Recommended immunization schedules: Canadian Immunization Guide

For health professionals

Notice

This chapter has not yet been updated with the following statement from the National Advisory Committee on Immunization (NACI):

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.

This CIG chapter has not been updated to contain any information regarding COVID-19 vaccines, refer to the COVID-19 vaccine chapter.

Last partial content update (see Table of Updates): July 2023

Clarifications were made to Table 5 to better align with information provided in Part 4 chapters.

Last complete chapter revision: December 2013

General recommendations
Table 1: Routine childhood immunization schedule, infants and children (birth to 17 years of age)
Table 2: Recommended immunization schedule, children (less than 7 years of age), NOT Previously Immunized as Infants
Table 3: Recommended immunization schedule, children (7 to 17 years of age), NOT Previously Immunized
Table 4: Additional recommended immunizations, children (birth to 17 years of age), Considered AT RISK due to Underlying Medical Conditions
Table 5: Recommended immunization schedule, adults (18 years of age and older), NOT Previously Immunized
Table 6: Recommended immunizations, adults (18 years of age and older), Previously Immunized
Table 7: Additional recommended immunizations, adults (18 years of age and older), Considered at risk

General recommendations

Administration of vaccines in accordance with the immunization schedules summarized in the following tables will provide optimal protection from vaccine preventable diseases for most individuals. However, modifications of the recommended schedule may be necessary due to missed appointments or illness. In general, interruption of an immunization series does not require restarting the vaccine series, regardless of the interval between doses. Individuals with interrupted immunization schedules should be vaccinated to complete the appropriate schedule for their current age. Refer to Timing of vaccine administration in Part 1 and vaccine-specific chapters in Part 4 for additional information.

Similar, but not identical, vaccines may be available from different manufacturers; therefore, it is useful to review the relevant vaccine-specific chapters in the Canadian Immunization Guide as well as the manufacturer's product leaflet or product monograph before administering a vaccine. Refer to Principles of vaccine interchangeability in Part 1 for information about the interchangeability of similar vaccines from different manufacturers. Product monographs are periodically updated; it is a best practice to consult the information contained within the product monographs available through Health Canada's Drug Product Database.

Table 1: Routine childhood immunization schedule, infants and children (birth to 17 years of age)

For children at-risk due to underlying medical conditions, refer to Table 4 for additional recommendations for immunization.
[ ] = dose(s) may not be required depending upon age of child or vaccine used or both (refer to the relevant vaccine-specific chapter in Part 4 and provincial/territorial schedule). mos = months. yrs = years. P/T = provincial and territorial.
Refer to Timing of vaccine administration and Vaccine administration practices in Part 1 regarding administration of multiple injections.
Refer to vaccine-specific chapters in Part 4 for additional information.

