Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
SECTION 8 – BIOLOGICAL PRODUCTS
TABEL OF CONTENTS
DIPHTHERIA - TETANUS- ACELLULAR PERTUSSIS - HEPATITIS B- POLIO- HAEMOPHILUS
INFLUENZAE TYPE B ADSORBED (DTAP- HB- IPV- HIB) (INFANRIX HEXA) ............................................. 3
DIPHTHERIA -TETANUS - ACELLULAR PERTUSSIS-POLIO-HAEMOPHILUS INFLUENZAE TYPE B
ADSORBED (DTAP-IPV-HIB) (PEDIACEL) ............................................................................................................. 4
DIPHTHERIA-TETANUS- ACELLULAR PERTUSSIS - POLIO ADSORBED (DTAP-IPV) (QUADRACEL) 5
HAEMOPHILUS B CONJUGATE VACCINE (ACT-HIB ) ...................................................................................... 6
HEPATITIS A VACCINE: INDICATIONS .................................................................................................................... 7
HEPATITIS A VACCINE (INACTIVATED VIRAL) (HAVRIX ) ........................................................................... 8
HEPATITIS A VACCINE (INACTIVATED VIRAL) (VAQTA ) ........................................................................... 10
HEPATITIS B VACCINE PRE-EXPOSURE INDICATIONS ................................................................................... 11
HEPATITIS B VACCINE (ENGERIX-B) .................................................................................................................. 12
HEPATITIS B VACCINE PRE-EXPOSURE (RECOMBIVAXHB) (10 MCG/1.0 ML) ....................................... 13
HEPATITIS B VACCINE POST-EXPOSURE INDICATIONS ................................................................................. 15
HEPATITIS B IMMUNE GLOBULIN (HBIG) (BAYHEP B ) ............................................................................... 17
HEPATITIS B VACCINE POST EXPOSURE (RECOMBIVAXHB) (10 MCG/1.0 ML) ..................................... 19
HEPATITIS B VACCINE PROGRAM FOR CHRONIC KIDNEY DISEASE CLIENTS ...................................... 20
HUMAN PAPILLOMAVIRUS VACCINE (GARDASIL)........................................................................................ 21
SEASONAL TRIVALENT INFLUENZA VACCINE (INACTIVATED SPLIT VIRION OR SUBUNIT) ............ 23
INFLUENZA VACCINE (INACTIVATED SPLIT VIRION) (FLUVIRAL) ......................................................... 24
JAPANESE ENCEPHALITIS VACCINE (IXIARO) ............................................................................................... 25
MEASLES/MUMPS/RUBELLA VACCINE (LIVE ATTENUATED VIRAL) MMRII & PRIORIX............. 26
MUMPS, MEASLES AND RUBELLA ALGORITHM DETERMINING IMMUNITY/VACCINATION
REQUIREMENTS OF ADULTS.................................................................................................................................... 28
MENINGOCOCCAL C CONJUGATE (MCC) VACCINE (NEIS VAC-C®) ........................................................... 29
MENINGOCOCCAL QUADRIVALENT CONJUGATE VACCINE (MENACTRA).......................................... 31
PNEUMOCOCCAL CONJUGATE VACCINE (PREVNAR®13)............................................................................... 33
COMPLETING A PNEUMOCOCCAL CONJUGATE VACCINE SERIES ............................................................ 35
RECOMMENDATIONS FOR PNEUMOCOCCAL IMMUNIZATION WITH 13-VALENT PNEUMOCOCCAL
CONJUGATE VACCINE (PCV 13) AND 23-VALENT PNEUMOCOCCAL POLYSACCHARIDE VACCINE
(PPV 23) FOR CHILDREN AT HIGH RISK OF PNEUMOCOCCAL DISEASE ................................................... 36
PNEUMOCOCCAL POLYSACCHARIDE VACCINE (PNEUMOVAX 23) ......................................................... 37
PNEUMOCOCCAL POLYSACCHARIDE VACCINE (PNEUMO 23) ................................................................. 39
POLIO VACCINE (INACTIVATED) (IMOVAX ®POLIO) (VERO CELL ORIGIN) ........................................... 41
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 2
RABIES VACCINE PRE-EXPOSURE [HUMAN DIPLOID CELL VACCINE (HDCV)] (INACTIVATED)
IMOVAX RABIES ........................................................................................................................................................ 43
RABIES VACCINE PRE-EXPOSURE [PURIFIED CHICK EMBRYO CELL VACCINE] (PCECV .................. 45
RABIES POST-EXPOSURE PROPHYLAXIS INSTRUCTIONS .............................................................................. 47
RABIES INVESTIGATION FORM............................................................................................................................... 48
RELEASE OF BIOLOGICALS FOR RABIES POST-EXPOSURE PROPHYLAXIS (RPEP) .............................. 49
HUMAN RABIES IMMUNE GLOBULIN (RABIG) (HYPERRAB™ S/D) .............................................................. 50
RABIES VACCINE POST-EXPOSURE [HUMAN DIPLOID CELL VACCINE (HDCV)] (INACTIVATED)
IMOVAXRABIES ......................................................................................................................................................... 52
RHO (D) IMMUNE GLOBULIN (RHIG) (WINRHO ) ............................................................................................. 54
TETANUS-DIPHTHERIA (TD) ADSORBED .............................................................................................................. 55
TETANUS-DIPHTHERIA-ACELLULAR PERTUSSIS (TDAP) (ADACEL) ....................................................... 56
TETANUS-DIPHTHERIA-ACELLULAR PERTUSSIS (TDAP) (BOOSTRIX) ................................................... 58
TETANUS IMMUNE GLOBULIN (TIG) (HYPERTETS/D) .................................................................................. 60
TETANUS PROPHYLAXIS IN WOUND MANAGEMENT ...................................................................................... 62
TUBERCULIN SKIN TEST (MANTOUX) TUBERSOL  ........................................................................................ 63
TYPHOID VACCINE (SALMONELLA TYPHI VI CAPSULAR POLYSACCHARIDE)(TYPHERIX) ........... 64
VARICELLA VACCINE (LIVE ATTENUATED VIRAL) VARIVAX III AND VARILRIX........................... 65
VARICELLA ZOSTER VACCINE (LIVE ATTENUATED VIRAL) (ZOSTAVAX) ........................................... 68
YELLOW FEVER (YF-VAX) ..................................................................................................................................... 70
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 3
Diphtheria - Tetanus- Acellular Pertussis - Hepatitis B- Polio- Haemophilus Influenzae
Type b Adsorbed (DTaP- HB- IPV- Hib) (INFANRIX hexa)
Supplier: GlaxoSmithKline Inc
INDICATIONS
(1) Primary series for infants starting at 2 months of age
(2) Primary series for high risk infants who have received a
birth dose of HBIg and/or Hepatitis B vaccine
INITIAL SERIES
(1) & (2)
Dose 1: 0.5ml IM
Dose 2: 0.5ml IM
Dose 3: 0.5ml IM
Give each dose 2 months
apart
(3) Primary series for previously unimmunized infants and
(3) See Section 3, 1.2
children who are late starting immunization and can complete a
SCHEDULE B
primary INFANRIX hexa series before 7 years of age
REINFORCEMENTS
(1) & (2) Booster dose at 18 months of age: 0.5 ml IM of DTaP-IPV-Hib (PEDIACEL)
(3) Booster dose 6-12 months after dose 3:
 0.5ml IM of DTaP-IPV-Hib ((PEDIACEL) if child is  6 years of age and no Hib dose has been
given at 15 months of age, or
 0.5 ml IM of DTaP-IPV (QUADRACEL) if child is  6 years of age and a Hib dose has been
given at  15 months of age, or
 0.5ml IM of Tdap if the child is  7 years of age at time of booster dose. Also give a dose of IPV
if child did not receive their 3rd dose of an IPV-containing vaccine after their 4th birthday.
CONTRAINDICATIONS
1. History of anaphylactic reaction to a previous dose of DPT, DTaP, IPV, Hib or HB - containing
vaccine or to any INFANRIX hexa vaccine component, or to latex.
2. History of Guillain-Barré syndrome (GBS) within 8 weeks of receipt of a tetanus-containing
vaccine.
3. INFANRIX hexa is not indicated for children  7 years of age.
VACCINE COMPONENTS
Aluminum hydroxyphosphate sulfate, L-histidine, polysorbate 80, trace amounts of polymyxin and
neomycin
ADVERSE EVENTS
Local: redness, swelling, pain.
Systemic: fever > 38.3° C, anorexia, restlessness, irritability, persistent or unusual crying.
SPECIAL CONSIDERATIONS
 INFANRIX hexa™ contains only a single dose of HB vaccine (as Engerix) and is not indicated
for infants and children requiring a double dose of hepatitis B vaccine
 INFANRIX hexa and PEDIACEL are NOT interchangeable in a primary series. Clients
started on PEDIACEL should finish primary series with PEDIACEL
 Hypotonic-hyporesponsive episodes are not a contraindication to diphtheria, tetanus or acellular
pertussis-containing vaccines, and continued immunization with all antigens is recommended.
 While the number of Hib doses varies with age of presentation, give INFANRIX hexa as
indicated above, even when doing so provides “extra” Hib doses for age.
Community Nursing
Yukon Immunization Program
Biological Products
March 2011
Page 4
Diphtheria -Tetanus - Acellular Pertussis-Polio-Haemophilus Influenzae Type b
Adsorbed (DTaP-IPV-Hib) (PEDIACEL)
Supplier: sanofi pasteur
INDICATIONS
INITIAL SERIES 
REINFORCEMENTS
CONTRAINDICATIONS
VACCINE
COMPONENTS
ADVERSE EVENTS
SPECIAL
CONSIDERATIONS



(1) Primary series and booster for infants and children 2-59 months of
age who have had one or more doses of PEDIACEL
(2) Primary series for high risk infants who have had doses of
hepatitis B vaccine at birth and 1 month of age
(3) Booster dose at 18 months of age for infants who have received
a primary Infanrix hexa series or a primary PEDIACEL series
Dose 1: 0.5ml IM
Dose 2: 0.5ml IM
Dose 3: 0.5ml IM
Give doses 1, 2 and 3
2 months apart
+
Dose 4: 0.5ml IM
Give dose 4 twelve months after 3rd dose 
School-entry booster is:
0.5 ml IM of DTaP-IPV (QUADRACEL)
1. History of anaphylactic reaction to a previous dose of DPT,
DTaP, IPV or Hib--containing vaccine or to any PEDIACEL
vaccine component
2. Children  7 years of age.
3. History of Guillain-Barré syndrome (GBS) within 8 weeks of
receipt of a tetanus-containing vaccine.
Neomycin, streptomycin, polymyxin B, aluminum phosphate, 2phenoxyethanol, polysorbate 80, tetanus protein, formaldehyde and
bovine serum.
Local: redness, tenderness, swelling.
Systemic: irritability, crying, fever >38.3°C, drowsiness, decreased
activity and decreased appetite, vomiting and diarrhea.
 Hypotonic-hyporesponsive episodes are not a contraindication to
diphtheria, tetanus or acellular pertussis-containing vaccines, and
continued immunization with all antigens is recommended
If the child’s immunization schedule is delayed, so that the child requires fewer doses of Hib
vaccine, administer QUADRACEL rather than PEDIACEL.
If required, this dose can be given as early as 6 months following dose number 3. For
protection against Hib, do not give this dose before 15 months of age.
Dose number 5 should be given 30 to 54 months after dose number 4 and no sooner than
age 4 (the minimum interval between dose 4 and 5 is six months). A 5th dose is not
necessary if the 4th dose was given after the 4th birthday.
Community Nursing
Yukon Immunization Program
Biological Products
March 2011
Page 5
Diphtheria-Tetanus- Acellular Pertussis - Polio Adsorbed (DTaP-IPV)
(QUADRACEL)
Supplier: sanofi pasteur
INDICATIONS
DOSE
(1)
0.5 ml IM 
School Entry Booster
(2)
0.5 ml IM 
Used to complete the primary series and booster for
children in whom Hib is not indicated (see routine Hib
schedule).
CONTRAINDICATIONS 1. History of anaphylactic reaction to a previous dose of DPT, DTaP or
IPV-containing vaccine or to any QUADRACEL vaccine component
2. Children ≥ 7 years of age.
3. History of Guillain-Barré syndrome(GBS) within 8 weeks of receipt of
a tetanus – containing vaccine.
(1)
(2)
VACCINE
COMPONENTS
ADVERSE EVENTS
Neomycin, polymyxin B, aluminum phosphate, 2-phenoxyethanol,
tween 80, formaldehyde and bovine serum.
Minor local: redness, tenderness, swelling, pain
Minor systemic: fever > 38.3° C, anorexia, vomiting, irritability,
drowsiness, listlessness, fretfulness, persistent or unusual crying
SPECIAL
CONSIDERATIONS
Hypotonic-hyporesponsive episodes are not a contraindication to
diphtheria, tetanus or acellular pertussis-containing vaccines, and
continued immunization with all antigens is recommended.
 Not necessary if the 4th dose of PEDIACEL, or QUADRACEL was given after the 4th
birthday.
 An interval of 8 weeks is preferred between doses 1, 2, and 3. An interval of 12 months is
preferred between doses 3 and 4 (minimum interval between dose 3 and dose 4 is six
months.) Dose number 5 should be given 30 to 54 months after dose number 4 and no
sooner than age 4 (the minimum interval between dose 4 and 5 is six months).
Community Nursing
Yukon Immunization Program
Section 8- Biological Products
2011 March
Page 6
Haemophilus B Conjugate Vaccine (Act-HIB )
Supplier: sanofi pasteur
INDICATIONS
(1)
All children 2-59 months of age  
AGE AT PRESENTATION
INITIAL SERIES
0.5 ml IM (3 doses)
2 – 6 months
2 months apart
0.5 ml IM (2 doses)
7 – 11 months
2 months apart
0.5 ml IM (1 dose)
12 – 14 months
15 – 59 months
0.5 ml IM (1 dose)
(2)
(3)
REINFORCEMENTS
0.5 ml IM at 18 months 
0.5 ml IM at 18 months 
0.5 ml IM at 18 months 
None required 
Unimmunized persons > 5 years of age with the following conditions: anatomic
or functional asplenia; sickle cell disease; immunosuppression related to disease
(e.g., congenital immunodeficiency states such as complement, properdin or factor D
deficiency; malignant neoplasm including leukemia and lymphoma; HIV infection) or
therapy (e.g., high dose, systemic steroids; or severe rheumatoid arthritis requiring
immunosuppressive therapy); candidates or recipients of solid organ or islet cell
transplants, or cochlear implants:
 0.5 ml IM (1 dose)
 No reinforcement required
Re-immunization following receipt of a hematopoietic stem cell transplant (HSCT)
0.5 ml IM (3 doses) 
History of anaphylactic reaction to a previous dose of a HibCONTRAINDICATIONS
containing vaccine or to any component of Act-HIB .
VACCINE COMPONENTS Tetanus protein and Trometamol.
ADVERSE EVENTS
Minor Local: redness, tenderness, swelling, pain.
Minor Systemic: fever > 38.3° C, fussiness, irritability, lethargy,
loss of appetite.
 It is preferable to use the same Hib product for all doses of the primary series. Using
different Hib products during the primary series is acceptable if it is not possible to continue
with the initial product.
 Children who had Hib disease prior to 24 months of age may not have mounted an
adequate immune response for protection against Hib disease and should receive vaccine
according to the schedule consistent with their age.
 If series is interrupted, complete series according to age at which child re-presents.
 The booster recommended at 18 months may be given as early as 15 months provided
there is a 2 month interval following the previous dose.
 At 15 months of age and older, a single dose of any Hib product is all that is required for
protective antibody levels.
 Give vaccine at least 14 days prior to elective splenectomy, or if not possible, 14 or more
days post-splenectomy. If there is concern that the patient may not present later for
immunization, give vaccine before discharge.
 One Hib dose is recommended for children and adult asplenics > 5 years of age,
regardless of previous Hib immunization.
 Contact the Vaccine Program Manager prior to immunization for this indication.
Community Nursing
Yukon Immunization Program
Biological Products
March 2011
Page 7
Hepatitis A Vaccine: Indications
Recommended and provided free to:

Individuals with haemophilia A or B receiving plasma-derived replacement clotting factors
and testing negative for anti-HAV IgG/HAV total (combined IgM & IgG) negative. 

Previously unimmunized anti-HCV positive individuals who are anti-HAV IgG/HAV total
negative. 

Previously unimmunized individuals chronically infected with hepatitis B virus who are
anti-HAV IgG/HAV total negative. 

Individuals with other chronic liver disease (including cirrhosis and liver transplant
candidates or recipients, liver damage from hemachromatosis) who are anti-HAV
IgG/HAV total negative. 

Users of illicit injection drugs; persons sharing illicit drug snorting, smoking or injecting
equipment.

Men who have sex with men.

Individuals with sexual life-style risks of infection where there is a likelihood of oral-anal
contact.

Individuals who are HIV positive.

Inmates of correctional facilities in which there is epidemiological evidence of sustained
Hepatitis A infection (on order of Medical Officer of Health only).

Haematopoietic stem cell transplant (HSCT) recipients.

Individuals receiving chronic blood transfusions.

Contacts of a confirmed case of hepatitis A:  Household, Close non-household,
Daycare, Drug-sharing, Sexual contacts, Other food handlers at the same establishment if
the case is a food handler, Patrons of involved food-handling establishment at risk of hep
A as assessed by Public Health staff.
Recommended but not provided free to:

Travelers, military personnel, and others who will work or live in countries with
intermediate or high endemic rates of HAV infection, especially when travel or work will
involve rural or primitive conditions. 

Persons with multiple sex partners.

Food handlers.

