Canadian Immunization Guide: Table of updates

Table of updates (2024)

Date	Chapter	Updates
2024-05	Pneumococcal vaccines	This chapter was updated based on the following guidance from the National Advisory Committee on Immunization (NACI): May 3, 2024: Summary of updates in the Canadian Immunization Guide: Updated guidance on pneumococcal vaccines in Canada March 11, 2024: Recommendations for public health programs on the use of pneumococcal vaccines in children, including the use of 15-valent and 20-valent conjugate vaccines March 21, 2023: Interim guidance on the use of pneumococcal 15-valent conjugate vaccine (PNEU-C-15) in pediatric populations February 24, 2023: Public health level recommendations on the use of pneumococcal vaccines in adults, including the use of 15-valent and 20-valent conjugate vaccines For NACI recommendations for the prevention of invasive pneumococcal disease using Prevnar^®13 (PNEU-C-13) and the pneumococcal polysaccharide vaccine Pneumovax^®23 (PNEU-P-23), refer to the archived Pneumococcal vaccines chapter.
2024-04	Immunization in pregnancy and breastfeeding	This chapter was updated to incorporate guidance from the COVID-19 vaccines chapter, the smallpox and mpox (monkeypox) vaccines chapter, and the following National Advisory Committee on Immunization (NACI) statements: December 2023: Updated guidance on influenza vaccination during pregnancy September 2022: Updated guidance on COVID-19 vaccines for individuals who are pregnant and breastfeeding

Date

Chapter

Updates

2024-05

This chapter was updated based on the following guidance from the National Advisory Committee on Immunization (NACI):

May 3, 2024: Summary of updates in the Canadian Immunization Guide: Updated guidance on pneumococcal vaccines in Canada
March 11, 2024: Recommendations for public health programs on the use of pneumococcal vaccines in children, including the use of 15-valent and 20-valent conjugate vaccines
March 21, 2023: Interim guidance on the use of pneumococcal 15-valent conjugate vaccine (PNEU-C-15) in pediatric populations
February 24, 2023: Public health level recommendations on the use of pneumococcal vaccines in adults, including the use of 15-valent and 20-valent conjugate vaccines

For NACI recommendations for the prevention of invasive pneumococcal disease using Prevnar^®13 (PNEU-C-13) and the pneumococcal polysaccharide vaccine Pneumovax^®23 (PNEU-P-23), refer to the archived Pneumococcal vaccines chapter.

2024-04

Immunization in pregnancy and breastfeeding

This chapter was updated to incorporate guidance from the COVID-19 vaccines chapter, the smallpox and mpox (monkeypox) vaccines chapter, and the following National Advisory Committee on Immunization (NACI) statements:

December 2023: Updated guidance on influenza vaccination during pregnancy
September 2022: Updated guidance on COVID-19 vaccines for individuals who are pregnant and breastfeeding

Table of updates (2021 to 2023)

