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Immunization of persons new to Canada: Canadian Immunization Guide

For health professionals

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

February 2023 : This chapter was updated to align with changes made to the Poliomyelitis vaccine chapter in Part 4 regarding individuals previously immunized with bivalent oral poliomyelitis vaccine (bOPV).

Last complete chapter revision: July 2015

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Introduction

A high proportion of individuals newly arrived in Canada may be susceptible to vaccine preventable diseases because of a lack of effective immunization programs in their country of origin. Immunization of persons new to Canada is often challenging because:

Evaluation of Immunization Status

New immigrants, refugees and internationally adopted children may lack immunizations and immunization records. Vaccination should only be considered valid if there is written documentation of administration of vaccine at ages and intervals comparable with the Canadian immunization schedule. Although the potency of vaccines administered in other countries can generally be assumed to be adequate, immunization schedules vary. The age at immunization (for example, 9 months of age for immunization against measles in some countries), the number of doses, and the intervals between doses should be carefully reviewed and compared with Canadian, provincial or territorial recommendations to determine the need for additional doses of vaccines.

In many countries outside of Canada, mumps and rubella vaccines are in limited use, and measles vaccine alone is given. Haemophilus influenzae type b (Hib), hepatitis B (HB), hepatitis A (HA), varicella, pneumococcal conjugate, and meningococcal conjugate vaccines are also in limited use. An adult booster of pertussis vaccine is a relatively new recommendation in developed countries. Refer to the World Health Organization (WHO) information on vaccination schedules in other countries. Refer to Immunization of Persons with Inadequate Immunization Records in Part 3 for additional information.

Internationally Adopted Children

Studies of internationally adopted children have shown that, despite written documentation of adequate immunization, serologic evidence of protection against diphtheria and tetanus may be lacking. Recommendations regarding an approach to vaccinating these children vary and include:

Judgment is required to determine the best option in any particular situation.

Family members travelling outside of Canada to adopt a child should receive all appropriate routine and travel immunizations before departure from Canada to pick up adopted children, with particular focus on immunization against polio, HA and HB, as outlined in Recommended Immunization. Refer to Immunization of Travellers in Part 3 for additional information.

Health Assessment of Persons New to Canada

Assessment before arrival to Canada

Immigration, Refugee and Citizenship Canada generally conduct Immigration Medical Examinations (IME) before foreign nationals (non-Canadian citizens) arrive in Canada. IME is required for:

If the IME is not conducted prior to arrival (such as refugee claimants in Canada) it is done as soon as possible after arrival.

Assessment after arrival in Canada

Health care providers in Canada who see persons newly arrived in the country should prioritize assessing and updating immunizations for persons new to Canada because the IME does not include a review of immunization status. In addition, health care providers should perform a complete health assessment, including comprehensive testing for a variety of chronic and non-vaccine preventable diseases.
As part of the health assessment, the following tests should be completed (if not already available from a completed IME) to determine the need for vaccines or contraindications to vaccination:

Recommended Immunization

Persons newly arrived in Canada lacking adequate documentation of immunization should be considered unimmunized and started on an immunization schedule appropriate for their age and risk factors unless known to be immune by serologic testing. In addition to the routine immunization schedule, certain vaccines may be recommended for people newly arrived in Canada as follows:

Hepatitis A vaccine

Vaccination against HA should be considered for people from countries that are endemic for HA. Individuals born in developing countries are more likely to be immune to HA; therefore, testing for immunity before administering HA vaccine to persons from HA endemic countries should be considered. Household or close contacts of children adopted from HA endemic countries should be immunized with HA-containing vaccine. Persons new to Canada should be tested for HB and HC infection and persons chronically infected with HB (HB carriers) or HC should be vaccinated against HA, based on susceptibility testing if indicated. Refer to Hepatitis A Vaccine in Part 4 for additional information.

Hepatitis B vaccine

All persons from a country that is endemic for HB should be assessed and vaccinated against HB if not immune and not infected. Individuals born in developing countries are more likely to be carriers of HB, necessitating vaccination of their sexual and household contacts based on review of their serologic test results. HB vaccine is recommended for all household contacts whose families have immigrated to Canada from areas where there is a high prevalence of HB and who may be exposed to HB carriers through their extended families or when visiting their country of origin. Children adopted from countries in which there is a high prevalence of HB infection should be screened for HBsAg and, if positive, household or close contacts in the adopting family should be immunized before adoption or as soon as possible thereafter. Refer to Hepatitis B Vaccine in Part 4 for additional information.