Employees who have been directed to receive this immunization, as per employer
direction, must pay upfront for the immunization, ie Department of Highways & Public
Works, City of Whitehorse

Zookeepers, veterinarians, and researchers who handle non-human primates; certain
workers involved in research on hepatitis A virus or the production of hepatitis A vaccine
 One dose of vaccine is to be provided when it is within 14 days after the last exposure to
the case while case was in the infectious period. If a client received 1 dose of hepatitis A
vaccine more than 6 months previously, provide a 2nd dose of hepatitis A vaccine.
 Travelers who opt not to undergo HAV immunization may consider Ig prophylaxis.
 That is, those who do not have evidence of past hepatitis A infection. Those who have
started a vaccine series who now have positive serology should complete the series
regardless of the interval between dose 1 & 2. Those who have not started a vaccine
series with a positive anti-HAV IgG or HAV total are considered to have lab evidence of
immunity against Hepatitis A.
 For individuals who are HIV positive, please contact YCDC for most recent CD4 counts
prior to immunization.
Community Nursing
Yukon Immunization Program
Biological Products
March 2011
Page 8
Hepatitis A Vaccine (Inactivated Viral) (Havrix )
Supplier: GlaxoSmithKline
See Hepatitis A Vaccine Indications
INDICATIONS
 6 months up to and including 18 years of age: 
INITIAL SERIES  
USING HAVRIX presentation of 720 ELU per 0.5ml
Dose 1: 0.5 ml IM
Dose 2: 0.5 ml IM 6 to 12 months after dose 1
 19 years and older:
USING HAVRIX presentation of 1440 ELU per 1.0 ml
Dose 1: 1.0 ml IM
Dose 2: 1.0 ml IM (1440 ELU presentation) or 0.5 ml IM (720 ELU
presentation) 6 to 12 months after dose 1
REINFORCEMENTS
Currently no recommendation for booster dose(s).
CONTRAINDICATIONS
History of an anaphylactic reaction to a previous dose of any hepatitis
A vaccine, to any component of HAVRIX  vaccine or to latex (prefilled syringe presentation only).
VACCINE
COMPONENTS
Formaldehyde, aluminum hydroxide, 2-phenoxyethanol, polysorbate
20, neomycin B sulphate, potassium chloride, disodium phosphate,
monopotassium phosphate, bovine serum albumin, amino acids.
ADVERSE EVENTS
Tend to be mild and transient.
Local: Soreness and redness at injection site
Systemic: Headache, fatigue, fever, malaise, and gastrointestinal
symptoms
SPECIAL
CONSIDERATIONS
Active immunization with hepatitis A vaccine is the first choice for
protection against hepatitis A for travellers. Given the good serologic
response to vaccine after the primary dose, simultaneous
administration of Ig is not indicated even if the vaccine is given
immediately before departure. Ig may be used for infants  6 months
of age and individuals for whom the vaccine is contraindicated.
Post – vaccination testing is not indicated following a Hepatitis A
vaccine series
Community Nursing
Yukon Immunization Program
Biological Products
March 2011
Page 9
Hepatitis A Vaccine (Inactivated Viral) (Havrix )
Supplier: GlaxoSmithKline




The hepatitis A vaccines HAVRIX, VAQTA, AVAXIM, AVAXIM Pediatric, and
ViVAXIM are interchangeable at any scheduled dose for children or adults, using the
age-specific dosage for the particular product.
HAVRIX is licensed for persons 1 year of age. However, numerous studies have
demonstrated the immunogenicity and safety of hepatitis A vaccine for infants at 6
months of age. Immune response may be blunted in some children less than 6 months
of age due to interference with maternally derived antibody. As maternal hepatitis A
antibody status is usually not known, contact the Vaccine Program Manger to discuss
giving Ig to infants 6 months of age who are at risk for hepatitis A.
Studies have shown that 720 ELISA units provides an effective booster dose in those
≥19 years of age
For individuals who are HIV positive, please contact YCDC for most recent CD4 counts
prior to immunization.
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 10
Hepatitis A Vaccine (Inactivated Viral) (Vaqta )
Supplier: Merck Frosst
INDICATIONS
See Hepatitis A Vaccine Indications
INITIAL SERIES
 6 months up to and including 17 years of age:

Dose 1: 0.5 ml (25U) IM
Dose 2: 0.5 ml (25U) IM 6 to 18 months after dose 1
18 years of age:
Dose 1: 1.0 ml (50U) IM
Dose 2: 1.0 ml (50U) IM 6 months after dose 1
REINFORCEMENTS
Currently no recommendation for booster dose(s)
CONTRAINDICATIONS
History of anaphylactic reaction to a previous dose of any hepatitis A
vaccine or to any component of VAQTA  vaccine or to latex.
VACCINE
COMPONENTS
Bovine albumin, formaldehyde, neomycin B sulphate, aluminum
hydroxide, sodium borate.
ADVERSE EVENTS
Tend to be mild and transient.
Local: Soreness and redness at injection site
Systemic: Headache, fatigue, fever, malaise and gastrointestinal
symptoms
SPECIAL
CONSIDERATIONS
Active immunization with hepatitis A vaccine is the first choice for
protection against hepatitis A for travellers. Given the good serologic
response to vaccine after the primary dose, simultaneous administration
of Ig is not indicated even if the vaccine is given immediately before
departure. Ig may be used for infants  6 months of age and individuals
for whom the vaccine is contraindicated.




Post – vaccination testing is not indicated following a Hepatitis A
vaccine series
The hepatitis A vaccines HAVRIX, VAQTA, AVAXIM, AVAXIM Pediatric, and
ViVAXIM are interchangeable for children or adults at any scheduled dose, using the
age-specific dosage for the particular product.
Vaqta does not contain a preservative; use immediately and discard any remainder.
Vaqta is licensed for persons  1 year of age. However, numerous studies have
demonstrated the immunogenicity and safety of hepatitis A vaccine for infants at 6 months
of age. Immune response may be blunted in some children less than 6 months of age due
to interference with maternally-derived antibody. As maternal hepatitis A antibody status
is usually not known, contact the vaccine program manager to discuss giving Ig to infants
 6 months of age who are at risk for hepatitis A.
For individuals who are HIV positive, please contact YCDC for most recent CD4 counts
prior to immunization.
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 11
Hepatitis B Vaccine Pre-exposure Indications
Provided free to: 
 All children ≤ 19 years of age.
 All Community Nursing personnel and Yukon Communicable Disease Control personnel
 All Yukon EMS personnel in Whitehorse and the rural communities (complete log & submit March
31 of each year to CN financial admin assistant, and immunizations will be paid for by EMS).
 Household contacts of acute Hepatitis B cases or Hepatitis B chronic carriers.
 Sexual contacts of acute Hepatitis B cases or Hepatitis B chronic carriers.
 Users of illicit injectable drugs and their sexual partners.
 Persons sharing illicit drug snorting, smoking or injecting equipment.
 Males who have sexual contact with other males.
 Individuals who are HIV positive  
 Persons with multiple sexual partners or recent history of a sexually transmitted infection (STI).
 Anti-HCV positive individuals who do not have past or current evidence of hepatitis B infection.
 Individuals with significant chronic liver disease (including cirrhosis, candidates or recipients of liver
transplant, and liver damage from hemachromatosis) who do not have past or current evidence of
hepatitis B infection. 
 Hemophiliacs and others receiving repeated infusions of blood or blood products. Individuals with
chronic kidney disease (predialysis, hemodialysis, and peritoneal dialysis clients) and candidates or
recipients of a kidney transplant.  
 Previously unimmunized residents and staff of developmentally challenged known hepatitis B
carriers whose behavior or medical condition increases risk to others
 Previously unimmunized children and staff in childcare settings in which there is a child infected
with hepatitis B (upon order of Medical Health Officer).
Recommended but not provided free to:
 All Health Care Workers
 All employees who have been directed to receive this immunization, as per employer direction,
must pay upfront for the immunization ie City of Whitehorse, Department of Highways & Public
Works
 Persons visiting countries with high HBV endemicity areas and/or having sexual or blood contact
with local residents regardless of length of stay.
 Starting in 1994 YT has had either a school based or infant hepatitis B immunization program; therefore
many individuals born in 1983 through present day are immunized. If no records are available and the client
is unable to recall receiving hepatitis B vaccine, proceed with hepatitis B vaccination as per indication.
 Prevaccination testing for HBsAg, anti-Hbc and anti-HBs is recommended for persons at high risk of having
been infected (i.e., IDU, STW, individuals with HCV or chronic liver disease, and persons born in countries of
high hepatitis B prevalence). Post vaccination serology is recommended for those with chronic liver disease.
not routinely recommended.
 Serology to determine protective status for hepatitis B is prudent in those with chronic liver, chronic renal &
HIV infection. If anti-HBs is < 10IU/L but is detectable, provide one dose of vaccine and retest 4 weeks after
this dose. If level is ≥ 10 following this dose, no further vaccine is required. When anti-HBs is <10 IU/L after
this one dose, complete the second vaccine series and retest 4 weeks after the last dose. Do not complete
more than 2 complete Hepatitis B series.
 Hemodialysis clients require a specific hepatitis B vaccine dosage and series. See Section 5, Immunization of
Special Populations, Chronic Kidney Disease.
 For individuals who are HIV positive, please contact YCDC for most recent CD4 counts prior to immunization.
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 12
Hepatitis B Vaccine (Engerix-B)
Supplier: GlaxoSmithKline
Pediatric presentation 10 mcg/0.5 ml; adult presentation 20mcg/1.0 ml
INDICATIONS
INITIAL SERIES 
(1) See Hepatitis B Vaccine Preexposure Indications
(2) See Hepatitis B Vaccine Postexposure Indications
(3) Use when there is a
contraindication to
RecombivaxHB or when
RecombivaxHB is not available
(1) (2) & (3)
Infants from birth, children, and adolescents to 19 years
of age inclusive (except the routine infant program and
neonates who will be contacts of chronic carriers)0.5 ml
IM (10 mcg) at 0, 1 and 6 months
(4) Adolescents 11 years of age,
but 15 years of age at the
initiation and completion of
series.
REINFORCEMENTS
CONTRAINDICATIONS
VACCINE COMPONENTS
ADVERSE EVENTS







Eligible adults  20 years of age
1.0 ml IM (20 mcg) at 0, 1 and 6 months
(4) 1.0 ml IM (20 mcg) at 0 and 6 months
(Use adult single dose formulation)
None
History of anaphylactic reaction to a previous dose of any
hepatitis B vaccine or to any component of Engerix-B.
Aluminum hydroxide, and traces of yeast. Thimerosal
Fever ( 37.7C) and mild short-term soreness at injection
site.
Engerix-B & RecombivaxHB are interchangeable at any dose, using age-specific dosage and
recommended schedule for the respective product. There must be a minimum of 6 months between
doses 1 and 2 whenever both products are used in a 2-dose series.
The single dose pediatric formulation (10 mcg/0.5 ml vial) and the adult single dose (20
mcg/1.0 ml) formulation are thimerosal-free.
A minimum of 1 month must pass between dose 1 and 2. Dose 3 must be given at least 4 months
after the 1st dose and 2 months after the 2nd dose. If the immunization series is interrupted after the
1st dose, the 2nd dose should be administered as soon as possible. If only the 3rd is delayed,
administer as soon as possible.
Hemodialysis clients require a specific hepatitis B vaccine dosage and series (see Hepatitis B
Vaccine Program for Chronic Kidney Disease Clients).
Serology to determine protective status for hepatitis B is prudent in those with chronic liver, chronic
renal & HIV infection. If anti-HBs is < 10IU/L but is detectable, provide one dose of vaccine and
retest 4 weeks after this dose. If level is ≥ 10 following this dose, no further vaccine is required.
When anti-HBs is <10 IU/L after this one dose, complete the second vaccine series and retest 4
weeks after the last dose. Do not complete more than 2 complete Hepatitis B series.
High risk infants who receive a birth dose of Hepatitis B vaccine and/or HBIg can complete their
vaccine series with INFANRIX hexa at 2, 4 and 6 months of age. Infants who have been given
doses of Hepatitis B vaccine at birth and 1 month of age should be given PEDIACEL vaccine at 2,
4 and 6 months of age, and a 3rd dose of Hepatitis B vaccine at 6 months of age. These infants
weighing < 2000 grams at birth will require a 4th dose of Hepatitis B vaccine at 8 months of age.
There must be a minimum of 6 months between doses 1 and 2.
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 13
Hepatitis B Vaccine Pre-Exposure (RecombivaxHB) (10 mcg/1.0 ml)
(Pediatric presentation: 5 mcg/0.5 ml, thimerosal free)
Supplier: Merck Frosst
INDICATIONS
INITIAL SERIES  
(1) Infants, including infants weighing (1) Give 0.5ml IM (5mcg) at birth
< 2000 grams at birth, whose
father or other primary caregiver
Give INFANRIX hexa  at 2 - 4 - 6 months 
or household contact has chronic
hepatitis B infection.
Use thimerosal free vaccine.
(2) Infants who are part of the routine (2) 0.5 ml IM (5 mcg) at 2-4-6 months.
Hepatitis B program and
receiving PEDIACEL in the
primary series
Use thimerosal free vaccine.
(3) 0.5 ml IM (5 mcg) at 0-1-6 months
(3) Infants and children and
adolescents to19 years of age
inclusive (except the routine
infant program, neonates who will
be contacts of chronic carriers).
Use thimerosal free vaccine.
(4) Adolescents 11years of age, but (4) 1.0 ml IM (10 mcg) at 0 and 6 months
15 years of age at time of initiation
& completion of series.
Use thimerosal free vaccine.
(5) 1.0 ml IM (10 mcg) at 0-1-6 months.
(5) Eligible adults  20 years of age.
(6) See Hepatitis B Vaccine Preexposure Indications
(7) See Hepatitis B Vaccine Postexposure Indications
REINFORCEMENTS
None.
CONTRAINDICATIONS
History of anaphylactic reaction to a previous dose of any
hepatitis B vaccine, to any component of RecombivaxHB
or to latex.
Aluminum hydroxide, formaldehyde, yeast, and thimerosal
when the 3 mL vial presentation is used.
Fever ( 37.7 C) and mild short-term soreness at injection
site.
VACCINE COMPONENTS
ADVERSE EVENTS
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 14
Hepatitis B Vaccine Pre-Exposure (RecombivaxHB) (10 mcg/1.0 ml)
(Pediatric presentation: 5 mcg/0.5 ml, thimerosal free)
Supplier: Merck Frosst







Engerix-B & RecombivaxHB are interchangeable at any dose, using age-specific
dosage and recommended schedule for the respective product. There must be a minimum
of 6 months between doses 1 and 2 whenever both products are used in a 2-dose series.
A minimum of 1 month must pass between dose 1 and 2. Dose 3 must be given at least 16
weeks after the 1st dose and 8 weeks after the 2nd dose. If the immunization series is
interrupted after the 1st dose, the 2nd dose should be administered as soon as possible. If
only the 3rd is delayed, administer as soon as possible. If years have lapsed between the
1st and 2nd dose, it may be prudent to assess antibody response post series, especially if
the client is at significant risk.
Hemodialysis clients require a specific hepatitis B vaccine dosage and series (see Hepatitis
B Vaccine Program for Chronic Kidney Disease Clients)
A 0.5 ml (5mcg) Recombivax HB dose represents a double dose for infants and
children < 11 years of age.
Infants who have been given doses of Hepatitis B vaccine at birth and 1 month of age
should be given PEDIACEL vaccine at 2, 4 and 6 months of age, and a 3rd dose of
Hepatitis B vaccine at 6 months of age. These infants weighing < 2000 grams at birth will
require a 4th dose of Hepatitis B vaccine at 8 months of age.
While a second dose can be given 4 – 6 months following the first dose, the dose is
suggested at 6 months for consistent timing with other vaccine programs administered in
the school setting.
Serology to determine protective status for hepatitis B is prudent in those with chronic liver,
chronic renal & HIV infection. If anti-HBs is < 10IU/L but is detectable, provide one dose of
vaccine and retest 4 weeks after this dose. If level is ≥ 10 following this dose, no further
vaccine is required. When anti-HBs is <10 IU/L after this one dose, complete the second
vaccine series and retest 4 weeks after the last dose. Do not complete more than 2
complete Hepatitis B series.
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 15
Hepatitis B Vaccine Post-Exposure Indications
Provided free to: 













