Canadian Immunization Guide: Introduction
The Canadian Immunization Guide (CIG) has been a trusted, reader-friendly summary of recommendations on immunization by the National Advisory Committee on Immunization (NACI) since 1979 when it was first published. The CIG addresses advances in vaccines and immunization practices in Canada. It is written for health care providers and public health practitioners, policy makers, program planners and the general public with knowledge and interest in immunization and vaccines.
Vaccines are a cornerstone of public health and their use has significantly contributed to the prevention and control of infectious diseases in Canada and internationally. Immunization is not just for children; adolescents now routinely receive vaccines to protect against meningococcal disease, HPV, hepatitis B, influenza, tetanus, diphtheria, and pertussis, and there are a growing number of vaccines that are routinely recommended for adults. There are also other vaccines that are specifically recommended for specific populations, such as travellers or people with underlying medical conditions.
The risk of vaccine preventable disease transmission remains and would significantly increase if vaccination were stopped. Immunization providers and the public should be aware that, with the success of childhood immunization programs, there is a tendency to underestimate the risks of vaccine-preventable diseases and overestimate the risks of vaccines.
In Canada, immunization programming is a shared responsibility between federal, provincial and territorial governments, with provincial and territorial governments and local public health authorities undertaking the planning and delivery of immunization programming. The national scientific advisory body on immunization, NACI, has been developing recommendations for the use of vaccines for Canadians since the 1960s. NACI works in parallel with the Committee to Advise on Tropical Medicine and Travel (CATMAT) that advises the Public Health Agency of Canada on travel-related health hazards including vaccine preventable diseases. PHAC regularly publishes advice from NACI and CATMAT as statements about new vaccines and, as new evidence and indications emerge, updates recommendations for the use of vaccines that are available in Canada.
The CIG is divided into four parts:
- Part 1 provides an overview of Key Immunization Information, which includes key scientific principles of immunology and vaccinology, vaccine administration, storage and handling of immunizing agents and information about communicating effectively about the benefits of immunization.
- Part 2 addresses Vaccine Safety. The chapters in this part provide information about vaccine safety monitoring in Canada, product-specific contraindications, precautions and concerns, and assessment and management of anaphylaxis.
- Part 3 provides recommendations for the Vaccination of Specific Populations, including adults, workers, persons with inadequate immunization records, women who are pregnant or breastfeeding, infants born prematurely, persons in health care institutions, immunocompromised persons, persons with chronic diseases, travellers, and those who are new to Canada.
- Part 4, Immunizing Agents, is organized into disease-specific chapters. It provides information about disease characteristics and epidemiology, as well as vaccine-specific information and recommendations for use.
Chapters are updated as new evidence about vaccines and vaccine preventable diseases becomes available and as NACI and CATMAT statements and updates are published.
Chapter Revision Process
The CIG is informed by recommendations, statements and updates by NACI and CATMAT.
For NACI recommendations, statements and updates, new publications are developed by a vaccine preventable disease-specific Working Group. A Working Group consists of NACI members and representatives as well as external experts and NACI Secretariat technical staff. NACI Secretariat technical staff consists of medical advisors, research scientists, nurse advisors, pharmacists, epidemiologists, health economists, mathematical modellers, and project officers.
Following the NACI approval and subsequent PHAC approval of a new statement or statement update, the corresponding CIG chapter is subsequently updated by a NACI Secretariat Medical Advisor and Senior Nurse Advisor, and approved by the Working Group Chair. The CIG is also reviewed by the NACI Secretariat technical staff to identify other chapters that have been impacted by the approved changes.
Chapters, revised to include new recommendations not contained in a NACI statement, are written by NACI Secretariat technical staff and approved by the appropriate Working Group Chair, as well as the entire National Advisory Committee on Immunization.
Updates to chapters in Part 1 are made by the Part 1 Working Group and approved by the Part 1 Working Group chair. Updates to chapters in Part 2 are informed by the NACI Vaccine Safety Working Group (VSWG) and approved by the VSWG chair. Updates to chapters in Part 3 are made by the Part 3 Working Group and approved by the Part 3 Working Group Chair.
For travel vaccine recommendations, new publications are developed by CATMAT. Updates to CIG chapters related to travel vaccines are based on statements and recommendations by CATMAT. These chapter updates are coordinated by NACI Secretariat technical staff and the CATMAT Secretariat.
Chapter reviews are based on a four year cycle. Chapter reviews may occur more frequently in the event of a new NACI or CATMAT publication or a changing practice, which triggers an update of relevant chapters. A Table of Updates summarizes key changes as they are made to individual chapters. The date on which a chapter has last been reviewed or updated is noted on the respective chapter webpage.
The CIG contains select references. Please consult NACI and CATMAT statements for additional references and other information.