Recommended immunization schedules: Canadian Immunization Guide
For health professionals
Notice
This chapter has not yet been updated with the following statement from the National Advisory Committee on Immunization (NACI):
- February 24, 2023: 
This CIG chapter has not been updated to contain any information regarding COVID-19 vaccines, refer to the .
 Last partial content update (see ): July 2023
Clarifications were made to Table 5 to better align with information provided in Part 4 chapters.
Last complete chapter revision: December 2013
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General recommendations
Administration of vaccines in accordance with the immunization schedules summarized in the following tables will provide optimal protection from vaccine preventable diseases for most individuals. However, modifications of the recommended schedule may be necessary due to missed appointments or illness. In general, interruption of an immunization series does not require restarting the vaccine series, regardless of the interval between doses. Individuals with interrupted immunization schedules should be vaccinated to complete the appropriate schedule for their current age. Refer to  in Part 1 and  in Part 4 for additional information.
Similar, but not identical, vaccines may be available from different manufacturers; therefore, it is useful to review the relevant  in the Canadian Immunization Guide as well as the manufacturer's product leaflet or product monograph before administering a vaccine. Refer to  in Part 1 for information about the interchangeability of similar vaccines from different manufacturers. Product monographs are periodically updated; it is a best practice to consult the information contained within the product monographs available through .
- For children at-risk due to underlying medical conditions, refer to  for additional recommendations for immunization.
 or 
 or 
 or 
 or 4th dose
 2 or 3 doses
 1 or 2 doses
 1 dose
For abbreviations and brand names of vaccines refer to  in Part 1.
 (HPV): Girls, 9-14 years of age: HPV bivalent (HPV2) or HPV quadrivalent (HPV4) vaccine or HPV nonavalent (HPV9) vaccine - months 0 and 6-12 (first dose = month 0). Alternatively, a 3 dose schedule may be used for HPV2 vaccine - months 0, 1 and 6 (first dose = month 0), for HPV4 vaccine - months 0, 2 and 6 (first dose = month 0), and HPV nonavalent (HPV9) vaccine - months 0, 2 and 6 (first dose = month 0). Boys, 9-14 years of age: HPV4 or HPV9 vaccine - months 0 and 6-12 (first dose = month 0). Alternatively, a 3 dose schedule may be used for HPV4 vaccine - months 0, 2 and 6 (first dose = month 0), and HPV9 vaccine - months 0, 2 and 6 (first dose = month 0). For a 2 or 3 dose schedule, the minimum interval between first and last doses is 6 months.
Influenza: recommended annually for anyone 6 months of age and older without contraindications. Children 6 months-less than 9 years of age, receiving influenza vaccine for the first time - 2 doses, at least 4 weeks apart. Children 6 months-8 years of age, previously immunized with influenza vaccine and children 9 years of age and older - 1 dose.
- For children at-risk due to underlying medical conditions, refer to  for additional recommendations for immunization.
For abbreviations and brand names of vaccines refer to  in Part 1.
Diphtheria toxoid- tetanus toxoid- acellular pertussis- inactivated polio- *Haemophilus influenzae- type b (DTaP-IPV-Hib) or diphtheria toxoid- tetanus toxoid- acellular pertussis- inactivated polio (DTaP-IPV): 4 doses of DTaP-IPV-containing vaccine. The number of doses of Hib-containing vaccine required varies by age at first dose. If first visit at 12-14 months of age: 1 dose of Hib-containing vaccine at first visit and booster dose at least 2 months after the previous dose. If first visit at 15 months-less than 60 months of age: 1 dose of Hib-containing vaccine. If first visit at 60 months of age or older, Hib-containing vaccine is not required.
Diphtheria toxoid- tetanus toxoid- acellular pertussis- inactivated polio (DTaP-IPV) or tetanus toxoid- reduced diphtheria toxoid- reduced acellular pertussis- inactivated polio (Tdap-IPV): if the fourth dose of DTaP-IPV vaccine was given before the fourth birthday, a booster dose of DTaP-IPV or Tdap-IPV vaccine should be provided at 4-6 years of age.
