Vaccination Coverage Goals and Vaccine Preventable Disease Reduction Targets by 2025

As part of the National Immunization Strategy objectives for 2016-2021, vaccination coverage goals and vaccine preventable disease reduction targets were set based on international standards and best practices. The goals and targets are consistent with Canada’s commitment to World Health Organization (WHO) disease elimination targets and Global Vaccine Action Plan, while reflecting the Canadian context.

Table of Contents

Vaccination Coverage Goals by 2025

Vaccination coverage goals were developed for infants, childhood, adolescent and adult vaccines that are publically funded in all provinces and territories (PT). Progress toward the national vaccination coverage goals will be reported based on the data collected using national coverage surveys. Vaccine coverage monitoring at the national level takes into account variations in PT vaccination programs.

Infants and Children

To ensure children are protected through routine vaccination, a high vaccination coverage goal of 95% has been established for all childhood vaccines by two and seven years of age.  

This level of vaccination coverage is based on the level of population protection required for measles, the most easily-spread vaccine preventable disease. 

Achieve 95% vaccination for the first three doses of the pertussis vaccine for infants

The majority of hospitalizations due to pertussis occur in infants under one year of age.  The first three doses of the vaccine are highly effective in preventing death. Specific vaccination goals have been set for infants under one year of age. 

First dose of pertussis vaccine by three months of age
Baseline:
In 2013, 87% of Canadian two-year-old children had their first dose of pertussis vaccine before turning three months.
Target:
95%
Data sources:
Childhood National Immunization Coverage Survey 2013, 2015: unpublished data
Figure 1 - Percentage of two-year-old children having received their first dose of pertussis vaccine before turning three months
Text description: Figure 1
Percentage of two-year-old children having received their first dose of pertussis vaccine before turning three months
% vaccinated Year 2025 goal of percent vaccinated
87.0 2013 95
87.3 2015 95
Three doses of pertussis vaccine by seven months of age
Baseline:
In 2013, 70% of Canadian two-year-old children had three doses of pertussis vaccine before turning seven months.
Target:
95%
Data sources:
Childhood National Immunization Coverage Survey 2013, 2015:  unpublished data
Figure 2 - Percentage of two-year-old children having received three doses of pertussis vaccine before turning seven months
Text description: Figure 2
Percentage of two-year-old children having received three doses of pertussis vaccine before turning seven months
% vaccinated Year 2025 goal of percent vaccinated
70.0 2013 95
71.9 2015 95
Three doses of pertussis vaccine by one year of age
Baseline:
In 2013, 86% of Canadian two-year-old children had three doses of pertussis vaccine before turning 12 months.
Target:
95%
Data sources:
Childhood National Immunization Coverage Survey 2013, 2015:  unpublished data
Figure 3 - Percentage of two-year-old children having received three doses of pertussis vaccine before turning twelve months
Text description: Figure 3
Percentage of two-year-old children having received three doses of pertussis vaccine before turning twelve months
% vaccinated Year 2025 goal of percent vaccinated
86.0 2013 95
87.1 2015 95

Achieve 95% vaccination coverage by two years of age for the following childhood vaccines:

Four doses of diphtheria, tetanus, pertussis and Haemophilius influenzae type B (Hib) vaccine
Baseline:
In 2013, 77% of Canadian two-year-old children had four doses of diphtheria, tetanus, pertussis and Hib vaccine before their second birthday.
Target:
95%
Data sources:

2013 Vaccine coverage in Canadian children; 2015 Vaccine Uptake in Canadian Children

Figure 4 - Percentage of children having received four doses of diphtheria, tetanus, pertussis and Haemophilius influenzae type B (Hib) vaccine by their second birthday
Text description: Figure 4
Percentage of children having received four doses of diphtheria, tetanus, pertussis and Haemophilius influenzae type B (Hib) vaccine by their second birthday
% vaccinated Year 2025 goal of percent vaccinated
76.6 2013 95
76.9 2015 95
Three doses of polio vaccine
Baseline:
In 2013, 91% of Canadian two-year-old children had three doses of polio vaccine before their second birthday.
Target:
95%
Data sources:

