Childhood vaccines
at work in Canada
Presented by:
Date:
Location:
Presentation overview
The case for immunization
Vaccine safety
Vaccines in Canada
Myths, facts and commonly asked questions
Public policy
Resources
© 2010 Canadian Paediatric Society I www.cps.ca
Sources of information
Based on Your Child’s Best Shot:
A parent’s guide to vaccination
(3rd edition, 2006)
For updates including position statements from the
CPS Infectious Diseases and Immunization Committee
and current information for parents, visit the CPS
websites: www.cps.ca and www.caringforkids.cps.ca
Reviewed by the CPS Infectious Diseases and
Immunization Committee. Lead reviewers:
Dr. Bob Bartolussi and Dr. Dorothy Moore.
© 2010 Canadian Paediatric Society I www.cps.ca
The case for
immunization
© 2010 Canadian Paediatric Society I www.cps.ca
Why we immunize
• Vaccines save lives: A public health success story
• Vaccines are safe and effective: The diseases they prevent can
cause permanent disability or even death
• It’s a small world: Travel can spread rare diseases quickly
• Many vaccine-preventable diseases have no effective treatments
• For some diseases, like tetanus, infection does not produce
immunity: Vaccines produce immunity
… Last, but not least …
© 2010 Canadian Paediatric Society I www.cps.ca
…Vaccines protect everyone
• Directly: the person vaccinated, and
• Indirectly: people who are vulnerable to disease, eg., babies,
children, the elderly, people with a weak immune system
• Vaccines keep communities healthier: children in school,
parents working, people interacting normally
© 2010 Canadian Paediatric Society I www.cps.ca
How vaccines work
Immunology 101
• Bacteria and viruses have unique proteins and polysaccharides
(complex sugars) on their surfaces called antigens
• Immune system targets antigens using antibodies and lymphocytes
• Lymphocytes (a type of white blood cell): include B-cells, T-cells
and memory cells
• Memory cells enable the immune system to recognize germs it has
seen before, creating immune memory
© 2010 Canadian Paediatric Society I www.cps.ca
Immunity
• Long-lasting immunity depends on memory cells. Immune
memory is the ability the immune system acquires to identify the
presence of a germ and destroy it
• Two ways to achieve immunity: Natural infection or
immunization
– Natural infection causes illness and can lead to complications,
permanent damage, even death
– Vaccines protect without causing severe illness
© 2010 Canadian Paediatric Society I www.cps.ca
Immunology of vaccines
Types of vaccines
TYPE OF VACCINE
Killed, intact virus
EXAMPLES
Inactivated polio vaccine, hepatitis A vaccine
Killed, intact bacteria
Oral cholera vaccine (Dukoral)
Killed, disrupted virus
Influenza vaccine
Live, attenuated (weakened) bacteria
Oral typhoid vaccine, BCG vaccine (for TB)
Live, attenuated (weakened) or genetically modified virus
Measles, mumps, rubella, varicella, yellow fever
vaccines; oral polio, rotavirus vaccines; intranasal
influenza vaccine
Acellular pertussis vaccine, injectable typhoid vaccine
Purified bacterial protein
Purified bacterial polysaccharide (complex sugar)
Purified viral protein
Haemophilus influenzae type b, pneumococcal and
meningococcal vaccines
Hepatitis B vaccine, human papillomavirus vaccine
Inactivated bacterial toxin
Diphtheria and tetanus toxoids
© 2010 Canadian Paediatric Society I www.cps.ca
Vaccine success in Canada
DISEASE
AVERAGE NUMBER OF CASES AND RELATED DEATHS (per year)
Diphtheria
Before Vaccine
12,000 cases with 1,000 deaths
After Vaccine
0–5 cases with 0 deaths
Tetanus
60–75 cases with 40–50 deaths
0–2 cases and no deaths since 1991
Pertussis
30,000–50,000 cases with 50–100 deaths
3,000 cases with 1–5 deaths
Polio
2,000 cases in last epidemic in 1959
0
Hib
1,500 cases of meningitis and 1,500 cases of
infections of blood, bone, lungs, skin, joints
About 30 cases
Measles
95% of children had measles by age 18, or 300,000 Less than 50 cases with 0 deaths
cases with 300 deaths, and 300 children with brain
damage
30,000 cases
95 cases
Mumps
Rubella
85% of children have rubella by age 20, or 250,000 25 cases. 0–3 babies with congenital rubella
cases. About 200 cases of congenital rubella
syndrome born to unvaccinated mothers
syndrome
© 2010 Canadian Paediatric Society I www.cps.ca
Vaccine success in Canada (cont’d)
Meningococcus
AVERAGE NUMBER OF CASES AND RELATED DEATHS (per year)
Before Vaccine
After Vaccine
3,000 cases of severe disease
About 250 cases
(meningitis, bacteremia, pneumonia)
in children < age 5
300,000 cases
By 2007, an 85% reduction in hospitalizations in
provinces with early (2000-02) school programs;
a 65% reduction for later (2004-06) programs
20,000 new cases, with 480-500
< 1,000 cases
deaths
200-400 cases, with 20-40 deaths
Program too new to see full effect
Hepatitis A
10,000-20,000 cases
Program too new to see full effect
Human papillomavirus
(HPV)
1,350 cases of cervical cancer, with
400 deaths and 200 deaths from
other forms of cancer caused by
HPV
400,000 cases, with 2-4 deaths
in children under age 2
Program too new to see full effect
DISEASE
Pneumococcus
Varicella
Hepatitis B
Rotavirus
Program too new to see full effect
© 2010 Canadian Paediatric Society I www.cps.ca
Risks and benefits of vaccines
DISEASE
Diphtheria
EFFECTS OF DISEASE
Severe sore throat, marked weakness, nerve
damage, heart failure. Death in 10% of cases
Tetanus
Toxin affects nerve endings leading to painful
muscle spasms and seizures
Severe spasms of cough lasting 3–6 weeks,
pneumonia, convulsions. Brain damage or
death in 1 of every 400 infants
Muscle paralysis in 1 out of 100 persons
infected with polio. Death in severe cases
Meningitis kills in 5% of cases and leads to
brain damage and deafness in 10–15% of
survivors
Severe bronchitis, high fever, rash for 7–14
days; death in 1 per 1,000 cases; encephalitis
in 1 per 1,000 cases
Pertussis
Polio
Hib
Measles
Mumps
Fever, swollen salivary glands. No visible
illness in > 50% of cases. Encephalitis in 1 per
200 cases; deafness in 1 per 200,000 cases
SIDE EFFECTS OF VACCINE
DTaP vaccine: 20% of infants have local redness,
pain; < 5% have fever; more redness and swelling
with booster at 4–6 years
See above for DTaP. Local redness and pain
common with adult booster
See above for DTaP. The risk of brain damage after
pertussis vaccine is too small to be measured
IPV. No risk of disease from vaccine. Given
combined with DTaP (see above for side effects)
Given in combination with DTaP/IPV (see above for
side effects)
Given combined with mumps and rubella vaccines
(MMR). 5–10% have fever with or without rash 8–10
days after vaccine. No risk of disease from vaccine.