Pneumococcal conjugate 13-valent: 12-23 months of age - 2 doses, at least 8 weeks apart. 24-59 months of age - 1 dose.
Meningococcal conjugate monovalent: 12-59 months of age - 1 dose; 5-11 years of age - consider 1 dose.
Measles-mumps-rubella: 2 doses, at least 4 weeks apart; second dose after 18 months of age, but should be given no later than around school entry.
Varicella: 2 doses, at least 3 months apart; second dose after 18 months of age, but should be given no later than around school entry. A minimum interval of 4 weeks between doses may be used if rapid, complete protection is required.
Measles-mumps-rubella-varicella: 2 doses, at least 3 months apart; second dose after 18 months of age, but should be given no later than around school entry. A minimum interval of 4 weeks between doses may be used if rapid, complete protection is required.
Hepatitis B: 3 doses - months 0, 1 and 6 (first dose = month 0) with at least 4 weeks between the first and second dose, 2 months between the second and third dose, and 4 months between the first and third dose.
Influenza: 2 doses, at least 4 weeks apart.
- For children at-risk due to underlying medical conditions, refer to  for additional recommendations for immunization.
 9-14 years of age
 15-17 years of age
For abbreviations and brand names of vaccines refer to  in Part 1.
Tetanus toxoid- reduced diphtheria toxoid- reduced acellular pertussis- inactivated polio (Tdap-IPV): 2 doses, 8 weeks apart; third dose 6-12 months after second dose.
Tetanus toxoid- reduced diphtheria toxoid- reduced acellular pertussis: 10 years after last dose of Tdap-IPV.
Meningococcal conjugate monovalent: 7-11 years of age - consider 1 dose.
Meningococcal conjugate monovalent or quadrivalent: 12-17 years of age - 1 dose, even if meningococcal conjugate vaccine received at a younger age. Vaccine chosen depends on local epidemiology and programmatic considerations.
Measles-mumps-rubella: 2 doses, at least 4 weeks apart.
Varicella (chickenpox): 7-12 years of age - 2 doses, at least 3 months apart. 13 years of age and older - 2 doses, at least 6 weeks apart. A minimum interval of 4 weeks between doses may be used if rapid, complete protection is required.
Measles-mumps-rubella-varicella: 7-12 years of age - 2 doses, at least 3 months apart. A minimum interval of 4 weeks between doses may be used if rapid, complete protection is required.
Hepatitis B: 7-17 years of age - 3 doses, months 0, 1 and 6 (first dose = month 0) with at least 4 weeks between the first and second dose, 2 months between the second and third dose, and 4 months between the first and third dose. 11-15 years of age - two doses; schedule depends on the product used.
Human papillomavirus (HPV): Girls, 9-14 years of age - HPV bivalent (HPV2) or HPV quadrivalent (HPV4) vaccine or HPV nonavalent (HPV9) - months 0 and 6-12 (first dose = month 0). Alternatively, a 3 dose schedule may be used for HPV2 vaccine - months 0, 1 and 6 (first dose = month 0), for HPV4 vaccine - months 0, 2 and 6 (first dose = month 0), and for HPV nonavalent (HPV9) vaccine - months 0, 2 and 6 (first dose = month 0). Boys, 9-14 years of age HPV4 vaccine or HPV9 - months 0 and 6-12 (first dose = month 0). Alternatively, a 3 dose schedule may be used for HPV4 or HPV9 vaccine - months 0, 2 and 6 (first dose = month 0). For a 2 or 3 dose schedule, the minimum interval between first and last doses is 6 months.
