals active against influenza (e.g., oseltamivir, zanamivir).  
  • Offer annually to anyone 6 months of age and older who does not have a contraindication to the vaccine. 
  • Particularly recommended for individuals at high risk of severe disease, influenza-related complications or hospitalization 
  • Individuals at greatest risk include adults and children with chronic health conditions, cardiac or pulmonary disorders (includes bronchopulmonary dysplasia, cystic fibrosis, and asthma)
 

Parameters

Oseltamivir (Tamiflu®) 

Zanamivir (Relenza®) 

Dosage

  • Adults: 75mg twice daily for 5 days 
  • Dose adjust for renal impairment. 
  • Adults and pediatric patients ≥ 7 years: 10mg (2 inhalations; 5mg/inhalation) twice daily*, for 5 days (or longer if clinically indicated)  
  • *On first day of treatment, a second dose should be taken provided there is at least 2 hours between doses. On the remaining days, doses should be taken about 12 hours apart. 

Contraindications

N/A

  • Severe underlying airway conditions (e.g., chronic obstructive pulmonary disease or asthma). 
  • Allergy to milk protein 
  • Influenza vaccines should not be given to: 
    • Individuals who have had an anaphylactic reaction to a specific influenza vaccine, or to any of the components (offer another influenza vaccine that does not contain that component) with the exception of egg; 
  • In addition, LAIV should not be given to: 
    • Individuals with severe asthma, active wheezing, or medically attended wheezing in the 7 days prior to the proposed date of vaccination 
    • LAIV is not contraindicated for individuals with a history of stable asthma or recurrent wheeze which is not active. 
    • Children less than 24 months of age 
    • Children 2 to 17 years of age currently receiving long-term aspirin or aspirin-containing therapy 
    • Pregnant individuals. Not contraindicated during breastfeeding (lactating). 
    • Individuals who are immunocompromised due to underlying disease and/or therapy. 
  • Postpone in individuals with serious acute illnesses until their symptoms have improved. 
  • Individuals who have developed Guillain-Barré Syndrome (GBS) within 6 weeks of a previous influenza vaccination unless another cause was found for the GBS.
  • For LAIV, NACI additional precautions include:
    • Significant nasal congestion or discharge  
    • For close contacts of individuals with severe immune compromising conditions 
    • When there is administration of antivirals active against influenza (e.g., oseltamivir, zanamivir).  

Parameters

Oseltamivir (Tamiflu®) 

Zanamivir (Relenza®) 

Dosage

  • Adults: 75mg twice daily for 5 days 
  • Dose adjust for renal impairment. 
  • Adults and pediatric patients ≥ 7 years: 10mg (2 inhalations; 5mg/inhalation) twice daily*, for 5 days (or longer if clinically indicated)  
  • *On first day of treatment, a second dose should be taken provided there is at least 2 hours between doses. On the remaining days, doses should be taken about 12 hours apart. 

Contraindications

N/A

  • Severe underlying airway conditions (e.g., chronic obstructive pulmonary disease or asthma). 
  • Allergy to milk protein 

COVID-19

  • Offer to previously vaccinated and unvaccinated individuals at increased risk of exposure or severe COVID-19 disease, including:
    • Adults ≥ 65  
    • Individuals ≥ 6 months with medical conditions that put them at higher risk of severe COVID-19 
  • The following individuals should receive a second dose of COVID-19 vaccine per year: 
    • Adults ≥ 80 
    • Adults in long-term care homes and other congregate living settings for seniors 
    • Individuals ≥ 6 months who are moderately to severely immunocompromised  
  • The following individuals may receive a second dose of COVID-19 vaccine per year: 
    • Adults 65 to 79 years of age
  • All other previously vaccinated and unvaccinated individuals (> 6 months) who are not at increased risk may receive a COVID-19 vaccine. 

Individuals with hypersensitivities may receive the COVID-19 vaccine under medical supervision.  