2013 Vaccine coverage in Canadian children; 2015 Vaccine Uptake in Canadian Children

Figure 5 - Percentage of children having received three doses of polio vaccine by their second birthday
Text description: Figure 5
Percentage of children having received three doses of polio vaccine by their second birthday
% vaccinated Year 2025 goal of percent vaccinated
90.9 2013 95
91.2 2015 95
Three doses of hepatitis B vaccine among children targeted in publicly-funded programs  
Baseline:
In 2013, 74% of two-year-old children had three doses of hepatitis B vaccine before their second birthday
Target:
95%
Data sources:

2013 Vaccine coverage in Canadian children; 2015 Vaccine Uptake in Canadian Children

Notes:

Measured in provinces and territories where this vaccine is given to infants. In other jurisdictions, it is given at school.

High vaccination coverage is required to support the WHO goal of eliminating viral hepatitis by 2030.

Figure 6 - Percentage of children having received three doses of hepatitis B vaccine by their second birthday
Text description: Figure 6
Percentage of children having received three doses of hepatitis B vaccine by their second birthday
% vaccinated Year 2025 goal of percent vaccinated
73.5 2013 95
69.2 2015 95
One dose of measles, mumps, and rubella vaccine
Baseline:
In 2013, 90% of Canadian two-year-old children had their first dose of measles, mumps and rubella vaccine before their second birthday.
Target:
95%
Data sources:

2013 Vaccine coverage in Canadian children; 2015 Vaccine Uptake in Canadian Children

Figure 7 - Percentage of children having received one dose of measles, mumps and rubella vaccine by their second birthday
Text description: Figure 7
Percentage of children having received one dose of measles, mumps and rubella vaccine by their second birthday
% vaccinated Year 2025 goal of percent vaccinated
89.4 2013 95
88.9 2015 95
One dose of varicella vaccine
Baseline:
In 2013, at least 73% of Canadian two-year-old children had their first dose of varicella vaccine before their second birthday.
Target:
95%
Data sources:

2013 Vaccine coverage in Canadian children; 2015 Vaccine Uptake in Canadian Children

Notes:
Due to an issue with data collection, varicella vaccination was underreported in previous cNICS cycles. This issue will be corrected for cNICs 2017 onwards.
Figure 8 - Percentage of children having received one dose of varicella vaccine by their second birthday
Text description: Figure 8
Percentage of children having received one dose of varicella vaccine by their second birthday
% vaccinated Year 2025 goal of percent vaccinated
73.2 2013 95
74.8 2015 95
Three or four doses of pneumococcal vaccine  
Baseline:
In 2013, 79% of Canadian two-year-old children had the recommended number of doses of pneumococcal vaccine before their second birthday.
Target:
95%
Data sources:

2013 Vaccine coverage in Canadian children; 2015 Vaccine Uptake in Canadian Children

Notes:
Three or four doses, depending on province or territory
Figure 9 - Percentage of children having received the recommended number of doses of pneumococcal vaccine by their second birthday
Text description: Figure 9
Percentage of children having received the recommended number of doses of pneumococcal vaccine by their second birthday
% vaccinated Year 2025 goal of percent vaccinated
79.2 2013 95
80.3 2015 95
One dose of meningococcal C vaccine
Baseline:
In 2013, 89% of Canadian two-year-old children had at least one dose of meningococcal C vaccine before their second birthday.
Target:
95%
Data sources:

2013 Vaccine coverage in Canadian children; 2015 Vaccine Uptake in Canadian Children

Figure 10 - Percentage of children having received one dose of meningococcal C vaccine by their second birthday
Text description: Figure 10
Percentage of children having received one dose of meningococcal C vaccine by their second birthday
% vaccinated Year 2025 goal of percent vaccinated
88.7 2013 95
87.8 2015 95

Achieve 95% vaccination coverage by seven years of age for the following childhood vaccines:

Five doses of diphtheria, tetanus and pertussis vaccine
Baseline:
In 2013, 71% of Canadian seven-year-old children had five doses of diphtheria, tetanus and pertussis vaccine before their seventh birthday.
Target:
95%
Data sources:

