Canadian Immunization Guide: Table of updates

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Table of updates (2021 - present)

Date Chapter Updates
2021-08 Mumps vaccine

This chapter has been updated to align with the National Advisory Committee on Immunization Statement (NACI): Use of Measles-Mumps-Rubella (MMR) Vaccine for the Management of Mumps Outbreaks in Canada.

Updates include:

  • The section on “Epidemiology” provides additional information on transmission, risk factors, and national incidence rates of mumps cases.
  • The section on “Outbreak control” was revised to provide additional information on mumps outbreak management. In an outbreak setting, implementation of an outbreak dose of MMR vaccine may be considered as a part of the broader outbreak management strategy.
  • The section on “Guidance on reporting Adverse Events Following Immunization (AEFI)” was updated to expand on AEFI reporting requirements.
  • New section for the chapter revision process added.
2021-07 Immunization in Canada This chapter has been completely reviewed and updated to include additional information on immunization programs in Canada and the responsibilities of Federal, Provincial and Territorial immunization committees, advisory bodies, stakeholders, and networks in immunization policy and program development.
2021-03 Anaphylaxis and other Acute Reactions following Vaccination EMERADE™, an EPINEPHrine autoinjector, has been added to Table 4: Dosage of intramuscular EPINEPHrine 1:1000 (1mg/mL), by age or weight
2021-02 Immunization of Persons with Chronic Diseases The section on "Chronic inflammatory conditions" has been renamed "Autoimmune conditions" and has been updated to include information on COVID-19 mRNA vaccines.

Table of updates (2018 - 2020)

Date Chapter Updates
2020-12 Anaphylaxis and other acute reactions following vaccination

This chapter has been reviewed and updated with major revisions such as:

  • New Table 1. Key distinguishing features of anaphylaxis and vasovagal syncope
  • New Table 2: Signs and symptoms of anaphylaxis
  • Updated Table 3: Anaphylaxis management kits: recommended items
  • Updated steps for basic management of anaphylaxis in a community setting
  • Updated Table 4: Dosage of intramuscular EPINEPHrine 1:1000 (1mg/mL) solution, by age or weight
  • Removal of the use of adjunctive treatment
2020-09 Measles Vaccine

The criterion for measles immunity was previously listed for travellers to destinations outside of North America. Due to the changes in global measles epidemiology, this criterion for measles immunity was changed to travellers to destinations outside of Canada.

Chapters revised to reflect this change: Immunization of Travellers, and Immunization of Adults.

2020-02 Meningococcal Vaccine

Updated recommendations: The chapter has been updated to align with the National Advisory Committee on Immunization Statement (NACI): The Use of Bivalent Factor H Binding Protein Meningococcal Serogroup B (MenB-fHBP) Vaccine for the Prevention of Meningococcal B Disease.

Updates include:

MenB-fHBP vaccine may be considered as an option for use in individuals 10 years of age and older in situations when a serogroup B meningococcal vaccine should be offered:

  1. during serogroup B meningococcal disease outbreaks or with the emergence of hyperendemic Neisseria meningitidis strains that are predicted to be susceptible to the vaccine;
  2. for individuals who are close contacts with a case of invasive meningococcal disease caused by serogroup B Neisseria meningitidis;
  3. for individuals with underlying medical conditions that would put them at higher risk of meningococcal disease than the general population; or
  4. for individuals at higher risk of exposure to serogroup B meningococcal isolates than the general population.

MenB-fHBP vaccine may be considered as an option for individuals 10–25 years of age who are not at higher risk of meningococcal disease than the general population, but who wish to reduce their risk of invasive serogroup B meningococcal disease.

2019-12 Adverse Events Following Immunization *NEW CHAPTER* The content on adverse events following immunization (AEFI) has been completely reviewed and moved from the Vaccine Safety and Pharmacovigilance chapter into its own chapter.
2019-12 Vaccine safety and pharmacovigilance

This chapter was completely reviewed with several revisions which expand on the previous content related to Canadian and international vaccine pharmacovigilance definitions, regulation, processes and stakeholders.

