Summary of updates in the Canadian Immunization Guide as of May 3, 2024: Updated guidance on pneumococcal vaccines in Canada

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On May 3, 2024, the Public Health Agency of Canada (PHAC) released updated guidance for health care providers in the Canadian Immunization Guide (CIG) based on guidance from the National Advisory Committee on Immunization (NACI) on the use of pneumococcal vaccines in children and adults. This guidance is based on current evidence and/or NACI's expert opinion.

What you need to know

NACI often provides clarification or additional details to support clinical decisions in the CIG after the main NACI statements have been published.

The Pneumococcal vaccines chapter of the CIG was updated based on new advice from NACI that was not included in recent NACI statements. These changes and the supporting rationale are outlined below to support transparency, record keeping, and clarity of communication.

Specifically, changes include:

  1. An updated list of population groups at risk of invasive pneumococcal disease (IPD) requiring special immunization regimens:
    • Previously, conditions considered to result in the highest risk of IPD were identified in Table 1 of the CIG Pneumococcal vaccines chapter (which listed medical conditions leading to increased risk of IPD) with an asterisk. These included chronic kidney disease, chronic liver disease, functional/anatomic asplenia, and immunocompromising conditions.
    • The updated Table 1 now organizes all IPD risk factors into medical and non-medical conditions. Additional risk factors for which immunization with Pneu-C-20 is recommended independent of age include chronic cerebrospinal fluid (CSF) leak, cochlear implants, and individuals who are underhoused/experiencing homelessness, who live in communities or settings experiencing sustained high IPD rates, and who are in residential care including long-term care homes and residential care homes for children with complex medical needs.
    • The rationale for these changes was the similar risk of disease complications compared to population groups that have previously been identified as being at highest risk, based on expert opinion and a targeted review of literature.
    • Additions to Table 1 reflect the evidence review deliberated by NACI and external experts from the NACI Pneumococcal Working Group.
  2. Alignment of pneumococcal vaccine advice across age groups:
    • This includes guidance for the immunization of adults less than 65 years of age who have been previously immunized with a pneumococcal vaccine (now aligned with recommendations for adults aged 65 and over) as well as the harmonization of re-immunization guidance and minimum intervals (between Pneu-C-20 and Pneu-C-13/Pneu-P-23 vaccines) for adults and children.
    • Alignment of recommendations in the NACI adult pneumococcal immunization statement with the format and wording used in the CIG, including the expansion of existing recommendations for immunocompromised individuals to include all those previously identified as being at highest risk (immunocompromised-equivalent adults).

Supporting information

For more information on NACI's recommendations on the use of pneumococcal vaccines, please refer to the Pneumococcal vaccines chapter in the CIG, as well as additional statements on the NACI web page.

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