THE JOURNAL OF THE CANADIAN PAEDIATRIC SOCIETY

PROGRAM UPDATE

TABLE 15: Provincial and territorial hepatitis B immunization programs, 1998
	AB	BC	MB	NB	NF	NS	NT	ON	PE	QC	SK	YT
Grade and year school program began	5 1995	6 1992	4 1998	4 1995	4 1995	4 1995	4 1995	7* 1994	3 1995	4 1994	6 1995	4 1994
Infant program	No	No	No	Yes	No	No	Yes	No	Yes†	No	No	Yes‡
Health care and emergency service workers and other occupational exposure	1985				1985		1986					1995
Residents and staff of institutions for the developmentally disabled	1985			1986§	1985		1996	1980s ¶	1990	1983	Yes	1998
Homosexual and bisexual males	1990	1990	1997		1995		1996	1991		1994		1994
Heterosexual males or females with multiple sexual partners or with a recent history of a sexually transmissible disease	1990	1990	1997		1995		1996	1991		1994		1994
Injection drug users	1990	1990	1997		1995	1997	1998	1991		1994		1998
Hemophiliacs and others receiving repeated infusions of blood or blood products	1985	1992		1986	1985	1997	1986	1980s ¶	1990	1983	1993	1994
Hemodialysis patients	1985	1993		1986	1985	1997	1996	1980s ¶	1990	1983	1993	1994
Inmates of long term correctional facilities		1993										1998
Household and sexual contacts of acute hepatitis B virus (HBV) cases and HBV carriers	1995	1990		1986 **	1985	1997	1995	1980s	1990	1994	1993	1994
Populations or communities in which HBV is highly endemic	1990						1985
Children younger than seven years of age whose families have immigrated to Canada from areas where there is a high prevalence of HBV, and who are exposed to HBV carriers through their extended families	1990				††		1993	1994		1994		1985
Travellers to HBV endemic areas	‡‡				‡‡		1995
Children in child care settings in which there is a HBV-infected child							1996	††	1990
Does your province/territory have a stated prenatal screening policy for HBV?	Yes §§	Yes ¶¶	Yes ***	No	Yes †††	Yes ‡‡‡	Yes §§§	Yes ¶¶¶	Yes ****	Yes ††††		Yes ‡‡‡‡
Is there a formal public health program in place to identify and follow-up neonates of HBV surface antigen infected mothers?	Yes §§§§	Yes			Yes ¶¶¶¶	Yes *****	Yes	Yes	Yes	Yes †††††	Yes	Yes
*Catch-up campaign undertaken in 1996 for those grades above 7, ie, grades 10 to 13. †Hepatitis B  vaccine is given at age two, three and 15 months (not given in hospital at birth). ‡Infant program began in March 1998 at two, four and 12 months. §Residents only. ¶Began in the late 1980s in hospitals. **Household contacts of HBV carriers only. ††Assessed on a case by case basis. ‡‡Recommended, but at client’s expense. §§Since 1985, all those who seek prenatal care and those without prenatal care are screened at delivery by the Red Cross (now the Canadian Blood Services, referred to below as Red Cross). ¶¶All prenatals have been screened since 1975. Private physicians initiate testing via Red Cross. ***Since 1989, all prenatals have been screened. †††Since January 1994, all prenatals have been tested. Public health follows-up on newborns. ‡‡‡Dependent on situation. §§§All prenatals are screened either by public health or private sector. ¶¶¶Public health began prenatal screening in early 1990s. ****All prenatals have been screened since 1990. ††††All prenatals are screened. ‡‡‡‡Since 1985, all prenatals have been screened when first seen by physicians and community health nurses. §§§§Red Cross and physicians organize availability of hepatitis B immunoglobulin at delivery. Hospital staff give first dose and Public Health gives doses two and three in the community. Public Health arranges for postseries seriological testing. ¶¶¶¶Since 1984, neonates of hepatitis B surface antigen positive mothers are started on hepatitis B vaccine series at birth. *****A policy was developed in 1991 whereby prenatals are tested on first visit to primary physician. †††††Once identified, cases are referred to Public Health. AL Alberta; BC British Columbia; MB Manitoba; NB New Brunswick; NF Newfoundland; NS Nova Scotia; NT Northwest Territories; ON Ontario; PE Prince Edward Island; QC Quebec; SK Saskatchewan; YT Yukon Territory

