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Canadian Immunization Guide

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Part 1
Key Immunization Information 2013

Recommended Immunization Schedules

General Recommendations

Administration of vaccines in accordance with the immunization schedules summarized in the following tables will provide optimal protection from vaccine preventable diseases for most individuals. However, modifications of the recommended schedule may be necessary due to missed appointments or illness. In general, interruption of an immunization series does not require restarting the vaccine series, regardless of the interval between doses. Individuals with interrupted immunization schedules should be vaccinated to complete the appropriate schedule for their current age. Refer to Timing of Vaccine Administration in Part 1 and vaccine-specific chapters in Part 4 for additional information.

Similar, but not identical, vaccines may be available from different manufacturers; therefore, it is useful to review the relevant vaccine-specific chapters in the Canadian Immunization Guide as well as the manufacturer’s product leaflet or product monograph before administering a vaccine. Refer to Principles of Vaccine Interchangeability in Part 1 for information about the interchangeability of similar vaccines from different manufacturers. Product monographs are periodically updated; it is a best practice to consult the information contained within the product monographs available through Health Canada’s Drug Product Database.

Table 1: Routine Childhood Immunization Schedule, Infants and Children (birth to 17 years of age)

  • For children at-risk due to underlying medical conditions, refer to Table 4 for additional recommendations for immunization.
  • [ ] = dose(s) may not be required depending upon age of child or vaccine used or both (refer to the relevant vaccine-specific chapter in Part 4 and provincial/territorial schedule). mos = months. yrs = years. P/T = provincial and territorial.
  • Refer to Timing of Vaccine Administration and Vaccine Administration Practices in Part 1 regarding administration of multiple injections.
  • Refer to vaccine-specific chapters in Part 4 for additional information.
Table 1: Routine Childhood Immunization Schedule, Infants and Children (birth to 17 years of age)
Vaccine* Age
Birth 2 mos 4 mos 6 mos 12 mos 15 mos 18 mos 23 mos 2 years 4 years 5 years 6 years 9 years 12 years 14 years 15 yrs 16 yrs 17 years
Table 1 - Footnote A
Diphtheria toxoid- tetanus toxoid- acellular pertussis- inactivated polio- Haemophilus influenzae type b (DTaP-IPV-Hib). For infants and children beginning primary immunization at 7 months of age and older, the number of doses of Hib vaccine required varies by age.
Table 1 - Footnote B
Diphtheria toxoid- tetanus toxoid- acellular pertussis- hepatitis B- inactivated polio- Haemophilus influenzae type b (DTaP-HB-IPV-Hib ). Alternative schedules may be used : DTaP-HB-IPV-Hib at 2, 4 and 12 -23 months of age with DTaP-IPV-Hib vaccine at 6 months of age; or DTaP-HB-IPV -Hib at 2, 4 and 6 months of age with DTaP-IPV-Hib vaccine at 12-23 months of age.
Table 1 - Footnote C
Diphtheria toxoid- tetanus toxoid- acellular pertussis- inactivated polio or tetanus toxoid- reduced diphtheria toxoid- reduced acellular pertussis- inactivated polio.
Table 1 - Footnote D
Tetanus toxoid- reduced diphtheria toxoid- reduced acellular pertussis (Tdap): 10 years after last dose of DTaP- or Tdap-containing vaccine.
Table 1 - Footnote E
Rotavirus: Rotavirus pentavalent vaccine – 3 doses, 4 to 10 weeks apart; Rotavirus monovalent vaccine – 2 doses, at least 4 weeks apart. Give the first dose starting at 6 weeks and before 15 weeks of age. Administer all doses before 8 months of age.
Table 1 - Footnote F
Pneumococcal conjugate 13-valent (Pneu-C-13): healthy infants  beginning primary immunization at 2-6 months of age: 3 or 4 dose schedule. For a 3 dose schedule : 2, 4 months of age, followed by a booster dose at 12 months of age. For a 4 dose schedule: minimum of 8 weeks interval between doses beginning at 2 months of age, followed by a booster dose at 12-15 months of age. Healthy infants beginning primary immunization at 7-11 months of age : 2 doses, at least 8 weeks apart followed by a booster dose at 12-15 months of age, at least 8 weeks after the second dose. Children who have received age-appropriate pneumococcal vaccination with a pneumococcal conjugate vaccine but not Pneu-C-13 vaccine: 12-35 months of age – 1 dose; 36-59 months of age and of aboriginal origin or attend group child care – 1 dose; other healthy children 36-59 months of age - consider 1 dose.
Table 1 - Footnote G
Meningococcal conjugate monovalent: children 12-48 months of age: 1 dose routinely provided at 12 months of age, regardless of any doses given during the first year of life. Immunization may be considered for unimmunized children 5-11 years of age.
Table 1 - Footnote H
Meningococcal conjugate monovalent or meningococcal conjugate quadrivalent: early adolescence (around 12 years of age) – 1 dose, even if meningococcal conjugate vaccine received at a younger age. Vaccine chosen depends on local epidemiology and programmatic considerations.
Table 1 - Footnote I
Measles-mumps-rubella: first dose at 12-15 months of age; second dose at 18 months of age or anytime thereafter, but should be given no later than around school entry.
Table 1 - Footnote J
Varicella (chickenpox): first dose at 12-15 months of age; second dose at 18 months of age or anytime thereafter, but should be given no later than around school entry.
Table 1 - Footnote K
Measles-mumps-rubella-varicella: first dose at 12-15 months of age; second dose at 18 months of age or anytime thereafter, but should be given no later than around school entry.
Table 1 - Footnote L
Hepatitis B : months 0, 1 and 6 (first dose = month 0) with at least 4 weeks between the first and second dose, at least 2 months between the second and third dose, and at least 4 months between the first and third dose. Alternatively, can be administered as DTaP-HB-IPV-Hib vaccine, with first dose at 2 months of age.
Table 1 - Footnote M
Hepatitis B: 9-17 years of age - months 0, 1 and 6 (first dose = month 0) with at least 4 weeks between the first and second dose, at least 2 months between the second and third dose, and at least 4 months between the first and third dose . 11-15 years of age – 2 doses; schedule depends on the product used.
Table 1 - Footnote N
Human papillomavirus(HPV): Girls, 9–14 years of age: HPV bivalent (HPV2) or HPV quadrivalent (HPV4) vaccine – months 0 and 6-12 (first dose = month 0). Boys, 9-14 years of age: HPV4 vaccine – months 0 and 6-12 (first dose = month 0). For a 2 dose schedule, the minimum interval between doses is 6 months. A 3 dose schedule may be used.
Table 1 - Footnote O
Human papillomavirus: Girls, 15–17 years of age: HPV2 vaccine – months 0, 1 and 6 (first dose = month 0) or HPV4 vaccine – months 0, 2 and 6 (first dose = month 0). Boys, 15-17 years of age:  HPV4 vaccine – months 0, 2 and 6 (first dose = month 0). In individuals who received the first dose between 9-14 years of age, a 2 dose schedule can be used with the second dose administered at least 6 months after the first dose.
Table 1 - Footnote P
Influenza: recommended annually for anyone 6 months of age and older without contraindications. Children 6 months-less than 9 years of age, receiving influenza vaccine for the first time – 2 doses, at least 4 weeks apart. Children 6 months-8 years of age, previously immunized with influenza vaccine and children 9 years of age and older – 1 dose.