Risk of encephalitis 1 case per 1 million doses. 1 in
24,000 develops low platelets
See MMR above
© 2010 Canadian Paediatric Society I www.cps.ca
Risks and benefits of vaccines (cont’d)
DISEASE
Rubella
EFFECTS OF DISEASE
Fever, swollen glands, rash. No symptoms
in about 50% of cases. Severe damage to
fetus if mother infected during first
trimester of pregnancy
Pneumococcus
Deaths in approximately 30–50 children;
15–20% of survivors of meningitis have
brain damage, deafness
Hospitalization in 1,000 and death in
10 cases/year due to pneumonia,
encephalitis, severe skin infections;
shingles (zoster) later in life
Death from complication of chronic
infection (cirrhosis, liver cancer) or from
severe acute illness
Death in 10% of cases; brain damage,
deafness, amputations, skin loss in 10%
of survivors
Death from overwhelming liver damage in
a very small proportion of cases
Death from cervical and other forms of
cancer
Death from severe dehydration caused by
profuse, watery diarrhea
Varicella
Hepatitis B
Meningococcus
Hepatitis A
Human Papillomavirus
(HPV)
Rotavirus
SIDE EFFECTS OF VACCINE
Given combined with mumps and rubella
vaccines (MMR). 5–10% have fever with
or without rash 8–10 days after vaccine.
No risk of disease from vaccine. Risk of
encephalitis 1 case per 1 million doses.
1 in 24,000 develops low platelets
Minor local redness, swelling and pain in
15% of recipients
Minor local reaction; rash in about 5% of
children
Minor local redness, swelling and pain
Minor local redness, swelling and pain in
15% of recipients
Mild pain and redness at injection site
Mild pain and redness at injection site
No significant reactions
© 2010 Canadian Paediatric Society I www.cps.ca
Vaccine success stories
• Smallpox has been eradicated. No cases anywhere in the world
since 1979. Children are no longer vaccinated against smallpox
• Paralytic polio eliminated from most of the world. Today,
endemic in only four countries: Afghanistan, India, Nigeria,
Pakistan
– Cases dropped from 350,000 in 1988 to 1606 in 2009
– Recent outbreaks in former Soviet republics of Tajikistan,
Uzbekistan
– To completely eradicate polio, all children must be vaccinated
© 2010 Canadian Paediatric Society I www.cps.ca
Why we (still) immunize
• When vaccination rates decline, rates of disease increase
• Example: In the late 1980s, former Soviet Union states saw vaccine
supplies disrupted, collapse of their public health system and
socioeconomic instability
• Result: decrease in childhood immunization rates
• Diphtheria epidemic followed: more than 150,000 cases and more
than 4,000 deaths in the newly independent and Baltic states
• Mass vaccination program eventually controlled the epidemic
• Lesson: Complacency can be fatal
© 2010 Canadian Paediatric Society I www.cps.ca
Why outbreaks (still) occur
Outbreaks occur for different reasons, such as:
• Public doubt: In the early 2000s, a flawed autism/MMR study in
the U.K. led to decline in measles vaccination
– Results: Increase in local measles infection rates and deaths, and
spread of measles to other countries
– Lesson: Vaccination must continue to prevent disease outbreaks
• Travel: Measles and mumps have been introduced into Canada by
travellers, causing local outbreaks
• 2008: Polio spread by travellers from the 4 countries where it
remains endemic to 20 others
– Lesson: It’s a small world! Travel can spread a rare disease very
quickly
© 2010 Canadian Paediatric Society I www.cps.ca
Why outbreaks (still) occur (cont’d)
Waning immunity: Large mumps outbreak in 2007-08. Started in
Nova Scotia, spread to New Brunswick and Alberta, with sporadic
cases elsewhere
• Mainly affected 20 to 29-year-olds in school settings
• Prompted recommendation for a second dose of vaccine for high
school, college/university students who had received only one dose
in early childhood
• Lesson: There may be a need for a second “booster” dose of
mumps vaccine
© 2010 Canadian Paediatric Society I www.cps.ca
Vaccine safety
© 2010 Canadian Paediatric Society I www.cps.ca
How vaccines are approved
for use in Canada
• The Biologics and Genetic Therapies Directorate (BGTD),
Health Canada, reviews and approves all vaccines for human use in
Canada
• To be approved, vaccine providers must meet acceptable standards
of safety, quality (efficacy)
• Production: All aspects of production are supervised by the BGTD
• Safety: BGTD does independent lab testing to evaluate safety and
efficacy of early batches of vaccine
• Quality: Specified by the BGTD, and repeatedly tested by lot
sampling before and after vaccine is released for sale
© 2010 Canadian Paediatric Society I www.cps.ca
Recommendations for
vaccine use
• NACI: National Advisory Committee on Immunization makes
recommendations to the Chief Public Health Officer
• CIC: Canadian Immunization Committee assesses NACI
recommendations and advises on operational plans
• Provinces/territories use NACI and CIC recommendations to
develop immunization programs
• NACI’s Canadian Immunization Guide: Web-based guidelines
from the Public Health Agency of Canada, published every 4 years
(most recent edition 2010), at www.phac-aspc.gc.ca
• Canadian Paediatric Society: Infectious Diseases and
Immunization Committee’s position statements, at www.cps.ca
© 2010 Canadian Paediatric Society I www.cps.ca
Monitoring vaccine safety
• Adverse events: Health effects occurring after immunization that
may or may not be related to the vaccine
• Mild adverse events, such as fever and swelling at the injection site,
are common. More serious reactions are rare
• Post-marketing surveillance of adverse events: The system for
reporting and reviewing adverse events once a vaccine has been
approved for use
• Information gets to the Public Health Agency of Canada through
doctors and nurses reporting to health officials
• Doctors and nurses providing vaccines should know the local
procedure for reporting vaccine adverse events to public health
© 2010 Canadian Paediatric Society I www.cps.ca
Entities involved in monitoring
vaccine safety
• Canadian Adverse Events Following Immunizations Surveillance
System (CAEFISS): Receives reports from doctors, nurses
• Advisory Committee on Causality Assessment (ACCA): Reviews all
reported cases of serious adverse events
• IMPACT: Immunization Monitoring Program, ACTive
• The Vaccine Adverse Event Reporting System (VAERS): Postmarketing safety surveillance program in the U.S.