TABLE 16: Other provincial and territorial immunization programs, 1998: Meningococcal vaccine (1); hepatitis A vaccine (2); Bacille Calmette-Guérin vaccine (BCG) (3); pneumococcal vaccine (4); and influenza vaccine (5)
Risk group	AB	BC	MB	NB	NF	NS	NT	ON	PE	QC	SK	YT
All persons age 65 years or older	4* 5	4 5		4 5		4 5	4 5	4 5	4 5			4 5
Adults under age 65 years within a high     risk group	1† 2‡ 4 5	2§ 4¶ 5	4**	4 5††	4†† 5	4 5	4 5	1 4 5	2§§	2¶¶ 5	4 5	1 2 4 5
Children age two years or older within a high risk group	4	1*** 4¶	4	4	4	4	4	4			4	4
Children within a high risk group for influenza	5	5	5	5	5	5	5	5		5	5	5
Travellers to endemic areas		3	1	1 2†††			2					1 2
Residents of nursing homes and other chronic care facilities	4* 5	4 5		4 5‡‡‡	4 5	4 5	4 5	4 5	4	5	4 5	4 5
People who provide essential community services						5§§§	5¶¶¶					5
Health care personnel who have significant contact with people in high risk groups or high risk groups for influenza	5	5	5			5§§§	5			5	4§§§§	5
Patient care staff in long term care facilities	5	5				5§§§	5	5		5		5
Contacts of cases		3††††			1 2		1 2			1	1 2	1 2
Contacts of people who are at high risk of influenza (if the cases cannot be vaccinated or may respond inadequately)	5	5	5			5	5			5		5
Pregnant women	4‡‡‡‡ 5‡‡‡‡					4‡‡‡‡ 5‡‡‡‡	4‡‡‡‡ 5‡‡‡‡	4‡‡‡‡ 5‡‡‡‡			4‡‡‡‡ 5‡‡‡‡	5
Native Indian population	3		3§§§§				3	3¶¶¶¶			2
Inuit population							3			3
Other									4*****	4†††††
High risk groups in general include individuals with one or more of the following conditions: asplenia, splenic dysfunction, sickle-cell disease, chronic cardiorespiratory disease (except asthma), cirrhosis, alcoholism, chronic renal disease, nephrotic syndrome, diabetes mellitus, chronic cerebrospinal fluid leak, human immunodeficiency virus (HIV) infection and other conditions associated with immunosuppression (ie, Hodgkin’s disease, lymphoma, multiple myeloma, induced immunosuppression for organ transplantation) and children or adolescents on long term salicylate therapy (pneumococcal excluded). High risk groups for influenza include individuals with one or more of the following conditions: chronic cardiac or pulmonary disorders, diabetes, other metabolic diseases, cancer, HIV or another immune deficiency or suppression, children and adolescents on long term salicylate therapy, renal disease, anaemia and hemoglobinopathy. *Launching three-year program in fall 1998; “catch-up” for high risk groups and long term care residents 1998/99; Fiscal 1999 to 2000 and 2000 to 2001 focus on catch-up of those 65 years or older; to become a routine program after 2001. †Meningococcal vaccine is provided for functional or anatomic asplenia only and for outbreak control on advice of provincial health officer. ‡Hepatitis A vaccine is provided for hemophiliacs only. §Hepatitis A vaccine is provided to: 1) those with hemophilia A or B receiving plasma-derived replacement clotting factors or testing anti-hepatitis A virus immunoglobulin (Ig)-negative; 2) illicit, injectable drug users; and 3) anti-hepatitis C virus positive people who are antihepatitis A virus IgG-negative. ¶Only covers the following high risk groups: asplenia, splenic dysfunction, sickle-cell disease and bone marrow transplant recipients.  **At specific request of physician. ††All adults within a high risk group. §§Hepatitis A provided to hemophiliacs, hepatitis A and B provided to all hepatitis C patients. ¶¶Hepatitis A is provided to hepatitis C patients, intravenous drug users and homosexual population. ***Meningococcal vaccine is provided for outbreak control and for individuals age two years or older who are members of selected high risk groups. †††At client’s expense. ‡‡‡Includes individuals in extended care units of hospitals. §§§Vaccine is recommended and provided at cost. ¶¶¶At the employees expense. ****Provided to patient care staff in long term care facilities. ††††Provided to tuberculin-negative persons of any age who are unavoidably exposed to a greater risk of tuberculosis infection than the general population of Canada. ‡‡‡‡Provided if at high risk. §§§§If living on reserve. ¶¶¶¶Only to infants in Sioux Lookout/Moose Factory Zone (northern regions). *****Provided to all persons 75 years of age or older. †††††Provided to individuals with HIV or asplenia. AL Alberta; BC British Columbia; MB Manitoba; NB New Brunswick; NF Newfoundland; NS Nova Scotia; NT Northwest Territories; ON Ontario; PE Prince Edward Island; QC Quebec; SK Saskatchewan; YT Yukon Territories

