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Canada Communicable Disease Report
Volume 31 ACS-12 1 December 2005 An Advisory Committee Statement (ACS) Updated Recommendations on the use of Thimerosal-Containing Vaccines in CanadaPDF Version PreambleThe National Advisory Committee on Immunization (NACI) provides the Public Health Agency of Canada with ongoing and timely medical, scientific, and public health advice relating to immunization. The Public Health Agency of Canada 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 the Public Health Agency of Canada's Policy on Conflict of Interest, including yearly declaration of potential conflict of interest. IntroductionNACI previously published evidence-based recommendations regarding the use of vaccines containing the mercury-based preservative thimerosal(1). Since that time new data have been published(2-5) and considered in depth by the Institute of Medicine (IOM) Immunization Safety Review Committee(6). The IOM is an independent, scientific advisory body that reviews evidence and provides advice concerning significant public health policy issues. Members of the Safety Review Committee were chosen not only for their expertise but also for their lack of any real or perceived conflicts of interest. In their detailed report, released in April 2004, the Immunization Safety Review Committee summarized their conclusions and made the following recommendations:
Additional studies(7,8) published after the IOM deliberations and expert reviews(9-12) fully support these conclusions. RecommendationsCurrently, in Canada, some multidose preparations of influenza or hepatitis B vaccines are the only thimerosal-containing products that might be offered to children as part of the routine childhood immunization schedule. Thimerosal-free influenza and hepatitis B vaccines have also become available in recent years. NACI will prepare a full revised statement regarding thimerosal in vaccines to replace its previous statement published in 2003(1). However, as the annual influenza vaccine campaign is getting under way, and questions as to the preference of one product over another are bound to arise, NACI has revisited the issue and makes the following recommendations:
ConclusionPublic confidence in vaccines and high rates of vaccine uptake are critical to the continued effectiveness of immunization programs. Even when risks are purely theoretical, experience has shown that unaddressed public concerns can drastically decrease immunization coverage, to the detriment of public health. Thus the call to remove thimerosal from vaccines seeks to maintain public confidence by avoiding even theoretical risk. NACI makes recommendations based on the best available scientific evidence. Vaccine safety is an essential consideration in any recommendation made by NACI. Concerns regarding thimerosal, as reviewed in the 2003 statement, were purely theoretical. Nevertheless, NACI identified them as important issues for further consideration and study. The weight of evidence now available, however, refutes any link between thimerosal and autism. As such, NACI concludes that there is no reason for vaccine providers or other health care professionals who may counsel individuals regarding immunization to raise any concerns regarding exposure to thimerosal. References
___________________________________ * Members: Dr. M. Naus (Chair), Dr. T. Tam (Executive Secretary), Dr. S. Dobson, Dr. B. Duval, Dr. J. Embree, Ms. A. Hanrahan, Dr. J. Langley, Dr. A. McGeer, Dr. K. Laupland, Dr. M-N Primeau, Dr. B. Tan, Dr. B. Warshawsky. Liaison Representatives: S. Callery (CHICA), Dr. J. Carsley (CPHA), Dr. A. Mawle (CDC), Dr. D. Money (SOGC), A. Honish (CNCI), Dr. B. Larke (CCMOH), Dr. B. Law (ACCA), Dr. M. Salvadori (AMMI Canada), Dr. S. Rechner (CFPC), Dr. J. Salzman (CATMAT), Dr. L. Samson (CPS), Dr. D. Scheifele (CAIRE). Ex-Officio Representatives: Dr. S. Deeks (CIDPC), Dr. H. Rode (BGTD), Dr. M. Lem (FNIHB), Dr. M. Tepper (DND). †This statement was prepared by Dr. Barbara Law and was approved by NACI and the Public Health Agency of Canada. |
Last Updated: 2005-12-01 |