Date	Chapter	Updates
2023-12	COVID-19 vaccines	This chapter was updated to further reflect the authorization of Novavax Nuvaxovid XBB.1.5 vaccine.
2023-12	Influenza vaccines	This chapter was updated based on the following guidance from the National Advisory Committee on Immunization (NACI): December 18, 2023: Updated guidance on influenza vaccination during pregnancy
2023-12	COVID-19 vaccines	This chapter was updated based on the following guidance from the National Advisory Committee on Immunization (NACI): October 27, 2023: Updated guidance on the use of COVID-19 vaccines in individuals who have not previously been vaccinated against COVID-19
2023-10	COVID-19 vaccines	This chapter was updated based on the following guidance from the National Advisory Committee on Immunization (NACI): September 12, 2023: Addendum to the guidance on the use of COVID-19 vaccines in the fall of 2023 July 11, 2023: Guidance on the use of COVID-19 vaccines in the fall of 2023 June 9, 2023: Interim guidance on the use of bivalent Omicron-containing COVID-19 vaccines for primary series
2023-10	Herpes zoster (shingles) vaccine	This chapter was revised to reflect the discontinuation of Zostavax^®, the live-attenuated zoster vaccine (LZV), in 2023.
2023-09	Immunization of travellers	This chapter was updated to align with the Statement on the Use of Booster Doses of Yellow Fever Vaccine and the Statement on Prevention of Japanese Encephalitis, both developed by the Committee to Advise on Tropical Medicine and Travel (CATMAT). Additionally, a new section on COVID-19 vaccine has been added which includes recommendations based on the CATMAT Statement on COVID-19 and International Travel.
2023-09	Japanese encephalitis vaccine	Recommendations for use of Japanese Encephalitis (JE) vaccine have been updated based on the Committee to Advise on Tropical Medicine and Travel (CATMAT) Statement on Prevention of Japanese Encephalitis.
2023-09	Ebola virus vaccine	This new chapter was developed based on the following statements: March 2023: Ebola Disease Prevention, Monitoring and Surveillance Recommendations from the Committee to Advise on Tropical Medicine and Travel (CATMAT) February 2020: Interim Statement on the Use of the rVSVΔGZEBOV-GP Vaccine for the Prevention of Ebola Virus Disease Chapters revised to reflect these updates: Immunization of adults, Immunization of workers, Immunization in pregnancy and breastfeeding.
2023-07	Recommended immunization schedules	Clarifications were made to Table 5 to better align with information provided in Part 4 chapters.
2023-06	Smallpox and mpox (monkeypox) vaccine	The chapter was revised to align with the World Health Organization's preferred term of 'mpox' for monkeypox disease. Additionally, the "Safety and adverse events" section was updated to expand on the safety of Imvamune vaccine based on data from clinical trials.
2023-06	Immunization of Workers	This chapter was updated based on the following statement from the National Advisory Committee on Immunization (NACI): 23 September 2022: NACI Rapid Response: Updated interim guidance on Imvamune in the context of ongoing monkeypox outbreaks
2023-06	COVID-19 vaccine	This chapter was updated based on the following guidance from the National Advisory Committee on Immunization (NACI): Recommendations on the use of Moderna bivalent BA.1 and BA.4/5 as a booster dose in individuals 6 to 17 years of age Recommendations on the use of Novavax Nuvaxovid COVID-19 vaccine as a primary series in adolescents (12 to 17 years of age) Update to previous recommendations on the use of Novavax Nuvaxovid COVID-19 vaccine as a primary series and as a booster dose in adults (18 years of age and older) For additional information on these updates, including a list of selected references, refer to Summary of updates in the Canadian Immunization Guide as of June 27, 2023: Updated guidance on COVID-19 vaccines in Canada.
2023-05	Influenza vaccine	This chapter was developed based on the following statements from the National Advisory Committee on Immunization (NACI): May 31, 2023: Statement on seasonal influenza vaccine for 2023-2024 February 21, 2023: Recommendation on repeated seasonal influenza vaccination
2023-05	Vaccine administration practices	The section on “Route, site and technique for vaccine administration” was updated to expand on the administration of intradermal injections.