• Institute of Medicine (IOM, U.S.): Immunization Safety Review
Committee
• GACVS (WHO): Global Advisory Committee on Vaccine Safety
© 2010 Canadian Paediatric Society I www.cps.ca
Vaccines in Canada
© 2010 Canadian Paediatric Society I www.cps.ca
Routine childhood vaccines
• 5-in-1 (DTaP-IPV-Hib): Protects
against diphtheria, tetanus,
pertussis, polio, and bacterial
infections caused by Hib
(Haemophilus influenzae type b),
including meningitis (a brain
infection), and other serious
infections
• MMR: Protects against measles,
mumps, and rubella
• Hepatitis B vaccine
• Varicella (chickenpox) vaccine
• Seasonal influenza (“flu”) vaccine
• Tdap: Tetanus, diphtheria and
pertussis booster for teens and
adults
• Pneumococcal vaccine: Protects
against bacterial infections caused by
Streptococcus pneumoniae, including
meningitis, pneumonia, and ear
infections
• Meningococcal vaccine: Protects
against bacterial infections caused by
Neisseria meningitidis, including
meningitis and septicemia, a serious
blood infection
• HPV vaccine: Protects against human
papillomavirus types that cause
cervical/vaginal cancer and genital
warts
• Rotavirus vaccine: Prevents
rotavirus diarrhea
© 2010 Canadian Paediatric Society I www.cps.ca
Additional vaccines or a
“catch-up” schedule
• Children with certain chronic conditions or who travel outside of
North America may require additional vaccines
• Children new to Canada may not have received vaccines which are
routine here
• Children who move within Canada may miss a dose of vaccine
because schedules are not uniform across the country
© 2010 Canadian Paediatric Society I www.cps.ca
Contraindications to
vaccination
• Anaphylactic or other serious allergic reaction after receiving a
vaccine is a contraindication to further doses of that vaccine
• People with certain immune system disorders should not be given
live vaccines (eg., measles, mumps, rubella, varicella, oral
typhoid)
• Avoid live vaccines during pregnancy, except when expected
benefits to mother and baby outweigh risk
© 2010 Canadian Paediatric Society I www.cps.ca
Precautions
Delay giving vaccine if child has:
• Moderate to severe illness
• People treated with blood products should not get a live vaccine
(eg., measles, mumps, rubella, varicella) for 3 months or more.
Depending on the blood product and dose received, these vaccines
may not work
Don’t delay vaccination because of minor illness (eg., a cough or
cold, with or without fever).
© 2010 Canadian Paediatric Society I www.cps.ca
Diphtheria
• Caused by a toxin made by bacteria that infect the nose, throat or
skin
• Can cause breathing problems, heart failure, nerve damage,
kidney failure
• About 1 person in 10 dies
• Spread by close, direct contact with droplets from a cough or
sneeze
• Before 1900, one of the main causes of childhood death. An
estimated 12,000 cases/year in Canada, with 100 deaths
• 1924: 9,000 cases in Canada
• Routine immunization of Canadian children after 1930
• Since 1983:  5 cases/year, no deaths
© 2010 Canadian Paediatric Society I www.cps.ca
Diphtheria vaccine
• Inactivated bacterial toxin
• Given with tetanus, acellular pertussis, polio and Hib vaccines as
5-in-1
• Also given with tetanus and pertussis as a booster in adolescence
• Also given with tetanus as a booster—recommended every 10
years for adults
• Common local reactions: redness, swelling, pain and tenderness at
the injection site
• Only contraindication: anaphylactic or other serious allergic
reaction to a previous dose of the vaccine
© 2010 Canadian Paediatric Society I www.cps.ca
Tetanus
• Caused by a toxin made by bacteria that block normal control of
nerve reflexes in the spinal cord: also known as “lockjaw”
• Not contagious: Spread through spores (seed-like cells) in the
environment, especially contaminated soil and dust
• Before vaccine: 60-75 cases/year in Canada, with 40-50 deaths
• Routine immunization began in 1944
• Today  2 cases/year in Canada
• Since tetanus spores are in the environment, vaccination is the
only means of prevention
• Tetanus infection does not produce immunity to tetanus
• In countries without vaccination, tetanus still kills
© 2010 Canadian Paediatric Society I www.cps.ca
Tetanus vaccine
• Inactivated bacterial toxin
• Most often given with diphtheria, acellular pertussis, polio and
Hib vaccines as 5-in-1
• Also given with diphtheria and pertussis as a booster in
adolescence
• Also given with diphtheria as a booster—recommended every
10 years for adults
• Common local reactions: redness, swelling, pain and tenderness
at the injection site
• Only contraindication: an anaphylactic or other serious allergic
reaction to a previous dose of the vaccine
© 2010 Canadian Paediatric Society I www.cps.ca
Pertussis
•
•
•
•
•
•
Respiratory infection caused by bacteria: “whooping cough”
Causes severe coughing spells followed by a “whoop” sound
Lasts 6 to 12 weeks
20-30% of infants with pertussis will be hospitalized
1 in 400 infants will have brain damage
Very contagious: Spread by close, direct contact with droplets
from a cough or sneeze
• Before vaccine: 30,000-50,000 cases/year with 50-100 deaths
• Today: 3,000 cases in Canada, with about 5 deaths each year
• Recent years: increasing number of cases in teens, young
adults. Pertussis still a common cause of chronic cough
(> 2 weeks) in teens and adults
© 2010 Canadian Paediatric Society I www.cps.ca
Pertussis vaccine
•
•
•
•
•
•
•
•
•
Whole-cell vaccine introduced in Canada in 1943
Acellular pertussis replaced whole-cell vaccine in 1997
Purified bacterial proteins: fewer side effects
Given with diphtheria, tetanus, polio and Hib vaccines as 5-in-1
Also given to older children, teens and adults as a booster,
combined with Td
Immunizing parents, adults working with children protects
babies too young to be fully immunized
Does not prevent infection in everyone but effective in reducing
severity of illness and the risk of complications
Minor local side effects are common
Only contraindication: anaphylactic or other serious allergic
reaction to a previous dose of the vaccine
© 2010 Canadian Paediatric Society I www.cps.ca
Polio
• Caused by poliovirus
• Before 1955, a common infection in Canada
• Most infections asymptomatic (no symptoms) or mild, but 1-5%
cause meningitis and 1%, paralytic polio
• Virus in throat and feces of people who are infected: spreads by
close direct contact with throat secretions and indirect contact
(eg., contaminated hands, water, food)
• 1959: last epidemic in Canada, with 2,000 cases of paralytic polio
• Children ages 5 to 9 years the most affected.
