THE JOURNAL OF THE CANADIAN PAEDIATRIC SOCIETY

PREFACE

This interim report is the third Canadian National Report on Immunization produced by the Division of Immunization, Laboratory Centre for Disease Control at Health Canada. Its purpose is to update pertinent information and technical reports related to immunization in Canada that were published during the year 1998. Therefore, it should not replace the others, rather readers are encouraged to also read the 1997 (1) and 1996 (2) National Reports.

In several ways, the year 1998 was important for immunization and vaccines in Canada. Many of these activities are highlighted in this report. Milestones include:

• the availability of a new vaccine against chickenpox;
• the licencing of a vaccine against Lyme disease;
• the implementation of childhood hepatitis B vaccination in the last province, finally allowing Canada to fulfil the recommendations made in 1992 by the World Health Organization, which were to have in place universal immunization against the disease by 1997;
• the first full year of experience with the new acellular pertussis vaccines in some jurisdictions, but also the final adoption by every province and territory in Canada and the first indications that it is indeed considerably less reactogenic than its whole cell predecessors;
• the lowest reported number of cases for many vaccine preventable diseases (pages 17C-22C);
• a major boost towards the development of a nationwide immunization records network (page 16C);
• the hosting of the most widely attended National Immunization Conference entitled Partnerships for Health Through Immunization;
• the launching of the first National Immunization Week; and
• the release of the 5th edition of the Canadian Immunization Guide which was featured in the 1997 National Report).

At the same time, there were some disappointing trends. Internationally, France chose to suspend its hepatitis B immunization delivery program in the school setting, responding to the antivaccination lobby rather than accepting the fact that there is no evidence that yet questions the benefit of the vaccine relative to any risk. The World Health Organization responded to this suspension with a terse statement reaffirming the value of the vaccine. Unfortunately, this announcement came on the eve of Manitoba implementing a school-based program, and provided a platform for opponents of vaccination to air their views. Approximately 15% of parents rescinded permission to allow their child to be immunized, and this  led to an initial coverage rate of only about 60% to 65%. The year 1999 will reveal whether the impact will continue or whether it will be short-lived, as experience has proven in other situations.

Nevertheless, 1998 was in many ways a wake-up call for the need to maintain public trust in immunization, a notion that will continue as we head for the 21st century. Fortunately, initiatives are being put into place in Canada and elsewhere to promote immunization. The feature editorial in this update is by Dr Roy West, chair of the Canadian Immunization Awareness Program, a coalition of organizations dedicated to the public's health through promoting timely and complete immunization of infants and children, and reminding adults of the importance of maintaining up to date vaccinations.

So, as we enter into another year, I expect a minority of vocal opponents will continue to agitate, but I know that health professionals will forge ahead planning, implementing and evaluating vaccination programs, and ensuring a continued high degree of safety and continued efficacy of vaccine products while knowing that immunization remains one of the safest and most cost beneficial health interventions.

Robert Pless MD MSc
Acting Chief and Head, Vaccine-Associated
Adverse Events Surveillance Section
Division of Immunization, Bureau of Infectious Diseases
Laboratory Centre for Disease Control
Ottawa, Ontario

REFERENCES

1. Canadian National Report on Immunization, 1997. Paediatr Child Health 1998;3(Suppl B).

2. Canadian National Report on Immunization, 1996. Can Commun Dis Rep 1997;(Suppl 23S4).

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