New vaccine recommendations in the Canadian Immunization Guide
Volume 40-8, April 17, 2014: Vaccine preventable diseases
What are the new active vaccine recommendations in the Canadian Immunization Guide?
Warshawsky B1 and Gemmill I2 on behalf of the National Advisory Committee on Immunization (NACI)*
1 NACI Chair, London, Ontario
2 NACI Vice-Chair, Kingston, Ontario
The scientific advisory body on immunization for the Public Health Agency of Canada is the National Advisory Committee on Immunization (NACI), which develops recommendations for the use of vaccines for Canadians Footnote 1. These recommendations and other immunization information are published in the Canadian Immunization Guide (the Guide).
Since the first edition in 1979, the Guide has been a trusted, reader-friendly summary of information that has been used by health care providers to give advice and vaccinations to their patients, and by policy-makers for the delivery of vaccination programs. The document consists of five parts, covering key immunization information, vaccine safety, special populations, active vaccines, and passive immunization agents. Since the 2006 edition, the Guide has undergone extensive revisions and is now published online in an electronic format Footnote 2. The objective of this article is to provide some highlights of updates made to Part 4 on Active Vaccines up to February 28, 2014.
In revising the Active Vaccine chapters of the Guide, NACI reviewed literature regarding new products, changes in indication, evolving science and practices, as well as national and international recommendations released since 2006. In addition NACI consulted external expertise as necessary.
Summary of updates and additions to Part 4 (Active Vaccines)
Several new vaccines have been produced since 2006, including vaccines against herpes zoster, human papillomavirus, and rotavirus. Additionally, indications and recommendations have been revised for other vaccines.
Table 1 provides an overview of key changes and additions up to February 28, 2014. As with any therapy, it is most prudent to check the most recent prescribing information prior to use.
|Active vaccine||New NACI recommendation|
|BCG||Revised recommendation regarding when a TB skin test should be given before administering BCG vaccine to children < 6 months of age|
|Haemophilus influenzae type b||One dose is recommended regardless of past immunization for those 5 years of age or older with the following high-risk conditions:
|Hepatitis A||Vaccination recommended for family and close contacts of children adopted from hepatitis A endemic countries.|
|Hepatitis B||Higher doses recommended for the following:
|Herpes zoster||New chapter: Live attenuated vaccine was authorized for the prevention of shingles, August 2008.
|Human papillomavirus||New chapter: Since 2006, two human papillomavirus (HPV) vaccines have been authorized for use that protect against four (HPV-4) and two (HPV-2) types of HPV.
For up-to-date information on influenza immunization, please review the most recent version of the annual influenza statement.
|Measles mumps rubella||
High risk due to medical conditions
High risk due to exposures
If at ongoing high risk because of medical condition or exposure, a booster is recommended:
Recommendations are provided for post-exposure revaccination of those previously vaccinated.
|Pertussis||Preschool booster at 4-6 years of age
|Pneumococcal||Chapter includes updated vaccination schedules and recommendations for the use of Pneu-C-13 (Prevnar®13).
Pneu-C-13 is recommended for the following:
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.
|Rotavirus||New chapter: Since mid-2006, two live, oral rotavirus vaccines have been authorized for use; one requires three doses and the other requires two doses. For both products, the first dose should be given before 14 weeks and 6 days of age and the last dose before 8 months of age. Intussusception is recognized as a rare adverse event following rotavirus vaccination.|
|Travel vaccines||Japanese encephalitis vaccine
The Canadian Immunization Guide is a trusted and reliable resource for immunizers in Canada. Part 4 of the Guide on active vaccines has been updated to incorporate new science and practices and reflects recent recommendations by NACI. NACI and the Public Health Agency of Canada are committed to providing this information in an easily accessible, reader-friendly format through timely and ongoing updates of the on-line version.
The authors would like to thank the extremely dedicated members of NACI who devoted considerable time and effort to revising the Guide as well as the excellent Public Health Agency of Canada staff who have supported the revision process.
Conflict of Interest
No conflicts of interest to declare.
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