Table 1: Routine childhood immunization schedule, infants and children (birth to 17 years of age)
Vaccine^{Footnote *}	Age
Vaccine^{Footnote *}	Birth	2 mos	4 mos	6 mos	12 mos	15 mos	18 mos	23 mos	2 years	4 years	5 years	6 years	9 years	12 years	14 years	15 years	16 years	17 years
DTaP-IPV-Hib or DTaP-HB-IPV-Hib	-	^{Table 1 - Footnote A} or ^{Table 1 - Footnote B} 1st dose	^{Table 1 - Footnote A} or ^{Table 1 - Footnote B} 2nd dose	^{Table 1 - Footnote A} or ^{Table 1 - Footnote B} 3rd dose	^{Table 1 - Footnote A} or 4th dose Generally at 18 months of age				-	-	-	-	-	-	-	-	-	-
DTaP-IPV or Tdap-IPV	-	-	-	-	-	-	-	-	-	^{Table 1 - Footnote C}			-	-	-	-	-	-
Tdap	-	-	-	-	-	-	-	-	-	-	-	-	-	-	^{Table 1 - Footnote D}			-
Rot	-	^{Table 1 - Footnote E} 2 or 3 doses Complete series before 8 months			-	-	-	-	-	-	-	-	-	-	-	-	-	-
Pneu-C-13	-	^{Table 1 - Footnote F}			^{Table 1 - Footnote F}		-	-	-	-	-	-	-	-	-	-	-	-
Men-C-C	-	^{Table 1 - Footnote [G]} According to P/T schedule			^{Table 1 - Footnote G} Generally at 12 months						-	-	-	-	-	-	-	-
Men-C-C or Men-C-ACYW	-	-	-	-	-	-	-	-	-	-	-	-	-	^{Table 1 - Footnote H}	-	-	-	-
MMR and Var	-	-	-	-	^{Table 1 - Footnote I} + ^{Table 1 - Footnote J}		^{Table 1 - Footnote I} + ^{Table 1 - Footnote J}						-	-	-	-	-	-
OR
MMRV	-	-	-	-	^{Table 1 - Footnote K}		^{Table 1 - Footnote K} Generally at 4-6 years						-	-	-	-	-	-
HB	^{Table 1 - Footnote L} 3 doses					-	-	-	-	-	-	-	-	-	-	-	-	-
OR
HB	-	-	-	-	-	-	-	-	-	-	-	-	^{Table 1 - Footnote M} 2 or 3 doses
HPV	-	-	-	-	-	-	-	-	-	-	-	-	^{Table 1 - Footnote N} 2 or 3 doses			-	-	-
OR
HPV	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	^{Table 1 - Footnote O} 3 doses
Inf	-	-	-	^{Table 1 - Footnote P} 1 or 2 doses Recommended annually										^{Table 1 - Footnote P} 1 dose Recommended annually
Table 1 - Footnote * For abbreviations and brand names of vaccines refer to Contents of immunizing agents authorized for use in Canada in Part 1. Return to Table 1 first footnote * referrer Table 1 - Footnote A *Diphtheria toxoid- tetanus toxoid- acellular pertussis- inactivated polio- Haemophilus influenzae* type b (DTaP-IPV-Hib). For infants and children beginning primary immunization at 7 months of age and older, the number of doses of Hib vaccine required varies by age. Return to first Table 1 footnote A referrer Table 1 - Footnote B Diphtheria toxoid- tetanus toxoid- acellular pertussis- hepatitis B- inactivated polio- Haemophilus influenzae type b (DTaP-HB-IPV-Hib). Alternative schedules may be used : DTaP-HB-IPV-Hib at 2, 4 and 12-23 months of age with DTaP-IPV-Hib vaccine at 6 months of age; or DTaP-HB-IPV -Hib at 2, 4 and 6 months of age with DTaP-IPV-Hib vaccine at 12-23 months of age. Return to first Table 1 footnote B referrer Table 1 - Footnote C Diphtheria toxoid- tetanus toxoid- acellular pertussis- inactivated polio or tetanus toxoid- reduced diphtheria toxoid- reduced acellular pertussis- inactivated polio. Return to Table 1 footnote C referrer Table 1 - Footnote D Tetanus toxoid- reduced diphtheria toxoid- reduced acellular pertussis (Tdap): 10 years after last dose of DTaP- or Tdap-containing vaccine. Return to Table 1 footnote D referrer Table 1 - Footnote E Rotavirus: Rotavirus pentavalent vaccine - 3 doses, 4 to 10 weeks apart; Rotavirus monovalent vaccine - 2 doses, at least 4 weeks apart. Give the first dose starting at 6 weeks and before 15 weeks of age. Administer all doses before 8 months of age. Return to Table 1 footnote E referrer Table 1 - Footnote F Pneumococcal conjugate 13-valent (Pneu-C-13): healthy infants beginning primary immunization at 2-6 months of age: 3 or 4 dose schedule. For a 3 dose schedule : 2, 4 months of age, followed by a booster dose at 12 months of age. For a 4 dose schedule: minimum of 8 weeks interval between doses beginning at 2 months of age, followed by a booster dose at 12-15 months of age. Healthy infants beginning primary immunization at 7-11 months of age : 2 doses, at least 8 weeks apart followed by a booster dose at 12-15 months of age, at least 8 weeks after the second dose. Children who have received age-appropriate pneumococcal vaccination with a pneumococcal conjugate vaccine but not Pneu-C-13 vaccine: 12-35 months of age - 1 dose; 36-59 months of age and of aboriginal origin or attend group child care - 1 dose; other healthy children 36-59 months of age - consider 1 dose. Return to first Table 1 footnote F referrer Table 1 - Footnote G Meningococcal conjugate monovalent: children 12-48 months of age: 1 dose routinely provided at 12 months of age, regardless of any doses given during the first year of life. Immunization may be considered for unimmunized children 5-11 years of age. Return to first Table 1 footnote G referrer Table 1 - Footnote H Meningococcal conjugate monovalent or meningococcal conjugate quadrivalent: early adolescence (around 12 years of age) - 1 dose, even if meningococcal conjugate vaccine received at a younger age. Vaccine chosen depends on local epidemiology and programmatic considerations. Return to Table 1 footnote H referrer Table 1 - Footnote I Measles-mumps-rubella: first dose at 12-15 months of age; second dose at 18 months of age or anytime thereafter, but should be given no later than around school entry. Return to first Table 1 footnote I referrer Table 1 - Footnote J Varicella (chickenpox): first dose at 12-15 months of age; second dose at 18 months of age or anytime thereafter, but should be given no later than around school entry. Return to first Table 1 footnote J referrer Table 1 - Footnote K Measles-mumps-rubella-varicella: first dose at 12-15 months of age; second dose at 18 months of age or anytime thereafter, but should be given no later than around school entry. Return to first Table 1 footnote K referrer Table 1 - Footnote L Hepatitis B : months 0, 1 and 6 (first dose = month 0) with at least 4 weeks between the first and second dose, at least 2 months between the second and third dose, and at least 4 months between the first and third dose. Alternatively, can be administered as DTaP-HB-IPV-Hib vaccine, with first dose at 2 months of age. Return to Table 1 footnote L referrer Table 1 - Footnote M Hepatitis B: 9-17 years of age - months 0, 1 and 6 (first dose = month 0) with at least 4 weeks between the first and second dose, at least 2 months between the second and third dose, and at least 4 months between the first and third dose. 11-15 years of age - 2 doses; schedule depends on the product used. Return to Table 1 footnote M referrer Table 1 - Footnote N Human papillomavirus (HPV): Girls, 9-14 years of age: HPV bivalent (HPV2) or HPV quadrivalent (HPV4) vaccine or HPV nonavalent (HPV9) vaccine - months 0 and 6-12 (first dose = month 0). Alternatively, a 3 dose schedule may be used for HPV2 vaccine - months 0, 1 and 6 (first dose = month 0), for HPV4 vaccine - months 0, 2 and 6 (first dose = month 0), and HPV nonavalent (HPV9) vaccine - months 0, 2 and 6 (first dose = month 0). Boys, 9-14 years of age: HPV4 or HPV9 vaccine - months 0 and 6-12 (first dose = month 0). Alternatively, a 3 dose schedule may be used for HPV4 vaccine - months 0, 2 and 6 (first dose = month 0), and HPV9 vaccine - months 0, 2 and 6 (first dose = month 0). For a 2 or 3 dose schedule, the minimum interval between first and last doses is 6 months. Return to Table 1 footnote N referrer Table 1 - Footnote O Human papillomavirus: Girls, 15-17 years of age: HPV2 vaccine - months 0, 1 and 6 (first dose = month 0), HPV4 vaccine - months 0, 2 and 6 (first dose = month 0) or HPV9 vaccine - months 0, 2 and 6 (first dose = month 0). Boys, 15-17 years of age: HPV4 vaccine - months 0, 2 and 6 (first dose = month 0) or HPV9 vaccine - months 0, 2 and 6 (first dose = month 0). In individuals who received the first dose of HPV2 or HPV4 or HPV9 vaccine between 9-14 years of age, a 2 dose schedule can be used with the second dose administered at least 6 months after the first dose. Return to Table 1 footnote O referrer Table 1 - Footnote P Influenza**: recommended annually for anyone 6 months of age and older without contraindications. Children 6 months-less than 9 years of age, receiving influenza vaccine for the first time - 2 doses, at least 4 weeks apart. Children 6 months-8 years of age, previously immunized with influenza vaccine and children 9 years of age and older - 1 dose. Return to first Table 1 footnote P referrer