2013 Vaccine coverage in Canadian children; 2015 Vaccine Uptake in Canadian Children

Notes:
Outbreaks of pertussis occur during school-age; therefore, an additional dose before school entry is important.
Figure 11 - Percentage of children having received five doses of diphtheria, tetanus and pertussis vaccine by their seventh birthday
Text description: Figure 11
Percentage of children having received five doses of diphtheria, tetanus and pertussis vaccine by their seventh birthday
% vaccinated Year 2025 goal of percent vaccinated
71.4 2013 95
74.6 2015 95
Four doses of polio vaccine  
Baseline:
In 2013, 90% of Canadian seven-year-old children had four doses of polio vaccine before their seventh birthday.
Target:
95%
Data sources:

2013 Vaccine coverage in Canadian children; 2015 Vaccine Uptake in Canadian Children

Figure 12 - Percentage of children having received four doses of polio-containing vaccine by their seventh birthday
Text description: Figure 12
Percentage of children having received four doses of polio-containing vaccine by their seventh birthday
% vaccinated Year 2025 goal of percent vaccinated
85.9 2013 95
90.2 2015 95
Two doses of measles, mumps, and rubella vaccine
Baseline:
In 2013, 85% of Canadian seven-year-old children had two doses of measles, mumps, and rubella vaccine before their seventh birthday.
Target:
95%
Data sources:

2013 Vaccine coverage in Canadian children; 2015 Vaccine Uptake in Canadian Children

Figure 13 - Percentage of children having received two doses of measles, mumps and rubella vaccine by their seventh birthday
Text description: Figure 13
Percentage of children having received two doses of measles, mumps and rubella vaccine by their seventh birthday
% vaccinated Year 2025 goal of percent vaccinated
85.1 2013 95
86.2 2015 95

Adolescents

The vaccine coverage goal of 90% for all adolescent vaccines is based on disease reduction targets, program impact, disease characteristics, achievability, and jurisdictional variation in vaccination programs as well as quality of and effectiveness of vaccine.

Achieve 90% vaccination coverage by 17 years of age for the following adolescent vaccines:

One dose of meningococcal vaccine
Baseline:
Not available
Target:
90%
Data sources:
Meningococcal vaccine in adolescents will be measured starting in the 2017 cNICS.
Notes:
The strain of meningococcal vaccine administered varies by provincial/territorial program.
One or more doses of hepatitis B vaccine among adolescents
Baseline:
In 2013, 88% of Canadian 17-year-old adolescents had at least one dose of hepatitis B vaccine.
Target:
90%
Data sources:

2013 Vaccine coverage in Canadian children; 2015 Vaccine Uptake in Canadian Children

Notes:

cNICs report at age 14: if parent recalled child ever having received a dose.

High vaccination coverage is required to support the WHO goal of eliminating viral hepatitis by 2030 (WHO Global Health Sector Strategy).

Figure 14 - Percentage of 17-year-old adolescents having received at least one dose of hepatitis B vaccine
Text description: Figure 14
Percentage of 17-year-old adolescents having received at least one dose of hepatitis B vaccine
% vaccinated Year 2025 goal of percent vaccinated
87.9 2013 90
88.1 2015 90
Two or more doses of human papillomavirus vaccine (HPV)
Baseline:
In 2013, 73% of Canadian 12-14 year-old girls had at least one dose of HPV vaccine.
Target:
90%
Data sources:

2013 Vaccine coverage in Canadian children; 2015 Vaccine Uptake in Canadian Children

Notes:

cNICs report at age 14: if parent recalled child ever having received a dose.

The age group measured over the years has changed therefore data cannot be compared over time.

Figure 15 - Percentage of 12-14-year-old girls having received at least one dose of HPV vaccine
Text description: Figure 15
Percentage of 12-14-year-old girls having received at least one dose of HPV vaccine
% vaccinated Year 2025 goal of percent vaccinated
73.1 2013 90
74.6 2015 90
One dose of tetanus-diphtheria-pertussis booster vaccine (Tdap)
Baseline:
Not Available
Target:
90%
Data sources:
Starting in 2017, cNICs will determine the percentage of adolescents having received one dose of Tdap between their 14th and 16th birthday.
Notes:
Until cNICs 2015, the survey determined the percentage of children having received 6 doses of diphtheria, pertussis, and tetanus antigens.