The content on adverse events following immunization (AEFI) has been moved to its own chapter, Adverse Events Following Immunization.

2019-06 Immunization of Immunocompromised Persons

June 2019 - Erratum: The permissive use of MMRV vaccine in the post-transplantation vaccination of hematopoietic stem cell transplantation (HSCT) recipients has been removed from the text. Table 3 has been revised to reflect this change. MMR and univalent varicella vaccines should be used instead.

May 2018 - The chapter has been reviewed and updated with major revisions such as:

Primary immunodeficiency:
  • Updated to reflect more recent information on primary immunodeficiencies and vaccine recommendations from expert groups
  • New section on defects in innate immunity added.
  • Criteria for consideration of MMR and varicella vaccines with partial T cell defects added.
  • Contraindication for live viral vaccines in some types of phagocytic cell defects added.
Secondary immunodeficiency:
  • Complement deficiency: alert added regarding eculizumab and hemolysis with meningococcal B vaccine
  • Malignant hematologic disorders: changes to recommendation for varicella vaccine use in children with leukemia
  • HSCT and SOT: caution regarding use of BCG pre-transplant.
  • Immunosuppressive therapy: recommendations on use of live vaccines with low dose immuno-suppression added
  • HIV: criteria for use of MMR and varicella vaccines updated

Chapter revised to reflect this change: Contraindications, Precautions and Concerns

2018-10 Measles Vaccine

Updated recommendation:
The concentrations of anti-measles antibodies in human Ig products have shown trends of gradually declining and are no longer considered optimally protective using the previously recommended dosing strategies.

The chapter features new dosing and route of administration for measles Ig PEP in susceptible infants and individuals who are immunocompromised or pregnant.

2018-08 Herpes Zoster (Shingles) Vaccine

Updated recommendation: This chapter has been revised to reflect NACI's Updated recommendations on the use of herpes zoster vaccines. Most sections were revised to include information and practice recommendations for the new recombinant zoster vaccine (RZV) which is now available in Canada. Changes include:

  • Recommendations for use in different populations
  • Contraindications and precautions
  • Administration of the HZ vaccines: Table 1 was added to summarize key information.
  • Considerations on the efficacy, effectiveness and immunogenicity of HZ vaccines: Table 2 was added to summarize key information.
  • Vaccine safety and adverse events
2018-08 Immunization in pregnancy and breastfeeding

August 2018 - [Errata] This chapter was partially updated to replace Table 1: Summary of Recommendations for Immunization in Pregnancy and Breastfeeding - Inactivated vaccines.

April 2018 - The chapter has been reviewed and updated to align with the updated NACI Statement on immunization in pregnancy with Tdap vaccine.

  • New recommendation: One dose of Tdap vaccine should be administered in every pregnancy. Rationale: Transplacental antibody transfer to newborns provides protection during the 2 first months of life where morbidity and mortality is highest, ideally between 27 and 32 weeks of gestation.

Additional updates include:

  • Considerations regarding the administration of immune globulin and of the following vaccines: conjugate quadrivalent meningococcal, meningococcus B vaccine, yellow fever, Japanese encephalitis.
  • Data on the efficacy and safety of Human papillomavirus (HPV) vaccination in pregnancy is limited. Consider reporting exposure to HPV vaccine during pregnancy to the vaccine manufacturer.
  • Vaccines containing thimerosal are safe in pregnancy and should be used if indicated.
  • When available and indicated, inactivated vaccines are preferred to live attenuated vaccines.
Live herpes zoster vaccine is contraindicated during pregnancy. It is unknown whether it is secreted in human milk.
2018-08 Meningococcal Vaccine

The chapter has been updated with minor revisions:

Vaccine administration:

  • Updated to reflect most recent age indication for the 4CMenB vaccine.
2018-03 Pertussis vaccine

New recommendation: One dose of Tdap vaccine should be administered in every pregnancy, ideally between 27 and 32 weeks of gestation.