Human papillomavirus: Girls, 15-17 years of age: HPV2 vaccine - months 0, 1 and 6 (first dose = month 0), HPV4 vaccine - months 0, 2 and 6 (first dose = month 0) or HPV9 vaccine - months 0, 2 and 6 (first dose = month 0). Boys, 15-17 years of age: HPV4 vaccine - months 0, 2 and 6 (first dose = month 0) or HPV9 vaccine - months 0, 2 and 6 (first dose = month 0). In individuals who received the first dose of HPV2 or HPV4 or HPV9 vaccine between 9-14 years of age, a 2 dose schedule can be used with the second dose administered at least 6 months after the first dose.
Influenza: children less than 9 years of age - 2 doses, at least 4 weeks apart. Children 9 years of age and older - 1 dose.
 1 or 2 doses
 1 dose
For abbreviations and brand names of vaccines refer to  in Part 1.
*Haemophilus influenzae- type b (Hib): 5 years of age and older with increased risk of invasive Hib disease - 1 dose regardless of prior history of Hib vaccination and at least 1 year after any previous dose.
Pneumococcal polysaccharide 23-valent: children 2 years of age or older at high risk of invasive pneumococcal disease (IPD) - 1 dose. Children at highest risk of IPD including those with functional or anatomic asplenia or sickle cell disease; hepatic cirrhosis; chronic renal failure; nephrotic syndrome; HIV infection; and immunosuppression related to disease or therapy - 1 booster dose after 5 years. If pneumococcal conjugate 13-valent (Pneu-C-13) vaccine is also required, it should be provided first, followed by Pneu-P-23 vaccine, at least 8 weeks later.
Pneumococcal conjugate 13-valent: infants at high risk of IPD - in addition to the doses at 2, 4, and 12 months of age, give an extra dose at 6 months to make a 4 dose primary series. Children aged 3 years and older at high risk of IPD who have not previously received Pneu-C-13 vaccine - 1 dose
Meningococcal conjugate quadrivalent (Men-C-ACYW): infants and children at high risk of invasive meningococcal disease (IMD): 2-11 months of age - 2 or 3 doses of Men-C-ACYW-CRM vaccine, 8 weeks apart with another dose between 12-23 months of age and at least 8 weeks after the previous dose; 12-23 months of age - 2 doses of Men-C-ACYW-CRM vaccine,8 weeks apart; 24 months of age and older - 2 doses of any Men-C-ACYW vaccine, 8 weeks apart. Give additional booster doses every 3 to 5 years if last vaccinated at 6 years of age and younger and every 5 years if last vaccinated at 7 years of age and older.
Multicomponent meningococcal (4CMenB): infants and children at high risk of IMD should be considered for immunization: 2-11 months of age - 2 or 3 doses of 4CMenB vaccine, 8 weeks apart with another dose between 12-23 months of age and at least 8 weeks after the previous dose; 1-10 years of age- 2 doses of 4CMenB vaccine, 8 weeks apart; 11 years of age and older - 2 doses of 4CMenB vaccine, at least 4 weeks apart. The need for and timing of 4CMenB vaccine booster doses have not yet been determined.
Hepatitis A: 6 months of age and older in high-risk groups: 2 doses, given 6-36 months apart (depending on product used).
Hepatitis B: 3 or 4 doses of higher dose of monovalent hepatitis B vaccine recommended for those with certain immunocompromising conditions, chronic renal failure and dialysis. Premature infants weighing less than 2,000 grams at birth born to HB infected mothers: 4 doses.
Influenza: recommended annually for all individuals 6 months of age and older without contraindications, with focus on children at risk of influenza-related complications. Children 6 months-less than 9 years of age receiving influenza vaccine for the first time: 2 doses, at least 4 weeks apart. Children 6 months-8 years of age, previously immunized with influenza vaccine and children 9 years of age and older: 1 dose.
- For adults considered at-risk, refer to  for additional recommendations for immunization.
 Tdap
 Td
For abbreviations and brand names of vaccines refer to  in Part 1.