Table 2: Recommended Immunization Schedule, Children (less than 7 years of age), NOT Previously Immunized as Infants

For children at-risk due to underlying medical conditions, refer to Table 4 for additional recommendations for immunization.
[ ] = dose(s) may not be required depending upon age of child or vaccine used or both (refer to the relevant vaccine-specific chapter in Part 4 and provincial/territorial schedule). mos = months.
Refer to Timing of vaccine administration and Vaccine administration practices in Part 1 regarding administration of multiple injections.
Refer to vaccine-specific chapters in Part 4 for additional information.

Table 2: Recommended immunization schedule, children (less than 7 years of age), not previously immunized as Infants
Vaccine^{Footnote *}	First visit	Time after first visit					6-12 mos after last dose
Vaccine^{Footnote *}	First visit	4 weeks	8 weeks	3 mos	4 mos	6 mos	6-12 mos after last dose
DTaP-IPV-Hib or DTaP-IPV	^{Footnote A}	-	^{Footnote A}	-	^{Footnote A}	-	^{Footnote A} ^{Footnote [B]}
Pneu-C-13	^{Footnote [C]}	-	^{Footnote [C]}	-	-	-	-
Men-C-C	^{Footnote D}	-	-	-	-	-	-
MMR	^{Footnote E}	^{Footnote E}	-	-	-	-	-
Var	^{Footnote F}	-	-	^{Footnote F}	-	-	-
OR
MMRV	^{Footnote G}	-	-	^{Footnote G}	-	-	-
HB	^{Footnote [H]}	^{Footnote [H]}	-	-	-	^{Footnote [H]}	-
Inf	^{Footnote I}	^{Footnote I}	-	-	-	-	-
Table 2 - Footnote * For abbreviations and brand names of vaccines refer to Contents of Immunizing agents authorized for use in Canada in Part 1. Return to Table 2 footnote * referrer Table 2 - Footnote A *Diphtheria toxoid- tetanus toxoid- acellular pertussis- inactivated polio- Haemophilus influenzae* type b (DTaP-IPV-Hib) or diphtheria toxoid- tetanus toxoid- acellular pertussis- inactivated polio (DTaP-IPV): 4 doses of DTaP-IPV-containing vaccine. The number of doses of Hib-containing vaccine required varies by age at first dose. If first visit at 12-14 months of age: 1 dose of Hib-containing vaccine at first visit and booster dose at least 2 months after the previous dose. If first visit at 15 months-less than 60 months of age: 1 dose of Hib-containing vaccine. If first visit at 60 months of age or older, Hib-containing vaccine is not required. Return to first Table 2 footnote A referrer Table 2 - Footnote B Diphtheria toxoid- tetanus toxoid- acellular pertussis- inactivated polio (DTaP-IPV) or tetanus toxoid- reduced diphtheria toxoid- reduced acellular pertussis- inactivated polio (Tdap-IPV): if the fourth dose of DTaP-IPV vaccine was given before the fourth birthday, a booster dose of DTaP-IPV or Tdap-IPV vaccine should be provided at 4-6 years of age. Return to Table 2 footnote B referrer Table 2 - Footnote C Pneumococcal conjugate 13-valent: 12-23 months of age - 2 doses, at least 8 weeks apart. 24-59 months of age - 1 dose. Return to first Table 2 footnote C referrer Table 2 - Footnote D Meningococcal conjugate monovalent: 12-59 months of age - 1 dose; 5-11 years of age - consider 1 dose. Return to Table 2 footnote D referrer Table 2 - Footnote E Measles-mumps-rubella: 2 doses, at least 4 weeks apart; second dose after 18 months of age, but should be given no later than around school entry. Return to first Table 2 footnote E referrer Table 2 - Footnote F Varicella: 2 doses, at least 3 months apart; second dose after 18 months of age, but should be given no later than around school entry. A minimum interval of 4 weeks between doses may be used if rapid, complete protection is required. Return to first Table 2 footnote F referrer Table 2 - Footnote G Measles-mumps-rubella-varicella: 2 doses, at least 3 months apart; second dose after 18 months of age, but should be given no later than around school entry. A minimum interval of 4 weeks between doses may be used if rapid, complete protection is required. Return to first Table 2 footnote G referrer Table 2 - Footnote H Hepatitis B: 3 doses - months 0, 1 and 6 (first dose = month 0) with at least 4 weeks between the first and second dose, 2 months between the second and third dose, and 4 months between the first and third dose. Return to first Table 2 footnote H referrer Table 2 - Footnote I Influenza**: 2 doses, at least 4 weeks apart. Return to first Table 2 footnote I referrer