Chapters revised to reflect this change: Principles of Combination vaccines, Recommended immunization schedules, Immunization of adults, Immunization in pregnancy and breastfeeding

Table of updates (2015 - 2017)

Date Chapter Updates
2017-11 Vaccine Administration Practices

The chapter has been reviewed and updated with major revisions, such as:

  • Vaccine providers should adhere to jurisdictional or organizational policies and procedures regarding combining the contents of multi-dose vials.
  • Clinical judgement should be used when selecting needle length for IM injections that take into account the vaccine recipient's weight, gender and age (refer to Table 3: Needle selection guidelines).
  • Filter needles are not recommended for vaccine administration as they may filter out active ingredients such as adjuvants.
  • When possible, consider an alternative injection site to an area where lymphatic drainage may be impaired.
  • There is no evidence or theoretical rationale for avoiding injection through a tattoo or superficial birthmark.
  • Immunization pain management strategies have now been provided for all ages (refer to Table 4: Immunization pain management strategies, by age groups).
2017-05 Timing of Vaccine Administration The chapter has been reviewed and a new table has been added: "Table 1: Minimum age and minimum intervals between vaccine doses in healthy children less than 18 years of age".
2017-04 Contents of Immunizing Agents Available for Use in Canada Information on the contents of immunizing agents (e.g., adjuvants, preservatives, etc.) has been moved from the Basic Immunology and Vaccinology chapter to this chapter.
2017-04 Basic Immunology and Vaccinology The chapter has been reviewed and updated with minor revisions.
2017-04 Cholera and Enterotoxigenic Escherichia coli (ETEC) Travellers' Diarrhea Vaccine This chapter has been reviewed and revised to align with the Statement on Travellers' Diarrhea from the Committee to Advise on Tropical Medicine and Travel (CATMAT).
2017-04 Typhoid Vaccine This chapter has been reviewed and revised to align with the Statement on International Travellers and Typhoid from the Committee to Advise on Tropical Medicine and Travel (CATMAT).
2017-04 Immunization of Travellers This chapter has been reviewed and revised to align with the updated chapters on Typhoid Vaccine and Cholera and Enterotoxigenic Escherichia coli (ETEC) Traveller's Diarrhea Vaccine.
2017-03 Hepatitis B

Updated recommendation: For immunocompromised individuals, initial annual monitoring of HB antibody levels may be considered.

Chapter(s) revised to reflect this change: Immunization of Immunocompromised Persons

Table 3: Recommended Dosages and Schedules for Hepatitis B-Containing Vaccines -The dosage of Recombivax HB® for infants (of HB-negative mothers) to children less than 11 years of age has been changed from 0.25mL to 0.5mL.

A footnote has been added to Table 3 to explain this change.

2017-03 Storage and Handling of Immunizing Agents The chapter has been reviewed and revised to align with the Public Health Agency of Canada's National Vaccine Storage and Handling Guidelines for Immunization Providers 2015
2016-11 Immunization of Immunocompromised Persons

An update has been made to the "Immunosuppressive therapy" section on immunizing infants following exposure to monoclonal antibodies during pregnancy or breastfeeding. Information regarding live rotavirus vaccine administration has been included in the updated content.

Chapter(s) revised to reflect this change: Diphtheria Toxoid, Herpes Zoster Vaccine, Rotavirus and Yellow Fever Vaccine.

2016-10 Pneumococcal vaccine New recommendation: On an individual basis, PNEU-C-13 vaccine may be recommended to immunocompetent adults aged 65 years and older not previously immunized against pneumococcal disease, for the prevention of community acquired pneumonia and invasive pneumococcal disease caused by the 13 pneumococcal serotypes included in the conjugate vaccine. When it is given, it should precede PNEU-P-23 vaccine.
2016-09 Influenza Vaccine Updated recommendation: The current evidence does not support a recommendation for the preferential use of LAIV in children and adolescents 2-17 years of age.
2016-09 Influenza Vaccine

New recommendation: egg allergic individuals may be vaccinated against influenza using the low ovalbumin-containing live attenuated influenza vaccine (LAIV) licensed for use in Canada.