2023-04	Part 5: Passive Immunization	This chapter entitled "Part 5: Passive Immunization" has been removed from the Canadian Immunization Guide and the content has been moved elsewhere within the Guide. Information on standard immunoglobulin has been moved to the following chapters: Basic Immunology and Vaccinology Contents of Immunizing Agents Authorized for Use in Canada Hepatitis A Vaccine Measles Vaccine Information on specific immunoglobulins has been moved to the following chapters: Basic Immunology and Vaccinology Contents of Immunizing Agents Authorized for Use in Canada Diphtheria Toxoid Hepatitis B Vaccine Rabies Vaccine Smallpox and Monkeypox Vaccine Tetanus Toxoid Varicella (Chickenpox) Vaccine The information on botulism antitoxin and botulism immunoglobulin as well as the information on cytomegalovirus immunoglobulin has been moved to Table 2 in the Contents of Immunizing Agents Authorized for Use in Canada in Part 1.
2023-03	Respiratory syncytial virus	This new chapter was developed based on the statement, Recommended use of palivizumab to reduce complications of respiratory syncytial virus infection in infants from the National Advisory Committee on Immunization (NACI). This chapter replaces the Respiratory syncytial virus monoclonal antibody section in the former Part 5 Passive Immunization. Chapters revised to reflect these updates: Adverse events following immunization, Immunization of immunocompromised persons, Immunization of infants born prematurely, Immunization of patients in health care institutions, Immunization of persons with chronic diseases
2023-03	COVID-19 vaccine	This chapter was updated based on the following statement from the National Advisory Committee on Immunization (NACI): March 3, 2023: Guidance on an additional COVID-19 booster dose in the spring of 2023 for individuals at high risk of severe illness due to COVID-19 Additionally, the following content was added: Information on a Health Canada-authorized Moderna Spikevax Original & Omicron BA.1 (bivalent) booster dose for individuals 6 years of age and older. Previously, a booster dose had been authorized only for individuals 18 years of age and older.
2023-03	COVID-19 vaccine	This chapter was updated based on the statements from the National Advisory Committee on Immunization (NACI): January 20, 2023: Guidance on COVID-19 vaccine booster doses: Initial considerations for 2023 December 9, 2022: Updated recommendations on the use of COVID-19 vaccine booster doses in children 5 to 11 years of age and concurrent vaccine administration
2023-03	Yellow fever vaccine	March 2023: This chapter has been reviewed and revised to align with the Statement on the use of booster doses of yellow fever vaccine from the Committee to Advise on Tropical Medicine and Travel (CATMAT). Revisions to this chapter include: The section on epidemiology was updated to expand on affected areas and number of cases. International regulations no longer require proof of re-vaccination or a booster dose of yellow fever (YF) vaccine: a single dose confers lifelong immunity for most travellers. A booster dose is recommended for certain individuals. Refer to Booster doses and re-immunization for details. The proof of YF vaccination entered on the International certificate of vaccination or prophylaxis should notate the duration of validity as "For the lifetime of the person vaccinated" as suggested by the World Health Organization (WHO). YF vaccine is contraindicated in individuals with a past history of thymus disease with abnormal immune function (e.g., thymoma, thymectomy, myasthenia gravis). Previous guidance stated that YF vaccine was "generally not recommended". Chapter revised to reflect this update: Immunization of adults
2023-02	Contraindications and precautions	This chapter was updated with guidance on contraindications and precautions associated with allergies to a vaccine component or its container.
2023-02	Contents of immunizing agents authorized for use in Canada	This chapter was updated to align with changes made to: Canadian Immunization Guide chapter on influenza and statement on seasonal influenza vaccine for 2022-2023 COVID-19 Vaccine chapter in Part 4 Pneumococcal vaccine chapter in Part 4 The section on "Adjuvants" was updated to include two additional adjuvants: AS03 and Matrix M adjuvant used in COVIFENZ^® AND NUVAXOVID^TM COVID-19 vaccines, respectively
2023-02	Poliomyelitis vaccine	The chapter was updated to include information on circulating vaccine-derived poliovirus 2 (cVDPV2) outbreaks outside of Canada. Guidance on the immunization of individuals previously immunized with bivalent oral polio vaccine (bOPV) is provided. Chapters revised to reflect these updates: Immunization of persons new to Canada, immunization of travellers
