Persius/hicric huggingface dataset:
On December 13, 2007, certain lots of Haemophilus influenzae type b (Hib) vaccine marketed as PedvaxHIB (monovalent Hib vaccine) and Comvax (Hib-HepB vaccine), and manufactured by Merck & Co., Inc., were recalled voluntarily, and the company temporarily suspended production of these vaccines. To conserve the limited supply of Hib-containing vaccines, CDC, in consultation with the Advisory Committee on Immunization Practices (ACIP), the American Academy of Family Physicians (AAFP), and the American Academy of Pediatrics (AAP), on December 18, 2007, recommended that vaccination providers temporarily defer the routine Hib vaccine booster dose administered to most healthy children at age 12--15 months (1--5). Production of Merck Hib vaccine products is still suspended. However, two other Hib-containing vaccines manufactured by Sanofi Pasteur have been available for use in the United States during this shortage: monovalent Hib vaccine (ActHIB) and DTaP-IPV/Hib (Pentacel). Beginning in July 2009, the manufacturer of these two vaccines will increase the number of doses of these two products available for use in the United States, which will result in the supply being sufficient to reinstate the Hib vaccine booster dose.# Reinstatement of Hib Booster Dose
Effective immediately, CDC, in consultation with ACIP, AAFP, and AAP, is recommending reinstatement of the booster dose of Hib vaccine for children aged 12--15 months who have completed the primary 3-dose series. Infants should continue to receive the primary Hib vaccine series at ages 2, 4, and 6 months. Children aged 12--15 months should receive the booster dose on time. Older children for whom the booster dose was deferred should receive their Hib booster dose at the next routinely scheduled visit or medical encounter. Although supply is sufficient to reinstate the booster dose and begin catch-up vaccination, supply is not yet ample enough to support a mass notification process to contact all children with deferred Hib booster doses. Sufficient vaccine will be available to administer the primary series at ages 2, 4, and 6 months and a booster dose on time to children aged 12--15 months. As part of delivering the booster dose to those children for whom it was deferred at the next routinely scheduled appointment or medical encounter, practices should discuss with parents the reasons for the change in recommendation and might consider 1) reviewing electronic or paper medical records or immunization information system records to identify children in need of a booster dose before physician encounters, 2) evaluating children's vaccination status during their scheduled visit, and 3) sharing immunization schedules with parents to make them aware of this plan.

# Use of Combination Vaccines
Crimean-Congo Hemorrhagic fever | Disease Directory | Travelers' Health | CDC

### Crimean-Congo Hemorrhagic fever
 window.location.href = 'https://www.cdc.gov/vhf/crimean-congo/index.html';
Flu (Influenza) | Disease Directory | Travelers' Health | CDC

### Flu (Influenza)
![man getting a flu shot](/travel/images/man-getting-flu-shot-2.jpg)
The best way to reduce the risk of flu and possible flu complications is to get vaccinated each year, learn about special considerations for travel.
#### You may need a flu vaccine before travel at other times of the year, depending on your destination .
-  In the Northern Hemisphere, flu season can begin as early as October and can last until April or May.
-  In the temperate regions (areas with seasons) in the Southern Hemisphere, flu activity typically occurs from April to September.
-  In the tropics, flu activity occurs throughout the year.
-  Travelers who are part of large tourist groups that include people from other parts of the world, such as on cruise ships, may be at risk.
-  People should get vaccinated at least 2 weeks before travel because it takes 2 weeks for immunity to develop after vaccination.
-  Getting a flu vaccine is very important for [people at higher risk of serious flu complications](https://www.cdc.gov/flu/highrisk/index.htm).
-  If you already got your annual flu vaccine, you usually don't need to get vaccinated again during the same season.
#### Do not travel if you are sick
-  If you are sick with flu-like symptoms, do not travel. Stay home until you are fever-free for at least 24 hours without using a fever-reducing medicine, such as acetaminophen.
-  Flu symptoms include:
	- Fever (Not everyone with flu will have a fever.)
	- Cough o Sore throat
	- Runny or stuffy nose
	- Muscle or body aches
	- Some people may have vomiting and diarrhea, though this is more common in children.
### During Travel
During your trip, follow local guidelines and practice healthy habits.
-  Avoid close contact with sick people.
-  Wash your hands often with soap and running water, especially after coughing or sneezing.
-  If soap and water are not readily available, use a hand sanitizer that contains at least 60% alcohol. Cover all surfaces of your hands and rub them together until they feel dry.
-  Cover your mouth and nose with a tissue when you cough or sneeze and put the used tissue in the trash. If you dont have a tissue, cough or sneeze into your upper sleeve, not your hands.
