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Canadian Immunization Guide 2006

Canadian Immunization Guide
Seventh Edition - 2006

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Part 3
Recommended Immunization

Recommended Immunization Schedules

Few measures in preventive medicine are of such proven value and as easy to implement as routine immunization against infectious diseases. Immunization carried out as recommended in the following schedules will provide good basic protection for most children against the diseases shown.

Following a standard schedule ensures that the maximal achievable protection is achieved. However, modifications of the recommended schedule may be necessary because of missed appointments or intercurrent illness. Interruption of a recommended series does not require starting the series over again, regardless of the interval elapsed. Children, youth and adults with interruptions to their vaccines should be vaccinated to complete the appropriate schedule for their current age.

Similar vaccines are now available from different manufacturers but may not be identical. It is therefore essential for the user to read the appropriate chapter in this Guide as well as the manufacturer's package insert.

Table 1. Routine Immunization Schedule for Infants and Children

Age at vaccination	MMR	HB	Pneu- C-7	Men-C	Inf
Birth		Infancy 3 doses or Pre-teen/teen 2-3 doses
2 months
4 months				()
6 months				or	6-23 months 1-2 doses
12 months			12-15 months	if not yet given
18 months	or
4-6 years	or
14-16 years				if not yet given

Table 2. Routine Immunization Schedule for Children < 7 Years of Age Not Immunized in Early Infancy

Timing	DTaP -IPV	Hib	Pneu- C-7	Men-C
First visit
2 months later		()	()	()
2 months later			()
6-12 months later		()
4-6 years of age	()
14-16 years of age

Table 3. Routine Immunization Schedule for Children ≥ 7 Years of Age up to 17 Years of Age Not Immunized in Early Infancy

Timing	Var	HB
First visit
2 months later	()	()
6-12 months later
10 years later

Table 4. Routine Immunization Schedule for Adults (≥ 18 Years of Age) Not Immunized in Childhood

Timing	MMR	Men-C	Pneu- C-23	Inf
First visit		()	()	()
2 months later	()
6-12 months later
10 years later

Notes

	Symbols with brackets around them imply that these doses may not be required, depending upon the age of the child or adult. Refer to the relevant chapter for that vaccine for further details.
	Diphtheria, tetanus, acellular pertussis and inactivated polio virus vaccine (DTaP-IPV): DTaP-IPV(± Hib) vaccine is the preferred vaccine for all doses in the vaccination series, including completion of the series in children who have received one or more doses of DPT (whole cell) vaccine (e.g., recent immigrants). In Tables 1 and 2, the 4-6 year dose can be omitted if the fourth dose was given after the fourth birthday.
	Haemophilus influenzae type b conjugate vaccine (Hib): the Hib schedule shown is for the Haemophilus b capsular polysaccharide - polyribosylribitol phosphate (PRP) conjugated to tetanus toxoid (PRP-T). For catch up, the number of doses depends on the age at which the schedule is begun (see Haemophilus Vaccine chapter). Not usually required past age 5 years
	Measles, mumps and rubella vaccine (MMR): a second dose of MMR is recommended for children at least 1 month after the first dose for the purpose of better measles protection. For convenience, options include giving it with the next scheduled vaccination at 18 months of age or at school entry (4-6 years) (depending on the provincial/territorial policy) or at any intervening age that is practical. In the catch-up schedule (Table 2), the first dose should not be given until the child is ≥ 12 months old. MMR should be given to all susceptible adolescents and adults.
	Varicella vaccine (Var): children aged 12 months to 12 years should receive one dose of varicella vaccine. Susceptible individuals ≥ 13 years of age should receive two doses at least 28 days apart.
	Hepatitis B vaccine (HB): hepatitis B vaccine can be routinely given to infants or pre-adolescents, depending on the provincial/territorial policy. For infants born to chronic carrier mothers, the first dose should be given at birth (with hepatitis B immunoglobulin), otherwise the first dose can be given at 2 months of age to fit more conveniently with other routine infant immunization visits. The second dose should be administered at least 1 month after the first dose, and the third at least 2 months after the second dose, but these may fit more conveniently into the 4 and 6 month immunization visits. A two-dose schedule for adolescents is an option (see Hepatitis B Vaccine chapter).
	Pneumococcal conjugate vaccine - 7-valent (Pneu-C-7): recommended for all children under 2 years of age. The recommended schedule depends on the age of the child when vaccination is begun (see Pneumococcal Vaccine chapter).
	Pneumococcal polysaccharide - 23-valent (Pneu-P-23): recommended for all adults ≥ 65 years of age (see Pneumococcal Vaccine chapter).
	Meningococcal C conjugate vaccine (Men-C): recommended for children under 5 years of age, adolescents and young adults. The recommended schedule depends on the age of the individual (see Meningococcal Vaccine chapter) and the conjugate vaccine used. At least one dose in the pimary infant series should be given after 5 months of age. If the provincial/territorial policy is to give Men-C to persons ≥ 12 months of age, one dose is sufficient.
	Diphtheria, tetanus, acellular pertussis vaccine - adult/adolescent formulation (Tdap): a combined adsorbed "adult type" preparation for use in people ≥ 7 years of age, contains less diphtheria toxoid and pertussis antigens than preparations given to younger children and is less likely to cause reactions in older people.
	Diphtheria, tetanus vaccine (Td): a combined adsorbed "adult type" preparation for use in people ≥ 7 years of age, contains less diphtheria toxoid antigen than preparations given to younger children and is less likely to cause reactions in older people. It is given to adults not immunized in childhood as the second and third doses of their primary series and subsequent booster doses; Tdap is given only once under these circumstances as it is assumed that previously unimmunized adults will have encountered Bordetella pertussis and have some pre-existing immunity.
	Influenza vaccine (Inf): recommended for all children 6-23 months of age and all persons ≥ 65 years of age. Previously unvaccinated children < 9 years of age require two doses of the current season's vaccine with an interval of at least 4 weeks. The second dose within the same season is not required if the child received one or more doses of Influenza vaccine during the previous Influenza season (see Influenza Vaccine chapter).
	IPV Inactivated polio virus