Infant born to known HBsAg + mother. Give HBIg and hepatitis B vaccine at birth.
Infant born to a mother who is at high risk for hepatitis B infection (intravenous drug use
or sex trade work) and her infectious status at delivery is unknown or negative
(possible window period); give HBIg and hepatitis B vaccine at birth. 
Infants born to mother who has risk factors (other than IDU and/or STW) for hepatitis B
infection and her infectious status at delivery is unknown or negative (possible window
period). Give hepatitis B vaccine at birth. 
Infant whose father or other primary care giver or household contact has chronic
hepatitis B infection. Give hepatitis B vaccine at birth. 
Infants from birth to  12 months of age if father or other primary caregiver are at high
risk for hepatitis B infection and their infectious status is unknown or negative (possible
window period). Give hepatitis B vaccine at birth. 
Infant < 12 months of age whose mother has acute hepatitis B. 
Household contacts (including infants) of acute case or chronic carrier.
Sex with a person who has acute or chronic hepatitis B infection. 
Percutaneous or mucosal exposure in the community (i.e. sexual assault, needle
sticks) and household contacts with percutaneous or mucosal exposure (i.e. sharing of
toothbrushes or razors) of acute or chronic hepatitis B infection. 
Refer to Yukon Immunization Program, Section 16, Blood & Body Fluid
Management for complete guidelines to assess need for HBIg and hepatitis B
vaccine. These guidelines do not include post exposure to newborns. For
newborn exposure see, Hepatitis B Vaccine Post Exposure (RecombivaxHB).
Post-vaccination testing (HBsAg and anti-HBs) of infants must be performed 1 month
after completion of the hepatitis B vaccine series. If HBsAg is found, the infant is likely
to become a chronic carrier. If the infant is negative for HBsAg and anti-HBs, a 2nd
series of hepatitis B vaccine should be given and serological testing repeated 1 month
post-series. See .
For steady long-term sexual partners of chronic HBV carriers, test for HBsAg, anti-HBc
and anti-HBs prior to administering HBIG. If the client is susceptible to HBV, give HBIg
as soon as possible and no later than 14 days of last sexual exposure. See .
Post-vaccination testing should be performed 1 month after completion of the hepatitis
B vaccine series for steady sexual partners of HBV chronic carriers, household
contacts of acute and chronic carriers, sexual assault victims and those with
percutaneous or mucosal exposures. See .
Yukon & HBIg availability
HBIG for post exposure prophylaxis is located in the following rural Community Health
Centres throughout the territory:
Beaver Creek, Dawson City, Haines Junction, Mayo, Old Crow, Ross River, Watson Lake
When you receive the HBIg there will be a transfer log enclosed. It must be completed and
faxed to the WGH Lab when either a client has received HBIg or the Lot has expired.
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 16
Hepatitis B Vaccine Post-Exposure Indications
Yukon & HBIg availability
In the event a community not listed above requires HBIg, please contact the nearest
community to you that has HBIg and make arrangements to have the HBIg brought to
your community. For communities with close proximity to Whitehorse there are two
routes that can be followed. If a nurse is traveling to the community within 48 hrs
contact the Lab and Community Nursing staff will pick up the HBIg and give it to the
nurse. In the case where there is no staff traveling to the community, the client may
come to WGH Emergency to receive the HBIg. See Section 16, Blood & Body Fluid
Management, How to Access HBIg.
HBIg is automatically sent to the Whitehorse General Hospital Lab about 6 to 8 weeks
prior to EDC. (Since most Yukon babies are born in WGH). Watson Lake Hospital must
secure the HBIg from the Whitehorse General Hospital Lab).
If any other health facility requires HBIg, call the Lab at Whitehorse General Hospital.
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 17
Hepatitis B Immune Globulin (HBIg) (BayHep B )
Supplier: Bayer
INDICATIONS
(1)
Infant born to known HBsAg positive
woman
DOSAGE
(1)
Give HBIg 0.5 ml IM immediately after
birth, along with first dose of hepatitis B
vaccine series. 
(2)
Infant born to woman at high risk for
hepatitis B infection (i.e., intravenous
drug use, sex trade work)) whose
infectious status is unknown or
negative (possible window period)
(2)
Give HBIg 0.5 ml IM immediately after
birth, along with first dose of hepatitis B
vaccine series. 
(3)
Infant  12 months of age has mother
with acute hepatitis B infection
(3)
Consider the immune status of the
infant and history of hepatitis B
immunization and give HBIg 0.06ml/kg
of body weight IM and hepatitis B
vaccine as required 
(4)
Percutaneous or mucosal exposure to
HBsAg positive source
(4)
Give HBIg 0.06 ml/kg of body weight
and hepatitis B vaccine IM as required,
considering the client’s immune status
and history of hepatitis B
immunization. 
(5)
Sex with a person who has acute or
chronic hepatitis B infection
(5)
REINFORCEMENTS
CONTRAINDICATIONS
Give HBIg 0.06 ml/kg of body weight
IM as soon as possible following the
last sexual exposure, along with
hepatitis B vaccine series 
An at-risk known non-responder to two
series of vaccine requires 2 doses of HBIG
one month apart
None
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 18
Hepatitis B Immune Globulin (HBIg) (BayHep B )
Supplier: Bayer
PRECAUTIONS








Human Ig products are among the safest blood-derived products available. The method of
preparation includes one or more steps that exclude or inactivate hepatitis B, C and HIV;
therefore the risk of transmission is extremely low. However, it is possible that unknown
infectious agents may be present in such products.
Regarding HBIg and the administration of live vaccines see CIG (2006), p 54, Guidelines
for the interval between Administration of Immune Globulin Preparations or Blood
Products and MMR or Varicella Virus.
For full Hepatitis B Post-Exposure Prophylaxis guidelines see Section 16, Blood & Body
Fluid Exposure Management.
Give HBIg with caution (i.e., in a setting capable of managing anaphylaxis) if the person
has a history of anaphylactic reaction following receipt of any human Ig product, or a
history of anaphylactic reaction to latex (assess risks versus benefits).
Clients with severe thrombocytopenia or coagulation disorders that contraindicate IM
injections should not be given HBIg unless the benefits outweigh the risks.
HBIg does not contain preservatives. Vials are single dose use; discard unused
contents.
HBIg must be given at a separate anatomic site from hepatitis B vaccine.
The preferred site for the administration of HBIg is the ventrogluteal area, which may be
used in those > 7 months of age. However, the vastus lateralis is most often used in
infants and children up to 5 years of age.
ADVERSE EVENTS
Local pain and tenderness at injection site, urticaria and angioedema may occur.







There is no upper limit to the volume of HBIg that can be administered.
Provide a written record to a client who receives any immune globulin product.
There is no outer time limit for administering HBIg in infants 12 month’s of age, when the
infant’s exposure to the known risk factor(s) is ongoing. For infants < 8.3 kg, give 0.5 ml
HBIg.
HBIg dose for all clients  8.3kg is 0.06ml/kg. Give HBIg as soon as possible, preferably
within 48 hours of the exposure. For a percutaneous exposure, HBIg may be given up to
7days following the exposure. If the client presents  7 days following a percutaneous
exposure, give Hepatitis B vaccine only. For permucosal or sexual exposures, HBIg may be
given up to 14 days following the last exposure. If the client presents  14 days following a
permucosal or sexual exposure, give Hepatitis B vaccine only. See Section Hepatitis B
Post-Exposure Prophylaxis table located in, Section 16, Blood & Body Fluid Management.
See CIG (2006) for maximum volume to be administered per site according to age.
For steady, long term sexual partners of chronic hepatitis B carriers, test for HBsAg, antiHBc and anti-HBs as per scope of practice. See Section 16, Blood & Body Fluid
Management for complete guidelines
See Section 16, Blood & Body Fluid Management for complete guidelines
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 19
Hepatitis B Vaccine Post Exposure (RecombivaxHB) (10 mcg/1.0 ml)
(Pediatric presentation: 5 mcg/0.5 ml, thimerosal free)
Supplier: Merck Frosst
INDICATIONS
INITIAL SERIES
(1) Infants born to HBsAg positive mothers
(2) Infant weighing  2000 grams at birth and
requiring a birth dose of hepatitis B vaccine
(3) Infant whose mother is at high risk and
infectious status unknown
(4) Infant whose caregiver or household contact
is a chronic hepatitis B carrier
(1) (2) (3) & (4)
POST EXPOSURE SCHEDULE FOR OTHER
INDICATIONS
(1) Infants and children ≤15 years of age. Use
thimerosal free vaccine.
0.5 ml IM (5 mcg) at 0-1-6 months.
Give 0.5 ml IM (5 mcg) at birth (must be given
within 12 hours along with HBIg)
Use thimerosal free vaccine
Give Infanrix hexa at 2-4-6 months.
(2) Adolescents  16 and  20 years of age.
0.5 ml IM (5 mcg) at 0-1-6 months.
SPECIAL CONSIDERATIONS






(3) Adults  20 years of age.
1.0 ml IM (10 mcg) at 0-1-6 months.
Routine information regarding RecombivaxHB
vaccine is located on the pre-exposure vaccine
page (e.g. vaccine interchangeability,
contraindications, precautions, schedule
variations, etc).
Hemodialysis clients require a specific dose and series (See Hepatitis B Vaccine Program for
Chronic Kidney Disease Clients)
See Hepatitis B Vaccine Post-Exposure Indications and Blood & Body Fluid Management for
complete guidelines to assess need for HBIg, hepatitis B vaccine, and serologic testing for all
other groups (i.e., baseline and post exposure).
Post-vaccination testing (HBsAg and anti-HBs) should be performed 1 month after completion
of the hepatitis B vaccine series. If HBsAg is found, the child is likely to become a chronic
carrier. If the infant is negative for HBsAg and anti-HBs, a 2nd series of hepatitis B vaccine
should be given and serological testing repeated 1 month post 2nd series.
Engerix-B & RecombivaxHB are interchangeable at any dose, using age-specific dosage
and recommended schedule for the respective product. There must be a minimum of 6 months
between doses 1 and 2 whenever both products are used in a 2-dose series
Infants who have been given doses of Hepatitis B vaccine at birth and 1 month of age
should be given PEDIACEL vaccine at 2, 4 and 6 months of age, and a 3rd dose of
Hepatitis B vaccine at 6 months of age. These infants weighing < 2000 grams at birth will
require a 4th dose of Hepatitis B vaccine at 8 months of age.
Post-exposure vaccine schedules are individualized based on a number of factors (e.g.
immune status of client and history of hepatitis B immunization) See Section Hepatitis B PostExposure Prophylaxis table located in, Section 16, Blood & Body Fluid Management.
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 20
Hepatitis B Vaccine Program for Chronic Kidney Disease Clients
Chronic hemodialysis clients are at high risk for HBV infection because the process of
hemodialysis requires vascular access for prolonged periods. In an environment where multiple
clients receive dialysis concurrently, repeated opportunities exist for person-to-person
transmission of infectious agents, directly or indirectly via contaminated devices, equipment and
supplies, environmental surfaces or hands of personnel. Furthermore, hemodialysis clients are
immunosuppressed, which increases their susceptibility to infection.
ELIGIBILITY
All predialysis, hemodialysis and peritoneal dialysis clients in hospital, community, home or selfcare settings are eligible for this program. Vaccine administration often occurs at the dialysis
facility; please verify if this has occurred prior to immunization and enter the appropriate
immunization records into iPHIS.
PRE-DIALYSIS AND DIALYSIS CLIENTS  
Engerix-B
Schedule Dose
Volume
Schedule
0, 1 and 6 40 mcg
2.0 ml
0, 1, 2 and 6
months
months
7 – 19
0, 1 and 6 20mcg
1.0 ml
0, 1, 2 and 12
10 mcg 1.0 ml
years
months
months
Birth – 6
0.5 ml
0, I and 6
0, 1, 2 and 12
5 mcg 
20 mcg  1.0 ml
years
months
months
Post-vaccination serology: measure anti-HBs 1 month after completion of a primary series. If
anti-HBs is  10 IU/L, the client is a non-responder. Provide a second vaccine series and
assess anti-HBs. If anti-HBs is 10 IU/L, the client, as a non-responder to 2 vaccine series, is
susceptible to hepatitis B. There is no benefit to further vaccination. If an exposure to
blood or body fluids occurs, the client will require post-exposure prophylaxis.
Age
 20 years
RECOMBIVAX HB
Dose
Volume
40 mcg  1.0 ml
 All doses of hepatitis B vaccine should be administered in the deltoid by the IM route, or for
infants <12 months of age, in the vastus lateralis.
 Pre-dialysis clients and dialysis clients receive the same dose volume of hepatitis B vaccine
because there is no discrete level of renal function that correlates well with vaccine
immunogenicity.
 Special formulation for adult dialysis clients.
 Use adult formulation (10mcg/1.0ml).
 Use thimerosal-free RecombivaxHB or pediatric Engerix-B formulation. Dosage for this
age group is based on NACI guidelines.
NOTE: If a client has received Engerix-B vaccine as dose 1, the client will require a 4 dose
series regardless of which vaccine is used to complete the series. If a client has received
RecombivaxHB vaccine as dose 1, the client will only require a 3 dose series regardless of
which vaccine is used to complete the series.
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 21
Human Papillomavirus Vaccine (GARDASIL)
[Quadrivalent (Types 6, 11, 16, 18) Recombinant]
Supplier: Merck Frosst
INDICATIONS
INITIAL SERIES 
Recommended and provided free to:
(1) Girls in grade 6 starting 2011-2012 school
year (extended dose schedule)  
(1) 2 doses in grade 6:
Dose1: 0.5 ml IM
Dose 2: 0.5 ml IM
(minimum of 6 months after dose one)
Dose 3: 0.5 ml IM in grade 11
(60 months)
(2) Girls aged  9 years to ≤ 13 years at time
of initiation of immunization series
(extended dose schedule)
(3) Girls in grade 6, 7 & 8 2010-2011 school
year 
(2) 2 doses:
Dose1: 0.5 ml IM
Dose 2: 0.5 ml IM
(minimum of 6 months after dose one)
Dose 3: 0.5 ml IM in grade 11
(60 months)
(3) (4) & (5) Females or males
(4) Other females  14 years to ≤ 26 years of
age at initiation of series.
3 doses:
0.5 ml IM
0.5 ml IM at 2 months
0.5 ml IM at 6 months
Recommended but NOT provided free:
(5) Males  9 years to ≤ 26 years of age at
initiation of immunization series.
REINFORCEMENTS
The duration of vaccine protection is unclear.
Current studies (with five-year follow up)
indicate that the vaccine is effective for at least
five years. This information will be updated as
additional data regarding duration of immunity
become available.
CONTRAINDICATIONS
1. History of anaphylactic reaction to a previous dose of HPV vaccine, or to any component of
GARDASIL
2. Pregnancy. Although the vaccine has not been causally associated with adverse outcomes of
pregnancy or adverse events to the developing fetus, the data on vaccination in pregnancy are
limited. Administer vaccine series after completion of the pregnancy. If a woman is found to be
pregnant after initiating the vaccine series, delay completion of the series until after pregnancy. If a
vaccine dose has been administered during pregnancy, there is no indication for any intervention.
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 22
Human Papillomavirus Vaccine (GARDASIL)
[Quadrivalent (Types 6, 11, 16, 18) Recombinant]
Supplier: Merck Frosst
SPECIAL
Women for whom HPV vaccine is recommended may be immunized
CONSIDERATIONS
even if already sexually active, or if they have had previous Pap
abnormalities (including cervical cancer), genital warts, or known HPV
infection. This is because the likelihood that they have been infected
with all four types of HPV contained in the vaccine is low and they
stand to benefit from immunization.
Sexually active vaccine recipients should continue to be
routinely screened for cervical cancer.
VACCINE
Amorphous aluminum hydroxyphosphate sulfate, L-histidine,
COMPONENTS
polysorbate 80, sodium borate, yeast.
ADVERSE EVENTS
Local: mild to moderate pain, redness, swelling
Systemic: headache
 HPV vaccine was offered in the 2009-2010 & 2010-2011 school years for females in grades
6, 7 & 8. 2010-2011 is the last year of the grade 7 & 8 program.
 Grade 6 girls who are known to have immune system defects associated with solid organ
transplant, stem cell transplant, or HIV infection should receive HPV vaccine in the three
dose schedule at 0, 2 and 6 months. The immunosuppressed state results in a less robust
immune response, and those with such conditions are at risk of persistent HPV infection and
associated HPV disease if they become infected.
 Currently, routine HPV testing is not recommended before or after immunization. In addition,
serologic tests are not routinely available in Canada.
 Females who are immunocompromised, either from disease or medication, can receive this
vaccine; however, the immune response to vaccination and vaccine efficacy might be less
than in immunocompetent females.
 Gardasil™ vaccine can be administered at the same visit as other age-appropriate vaccines,
using a separate needle and syringe for each injection.
 If the schedule is interrupted, the vaccine series does not need to be restarted. If the series
is interrupted after any dose, the subsequent dose should be given as soon as possible. The
minimum interval schedule between dose one and dose two is 4 weeks, and between dose
two and dose three is 12 weeks The minimum interval schedule should not be followed on a
routine basis; it should only be used at the client – specific level based on health care
provider assessment. The preferred schedule is 0 – 2 – 6 months.
 In some areas in Canada a 0-6-12 month dosing schedule was used to accommodate
pandemic influenza mass immunization. General principles for vaccine series are that longer
intervals between doses are not known to result in lower response rates to the series.
 Advise vaccine recipients that there are no data to suggest the vaccine will have any
therapeutic effect on existing cervical lesions (i.e., vaccine does not prevent the
consequences of current HPV infection).
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 23
Seasonal Trivalent Influenza Vaccine (Inactivated Split Virion or Subunit)
Recommended and provided free to all Yukoners.
Special attention should be given to encourage immunization in these high risk groups:
(1) People at high risk:
 People ≥ 65 years of age
 People of any age who are residents of long-term care facilities
 Adults (including pregnant women) and children with the following chronic health conditions:
- Cardiac or pulmonary disorders (e.g., bronchopulmonary dysplasia, cystic fibrosis, asthma)
- Diabetes and other metabolic diseases
- Cancer; immunodeficiency (including human immunodeficiency virus [HIV] infection); immunosuppression
due to underlying disease or therapy (e.g., severe rheumatoid arthritis requiring immunosuppressive
therapies)
- Chronic kidney disease
- Chronic liver disease, including hepatitis C
- Anemia and hemoglobinopathy
- Conditions that compromise the management of respiratory secretions and are associated with an
increased risk of aspiration (e.g., cognitive dysfunction, spinal cord injury, seizure disorder, and
neuromuscular disorders)
 Children and adolescents (age 6 months to 18 years) with conditions treated for long periods with
acetylsalicylic acid
 Adults who are morbidly obese (BMI ≥40)
 Aboriginal peoples (on and off reserve) for the 2010 – 2011 influenza season
 Healthy children age 6 to 23 months 
 Pregnant women. Especially those who will be in their 3rd trimester during the influenza season
(typically spanning November to April)
 Inmates of provincial correctional institutions
 People working with live poultry (Immunization may reduce the potential for human-avian
reassortment of genes should such workers become coinfected with human and avian influenza.)
(2) People capable of transmitting influenza to those at high risk:
 Healthcare workers (HCW) and other personnel who have significant contact with people in the high-risk
groups previously described  The HCW groups include independent health care practitioners and their staff
in community settings.
 Household contacts (including children) of people at high risk whether or not those high-risk people have
been immunized
 Those who provide care or service in potential outbreak settings housing high risk persons (e.g., crew on
ships)
 Household contacts of children age 0 to 23 months
 Those providing regular child care to children age 0 to 23 months, whether in or out of the home
(3) People who provide essential community services:
 First responders: police, fire fighters, ambulance
 Corrections Officers
 Large cohort studies of health databases have demonstrated that there is no association between childhood vaccination with thimerosal-containing vaccines and neurodevelopmental outcomes, including
autistic-spectrum disorders.
 This includes persons carrying out paid or unpaid work in a health care facility; including persons who
volunteer or undergo training in a health care facility for any period of time between November and April.
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 24
Influenza Vaccine (Inactivated Split Virion) (FLUVIRAL)
Supplier: GlaxoSmithKline Inc.
INDICATIONS
See Seasonal Trivalent Influenza Vaccine
DOSE BY AGE GROUP
Age Group
Dosage
No. Of Doses
6-35 months
0.25 ml IM
1 or 2 
3-8 years
0.5 ml IM
1 or 2 
 9 years
0.5 ml IM
1
REVACCINATIONS
Yearly
CONTRAINDICATIONS
1.
PRECAUTIONS
VACCINE
COMPONENTS
ADVERSE EVENTS
SPECIAL
CONSIDERATIONS
History of anaphylactic reaction to a previous dose of any type of
influenza vaccine
2. History of anaphylactic reaction to any component of
FLUVIRAL
3. History of anaphylactic reaction to eggs
4. History of Guillain-Barré syndrome (GBS) within 8 weeks of
receipt of a previous dose of influenza vaccine
5. Infants less than 6 months of age
Severe oculo-respiratory syndrome (ORS) after a previous dose of
influenza vaccine.
Egg protein, formaldehyde, thimerosal (50 μg per 0.5 mL, = 0.01% w/v),
sodium deoxycholate

Transient injection site reactions

Fever, malaise, myalgia, and fatigue 6-12 hours following
vaccination and lasting ~1 - 2 days, especially in individuals
receiving influenza vaccine for the 1st time

About 1 in 20 people may have cough, sore throat, hoarseness
or red eyes, sometimes called “oculo-respiratory syndrome.”