2022-12	COVID-19 vaccine	This chapter was updated based on the following statements from the National Advisory Committee on Immunization (NACI): November 3, 2022: Recommendations on the use of Moderna Spikevax BA.4/5 bivalent mRNA (50 mcg) COVID-19 booster vaccine in adults October 21, 2022: Recommendations on the use of Pfizer-BioNTech Comirnaty (3 mcg) COVID-19 vaccine in children 6 months to 4 years of age The following additional update was also made: For individuals 6 months of age and older, COVID-19 vaccines may be given concurrently with (i.e., same day), or at any time before or after, non-COVID-19 vaccines (including live and non-live vaccines).
2022-12	Smallpox and monkeypox vaccine	This chapter was updated to reflect guidance based on current evidence and the National Advisory Committee on Immunization's (NACI's) expert opinion on the use of Imvamune^® in the context of monkeypox outbreaks in Canada. For this information, refer to the following: September 27, 2022: Quick reference guide on use of Imvamune^® for health care professionals in the context of monkeypox outbreaks in Canada September 23, 2022: NACI rapid response: Updated interim guidance on Imvamune^® in the context of ongoing monkeypox outbreaks June 10, 2022: NACI rapid response: Interim guidance on the use of Imvamune^® in the context of monkeypox outbreaks in Canada
2022-10	COVID-19 vaccine	This chapter was updated based on the following statements from the National Advisory Committee on Immunization (NACI): July 14, 2022: Recommendations on the use of Moderna Spikevax COVID-19 vaccine in children 6 months to 5 years of age August 19, 2022: Recommendations on the use of a first booster dose of Pfizer-BioNTech Comirnaty COVID-19 vaccine in children 5 to 11 years of age September 1, 2022: Recommendations on the use of bivalent Omicron-containing mRNA COVID-19 vaccines September 9, 2022: Updated guidance on COVID-19 vaccines for individuals who are pregnant or breastfeeding October 7, 2022: Updated guidance on COVID-19 vaccine booster doses in Canada
2022-08	COVID-19 vaccine	The following updates were made: Information on a Health Canada-authorized Pfizer-BioNTech Comirnaty booster dose to include individuals 16 years to 17 years of age. Previously, a booster dose had been authorized by Health Canada only for individuals 18 years of age and older.* Existing guidance on further doses of mRNA COVID-19 vaccines among individuals who have experienced myocarditis and/or pericarditis following vaccination has been extended to those 5 to 11 years of age.* Guidance was revised for COVID-19 vaccination and tuberculin skin testing (TST) or interferon gamma release assay (IGRA).* Table 5. Suggested intervals between previous SARS-CoV-2 infection and COVID-19 vaccination has been revised to reflect updated guidance on a 6 month interval between previous infection and a booster dose of COVID-19 vaccine (unless a shorter interval of 3 to <6 months is warranted in the context of heightened epidemiological risk). This is to align with the guidance from NACI's Interim guidance on planning considerations for a fall 2022 COVID-19 vaccine booster program in Canada. A new table (Table 6) Moderna Spikevax Dosing, has been added to the listing for Moderna Spikevax in order to assist in dosing given the new presentation of 0.10 mg/mL in a 2.5mL multidose vial (with a royal blue vial cap). Minor corrections were made under Preparations authorized for use in Canada to reflect that the authorization by interim order has expired for COVISHELD and therefore it is no longer authorized for use or available in Canada. The potential of cross-reactive hypersensitivity between polyethylene glycol [PEG] and polysorbate has been added to Contraindications and Precautions, Confirmed allergies to a component of a COVID-19 vaccine to align with Recommendations on the use of COVID-19 vaccines [2021-10-22], Recommendations on the use of Medicago COVID-19 vaccine (Covifenz) [2022-03-11] and Recommendations on the use of Novavax Nuvaxovid COVID-19 vaccine [2022-02-17]. References to Janssen COVID-19 vaccine were adjusted to Janssen Jcovden COVID-19 vaccine to align with the updated product monograph [2022-08-05]. For current product monographs please refer to Health Canada's Drug Product Database. *For additional information on these updates, including a list of selected references, refer to Summary of updates in the Canadian Immunization Guide as of August 29, 2022: Updated guidance on COVID-19 vaccines in Canada.
2022-06	COVID-19 vaccine	The following updates were made: Guidance on concurrent administration of COVID-19 vaccines and other vaccines for children 5 to 11 years of age was added to the Concurrent administration with other vaccines section. Guidance on the use of Evusheld (AstraZeneca) in the context of COVID-19 vaccination was added to the Blood products, human immunoglobulin and timing of immunization section. For additional information on these updates, including a list of selected references, refer to Summary of updates in the Canadian Immunization Guide as of June 21, 2022: Updated guidance on COVID-19 vaccines in Canada.