• 1989: last case of paralytic polio due to poliovirus in Canada
• 2008: still seen regularly in 4 countries, and can be spread by
travellers
© 2010 Canadian Paediatric Society I www.cps.ca
Polio vaccine
• IPV (inactivated polio vaccine): killed, intact virus
• Given with diphtheria, tetanus, pertussis and Hib vaccines as
5-in-1
• OPV (oral polio vaccine): live, attenuated virus. Not used in
Canada since 1997-98, but still used in many countries
• Side effects of IPV are rare
• Effective and long-lasting: After 3 doses, 100% of infants develop
antibodies against all 3 types of poliovirus
• Only contraindication to IPV: an anaphylactic or other serious
allergic reaction to a previous dose of the vaccine
© 2010 Canadian Paediatric Society I www.cps.ca
Haemophilus influenzae type B (Hib)
• Not to be confused with seasonal influenza or “flu”
• Young children most at risk
• Until 1985, the most common cause of bacterial
meningitis in Canada: 1,500 cases/year in children
 5 years old
• Another 1,500 cases/year with serious infections (eg.,
of the blood, epiglottis, lungs, joints, bones and skin)
• Meningitis: infection of the fluid and membranes
covering the brain and spinal cord
• Without treatment, all children with Hib meningitis die
• Complications from Hib meningitis: brain damage,
developmental delay, speech and language disorders,
deafness
• Not highly contagious: Hib bacteria in mouth, nose
secretions spread by close, prolonged exposure or
contact with droplets from a cough or sneeze
© 2010 Canadian Paediatric Society I www.cps.ca
A recent
success story
1986: vaccine
approved for
use in Canada
Since 2000:
5-16 cases/
year of invasive
Hib disease in
children
Hib disease is
disappearing
from every
country with
routine
immunization
for infants
Hib vaccine
• Purified bacterial polysaccharide linked to a protein carrier, such
as diphtheria or tetanus toxoid
• Given with diphtheria, tetanus, pertussis and polio vaccines as
5-in-1
• Protects child against Hib and helps decrease spread among
children generally
• Local redness and pain in 5-15% of infants
• Only contraindication: anaphylactic or other serious allergic
reaction to a previous dose of the vaccine
© 2010 Canadian Paediatric Society I www.cps.ca
Pneumococcal disease
• Streptococcus pneumoniae: most common cause of
meningitis and other invasive, serious bacterial
infections in children in Canada, especially in children
< 2 years of age
• Older children, teens and adults with certain chronic
conditions are also at higher risk
• Infection starts in nose or throat. Many people are
asymptomatic carriers (have no symptoms)
• Not highly contagious, but spreads through close, direct
contact: children in day care more at risk
• Local infections: acute otitis media, acute sinusitis, acute
bronchitis, pneumonia
• Invasive infections: meningitis, bacteremia, septicemia,
endocarditis, septic arthritis, osteomyelitis, peritonitis
• Many pneumococci are becoming antibiotic-resistant
© 2010 Canadian Paediatric Society I www.cps.ca
A recent
success story
Since routine
vaccination of
infants began in
2005: 94%
decrease in
invasive disease
in children < 2
years old
Indirect effect:
decreased
exposure has led
to a 91%
decrease in
invasive disease
in the elderly
Pneumococcal vaccine
• Two types available: polysaccharide and conjugate
• Polysaccharide: not effective in children < 2 years of age. Used in older
children, teens and adults. Contains the 23 serotypes that cause > 90% of
serious infections
• Conjugate: approved in 2001. Effective at 2 months of age. Contains
7 serotypes. Vaccines containing 10 and 13 serotypes were recently
licensed in Canada and have replaced the 7-serotype vaccine in some
jurisdictions
• Vaccines have dramatically reduced local and invasive forms of
infections in all age groups
• Strains that cause serious infections reduced by 40-50%
• Local reactions: redness, swelling, pain and tenderness at injection site in
10-20% of people
• Only contraindication: an anaphylactic or other serious allergic reaction
to a previous dose of the vaccine
© 2010 Canadian Paediatric Society I www.cps.ca
Meningococcal disease
• Neisseria meningitides: can cause meningitis, bacteremia, septicemia and
other invasive infections
• Before vaccine, 200-400 cases of invasive infection/year in Canada, with
20-40 deaths. Since 2001, rate in Canada has decreased, to about 200
cases/year
• People with certain chronic diseases are at higher risk
• Death from serious disease in 5% of cases, even with treatment, and can
occur within 6-12 hours of first signs of illness
• Meningococcal bacteria are fragile and infections are not very contagious
• Most spread occurs via healthy carriers—about 1 in 5 adolescents and
adults—by close, direct contact with mouth secretions, respiratory droplets
• 5 serogroups (A, B, C, Y, and W135) cause nearly all infections in Canada,
with Groups B and C causing the most illness
• Infections caused by serogroups A, B, Y, and W135 will likely drop, now
that conjugate quadrivalent vaccine (MCV4) is available in Canada
© 2010 Canadian Paediatric Society I www.cps.ca
Meningococcal vaccine
Vaccine Type Introduced
in Canada
Given to
Duration
Effective Result
against
C conjugate
2001-05
Infants, children
< 2 years, with a
booster at age 12
Immune memory
occurs: Program too
new to see full effect
Group C
only
Conjugate
quadrivalent
(MCV4)
2007
Children age 2
years and older,
with a booster at
age 12
Immune memory
occurs: Program too
new to see full effect
A, C, Y,
W135
Meningococcal C
infection rates down
by 50% in 2006
• A routine booster dose of either conjugate C or MCV4 is recommended for all
children at about age 12
• More frequent boosters may be needed for people at higher risk of
meningococcal infections
• There is no vaccine available against type B meningococcus
• Mild local reactions (redness, swelling, pain or tenderness at the infection site)
reported for all vaccine types in 10-20% of people
• Only contraindication is an anaphylactic or other serious allergic reaction to a
previous dose of the vaccine
© 2010 Canadian Paediatric Society I www.cps.ca
Measles
• Severe viral infection. Causes high fever, runny nose, cough, conjunctivitis, rash
of 1-2 weeks. Pneumonia is common (1-6% of cases)
• Encephalitis: 1 in 1,000 cases, can lead to brain damage or death
• Rare cases: SSPE (subacute sclerosing panencephalitis)
• Highly contagious: Spreads by direct contact and through the air. Germs
become airborne in a cough or sneeze
• Before vaccine: large epidemics every 2-3 years. Most children had measles,
usually by 18 years of age
• 300,000 cases/year in Canada, with 300 deaths and 300 children with brain
damage
• Vaccine approved in 1963; two-dose schedule in 1996-97
• 2001-06: fewer than 20 cases/year
• 2007 outbreak in Quebec: 95 cases, almost all in persons who refused
vaccination
• 2008 outbreak in Ontario: in over 50 cases, most had received only one dose
of vaccine or had never been vaccinated
© 2010 Canadian Paediatric Society I www.cps.ca
Measles vaccine
• Live, attenuated (weakened) virus
• Given with mumps and rubella vaccines as MMR or with varicella as MMR-V
• 2 doses required, since about 5% of vaccinated children remain unprotected after
first dose
• Mild side effects: fever (in 5-10% of children) or rash (in 2% of children)
• Severe adverse events rare: risk of encephalitis is less than 1 case per one million
doses
• No evidence of links to other diseases/disorders (such as autism, developmental
delay, Crohn’s disease, ulcerative colitis)
Contraindications:
• Allergic reaction to neomycin, gelatin, or a previous dose of the vaccine
• Certain immune system disorders
• Pregnancy
Precautions:
• Delay vaccine for moderate to severe illness
• Delay vaccine for 3 months or more for anyone who has received blood products,
as the vaccine may not work
© 2010 Canadian Paediatric Society I www.cps.ca
Mumps
• Viral infection that can cause fever, headache and swelling of salivary
glands around the jaw and cheeks