Three doses of either tetanus toxoid- reduced diphtheria (Td, if not previously immunized with tetanus or diphtheria), or polio-containing vaccine if at increased risk of polio (Tdap-IPV, if not previously immunized with tetanus, diphtheria and polio, or IPV, if not previously immunized with polio) provided with an interval of 8 weeks between the first two doses followed by a third dose administered 6 to 12 months after the second dose. One dose of reduced acellular pertussis-containing vaccine should be provided to those who never previously received a pertussis-containing vaccine in adulthood. 
 Adults who are unimmunized against polio but are not at increased risk and have had a primary series of tetanus and diphtheria containing vaccine, should receive IPV-containing vaccine as a part of their next tetanus and diphtheria booster.
Tetanus toxoid- reduced diphtheria toxoid (Td): 10 years after last dose of Td-containing vaccine.
Measles-mumps-rubella (MMR): adults born in or after 1970 - 1 dose, except - travellers, health care workers, students in post-secondary educational settings, and military personnel - 2 doses, at least 4 weeks apart. Adults born before 1970 can be presumed to have acquired natural immunity to measles and mumps and do not need MMR vaccination except - non-immune military personnel or health care workers (2 doses, at least 4 weeks apart), non-immune travellers (1 dose), non-immune students in post-secondary educational settings (consider 1 dose). Rubella-susceptible adults, regardless of age - 1 dose.
Varicella (chickenpox): adults 18-49 years of age - 2 doses, at least 6 weeks apart; adults 50 years of age and older are generally presumed to be immune.
Recombinant Zoster Vaccine (RZV): adults 50 years of age and older - 2 doses, 2 to 6 months apart; may be considered for immunocompromised adults 50 years of age and older based on a case-by-case assessment of benefits vs risks.
Pneumococcal polysaccharide 23-valent: adults 65 years of age and older - 1 dose; immunocompetent residents of long-term care facilities 18-64 years of age - 1 dose.
Meningococcal conjugate monovalent or quadrivalent: adults less than 25 years of age - 1 dose (vaccine chosen depends on local epidemiology).
Human papillomavirus (HPV): recommended for women up to and including 26 years of age, may be given to women 27 years of age and older at ongoing risk of exposure: HPV bivalent (HPV2) vaccine - months 0, 1 and 6 (first dose = month 0), HPV quadrivalent (HPV4) vaccine - months 0, 2 and 6 (first dose = month 0) or nonavalent (HPV9) vaccine- months 0, 2 and 6 (first dose = month 0). Recommended for men up to and including 26 years of age, may be given to men 27 years of age and older at ongoing risk of exposure: HPV4 or HPV9 vaccine - months 0, 2 and 6 (first dose = month 0).
Influenza: 1 dose recommended for adults without contraindications, with focus on: adults at high risk of influenza-related complications (including pregnant women, adults 65 years of age and older); adults capable of transmitting influenza to individuals at high risk; adults who provide essential community services; and people in direct contact during culling operations with poultry infected with avian influenza.
- For adults considered at-risk, refer to  for additional recommendations for immunization.
For abbreviations and brand names of vaccines refer to  in Part 1.
Tetanus toxoid- reduced diphtheria toxoid: 1 booster dose every 10 years.
Tetanus toxoid- reduced diphtheria toxoid- reduced acellular pertussis (Tdap): 1 dose in adulthood for pertussis protection regardless of interval since last dose of tetanus toxoid- and diphtheria toxoid-containing vaccine; 1 dose in every pregnancy, ideally between 27 and 32 weeks of gestation, for pertussis protection of infants. Refer to  in Part 4 for additional information.
Pneumococcal polysaccharide 23-valent: adults 65 years of age and older - 1 dose.
Recombinant Zoster Vaccine (RZV): adults 50 years of age and older - 2 doses, 2 to 6 months apart and at least one year after LZV.
Influenza: recommended for all adults without contraindications, with focus on: adults at high risk of influenza-related complications (including pregnant women, adults 65 years of age and older); adults capable of transmitting influenza to individuals at high risk; adults who provide essential community services; and people in direct contact during culling operations with poultry infected with avian influenza. One dose annually.
