New vaccine recommendations in the Canadian Immunization Guide

• Anatomic or functional asplenia (including sickle cell disease)
• Cochlear implants
• Congenital (primary) immunodeficiency
• HIV
• Malignant hematologic disorders
• Transplant candidates/recipients (see Guide for details - three doses recommended post-hematopoietic stem cell transplant)

• Chronic renal failure or dialysis
• Congenital immunodeficiency
• Hematopoietic stem cell transplant (HSCT)
• Solid organ transplant
• HIV infection
• Non-responder with advanced liver disease
• Schedules provided for DTaP-HB-IPV-Hib (INFANRIX hexa)

• Recommended for individuals 60 years of age and older, and can be considered for those 50 to 59 years of age.
• As it is a live vaccine, it is contraindicated in people with immunocompromising conditions and people taking immunocompromising drugs, with some exceptions as outlined in the Guide.
• Expert opinion recommends waiting at least one year from a previous episode of shingles before receiving the herpes zoster vaccine.
• Re-occurrence of herpes zoster ophthalmicus after vaccination (in persons with previous herpes zoster ophthalmicus) has been reported in several cases world-wide. The Guide contains management and patient counseling advice.
• In contrast to previous recommendations, the herpes zoster vaccine and pneumococcal vaccines can be co-administered.

• Women: HPV-4 or HPV-2 is recommended for 9-26-year-olds; consider in those 27 years and older with ongoing risk of exposure.
• Men: HPV-4 is recommended for 9-26-year-olds; consider in 27 years and older with ongoing risk; strongly consider for men who have sex with men regardless of age.

• Egg allergy is not a contraindication.
• Children: 0.5 mL dose is recommended for children when the intramuscular products are used; live attenuated intranasal vaccine is preferentially recommended for some age groups; see Guide for details.

For up-to-date information on influenza immunization, please review the most recent version of the annual influenza statement.

• Chapters clarify who is considered immune, including health care workers, military personnel, students in post-secondary educational settings, and travellers.
• Health care workers and military personnel require two doses of measles and mumps vaccine, regardless of year of birth, to be considered immune.

• If vaccinated as infants with meningococcal C vaccine, another dose is recommended in the second year of life (12-23 months).
• The use of quadrivalent conjugate meningococcal vaccines is reviewed.

High risk due to medical conditions

• Expanded to include terminal complement inhibitor eculizumab (Soliris™).
• Others include functional or anatomic asplenia, including that associated with sickle cell disease; congenital properdin, factor D, or primary antibody deficiencies; consider in HIV, especially if congenitally acquired.
• For high-risk children < 2 years of age, Men-C-ACYW-135-CRM (Menveo) is the recommended product. For those 2 years and older, any quadrivalent conjugate meningococcal vaccine can be used. Number of doses depends on age. For those 12 months and over, two doses given 8 weeks apart is now recommended.

High risk due to exposures

• Travellers; laboratory workers with potential routine exposure to meningococci; military personnel during recruit training and during certain deployments.
• For 2 years of age and over, one dose of any quadrivalent conjugate meningococcal vaccine.
• For children < 2 years of age, Men-C-ACYW-135-CRM (Menveo) is the recommended product; two or more doses recommended depending on age.

Boosters

If at ongoing high risk because of medical condition or exposure, a booster is recommended:

• Every 3-5 years, if  < 7 years old at last vaccination
• Every 5 years, if 7 years or over at last vaccination

Recommendations are provided for post-exposure revaccination of those previously vaccinated.

• Either DTaP-IPV or Tdap-IPV can be used.

Adult dose

• One dose of pertussis-containing vaccine (Tdap) if not previously vaccinated in adulthood.
• Tdap can be given after previous Td without delay.

Pregnancy

• One dose of Tdap can be offered to pregnant women (26 weeks' gestation or over) who have not previously been vaccinated against pertussis in adulthood.
• In special circumstances, e.g. regional outbreaks, Tdap may be offered to pregnant women (26 weeks' gestation or over) irrespective of previous immunization.

Pneu-C-13 is recommended for the following:

• Children < 59 months of age who have never received conjugate pneumococcal vaccine
• High-risk children < 18 years of age who have never received Pneu-C-13
• Adults with immunocompromising conditions

Number of doses is dependent on age; those 2 years and over receive only one dose, except for those who are post-HSCT, for whom a three-dose schedule is recommended.

Polysaccharide vaccine is also recommended for high-risk children 2 years of age and over after receipt of PCV 13.

Definitions of high-risk and immunocompromising conditions are provided in the Guide.

Catch-up schedules for those < 59 months of age who have received another conjugate pneumococcal vaccine, but not Prevnar 13, are provided in the Guide.

• Adults should be vaccinated if not previously vaccinated.
• Priority for people at risk, such as travellers possibly exposed to someone excreting polio virus; others should be vaccinated when they need a primary tetanus series or tetanus booster.

• A four-dose schedule (instead of five) is recommended for post-exposure management for those who are not immunocompromised and not taking anti-malarial prophylaxis. Give on day 0 (first dose), 3, 7, and 14.
• If immunocompromised or taking anti-malarial prophylaxis, give five doses on day 0 (first dose), 3, 7, 14, and 28.
• Post-exposure management based on risk assessment. Factors to consider provided in the Guide.

• New inactivated vaccine (Ixiaro) for 18 years and over.

Yellow fever

• Classification of countries into risk levels.
• Probable transmission during breastfeeding reported.

Tick-borne encephalitis

• New chapter has been added to the Guide.

• Two doses recommended for susceptible individuals of all ages.
• Use of MMRV vaccine outlined in the chapter.
• Chapter outlines who is considered immune. Adults 50 years of age and older can be considered immune unless known to be susceptible on the basis of previous laboratory testing; health care providers and those born in or after 2004 require a health care provider diagnosis of chickenpox, two documented doses of varicella vaccine or laboratory-confirmed disease, or immunity (this is currently under review by NACI).
• Minimum intervals between varicella-containing vaccines identified.