• Can also cause a mild form of meningitis (in 1 in 10 cases) or severe
encephalitis, leading to brain damage
• Complications: deafness, swelling of testicles, infection of ovaries and
(rarely) sterility
• Virus in mouth and nose secretions spreads easily by close, direct contact
and in droplets from a cough or sneeze
• Before vaccine, over 30,000 cases/year reported in Canada
• Vaccination programs began in the 1970s
• Cases dropped to < 400/year with one-dose schedule, and to an average
79 cases/year in 2000-06, with a two-dose schedule
• Increasing numbers of cases in adolescents and young adults since
2007 may reflect waning immunity after single dose of vaccine
© 2010 Canadian Paediatric Society I www.cps.ca
Mumps vaccine
• Live, attenuated virus
• Given in combination with measles and rubella vaccines as MMR or
with varicella as MMR-V: 2 doses
• Side effects are rare: Meningitis reported to occur in 1 case per 800,000
doses
Contraindications:
• Allergic reaction to neomycin, gelatin, or a previous dose of the vaccine
• Certain immune system disorders
• Pregnancy
Precautions:
• Delay vaccine for moderate to severe illness
• Delay vaccine for 3 months or more for anyone who has received blood
products, as the vaccine may not work
© 2010 Canadian Paediatric Society I www.cps.ca
Rubella
• Viral infection, also known as German measles
• Can lead to fever, sore throat, swollen glands, rash
• Usually mild in children. More severe in teens and adults: arthralgias,
arthritis are common in adults
• In pregnancy, can infect the fetus, causing severe disabilities: congenital
rubella syndrome (CRS), which can result in heart disease, deafness,
cataracts, mental retardation
• Spreads by direct contact with mouth or nose secretions and droplets from
a cough or sneeze. Less contagious than chickenpox or measles
• Before vaccine, 85% of children had rubella by age 20: 250,000 cases/year,
with 200 cases of congenital rubella syndrome
• Worldwide epidemic in 1964: In U.S., ~30,000 babies infected during first
20 weeks of pregnancy. Of those, ~20,000 cases of CRS and 8,000 deaths
• Since routine immunization began in 1980: Only 0-3 babies with CRS are
born in Canada each year to unvaccinated mothers
© 2010 Canadian Paediatric Society I www.cps.ca
Rubella vaccine
• Live, attenuated virus
• Given to infants with measles and mumps vaccines as MMR or with
varicella as MMR-V: 2 doses
Contraindications:
• Allergic reaction to neomycin, gelatin, or a previous dose of vaccine
• Certain immune system disorders
• Pregnancy
Precautions:
• Delay vaccine for moderate to severe illness
• Delay vaccine for 3 months or more for anyone who has received blood
products, as the vaccine may not work
© 2010 Canadian Paediatric Society I www.cps.ca
Rubella vaccine and pregnancy
• Women of child-bearing age should be tested for immunity to rubella
before first pregnancy
• Women not immune and not pregnant should be vaccinated
• If pregnant and not immune, delay vaccine, but mother should be
vaccinated as soon as possible after delivery for future protection
• Side effects of vaccine rare in infants
• 25% of vaccinated women experience joint pain
© 2010 Canadian Paediatric Society I www.cps.ca
Varicella (chickenpox)
•
•
•
•
•
•
•
•
•
Caused by varicella-zoster virus
Fever, headache, aches and pains, and itchy rash
Usually a mild (but costly) disease: Parents often stay home for
3 days; 30-65% of children are brought to a clinic or hospital
Can lead to complications such as pneumonia, bacteremia, or
severe skin infections
Illness is more severe, and complications more common, in
teenagers and adults
Severe cases can pose serious health risks, especially for
newborn babies, adults, or anyone with a weakened immune
system
Highly contagious: Viruses from the throat and scratched
skin lesions spread easily through the air. Also spreads by
contact with rash
Contagious 2 days before rash appears until the last blister has
crusted—usually about 5 days after rash begins
Virus remains dormant in the nervous system and can be
reactivated later to cause shingles (zoster)
© 2010 Canadian Paediatric Society I www.cps.ca
A recent success
story
Before vaccine
> 300,000 cases/year
(95% of Canadians
got chickenpox)
Number of children
hospitalized with
varicella has dropped
dramatically since
vaccination programs
began. By 2007, an
84% reduction in
hospitalizations in
provinces/territories
with early (2000-02)
programs; a 65%
reduction for later
(2004-06) programs
Varicella vaccine
•
•
•
•
•
•
•
•
Live, attenuated virus
85-90% effective in preventing chickenpox and 100% effective in preventing moderate to
severe disease
2 doses of vaccine now recommended for all children > one year of age (previously,
2 doses given only to people vaccinated at ≥ 13 years of age)
Duration of protection at least 20 years—possibly lifelong
Mild local reactions in about 20% of children
Vaccine-modified disease does occur but is uncommon, and the illness less severe
Transmission of vaccine virus from healthy vaccinated children to susceptible contacts is rare
Given as varicella vaccine or in combination as MMR-V
Contraindications:
• Allergic reaction to neomycin or gelatin, or to a previous dose of the vaccine
• Certain immune system disorders
• Pregnancy
Precautions:
• Delay vaccine for moderate to severe illness
• Delay vaccine for 3 months or more for anyone who has received blood products, as the
vaccine may not work
© 2010 Canadian Paediatric Society I www.cps.ca
Hepatitis B
• Viral infection of the liver
• Half of infected people have no symptoms. Other half
become ill: fever, fatigue, loss of appetite and jaundice,
which may last weeks or months
• 10% of those infected become chronic carriers, who
may develop liver disease or cancer years later
• Spread through blood and genital secretions. Found in
very low concentrations in saliva, but not in breast milk
• Sexual activity and shared needles the most common
means of spread in Canada
• Can be passed by an infected mother to her child during
pregnancy or delivery
• Before vaccine, nearly 500 deaths/year in Canada and
about 1 person in 200 was a chronic carrier
© 2010 Canadian Paediatric Society I www.cps.ca
A recent
success story
Since 1997,
average number
of new cases
/year in Canada
has decreased
from 20,000 to
about 1,000
School
vaccination
programs have
reached more
than 90% of
eligible children
Hepatitis B vaccine
• Purified viral protein
• Available alone or with hepatitis A vaccine
• No uniform schedule for routine immunization, but school programs are
widespread. In some provinces/territories, vaccine given during infancy
• Recommended for:
– Newborns of mothers who have hepatitis B
– Children attending child care programs and their caregivers
– All children before or in early adolescence
– People travelling to countries where there is a risk of contracting
hepatitis B
– Children under 7 years of age who have immigrated to Canada from
areas with high rates of hepatitis B
– Household or close contacts of an infected person
– People who are at higher risk of contact with blood, such as:
• health care workers
• patients on hemodialysis (treatment for kidney disease)
© 2010 Canadian Paediatric Society I www.cps.ca
Hepatitis A
• Infection of the liver caused by hepatitis A virus
• Many young children have no symptoms or fever only, but they are still
contagious and can infect others
• Adolescents and adults more likely to become ill
• Infection causes fever, fatigue, loss of appetite, nausea, vomiting and
jaundice
• Does not cause chronic hepatitis
• Spreads through contact with stool, which contains virus for as long as
14 days before onset of symptoms. Also through contaminated water or
food
• Infection most common in travellers to countries where hepatitis A is
endemic, and in Canadian communities where basic sanitation, clean
water supply are inadequate
• Before vaccine, 10,000-20,000 cases/year in Canada
© 2010 Canadian Paediatric Society I www.cps.ca
Hepatitis A vaccine
•
•
•
•
•
•
Killed, intact virus vaccine
Not on the routine childhood immunization schedule, except in Quebec