Table 3: Recommended immunization schedule, children (7 to 17 years of age), not previously immunized

For children at-risk due to underlying medical conditions, refer to Table 4 for additional recommendations for immunization.
[ ] = dose(s) may not be required depending upon age of child or vaccine used or both (refer to the relevant vaccine-specific chapter in Part 4 and provincial/territorial schedule). mos = months. yrs = years.
Refer to Timing of vaccine administration and Vaccine administration practices in Part 1 regarding administration of multiple injections.
Refer to the vaccine-specific chapters in Part 4 for additional information.

Table 3: Recommended immunization schedule, children (7 to 17 years of age), not previously immunized
Vaccine^{Table 3 Footnote *}	First visit	Time after first visit				6-12 mos after last dose	10 yrs after last dose
Vaccine^{Table 3 Footnote *}	First visit	4 weeks	8 weeks	3 mos	6 mos	6-12 mos after last dose	10 yrs after last dose
Tdap-IPV Tdap	^{Table 3 Footnote A}	-	^{Table 3 Footnote A}		-	^{Table 3 Footnote A}	^{Table 3 Footnote B}
Men-C-C	^{Table 3 Footnote [C]} 7-11 years of age	-	-	-	-	-	-
OR
Men-C-C or Men-C-ACYW	^{Table 3 Footnote D} 12-17 years of age	-	-	-	-	-	-
MMR	^{Table 3 Footnote E}	^{Table 3 Footnote E}	-	-	-	-	-
Var	^{Table 3 Footnote F}	-	-	^{Table 3 Footnote F}	-	-	-
OR
MMRV	^{Table 3 Footnote G} 7-12 years of age	-	-	^{Table 3 Footnote G}	-	-	-
HB	^{Table 3 Footnote H}	^{Table 3 Footnote [H]}	-	-	^{Table 3 Footnote H}	-	-
HPV	^{Table 3 Footnote I} 9-14 years of age	-	-	-	^{Table 3 Footnote I}	-	-
OR
HPV	^{Table 3 Footnote I} 9-14 years of age 3 doses					-	-
OR
HPV	^{Table 3 Footnote J} 15-17 years of age 3 doses					-	-
Inf	^{Table 3 Footnote K} 7-8 years of age	^{Table 3 Footnote K}	-	-	-	-	-
OR
Inf	^{Table 3 Footnote K} 9-17 years of age	-	-	-	-	-	-
Table 3 - Footnote * For abbreviations and brand names of vaccines refer to Contents of immunizing agents authorized for use in Canada in Part 1. Return to Table 3 footnote * referrer Table 3 - Footnote A Tetanus toxoid- reduced diphtheria toxoid- reduced acellular pertussis- inactivated polio (Tdap-IPV): 2 doses, 8 weeks apart; third dose 6-12 months after second dose. Return to first Table 3 footnote A referrer Table 3 - Footnote B Tetanus toxoid- reduced diphtheria toxoid- reduced acellular pertussis: 10 years after last dose of Tdap-IPV. Return to Table 3 footnote B referrer Table 3 - Footnote C Meningococcal conjugate monovalent: 7-11 years of age - consider 1 dose. Return to Table 3 footnote C referrer Table 3 - Footnote D Meningococcal conjugate monovalent or quadrivalent: 12-17 years of age - 1 dose, even if meningococcal conjugate vaccine received at a younger age. Vaccine chosen depends on local epidemiology and programmatic considerations. Return to Table 3 footnote D referrer Table 3 - Footnote E Measles-mumps-rubella: 2 doses, at least 4 weeks apart. Return to first Table 3 footnote E referrer Table 3 - Footnote F Varicella (chickenpox): 7-12 years of age - 2 doses, at least 3 months apart. 13 years of age and older - 2 doses, at least 6 weeks apart. A minimum interval of 4 weeks between doses may be used if rapid, complete protection is required. Return to first Table 3 footnote F referrer Table 3 - Footnote G Measles-mumps-rubella-varicella: 7-12 years of age - 2 doses, at least 3 months apart. A minimum interval of 4 weeks between doses may be used if rapid, complete protection is required. Return to first Table 3 footnote G referrer Table 3 - Footnote H Hepatitis B: 7-17 years of age - 3 doses, months 0, 1 and 6 (first dose = month 0) with at least 4 weeks between the first and second dose, 2 months between the second and third dose, and 4 months between the first and third dose. 11-15 years of age - two doses; schedule depends on the product used. Return to first Table 3 footnote H referrer Table 3 - Footnote I Human papillomavirus (HPV): Girls, 9-14 years of age - HPV bivalent (HPV2) or HPV quadrivalent (HPV4) vaccine or HPV nonavalent (HPV9) - months 0 and 6-12 (first dose = month 0). Alternatively, a 3 dose schedule may be used for HPV2 vaccine - months 0, 1 and 6 (first dose = month 0), for HPV4 vaccine - months 0, 2 and 6 (first dose = month 0), and for HPV nonavalent (HPV9) vaccine - months 0, 2 and 6 (first dose = month 0). Boys, 9-14 years of age HPV4 vaccine or HPV9 - months 0 and 6-12 (first dose = month 0). Alternatively, a 3 dose schedule may be used for HPV4 or HPV9 vaccine - months 0, 2 and 6 (first dose = month 0). For a 2 or 3 dose schedule, the minimum interval between first and last doses is 6 months. Return to first Table 3 footnote I referrer Table 3 - Footnote J Human papillomavirus: Girls, 15-17 years of age: HPV2 vaccine - months 0, 1 and 6 (first dose = month 0), HPV4 vaccine - months 0, 2 and 6 (first dose = month 0) or HPV9 vaccine - months 0, 2 and 6 (first dose = month 0). Boys, 15-17 years of age: HPV4 vaccine - months 0, 2 and 6 (first dose = month 0) or HPV9 vaccine - months 0, 2 and 6 (first dose = month 0). In individuals who received the first dose of HPV2 or HPV4 or HPV9 vaccine between 9-14 years of age, a 2 dose schedule can be used with the second dose administered at least 6 months after the first dose. Return to first Table 3 footnote J referrer Table 3 - Footnote K Influenza: children less than 9 years of age - 2 doses, at least 4 weeks apart. Children 9 years of age and older - 1 dose. Return to Table 3 footnote K referrer