#### What to do if you feel sick
Most people with flu will recover without needing medical care. However, if you have severe illness or are [at risk of getting serious flu complications](https://www.cdc.gov/flu/highrisk/index.htm), seek medical care.
A U.S. consular officer can help you find local medical care in a foreign country. To contact the U.S. Embassy or consulate in the country you are visiting, call Overseas Citizens Services at 1-888-407-4747 if calling from the U.S. or Canada, 00-1-202-501-4444 if calling from other countries. You can also visit the [websites of U.S. Embassies, consulates, and diplomatic missionsExternal Link](https://www.usembassy.gov/) to find the contact information for the local U.S. Embassy of the country you are visiting.
Follow all local health recommendations
Hand, Foot, and Mouth Disease | Disease Directory | Travelers' Health | CDC

### Hand, Foot, and Mouth Disease
### What is hand, foot, and mouth disease?
Hand, foot, and mouth disease is a contagious disease that is caused by different viruses. It usually affects infants and children under 5 years old, occasionally adults will also get the disease. [Symptoms](http://www.cdc.gov/hand-foot-mouth/about/signs-symptoms.html) of hand, foot, and mouth disease include fever, painful blister-like sores in the mouth, and a rash that may appear as blisters. It is usually a mild disease, and nearly all infected people recover in 7 to 10 days.
Hand, foot, and mouth disease spreads through close personal contact, such as kissing or hugging, coughing and sneezing, contact with feces (poop), and touching objects or surfaces that have the virus on them then putting your fingers in your eyes, nose or mouth.
### Who is at risk?
![girls washing hands](/travel/images/girls-washing-hands.jpg)
Viruses that cause hand, foot, and mouth disease occur worldwide and are more common in summer and fall in temperate climates. Large, severe outbreaks affecting thousands of people occur frequently in some countries in Asia. 
### What can travelers do to prevent hand, foot, and mouth disease?
There is no vaccine to prevent hand, foot, and mouth disease but you can take steps to lower your risk of getting it.
#### Wash your hands:
-  Wash your hands often with soap and water, especially after using the bathroom and before eating. If soap and water aren't available, use an alcohol-based hand sanitizer.
-  Dont touch your eyes, nose, or mouth. If you need to touch your face, make sure your hands are clean.
-  Cover your mouth and nose with a tissue or your sleeve (not your hands) when coughing or sneezing.
-  Try to avoid close contact, such as kissing, hugging, or sharing eating utensils or cups with people who are sick.
#### Disinfect dirty surfaces and soiled items:
-  If you are able, first wash items with soap and water, then disinfect them with a solution of chlorine bleach (made by mixing 1 tablespoon of bleach with 4 cups of water) or a cleaning product that contains bleach.
#### If you develop mouth sores and think you have hand, foot, and mouth disease:
-  Take over-the-counter medications to relieve pain and fever.
	- Children should not take aspirin.
-  Use mouthwashes or sprays that numb mouth pain.
-  Drink plenty of liquids to stay hydrated.
-  Seek medical care if
	- Your child is not drinking enough to stay hydrated
	- Symptoms do not improve after 10 days
	- Your child has a weakened immune system
	- Symptoms are severe
	- Your child is very young, especially younger than 6 months
Routine Vaccines | Travelers' Health | CDC

### Routine Vaccines
![family showing vaccine band-aids](/travel/images/family-vaccines.jpg)
### What are "routine vaccines"?
Routine vaccines are those recommended for everyone in the United States, depending on age and vaccine history. Most people think of these as [childhood vaccines](https://www.cdc.gov/vaccines/parents/protecting-children/index.html) that you get before starting school, but but there are also routine vaccines for [adolescents](https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html) and [adults](https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html).
### Why are routine vaccines important for travelers?
Because most U.S. children get routine vaccines, many vaccine-preventable diseases, such as measles, mumps, or chickenpox, are not common in the United States. If you are not vaccinated, international travel increases your chances of getting and spreading diseases that are not common in the United Sates. Popular destinations, including Europe, still have outbreaks of [measles](https://www.cdc.gov/measles/travelers.html) and other vaccine-preventable diseases. 
Make sure you are up-to-date on all of your [routine vaccines](/travel/page/routine-vaccines). Routine vaccinations protect you from infectious diseases such as measles that can spread quickly in groups of unvaccinated people. Many diseases prevented by routine vaccination are not common in the United States but are still common in other countries.
[Check CDCs destination pages for travel health information](/travel/destinations/list). Check CDCs webpage for your destination to see what vaccines or medicines you may need and what diseases or health risks are a concern at your destination.
Make an appointment with your healthcare provider or a [travel health specialist](/travel/page/find-clinic) that takes place at least one month before you leave. They can help you get destination-specific vaccines, medicines, and information. Discussing your health concerns, itinerary, and planned activities with your provider allows them to give more specific advice and recommendations.