> 95% effective in preventing infection
Not recommended for children < 1 year of age
For longer protection, 2 doses given 6 to 12 months apart are recommended
Recommended for:
– People travelling to places where hepatitis A is common, including
children of new Canadians who visit relatives abroad
– People with chronic liver disease or hemophilia
– Communities lacking adequate sanitation or safe water supply
– People in hazardous occupations (eg., relief workers, sewer workers) or
with riskier lifestyles (eg., illicit drug users, men who have sex with men)
– Close contacts of known cases
• Local reactions: mild pain and redness at injection site
• Only contraindication: anaphylactic or other serious allergic reaction to a
previous dose of the vaccine
© 2010 Canadian Paediatric Society I www.cps.ca
Seasonal influenza (flu)
• Influenza virus causes yearly epidemics of respiratory illness
• Can cause periodic pandemics when the virus changes suddenly and no one
is immune
• During outbreaks, hospitalization rates for infants and the elderly increase
• Highly contagious: spreads in respiratory secretions, on contaminated
hands, droplets from a cough or sneeze, and on contaminated objects or
surfaces
• Spreads easily in schools and child care settings. Children bring the infection
home to family members
• Complications of flu in young children can include: pneumonia, otitis media,
febrile seizures, severe muscle inflammation, and encephalopathy
• Annual seasonal influenza shot is recommended for people at high risk of
complications from the flu, including:
– all children aged 6 to 23 months, and older children with certain chronic
disorders
– parents, siblings, household contacts and caregivers of high-risk children
© 2010 Canadian Paediatric Society I www.cps.ca
Influenza (flu) vaccine
• Killed, disrupted virus, with vaccine strains changing every year
• Virus changes every year: annual vaccination in fall needed to protect
against seasonal flu
• First year of immunization: children < 9 years old need 2 doses, 4 weeks
apart
• Local reactions in 10-50% of recipients: soreness at injection site for
1-2 days
• Some vaccines contain a trace amount of thimerosal (0.01% /dose, or
100 parts per million), to prevent bacterial contamination
• Not recommended for:
– children < 6 months old (not effective)
– people with anaphylactic or other serious allergic reaction to eggs or to
a previous dose of the vaccine
• People allergic to thimerosal should receive thimerosal-free vaccine
© 2010 Canadian Paediatric Society I www.cps.ca
A new flu vaccine
• A live, attenuated intranasal vaccine (LAIV) licensed in Canada in
2010
• Not yet funded by any province/territory, or incorporated into any
public program
• Licensed for all healthy children > 2 years of age, and all healthy
persons younger than 59 years of age
• Some evidence that in children it works better than inactivated flu
vaccine
• Vaccine strains are adapted to grow only in the nasal passages, where
they induce immunity but cannot invade the body
• The flu strains vary each year and are the same ones included in the
inactivated vaccine
Pandemic vs. seasonal influenza
In a pandemic:
• Influenza virus changes suddenly, spreads quickly around the world, and
no one—or only a very small segment of the population—has immunity
to the new virus
• Populations at risk of developing severe illness may be different than
during yearly seasonal influenza
• Seasonal influenza vaccine is ineffective against the new virus strain
© 2010 Canadian Paediatric Society I www.cps.ca
Pandemic influenza vaccine
Global, national and regional health authorities respond to a declared
pandemic by:
• Being prepared. Government, health authorities worldwide:
– activate pandemic plans for health care workers and the general public,
to prevent spread and protect groups most vulnerable to severe illness
– conduct aggressive messaging on how to minimize spread of the new
strain (eg., wash hands, cough into a sleeve not hands, and stay home
if ill)
• Surveillance. Positive cases are tracked, monitored and reported
• Immunization. A pandemic influenza vaccine intended for at-risk
populations anywhere in the world is developed and tested:
– vaccine becomes available in allotments, not all at once
– new vaccines go through a stiff approval process to ensure high quality
© 2010 Canadian Paediatric Society I www.cps.ca
Human papillomavirus (HPV)
• Most common sexually transmitted infection in Canada
• Prevalence in Canada: between 11% and 29%
• Highest rates of HPV acquisition occur in the first 5 years following onset
of sexual activity. About 3 in 4 sexually active Canadians are infected at
some point
• Usually no symptoms, but HPV is the major cause of cervical and vaginal
cancer in women. Can cause genital warts in both men and women
• An average 1,350 cases of cervical cancer diagnosed/year in Canada,
with 400 deaths, and 200 deaths from other forms of cancer caused by
HPV
• HPV vaccine highly effective in preventing infection with the most
common cancer-causing types of HPV
• Vaccination programs are still too new for data on the long-term effect on
disease rates
© 2010 Canadian Paediatric Society I www.cps.ca
HPV vaccine
• Purified viral protein vaccine
• 2006: Vaccine approved for use in Canada in girls/women 9 to 26 years of
age
• 2007: Federal government announced funding to implement HPV
immunization programs
• 2010: Quadrivalent vaccine approved for use in both females and males
ages 9 to 26. NACI reviewing recommendations with a view to expanding
school programs to boys and young men
• Bivalent vaccine against HPV-16 and -18 and quadrivalent vaccine against
HPV-6, -11, -16 and -18 genotypes
• Either vaccine needs to be given before the onset of sexual activity,
between the ages of 9 and 13 years of age
• Local reaction: soreness at injection site for 1-2 days
• Only contraindication: an anaphylactic or other serious allergic reaction to
a previous dose of the vaccine
• Mild to moderate illness not a reason to delay vaccination
© 2010 Canadian Paediatric Society I www.cps.ca
Rotavirus
• Leading cause of acute diarrhea in babies and young children
worldwide: at least 20% of all childhood gastroenteritis caused by
rotavirus
• Almost all children are infected by 5 years of age
• Outbreaks usually happen February to May
• Causes fever, vomiting, severe watery diarrhea, and rapid dehydration in
young children who cannot keep down enough fluid
• Death is rare in Western countries, but in the developing world rotavirus
kills as many as 5 in 100 children before their 5th birthday
• Highly contagious before and after symptoms develop: viruses in
stool spread easily by contact with contaminated hands, objects or
surfaces that then touch the mouth
• Vaccine effective in preventing severe disease and hospitalization due to
rotavirus infection
© 2010 Canadian Paediatric Society I www.cps.ca
Rotavirus vaccine
• 2010: Recommended for routine use in Canada
• Two live, attenuated (weakened) oral vaccines available for preventing rotavirus
gastroenteritis in infants 6 to 32 weeks of age
• Both safe, effective, and given orally, in liquid form
• Given in 2 or 3 doses, usually at 2, 4 and 6 months of age. First dose must be
given between 6-14 weeks of age, and all doses completed before 8 months of
age
• Doses are given at least 4 weeks apart
Contraindications:
• Anaphylactic or other serious allergic reaction to a previous dose of the vaccine
• A history of bowel obstruction
• Disorders of the immune system (as safety data is not yet available)
Precautions
• A weakened immune system
• Delay vaccine for moderate to severe illness, especially diarrhea
© 2010 Canadian Paediatric Society I www.cps.ca
Myths, facts and
commonly asked
questions
© 2010 Canadian Paediatric Society I www.cps.ca
Myth:
Vaccines can cause brain damage and other
illnesses that can’t otherwise be explained
FACTS:
• Vaccinations are frequently given in early infancy
• Brain abnormalities are often not recognizable this early.
