Immunization

The Canadian Immunization Guide and NACI set national advice; each province publishes its own schedule, so exact timing can differ.

Childhood schedule (the usual shape)

• 2, 4 and 6 months: DTaP-IPV-Hib (often with hepatitis B), pneumococcal conjugate, and rotavirus by mouth.
• Rotavirus: first dose by 15 weeks of age, finished by 8 months.
• 12 months: MMR, meningococcal C, pneumococcal booster, and varicella (12 to 15 months).
• 18 months: DTaP-IPV-Hib booster, and the second MMR and varicella in some provinces (at 4 to 6 years in others).
• 4 to 6 years: Tdap-IPV.
• School programs (about grades 6 to 7): HPV (one dose for ages 9 to 20, NACI 2024), hepatitis B where not given in infancy, and meningococcal ACYW.
• About 14 to 16 years: Tdap booster.
• Influenza: every year from 6 months; two doses 4 weeks apart in the first season for children under 9.
• RSV: nirsevimab for infants entering their first RSV season, in many provinces.
• Preterm babies: vaccinate by chronological age.

Adults and pregnancy

• Every pregnancy: Tdap, to protect the newborn from pertussis.
• Pregnancy: inactivated influenza and other inactivated vaccines as needed; no live vaccines. Give MMR after the birth if not immune.
• Older adults: influenza every year, pneumococcal and shingles vaccines, and RSV by provincial program.
• Asplenia or sickle cell disease: extra pneumococcal, meningococcal (ACYW and B) and Hib doses.

True contraindications

• Anaphylaxis to a previous dose or a vaccine component.
• Live vaccines (MMR, varicella, rotavirus, BCG, nasal influenza, yellow fever): not in pregnancy or significant immunosuppression (for example high-dose steroids for 14 days or more, chemotherapy).
• Rotavirus: past intussusception or SCID.
• After IVIG or blood products: delay MMR and varicella (for 11 months after high-dose IVIG for Kawasaki disease).

Not contraindications

• A mild illness, with or without fever, or being on antibiotics.
• Egg allergy (MMR and influenza vaccines are safe).
• Prematurity, breastfeeding, or a pregnant woman at home.
• A local reaction to an earlier dose, or a family history of reactions.

Giving vaccines

• Give everything due at the same visit. Two live injected vaccines not given together need 4 weeks between them.
• Never restart a series; continue where it stopped.
• Infants: the anterolateral thigh. Reduce pain with breastfeeding, sucrose, topical anesthetic and holding the baby upright.
• Watch everyone for 15 minutes. Anaphylaxis: epinephrine 0.01 mg/kg IM (maximum 0.5 mg).
• Report serious or unexpected events following immunization to public health.

Exposures

• Measles contact, not immune: MMR within 72 hours, or immune globulin within 6 days for infants, pregnant women and the immunocompromised.
• Baby of a hepatitis B-positive mother: HBIG and hepatitis B vaccine within 12 hours of birth.
• Needlestick, worker not immune, source positive or unknown: hepatitis B vaccine and HBIG.
• Rabies: wash the wound, then rabies immune globulin and vaccine on days 0, 3, 7 and 14. Any bat in a room with a sleeping person or a child can warrant it.
• Tetanus-prone wound: a booster if more than 5 years since the last dose; add tetanus immune globulin if the person was never fully vaccinated.

Talking with hesitant families

• Presume they will vaccinate, listen, and give clear facts: MMR does not cause autism.
• Document the discussion and offer again at every visit. Do not dismiss the family from the practice.