2022-06	Part 5 - Passive Immunization	June 2022: The content on respiratory syncytial virus (RSV) monoclonal antibody (palivizumab [SYNAGIS^®) has been removed from this chapter. For information on the use of palivizumab, refer to the National Advisory Committee on Immunization (NACI) Statement on Recommended use of palivizumab to reduce complications of respiratory syncytial virus infection in infants.
2022-06	COVID-19 vaccine	This chapter was updated based on the following statements from the National Advisory Committee on Immunization (NACI): March 11, 2022: Recommendations on the use of Medicago COVID-19 vaccine (Covifenz) March 17, 2022: Recommendations on the use of Moderna Spikevax COVID-19 vaccine in children 6 to 11 years of age April 5, 2022: Initial guidance on a second booster dose of COVID-19 vaccines in Canada April 12, 2022: Updated guidance on a first booster dose of COVID-19 vaccines in Canada The following additional updates were also made: Guidance on the interval between multisystem inflammatory syndrome in adults (MIS-A) and COVID-19 vaccination was added to Table 5 and the Precautions section. This guidance aligns with the previously-noted guidance on the interval between multisystem inflammatory syndrome in children (MIS-C) and COVID-19 vaccination. Information on a Health Canada authorized Janssen booster dose. A revised list of those considered to be moderately to severely immunocompromised in the Immunocompromised Persons section. Guidance on the re-vaccination with mRNA COVID-19 vaccines for those with thrombosis with thrombocytopenia syndrome (TTS) following vaccination with viral vector COVID-19 vaccines in the Contraindications section. For additional information on these updates, including a list of selected references, refer to Summary of updates in the Canadian Immunization Guide as of June 3, 2022: Updated guidance on COVID-19 vaccines in Canada.
2022-05	Hepatitis B vaccine	May 2022 - Erratum: The footnotes in Figure 1: Management of Individuals with Percutaneous or Mucosal Exposure to an Infected or High-Risk Source and the accompanying text description for the figure have been revised to align with the corresponding figure in Protocole d'immunisation du Québec, 5^e édition (2009) from which it was adapted.
2022-05	Immunization of persons with chronic diseases	This chapter has been reviewed and updated with revisions, such as: The section on "Autoimmune conditions" has been updated to expand on recommended vaccines for individuals with autoimmune conditions. Individuals with an autoimmune condition should receive any indicated live vaccines as early as possible, as live vaccines will be contraindicated if immunosuppressive therapy is later needed. Indicated non-live vaccines should also be given. The section on "Endocrine and metabolic diseases" has been revised to include the contraindication for yellow fever vaccine in individuals with thymus disease associated with abnormal thymus function. The section on "Bleeding disorders" has been updated with post-injection considerations for individuals with bleeding disorders and individuals receiving long-term anticoagulation therapy. New sections for chapter revision methodology and acknowledgements were added.
2022-05	Immunization of immunocompromised persons	The chapter was updated to include guidance on vaccination with COVID-19 vaccines for individuals pre- and post-hematopoietic stem cell transplantation (HSCT) and for chimeric antigen receptor (CAR) T cell therapy recipients.
2022-04	COVID-19 vaccine	This chapter was updated with the following content: Table 2. Immunization schedule for a primary series for moderately to severely immunocompromised individuals, by COVID-19 vaccine has been updated to include Novavax Nuvaxovid COVID-19 vaccine
2022-04	Immunization of persons new to Canada	This chapter was updated to include a new section on COVID-19 vaccine with recommendations for individuals planning to live, work or study in Canada who have received 1 or 2 doses of a non-Health Canada authorized vaccine.
2022-03	COVID-19 vaccine	This chapter was updated based on the following statement from the National Advisory Committee on Immunization (NACI): February 17, 2022: Recommendations on the use of Novavax Nuvaxovid COVID-19 vaccine