Precautions:

  • Hypersensitivities and allergies 
  • Acute illness  
  • Bleeding disorders 
  • Myocarditis and/or pericarditis following vaccination 
  • Guillain-Barré syndrome 
  • Bell’s palsy 
  • Multisystem inflammatory syndrome in children or adults (MIS-C or MIS-A) 

Antivirals can be considered when individuals have:  

  • Chronic lung diseases, limited to: asthma, bronchiectasis, chronic obstructive pulmonary disease, interstitial lung disease, pulmonary embolism, pulmonary hypertension 
  • Heart conditions (e.g., heart failure, coronary artery disease, cardiomyopathies)

Parameter

Nirmatrelvir/Ritonavir (Paxlovid)  

Remdesivir (Veklury) 

Place in Therapy

Preferred first-line therapy 

Alternative when nirmatrelvir/ritonavir cannot be used 

Prescribing Window 

Within 5 days of symptom onset 

Within 7 days of symptom onset 

Dosage

Nirmatrelvir 300 mg and ritonavir 100 mg orally twice daily for 5 days 

 Dose adjust for renal impairment. 

200 mg IV single dose on day 1, then 100 mg IV once daily on day 2 and day 3 

RSV Immunization for Older Adults 

Arexvy 

Abrysvo 

If individuals received an RSV immunization in a previous season, they do not need another dose this respiratory season as studies show multi-year protection (Ontario Health Memo, 2025). 

  • Adults aged 75 and older  
  • Adults aged 60 and older who are: 
    • Residents of long-term care homes, Elder Care Lodges, or retirement homes including similar settings (e.g., co-located facilities) 
    • Patients in hospital receiving alternate level of care (ALC) including similar settings (e.g., complex continuing care, hospital transitional programs) 
    • Patients with glomerulonephritis (GN) who are moderately to severely immunocompromised 
    • Patients receiving hemodialysis or peritoneal dialysis 
    • Recipients of solid organ or hematopoietic stem cell transplants 
    • Individuals experiencing homelessness 
    • Individuals who identify as First Nations, Inuit, or Métis  

Publicly funded RSV vaccines can be ordered through usual methods, via local public health units or the Ontario Government Pharmaceutical and Medical Supply Services (OGPMSS) (Ontario Health Memo, 2025). 

Product

Dose

Timing and setting

Arexvy 

1 dose (0.5 mL, intramuscular injection) 

  • Beginning of RSV season for optimal protection.  
  • Available before, during or at the end of RSV season.  (Ontario RSV site) 
  • Primary Care (publicly funded) 
  • Pharmacy with prescription (privately funded) 

Abrysvo 

1 dose (0.5 mL, intramuscular injection) 

  • Beginning of RSV season for optimal protection.  
  • Available before, during or at the end of RSV season.  (Ontario RSV site) 
  • Primary Care (publicly funded) 
  • Pharmacy with prescription (privately funded) 

For information on the RSV Prevention Program for infants in Ontario, see CEP’s RSV tool.

Storing and transporting vaccines

Maintaining the cold chain—from manufacturer to administration—is essential as breaks (temperature excursions) can cause irreversible potency loss (PHAC, 2022). 

  • Store refrigerated vaccines at +2°C to +8°C; frozen vaccines at –15°C or colder or as specified by product monograph (do not refreeze thawed vaccines). 
  • Keep vaccines in original packaging to prevent light/physical damage. 
  • Monitor and record storage/transport temperatures. 
  • Do not use expired or mishandled doses. 
  • Transport with insulated containers and temperature monitoring. 
  • Dispose vaccines according to jurisdictional standards.  

Vaccine communication 

Vaccine hesitancy

Addressing hesitancy requires individualized and community-based approaches that consider the unique circumstances, lived experiences, and cultural contexts of patients. Promote respectful dialogue grounded in cultural safety and trauma-informed care, recognizing that hesitancy may stem from multiple factors (PHO, 2021). 