Table 4: Additional recommended immunizations, children (birth to 17 years of age), considered at risk due to underlying medical conditions

[ ] = dose(s) may not be required depending upon age of child or vaccine used or both (refer to vaccine-specific chapter in Part 4 and provincial/territorial schedule). mos = months. yrs = years.
Refer to Immunization of travellers and Immunization of workers in Part 3 for additional information about vaccines recommended for travellers and workers.
Refer to Immunization of immunocompromised persons and Immunization of persons with chronic diseases in Part 3 for additional condition-specific recommendations.
Refer to Timing of vaccine administration and Vaccine administration practices in Part 1 regarding administration of multiple injections.
Refer to the vaccine-specific chapters in Part 4 for additional information

Table 4: Additional recommended immunizations, children (birth to 17 years of age), considered at risk due to underlying medical condition
Vaccine^{Footnote *}	Age
Vaccine^{Footnote *}	Birth	2 mos	6 mos	12 mos	15 mos	18 mos	23 mos	2 years	3 years	5-8 yrs	9-17 yrs
Hib	-	-	-	-	-	-	-	-	-	^{Footnote A} 1 dose
Pneu-P-23	-	-	-	-	-	-	-	^{Footnote B} 1 dose + 1 booster dose if at highest risk
Pneu-C-13	-	-	^{Footnote C}	-	-	-	-	-	^{Footnote [C]} If not previously received
Men-C-ACYW	-	^{Footnote D} 2, 3 or 4 doses + additional booster doses									-
4CMenB	-	^{Footnote E} 2, 3 or 4 doses + additional booster doses
HA	-	-	-	^{Footnote F} 2 doses
HB	^{Footnote G} 3 or 4 doses
Inf	-	-	^{Footnote H} 1 or 2 doses Recommended annually								^{Footnote H} 1 dose Recommended annually
Footnote * For abbreviations and brand names of vaccines refer to Contents of immunizing agents authorized for use in Canada in Part 1. Return to Table 4 footnote * referrer Table 4 - Footnote A Haemophilus influenzae type b (Hib): 5 years of age and older with increased risk of invasive Hib disease - 1 dose regardless of prior history of Hib vaccination and at least 1 year after any previous dose. Return to Table 4 footnote A referrer Table 4 - Footnote B Pneumococcal polysaccharide 23-valent: children 2 years of age or older at high risk of invasive pneumococcal disease (IPD) - 1 dose. Children at highest risk of IPD including those with functional or anatomic asplenia or sickle cell disease; hepatic cirrhosis; chronic renal failure; nephrotic syndrome; HIV infection; and immunosuppression related to disease or therapy - 1 booster dose after 5 years. If pneumococcal conjugate 13-valent (Pneu-C-13) vaccine is also required, it should be provided first, followed by Pneu-P-23 vaccine, at least 8 weeks later. Return to Table 4 footnote B referrer Table 4 - Footnote C Pneumococcal conjugate 13-valent: infants at high risk of IPD - in addition to the doses at 2, 4, and 12 months of age, give an extra dose at 6 months to make a 4 dose primary series. Children aged 3 years and older at high risk of IPD who have not previously received Pneu-C-13 vaccine - 1 dose Return to first Table 4 footnote C referrer Table 4 - Footnote D Meningococcal conjugate quadrivalent (Men-C-ACYW): infants and children at high risk of invasive meningococcal disease (IMD): 2-11 months of age - 2 or 3 doses of Men-C-ACYW-CRM vaccine, 8 weeks apart with another dose between 12-23 months of age and at least 8 weeks after the previous dose; 12-23 months of age - 2 doses of Men-C-ACYW-CRM vaccine,8 weeks apart; 24 months of age and older - 2 doses of any Men-C-ACYW vaccine, 8 weeks apart. Give additional booster doses every 3 to 5 years if last vaccinated at 6 years of age and younger and every 5 years if last vaccinated at 7 years of age and older. Return to Table 4 footnote D referrer Table 4 - Footnote E Multicomponent meningococcal (4CMenB): infants and children at high risk of IMD should be considered for immunization: 2-11 months of age - 2 or 3 doses of 4CMenB vaccine, 8 weeks apart with another dose between 12-23 months of age and at least 8 weeks after the previous dose; 1-10 years of age- 2 doses of 4CMenB vaccine, 8 weeks apart; 11 years of age and older - 2 doses of 4CMenB vaccine, at least 4 weeks apart. The need for and timing of 4CMenB vaccine booster doses have not yet been determined. Return to Table 4 footnote E referrer Table 4 - Footnote F Hepatitis A: 6 months of age and older in high-risk groups: 2 doses, given 6-36 months apart (depending on product used). Return to Table 4 footnote F referrer Table 4 - Footnote G Hepatitis B: 3 or 4 doses of higher dose of monovalent hepatitis B vaccine recommended for those with certain immunocompromising conditions, chronic renal failure and dialysis. Premature infants weighing less than 2,000 grams at birth born to HB infected mothers: 4 doses. Return to Table 4 footnote G referrer Table 4 - Footnote H Influenza: recommended annually for all individuals 6 months of age and older without contraindications, with focus on children at risk of influenza-related complications. Children 6 months-less than 9 years of age receiving influenza vaccine for the first time: 2 doses, at least 4 weeks apart. Children 6 months-8 years of age, previously immunized with influenza vaccine and children 9 years of age and older: 1 dose. Return to first Table 4 footnote H referrer