Generalized itching may occur, but is uncommon.
Discard multi-dose vials 28 days after first entry.
 Children under 9 years of age who have not previously received seasonal trivalent influenza vaccine
require 2 doses given 4 weeks apart. This applies regardless of whether the child received monovalent
pH1N1 vaccine in 2009-10. If the child has received one or more doses of seasonal trivalent influenza
vaccine in any previous season, only a single dose is required this season.
ORS consists of bilateral red eyes or facial swelling or respiratory symptoms such as cough, wheeze,
sore throat, chest tightness, difficulty breathing, difficulty swallowing, hoarseness, or sore throat beginning
within 24 hours of vaccination. Most people who have had ORS after a previous dose of influenza vaccine
do not experience it again. About 5 - 34% experience another episode but it is usually milder. If a client
has received influenza vaccine without difficulty following an episode of severe ORS, they may be
revaccinated with the vaccine prepared for this season.
Severe symptoms of ORS include wheezing, chest tightness/discomfort, difficulty breathing or severe
throat constriction/difficulty swallowing. When a client has had severe ORS following influenza vaccine and
not received influenza vaccine since, this is considered to be a precaution to future receipt of influenza
vaccine. Such individuals who wish to receive influenza vaccine should consult with their primary care
physician and MOH for an expert review to distinguish between severe ORS and any anaphylaxis risk.
Consult the National Advisory Committee on Immunization Statement on Influenza Vaccination for the
current season.
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 25
Japanese Encephalitis Vaccine (IXIARO)
Supplier: Novartis
INDICATIONS 
(1) Those ≥ 18 years of age who
are traveling to endemic regions
INITIAL SERIES
(1) 1st Dose: 0.5 mL IM deltoid
Day- 0
2nd Dose: 0.5 mL IM deltoid
Day-28
series needs to be completed at least one week before travel to
the high risk area
REINFORCEMENTS
None at this time
CONTRAINDICATIONS

VACCINE COMPONENTS
ADVERSE EVENTS
hypersensitive to Ixiaro or to any ingredient in the
formulation or component of the container. Individuals
who show hypersensitivity reactions after receiving the
first dose of the vaccine should not be given the
second dose
 individuals with the following conditions should be
considered as relative contraindications and thorough
assessment should be undertaken including risks and
benefits. Consider discussion with the clients physician
and/or MOH
- Pregnant or breastfeeding women
- Persons with a bleeding disorder
- Immunosuppressed persons due to disease or
therapy
 < 18 years of age
Adjuvant/Preservative: aluminum hydroxide
Others: sodium chloride, potassium dihydrogen
phosphate, disodium hydrogen phosphate.
Local: injection site pain, erythema, hardening, swelling
and itching
Systemic: myalgia, vertigo,fever, headache, rash.
G.I: nausea, diarrhea and vomiting
 allergic reactions usually occur within 3 days but some
reactions can occur up to 10 days after getting the
vaccine; for this reason counsel clients that they are
not to travel to another country for 10 days after you
receive the vaccine due to the possibly of delayed
reactions.
 See Section 5, Immunization of Special Populations, International Travelers.
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 26
Measles/Mumps/Rubella Vaccine (Live Attenuated Viral) MMRII & Priorix
Suppliers: Merck Frosst, MMRII ; GlaxoSmithKline, Priorix
INDICATIONS
INITIAL SERIES
(1)
Infants at 12 months of age
(1)
Dose 1: 0.5 ml SC 
Dose 2: 0.5 ml SC at
18 months of age 
(2)
Adult HSCT recipients
(2)
Dose 1: 0.5 ml SC 
Dose 2: 0.5 ml SC
(6 – 12 months later) 
(3)
Infants from 6 months but 12 months of age, if
travelling to endemic areas
(3)
One dose of 0.5 ml SC
(upon return, give 2
additional doses at routine
times)
(4)
All individuals who require protection against
measles, mumps, OR rubella 
(4)
Dose 1: 0.5 ml SC 
Dose 2: 0.5 ml SC 
(1 month later)
CONTRAINDICATIONS
1. History of anaphylactic reaction to a previous dose of a measles/mumps/rubella-containing
vaccine, to any component of MMRII or Priorix, or to latex when administering Priorix
with the pre-filled syringe (latex is present in the pre-filled syringe of diluent for Priorix).
2. Consult the appropriate physician (i.e., either the primary care physician most familiar with the
client’s current medical status or a medical specialist) and consult the Vaccine Program
Manager or MOH prior to administration to persons whose immune status may be suppressed
as the result of disease or therapy.
3. Pregnancy. Counsel female recipients to avoid pregnancy for 1 month following
immunization. Risk is theoretical and not observed. Inadvertent immunization during
pregnancy is not considered a medical indication for therapeutic abortion.
4. Recent administration of an immune globulin preparation or blood product (see CIG, 2006,
Recent Administration of Human Immune Globulin Products, http://www.phacaspc.gc.ca/publicat/cig-gci/pdf/cig-gci-2006-part-5_e.pdf)
5. Physician-diagnosed significant thrombocytopenia after first dose of a MMR vaccine.
6. For high risk/immunocompromised clients only: separate the administration of MMR and
varicella vaccine by least 4 weeks.
7. Family history of congenital immunodeficiency. See Yukon Immunization Program Manual,
Section 4, Contraindications and Routine Precautions for Immunization.
VACCINE COMPONENTS
Components of MMRII are neomycin, sorbitol, sucrose, sodium
phosphate, human albumin, fetal bovine serum, and hydrolyzed
gelatin.
Components of Priorix are neomycin sulphate, lactose, amino
acids, human albumin, mannitol, and sorbitol.
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 27
Measles/Mumps/Rubella Vaccine (Live Attenuated Viral) MMRII & Priorix
Suppliers: Merck Frosst, MMRII ; GlaxoSmithKline, Priorix
PRECAUTIONS
 Measles/mumps/rubella immunization should be given on the same day
or delayed until 4 weeks after administration of any other live vaccine.
 Anti-Rho (D) / Rho (D) immune globulin may interfere with response to
the rubella component of the vaccine. Rubella-susceptible women who
receive anti-Rho(D) / Rho (D) immune globulin post-partum should
either be given MMR vaccine at the same time and tested 2 months later
for rubella immunity, or should be immunized with MMR vaccine 2
months post-partum, with follow-up ensured.
 Do TB skin testing on the same day as MMR immunization, or delay TB
skin testing for  4 weeks.
ADVERSE EVENTS
Local - Tenderness, redness, swelling, induration, wheal and flare reaction,
urticaria
Systemic – Moderate fever, rash, malaise, headache, and nausea, myalgia,
and paraesthesia; thrombocytopenia; encephalitis. Acute transient arthritis or
arthralgia is uncommon in children, but frequency and severity increases with
age. 25% of post-pubertal females may experience arthralgia, and 10% may
have transient arthritis-like signs and symptoms.
SPECIAL
Consult the appropriate physician (i.e., either the primary care physician most
CONSIDERATIONS
familiar with the client’s current medical status or a medical specialist)
regarding the appropriateness of MMR vaccine administration to persons
whose immune status may be suppressed as the result of disease or
therapy(e.g., chronic renal disease / dialysis; HIV/AIDs (if no significant
compromise); solid organ transplant candidate; hyposplenia/asplenia; ≥ 3
months after being cured of a malignant disease and the end of
immunosuppressive treatment; and high doses of oral corticosteroid therapy)
 Administer the entire volume of reconstituted product, which may be 0.5 – 0.7 ml
 2nd dose must be given at least 1 month after 1st dose. Second dose is provided for protection against
measles and, for some age groups, mumps.
 Wait at least 24 months after ablative therapy before administering MMR and then only if the recipient is
deemed to be immunocompetent by the transplant specialist. MMR should not be given to those with chronic
graft-versus-host disease (GVHD) or those taking immunosuppressive therapy for chronic GVHD. Consult the
Vaccine Program Manager prior to immunization for this indication.
 Those born prior to 1957 are considered to have acquired natural immunity to measles, mumps, and rubella, if
not in a high risk group ONLY.
 All those borne on or after January 1, 1970 require documentation of 2 doses of a live MMR vaccine at ≥12
months of age and given at least 4 weeks apart. DOB prior to 1970 assumes immunity to measles and mumps,
with the exception of those at high risk including: HCWs, travellers to endemic areas, military recruits and
students attending a post secondary institution. In this population additional assessments are required. See
Mumps Measles and Rubella Algorithm Determining Immunity/Vaccination Requirements of Adult, on following
page.
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 28
Mumps, Measles and Rubella Algorithm
Determining Immunity/Vaccination Requirements of Adults
Born Before 1970
(DOB 1900-1969)
Asses risk status 
Not at
high risk
Documented 1
dose of rubella
containing
vaccine and/or
history of
disease 
Consider
immune to
mumps,
measles &
rubella
At high
risk
Assessment of
immune status
required 
Born After 1970
(DOB 1970-present)
Assessment of Immunization Status
Documented 2
doses of MMR
vaccine
Documented 1
dose of MMR
vaccine
Give 1 dose of MMR
vaccine
No documentation of
previous doses of
MMR vaccine
Check serology for
measles, mumps and
rubella AND Give 1
dose of MMR vaccine
Box A
Measles: Lab
evidence of immunity
(IgG positive) or,
After 2
documented
MMR 
vaccines no
further
vaccination
is warranted
regardless of
serology
history of lab-confirmed
disease
AND
Mumps: labconfirmed infection
AND
Rubella: Lab evidence
of immunity (IgG>10
IU/mL) or,
lab evidence of acute
infection (IgM) 
Consider immune to mumps,
measles & rubella
Negative or
indeterminate
status in ANY one
of the following:
Measles, Mumps,
or Rubella - as
defined in Box A
Consider non
immune
Give 2nd dose of
MMR vaccine
 A birth date prior to 1970 is not definitive for immunity against mumps or measles. Further assessment is required
if the client is in a high risk group including: travelers to endemic areas, health care workers, military recruits,
students at post-secondary institutions.
 Additional assessment may include history of disease, exposure to clinical illness after exposure to a confirmed
case, clinical history of illness in conjunction with serology and assessment of immunization status.
 MMR vaccine must be given ≥ 12 months of age at least 4 weeks apart
 If current screening results are “indeterminate”, with a documented prior history of Rubella “immune”
(IgG>10IU/mL) client is considered immune to rubella.
 If DOB prior to 1957, assume immunity to mumps, measles and rubella. If not at high risk ONLY.
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 29
Meningococcal C Conjugate (MCC) Vaccine (Neis Vac-C®)
Supplier: GlaxoSmithKline
INDICATIONS
INITIAL SERIES
(1) Two-dose program for infants
(1) Dose 1: 0.5 ml IM at 2 months of age or age at
presentation. (When age of presentation is 12
months, one dose only is required.)
Dose 2: 0.5 ml IM at  12 months of age (at
least 2 months after 1st dose)
(2) Children not previously vaccinated or
who received their last dose of any
MCC vaccine when they were less
than 12 months of age
(2) One dose: 0.5 ml IM at  12 months of age 
(3) Medically high risk children  2 months
to < 12 months of age
(4) Close contacts of a case of invasive
meningococcal group C disease that
meet the criteria for
chemoprophylaxis who have NOT
been previously vaccinated with MCC
vaccine as directed by YCDC
(5) Medically high risk children 2 – 10
years of age who have NOT been
previously vaccinated with any MCC
vaccine
(3) & (4) Age at presentation:
 2 months to < 12 months of age:
Dose 1: 0.5 ml IM
Dose 2: 0.5 ml IM at least 2 months after 1st dose
Dose 3: 0.5 ml IM at  12 months of age (at least 2
months after 2nd dose)
 12 months of age (any MCC vaccine may be
used):
One dose: 0.5 ml IM 
(5) One dose: 0.5 ml IM 
(6) Children up to 19 years of age who
are previously unimmunized.
(6) One dose: 0.5 ml IM
(7) Grade 6 students starting 2011-2012
school year
(7), (8) & (9) One dose: 0.5 ml IM 
(8) Grade 9 students in 2011/2012,
2012/2013 & 2013/2014 school
years
(9) Students attending post secondary
education outside of YT not previously
immunized.
CONTRAINDICATIONS
VACCINE COMPONENTS
History of anaphylactic reaction to a previous dose
of any meningococcal vaccine or to any
component of Neis Vac-C vaccine.
Aluminum hydroxide, tetanus toxoid
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 30
Meningococcal C Conjugate (MCC) Vaccine (Neis Vac-C®)
Supplier: GlaxoSmithKline
ADVERSE EVENTS
All: redness, swelling and pain at injection site;
headache, fever
Infants and toddlers: crying, irritability,
drowsiness, somnolence/impaired sleeping
Infants: vomiting/nausea/diarrhea/loss of appetite
SPECIAL CONSIDERATIONS
Upon storage, a white deposit and clear
supernatant can be observed. Shake the vaccine
well in order to obtain a homogenous suspension.
 There must be an interval of at least 6 months since the prior administration of a
meningococcal polysaccharide vaccine and the administration of Neis Vac-C.
 Meningococcal C conjugate vaccines are interchangeable for those  12 months of age.
 If an infant has a history of receiving their last dose before 12 months of age, give an
additional dose at  12 months of age.
 Administer concurrently with chemoprophylaxis or as soon as possible.
 A MCC vaccine is preferred in this situation as it provides longer duration of protection and
induction of immunologic memory than does a meningococcal C-containing polysaccharide
vaccine and is less expensive than Menactra.
 See Meningococcal Quadrivalent Conjugate Vaccine (Menactra) for list of medical
indications. Medically high risk children < 2 yrs old: give MCC 1st, followed by Menactra
after 2nd birthday. Medically high risk children 2 yrs to 10 years of age (inclusive): give
Menactra first, followed by MCC vaccine one month later.
 A grade 6 or 9 student is considered up-to-date for MCC vaccine if they have a dose of
MCC vaccine on or after their 10th birthday. The interval between MCC doses is a
minimum of 8 weeks.
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 31
Meningococcal Quadrivalent Conjugate Vaccine (Menactra)
(Groups A, C, Y, W-135)
Supplier: sanofi pasteur
INDICATIONS
(1) Provided free to medically high risk individuals  2 years of age:
 Functional or anatomic asplenia 
 Congenital immunodeficiency states (e.g., complement, properdin or factor D deficiency, primary antibody
deficiencies)
 Hematopoietic Stem Cell Transplant
 Solid organ transplant (candidate or recipient)
 Islet cell transplant (candidate or recipient)
Refer to Yukon Immunization Program Manual, Section 5, for more information on specific medical
conditions.
Note: Children 2 – 10 years of age (inclusive) with a medical indication (as specified above) who have NOT
been previously vaccinated with MCC vaccine:
 Administer Menactra followed by MCC vaccine one month later 
(2) Close contacts (  2 years of age) of a case of invasive meningococcal disease (serogroups A, Y, or
W-135) that meet the public health criteria for chemoprophylaxis 
(3) Individuals who have previously been vaccinated with Menomune and for whom there is a need
for re-vaccination due to:
 high risk medical status
 continuing outbreak exposure, or
 expected ongoing exposure during travel
Administer Menactra as follows:
First dose of Menomune
(polysaccharide A/C/Y/W-135) received at:
 3 – 12 months of age
 13 – 23 months of age
 2 – 5 years of age
  6 years of age
Immunize with Menactra when  2 years of age
and it is:
6 months since last dose of Menomune
1 year since last dose of Menomune
2 years since last dose of Menomune
5 years since last dose of Menomune
(4) Recommended, but NOT provided free to:
 research, industrial, and clinical laboratory personnel who are routinely exposed to N. meningitidis
 military recruits
 travellers for whom meningococcal vaccine is indicated
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 32
Meningococcal Quadrivalent Conjugate Vaccine (Menactra)
(Groups A, C, Y, W-135)
Supplier: sanofi pasteur
DOSE
Persons  2 years of age: One dose: 0.5 ml IM
REINFORCEMENTS
 Medically high risk persons: (dose: 0.5 ml IM)
 First dose received at ≥ 7 years of age: give 5 years after 1st dose
 First dose received at ages 2 – 6 years: give 3 years after 1st dose
 Thereafter, re-immunize every 5 years as long as medical condition exists.
SPECIAL CONSIDERATIONS
If a Grade 6 or 9 child received Menactra when they were 2 – 10 years of age, and have not
received a dose of MCC vaccine on or after their 10th birthday, administer MCC vaccine.
CONTRAINDICATIONS
(1)
(2)
Known history of Guillain-Barré syndrome (GBS).
History of anaphylactic reaction to a previous dose of any meningococcal or diphtheriacontaining vaccine, to any component of Menactra or to latex (if using the vial
presentation). The pre-filled syringe presentation does not contain latex.
VACCINE COMPONENTS
Sodium phosphate, dibasic, anhydrous; sodium phosphate, monobasic.
ADVERSE EVENTS
Local pain, redness, swelling, headache, malaise, chills, fever.
 Give vaccine at least 14 days prior to elective splenectomy, or if not possible, 14 or more
days post-splenectomy. When there is concern that the patient may not present later for
immunization, give vaccine before discharge.
 The recommended interval between the administration of any meningococcal C conjugate
vaccine and Menactra is one month (regardless of which vaccine was given first).
 Administer vaccine concurrently with chemoprophylaxis or as soon as possible.
 Any prior history of GBS is a relative contraindication to Menactra vaccine. Immunization
may be considered if the benefit of vaccination outweighs the potential risk of recurrence of
GBS if the vaccine is given. Discuss with the Vaccine Program Manager/ MOH.
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 33
Pneumococcal Conjugate Vaccine (Prevnar®13)
Supplier: Wyeth, a Pfizer Company
INDICATIONS
(1) Healthy infants and children 2 to 59 months of age to
start or complete a pneumococcal conjugate vaccine
series
INITIAL SERIES
(1) Healthy children:
(2) Children 2 months to 59 months of age who are at
high risk of pneumococcal disease due to: 
 Sickle cell disease and other hemoglobinopathies
 Immunosuppression related to disease [e.g., malignant
neoplasm (including leukemia and lymphoma); HIV;
multiple myeloma] or therapy (e.g., high dose, systemic
steroids or severe rheumatoid arthritis requiring
immunosuppressive therapy)
 Congenital immunodeficiencies involving any part of the
immune system, including B-lymphocyte (humoral)
immunity, T-lymphocyte (cell-mediated) immunity,
complement system (properdin or factor D deficiencies)
or phagocytic function.
 Receipt of hematopoietic stem cell transplant (HSCT)
 Solid organ or islet cell transplant (candidate or recipient)
 Chronic heart or lung disease (except asthma, unless
management involves ongoing high dose oral
corticosteroid therapy)
 Chronic liver disease including cirrhosis, chronic hepatitis
B, chronic hepatitis C
 Chronic kidney disease
 Diabetes, cystic fibrosis or chronic CSF leak
 Chronic neurological conditions that may impair
clearance of oral secretions
 Cochlear implant (candidate or recipient)
 Anatomic or functional asplenia (children up to and
including 16 years of age) 
(2) Children medically at high risk:
(3) All children to 59 months of age and asplenics ≤ 16
years of age who have completed a PVC 7 or PCV 10
vaccine series
Dose 1: 2 months of age: 0.5 ml IM
Dose 2: 4 months of age: 0.5 ml IM
Dose 3:  12 months of age: 0.5 ml IM
(at least 8 weeks after second dose).
Dose 1: 2 months of age: 0.5 ml IM
Dose 2: 4 months of age: 0.5 ml IM
Dose 3: 6 months of age: 0.5 ml IM
Dose 4:  12 months of age: 0.5 ml IM
(at least 8 weeks after third dose)
(3) One dose 0.5 ml IM at least 8
weeks after a previous PCV7 or PCV10
dose
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 34
Pneumococcal Conjugate Vaccine (Prevnar®13)
Supplier: Wyeth, a Pfizer Company
CONTRAINDICATIONS
VACCINE COMPONENTS
ADVERSE EVENTS
History of an anaphylactic reaction to a previous dose of
any pneumococcal vaccine, or to any component of
Prevnar®13.
Diphtheria toxoid, succinic acid, polysorbate 80, aluminum
phosphate
Redness, swelling, tenderness at injection site; fever,
irritability, drowsiness, restless sleep, decreased appetite,
vomiting, diarrhea
 High risk children should receive one dose of pneumococcal polysaccharide vaccine at 2 years
of age, and at least 8 weeks after the final dose of pneumococcal conjugate vaccine.
 Unimmunized asplenics identified at 5-16 years of age require two doses of vaccine, 8 weeks
apart. Give vaccine at least 14 days prior to elective splenectomy, or, if not possible 14 days
post-splenectomy. If there is concern that the patient may not present later for immunization,
give at hospital discharge.
 Give vaccine before initiation of immunosuppression therapy, and early in the course of HIV
infection. If HIV positive contact YCDC, for most recent CD4 counts.
 A complete series for a child is:
 three (PVC7 or PCV10) primary doses given at appropriate intervals and a 4th dose given on
or after 12 months of age and at least 8 weeks after previous dose, or
 a delayed or interrupted schedule that has been completed at a later age according to the
information in table “Completing a Pneumococcal Conjugate Vaccine Series.”
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 35
Completing a Pneumococcal Conjugate Vaccine Series
Age at presentation
for immunization
History of prior doses of
PCV7, PCV10 or PCV13
given
3 to 11 months
12 to 23 months