Diagnosis of cerebral palsy, mental retardation or developmental
delay are usually not made until a child is several months old
• An abnormality is often recognized only after one or more
vaccine doses have been given, but this does not mean the
vaccine caused the problem
© 2010 Canadian Paediatric Society I www.cps.ca
Myth:
Rates of disease were declining before the
use of vaccines
FACT:
Not so. There were fewer deaths from some diseases (eg., measles,
diphtheria) because of improved nutrition and health care, but for
other diseases (eg., polio) healthy children continued to die or
become disabled
© 2010 Canadian Paediatric Society I www.cps.ca
Myth:
Compulsory vaccination violates civil rights
FACT:
Vaccination is not compulsory. But not vaccinating puts others at
risk of disease, compromising their rights
© 2010 Canadian Paediatric Society I www.cps.ca
Myth:
Infections like measles stimulate the immune
system
FACT:
No infection acts as a general stimulus to the immune system.
Measles and influenza actually suppress the immune system.
© 2010 Canadian Paediatric Society I www.cps.ca
The autism myth: MMR
• 1998: The Lancet published a study led by Dr. Andrew Wakefield,
which appeared to link vaccine with autism
• Caused MMR immunization rates to drop in Britain  measles
outbreak
• The study itself has since been thoroughly discredited
• March 2004: 10 of original study’s 13 authors published a retraction of
their interpretation in The Lancet
• January 2010: U.K.’s regulating General Medical Council, found
Wakefield had acted “dishonestly and irresponsibly” in doing his
research
• February 2010: Editors at The Lancet fully retracted Wakefield’s paper
from the published record
• May 2010: Wakefield was struck off the medical registry in the U.K.
• Many recent, large studies by major medical bodies have repeatedly
shown no causal link between MMR vaccine and autism
© 2010 Canadian Paediatric Society I www.cps.ca
The thimerosal myth
• Thimerosal: A preservative used to prevent growth of bacteria and fungi in
multidose vials of vaccines
• Not added to single-dose vaccines
• In the body, metabolized to ethyl mercury
• 1999: Concern in the U.S. about possible toxicity of ethyl mercury
• 2004: U.S. Institute of Medicine review found no evidence of relationship
between thimerosal and autism or any other neurological disease. More
recent studies confirm their findings
• Diagnoses of autism continued to increase after thimerosal was removed
from childhood vaccines
• Thimerosal is a component in only one vaccine for routine immunization of
Canadian children—flu vaccine—which is generally marketed in multidose
vials
• A thimerosal-free, stable, influenza vaccine is also available for children
• Still used as a preservative in certain vaccines produced for adults, not
children
© 2010 Canadian Paediatric Society I www.cps.ca
Commonly asked questions
Won’t breastfeeding protect babies from
infection?
• Breast milk is the ideal food for babies. It provides important
nutritional and immune factors, and contains antibodies that help
prevent some infections.
• However, this protection is incomplete and breast milk does not
protect against all infections preventable by vaccines
• Breastfeeding is not an alternative to immunization and does not
enhance responses to vaccines
• Protection decreases rapidly when breastfeeding stops
© 2010 Canadian Paediatric Society I www.cps.ca
Commonly asked questions
Is “natural” immunity more effective?
• Immunity after most vaccines is just as effective as that induced by
disease, without the risks of disease
• Every vaccine-preventable infection can cause serious harm
• Immune response to natural infection may be too late to prevent
serious harm
• With vaccines, the immune system is stimulated to develop
protection against the disease without full-blown infection
© 2010 Canadian Paediatric Society I www.cps.ca
Commonly asked questions
Shouldn’t vaccines be delayed until children
are older and there is less risk of side effects?
• No evidence that side effects are more common in infants or
babies than in older children
• Delaying vaccination leaves very young children at risk of
complications and death from common diseases (eg., pertussis,
Hib and pneumococcal infections are more severe for babies)
© 2010 Canadian Paediatric Society I www.cps.ca
Commonly asked questions
Can too many vaccines overload a baby’s
immune system?
• Infants can respond to about 10,000 different antigens at any one
time
• Bacteria and viruses expose an infant to large numbers of antigens
at once—far more than are found in vaccines
• Giving combined vaccines and multiple shots means fewer needles
for a child
© 2010 Canadian Paediatric Society I www.cps.ca
Commonly asked questions
Since most other children are vaccinated
and diseases are disappearing, why bother
vaccinating my child?
• As long as a vaccine-preventable disease exists somewhere in the
world, any unimmunized child is at risk:
– A traveller may bring the disease to any area
– A child may travel to an area where the disease is more common
• Vaccination does not get rid of some germs (eg., pneumococcus)
which may still be carried by older children and adults
• Tetanus bacteria are present in soil and dust everywhere in the
world. Any child can be infected from a dirty wound
© 2010 Canadian Paediatric Society I www.cps.ca
Commonly asked questions
Why should my pre-teen be vaccinated
against HPV?
• For maximum protection, complete vaccine series well before
sexual activity starts
• School-based programs more effective in reaching target
populations in primary school than in secondary school
• Younger children have a better immune response to the vaccine
© 2010 Canadian Paediatric Society I www.cps.ca
Commonly asked questions
Can vaccines cause the infection they are
supposed to prevent?
• Inactivated vaccines do not contain live germs and cannot cause the
infections they protect against
• Live vaccines contain viruses that have been changed so that they
are very weak and unable to cause disease in healthy people.