Table 5: Recommended immunization schedule, adults (18 years of age and older), not previously immunized

For adults considered at-risk, refer to Table 7 for additional recommendations for immunization.
[ ] = dose(s) may not be required depending upon age of vaccinee or vaccine used or both (refer to vaccine-specific chapter in Part 4 and provincial/territorial schedule). mos = months.
Refer to Immunization of travellers and Immunization of workers in Part 3 for additional information about vaccines recommended for travellers and workers.
Refer to Timing of vaccine vdministration and Vaccine vdministration practices in Part 1 regarding administration of multiple injections.
Refer to vaccine-specific chapters in Part 4 for further information.

Table 5: Recommended immunization schedule, adults (18 years of age and older), not previously immunized
Vaccine^{Footnote *}	First visit	Time after First visit				6-12 mos after last dose	10 years after last dose
Vaccine^{Footnote *}	First visit	4 weeks	6 weeks	8 weeks	6 mos	6-12 mos after last dose	10 years after last dose
Tdap-IPV Tdap Td IPV	^{Footnote A}	-	-	^{Footnote A}	-	^{Footnote A}	^{Footnote B}
MMR	^{Footnote C}	-	-	-	-	-	-
Var	^{Footnote D} 18-49 years of age	-	^{Footnote D}	-	-	-	-
OR
RZV	^{Footnote E} 50 years of age and over	-	-	^{Footnote E}	-	-	-
Pneu-P-23	^{Footnote F}	-	-	-	-	-	-
Men-C-C or Men-C-ACYW	^{Footnote G} 18-24 years of age	-	-	-	-	-	-
HPV	^{Footnote H} 3 doses					-	-
Inf	^{Footnote I} Annually
Footnote * For abbreviations and brand names of vaccines refer to Contents of immunizing agents authorized for use in Canada in Part 1. Return to Table 5 footnote * referrer Table 5 - Footnote A Three doses of either tetanus toxoid- reduced diphtheria (Td, if not previously immunized with tetanus or diphtheria), or polio-containing vaccine if at increased risk of polio (Tdap-IPV, if not previously immunized with tetanus, diphtheria and polio, or IPV, if not previously immunized with polio) provided with an interval of 8 weeks between the first two doses followed by a third dose administered 6 to 12 months after the second dose. One dose of reduced acellular pertussis-containing vaccine should be provided to those who never previously received a pertussis-containing vaccine in adulthood. Adults who are unimmunized against polio but are not at increased risk and have had a primary series of tetanus and diphtheria containing vaccine, should receive IPV-containing vaccine as a part of their next tetanus and diphtheria booster. Return to Table 5 footnote A referrer Table 5 - Footnote B Tetanus toxoid- reduced diphtheria toxoid (Td): 10 years after last dose of Td-containing vaccine. Return to Table 5 footnote B referrer Table 5 - Footnote C Measles-mumps-rubella (MMR): adults born in or after 1970 - 1 dose, except - travellers, health care workers, students in post-secondary educational settings, and military personnel - 2 doses, at least 4 weeks apart. Adults born before 1970 can be presumed to have acquired natural immunity to measles and mumps and do not need MMR vaccination except - non-immune military personnel or health care workers (2 doses, at least 4 weeks apart), non-immune travellers (1 dose), non-immune students in post-secondary educational settings (consider 1 dose). Rubella-susceptible adults, regardless of age - 1 dose. Return to Table 5 footnote C referrer Table 5 - Footnote D Varicella (chickenpox): adults 18-49 years of age - 2 doses, at least 6 weeks apart; adults 50 years of age and older are generally presumed to be immune. Return to first Table 5 footnote D referrer Table 5 - Footnote E Recombinant Zoster Vaccine (RZV): adults 50 years of age and older - 2 doses, 2 to 6 months apart; may be considered for immunocompromised adults 50 years of age and older based on a case-by-case assessment of benefits vs risks. Return to Table 5 footnote E referrer Table 5 - Footnote F Pneumococcal polysaccharide 23-valent: adults 65 years of age and older - 1 dose; immunocompetent residents of long-term care facilities 18-64 years of age - 1 dose. Return to Table 5 footnote F referrer Table 5 - Footnote G Meningococcal conjugate monovalent or quadrivalent: adults less than 25 years of age - 1 dose (vaccine chosen depends on local epidemiology). Return to Table 5 footnote G referrer Table 5 - Footnote H Human papillomavirus (HPV): recommended for women up to and including 26 years of age, may be given to women 27 years of age and older at ongoing risk of exposure: HPV bivalent (HPV2) vaccine - months 0, 1 and 6 (first dose = month 0), HPV quadrivalent (HPV4) vaccine - months 0, 2 and 6 (first dose = month 0) or nonavalent (HPV9) vaccine- months 0, 2 and 6 (first dose = month 0). Recommended for men up to and including 26 years of age, may be given to men 27 years of age and older at ongoing risk of exposure: HPV4 or HPV9 vaccine - months 0, 2 and 6 (first dose = month 0). Return to Table 5 footnote H referrer Table 5 - Footnote I Influenza: 1 dose recommended for adults without contraindications, with focus on: adults at high risk of influenza-related complications (including pregnant women, adults 65 years of age and older); adults capable of transmitting influenza to individuals at high risk; adults who provide essential community services; and people in direct contact during culling operations with poultry infected with avian influenza. Return to Table 5 footnote I referrer

