Principles of vaccine interchangeability: Canadian Immunization Guide

For health professionals

Notice

This CIG chapter has not been updated to contain any information regarding COVID-19 vaccines, refer to the COVID-19 vaccine chapter.

Updated : March 2024

Introduction

Similar vaccines from different manufacturers are routinely authorized for use in Canada. Circumstances such as vaccine shortages, contraindication to a specific vaccine, changes in product availability, or migration across jurisdictions may necessitate giving vaccines from different manufacturers to the same individual over time. Because immunization schedules and specific products used vary across provinces and territories and among countries, questions about vaccine interchangeability may arise when evaluating the immunization status of persons new to Canada or people who have moved between jurisdictions.

General Principles of Vaccine Interchangeability

In general, the same manufacturer's product should be used for all doses in a vaccine series. However, routine immunization should not be deferred because of the lack of availability of a specific product.
To be considered interchangeable, the vaccines should:
- be authorized with the same indications and with equally acceptable schedules, and
- be authorized for the same population, and
- contain comparable type and quantity of antigen, and
- be similar in terms of safety, reactogenicity, immunogenicity and efficacy.
Even when vaccines from different manufacturers are authorized for the same indications, the manufacturers may use differing production methods, antigens or antigen concentrations, adjuvants, conjugating proteins, stabilizers and preservatives. Each of these factors can affect the vaccine's potential for interchangeability.
In general, vaccine diluents are not interchangeable. Lyophilized vaccines should be reconstituted only with the diluent provided by the manufacturer for that purpose, unless otherwise permitted by the manufacturer.

Vaccine Interchangeability Recommendations

The following recommendations for vaccine interchangeability are applicable only to vaccines with the same indications and authorization for use in the same populations.

Diphtheria, tetanus, pertussis, poliomyelitis, Haemophilus influenzae type b vaccines: The routine primary immunization series of diphtheria toxoid, tetanus toxoid, pertussis, poliomyelitis, Haemophilus influenzae type b-containing vaccine should be completed with an appropriate combination vaccine from the same manufacturer whenever possible. However, if the original vaccine is unknown or unavailable, an alternative combination vaccine from a different manufacturer may be used to complete the primary series. On the basis of expert opinion, an appropriate product from any manufacturer can be used for booster doses. Refer to vaccine-specific chapters in Part 4 for additional information.
Hepatitis A vaccines: Monovalent hepatitis A (HA) vaccines may be used interchangeably. Any HA-containing vaccine indicated for the age of the vaccine recipient will provide an effective booster dose after a first dose of vaccine from a different manufacturer. Refer to Hepatitis A Vaccine in Part 4 for additional information.
Hepatitis B vaccines: Monovalent hepatitis B vaccines may be used interchangeably, using the dosage and schedules recommended by the manufacturer for the vaccine recipient’s age group. Hepatitis A and hepatitis B combination vaccine can be used to complete the hepatitis B primary series. Refer to Hepatitis A Vaccine and Hepatitis B Vaccine in Part 4 for appropriate schedules.
Human papillomavirus vaccines: Whenever possible, the same Human papillomavirus (HPV) vaccine should be used to complete the vaccine series. If the vaccine used for previously received doses is not known, or not available, any of the HPV vaccines authorized for use in Canada may be used to complete the series. All HPV vaccines provide protection against HPV types 16 and 18, and will likely achieve protective antibody levels against these HPV types if the vaccines are interchanged. HPV2 vaccine is not authorized for use in boys and men. Refer to Human Papillomavirus Vaccine in Part 4 for additional information.
Influenza vaccines: If a child (aged less than 9 years) requires 2 doses of influenza vaccine in the same influenza season, it is preferable to use the same type of vaccine for both doses. However, if the type of vaccine used for the first dose is not available; any other age appropriate vaccine may be used for the second dose.
Measles, mumps and rubella vaccines: On the basis of expert opinion, the measles-mumps-rubella (MMR) vaccines authorized for use in Canada may be used interchangeably.
Meningococcal conjugate vaccines: There are no published data regarding the interchangeability of monovalent meningococcal conjugate vaccines, but the vaccines have been safely interchanged without a noticeable decrease in efficacy. When possible, the infant series should be completed with the same vaccine. Any of the quadrivalent meningococcal conjugate vaccines may be used for re-vaccination when indicated, regardless of which meningococcal vaccine was used for initial vaccination. Refer to Meningococcal Vaccine in Part 4 for additional information.
Rabies vaccines: Wherever possible, a rabies vaccine series should be completed with the same product. However, if it is not feasible, rabies vaccines are considered interchangeable. People who require a booster dose of rabies vaccine for pre-exposure prophylaxis can be given either formulation of rabies vaccine, regardless of the vaccine used for the initial vaccination series.
Rotavirus vaccines: There are no data on safety, immunogenicity, or efficacy when monovalent rotavirus (Rot-1) vaccine is administered as the first dose and pentavalent rotavirus (Rot-5) vaccine is used as the second dose or vice versa. Given that the two vaccines differ in composition and schedule, the vaccine series should be completed with the same product whenever possible. However, in the event that the product used for a previous dose(s) is unknown, the series should be completed with the available product. If any dose in the series was Rot-5 vaccine, a total of 3 doses of vaccine should be administered.
Typhoid vaccines: Although there are no data regarding the interchangeability of typhoid vaccines, it is presumed that boosting can be performed with any of the available formulations, regardless of the vaccine used initially. Refer to Typhoid Vaccine in Part 4 for additional information.
Varicella-containing vaccines: For a 2 dose schedule, it is recommended that the same manufacturer’s univalent varicella vaccine or measles-mumps-rubella-varicella (MMRV) vaccine be used to complete the schedule, unless there are unavoidable barriers (for example, the vaccine used for the first dose is not available). All varicella-containing vaccines authorized for use in Canada contain the Oka strain of live attenuated varicella virus. Refer to Varicella (Chickenpox) Vaccine in Part 4 for additional information.

Evidence-base for Vaccine Interchangeability Recommendations

Ideally, as new vaccines become available, clinical trials should be conducted evaluating interchangeability with existing products. To date, most of the available information regarding vaccine interchangeability has been gathered as a result of vaccine shortages or new product purchases resulting from negotiation of new contracts. Given the importance of this issue and the limited data available regarding the interchangeability of vaccines, further research in this area should be encouraged.

Selected References

Abarca K, Ibanez I, Perret C et al. Immunogenicity, safety, and interchangeability of two inactivated hepatitis A vaccines in Chilean children. Int J Infect Dis 2008;12(3):270-77.
Centers for Disease Control and Prevention. General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 2011;60(02):1-61.
Halperin SA, Tapiero B, Law B et al. Interchangeability of two diphtheria and tetanus toxoids, acellular pertussis, inactivated poliovirus. Haemophilus influenzae type b conjugate vaccines as a fourth dose in 15-20-month-old toddlers. Vaccine 2006;24(18):4017-23.
Kwak GY, Kwon HJ, Kim JH et al. The immunogenicity and safety of DTaP interchangeable immunization among Korean children. Vaccine 2012;30(31):4644-7.
National Advisory Committee on Immunization. Interchangeability of diphtheria, tetanus, acellular pertussis, polio, Haemophilus influenzae type b combination vaccines presently approved for use in Canada for children <7 years of age. Can Commun Dis Rep 2005;31(ACAS-1):1-10.

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Date modified:: 2024-03-20

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