Completion of series
requires
Booster dose
Healthy and
High Risk 
Healthy
Infant
High Risk
Infant

0 doses
2 doses
3 doses
1 dose
1 dose
2 doses 
2 doses
0 doses
1 dose 
0 doses
2 doses 
2 doses 
No booster dose
1 dose < 12 months
2 doses 
2 doses 
No booster dose
1 dose ≥ 12 months
1 dose 
1 dose 
No booster dose
One dose at 12
months of age
2 doses < 12 mos.
1 dose
2 doses  No booster dose
1 dose < 12 mos. &
1 dose 
1 doses  No booster dose
1 dose ≥ 12 mos
24 to 59 months
0 doses
1 dose
1 dose
No booster dose
Any age- appropriate
series incomplete by 24
1 dose 
1 dose 
No booster dose
months
Complete PCV7 or PCV10
1 doses 
1 dose 
No booster dose
series 
When an infant has received one or two doses of vaccine, and is subsequently diagnosed with
a high risk medical condition, use the table to complete the immunizations as “high risk.” When
a high risk condition is diagnosed after an infant has completed the 3 dose schedule for healthy
children, further immunization will be determined on a case-by-case basis.
High risk children should receive one dose of pneumococcal polysaccharide vaccine at 2 years
of age, and at least 8 weeks after their final pneumococcal conjugate vaccine dose.
When there is a delay in initiating or completing the vaccine series, use the minimum interval of
4 weeks between vaccine doses given in infancy. See Section 3 Immunization Schedules, 3.0
Minimum Intervals between Vaccine Doses.
At least 8 weeks after the previous dose.
8 weeks between doses.
A complete series is:
 three (PVC7 or PCV10) primary doses given at appropriate intervals and a 4th dose given on
or after 12 months of age and at least 8 weeks after previous dose, or
 a delayed or interrupted schedule that has been completed at a later age according to the
information in this table.
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 36
Recommendations for Pneumococcal Immunization With 13-Valent Pneumococcal
Conjugate Vaccine (PCV 13) and 23-Valent Pneumococcal Polysaccharide Vaccine
(PPV 23) for Children at High Risk of Pneumococcal Disease
Age:
Previous doses
PCV 13
Recommendations: 
 23 months
None
PCV 13 as per primary series schedule 
24 to 59 months
None
2 doses of PCV 13, followed by one dose of PPV 23, 8
weeks after the dose of PCV 13.
Once-only revaccination with PPV 23, 3 years after the
first dose of PPV 23 
2 doses of PCV 13, followed by one dose of PPV 23, 8
weeks after the dose of PCV 13.
Once-only revaccination with PPV 23, 3 years after the
first dose of PPV 23 
One dose of PPV 23 at 24 months of age, 
Once-only revaccination with PPV 23, 3 years after the
first dose of PPV 23 
Two doses of PCV 13, 8 weeks apart, and 8 weeks
after the administration of PPV 23.
Once-only revaccination with PPV 23, 3 years after the
first dose of PPV 23 
≤ 2 doses PCV13
before 24 months
PCV 13 series
completed
One dose of
PPV 23





For list of children at high-risk for pneumococcal disease, see Pneumococcal
Conjugate Vaccine (Prevnar®13)
PPV 23 is provided free for high risk children.
Children who have completed a PCV13 vaccine series before they are 2 years of
age, and who are among the high risk groups for pneumococcal disease, should
receive one dose of pneumococcal polysaccharide vaccine at 2 years of age, no
sooner than 8 weeks after the last dose of PCV 13.
If high risk children  2 years of age received pneumococcal polysaccharide vaccine
first, offer pneumococcal conjugate vaccine at least 8 weeks after the polysaccharide
vaccine.
For list of high-risk conditions for which revaccination with PPV23 is recommended,
see Pneumococcal Polysaccharide Vaccine (Pneumo 23).
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 37
Pneumococcal Polysaccharide Vaccine (Pneumovax 23)
Supplier: Merck Frosst
Recommended and provided free to:
INDICATIONS
All persons  65 years of age
All residents of Extended or Intermediate Care Facilities
INITIAL SERIES
REINFORCEMENT
All persons  2 years of age with:
 Anatomic or functional asplenia 
 Sickle cell disease
 Immunosuppression related to disease (e.g., malignant neoplasm
(including leukemia and lymphoma); HIV; multiple myeloma)  or
therapy (e.g., high dose, systemic steroids or severe rheumatoid
arthritis requiring immunosuppressive therapy)
 Congenital immunodeficiency states (e.g., complement, properdin or
factor D deficiency)
 Chronic heart or lung disease
 Chronic kidney disease
 Chronic liver disease including cirrhosis, chronic Hepatitis B, Hepatitis C
 Receipt of hematopoietic stem cell transplant (HSCT)
 Solid organ or islet cell transplant (candidate or recipient)
 Diabetes
 Alcoholism
 Cystic fibrosis
 Chronic CSF leak
 Cochlear implant (candidate or recipient)
 Homelessness and/or illicit drug use
 Smokers
Adults and children  2 years of age:
1 dose: 0.5 ml SC or IM 
HSCT Recipients ≥ 2 years of age:
2 doses: 0.5 ml SC or IM 7 months apart (See Section 6, Immunization of
special populations)
Revaccination is not routinely recommended.
A once-only revaccination should be offered to those who have:

Anatomic or functional asplenia

Sickle cell disease

Immunosuppression related to disease (e.g., HIV, lymphoma, Hodgkin’s,
multiple myeloma, severe rheumatoid arthritis), or therapy (e.g., high dose,
systemic steroids)

Congenital immunodeficiency states (as above)

Chronic kidney disease

Chronic liver disease including cirrhosis, chronic hepatitis B, and chronic
hepatitis C
For individuals 10 years old at time of initial vaccination:

1 dose of 0.5 ml SC or IM 5 years after the initial immunization.
For children  10 years old at time of initial vaccination:

1 dose of 0.5 ml SC or IM 3 years after the initial immunization.
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 38
Pneumococcal Polysaccharide Vaccine (Pneumovax 23)
Supplier: Merck Frosst
CONTRAINDICATIONS
VACCINE
COMPONENTS
PRECAUTIONS
History of an anaphylactic reaction to a previous dose of a
pneumococcal vaccine or to any component of Pneumovax 23™
vaccine
Phenol, monosodium and disodium phosphate
 Adverse reaction may intensify if revaccination occurs within 2 years
 Do not administer Pneumovax23 and ZOSTAVAX at the same
time due to the possibility of an inferior immune response to
ZOSTAVAX. Separate these vaccines by 4 weeks.
 Hodgkin’s Disease:
 Do not administer to clients with Hodgkin’s disease less than 10
days prior to or during immunosuppressive therapy.
 Following intense chemotherapy with or without radiation, the
immune response may be depressed for 2 years. During the 2
years following completion of treatment, the antibody response
may improve as the interval between treatment and
pneumococcal vaccination increases.
ADVERSE EVENTS
Local: Soreness and erythema; rarely severe arthus reaction
Systemic: Occasionally low grade fever
 Give vaccine at least 14 days before splenectomy, or, if not possible 14 days post-splenectomy.
If there is concern that the patient may not present later for immunization, give at hospital
discharge.
 Give vaccine before initiation of immunosuppression therapy, and early in the course of HIV
infection. Contact YCDC for most recent CD4 counts prior to immunization.
 Except asthma, unless management involves ongoing high dose oral corticosteroids
 Homelessness to be defined by local jurisdiction.
 Crack cocaine smokers have been shown to be at increased risk of invasive pneumococcal
disease.
 Pneumococcal polysaccharide vaccine can be given simultaneously with influenza, Hib, and
meningococcal vaccines, using separate syringes/needles at separate sites.
 Children who are among the high risk groups for pneumococcal disease and who have
completed the PCV vaccine series before they are 2 years of age, should receive one dose of
pneumococcal polysaccharide vaccine at 2 years of age, no sooner than 8 weeks after the last
dose of PCV. If high risk children  2 years of age received pneumococcal polysaccharide
vaccine first, offer pneumococcal conjugate vaccine at least 8 weeks after the polysaccharide
vaccine.
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 39
Pneumococcal Polysaccharide Vaccine (Pneumo 23)
Supplier: sanofi pasteur
INDICATIONS
Recommended and provided free to:
All persons  65 years of age.
All residents of Extended or Intermediate Care Facilities
INITIAL SERIES
REINFORCEMENT
All persons  2 years of age with:

Anatomic or functional asplenia 

Sickle cell disease

Immunosuppression related to disease [e.g., malignant neoplasm
(including leukemia and lymphoma); HIV; multiple myeloma)  or
therapy (e.g., high dose, systemic steroids or severe rheumatoid arthritis
requiring immunosuppressive therapy)

Congenital immunodeficiency states (e.g., complement, properdin or
factor D deficiency)

Chronic heart or lung disease 

Chronic kidney disease

Chronic liver disease including cirrhosis, chronic Hepatitis B, Hepatitis C

Receipt of hematopoietic stem cell transplant (HSCT)

Solid organ or islet cell transplant (candidate or recipient)

Diabetes

Alcoholism

Cystic fibrosis

Chronic CSF leak

Cochlear implant (candidate or recipient)

Homelessness and/or illicit drug use 

Smokers
Adults and children  2 years of age:
1 dose: 0.5 ml SC or IM 
HSCT Recipients ≥ 2 years of age:
2 doses: 0.5 ml SC or IM 7 months apart (See Section 6, Immunization of
special populations)
Revaccination is not routinely recommended.
A once-only revaccination should be offered to those who have:

Anatomic or functional asplenia

Sickle cell disease

Immunosuppression related to disease (e.g., HIV, lymphoma, Hodgkin’s,
multiple myeloma, severe rheumatoid arthritis), or therapy (e.g., high
dose, systemic steroids)

Congenital immunodeficiency states (as above)

Chronic kidney disease

Chronic liver disease including cirrhosis, chronic hepatitis B, and chronic
hepatitis C
For individuals 10 years old at time of initial vaccination:

1 dose of 0.5 ml SC or IM 5 years after the initial immunization.
For children  10 years old at time of initial vaccination:

1 dose of 0.5 ml SC or IM 3 years after the initial immunization.
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 40
Pneumococcal Polysaccharide Vaccine (Pneumo 23)
Supplier: sanofi pasteur
CONTRAINDICATIONS History of an anaphylactic reaction to a previous dose of a
pneumococcal vaccine or to any component of Pneumo 23™
vaccine
VACCINE
Phenol, monosodium and disodium phosphate
COMPONENTS
PRECAUTIONS
 Adverse reaction may intensify if revaccination occurs within 2
years
 Do not administer Pneumo23™ and ZOSTAVAX at the same
time due to the possibility of an inferior immune response to
ZOSTAVAX. Separate these vaccines by 4 weeks.
 Hodgkin’s disease:
 Do not administer to clients with Hodgkin’s disease less
than 10 days prior to or during immunosuppressive therapy.
 Following intense chemotherapy with or without radiation,
the immune response may be depressed for 2 years. During
the 2 years following completion of treatment, the antibody
response may improve as the interval between treatment
and pneumococcal vaccination increases.
ADVERSE EVENTS
Local: Soreness and erythema; rarely severe arthus reaction
Systemic: Occasionally low grade fever
 Give vaccine at least 14 days before elective splenectomy, or, if not possible 14 days
post-splenectomy. If there is concern that the patient may not present later for
immunization, give at hospital discharge.
 Give vaccine before initiation of immunosuppression therapy, and early in the course of
HIV infection. Contact YCDC for most recent CD4 counts prior to immunization.
 Except asthma, unless management involves ongoing high dose oral corticosteroid
therapy.
 Homelessness to be defined by local jurisdiction.
 Crack cocaine smokers have been shown to be at increased risk of invasive
pneumococcal disease.
 Pneumococcal polysaccharide vaccine can be given simultaneously with influenza, Hib,
and meningococcal vaccines, using separate syringes/needles at separate sites.
 Children who are among the high risk groups for pneumococcal disease and who have
completed the PCV vaccine series before they are 2 years of age, should receive one
dose of pneumococcal polysaccharide vaccine at 2 years of age, no sooner than 8 weeks
after the last dose of PCV. If high risk children  2 years of age received pneumococcal
polysaccharide vaccine first, offer pneumococcal conjugate vaccine at least 8 weeks after
the polysaccharide vaccine.
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 41
Polio Vaccine (Inactivated) (Imovax ®Polio) (vero cell origin)
Supplier: sanofi pasteur
INDICATIONS
Provided free to:
1) Infants and children  4 years of
age who do not require diphtheria,
pertussis, tetanus, or Hib.
INITIAL SERIES
(1) Infants and children < 4 years of age:
Dose 1: 0.5 ml SC
Dose 2: 0.5 ml SC give 4 to 8 weeks after dose 1
Dose 3: 0.5 ml SC give 6-12 months after dose 2
Dose 4: 0.5 ml SC at school entry (this dose not
necessary if dose 3 was given on or after the 4th birthday)
(2) Children  7 years and ≤ 17
years of age who do require polio
immunization 
(2) Individuals  4 years of age:
Dose 1: 0.5 ml SC
Dose 2: 0.5 ml SC give 4 to 8 weeks after dose 1
Dose 3: 0.5 ml SC give 6-12 months after dose 2
Note: Give 1 dose 0.5 ml SC to children  7 years of age
who have not received a polio booster on or after their 4th
birthday
(3) Adults who have previously
received less than a full primary
course of IPV or OPV regardless of
interval since the last dose, should
receive the remaining doses
(3) Use schedule (2) as appropriate based on previous
doses received.
(4) Previously unimmunized
children and adult solid organ
transplant (SOT) candidates and
recipients 
(4) Use schedule (1) or (2) above as appropriate for age
(5) HSCT recipients: Individuals ≥ 7
years of age who are receiving Tdap
concurrently 
(5) Dose 1: 0.5ml SC (12 months after HSCT)
Dose 2: 0.5ml SC (2 months after dose 1)
Dose 3: 0.5ml SC (12 months after dose 1)
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 42
Polio Vaccine (Inactivated) (Imovax®Polio) (vero cell origin)
Supplier: sanofi Pasteur
REINFORCEMENTS

No additional doses of IPV are recommended for
travellers < 18 years of age who have completed an IPV
or OPV vaccine series.