Table 6: Recommended immunizations, adults (18 years of age and older), previously immunized

For adults considered at-risk, refer to Table 7 for additional recommendations for immunization.
[] = dose may not be required.
Refer to Immunization of travellers and Immunization of workers in Part 3 for additional information about vaccines recommended for travellers and workers.
Refer to Timing of vaccine administration and Vaccine administration practices in Part 1 regarding administration of multiple injections.
Refer to vaccine-specific chapters in Part 4 for additional information.

Table 6: Recommended immunizations, adults (18 years of age and older), previously immunized
Vaccine^{Footnote *}	Age
Vaccine^{Footnote *}	18-26 years	27-49 years	50-59 years	60 years	65 years and older
Td	^{Footnote A} 1 dose every 10 years
Tdap	^{Footnote B} 1 dose
Pneu-P-23	-	-	-	-	^{Footnote C} 1 dose
RZV	-	-	^{Footnote D} 2 doses
Inf	^{Footnote E} Annually
Footnote * For abbreviations and brand names of vaccines refer to Contents of immunizing agents authorized for use in Canada in Part 1. Return to Table 6 footnote * referrer Table 6 - Footnote A Tetanus toxoid- reduced diphtheria toxoid: 1 booster dose every 10 years. Return to Table 6 footnote A referrer Table 6 - Footnote B Tetanus toxoid- reduced diphtheria toxoid- reduced acellular pertussis (Tdap): 1 dose in adulthood for pertussis protection regardless of interval since last dose of tetanus toxoid- and diphtheria toxoid-containing vaccine; 1 dose in every pregnancy, ideally between 27 and 32 weeks of gestation, for pertussis protection of infants. Refer to Pertussis vaccine in Part 4 for additional information. Return to Table 6 footnote B referrer Table 6 - Footnote C Pneumococcal polysaccharide 23-valent: adults 65 years of age and older - 1 dose. Return to Table 6 footnote C referrer Table 6 - Footnote D Recombinant Zoster Vaccine (RZV): adults 50 years of age and older - 2 doses, 2 to 6 months apart and at least one year after LZV. Return to Table 6 footnote D referrer Table 6 - Footnote E Influenza: recommended for all adults without contraindications, with focus on: adults at high risk of influenza-related complications (including pregnant women, adults 65 years of age and older); adults capable of transmitting influenza to individuals at high risk; adults who provide essential community services; and people in direct contact during culling operations with poultry infected with avian influenza. One dose annually. Return to Table 6 footnote E referrer

Table 7: Additional recommended immunizations, adults (18 years of age and older), considered at risk

Refer to Immunization of travellers and Immunization of workers in Part 3 for information about vaccines recommended for travellers and workers.
Refer to Immunization of immunocompromised persons and Immunization of persons with chronic diseases in Part 3 for additional condition-specific immunization recommendations.
Refer to Timing of vaccine administration and Vaccine administration practices in Part 1 regarding administration of multiple injections.
Refer to vaccine-specific chapters in Part 4 for additional information.

