Immunization in Canada: Update for 2015. (2016)

In our first immunization update in 2003,1 we briefly described the clinical and epidemiological features of vaccine-preventable diseases and outlined the routine, publicly funded immunization programs in Canada. At that time, children were immunized with vaccines to prevent 9 infectious diseases (diphtheria, tetanus, pertussis, polio, Haemophilus influenzae type b, measles, mumps, rubella, and hepatitis B). Vaccination was also recommended to prevent pneumococcal infection (7-valent pneumococcal conjugate), meningococcal infection (meningococcal C conjugate vaccine), pertussis in adolescents, and varicella, but publicly funded programs were not available in most provinces/territories. Publicly funded vaccination programs were also available for older adults to prevent influenza and pneumococcal infection (pneumococcal polysaccharide vaccine). In that commentary, we also discussed the risk-benefit of vaccination and described the safety surveillance system in place in Canada that monitors the safety of our publicly funded vaccination programs.

In our 2009/2010 update,2 we described the seven new vaccines that had been introduced into the Canadian immunization schedule. The four vaccines that were previously recommended but not funded (varicella vaccine, Tdap for adolescents, meningococcal C conjugate, 7-valent pneumococcal conjugate) had been incorporated into the publicly funded programs in all provinces/territories. Influenza vaccine was also recommended and funded for all children 6–23 months of age and for pregnant women. Quadrivalent meningococcal conjugate vaccine was available as an option where its use was supported by local epidemiology; three provinces had incorporated it into their publicly funded programs. Human papillomavirus (HPV) vaccine was also recommended and funded for all pre-adolescent girls in Canada. In the 2009/2010 commentary we also described the new Canadian Immunization Committee (CIC), its relationship to the longstanding National Advisory Committee on Immunization (NACI), and CIC’s use of the Erickson–De Wals framework3 for assessing whether a new vaccine should be incorporated into the publicly funded vaccine programs in Canada.

In this 2015 immunization update, we will review new immunization recommendations that have been introduced in the last 5–6 years. We will group these into new uses of “old vaccines” and new vaccines that have been introduced into Canada. We will also look at new vaccines that are on the horizon in the next 5–6 years. Finally, we will review some recent changes to the immunization infrastructure in Canada, emphasizing Canadian capabilities for research and evaluation of existing and new vaccination programs.

Old Vaccines, New Uses
A number of programmatic changes have been implemented by provinces/territories to vaccine programs that are already funded publicly.4,5 Based on the proven effectiveness of a two-dose priming regimen in the first year of life with a booster in the second year,6 pneumococcal conjugate vaccine is now being given at 2, 4, and 12 months of age rather than at 2, 4, 6, and 12–18 months of age in all provinces/territories except the Northwest Territories and Nunavut, thereby saving substantially on vaccine purchase and administrative costs. High-risk individuals are still provided with the six-month dose. Similarly, some provinces/territories have moved to a two-dose HPV vaccination schedule based on satisfactory immunogenicity compared to the three-dose regimen.7 An increasing number of jurisdictions have substituted the quadrivalent meningococcal conjugate vaccine for the meningococcal C conjugate vaccine for the pre-adolescent/adolescent booster dose.4 A single dose of Tdap vaccine is now recommended and publicly funded for all adults not previously immunized with Tdap.5 The annual influenza vaccine is now recommended more broadly; NACI now recommends universal influenza vaccination for the entire population, and many provinces/territories have joined Ontario in implementing this recommendation.4 Because of ongoing outbreaks of varicella,8 nearly all provinces/territories have moved to a two-dose varicella vaccine schedule.4 Finally, in keeping with the NACI recommendation for a universal HPV vaccination program for pre-adolescents using a quadrivalent HPV vaccine, Alberta, PEI, and Nova Scotia have extended their programs to include pre-adolescent boys.4