Immunization : Your Best Protection

Immunizations, also called shots or needles, help save lives, prevent serious illnesses, and are recognized as one of the most effective public health interventions. Immunizations help the body make its own protection (or antibodies) against certain diseases. Immunizations are given against diphtheria, pertussis (whooping cough), tetanus, polio, haemophilus influenzae type b (HIB), measles, mumps and rubella (German measles). Immunizations may also be given against hepatitis, influenza, chicken pox, meningococcal disease (meningitis) and pneumococcal disease (pneumonia). There are also a number of vaccines for other circumstances, for example people traveling to a country with diseases that are not common in Canada, such as typhoid fever.

When children are immunized, their bodies make antibodies that fight specific infections. If they are not protected and come in contact with one of these infections, they may get very sick and potentially experience complications, or even die.

Vaccines are very effective in preventing disease when given as recommended. However, no vaccine will work for 100 per cent of the children who receive it. Studies of disease outbreaks show that although immunized children can develop the infection, the illness is often less severe.

All vaccines have to be tested to make sure they are both safe and effective. The most common side effects are mild pain, swelling and redness where the shot was given. Some infant vaccines may cause a low-grade fever (approximately 38°C) or fussiness for a day or two after the needle. Physicians may recommend acetaminophen to prevent fever and pain. Serious side effects from immunizations are rare. Please report any side effects or severe vaccine reactions to your doctor or nurse practitioner. You should always discuss the benefits and risks of any vaccine with your doctor or nurse practitioner.

For children attending school in Ontario, a written immunization record or proof of immunization is required, by law, for diphtheria, tetanus, polio, measles, mumps and rubella unless there is a valid written exemption. Parents/guardians are required to provide this information to their local public health unit, and to update the information as necessary. There are specific vaccines required for children attending licensed daycare centres. You should contact your local public health unit or check with your daycare centre, for the specific immunization requirements.

You may decide because of medical, religious or philosophical reasons not to immunize your child. In this case, you will need to provide a valid written exemption to your local public health unit. If the disease appears in your child's school or daycare, your child may have to stay out of school/daycare until the disease is no longer present.

Call your doctor or nurse practitioner to make an appointment. If you don't have a health card, call your local public health unit to find out where you or your child can get immunized.

Recommended routine immunizations begin at two months of age to protect infants from illnesses that can be very serious for them. The following chart outlines the schedule for publicly funded vaccines in Ontario available for children beginning their routine immunization in early infancy.

Age at vaccination	Diptheria	Pertussis	Tetanus	Polio	HIB	Pneumo- coccal conjugate	Measles mumps rubella (MMR)*	Men-C conjugate	Chicken pox (Varicella)	Hepatitis B
2 months
4 months
6 months
12 months
15 months†
18 months
4-6 years									**
12 years (grade 7)								‡
14-16 years

NOTE : The MMR and varicella vaccines are live virus vaccines. If not given on the same day, they must be given at least 28 days apart.

1. Vaccines against the following diseases are available free of charge, and are required for attendance at school :

• DIPHTHERIA is a very serious bacterial infection. It can cause breathing problems, heart failure, paralysis (loss of control over muscles in the body) and death.
• TETANUS (Lockjaw) causes painful muscle spasms, breathing failure and can lead to death. It is caused by bacteria and spores in the soil that can infect wounds.
• POLIO can cause paralysis (loss of control over muscles in the body), inflammation of the brain and death. People get polio from drinking water or eating food with the polio virus in it. It is no longer common in Canada because of high immunization rates, but cases do occur elsewhere in the world and may be acquired when travelling.
• MEASLES causes rash, high fever, cough, runny nose and watery eyes. It can cause middle ear infection, pneumonia (lung infection), inflammation of the brain, hearing loss, brain damage and death.
• MUMPS causes fever, headache and painful swelling of the glands in the mouth and neck, earache and can cause inflammation of the brain. It can cause temporary or permanent deafness and swelling of the ovaries in women and testes in men, possibly leading to sterility.
• RUBELLA (German Measles) causes fever, rash, swelling of the neck glands and swelling and pain in the joints. It can cause bruising and bleeding. If a pregnant woman gets rubella, it can be very dangerous for the unborn baby.
2. Vaccines against the following diseases are recommended but not required for attendance at school. These vaccines are available free of charge :
• PERTUSSIS (Whooping Cough) causes severe coughing spells for weeks or months. It can also cause pneumonia (lung infection), middle ear infection, convulsions (seizures), inflammation of the brain and death. The risk of complications is greatest in children younger than one year of age.
• HEPATITIS B is a virus that can cause serious liver problems that can be fatal, such as liver failure and liver cancer. The vaccine is free to grade 7 students and certain high-risk groups (including infants born to mothers who are infected with hepatitis B and can pass the disease on to their babies).
• INFLUENZA is a viral infection that causes cough, high fever, chills, headache and muscle pain. It can cause pneumonia (infection of the lungs), middle ear infections, heart failure and death. The danger of this infection varies from year to year depending on the strain and can be mild to life-threatening. Anyone six months of age and older can get the vaccine each year free of charge.
• VARICELLA (Chicken pox) is a highly contagious viral infection. It can cause fever, headache, chills, muscle or joint aches a day or two before the itchy, red rash appears. A pregnant woman with chicken pox can pass it on to her unborn baby. Mothers with chicken pox can also give it to their newborn baby after birth. Chicken pox can be very severe or even life-threatening to newborn babies.
• MENINGOCCAL DISEASE-GROUP C is a very serious bacterial infection and a common cause of meningitis (infection of the lining of the brain and spinal cord) and meningococcaemia (severe infection of the blood) that can cause severe cmpolications and death.
3. Vaccines against the following diseases are recommended for younger children. These vaccines are available free of charge :
• HAEMOPHILUS INFLUENZAE B (HIB) is a bacteria that can infect any part of the body. It can cause middle ear infections, breathing problems, damage to joints, pneumonia (lung infection), inflammation of the brain leading to brain damage and death.
• PNEUMOCOCCAL DISEASE is a bacterial infection that can cause serious illnesses such as pneumonia, blood infection and meningitis. The pneumococcal conjugate vaccine is now available free of charge in Ontario for routine immunization of infants as well as high-risk children 2 to 59 months of age.

Talk to your doctor or nurse practitioner for more information on these vaccines and the diseases they prevent.

Get a yellow immunization card from your doctor or local public health unit to keep a record of the shots. An up-to-date immunization record will prevent unnecessary extra shots. Written immunization records are needed when :

• starting day nursery or school
• transferring to a school in another area
• going to camp
• starting university, college or a job
• receiving emergency health care
• travelling to other countries.

It is the parent/guardian's responsibility to provide immunization records for all school children to the local public health unit. Don't forget to update the health unit when/if your child gets another shot.

Because of changes in the influenza strains, adults need an influenza shot each year. As well as a tetanus and diphtheria shot every 10 years throughout life, to be protected against these diseases.

Be sure you are protected against rubella before pregnancy to protect your future baby from serious problems during its development.

For further information about immunization, or any other health topics, please contact your local public health unit or doctor/nurse practitioner.

• Ministry of Health Publications on Immunization
• The Canadian Paediatric Society
• Canadian Coalition for Immunization Awareness & Promotion
• The National Influenza Immunization Campaign
• Health Canada, Immunization Division

To learn more about immunization, please visit your local bookstores or library for the following books :

• Your Child's Best Shot : A parents' guide to vaccination. 2^nd edition (2002). Dr.Ron Gold.
• What every parent should know about vaccines (2002). Dr. Paul Offitt and Dr. Louis M. Bell.

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