Table 7: Additional recommended immunizations, adults (18 years of age and older), considered at risk
Vaccine^{Footnote *}	Age
Vaccine^{Footnote *}	18 years of age and older
Hib	^{Footnote A} 1 dose
IPV	^{Footnote B} 1 booster dose
MMR	^{Footnote C} Second dose
Pneu-C-13	^{Footnote D} 1 dose
Pneu-P-23	^{Footnote E} 1 dose + 1 booster dose if at highest risk
Men-C-ACYW	^{Footnote F} 2 doses + booster doses
4CMenB	^{Footnote G} 2 doses
HA	^{Footnote H} 2 doses
HB	^{Footnote I} 3 or 4 doses
OR
HAHB	^{Footnote J} 3 or 4 doses
Inf	^{Footnote K} Annually
Typh-I	^{Footnote L} 1 dose + booster doses if at ongoing risk
OR
Typh-O	^{Footnote L} 4 doses + booster doses if at ongoing risk
Rab	^{Footnote M} 3 doses + booster doses if required
Var	^{Footnote N} 2 doses
Footnote * List is not exhaustive of travel vaccines. For abbreviations and brand names of vaccines refer to Contents of immunizing agents authorized for use in Canada in Part 1. Return to Table 7 footnote * referrer Table 7 - Footnote A Haemophilus influenzae type b (Hib): adults with increased risk of invasive Hib disease - 1 dose regardless of prior history of Hib vaccination and at least 1 year after any previous dose. Return to Table 7 footnote A referrer Table 7 - Footnote B Inactivated polio: 1 booster dose for adults at increased risk of exposure to polio. Return to Table 7 footnote B referrer Table 7 - Footnote C Measles-mumps-rubella (MMR): adults born in or after 1970 - 1 dose, except - travellers, health care workers, students in post-secondary educational settings, and military personnel - 2 doses, at least 4 weeks apart. Adults born before 1970 can be assumed to have acquired natural immunity to measles and mumps and do not need MMR vaccination except - non-immune military personnel or health care workers (2 doses, at least 4 weeks apart), non-immune travellers (1 dose), non-immune students in post-secondary educational settings (consider 1 dose). Rubella-susceptible adults, regardless of age - 1 dose. Return to Table 7 footnote C referrer Table 7 - Footnote D Pneumococcal conjugate 13-valent (Pneu-C-13): adults with HIV or immunocompromising conditions (except hematopoietic stem cell transplant recipients [HSCT]) - 1 dose of Pneu-C-13 vaccine followed 8 weeks later by 1 dose of pneumococcal polysaccharide 23-valent (Pneu-P-23) vaccine. Administer Pneu-C-13 vaccine dose at least 1 year after any previous dose of Pneu-P-23 vaccine. Return to Table 7 footnote D referrer Table 7 - Footnote E Pneumococcal polysaccharide 23-valent: adults at high risk of invasive pneumococcal disease (IPD), including adults with alcoholism, smokers, and persons who are homeless - 1 dose. One dose should be considered for adults who use illicit drugs. Adults at highest risk of IPD, including those with functional or anatomic asplenia or sickle cell disease; hepatic cirrhosis; chronic renal failure; nephrotic syndrome; HIV infection; and immunosuppression related to disease or therapy - 1 booster dose at least 5 years from first vaccination with Pneu-P-23 vaccine. Return to Table 7 footnote E referrer Table 7 - Footnote F Meningococcal conjugate quadrivalent: in previously unimmunized adults at high risk of invasive meningococcal disease (IMD) - 2 doses, 8 weeks apart. In previously immunized adults -booster dose every 3 to 5 years if last vaccinated at 6 years of age and younger and every 5 years for those last vaccinated at 7 years of age and older. Return to Table 7 footnote F referrer Table 7 - Footnote G Multicomponent meningococcal (4CMenB): adults at high risk of IMD should be considered for immunization - 2 doses of 4CMenB vaccine, at least 4 weeks apart. Return to Table 7 footnote G referrer Table 7 - Footnote H Hepatitis A: adults in high risk groups - 2 doses, 6-36 months apart (depending on product used). Return to Table 7 footnote H referrer Table 7 - Footnote I Hepatitis B (HB): adults in high risk groups - 3 or 4 dose schedule (depending on product used). Higher dose of monovalent HB vaccine recommended for those with certain immunocompromising conditions, chronic renal failure and dialysis. Return to Table 7 footnote I referrer Table 7 - Footnote J Hepatitis A-hepatitis B: adults without chronic renal failure and immunocompromising conditions: combined vaccine preferred if both hepatitis A and standard dosage hepatitis B vaccines are recommended - 3 or 4 dose schedule. Return to Table 7 footnote J referrer Table 7 - Footnote K Influenza: recommended for all adults, with focus on adults at high risk of influenza-related complications - 1 dose annually. Return to Table 7 footnote K referrer Table 7 - Footnote L Typhoid: adults with ongoing or intimate exposure to a chronic carrier of Salmonella typhi - 1 dose injectable typhoid vaccine or 4 doses oral typhoid vaccine; re-immunization recommended if at continuing risk. Return to first Table 7 footnote L referrer Table 7 - Footnote M Rabies: adults at high risk of close contact with rabid animals - 3 doses for pre-exposure immunization. Periodic serologic testing and booster doses (if required) for those at continuing high risk. Return to Table 7 footnote M referrer Table 7 - Footnote N Varicella: adults 18 to less than 50 years of age without history of VZV infection (self-reported or diagnosed by a health care provider), documented evidence of immunization with 2 doses of a varicella-containing vaccine or laboratory evidence of immunity - 2 doses. Self-reported history or health care provider diagnosis is not considered a reliable correlate of immunity for pregnant women with significant exposure to varicella zoster virus, immunocompromised individuals and health care workers who are newly hired into the Canadian health care system. Return to Table 7 footnote N referrer

Page details

Report a problem on this page

Date modified:: 2023-07-28

Language selection

Search