Chapter(s) revised to reflect this change: Contraindications, Precautions and Concerns and Anaphylactic Hypersensitivity to Egg and Egg-Related Antigens

2016-05 Influenza Vaccine New product: Fluzone®High-Dose influenza vaccine has been approved for use in Canada in adults ≥65 years of age.
2016-05 Influenza Vaccine New recommendation: NACI now includes adults with neurologic or neurodevelopment conditions among the groups for whom influenza vaccination is particularly recommended.
2016-09 Hepatitis A vaccine

New recommendation: Hepatitis A (HA) vaccine may be administered to persons six months of age and older.

2016-09 Hepatitis A vaccine New recommendation: For post-exposure prophylaxis within 14 days of exposure of susceptible adults 60 years of age and older who are household or close contacts of a case, Ig may be provided in addition to HA vaccine.
2016-09 Hepatitis A vaccine New recommendation: Immunization with HA vaccine may be considered for all individuals receiving repeated replacement of plasma-derived clotting factors.
2016-09 Hepatitis A vaccine New recommendation: For post-exposure prophylaxis of susceptible individuals with chronic liver disease, Ig should be provided within 14 days of exposure in addition to HA vaccine.
2017-05 Human papillomavirus vaccine

New recommendation: HPV9 vaccine may be administered to immunocompetent males and females 9 to 14 years of age according to a 2-dose or 3-dose immunization schedule. The second dose of HPV9 vaccine in a 2-dose schedule should not be administered earlier than 24 weeks (6 months) following the first dose. Immunocompromised individuals should continue to receive a 3-dose immunization schedule, as previously recommended.

Chapter revised to reflect this change: Recommended Immunization Schedules

2016-07 Human papillomavirus vaccine New recommendation: Gardasil®9 (HPV9 vaccine) has recently been authorized for use in Canada for the prevention of HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58-related cancers and anogenital warts
2016-07 Human papillomavirus vaccine

New recommendation: Any of the currently authorized HPV vaccines in Canada can be used according to the recommended HPV immunization schedules

Chapter revised to reflect this change: Immunization of Adults

2017-04 Principles of Combination Vaccines The chapter has been reviewed and updated with minor revisions.
2016-09 Varicella vaccine

Updated recommendation: Susceptibility and Immunity section updated to provide further information about individuals who require immunization with varicella vaccine

Chapter(s) revised to reflect this change: Immunization of Workers

2016-09 Varicella vaccine Updated recommendation: Varicella immune globulin recommendations updated to allow for product administration up to 10 days since last exposure for the purpose of disease attenuation
2016-09 Varicella vaccine

A clarification on the minimum interval between two varicella-containing vaccines has been made in accordance with the information available in the Health Canada approved product monographs. NACI considers the minimum interval of 4 weeks to be acceptable in exceptional circumstances. If the second dose of varicella-containing vaccine is administered at an interval of less than 4 weeks, it should be repeated. NACI continues to recommend an interval between two varicella-containing vaccines of at least 3 months for children less than 13 years of age and 6 weeks for individuals 13 years of age and older.

Chapters revised to reflect this change: Timing of Vaccine Administration, Measles, Mumps

Table of updates (2012 - 2014)

Date Chapter Updates
2012-11 Herpes Zoster (shingles) vaccine

A herpes zoster vaccine has been authorized for use in adults aged 50 years and older.

2012-11 Herpes Zoster (shingles) vaccine

One dose of herpes zoster vaccine is recommended for adults over 60 years of age without contraindications to the vaccine.

2014-03 Herpes Zoster (shingles) vaccine

New recommendation: Herpes zoster (HZ) vaccine may be administered to individuals 50 years of age and older with a prior history of HZ disease with at least one year recommended following the last episode of HZ.

2014-03 Herpes Zoster (shingles) vaccine

New recommendation: In general, herpes zoster (HZ) vaccine should not be given to individuals with primary or acquired immune deficiency but may be administered to individuals on low dose immunosuppression.

2014-03 Herpes Zoster (shingles) vaccine

New recommendation: Herpes zoster (HZ vaccine) can be co-administered (using a different site) with pneumococcal vaccine.

