Immunization of persons with inadequate immunization records: Canadian Immunization Guide
For health professionals
Updated: July 2015
People may present to health care providers with inadequate or no immunization records. Vaccine providers should always attempt to obtain the person's immunization records from his or her previous health care provider.
Written or electronic documentation of immunization is preferred for both children and adults; however, information obtained by telephone from the person's health care provider with the exact dates of immunization may be accepted. For children, parental recall of prior immunization, in the absence of documentation from the vaccine provider, correlates poorly with vaccines received and should not be accepted as evidence of immunization. One possible exception is seasonal influenza vaccine, due to the increased reliability of recall as to whether or not influenza vaccine was received less than one year previously.
Routine serologic testing to determine the immunity of children and adults without immunization records is generally not practical. The following approach is recommended: Individuals who report incomplete immunization or lacking adequate documentation of immunization should be considered unimmunized and started on an immunization schedule appropriate for their age and risk factors. Refer to vaccine-specific chapters in Part 4 for additional information. Refer to the Recommended Immunization Schedules in Part 1 for information about immunization schedules recommended by the National Advisory Committee on Immunization for previously unimmunized children and adults. Refer to the vaccination schedule for infants and children and adult vaccination schedule for information about publicly funded immunization schedules.
The following considerations are of note:
- Adverse effects of repeated immunization with the following vaccines have not been demonstrated, regardless of possible prior receipt of the vaccine: combined measles-mumps-rubella with or without varicella; inactivated polio; Haemophilus influenzae type b; meningococcal; hepatitis A; hepatitis B; univalent varicella; and influenza vaccines.
- In general, injection site reactions are greatest after the first dose of a live vaccine and are less marked or absent with subsequent doses. In contrast, injection site reactions tend to increase with each subsequent dose of an inactivated vaccine. The presence of a large injection site reaction to a previous dose is not a contraindication to continuing the recommended schedule.
- People who develop a serious adverse injection site reaction after administration of vaccines, particularly tetanus, diphtheria and pertussis vaccines, should be individually assessed before they receive additional doses of these vaccines. The benefit of continuing the vaccine series needs to be weighed against the risk of further adverse reactions. Serologic testing, if available and appropriate, may guide the need for continued immunization. There are no established serologic correlates for protection against pertussis; diphtheria and tetanus serology may be used as a proxy.
Refer to Contraindications, Precautions and Concerns in Part 2 for additional information about adverse events following a previous immunization. Refer to Immunization of Persons New to Canada in Part 3 for additional information about immunization of people who have recently arrived in Canada.
Selected References
- Centers for Disease Control and Prevention. General recommendations on immunization
Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 2011;60(RR-2):1-61.