Rarely, they may cause a very mild form of the infection. Children
with certain immune system disorders may develop an infection
with these vaccines, and should not receive them
© 2010 Canadian Paediatric Society I www.cps.ca
Speaking with parents about
vaccination
•
•
•
•
•
•
•
•
Listen, evaluate and categorize
Recognize legitimate concerns
Provide context
Refute misinformation
Provide valid information
Recognize that immunizing is a parent’s decision
Educate about potential consequences of the decision
Make a clear recommendation
Source: Dr. Scott A. Halperin, Dalhousie University, Canadian Journal of CME, January 2000
© 2010 Canadian Paediatric Society I www.cps.ca
Public policy
© 2010 Canadian Paediatric Society I www.cps.ca
Public support for vaccination
• In 2010, 14 vaccines are publicly funded by all provinces/territories
• Schedules for some publicly funded programs—meningococcal
conjugate, pneumococcal conjugate, hepatitis B, flu, and HPV—
vary by province/territory
• Rotavirus vaccine is not currently funded by any province/territory
(as of Dec. 2010)
• Cost can be substantial for governments, as well as for individual
parents
© 2010 Canadian Paediatric Society I www.cps.ca
National Immunization
Strategy (NIS)
• Canada’s roadmap for ensuring vaccine access, supply, safety and
efficacy
• Established in 2003, with five mandates:
– Develop national goals and recommendations for immunization
programs
– Immunization program planning
– Vaccine safety
– Vaccine supply
– An immunization registry network
• Cross-cutting issues: immunization research, professional and public
education, special populations (immigrants, refugees, travellers and
First Nations and Inuit), and vaccine-preventable disease surveillance
© 2010 Canadian Paediatric Society I www.cps.ca
Progress toward NIS
• 2003: Launched with $45 million over five years to improve
Canada’s vaccination programs, and $32 million over five years for a
national on-reserve immunization strategy. Part of a $1.3-billion
program for First Nations and Inuit health
• 2004: Another $300 million over three years for vaccine
procurement, to allow the provinces/territories to add newly
recommended vaccines to publicly funded programs
• 2007: Federal government created a trust fund for three years for
provinces/territories to initiate HPV program
• Further advocacy is needed to ensure other vaccines continue to have
support
• Federal government currently provides some annual funding to
improve effectiveness and efficiency of immunization programs in
Canada
© 2010 Canadian Paediatric Society I www.cps.ca
Calls to action
• Provide sustained funding and support for a comprehensive National
Immunization Strategy
• Provide sustained funding to the provinces and territories to allow
them to offer newly recommended vaccines at no cost to the public
• Develop a national immunization registry to track numbers of
children and youth who are receiving vaccines. Ideally, this registry
would include electronic record-keeping functions, for easy
transmission and monitoring, and for making sure every child’s
schedule is up-to-date
• Standardize immunization schedule across Canada
• Ensure the involvement of nongovernmental and professional
organizations, such as the CPS, with expertise in immunization
© 2010 Canadian Paediatric Society I www.cps.ca
Resources
© 2010 Canadian Paediatric Society I www.cps.ca
Professional learning
Immunization Competencies for
Health Professionals
Published by the
Public Health Agency of Canada
in November 2008
www.phac-aspc.gc.ca/im/pdf/ichp-cips-eng.pdf
© 2010 Canadian Paediatric Society I www.cps.ca
Immunization Competencies for Health
Professionals
• Essential knowledge and skills for effective immunization
• Developed to support the National Guidelines for Immunization
Practices, published in the Canadian Immunization Guide
• Can be adapted and incorporated into all immunization training or
performance evaluations
– To educate health professionals involved in immunization
– To promote safe and competent practices
© 2010 Canadian Paediatric Society I www.cps.ca
Immunization Competencies for Health
Professionals (cont’d)
• The competencies cover:
1. the scientific basis of immunization
2. essential and safe practices
3. relevant contextual issues
• Handbook includes a practical tool for measuring competency
levels
© 2010 Canadian Paediatric Society I www.cps.ca
Immunization Competencies Education Program
An online course for health professionals, developed by CPS and the Public Health Agency
of Canada, is available at www.cps.ca/English/ProEdu/OnlineEdu.htm
Multidisciplinary: to meet the needs of the growing number, wider range of health professionals
involved in administering vaccines
Course designed to:
• build immunization skills and knowledge
• promote public confidence around vaccine effectiveness and delivery, and
• foster relationships among health professionals unaccustomed to working together
Basic competencies:
• how vaccines work
• the rationale and benefits of immunization
• the main steps in vaccine development and evaluation,
• the components and properties of immunizing agents
• principles of population health for improving coverage rates
Each competency is supported by a learning domain and a number of guiding learning objectives.
© 2010 Canadian Paediatric Society I www.cps.ca
Immunization websites
for professionals and parents
• Canadian Paediatric Society: www.cps.ca
• Health Canada, Public Health Agency of Canada:
www.phac-aspc.gc.ca/im/index.html
• National Advisory Committee on Immunization: www.naci.gc.ca
• Canadian Coalition for Immunization Awareness and Promotion:
www.immunize.cpha.ca
• American Academy of Pediatrics: www.aap.org
• Centers for Disease Control and Prevention: www.cdc.gov
• Advisory Committee on Immunization Practices (ACIP)
www.cdc.gov/vaccines/recs/ACIP/default.htm
• Immunization Action Coalition: www.immunize.org
• Institute of Medicine: www.iom.edu
© 2010 Canadian Paediatric Society I www.cps.ca
Assessing vaccine information
on the Internet
Asking a few key questions can help you tell whether or not you can trust the
information you find on the Internet:
1. What is the source of the information? Does the site:
• Identify who has produced the information
• List all sources of funding
• Provide a way to contact the provider of information
2. Has the medical information been reviewed by scientific experts?
3. Is there a date showing when the information was posted online and/or last
revised?
4. Is there scientific evidence to back up the claims? (e.g., articles from
respected medical journals)
Not all “studies” or “reports” are necessarily reliable
© 2010 Canadian Paediatric Society I www.cps.ca
Books and printable resources
for professionals and parents
• Canadian Paediatric Society. 3rd edn. 2006. Your Child’s Best Shot:
A Parent’s Guide to Vaccination.
• Canadian Paediatric Society. “MMR vaccine: Myths and Facts.”
A tear-away pad for informing families.
• Fisher, Margaret C. (2006) Immunization and Infectious Diseases: An
Informed Parent’s Guide. Elk Grove Village, Ill.: American Academy
of Pediatrics.
• Public Health Agency of Canada. 2008. Immunization Competencies
for Health Professionals.
• Public Health Agency of Canada. 2009. A Parent’s Guide to
Vaccination.
• Public Health Agency of Canada. Canadian Immunization Guide.
8th edn. 2010.
© 2010 Canadian Paediatric Society I www.cps.ca
Questions? Comments?
© 2010 Canadian Paediatric Society I www.cps.ca
Leave-behind materials
A list of resources and the routine immunization schedule are
available as pdfs on the CPS website, so users can print,
photocopy and distribute for their presentations at no cost.
© 2010 Canadian Paediatric Society I www.cps.ca