Adults

The following vaccination coverage goals for adults were established because of the importance of protecting Canadians at high risk for infection and medical complications.

Increase vaccination coverage for the following adult vaccines:

Achieve 80% vaccination coverage (one dose) of a pneumococcal vaccine among adults 65 years of age and older.
Baseline:
In 2014, 37% of Canadian seniors (aged 65 years or older) had been vaccinated with one dose of a pneumococcal vaccine.
Target:
80%
Data sources:
Vaccine uptake in Canadian adults: results from the 2014 adult National Immunization Coverage Survey (aNICs)
Figure 16 - Percentage of adults 65 years of age and older having received one dose of a pneumococcal vaccine
Text description: Figure 16
Percentage of adults 65 years of age and older having received one dose of a pneumococcal vaccine
% vaccinated Year 2025 goal of percent vaccinated
37 2014 80
42 2016 80
Achieve 90% coverage (one dose) of hepatitis B vaccine among healthcare professionals.
Baseline:
In 2014, 91% of Canadian healthcare workers had been vaccinated for hepatitis B.
Target:
90%
Data sources:
Vaccine uptake in Canadian adults: results from the 2014 adult National Immunization Coverage Survey (aNICs)
Figure 17 - Percentage of healthcare workers having received one dose of a hepatitis B vaccine
Text description: Figure 17
Percentage of healthcare workers having received one dose of a hepatitis B vaccine
% vaccinated Year 2025 goal of percent vaccinated
94 2014 90
91 2016 90

Seasonal Influenza Vaccination Coverage Goals

A vaccination coverage goal of 80% with the seasonal influenza vaccine has been established based on the importance of protecting Canadians at high-risk for influenza-related complications or hospitalizations. This goal also reflects the importance of the influenza vaccine as a component of comprehensive infection control practices to protect healthcare professionals and patients from getting influenza.

Increase vaccination coverage for the seasonal influenza vaccine for the following groups:

Achieve 80% vaccination coverage among adults aged 65 years and older.
Baseline:
For the 2015/2016 influenza season, 65% of adults aged 65 years and older have been vaccinated.
Target:
80%
Data sources:
Influenza vaccine uptake: Results from the 2015/16 national influenza immunization coverage survey in Canada; 2016/17 Seasonal Influenza Vaccine Coverage in Canada
Figure 18 - Percentage of adults aged 65 years and older vaccinated with seasonal influenza  vaccine
Text description: Figure 18
Percentage of adults aged 65 years and older vaccinated with seasonal influenza vaccine
% vaccinated Year 2025 goal of percent vaccinated
64.6 2015/16 80
69.5 2016/17 80
Achieve 80% vaccination coverage among adults aged 18-64 years with chronic medical conditions.
Baseline:
For the 2015/2016 influenza season, 37% of adults aged 18 to 64 years with a chronic medical condition have been vaccinated.
Target:
80%
Data sources:
Influenza vaccine uptake: Results from the 2015/16 national influenza immunization coverage survey in Canada; 2016/17 Seasonal Influenza Vaccine Coverage in Canada
Notes:
Chronic medical conditions are based on the 2016/17 Seasonal Influenza (Flu) Vaccine Coverage in Canada.
Figure 19 - Percentage of adults aged 18 to 64 years with chronic medical condition(s) vaccinated with seasonal influenza vaccine
Text description: Figure 19
Percentage of adults aged 18 to 64 years with chronic medical condition(s) vaccinated with seasonal influenza vaccine
% vaccinated Year 2025 goal of percent vaccinated
37.2 2015/16 80
37 2016/17 80
Achieve 80% vaccination coverage among health care professionals.
Baseline:
Not Available  
Target:
80%
Data sources:
Will be reported in 2018

Vaccine Preventable Disease Reduction Targets by 2025

Diseases under elimination: Maintain elimination status

Maintain zero cases of polio in Canada.

2015 Baseline (range 2011-2015):
0 cases
Target:
0 cases
Rationale:
Polio is expected to be globally eradicated before 2025.
Data sources:

Notifiable Diseases online

Vaccine Preventable Disease Surveillance Report to December 31, 2015

Notes:
The last Canadian acquired case of wild polio was in 1996 (asymptomatic).