A single booster dose (10 years after the primary series)
is recommended for individuals  18 years of age who
are at increased risk of exposure to wild polioviruses and
who completed an IPV or OPV series in childhood such
as travelers to areas of countries where wild polioviruses
are circulating- this is NOT publicly funded and at cost to
the client.
CONTRAINDICATIONS
History of anaphylactic reaction to any polio-containing
vaccine, or to any IPV vaccine component.
VACCINE COMPONENTS
2-phenoxyethanol, formaldehyde, residual calf serum protein,
neomycin, streptomycin, polymyxin B, Medium199 Hanks
ADVERSE EVENTS
Minor local reactions, fever.
 Routine polio immunization is not considered necessary for previously unimmunized adults
in Canada who do not intend to travel to areas in which polio outbreaks occur except for
those in Indication (3) & (4) above.
 Previously unimmunized travelers who will depart in less than 4 weeks should receive a
single dose of IPV. The remaining doses of vaccine should be given later at the
recommended intervals.
 Please contact the medical specialist most familiar with the client’s care and vaccine
program manager prior to immunization for this indication.
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 43
Rabies Vaccine Pre-exposure [Human Diploid Cell Vaccine (HDCV)] (Inactivated)
Imovax Rabies
Supplier: sanofi Pasteur
INDICATIONS
PRE-EXPOSURE PROPHYLAXIS:
Recommended but not provided free to the following persons at
risk of contact with the rabies virus:
High Risk:
 Rabies research lab workers
 Rabies biologicals production workers
Moderate Risk:

Rabies diagnostic lab workers

Spelunkers

Veterinarians and staff, and animal control workers in rabies
epizootic areas

Hunters and trappers in high risk areas such as the far north
Low Risk:
 Vets and staff, and animal control and wildlife workers in areas of
low rabies disease (enzootic)
 Vet students and animal health tech students (however, vaccine is
provided free to this group)
 Children and travelers visiting foreign epizootic areas
INITIAL SERIES 
PRE-EXPOSURE PROPHYLAXIS:



1.0ml IM (2.5 IU) at dosage intervals of 0 - 7 - 21 days
For infants and children  12 months of age, the site for
immunization is the anterolateral thigh.
For infants ≥12 months of age and adults, the preferred site is the
deltoid muscle.
DO NOT GIVE RABIES VACCINE IN THE GLUTEAL REGION.
ROUTE
While NACI considers the IM route of administration as the gold
standard, consideration may be given to using the ID route of
administration for pre-exposure immunization provided there is an
opportunity to assess the neutralizing antibody level at least 1 month
after administration, so that adequate protection can be ensured.
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 44
Rabies Vaccine Pre-exposure [Human Diploid Cell Vaccine (HDCV)] (Inactivated)
Imovax Rabies
Supplier: sanofi Pasteur
REINFORCEMENTS
As required 1.0 ml IM. An acceptable antibody level is  0.5 IU/ml.
High risk: test clients every 6 mos. and boost when level falls below
0.5 IU/ml.
Moderate risk: test clients every 2 years and boost when level falls
below 0.5 IU/ml.
Low risk: testing not required and no routine booster for clients.
CONTRAINDICATIONS 1. Persons with an anaphylactic reaction to a previous dose of rabies
vaccine, Imovax Rabies, any component of Imovax Rabies, or
to latex.
2. Severe allergic or neuroparalytic reactions during the course of a
rabies vaccine series pose a serious dilemma. The risk of
exposure to rabies must be carefully considered before a decision
is made to discontinue rabies vaccine.
VACCINE
Human albumin, neomycin sulfate, phenol red, and beta
COMPONENTS
propiolactone.
PRECAUTIONS
 Persons receiving high doses of steroids or immunosuppressive
therapy should receive vaccine by the IM route and have a rabies
antibody titre upon completion to ensure an adequate response
has developed. If titre is inadequate, give one booster dose and
retest.
 Persons taking chloroquine should receive vaccine by the IM route
or be vaccinated by the ID route at least 1 month prior to their
taking chloroquine.
 There are insufficient data regarding concurrent use of mefloquine
with rabies immunization.
ADVERSE EVENTS
Fever, nausea, headache, muscle aches, abdominal pain, fatigue, and
dizziness. Pain, redness, swelling and itching at injection site. Three
cases of neurologic illness resembling Guillain-Barré syndrome (GBS)
were reported in the early 1980s; all cases resolved without sequelae
within 12 weeks.
SPECIAL
Imovax Rabies is pink to red in color following reconstitution. Also, it
CONSIDERATIONS
does not contain any preservative and should be used immediately
after reconstitution or discarded.
 Whenever possible the immunization series should be completed with the same product.
However, if this is not feasible, Imovax and RabAvert are interchangeable in terms of
indications for use, immunogenicity, efficacy, and safety.
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 45
Rabies Vaccine Pre-exposure [Purified Chick Embryo Cell Vaccine] (PCECV)
(RabAvert)
Supplier: Novartis
INDICATIONS
PRE-EXPOSURE PROPHYLAXIS:
Recommended but not provided free to the following persons at
risk of contact with the rabies virus:
High Risk:
 Rabies research lab workers
 Rabies biologicals production workers
Medium Risk:
 Rabies diagnostic lab workers
 Spelunkers
 Veterinarians and staff, and animal control workers in rabies
epizootic areas
 Hunters and trappers in high risk areas such as the far north
Low Risk:
 Vets and staff, and animal control and wildlife workers in areas of
low rabies disease (enzootic)
 Vet students and animal health tech students (however, vaccine
is provided free to this group)
 Children and travelers visiting foreign epizootic areas
INITIAL SERIES
PRE-EXPOSURE PROPHYLAXIS:



ROUTE
REINFORCEMENTS
1.0 ml IM (2.5 IU) at dosage intervals of 0 - 7 - 21 days
In infants and children  12 months of age, the site for
immunization is the anterolateral thigh.
For children  12 months of age and adults, the preferred site is
the deltoid muscle.
DO NOT GIVE RABIES VACCINE IN THE GLUTEAL REGION.
NACI considers the IM route of administration as the gold standard,
consideration may be given to using the ID route of administration for
pre-exposure immunization provided there is an opportunity to
assess the neutralizing antibody level at least 1 month after
administration, so that adequate protection can be ensured.
As required 1.0 ml IM. An acceptable antibody level is  0.5 IU/ml.
 High risk: test clients every 6 mos. and boost when level falls
below 0.5 IU/ml.
 Moderate risk: test clients every 2 years and boost when level
falls below 0.5 IU/ml.
 Low risk: testing not required and no routine booster for clients.
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 46
Rabies Vaccine Pre-exposure [Purified Chick Embryo Cell Vaccine] (PCECV)
(RabAvert)
Supplier: Novartis

Use the longer of the 2 needles supplied (21g x 1.5”) to
RECONSTITUTION
withdraw the entire contents of the sterile diluent into the
syringe. Insert the needle at a 45 angle and slowly inject the
entire contents of the diluent into the vaccine vial. Mix gently to
avoid foaming. Unscrew the syringe from the needle to
eliminate negative pressure. Reinsert the syringe into the
needle. Withdraw the total amount of reconstituted vaccine into
the syringe. Replace the long needle with the smaller needle
(25g x 1”) for IM injection.
Persons with a history of anaphylaxis to a previous dose of
CONTRAINDICATIONS 1.
rabies vaccine, RabAvert, eggs or egg products, or to any
component of RabAvert.
2.
Severe allergic or neuroparalytic reactions during the course of
a rabies vaccine series pose a serious dilemma. The risk of
exposure to rabies must be carefully considered before a
decision is made to discontinue rabies vaccine.
VACCINE
Polygeline (processed bovine gelatin stabilizer), human serum
COMPONENTS
albumin, ovalbumin (egg white albumin), neomycin, chlortetracycline,
amphotericin B, potassium glutamate, sodium EDTA.
PRECAUTIONS

Persons receiving high doses of steroids or
immunosuppressive therapy should receive vaccine by the IM
route and have a rabies antibody titre upon completion to
ensure an adequate response has developed. If titre is
inadequate, give one booster dose and retest.

Persons taking chloroquine should receive vaccine by the IM
route or be vaccinated by the ID route at least 1 month prior to
their taking chloroquine.

There are insufficient data regarding concurrent use of
mefloquine with rabies immunization.
ADVERSE EVENTS
Fever, nausea, headache, muscle aches, abdominal pain, fatigue,
and dizziness. Pain, redness, swelling and itching at injection site.
Three cases of neurologic illness resembling Guillain-Barré
syndrome (GBS) were reported in the early 1980s; all cases
resolved without sequelae within 12 weeks.
SPECIAL
RabAvert does not contain a preservative and should be used
CONSIDERATIONS
immediately after reconstitution or discarded.
 Whenever possible the immunization series should be completed with the same product.
However, if this is not feasible, RabAvert and Imovax are interchangeable in terms of
indications for use, immunogenicity, efficacy, and safety.
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 47
RABIES POST-EXPOSURE PROPHYLAXIS INSTRUCTIONS
STEP 1
Was the person exposed i.e. bitten, scratched or in contact with saliva from a possibly rabid
animal?
Wound Management: The first and immediate action

Immediate and thorough washing of the wounds and scratches with soap and water may
reduce the risk of rabies and will reduce the risk of bacterial wound infection.

Wash and flush the wound and scratches with copious amounts of water under moderate
pressure, with a mild soap, for 5 to 10 minutes.
As appropriate, follow-up wound care in situations of potential rabies exposure should be
undertaken in consultation with a physician: Consideration can be given to disinfecting the
wound with either 70% ethanol, tincture of aqueous solution of iodine, or povidone iodine.
Decisions on primary versus delayed suturing of animal bites require medical assessment, and
depend on multiple factors including type of animal, time since injury, location of wound, presence
of crushed tissue or puncture wounds, and underlying medical status of the individual. If RPEP is
advised, sutures, if required, should be placed after local infiltration of RabIg. They should be
loose and not interfere with free bleeding and drainage.

Tetanus toxoid containing vaccine should be administered as required. See Section 8,
Biological Products, Tetanus Prophylaxis in Wound Management.
Assess risk of rabies - refer to the current edition of the Canadian Immunization Guide
for further rabies information.
STEP 2
Risk of rabies - CALL YCDC OR MOH FOR DIRECTION
The provision of Rabies Post Exposure Prophylaxis (RPEP) must be authorized by the
MOH:
Monday- Friday (0830-1630)
After hours and Weekends:
Yukon Communicable Disease Control
#4 Hospital Road,
Whitehorse, Yukon
Y1A 3H8
Dr. Brendan E. Hanley MD CCFP (EM) MPH
Chief Medical Officer of Health, Yukon
#4 Hospital Road,
Whitehorse, Yukon
Y1A 3H8
Telephone:
Local (867) 667-8323
Within Yukon 1-800-661-0408
Fax:
(867) 667-8349
Cell: (867) 332-1160
STEP 3
Complete the Rabies Investigation Form- See following page and Fax to YCDC
YCDC 2011
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 48
Rabies Investigation Form
Victim’s Name:
YHIS #:
Address:
DOB: Y______M____D ___
Physician/NP:
Gender: Male______Female_____
Bylaw informed on: Date:______________ Time:________
RCMP informed on: Date:______________Time:____
General Information
Location of incident:
Date of Incident: Y____M____D____
Time of Incident:
Biting Provoked: Yes______ No_______
Severity of wound: Site:__________ Number of wounds:_____________ Sutures Required: Yes
Any other pertinent details:
Wound management description:
Other circumstances about incident:
No
Immunization History of Client
Tetanus updated: Yes________ No___________
History of Pre-exposure rabies vaccination: Yes____ No____ Known titre level: Yes____No____
Details:
Rabies Immune Globulin advised: Yes____ No____ RIG administered: Yes____No____
If yes: Dose____________
Site________________
Post Exposure Vaccine advised: Yes____ No____
Animal Information
Animal species:  Bat  Cat  Dog  Other (describe)___________________  unknown
Animal type:  Household pet – indoor  Household pet – outdoor  Stray  Wild  Unknown
Animal immunized against rabies?  Yes: Y____M____D__  No  Unknown
Veterinarian:
Animal behavior at time of exposure:
Animal description: Breed:_______________ Size:______________ Color:_______________
Collar, tags: Yes No
Brief Description:
Owner’s Name:
Telephone:
Address:
Location of animal:
Report
Attending Physician/Nurse:
Telephone:
This Form is be Faxed to YCDC, (867) 667-8349
**Only Animal & Owner information can be released to Bylaw or RCMP
unless victim consents.
YCDC 2005
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 49
Release of Biologicals for Rabies Post-Exposure Prophylaxis (RPEP)
The MOH must authorize all releases of RPEP
How to access RPEP
Monday-Friday (0800-1600hrs)
The MOH or assigned designate will call the WGH Pharmacy to request the release of the
products: WGH Pharmacy (request Rabies Vaccine and RabIg) Phone 867-393-8737.
Afterhours, the MOH or assigned designate is to phone WGH Admitting and Discharge –
request that the Pharmacist on call be paged
Phone: 867-393-8700
Administration Arrangements - Location of Exposed Person
Whitehorse:
o In Whitehorse, the administration of initial dose of vaccine along with RabIg should occur
in the WGH ER or as arranged by YCDC.
WGH ER - phone 867-393-8926
o
Subsequent doses of vaccine will be arranged through YCDC - Potential sites include:
YCDC, Whitehorse Health Centre or WGH ER.
Communities:
o Old Crow Health Centre has a stock of RPEP (Vaccine and RabIg)
o
All other communities: arrangements will be made in collaboration with the nurse to have
RPEP sent as soon as possible to the community from WGH hospital, where the
administration of RPEP will be done by the Primary Health Care or Community Health
Nurse at the rural Community Health Centre. Arrangements for administration could
also include having the client come into Whitehorse.
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 50
Human Rabies Immune Globulin (RabIg) (HYPERRAB™ S/D)
Supplier: Talecris Biotherapeutics, Inc.
INDICATIONS
INITIAL SERIES
REINFORCEMENTS
RABIES POST-EXPOSURE PROPHYLAXIS (RPEP):

As determined by Yukon Medical Officer of Health.

Rabies Vaccine is given in conjunction with Rablg. Rabies
vaccine and Rablg must be administered with separate needles
and syringes at separate anatomical sites

If a rabies vaccine series has been started or completed
elsewhere and it was not given in accordance with the current
WHO standards, or if the vaccine was a nerve tissue vaccine
(Semple vaccine), administer Rablg (on day 0) in conjunction
with another full course of rabies vaccine.
Note: Do not give Rablg if clients were previously immunized in
accordance with the WHO standards or have documented
seroconversion (i.e. level ≥ 0.5 IU/ml) within the past 2 years
RABIES POST-EXPOSURE PROPHYLAXIS:

The recommended dosage for children and adults is the same:
20 IU/kg of body weight. Because of interference with active
antibody production, do not exceed recommended dose.

The does of Rablg is calculated as:
[20 IU/kg x weight in kg] =
ml
150 IU/ml

Rablg is supplied in 2 ml vials, each 1.0 ml = 150 IU

Infiltrate as much Rablg as possible deep into and around the
wound(s) in order to neutralize the virus. When more than one
wound site exists, each site should be infiltrated with a portion of
the Rablg, using a separate syringe and needle for each
infiltration. If there are extensive wounds, where the calculated
dose of Rablg (by weight) is not adequate in volume to infiltrate
all wounds, dilute the Rablg 2-3 fold in normal saline to create an
adequate volume to infiltrate all wounds.

When there is no wound site, the preferred site for the
administration of Rablg is the ventrogluteal area, which may be
used in those > 7 months of age. However, the vastus lateralis is
most often used in infants and children up to 5 years of age.
None
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 51
Human Rabies Immune Globulin (RabIg) (HYPERRAB™ S/D)
Supplier: Talecris Biotherapeutics, Inc.
CONTRAINDICATIONS
1.
PRECAUTIONS




ADVERSE EVENTS
There are no contraindications to Rablg given for post-exposure
purposes.
If client has a history of anaphylactic reaction following receipt of
any human Ig product, to any of the components of RabIg
(glycine) or to latex, administer RabIg in an emergency room
setting.
Human Ig products are among the safest blood-derived products
available. The method of preparation includes one or more steps
that exclude or inactivate hepatitis B, C and HIV; therefore the
risk of transmission is extremely low. However, it is possible,
that unknown infectious agents may be present in such products.
Regarding RabIg and the administration of live vaccines (MMR &
Varicella) see CIG Guildines for the Interval Between
Administration of Immune Globulin Preparations or Blood
Products and MMR or Vaccines.
Persons with IgA deficiency have the potential for developing
antibodies to IgA and could have an anaphylactic reaction to
subsequent blood products that contain IgA. Administer RabIg in
an emergency room setting.
Fever, headache, malaise, rash, chills. Local tenderness, soreness or
stiffness at the injection site
SPECIAL
RabIg contains no preservatives.
CONSIDERATIONS
Vials are single dose use: discard unused contents
 Since vaccine induced antibodies begin to appear within one week, there is no value in
administering Rablg more than 8 days after initiation of vaccine.
 Provide a written record to a client who receives any immune globulin product.
 When notification of an exposure is delayed, RPEP may be started as late as 6 or more
months after an exposure.
 The deltoid should not be used for Rablg administration. Both deltoid sites should be
reserved for administration of rabies vaccine.
 See CIG, for maxiumum volume to be administered per site according to age.
 See Release of Biologicals for Rabies Post-Exposure Prophylaxis (RPEP), for information
on how obtain Rablg in you community.
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 52
Rabies Vaccine Post-exposure [Human Diploid Cell Vaccine (HDCV)] (Inactivated)
ImovaxRabies
Supplier: sanofi pasteur
INDICATIONS
Post-Exposure Prophylaxis:

As determined by Yukon Medical Officer of Health.