Rubella-containing vaccine

Unless known to be immune to rubella because of prior serology or documentation of a dose of rubella-containing vaccine, rubella-containing vaccine should be given to persons new to Canada; pre-immunization serology is not needed. Unless there is a contraindication to use, rubella susceptible people should be immunized with one dose of a measles-mumps-rubella-containing (MMR) vaccine as soon as possible after entry to Canada. Foreign-born women of childbearing age from countries where rubella-containing vaccine is not in use should be a priority. Susceptible women who are pregnant should receive MMR vaccine after delivery. Refer to Rubella Vaccine in Part 4 for additional information.

Varicella-containing vaccine

In tropical countries, varicella tends to occur at older ages and most tropical countries do not have varicella immunization programs. People from tropical regions are more likely to be susceptible to varicella and should be a priority for varicella testing and immunization if non-immune. Susceptible women who are pregnant should be vaccinated after delivery. Refer to Varicella (Chickenpox) Vaccine and Herpes Zoster (Shingles) Vaccine in Part 4 for additional information.

Inactivated polio-containing vaccine (IPV)

Oral poliomyelitis vaccine (OPV) is not used in Canada.

Previous poliovirus vaccination is only considered valid if individuals have documented proof of age-appropriate complete immunization against the three types of poliovirus (e.g. receipt of inactivated poliomyelitis vaccine (IPV), fractional IPV, trivalent oral poliomyelitis vaccine, or combination of bivalent oral poliomyelitis vaccine (bOPV) and monovalent oral poliomyelitis vaccine type 2 [mOPV2]).

Children who have received one or more doses of polio vaccine before arriving in Canada should have their vaccine series completed with IPV-containing vaccine as appropriate for age. Children who were not vaccinated against all three types of poliovirus (e.g., received bOPV vaccine after April 2016 without receipt of at least two doses of mOPV2, novel oral polio vaccine type 2 (nOPV2) or IPV) remain at risk of infection. Those who received bOPV only should receive a complete age-appropriate IPV series to be optimally protected against polio, including vaccine-derived poliovirus type 2 (VDPV2).

Similar to vaccination of children, vaccination of adults is recommended to prevent the introduction and circulation of polio. A complete series of IPV-containing vaccine is recommended for previously unimmunized adults who are also receiving a primary series of tetanus toxoid-containing vaccine. For other adults who are unvaccinated against polio, vaccination efforts should be focused on those who are at increased risk of exposure to polioviruses including: family or close contacts of internationally adopted infants who may have been or will be vaccinated with OPV vaccine, and travellers to, or persons receiving travellers from, areas where poliovirus is known or suspected to be circulating. Close contacts of children who received OPV have a small but increased risk of infection with vaccine-derived polio virus because, following receipt of OPV poliovirus can be present in the throat for 1 to 2 weeks and can remain in feces for several weeks. Therefore, ensuring up-to-date polio vaccination of close contacts is important. Adults previously immunized with polio vaccine and at increased risk of exposure to polio should receive a single lifetime booster dose of IPV-containing vaccine. Refer to the WHO Polio Global Eradication Initiative for the current status of polio around the world.

Refer to Poliomyelitis vaccine in Part 4 for additional information.

Pertussis-containing vaccine

All individuals should have their vaccine series completed with an acellular pertussis-containing vaccine as appropriate for age. Refer to Pertussis Vaccine in Part 4 for additional information.

COVID-19 vaccine

People who are planning to live, work or study in Canada who have received 1 or 2 doses of a non-Health Canada authorized COVID-19 vaccine for their primary series should be offered an additional dose of an mRNA vaccine, unless they have already received 3 doses of a COVID-19 vaccine. The minimum interval between the previous dose and the additional dose should be 28 days. Individuals should also receive booster doses when eligible.

Refer to COVID-19 vaccine in Part 4 for additional information.

Visiting Friends and Relatives in Country of Origin

People new to Canada often return to their country of origin to visit friends and relatives. During such visits, people new to Canada, and particularly their Canadian-born family members, may be exposed to risks for vaccine preventable diseases which need to be considered when evaluating immunization status and recommending vaccines. Refer to Immunization of Travellers in Part 3 for additional information.

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