Maintain the elimination of endemic measles in Canada.

2015 Baseline (range 2011-2015):
0 endemic cases
Target:
0 endemic cases
Rationale:

Endemic measles has been eliminated from Canada since 1998 and in the Region of the Americas since 2016. 

The World Health Assembly has endorsed the Global Vaccine Action Plan with the objective to eliminate measles in 5 WHO Regions by 2020.

Data sources:

Surveillance of measles

Vaccine Preventable Disease Surveillance Report to December 31, 2015

Notes:

Measles elimination is defined as an interruption of endemic measles virus transmission for a period ≥12 months, in the presence of high-quality surveillance.

Canada may continue to detect occasional imported cases, but with a vaccination coverage goal of 95% by 2025, community (herd) immunity will help to protect against second and subsequent generation cases.

Maintain the elimination of endemic rubella in Canada.

2015 Baseline (range 2011-2015):
0 endemic cases
Target:
0 endemic cases
Rationale:
Endemic rubella has been eliminated in Canada since 2005 and the Region of the Americas since 2015. 
Data sources:

Surveillance of rubella

Vaccine Preventable Disease Surveillance Report to December 31, 2015

Notes:
Canada may continue to detect occasional imported cases, but with a vaccination coverage goal of 95% by 2025, community (herd) immunity will help to protect against second and subsequent generation of cases.

Maintain zero cases of Congenital Rubella Syndrome (CRS)/Congenital Rubella Infection (CRI) in Canada.

2015 Baseline (range 2011-2015):
0 cases
Target:
0 cases
Rationale:

There have been no cases of endemically acquired CRS/CRI in Canada since 2000. 

Endemic rubella has been eliminated in Canada since 2005 and the Region of the Americas since 2015.

Data sources:

Surveillance of rubella

Vaccine Preventable Disease Surveillance Report to December 31, 2015

Endemic diseases with low-level incidence: Maintain low levels

Achieve zero annual cases of respiratory diphtheria resulting from exposure in Canada. 

2015 Baseline (range 2011-2015):
Not Available
Target:
0 cases
Data sources:

Notifiable Diseases online

Vaccine Preventable Disease Surveillance Report to December 31, 2015

Notes:
An average of two cases per year (range 0-2) of diphtheria was reported for 2011 to 2015.  In order to measure this target, the national case definition for diphtheria requires revision to distinguish between respiratory and cutaneous diphtheria and to address geographic location of exposure.

Maintain less than five cases of tetanus annually in Canada.

2015 Baseline (range 2011-2015):
3 cases (2-5)
Target:
Less than 5 cases
Rationale:

Clostridium tetani spores are ubiquitous and are impossible to eliminate from the environment. 

A threshold of less than five cases is sufficiently low to demonstrate success of the vaccination program.

Data sources:

Notifiable Diseases online

Vaccine Preventable Disease Surveillance Report to December 31, 2015

Notes:
As tetanus is not a communicable disease, community (herd) immunity is not applicable.

Maintain zero cases of maternal/neonatal tetanus in Canada.

2015 Baseline (range 2011-2015):
Not Available  
Target:
0 cases
Rationale:
Remain consistent with WHO goal of eliminating maternal and neonatal tetanus.
Data sources:

Notifiable Diseases online

Vaccine Preventable Disease Surveillance Report to December 31, 2015

Notes:
Maternal and neonatal tetanus was eliminated in the Regions of the Americas in 2017. Due to universally available, high quality healthcare, maternal/ neonatal tetanus is unexpected in Canada. In order to measure this target, the national case definition for tetanus requires revision to distinguish maternal and neonatal tetanus from other forms of tetanus.

Maintain less than five cases of preventable Haemophilus influenzae type B (Hib) annually.

2015 Baseline (range 2011-2015):
1 case (0-5)
Target:
Less than 5 cases annually of preventable Hib in children less than five years of age. 
Rationale:
The threshold is sufficiently low to demonstrate success of the vaccination program and was set to address modifiable outcomes by targeting cases among un/partially-vaccinated children.
Data sources:

Immunization Monitoring Program ACTive (IMPACT) 

Vaccine Preventable Disease Surveillance Report to December 31, 2015

Notes:

Cases hospitalized at non-IMPACT hospitals are not included in the surveillance system.