If a rabies vaccine series has been started or completed
elsewhere and it was not given in accordance with current WHO
standards, or if the vaccine was a nerve tissue vaccine (Semple
vaccine), administer another full course of rabies vaccine.
Administer RabIg on day 0 of vaccine series.
SERIES
Unimmunized: 
(1) 1.0 ml IM on days 0 – 3 – 7 – 14 - 28
Day 0: 1.0 ml IM as soon as possible after exposure PLUS
RabIg
Days 3, 7, 14 and 28: 1.0 ml IM
Previously immunized:
(1) Completion of a course of pre/post-exposure prophylaxis with
rabies vaccine  2 years previously that used a WHO approved
rabies vaccine and schedule
OR
(2) Completion of a course of rabies pre/post exposure prophylaxis
that used a non-WHO approved vaccine or schedule OR
completion of a course of rabies pre/post exposure prophylaxis
> 2 years previously that used a WHO approved vaccine and
schedule AND expedited rabies antibody titre result
≥ 0.5 IU/ml
Give rabies vaccine on day 0 (as soon as possible after
exposure) & on day 3: 1.0 ml IM
(DO NOT GIVE RabIg)
CONTRAINDICATIONS
(3) Completion of a course of rabies pre/post exposure prophylaxis
that used a non-WHO approved vaccine or schedule OR
completion of a course of rabies pre/post exposure prophylaxis
> 2 years previously that used a WHO approved vaccine and
schedule AND expedited rabies antibody titre result < 0.5IU/ml
Give rabies vaccine on day 0 (as soon as possible after
exposure) & on days 3, 7, 14, 28: 1.0 ml IM
(DO NOT GIVE RabIg)
1. There are NO contraindications to rabies vaccine given for postexposure purposes.
2. DO NOT GIVE RABIES VACCINE IN THE GLUTEAL REGION.
3. Rabies vaccine and RabIg must NOT be administered in the
same anatomical site. Use separate needles and syringes for
each product.
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 53
Rabies Vaccine Post-exposure [Human Diploid Cell Vaccine (HDCV)] (Inactivated)
Imovax Rabies
Supplier: sanofi pasteur
VACCINE
Human albumin, neomycin sulfate, phenol red and beta propiolactone.
COMPONENTS
PRECAUTIONS

Administer vaccine in an emergency room setting if history of an
anaphylactic reaction to a previous dose of rabies vaccine,
Imovax Rabies, to any of the components of ImovaxRabies or
to latex.


Persons receiving high doses of steroids or immunosuppressive
therapy should receive vaccine by the IM route and have a rabies
antibody titre upon completion to ensure an adequate response
has developed. If titre is inadequate, give one booster dose and
retest.
There are insufficient data regarding concurrent use of
mefloquine with rabies immunization.
ADVERSE EVENTS
Fever, nausea, headache, muscle aches, abdominal pain, fatigue,
and dizziness. Pain, redness, swelling and itching at injection site.
Three cases of neurologic illness resembling Guillain-Barré syndrome
(GBS) were reported in the early 1980s; all cases resolved without
sequelae within 12 weeks.
SPECIAL
Imovax Rabies is pink to red in color following reconstitution. Also, it
CONSIDERATIONS
does not contain any preservative and should be used immediately
after reconstitution or discarded.
 Whenever possible the immunization series should be completed with the same product.
However, if this is not feasible, ImovaxRabies and RabAvert are interchangeable in terms of
indications for use, immunogenicity, efficacy, and safety.
 In infants and children 12months of age, the site for immunization is the anterolateral thigh. For
children ≥12 months of age and adults, the preferred site is the deltoid.
 Have serum sample taken and administer first dose of rabies vaccine while awaiting results. It is
very likely the rabies antibody titre result will not be available by day 7: administer 3rd dose of
rabies vaccine on day 7.
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 54
Rho (D) Immune Globulin (RhIg) (WinRho )   
Supplier: Cangana Corporation
INDICATIONS
1)
Recommended for the prevention of Rh immunization of Rho (D)
negative woman at risk of developing Rh antibodies, to prevent
haemolytic disease of the newborn. The reduction of Rh
alloimmunization is from 13% to 1 to 2 %.
DOSE
Dose 1: 300 μg IM 28
weeks of gestation
Dose 2: 300 μg IM
within 72hours
after delivery
CONTRAINDICATIONS




Do not give Ig intravenously
Rho (D) positives individuals including babies
Rho (D) negative women who are Rh immunized as evidenced by standard manual Rh antibody
screening tests.
Individuals with a history of anaphylactic or other severe systemic reaction to immune globulins.
PRECAUTIONS

Human Ig products are amongst the safest blood-derived products available. As the
method of preparation includes one or more steps that exclude or inactivate hepatitis B, C
and HIV, the risk of transmission is considered to be extremely low. However, it is possible
that unknown infectious agents may be present in such products.

Persons with severe thrombocytopenia or coagulation disorders that contraindicate IM
injections should not be give IM Ig unless the benefits outweigh the risks.

Give Ig with caution (i.e., in a setting capable of managing anaphylaxis) if the client has a
history of anaphylactic reaction following receipt of any human Ig product, or history of
anayphylactic reaction to glycine or to latex (assess risks versus benefits).

Persons with IgA deficiency have the potential for developing antibodies to IgA and could
have an anaphylactic reaction to subsequent administration of blood products that contain
IgA. Therefore, Ig should only be given to such persons if the expected benefits outweigh
the risks.

Ig contains no preservatives. Vials are single use. Once entered, discard any unused
contents.

The preferred site for the administration of Ig is the ventrogluteal area.

Should either be given at the same time as MMR or the MMR should be deferred 3 months
post injection of the Rho (D) Immune Globulin. If administration of Ig is necessary less than
14 days after MMR or varicella vaccine, repeat vaccine as per recommended intervals as in
CIG.
ADVERSE EVENTS

Local: pain and injection site tenderness
 A Physician’s order by prescription is always required.
 Order through Whitehorse General Hospital Lab on a stores order form, (and phone
Lab and give the patient's name, estimated date of confinement, whether the request is for
the 28 week or post-delivery injection, and the name of attending physician)

See product monograph for further information.
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 55
Tetanus-Diphtheria (Td) Adsorbed
Supplier: sanofi pasteur
INDICATIONS
(1) Booster dose for persons 7 years of age if both diphtheria
and tetanus are required, but Pertussis is not required.
(2) Adults  18 years of age who have not been immunized,
including immigrants with unknown immunization status
(1) 0.5 ml IM every 10 years 
DOSE
(2)
REINFORCEMENTS
CONTRAINDICATIONS
VACCINE
COMPONENTS
PRECAUTIONS
Administer one dose of Tdap followed by two doses of Td:
1st Td: 0.5 ml IM 1 month after Tdap
2nd Td: 0.5 ml IM 6 – 12 months after 1st Td dose
Every 10 years
Adults who have not received one dose of acellular pertussis
(Tdap) should receive a single dose of Tdap instead of Td (see
Tetanus-Diphtheria-acellular Pertussis)
1. History of anaphylactic reaction to a previous dose of any
tetanus or diphtheria-containing vaccine, or to any Td vaccine
component.
2. When a contraindication exists to tetanus toxoid and a client
sustains a major or unclean wound TIG should be given (see
Tetanus Immune Globulin (TIg) (HYPERTET S/D).
3. History of Guillain-Barré syndrome (GBS) occurring within 8
weeks of receipt of a tetanus – containing vaccine.
Aluminum phosphate and formaldehyde.

Persons who experience a major local reaction or high fever
following a dose of Td should not be given another dose for
at least 10 years.

When travel to a developing country is planned 5 years after
the last Td dose, it may be prudent to offer an early booster,
since some developing countries may not be able to
guarantee the safe administration of a booster dose if
required.
ADVERSE EVENTS
Discomfort, pain, swelling, redness at injection site.
SPECIAL
For wound prophylaxis, Td and Tetanus Immune Globulin should
CONSIDERATIONS
be administered using separate syringes and different sites.
 Tetanus toxoid should not be given routinely to clients who have received a booster
dose in the previous 5 years.
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 56
Tetanus-Diphtheria-acellular Pertussis (Tdap) (ADACEL)
Supplier: sanofi pasteur
INDICATIONS  
(1) Reinforcing dose for all grade 9 students 
INITIAL SERIES
(1) & (11)
One dose: 0.5 ml IM
(2) Children and adolescents from  7 years to
17 years of age (inclusive) who have not
received any doses of tetanus or diphtheria
(2) (3)
& (4)
Dose 1: 0.5 ml IM
Dose 2: 0.5 ml IM 1 month later
Dose 3: 0.5 ml IM 6 to 12 months
after dose 2
(5) Children and adolescents from  7 years to
17 years of age (inclusive) whose 3 dose
primary series of tetanus or diphtheria or
pertussis vaccine is incomplete
(5)
(6) Children and adolescents from  7 years to
17 years of age (inclusive) who have
received 3 – 4 doses of
tetanus/diphtheria/pertussis-containing
vaccine at < 7 years of age, but have not
received the school entry booster
(7) Adults  18 years of age who have not
been immunized, including immigrants with
unknown immunization status
(6)
One to two doses of Tdap (0.5 ml
IM) at time of presentation to
complete the primary series of 3
doses, followed by another dose of
0.5 ml IM in grade 9
One dose of Tdap (0.5 ml IM) at
time of presentation, followed by
another dose of 0.5 ml IM
in grade 9 
(8) HSCT recipients ≥ 7 to <18 years of age
(8)
(3) Children and adolescents from  7 years to
17 years of age (inclusive) who have not
received any doses of pertussis vaccine
(4) Immigrants from  7 years to 17 years of age
(inclusive) with unknown immunization status
(9) HSCT recipients ≥ 18 years of age
(7)
One dose of Tdap (0.5ml IM)
followed by two doses of Td
Three doses of Tdap (0.5ml IM) at
0, 1, and 12 months.
(9)& (10) One dose of Tdap (0.5ml IM)
followed by two doses of Td/IPV
(10) Solid organ transplant candidates or
recipients ≥ 7 years of age who have not been
previously immunized.
(11) All adults who have not received a dose of
acellular pertussis ≥ 14 years of age. 
REINFORCEMENTS
Publicly funded as per indication (11).
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 57
Tetanus-Diphtheria-acellular Pertussis (Tdap) (ADACEL)
Supplier: sanofi pasteur
CONTRAINDICATIONS 1. History of an anaphylactic reaction to a previous dose of any
tetanus, diphtheria, or pertussis-containing vaccine or to any
component of ADACEL vaccine.
2. History of Guillain-Barré syndrome (GBS) occurring within 8
weeks of receipt of a tetanus – containing vaccine.
3. < 4 years of age and ≥ 65 years of age.
Aluminum phosphate, 2-phenoxyethanol.
VACCINE
COMPONENTS
ADVERSE EVENTS





Minor local: redness, tenderness, swelling, induration, pain
Minor systemic: headache, decreased energy, generalized bodyache, nausea, diarrhea, fever, sore or swollen joints
There should be a minimum of 2 years since receipt of a previous booster dose of a
tetanus/diphtheria –containing vaccine. The exception to this, for Grade 9 Tdap
program only, is a minimum interval of 6 months. This recommendation is based on
unpublished data. In studies related to the interval between the grade 9 Tdap booster and
a previous dose of a tetanus-containing vaccine, there were a small number of students
with an interval of ~ 6 months since receipt of a tetanus-containing vaccine. Following
administration of the grade 9 tetanus booster they did not experience any marked local
reactions.
For clients ≥ 65 years of age, see BOOSTRIX.
Give Tdap to high school students who missed their grade 9 booster.
For example, if the student had received one dose of a tetanus/diphtheria/pertussis –
containing vaccine, give two doses of ADACEL, separated by a period of 6 - 12 months.
If the student had received two doses of a tetanus/diphtheria/pertussis – containing
vaccine, give one dose of ADACEL
The high school Tdap booster given at age 14-16 years is considered a dose of acellular
pertussis in adulthood. At this time, an additional dose of acellular pertussis is not
recommended.
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 58
Tetanus-Diphtheria-acellular Pertussis (Tdap) (BOOSTRIX)
Supplier: GlaxoSmithKline
INDICATIONS   Provided free:
(1) Reinforcing dose for all grade 9 students 
INITIAL SERIES
(1) & (11)
One dose: 0.5 ml IM
(2) Children and adolescents from  7 years to
17 years of age (inclusive) who have not
received any doses of tetanus or diphtheria
(2) (3)
& (4)
Dose 1: 0.5 ml IM
Dose 2: 0.5 ml IM 1 month later
Dose 3: 0.5 ml IM 6 to 12 months
after dose 2
(5) Children and adolescents from  7 years to
17 years of age (inclusive) whose 3 dose
primary series of tetanus or diphtheria or
pertussis vaccine is incomplete
(5)
(6) Children and adolescents from  7 years to
17 years of age (inclusive) who have
received 3 – 4 doses of
tetanus/diphtheria/pertussis-containing
vaccine at < 7 years of age, but have not
received the school entry booster
(7) Adults  18 years of age who have not
been immunized, including immigrants with
unknown immunization status
(6)
One to two doses of Tdap (0.5 ml
IM) at time of presentation to
complete the primary series of 3
doses, followed by another dose of
0.5 ml IM in grade 9
One dose of Tdap (0.5 ml IM) at
time of presentation, followed by
another dose of 0.5 ml IM
in grade 9 
(8) HSCT recipients ≥ 7 to <18 years of age
(8)
(3) Children and adolescents from  7 years to
17 years of age (inclusive) who have not
received any doses of pertussis vaccine
(4) Immigrants from  7 years to 17 years of age
(inclusive) with unknown immunization status
(9) HSCT recipients ≥ 18 years of age
(7)
One dose of Tdap (0.5ml IM)
followed by two doses of Td
Three doses of Tdap (0.5ml IM) at 0,
1, and 12 months.
(9)& (10) One dose of Tdap (0.5ml IM)
followed by two doses of Td/IPV
(10) Solid organ transplant candidates or
recipients ≥ 7 years of age who have not been
previously immunized.
(11) All adults who have not previously received
a dose of acellular pertussis after 14years. 
REINFORCEMENTS
Publicly funded as per indication (11)
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 59
Tetanus-Diphtheria-acellular Pertussis (Tdap) (BOOSTRIX)
Supplier: GlaxoSmithKline
CONTRAINDICATIONS 1. History of an anaphylactic reaction to a previous dose of any
tetanus, diphtheria, or pertussis-containing vaccine or to any
component of BOOSTRIX vaccine.
2. History of Guillain-Barré syndrome (GBS) occurring within 8
weeks of receipt of a tetanus – containing vaccine.
3. < 4 years of age.
Aluminum phosphate, 2-phenoxyethanol.
VACCINE
COMPONENTS
ADVERSE EVENTS





Minor local: redness, tenderness, swelling, induration, pain
Minor systemic: headache, decreased energy, generalized bodyache, nausea, diarrhea, fever, sore or swollen joints
There should be a minimum of 2 years since receipt of a previous booster dose of a
tetanus/diphtheria –containing vaccine. The exception to this, for Grade 9 Tdap
program only, is a minimum interval of 6 months. This recommendation is based on
unpublished data. In studies related to the interval between the grade 9 Tdap booster and
a previous dose of a tetanus-containing vaccine, there were a small number of students
with an interval of ~ 6 months since receipt of a tetanus-containing vaccine. Following
administration of the grade 9 tetanus booster they did not experience any marked local
reactions.
Approved for use in those ≤ 4 years of age with no upper age limit.
Give Tdap to high school students who missed their grade 9 booster.
For example, if the student had received one dose of a tetanus/diphtheria/pertussis –
containing vaccine, give two doses of Tdap separated by a period of 6 - 12 months. If the
student had received two doses of a tetanus/diphtheria/pertussis – containing vaccine,
give one dose of Tdap.
The high school Tdap booster given at age 14-16 years is considered a dose of acellular
pertussis in adulthood. At this time, an additional dose of acellular pertussis is not
recommended.
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 60
Tetanus Immune Globulin (TIg) (HYPERTETS/D)
Supplier: Talecris Biotherapeutics, Inc.
INDICATIONS
1)
TIg is indicated for prophylaxis against tetanus following a major
or unclean wound in individuals whose immunization history is
incomplete or uncertain (See Tetanus Prophylaxis in Wound
Management.)
2)
TIg is indicated when a contraindication to a tetanus toxoidcontaining vaccine exists and an individual sustains a major or
unclean wound.
3)
DOSE
TIg is indicated in individuals known to have a significant
immune deficiency state (i.e. HIV) regardless of their
immunization history, following any major or unclean wound.
Give 250 units IM (entire syringe) to adults and children who require
TIg. 
TIg is supplied in a 250 unit single dose pre-filled disposable syringe.
REINFORCEMENTS
The syringe fill volume for each lot is adjusted to ensure a potency of
250 IU/syringe. The actual fill volume for HyperTet syringes typically
ranges between 0.75 ml and 1.3 ml. The needle on the pre-filled
syringe is fixed and cannot be changed.
None if Td vaccine is given concurrently with TIg. 
CONTRAINDICATIONS
TIg should not be given intravenously.




Provide a written record to a client who receives any immune globulin product.
See CIG, for maximum volume to be administered per site according to age
If a contraindication to a tetanus toxoid-containing vaccine exists or a client refuses a tetanus
toxoid-containing vaccine, and a client sustains a major or unclean wound, consider offering
a 2nd dose of TIg 30 days post the 1st dose of TIg.
Tetanus Immune Globulin does not interfere with the development of active immunity from a
tetanus toxoid-containing vaccine
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 61
Tetanus Immune Globulin (TIg) (HYPERTETS/D)
Supplier: Talecris Biotherapeutics, Inc.
PRECAUTIONS
ADVERSE EVENTS

Human Ig products are among the safest blood-derived
products available. The method of preparation includes one or
more steps that exclude or inactivate hepatitis B, C and HIV;
therefore the risk of transmission is considered to be extremely
low. However, it is possible that unknown infectious agents
may be present in such products.