TABLE 17: Update on provincial and territorial legislation regarding immunization

AB

BC

MB

NB

NF

NS

NT

ON

PE

QC

SK

YT

In 1997/1998 did your province or territory change or enact new childhood immunization legislation?

No

No

Yes*

No

No

No

No

No

No

No

No

No

Are there any plans in the near future for your province or territory to change or enact childhood immunization legislation?

No

No

No

Yes†

No

No

No

N/A

No

No

No

No

In 1997/1998 has your province or territory changed or enacted any other legislation that impacts in the immunization program? (ie, privacy legislation)

Yes‡

No

No

No

No

No

No

Yes§

No

No

No

No

Is you province or territory planning to change or enact any other legislation that impacts on the Immunization program?

Yes¶

No

No

Yes**

No

No

Yes

Yes††

No

No

No

No

*Previously one dose measles required as prerequisite for first time entry to school. Now two doses of measles vaccine will be required for entry into grade 1 (waiver can be signed if parents do not wish immunization) †Within one year, New Brunswick will revise mandatory immunization for school entry to include daycare proof of pertussis immunization and rather than the number of doses required will use ‘age-appropriate’ immunization status. ‡Freedom of Information and Privacy Act or privacy act affecting access of Public Health to schools. §Potentially; the Services Improvement Act was enacted January 1, 1998, which changes funding for public health to 100% municipal (previously 75% provincial and 25% municipal). ¶The Health Information Protection Act is in the planning stages – may affect ability of public health to transfer client immunization records to new health unit when client changes place of residence. **Within one year, new regulation will require: 1) individuals who are employed in a licensed facility or community placement resource involving the care of the people younger than age 13 years, or those who are sick or dependent to be immunized as specified by the Minister; 2) physicians or nurses who administer vaccines to  record date, name of vaccine, dosage, site, route, lot number and manufacturer in the client’s medical record; and 3) physicians or nurses to give record of immunization to vaccinee. ††Eventually would like to have mandated access to preschool or infant records. Also considering varicella in requirements for day nursery and school attendance. AL Alberta; BC British Columbia; HBV Hepatitis B virus; MB Manitoba; N/A Not available; NB New Brunswick; NF Newfoundland; NS Scotia; NT Northwest Territories; ON Ontario; PE Prince Edward Island; QC Quebec; SK Saskatchewan; YT YukonTerritory

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