Canadian Immunization Guide 2006
Canadian Immunization Guide
Seventh Edition - 2006
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Part 1
General Guidelines
Timing of Vaccine
Administration
For most products that require more than
one dose or booster doses for full immunization, intervals longer
than those recommended between doses do not lead to a reduction
in final antibody concentrations. Therefore, as a general
rule, interruption of a series of
vaccinations for any reason does not require starting the series
over again, regardless of the interval elapsed. By contrast, doses given at less than the
recommended interval may result in less than optimal antibody
response and should not be counted as part of a primary
series.
There are obvious practical advantages
to giving more than one vaccine at the same visit, especially for
infant immunization schedules, for travel immunization or when
there is doubt that an individual will return for further doses
of vaccine. No increase in the frequency or severity of
clinically significant side effects has been observed. The
immune response to each antigen is generally adequate and
comparable to that found in persons receiving these vaccines at
separate times.
Simultaneous administration of childhood
vaccines (diphtheria, tetanus, acellular pertussis [DTaP];
inactivated poliovirus [IPV]; Haemophilus influenzae type b [Hib]; measles, mumps, and rubella [MMR];
varicella; pneumococcal conjugate and hepatitis B vaccine) is
encouraged for children who are the recommended age to receive
these vaccines and for whom no contraindications exist. If not
given during the same visit as other live virus vaccines,
administration of two live vaccines should generally be separated
by at least 4 weeks. A number of vaccines that deliver protection
against more than one disease (i.e., combination vaccines) are
available and approved for use in Canada.
Simultaneously administering
pneumococcal polysaccharide vaccine and inactivated influenza
vaccine elicits a satisfactory antibody response without
increasing the incidence or severity of adverse reactions.
Therefore, simultaneous administration is strongly recommended
for all persons for whom both vaccines are indicated.
Different formulations of vaccine
against the same disease (e.g., pneumococcal conjugate and
pneumococcal polysaccharide vaccine or meningococcal conjugate
and meningococcal polysaccharide vaccine) cannot be given
simultaneously, and a minimum time interval should elapse between
the administration of the two formulations.
Vaccines administered simultaneously
should be given using separate syringes at separate sites unless
otherwise specified by the manufacturer, with consideration being given to the precautions that
apply to each individual vaccine.
MMR vaccine can decrease the immunologic
response to tuberculin skin testing, resulting in false-negative
results. Therefore, tuberculin skin tests should be given either
on the same day as MMR immunization or at least 4-6 weeks later. The effect of other
live virus vaccines such as varicella and yellow fever vaccines
on tuberculin reacitivity is currently unknown, and no
recommendations for postponement of tuberculin skin testing can
be made at this time.
Please refer to the specific vaccine chapters in this Guide for further information.
Selected references
Centers for Disease Control and
Prevention. General
recommendations on immunization: recommendations of the Advisory
Committee on Immunization Practices (ACIP) and the American Academy of Family Physicians
(AAFP). Morbidity and Mortality
Weekly Report 2002;51(RR-2):1-35.
Centers for Disease Control and
Prevention. Travelers'
health: yellow book. Health information for international travel,
2005-2006. URL:
<http://www.cdc.gov/travel/>.
Centers for Disease Control and
Prevention. Typhoid immunization:
recommendations of the Advisory Committee on Immunization
Practices (ACIP). Morbidity and
Mortality Weekly Report
1994;43(RR-14):1-7.
Centers for Disease Control and
Prevention. Yellow fever vaccine:
recommendations of the Advisory Committee on Immunization
Practices (ACIP), 2002.
Morbidity and Mortality Weekly Report 2002;51(RR-17):1-10.
DeStefano F, Goodman RA, Noble GR et
al. Simultaneous administration
of influenza and pneumococcal vaccines. Journal of the American Medical
Association 1982;247(18):2551-54.
Halperin S, McDonald J, Samson L et
al. Simultaneous administration
of meningococcal C conjugate vaccine and
diphtheria-tetanus-acellular pertussis-inactivated
poliovirus-Haemophilus influenzae type b
conjugate vaccine in children: a randomized double-blind
study. Clinical and
Investigative Medicine 2002;25(6):243-51.
King GE, Hadler SC. Simultaneous administration of childhood vaccines:
an important public health policy that is safe and efficacious. Pediatric Infectious
Disease Journal 1994;13(5):394-407.
Yvonnet B, Coursaget P, Deubel V et
al. Simultaneous administration
of hepatitis B and yellow fever vaccines. Journal of Medical Virology
1986;19(4):307-11.
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