Regarding TIg and administration of live vaccines (MMR &
Varicella) see Immune Globulin Preparations or Blood: Timing
Intervals For Vaccines Containing Live Measles, Mumps,
Rubella, or Varicella Virus in CIG.

Give TIg with caution (i.e., in a setting capable of managing
anaphylaxis) if the client has a history of anaphylactic reaction
following receipt of any human Ig product, or a history of
anaphylactic reaction to latex (assess risks versus benefits).

Persons with IgA deficiency have the potential for developing
antibodies to IgA and could have an anaphylactic reaction to
subsequent administration of blood products that contain IgA.
Therefore, TIg should only be given to such persons if the
expected benefits outweigh the risks.

In clients who have severe thrombocytopenia or any
coagulation disorder that would contraindicate IM injections, TIg
should be given only if the expected benefits outweigh the risks.

TIg must be given at separate anatomic sites from a
tetanus toxoid-containing vaccine.

The preferred site for the administration of TIg is the
ventrogluteal area, which may be used in those > 7 months of
age. However, the vastus lateralis is most often used in infants
and children up to 5 years of age.
Local tenderness, erythema and stiffness of local muscles that may
persist for several hours. Systemic reactions include mild fever or
malaise.
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 62
Tetanus Prophylaxis in Wound Management
History of
Tetanus
Immunization
Clean, minor wounds
All other wounds 
Tetanus ToxoidContaining
Vaccine 
TIg
Tetanus ToxoidContaining
Vaccine 
TIg
Uncertain or  3
doses
Yes
No
Yes
Yes
Primary
immunization
complete 
No 
No
No 
No 
 Such as, but not limited to, wounds contaminated with dirt, feces, soil, and saliva;
puncture wounds; tearing away of body parts or structures; and wounds resulting from
missiles, crushing, burns and frostbite.
 May have been given as Td, Tdap, or Td/IPV. Monovalent tetanus toxoid is not available
in Canada.
 For additional information on the primary immunization schedule, refer to the Td, Tdap, or
Td/IPV vaccine pages.
 Wound management for children  7 years of age would be based on specific spacing
and doses required as per INFANRIX hexa, PEDIACEL® and QUADRACEL vaccine
pages.
 Yes, if > 10 years since last tetnus containing booster.
 Yes, if > 5 years since last tetnus containing booster.
 No, unless individuals are known to have a significant humoral immune deficiency state
(e.g., HIV, agammaglobulinemia), since immune response to tetanus toxoid may be suboptimal.
In adults, if a tetanus toxoid containing vaccine is required it may be administered as
Tdap (if not previously administered ≥ 14 years of age) or as Td. See individual product
information in this section.
Note: Tetanus-diphtheria (Td) / Tetanus-diphtheria- acellular pertussis (Tdap) vaccine and
Tetanus Immune Globulin (TIg) should be administered using separate syringes and different
sites. If a contraindication exists for a tetanus toxoid-containing vaccine, TIg would be given
where tetanus immunization is required.
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 63
Tuberculin Skin Test (Mantoux) Tubersol 
Supplier: sanofi pasteur
INDICATIONS
Recommended and provided free to everyone.
Target groups include:
 Suspected cases of TB
 Individuals referred for medical diagnostic reason
 Contacts of a known case of TB
 HIV positive individuals and persons at significant risk for HIV
infection
 International travelers who will be residing in countries where TB
is endemic and travelers returning from prolonged visits to
endemic areas.
 Establishment of a baseline prior to possible exposure to TB (as a
requirement for an educational program, volunteer position or
employment)
 Self-referral
INITIAL SERIES
PPD 5 TU 0.1 ml ID in anterior forearm (flexor or dorsal surface)
between the wrist and the elbow
 For contact tracing, if the initial skin test is negative, a second test
should be given 8 – 12 weeks after the last date of contact
REINFORCEMENTS
2 – STEP TESTING:
 A second test, done 7 - 21 days after the first test, may be
required in certain situations see Yukon Health & Social Services
Tuberculosis Manual, YCDC.
 A small percentage of persons will only react after a second test
or will react to a greater degree (so called “boosting” effect).
Intradermally
ROUTE
CONTRAINDICATIONS
1. History or documentation of previous positive reaction to tuberculin
testing (because of the severity of the reaction at the test site:
vesiculation, ulceration or necrosis)
2. Documentation of previous active TB
3. History of an anaphylactic reaction to a previous test using
Tubersol or a similar product, or to any component of Tubersol
4. Individual with severe burns or eczema
5. Individuals with severe viral infections or live-virus vaccination in
the past 4 weeks (to avoid negative reactions).
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 64
Typhoid Vaccine (Salmonella Typhi Vi Capsular Polysaccharide)(Typherix)
Supplier: GlaxoSmithKline
INDICATIONS 
Routine vaccination is not recommended in Canada.
Recommended but not provided free to:
 Travelers  2 years of age to countries where typhoid fever is
endemic or epidemic, or where sanitary conditions may be
doubtful and where travellers may be exposed to potentially
contaminated food and water.
INITIAL SERIES
Adults and children  2 years of age:
One dose: 0.5 ml IM
REINFORCEMENTS
Adults and children  2 years old every 2 years as required:
0.5 ml IM
History of anaphylactic reaction to a previous dose of any typhoid vaccine
or to any component of Typherix or to latex.
Sodium phosphate dihydrate, disodium phosphate dihydrate, phenol.
CONTRAINDICATIONS
VACCINE
COMPONENTS
PRECAUTIONS
ADVERSE EVENTS

An adequate immune response may not be achieved in clients receiving
immunosuppressive treatment or in clients who are
immunocompromised.
Soreness, redness and swelling at the injection site
Headache and fever.
The typhoid vaccines Vivotil, Typhim Vi, Typherix, and ViVAXIM are interchangeable
for children or adults at any scheduled dose, using the age-specific dosage for the particular
product.
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 65
Varicella Vaccine (live attenuated viral) Varivax III and Varilrix
Supplier: Varivax III, Merck Frosst Canada; Varilrix, GlaxoSmithKline
INDICATIONS
Recommended and provided free to:
(1) All infants at 12 months of age (including infants with a history of varicella disease
occurring at < 12 months of age).
(2) Susceptible children, adolescents, and adults at opportune health encounters. With
special attention to:
 children and adults on low dose steroid therapy (< 2 mg prednisone/kg daily to a
maximum of 20 mg/day for < 2 weeks), and those taking inhaled or topical steroids
 household contacts of immunocompromised individuals
 health care workers
AND susceptible individuals at high risk of severe varicella disease:
 Individuals with cystic fibrosis
 Individuals on chronic salicylate therapy (those  18 years of age must be able to
discontinue it for 6 weeks post vaccination)
(3)
Susceptible Immunocompromised CHILDREN and ADULTS.
Before vaccination of the following clients, receive approval from the appropriate physician
(i.e., either the primary care provider most familiar with the client’s current medical status or a
medical specialist). Refer to Yukon Immunization Program, Section 5, subsection 1.4
Immunization With Live Vaccines, for those who are immunosupressed; use Varilrix® ONLY:
 with chronic kidney disease (and not receiving immunosuppressant therapy)
 undergoing hemo or peritoneal dialysis (and not receiving immunosuppressant therapy)
 Asplenia
 Candidates for solid organ transplant, isolated immunodeficiency diseases, asymptomatic
HIV, HSCT, acute lymphocytic leukemia in remission and those cured of a malignant
disease and the end of immunosuppressive treatment. Discuss immunization with
Vaccine Program Manger, and medical specialist prior to immunization. Also see Yukon
Immunization Manual, Section 5 Immunization of Special Populations.
 ≥ 1 month after completion of high doses (>2mg/kg or >20 mg/day) oral corticosteroid
therapy more than 14 days duration
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 66
Varicella Vaccine (live attenuated viral)
INITIAL SERIES
 12 months to 12 years of age: One dose: 0.5 ml SC

 13 years of age: Two doses - dose 1: 0.5 ml SC
dose 2: 0.5 ml SC 4 weeks later
REINFORCEMENTS
Not indicated at this time
CONTRAINDICATIONS
1.
2.
3.
4.
5.
6.
7.
8.
9.
Children/adults with:
 T-cell or combined T-and B-cell immunodeficiencies (SCID)
 Total lymphocyte count < 1.2 x 109/L or presenting other evidence of lack of cellular
immune competence
 Advanced HIV (AIDS)
 Malignant solid tumours
 Conditions requiring chronic immunosuppressive therapy
 Acute lymphocytic leukemia (ALL) not in remission
 Acute myelogenous leukemia (AML)
Adult solid organ transplant recipients
Children or adults with chronic inflammatory diseases (e.g., inflammatory bowel disease,
collagen-vascular disease) receiving significant immunosuppressive therapy. However, they
may be immunized at least 6 to 12 weeks after they have completed or temporarily stopped
the immunosuppressive therapy.
History of an anaphylactic reaction to a previous dose of any varicella vaccine, or to any
component of VarivaxIII or Varilrix®.
Pregnancy. Women of childbearing age should avoid pregnancy for 1 month following
vaccination.
Active untreated TB.
For high risk/immunocompromised clients only - concurrent administration with
another live vaccine. Separate the administration of varicella vaccine and another live
vaccine by at least 4 weeks (expert opinion, BC Children’s Hospital, based on concerns
about adverse events with concurrent administration).
Recent administration of an immunoglobulin preparation or blood product. See CIG, P 53-56,
2006 
Family history of congenital immunodeficiency. See Yukon Immunization Program
Section 4, Contraindications and Routine Precautions for Immunization.
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 67
Varicella Vaccine (live attenuated viral)
VACCINE COMPONENTS
VarivaxIII: Hydrolyzed beef gelatin, neomycin, monosodium L-glutamate, sucrose, sodium
phosphate dibasic, urea, potassium phosphate monobasic, potassium chloride, fetal bovine
serum.
Varilrix®: Amino acids, human albumin, lactose, neomycin sulphate, and polyalcohols.
PRECAUTIONS
 Those  18 years of age should avoid taking salicylates for 6 weeks following
immunization.
 Do TB skin testing on the same day as varicella immunization or delay TB skin testing for 
4 weeks.
 Varicella immunization for immunocompetent clients should be given on the same day or
delayed until 4 weeks after administration of any other live vaccine.
ADVERSE EVENTS
Generally mild and include injection site reactions, non-injection site rash, and low-grade fever.
SPECIAL CONSIDERATIONS
Administer vaccine immediately after reconstitution. Discard if not used within 30 minutes of
reconstitution.

Assess varicella susceptibility before immunization. A varicella susceptible individual is
defined as an individual:
 with a history of varicella disease at <12 months of age
 with no history of varicella disease at > 12 months of age, no history of herpes
zoster, and no history of varicella immunization.
 For persons  13 years of age with negative or unknown history of prior
varicella infection, have serology done for VZV IgG (use BCCDC Laboratory
Services requisition).

Whenever possible, vaccine should be given at least 14 days prior to elective
splenectomy, or if not possible, 14 or more days post-splenectomy. However, vaccine is
indicated whenever an individual with functional or anatomic asplenia is identified.

Use same brand of varicella vaccine for dose 2. There is no data on the
interchangeability of Varivax III and Varilrix.

Varicella-susceptible women who receive RhIg post-partum should be given the first
dose of varicella vaccine 2 months after delivery. Also at 2 months after delivery, prior rubellasusceptible women should be tested for rubella immunity as they should have been immunized
against rubella immediately post-partum.
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 68
Varicella Zoster Vaccine (live attenuated viral) (ZOSTAVAX)
Supplier: Merck Frosst
INDICATIONS
Recommended but not currently provided free to:

Individuals > 60 years of age 
INITIAL SERIES
One dose: entire contents of vial (approximately 0.65ml) SC
REINFORCEMENTS
Not indicated at this time.
CONTRAINDICATIONS
1. History of anaphylactic reaction to a previous dose of varicella
zoster vaccine, or to any component of ZOSTAVAX
2. Immune suppression related to disease[e.g., malignant neoplasm
(including leukemia and lymphoma), HIV/AIDS]
3. Immune suppression related to therapy (e.g., high dose systemic
corticosteroid therapy, chemotherapy, radiation therapy, certain
medications for treatment of rheumatoid arthritis)
4. Congenital immunodeficiency
5. Active untreated tuberculosis
6. Pregnancy and breastfeeding
PRECAUTIONS
1. Delay immunization of individuals with severe acute illness until
recovery.
2. Varicella Zoster immunization should be given on the same day or
delayed until 4 weeks after administration of any other live vaccine.
3. Do TB skin testing on the same day as VZV immunization, or delay
TB skin testing for > 4 weeks.
4. ZOSTAVAX has not been studied in individuals who have
previously experienced an episode of herpes zoster. While these
individuals are at risk for further episodes, the efficacy of
ZOSTAVAX in this population is not known.
5. ZOSTAVAXand a pneumococcal polysaccharide 23 valent
vaccine should not be given at the same time due to the possibility
of an inferior immune response to ZOSTAVAX. Separate these
vaccines by 4 weeks.
6. Antiviral medications active against VZV (i.e., acyclovir, famciclovir,
valacyclovir taken less than 2 days before or within 14 days after
immunization may decrease vaccine effectiveness.
7. Delay ZOSTAVAX™ administration for 3 months after a dose of
intravenous immunoglobulin (IVIG).
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 69
Varicella Zoster Vaccine (live attenuated viral) (ZOSTAVAX)
Supplier: Merck Frosst
VACCINE
COMPONENTS
Neomycin, hydrolyzed porcine gelatin, sucrose, sodium chloride,
monosodium L-glutamate monohydrate, sodium phosphate dibasic,
potassium phosphate monobasic, potassium chloride, MRC-5 cells,
bovine calf serum.
ADVERSE EVENTS
Local: Mild to moderate pain, redness, swelling, itchiness, varicella-like
rash at the injection site
Systemic: Headache, fever
SPECIAL
CONSIDERATIONS
1. ZOSTAVAX™ should be stored FROZEN at an average
temperature of -15°C or colder until it is reconstituted for injection.
Do not freeze reconstituted vaccine. The diluent should be stored
separately at room temperature (20 to 25°C) or in the refrigerator
(2 to 8°C). Do not store the diluent in a freezer.
2. It is recommended that the vaccine be administered immediately
after reconstitution to minimize loss of potency. Discard
reconstituted vaccine if it is not used within 30 minutes.
 ZOSTAVAX™ is indicated for the prevention of herpes zoster in patients with prior chickenpox
infection. There is no known safety risk associated with vaccination of healthy individuals who are
varicella-susceptible. If individual is known to be serologically varicella susceptible, they should be
immunized with 2 doses of varicella vaccine.
 The efficacy of protection has not been assessed beyond 4 years and it is not known whether
booster doses of vaccine are beneficial.
 Consult client’s medical specialist regarding the appropriateness of zoster vaccine
administration to persons whose immune status may be suppressed as the result of disease or
therapy (e.g., chronic renal disease/dialysis; solid organ transplant candidate;
hyposplenia/asplenia; ≥ 3 months after being cured of a malignant disease and the end of
immunosuppressive treatment).
 ZOSTAVAX™ and trivalent influenza vaccine may be given at the same time or be separated
by any interval. Co-administration of ZOSTAVAX™ with other vaccines has not been studied.
 Individuals who inadvertently receive systemic anti-viral therapy active against VZV within 2
days before and 14 days after ZOSTAVAX™ immunization may benefit from a second dose of
vaccine 42 days later and after discontinuing antiviral therapy.
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 70
Yellow Fever (YF-VAX) 
Supplier: sanofi pasteur
INDICATIONS    
Recommended but not provided free to:
(1) International travelers ≥ 9 months & ≤ 60 years of
age, visiting yellow fever endemic areas
Single dose of 0.5 mL sc
REINFORCEMENTS
Booster every 10 years
CONTRAINDICATIONS
1.
2.
3.
4.
5.
PRECAUSIONS
VACCINE COMPONENTS
≤ 9 months of age
≥ 60 years of age 
Severe egg allergy
Immunosuppressed persons due to disease or therapy 
History of thymoma or other thymus disorders 
6. Post vaccine encephalitis, Guillain-Barre syndrome,
autoimmune central or peripheral nervous system
involvement.
7. History of anaphylactic reaction to Yellow Fever vaccine
or any of it’s components including latex
8. Pregnancy 
 individuals with the following conditions should be
considered as relative contraindications and thorough
assessment should be undertaken including risks and
benefits
- Breastfeeding women 
No adjuvants, no preservatives
Contains residual egg proteins, sorbitol, gelatin, sodium
chloride
ADVERSE EVENTS
5 - 10 days after injection possible:
2%-5% mild headaches, myalgia, fevers, or other minor
symptoms for 5 – 10 days.
Severe reactions following yellow fever vaccine increases
with age. Risk between 60-69 years old is 4/100,000 doses
and ≥ 70 years old is 7.5/100,000 doses. These serious
reactions include YEL-AVD, Multi organ failure and YELAND. 
Community Nursing
Yukon Immunization Program
Section 8 – Biological Products
2011 March
Page 71
Yellow Fever (YF-VAX) 
Supplier: sanofi pasteur
 Only administered at Whitehorse Health Centre. See discussion in Yukon Immunization
Manual, Section 5 Immunization of Special Populations. Requires completion of the
International Certificate of Vaccination or Prophylaxis for Yellow Fever, or medical
exemption for Yellow Fever Immunization required regions.
 Freeze dried product, requiring reconstitution
 Give Varicella or M.M.R. on the same day or 4 weeks apart from vaccine administration. PPD
≥ 6 weeks after live vaccine. Live vaccines can be given any time after PPD. No time restriction
on oral cholera and oral typhoid
 YEL-AVD: Yellow Fever Associated Viscerotropic disease & YEL-AND: Yellow Fever
Associated Neurotropic disease.
 Administration of Yellow Fever Vaccine to breastfeeding females is a relative precaution due
to a theoretical risk of transmission of the 17D vaccine virus from nursing mother to infant. If travel
to an endemic area is required the vaccination with YF vaccine is a lesser risk than that of
acquiring the disease.
 Under extreme risk situations and after careful examination of associated risks & benefits,
immunization under these situations may be recommended with consultation of a physician
and/or MOH.