This case count comes from those that were either vaccine eligible but did not receive the vaccine or, are under-vaccinated for their age-appropriate vaccination schedule. 

A Hib case is considered preventable if it occurs in an infant who was age-eligible to have completed the primary Hib vaccination schedule (3 doses) but who was unvaccinated or under-vaccinated for age. Vaccine failures are not considered to be preventable.

Maintain less than 100 mumps cases annually in Canada (based on a five year rolling average).

2015 Baseline (range 2011-2015):
100 cases (40-273). Five year average based on 2011-2015 data
Target:
Less than 100 cases annually
Rationale:
Given the cyclical nature of mumps outbreaks, the target number of cases is a five year average, rather than annual target.
Data sources:

Notifiable Diseases online

Vaccine Preventable Disease Surveillance Report to December 31, 2015

Notes:
The intended target should reflect the need for continued control of mumps and recognizes the cyclical nature of mumps outbreaks.

Maintain less than five cases of invasive meningococcal disease (IMD) serogroup C in children less than 18 years of age.

2015 Baseline (range 2011-2015):
0 cases (0-3)
Target:
Less than 5 cases in children under 18 years. 
Rationale:
The absence of new cases between 2013 and 2015 is indicative of an effective vaccine delivered through mature vaccination programs in the provinces and territories. This level of success should be sustained.
Data sources:

Surveillance of Invasive Meningococcal Disease

Enhanced Invasive Meningococcal Disease Surveillance System (eIMDSS), unpublished data

Reduce levels of endemic disease with moderate levels of incidence

Reduce incidence of invasive pneumococcal disease (IPD) in adults aged 65 years and older.

2015 Baseline (range 2011-2015):
23.5 cases per 100 000 population (23.5-26.2)
Target:
5% reduction in the overall incidence of IPD among ≥65 years of age.
Rationale:

Due to the serotypes associated with adult IPD it is estimated that 61% of isolates from patients aged 65 and older were potentially preventable by vaccination (serotypes contained in pneumococcal conjugate vaccine 13 and pneumococcal polysaccharide vaccine 23).

Despite the pneumococcal polysaccharide vaccine (PPV23) being funded in all provinces and territories, and the National Advisory Committee on Immunization recommending one dose for ages ≥65 years, coverage is only 37%.

Data sources:

Notifiable Diseases online

Vaccine Preventable Disease Surveillance Report to December 31, 2015

Maintain less than 50 hospitalizations annually for varicella in vaccine-eligible children less than 18 years of age.

2015 Baseline (range 2011-2015):
32 hospitalizations (23-32) – among non-immunized, vaccine-eligible children.
Target:
<50 hospitalizations annually.
Rationale:
The varicella vaccine program has been fully implemented across Canada since 2007 with an 86% reduction in varicella-related hospitalizations that has remained stable since 2008.
Data sources:

Immunization Monitoring Program ACTive (IMPACT)

Vaccine Preventable Disease Surveillance Report to December 31, 2015

Notes:
Varicella is not reportable in all provinces and territories. National reporting is inconsistent or incomplete, which results in under-estimation of disease incidence.

Maintain less than three deaths annually that are due to pertussis in infants less than six months of age (based on a three-year rolling average).

2015 Baseline (range 2011-2015):
0 deaths (0-3)
Target:
Less than 3 deaths in infants less than six months of age.
Rationale:

The highest incidence of pertussis is in infants less than one year of age, and most deaths are in infants less than six months of age. 

Due to the cyclical nature of pertussis incidence, targets should be based on a rolling average.

The goal of pertussis vaccination programs is to reduce hospitalizations and mortality in the under one age group. To align with this goal, the disease reduction target focuses on mitigating severe outcomes, including death, which are most likely to occur in infants less than six months.

Data sources:

Immunization Monitoring Program ACTive (IMPACT)

Vaccine Preventable Disease Surveillance Report to December 31, 2015

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