Canadian Immunization Guide update: 2015 - 2016

Abstract

The Canadian Immunization Guide (CIG) is a trusted, reader-friendly summary of information and advice on immunization that has been used by health care providers and policy makers for decades. It is continuously updated based on new recommendations from the National Advisory Committee on Immunization (NACI) and the Committee to Advise on Tropical Medicine and Travel (CATMAT), two external advisory bodies to the Public Health Agency of Canada. In September 2016, the CIG moved to a new web platform that has improved navigability and is more mobile friendly. Between April 2015 and October 2016, five new NACI statements were published and are reflected in the CIG. The objective of this article is to provide readers with highlights of recent key changes to active vaccine recommendations in the CIG. For example, for Hepatitis (HA) vaccine, it may now be administered to persons six months of age and older and considered for all individuals receiving repeated replacement of plasma-derived clotting factors. There are now new recommendations for the use of HA immunoglobulin post-exposure prophylaxis. For Human papillomavirus (HPV) vaccine, any of the authorized HPV vaccines in Canada, including HPV9 vaccine, can be used according to the recommended HPV immunization schedules. For influenza vaccine, adults with neurologic or neurodevelopment conditions have been added to the group for whom influenza vaccination is particularly recommended, high-dose influenza vaccine has been approved for use in Canada in adults ≥65 years of age and live attenuated influenza vaccine (LAIV) is no longer a preferentially recommended product for use in children and adolescents. On an individual basis, pneumococcal conjugate 13-valent (PNEU-C-13) vaccine may be recommended to immunocompetent adults aged 65 years and older if not previously immunized against pneumococcal disease. When it is given, it should precede the pneumococcal polysaccharide 23-valent (PNEU-P-23) vaccine. Varicella immune globulin may now be administered up to 10 days since last exposure for the purpose of disease attenuation and there were a number of minor changes to the criteria for assessing varicella immunity.

Introduction

Since 1979, the Canadian Immunization Guide (CIG) has provided a trusted, reader friendly summary of information on immunization and has been used by health care providers who administer vaccines to their patients and by policy makers for the delivery of immunization programs. The CIG, published by the Public Health Agency of Canada (PHAC), translates recommendations and guidance from the National Advisory Committee on Immunization (NACI) and the Committee to Advise on Tropical Medicine and Travel (CATMAT), into a single resource. NACI is a PHAC advisory body that makes recommendations for the use of vaccines currently or newly approved for use in humans in Canada, including the identification of groups at risk for vaccine-preventable diseases for whom vaccination should be targeted ^{Footnote 1}. CATMAT is an expert advisory body that assists PHAC with travel health-related advice for travellers and health care professionals. Both NACI and CATMAT recommendations are published by PHAC and summarized in the CIG ^{Footnote 2}.

The CIG is divided into five parts, covering key immunization information, vaccine safety, special populations, active vaccines and passive immunization agents. Part 4 on Active Vaccines, is organized into disease-specific chapters and provides information about disease characteristics and epidemiology, as well as vaccine-specific information and recommendations for use. It is the part of CIG that is most often updated in relation to new recommendations.

The CIG is maintained by NACI. Chapters are updated as new evidence about vaccines and vaccine preventable diseases becomes available and as NACI and CATMAT statements and updates are published. A Table of Updates summarizes key changes as they are made to individual chapters. The date on which a chapter has last been reviewed or updated is noted on the respective webpage. Since 2012, the CIG has been published online in an electronic format ^{Footnote 2}. In September 2016, the CIG was moved to a new web platform and is now mobile friendly with increased navigability for users.

The objective of this article is to provide highlights of recent key changes to active vaccine recommendations in the CIG that have been made since the last CIG update, specifically from April 2015 to October 2016 ^{Footnote 3}.

Approach

When developing recommendations, NACI conducts comprehensive knowledge syntheses and analyses incorporating scientific reviews, evolving practices and national and international recommendations. The recommendations are then translated into the corresponding chapters of the CIG. Detailed recommendations concerning immunization and the use of vaccines available in Canada can be found in the relevant statements and statement updates ^{Footnote 1}.

Summary of updates

Table 1 provides a summary of recent changes and additions to the CIG, noting what recommendations are now outdated.