2014-10 Human Papillomavirus (HPV) vaccine

New recommendation: HPV2 and HPV4 vaccines may be administered to non-immunocompromised, non-HIV infected, individuals 9-14 years of age as two separate 0.5 mL doses at months 0 and 6-12. A two dose schedule is also sufficient for individuals 15 years of age and older who received the first vaccine dose between 9-14 years when the second dose is administered at least 6 months after the first dose.

2012-11 Meningococcal vaccine

Recommendations for post-exposure immunoprophylaxis of close contacts of IMD who have been previously immunized have been provided.

2012-11 Meningococcal vaccine

Schedules (including booster doses) have been revised for high risk individuals as has the list of high risk individuals.

2014-10 Meningococcal vaccine

New product: A new quadrivalent conjugate meningococcal vaccine for serogroups A, C, Y, and W-135 (Men-C-ACYW-TT) has become available.

2014-10 Meningococcal vaccine

New product: A multi-component meningococcal vaccine (4CMenB) for serogroup B has become available.

2012-11 Pertussis vaccine

A new combination vaccine containing tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine (Tdap) has become available.

2012-11 Pertussis vaccine

Two new combination vaccines containing tetanus toxoid, reduced diphtheria toxoid, reduced acellular pertussis, and inactivated poliomyelitis vaccines (Tdap-IPV) have become available.

2012-11 Pertussis vaccine

A new combination vaccine containing diphtheria and tetanus toxoids, acellular pertussis, hepatitis B, inactivated poliomyelitis and Haemophilus influenzae type b vaccine (DTaP-HB-IPV-Hib) has become available for primary immunization of infants and young children.

2012-11 Pertussis vaccine

The combination vaccine containing diphtheria and tetanus toxoids, acellular pertussis, inactivated poliomyelitis and Haemophilus influenzae type b vaccine (DTaP-IPV-Hib) has become available in a pre-mixed format.

2012-11 Pertussis vaccine

A new recommendation for one dose of Tdap vaccine in adults, prioritizing adults who are in contact or anticipate contact with infants (e.g., parents, grandparents, childcare providers).

2012-11 Pertussis vaccine

One dose of combined diphtheria, tetanus, acellular pertussis containing vaccine (Tdap) can be offered to pregnant women (≥26 weeks of gestation) who have not been previously vaccinated against pertussis in adulthood.

2012-11 Pertussis vaccine

In special circumstances, such as a regional outbreak situation, immunization with Tdap may be offered to pregnant women (≥26 weeks of gestation) irrespective of their immunization.

2014-01 Pertussis vaccine

New recommendation: One dose of combined diphtheria, tetanus, acellular pertussis containing vaccine (Tdap) can be offered to pregnant women (≥26 weeks of gestation) who have not been previously vaccinated against pertussis in adulthood.

2014-01 Pertussis vaccine

New recommendation: In special circumstances, such as a regional outbreak situation, immunization with Tdap may be offered to pregnant women (≥26 weeks of gestation) irrespective of their immunization.

2012-11 Pneumococcal vaccine

Two new conjugate pneumococcal vaccines have become available: pneumococcal conjugate 10-valent (Pneu-C-10) and pneumococcal conjugate 13-valent (Pneu-C-13).

2012-11 Pneumococcal vaccine

Pneumococcal conjugate 7-valent (Pneu-C-7) vaccine is no longer available in Canada.

2012-11 Pneumococcal vaccine

Pneumococcal vaccination schedules have been updated.

2014-03 Pneumococcal vaccine

New recommendation: Individuals who required medical attention for asthma in the past 12 months should be vaccinated using the pneumococcal vaccine (conjugate vs. polysaccharide) and schedule recommended for their age group.

2014-03 Pneumococcal vaccine

New recommendation: PNEU-C-13 should be administered to adults with immunocompromising conditions.

2014-10 Pneumococcal vaccine

New recommendation: Adults 65 years or greater, regardless of risk factors, should receive one dose of Pneu-P-23 vaccine.

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