### What routine vaccines do I need?
The routine vaccines you need before travel may depend on your age, health, and vaccine history. You may need to get an accelerated dose of a vaccine or a booster dose before traveling.
Routine vaccinations related to travel may include the following:
-  Chickenpox (Varicella)
-  Hepatitis A
-  Hepatitis B
-  Human Papilloma Virus (HPV)
-  Measles, mumps, Rubella
-  Tetanus, diphtheria, pertussis
-  Shingles (Zoster)
The following are CDC immunization schedules for by age group:
-  [Recommended Vaccinations or Infants and Children (birth through 6 years)](https://www.cdc.gov/vaccines/schedules/easy-to-read/adolescent-easyread.html)
-  [Recommended Vaccinations for Children (7-18 years old)](https://www.cdc.gov/vaccines/schedules/easy-to-read/adolescent-easyread.html)
-  [Recommended Adult Immunization Schedule for ages 19 years or older](https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html)
Scabies | Disease Directory | Travelers' Health | CDC

### What is scabies?
Scabies is a skin condition in people caused by the human itch mite. The mite burrows into the upper layer of skin to live and lay eggs.
Common scabies symptoms include intense itching and a skin rash. Scabies can occur anywhere on the body but are more common on the following parts of the body:
-  Between the fingers
-  Genitals (Penis and Vagina)
-  Shoulder blades
Children are often more likely to get scabies. For babies and very young children scabies is often found on the head, face, neck, palms, and soles of the feet.
For people who have never had scabies before, symptoms usually take 4-6 weeks to appear. Symptoms appear more quickly in people who have had scabies before, in as few as 1 to 4 days. Scabies mites can spread to other parts of the body and from one person to another person even before symptoms start.
The same mite that causes scabies also causes crusted scabies. Crusted scabies is severe scabies that happens in people who have weakened immune systems. People with crusted scabies are infested with very large numbers of mites. This increases their risk of spreading mites to others, either from brief skin-to-skin contact or from contact with items such as bedding, clothing, furniture, rugs, and carpeting.
### Who is at risk?
Scabies is found worldwide and can spread rapidly under crowded conditions where close skin-to-skin contact is frequent. Child-care facilities, nursing homes, extended-care facilities, and prisons are often sites of scabies outbreaks. Scabies is more common in long-term travelers than in those who travel for less than 8 weeks at a time.
Animals do not have scabies and cannot spread scabies to people.
### What can travelers do to prevent scabies?
There is no vaccine or medicine to prevent scabies. Effective medicine to treat scabies is only available with a doctor's prescription.
Travelers can avoid scabies by not touching or having close skin-to-skin contact with a person who has a rash or who is itching. Avoid touching or handling a sick persons clothing or bedding.
Scabies mites die when you wash bedding and clothing using hot water and hot dryer cycles or dry-clean the items. Items that cannot be dry-cleaned or laundered can be disinfested by storing them in a closed plastic bag for more than 72 hours. Scabies mites generally do not survive more than 2 to 3 days away from human skin.
Canadian recommendations for the prevention and treatment of malaria
Overview
This guidance document is designed for Canadian health practitioners who prepare travellers to visit areas with a risk of malaria, and for those caring for ill travellers upon their return. The malaria guidelines aim to ensure appropriate prevention, diagnosis and management of this potentially life threatening infectious disease.
Who this guide is for
- Canadian health practitioners
In this guide
This guidance document consists of 8 chapters and 6 appendices. Chapters and appendices are updated as new evidence becomes available.
- Chapter 5: Malaria issues in special hosts
Canadian Immunization Guide
Overview
Who this guide is for
This guide was developed for those with an interest in immunization, including:
- health professionals
- vaccine program decision makers
- other Canadian stakeholders
In this guide
This guide consists of 54 chapters organized into 4 parts. Chapters are updated as new evidence becomes available, and NACI and CATMAT statements are completed. Email updates are available through our mailing list.
Details and history
Updated: see 
Part of topic(s): 
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Considerations for the use of nirmatrelvir/ritonavir (brand name Paxlovid) to treat COVID-19
Last updated: June 22, 2022
On January 17, 2022, Health Canada authorized the antiviral drug nirmatrelvir to be used in combination with ritonavir (brand name Paxlovid) to treat mild to moderate COVID-19 in adults at high risk of progressing to serious disease. A limited, initial supply was immediately made available to provinces and territories.
In February 2022, to help ensure the initial supply of Paxlovid reached those who would benefit most, the Public Health Agency of Canada (PHAC) published a document entitled .
The supply of nirmatrelvir/ritonavir is no longer limited: shipments have continued to arrive and Canada expects to receive a total of 1.5 million treatment courses in 2022. As such, the document has been archived.