List is not exhaustive of travel vaccines. For abbreviations and brand names of vaccines refer to  in Part 1.
*Haemophilus influenzae- type b (Hib): adults with increased risk of invasive Hib disease - 1 dose regardless of prior history of Hib vaccination and at least 1 year after any previous dose.
Inactivated polio: 1 booster dose for adults at increased risk of exposure to polio.
Measles-mumps-rubella (MMR): adults born in or after 1970 - 1 dose, except - travellers, health care workers, students in post-secondary educational settings, and military personnel - 2 doses, at least 4 weeks apart. Adults born before 1970 can be assumed to have acquired natural immunity to measles and mumps and do not need MMR vaccination except - non-immune military personnel or health care workers (2 doses, at least 4 weeks apart), non-immune travellers (1 dose), non-immune students in post-secondary educational settings (consider 1 dose). Rubella-susceptible adults, regardless of age - 1 dose.
Pneumococcal conjugate 13-valent (Pneu-C-13): adults with HIV or immunocompromising conditions (except hematopoietic stem cell transplant recipients ) - 1 dose of Pneu-C-13 vaccine followed 8 weeks later by 1 dose of pneumococcal polysaccharide 23-valent (Pneu-P-23) vaccine. Administer Pneu-C-13 vaccine dose at least 1 year after any previous dose of Pneu-P-23 vaccine.
Pneumococcal polysaccharide 23-valent: adults at high risk of invasive pneumococcal disease (IPD), including adults with alcoholism, smokers, and persons who are homeless - 1 dose. One dose should be considered for adults who use illicit drugs. Adults at highest risk of IPD, including those with functional or anatomic asplenia or sickle cell disease; hepatic cirrhosis; chronic renal failure; nephrotic syndrome; HIV infection; and immunosuppression related to disease or therapy - 1 booster dose at least 5 years from first vaccination with Pneu-P-23 vaccine.
Meningococcal conjugate quadrivalent: in previously unimmunized adults at high risk of invasive meningococcal disease (IMD) - 2 doses, 8 weeks apart. In previously immunized adults -booster dose every 3 to 5 years if last vaccinated at 6 years of age and younger and every 5 years for those last vaccinated at 7 years of age and older.
Multicomponent meningococcal (4CMenB): adults at high risk of IMD should be considered for immunization - 2 doses of 4CMenB vaccine, at least 4 weeks apart.
Hepatitis A: adults in high risk groups - 2 doses, 6-36 months apart (depending on product used).
Hepatitis B (HB): adults in high risk groups - 3 or 4 dose schedule (depending on product used). Higher dose of monovalent HB vaccine recommended for those with certain immunocompromising conditions, chronic renal failure and dialysis.
Hepatitis A-hepatitis B: adults without chronic renal failure and immunocompromising conditions: combined vaccine preferred if both hepatitis A and standard dosage hepatitis B vaccines are recommended - 3 or 4 dose schedule.
Influenza: recommended for all adults, with focus on adults at high risk of influenza-related complications - 1 dose annually.
Typhoid: adults with ongoing or intimate exposure to a chronic carrier of *Salmonella typhi* - 1 dose injectable typhoid vaccine or 4 doses oral typhoid vaccine; re-immunization recommended if at continuing risk.
Rabies: adults at high risk of close contact with rabid animals - 3 doses for pre-exposure immunization. Periodic serologic testing and booster doses (if required) for those at continuing high risk.
Varicella: adults 18 to less than 50 years of age without history of VZV infection (self-reported or diagnosed by a health care provider), documented evidence of immunization with 2 doses of a varicella-containing vaccine or laboratory evidence of immunity - 2 doses. Self-reported history or health care provider diagnosis is not considered a reliable correlate of immunity for pregnant women with significant exposure to varicella zoster virus, immunocompromised individuals and health care workers who are newly hired into the Canadian health care system.