2022-03	COVID-19 vaccine	This chapter was updated based on the following statements from the National Advisory Committee on Immunization (NACI): February 4, 2022: NACI rapid response: Updated guidance on COVID-19 vaccination timing for individuals previously infected with SARS-CoV-2 January 28, 2022: NACI rapid response: Guidance on the use of booster COVID-19 vaccine doses in adolescents 12 to 17 years of age January 25, 2022: NACI updated recommendations on the use of COVID-19 vaccines in children 5 to 11 years of age Following consultation with HIV experts, NACI has updated the suggested list of conditions for children 5 to 11 years of age to be considered moderately to severely immunocompromised, for the purposes of a 3-dose primary series.
2022-01	COVID-19 vaccine	This chapter was updated based on the following statements from the National Advisory Committee on Immunization (NACI): Recommendation on the use of the Pfizer-BioNTech COVID-19 vaccine (10mcg) in children 5 to11 years of age Rapid response: Updated recommendation on the use of authorized COVID-19 vaccines in individuals aged 12 years and older in the context of myocarditis and pericarditis reported following mRNA COVID-19 vaccines Guidance on booster COVID-19 vaccine doses in Canada: Update December 3, 2021 Summary of NACI advice from January 14, 2022: Vaccination with COVID-19 vaccines following myocarditis (with or without pericarditis) The COVID-19 vaccine recommendations section for "Individuals previously infected with SARS-CoV-2" has been updated and additional information provided in the rationale and evidence. Additionally, the "Vaccine safety and adverse events" and "Precautions" sections were updated to reflect: Updates to the product monographs of Pfizer Cominarty and Moderna Spikevax COVID-19 vaccines regarding Bell's palsy. Updates to the product monographs of Janssen and AstraZeneca Vaxzevria COVID-19 vaccines regarding immune thrombocytopenia (ITP) and venous thromboembolism (VTE).
2021-12	COVID-19 vaccine	This new chapter was developed based on the Recommendations on the use of COVID-19 vaccines and the Interim guidance on booster COVID-19 vaccine doses in Canada statements from the National Advisory Committee on Immunization (NACI).
2021-11	Hepatitis A vaccine	The immunoglobulin dosage for Hepatitis A pre-exposure and post-exposure prophylaxis was increased based on the Product Monograph update for GamaSTAN^®which is available on Health Canada's Drug Product Database. Chapter revised to reflect this change: Passive Immunization
2021-11	Typhoid vaccine	A change has been made in the "Drug-drug and drug-food interactions" sub-section regarding the interval between the oral typhoid vaccine and certain antibiotics and antimalarials. Chapter revised to reflect this change: Contraindications and Precautions
2021-11	Contraindications and Precautions	This chapter was completely reviewed with several revisions that include: Content on addressing concerns about immunization has been removed from this chapter. Refer to the "Communicating effectively about immunization" chapter in Part 1 for this information. The "Anaphylactic hypersensitivity to egg and egg-related antigens" chapter has been removed from the guide and the content has been included in this revision of the Contraindications & precautions chapter under the Allergies section. When administering a parenteral vaccine to persons with a bleeding disorder or on anticoagulants use a 23 gauge or smaller needle; apply firm pressure to the injection site for ≥ 2 minutes. Previous guidance was to apply pressure to the injection site for 5 to 10 minutes. For individuals with a past history of thymus disease with abnormal immune function (e.g., thymoma, thymectomy, myasthenia gravis), Yellow fever (YF) vaccine is contraindicated because of an increased risk of viscerotropic disease. Previous guidance stated that the YF vaccine was "generally not recommended". Chapters revised to reflect this change: Immunization of Persons with Chronic Diseases, Yellow Fever Vaccine
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 to 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: during serogroup B meningococcal disease outbreaks or with the emergence of hyperendemic Neisseria meningitidis strains that are predicted to be susceptible to the vaccine; for individuals who are close contacts with a case of invasive meningococcal disease caused by serogroup B Neisseria meningitidis; for individuals with underlying medical conditions that would put them at higher risk of meningococcal disease than the general population; or 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 to 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 revised to reflect this change: Contraindications and Precautions
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 to 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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Date modified:: 2024-05-03

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