Clinicians should refer to their jurisdiction's guidelines for management of COVID-19, including eligibility criteria. In addition, the following health technology agencies have provided guidance and tools for healthcare providers to assist with prescribing Paxlovid for the treatment of COVID-19 in the outpatient setting:
- Canadian Agency for Drugs and Health Technologies (CADTH)
- Institut national d'excellence en sante et en services sociaux (INESSS)
Please refer to the CADTH Drug Implementation Advice document: . Tools published on March 23, 2022, by INESSS include a:
Planning guidance for immunization clinics for COVID-19 vaccines: Introduction
The purpose of this document is to assist in planning immunization clinics for COVID-19 vaccines during the COVID-19 pandemic. Once COVID-19 vaccines are approved and available for use in Canada, they will need to be administered as quickly as possible according to allocation plans. Although they are not the only means of offering COVID-19 vaccines, immunization clinics offer the ability to immunize large numbers of people over a short period of time. The primary target audience for this document is immunization program planners of local/regional and provincial/territorial (PT) public health departments and federal health departments with responsibility for immunization programs. This document should be read in conjunction with other relevant jurisdictional (federal, provincial/territorial (FPT) and/or local) immunization program legislation, regulations, policies and planning documents. This planning guidance is meant to complement existing jurisdictional immunization campaign and clinic plans, and provides ideas and suggestions for consideration which may or may not be appropriate in particular settings and contexts.
Implementing immunization clinics is a large-scale operation which requires detailed planning, coordination, collaboration and efficiency. Typically in immunization clinics a large number of clients are being immunized, so any inefficiency in the processes can significantly decrease the clinic's capacity to safely immunize the optimal number of people. Any major incident (e.g., major injury requiring emergency medical services or technological problem) at a clinic can delay the receipt of immunizations and negatively impact the clients' confidence in the process. Building public confidence in vaccines will be even more important during the COVID-19 immunization clinics with the rollout of new vaccines.
This document builds on Appendix B of the . In the current context of the COVID-19 pandemic, planning is required to prevent COVID-19 infection of clinic staff, volunteers and clients. Larger clinics with more Immunizers are generally more efficient at vaccinating higher numbers of clients, however, in the context of COVID-19 community transmission, the need to maintain physical distancing and prevent crowding will be very important in determining the size and flow of people within immunization clinics. This document incorporates the recommendations of the Public Health Agency of Canada's (PHAC)  as applicable to COVID-19 immunization. It also builds on the National Advisory Committee on Immunization's (NACI) .
Although the focus of this guidance document is on immunization clinic planning, some information and resources are provided regarding alternate vaccine delivery methods. Issues related to vaccine availability and prioritization/eligibility are beyond the scope of this document, however it should be noted that COVID-19 vaccines are expected to be available progressively over time in a sequenced roll out and clinics may have specific eligibility criteria depending on vaccine availability.
Family-centred maternity and newborn care: National guidelines
Overview
Who these guidelines are for
The guidelines are for those interested in maternal and newborn health, such as:
- health care providers
- other Canadians involved with maternal and newborn health
- those who plan, manage and decide on maternal and newborn health programs and services
For assistance
Use of Measles-Mumps-Rubella (MMR) Vaccine for the Management of Mumps Outbreaks in Canada
Preamble
The National Advisory Committee on Immunization (NACI) provides the Public Health Agency of Canada (PHAC) with ongoing and timely medical, scientific, and public health advice relating to immunization.
In addition to burden of disease and vaccine characteristics, PHAC has expanded the mandate of NACI to include the systematic consideration of programmatic factors in developing evidence-based recommendations to facilitate timely decision-making for publicly funded vaccine programs at provincial and territorial levels.
The additional factors to be systematically considered by NACI include: economics, ethics, equity, feasibility, and acceptability. Over the coming years NACI will be refining methodological approaches to include these factors. Not all NACI Statements will require in-depth analyses of all programmatic factors. As NACI works towards full implementation of the expanded mandate, select Statements will include varying degrees of programmatic analyses for public health programs.
PHAC acknowledges that the advice and recommendations set out in this statement are based upon the best current available scientific knowledge and is disseminating this document for information purposes. People administering the vaccine should also be aware of the contents of the relevant product monograph(s). Recommendations for use and other information set out herein may differ from that set out in the product monograph(s) of the Canadian manufacturer(s) of the vaccine(s). Manufacturer(s) have sought approval of the vaccine(s) and provided evidence as to its safety and efficacy only when it is used in accordance with the product monographs. NACI members and liaison members conduct themselves within the context of PHAC's policy on conflict of interest, including yearly declaration of potential conflict of interest.
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Organization: 
Publication Date 2021-07-27
Cat.: HP40-286/2021E-PDF
ISBN: 9780660384337
Pub.: 210041