Canadian immunization guide: Table of updates

Table of updates (2018 - present)

Table of Updates (2018 Present)
Chapter Updates Date
Meningococcal Vaccine

The chapter has been updated with minor revisions:

Vaccine administration:

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

Detailed contents related to immunocompromise are now featured in Immunization of immunocompromised persons.

Updated recommendation: Hematopoietic stem cell transplantation recipients should be viewed as "never immunized". Two doses of MMR and varicella or MMRV vaccine are recommended 24 months post-HSCT (instead of 1 dose). Serology is recommended after the 2nd dose. Refer to Table 3 for associated contraindications and precautions.

2018-July
Immunization of immunocompromised persons

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
2018-May
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-August
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

2018-March

Table of updates (2015-2017)

Table of updates (2015-2017)
Chapter Updates Date
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-November
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-May
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-April
Basic Immunology and Vaccinology

The chapter has been reviewed and updated with minor revisions.

2017-April
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-April
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-April
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-April
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-March

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

2017-March
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-November
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-October
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-September
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-September
Influenza Vaccine

New product: Fluzone®High-Dose influenza vaccine has been approved for use in Canada in adults ≥65 years of age.

2016-May
Influenza Vaccine

New recommendation: NACI now includes adults with neurologic or neurodevelopment conditions among the groups for whom influenza vaccination is particularly recommended.

2016-May
Hepatitis A vaccine

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

2016-September
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-September
Hepatitis A vaccine New recommendation: Immunization with HA vaccine may be considered for all individuals receiving repeated replacement of plasma-derived clotting factors. 2016-September
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. 2016-September
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
2017-May
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-July
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

2016-July
Principles of Combination Vaccines The chapter has been reviewed and updated with minor revisions. 2017-April
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-September
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-September
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

2016-September

Table of updates (2012-2014)

Table of updates (2012-2014)
Chapter Updates Date
Herpes Zoster (shingles) vaccine

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

2012-November
Herpes Zoster (shingles) vaccine

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

2012-November
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-March
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-March
Herpes Zoster (shingles) vaccine

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

2014-March
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.

2014-October
Meningococcal vaccine

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

2012-November
Meningococcal vaccine

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

2012-November
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-October
Meningococcal vaccine

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

2014-October
Pertussis vaccine

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

2012-November
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-November
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-November
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-November
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-November
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-November
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.

2012-November
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-January
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.

2014-January
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-November
Pneumococcal vaccine

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

2012-November
Pneumococcal vaccine

Pneumococcal vaccination schedules have been updated.

2012-November
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-March
Pneumococcal vaccine

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

2014-March
Pneumococcal vaccine

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

2014-October
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