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Canadian Immunization Guide: Table of updates

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Table of updates (2024 to present)

Date Chapter Updates
2025-04 Pneumococcal vaccines

This chapter was updated based on the following guidance from the National Advisory Committee on Immunization (NACI):
2025-04 Respiratory syncytial virus (RSV) vaccines

This chapter was updated based on the following guidance from the National Advisory Committee on Immunization (NACI):
2025-04 Measles vaccines

This chapter was updated based on the following statement from the National Advisory Committee on Immunization (NACI):
2025-03 Meningococcal vaccines The chapter has been updated to align with the Summary of updates in the Canadian Immunization Guide as of March 31, 2025: Updated guidance on quadrivalent conjugate meningococcal vaccines available in Canada.
2025-02 Rabies vaccines

The chapter was updated to clarify bat exposure (i.e., when there has been direct contact between a person and a bat, or, much less commonly, when saliva from the bat enters into an open wound or mucous membrane).
2025-02 COVID-19 vaccines

This chapter was updated based on the following guidance from the National Advisory Committee on Immunization (NACI):
2024-12 Poliomyelitis (polio) vaccines The chapter was updated to provide clarification on guidance on the immunization of individuals previously immunized with bivalent oral polio vaccine (bOPV).
2024-11 Smallpox and mpox vaccines

This chapter was updated to include a new recommendation issued by the Public Health Agency of Canada, recommending immunization with Imvamune® for Canadian healthcare professionals in advance of deployment to support the mpox clade I outbreak in countries where there is a level 2 travel health notice for mpox.

Chapters revised to reflect these changes: Immunization of Travellers and Immunization of Workers.
2024-11 Japanese encephalitis vaccine

The Booster doses and re-immunization section has been updated with new guidance from the Committee to Advise on Tropical Medicine and Travel (CATMAT):

Chapter revised to reflect these changes: Immunization of travellers
2024-11 Immunization of immunocompromised persons

This chapter was updated to incorporate guidance from the COVID-19 vaccines and Pneumococcal vaccines chapters in Part 4 and the following statements from the National Advisory Committee on Immunization (NACI):
2024-10 Basic immunology and vaccinology This chapter has undergone a complete update to reflect current insights in the evolving fields of immunology and vaccinology. Building upon the foundational concepts previously introduced in the chapter, this update aims to capture the current state of understanding and provide general information on emerging research areas within these domains.
2024-10 Pneumococcal vaccines

Erratum: In the Hematopoietic stem cell transplantation (HSCT) section, the following change has been made:

"Pneumococcal vaccination should be started at 3 to 9 months after HSCT with 3 doses of Pneu-C-20 vaccine administered at least 4 weeks apart, followed by 1 dose of Pneu-C-20 vaccine 12 to 18 months post-transplant (6 to 12 months after the last dose of Pneu-C-20 vaccine) or when the HSCT recipient reaches 2 years of age."

The segment "…or when the HSCT recipient reaches 2 years of age" has been deleted from this recommendation. This was a remnant of an earlier pneumococcal vaccine recommendation relating to PPV23. The 2-year age restriction should not apply to the conjugate vaccine.
2024-09 COVID-19 vaccines

This chapter was updated based on the following guidance from the National Advisory Committee on Immunization (NACI):
2024-09 Smallpox and mpox vaccines

This chapter was updated based on the following statement from the National Advisory Committee on Immunization (NACI):
2024-08 Respiratory syncytial virus (RSV) vaccines

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

Chapters revised to reflect these changes: Immunization of adults, Immunization of patients in health care institutions, Immunization of persons with chronic diseases and Recommended immunization schedules.
2024-07 Influenza vaccines

This chapter was updated based on the following guidance from the National Advisory Committee on Immunization (NACI):
2024-07 Human papillomavirus (HPV) vaccines

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

New recommendations:

  • Individuals 9 to 20 years of age, unless immunocompromised, should receive 1 dose of HPV vaccine.
  • Individuals 21 to 26 years of age, unless immunocompromised, should receive 2 doses of HPV vaccine.
  • Individuals 27 years of age and older, unless immunocompromised, may receive a 2-dose schedule of the HPV vaccine with shared decision making and discussion with a healthcare provider.
  • HPV vaccine can be offered in pregnancy. Routine questioning about last menstrual period and/or pregnancy is not required or recommended before offering HPV vaccine.
  • Nonavalent 9vHPV vaccine should be used as it provides protection against the greatest number of HPV types and associated diseases.

Chapters revised to reflect these changes: Principles of vaccine interchangeability, Timing of vaccine administration, Immunization of adults and Immunization in pregnancy and breastfeeding
2024-06 Respiratory syncytial virus (RSV)

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

Chapters revised to reflect these changes: Immunization of infants born prematurely, Immunization in pregnancy and breastfeeding, Immunization of persons with chronic diseases, Varicella (chickenpox) vaccines, Blood products, human immunoglobulin and timing of immunization and Recommended immunization schedules.
2024-06 COVID-19 vaccines This chapter was updated based on the following guidance from the National Advisory Committee on Immunization (NACI): Additional edits were made:
2024-05 Meningococcal vaccines This chapter has been updated to align with the National Advisory Committee on Immunization (NACI) update on invasive meningococcal disease (IMD) epidemiology and program-relevant considerations for preventing IMD in individuals at high risk of exposure (CCDR).
2024-05 Pneumococcal vaccines

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

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.

Chapters revised to reflect these changes: Immunization of persons with chronic diseases, Immunization of infants born prematurely, Recommended immunization schedules, Immunization of adults, Immunization in pregnancy and breastfeeding and Timing of vaccine administration.
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:

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):
2023-12 COVID-19 vaccines

This chapter was updated based on the following guidance from the National Advisory Committee on Immunization (NACI):
2023-10 COVID-19 vaccines

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

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:

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):
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):
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:

Information on specific immunoglobulins has been moved to the following chapters:

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):

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):
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:
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):

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:
2022-10 COVID-19 vaccine

This chapter was updated based on the following statements from the National Advisory Committee on Immunization (NACI):
2022-08 COVID-19 vaccine

The following updates were made:

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):

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, 5e 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:
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):
2022-03 COVID-19 vaccine

This chapter was updated based on the following statements from the National Advisory Committee on Immunization (NACI):
2022-01 COVID-19 vaccine

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

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:

  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 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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