  • Limited understanding of vaccines  
  • Conflicting/misleading information 
  • Mistrust in institutions or industry motives  
  • Concerns about side effects, pain or anxiety 
  • Low awareness about the severity of vaccine-preventable diseases  
  • Sociocultural or religious beliefs 

*PrOTCT Framework modified with permission from the Centre for Effective Practice. (December 2021) Constantinescu, Ivers. N., Grindrod. K. PrOTCT Framework: Ontario. Toronto: Centre for Effective Practice. 

Build vaccine confidence with trusted messengers, clear communication and tailored strategies. Use the following strategies to address individual and community concerns:  

Strategy

Practical application

Presumptive approach 

  • Framing vaccination as the expected action (e.g., “When will you be getting your COVID-19 vaccine?”) rather than asking whether a patient intends to vaccinate. 

Motivational interviewing 

Engage in dialogue 

  • Determine the origins of vaccine hesitancy, encourage questions and acknowledge concerns without judgment.  
  • Clarify misunderstandings patiently to build trust. 

Be transparent

  • Clearly communicate vaccine safety processes, benefit-risk ratios and Canada’s robust vaccine safety monitoring system.  
  • Compare the risks of vaccines with the far greater risks of vaccine-preventable diseases. 

Adapt information to the patient’s needs 

  • Some individuals prefer scientific evidence, while others respond better to plain language or personal examples.  
  • Avoid jargon and use positive framing (e.g., “Vaccines are 99% safe” rather than “There is a 1% risk of side effects”). 

Respect differing views

  • Some individuals will remain hesitant despite discussion. Maintaining respect and trust leaves the door open for future dialogue. 

Address pain and anxiety

Ensure accessible materials

  • Use culturally relevant, multilingual communication tools available in both online and community settings. 

Equity and access

Culturally competent and safe care is essential to improving vaccination uptake and addressing inequities in the health system (PHAC, 2023; PHAC, 2024). 

Improving access for underserved populations 

Access to vaccination in Canada continues to be limited by multiple intersecting barriers, including (Stratoberdha et al., 2022): 

  • Limited information 
  • Limited access 
  • Fear of adverse reactions or needles 
  • Financial barriers 
  • Lack of awareness of vaccine existence 
  • Misconceptions that older adults do not need vaccination 
  • Misconception on vaccine effectiveness 
  • Designing supportive health care environments to create positive vaccination experiences such as building trusted relationships, co-administration of vaccines to reduce travel time and costs, and embedding culturally safe practices. 
  • Building information environments with tailored communication and outreach (community-informed and culturally relevant) that fills in information gaps and counters misinformation. 

While overall vaccine confidence among First Nations, Inuit, and Métis populations is high, coverage across regions remains uneven. These differences are shaped by systemic, social, and intrapersonal factors that can act as barriers or facilitators to vaccine uptake. 

Barriers and facilitators

Barriers:

  • Mistrust in healthcare institutions 
  • Patronizing or stigmatizing vaccine campaigns 
  • Limited access to booking technologies 
  • Language barriers 
  • Travel challenges 
  • Ineffective communication 

Facilitators:

  • Clear, respectful communication about vaccine safety and importance 
  • Prioritization of Indigenous populations in rollout  
  • Consistency in vaccine brands for multi-dose series 
  • Holistic supports (e.g., co-administering vaccines to reduce travel) 

Barriers:

  • Circulation of misinformation within communities 
  • Anti-immunization attitudes within communities  

Facilitators:

  • Positive, trusting interactions with health care providers 
  • Supportive community environments 

Barriers:

  • Misconceptions about vaccines 
  • Previous negative health experiences 
  • Perceptions that alternatives (e.g., homeopathic medicine, vitamin D, natural immunity) are just as effective 
  • Preference for Traditional medicine over Western medicine 

Facilitators:

  • Altruism (desire to protect others) 
  • Trust in providers and health systems 
  • Strong personal perception of risk