* For abbreviations and brand names of vaccines refer to Contents of Immunizing Agents Available for Use in Canada in Part 1.

DTaP-IPV-Hib
or
DTaP-HB-IPV-Hib
  Footnote A
or Footnote B
1st dose
Footnote A
or Footnote B
2nd dose
Footnote A
or Footnote B
3rd dose
Footnote A
or 4th dose
Generally at 18 months of age
                   
DTaP-IPV
or
Tdap-IPV
                  Footnote C            
Tdap                             Footnote D  
Rot   Footnote E
2 or 3 doses
Complete series before 8 months
                           
Pneu-C-13   Footnote F Footnote F                        
Men-C-C   Footnote [G]
According to P/T schedule
Footnote G
Generally at 12 months
               
Men-C-C
ou
Men-C-ACYW
                          Footnote H        
MMR and Var         Footnote I + Footnote J Footnote I + Footnote J            
OR
MMRV         Footnote K Footnote K
Generally at 4-6 years
           
HB Footnote L
3 doses
                         
OR
HB                         Footnote M
2 or 3 doses
HPV                         Footnote N
2 doses
     
OR
HPV                               Footnote O
3 doses
Inf       Footnote P
1 or 2 doses
Recommended annually
Footnote P
1 dose
Recommended annually

Table 2: Recommended Immunization Schedule, Children (less than 7 years of age), NOT Previously Immunized as Infants

Table 2: Recommended Immunization Schedule, Children (less than 7 years of age), NOT Previously Immunized as Infants
Vaccine* 1st visit Time after 1st visit 6-12 mos
after last dose
4 weeks 8 weeks 3 mos 4 mos 6 mos
Table 2 - Footnote A
Diphtheria toxoid- tetanus toxoid- acellular pertussis- inactivated polio- Haemophilus influenzae type b (DTaP-IPV-Hib) or diphtheria toxoid- tetanus toxoid- acellular pertussis- inactivated polio (DTaP-IPV): 4 doses of DTaP-IPV-containing vaccine. The number of doses of Hib-containing vaccine required varies by age at first dose. If first visit at 12-14 months of age: 1 dose of Hib-containing vaccine at first visit and booster dose at least 2 months after the previous dose. If first visit at 15 months-less than 60 months of age: 1 dose of Hib-containing vaccine. If first visit at 60 months of age or older, Hib-containing vaccine is not required.
Table 2 - Footnote B
Diphtheria toxoid- tetanus toxoid- acellular pertussis- inactivated polio (DTaP-IPV) or tetanus toxoid- reduced diphtheria toxoid- reduced acellular pertussis- inactivated polio (Tdap-IPV): if the fourth dose of DTaP-IPV vaccine was given before the fourth birthday, a booster dose of DTaP-IPV or Tdap-IPV vaccine should be provided at 4-6 years of age.
Table 2 - Footnote C
Pneumococcal conjugate 13-valent: 12-23 months of age - 2 doses, at least 8 weeks apart. 24-59 months of age – 1 dose.
Table 2 - Footnote D
Meningococcal conjugate monovalent: 12-59 months of age – 1 dose; 5-11 years of age – consider 1 dose.
Table 2 - Footnote E
Measles-mumps-rubella: 2 doses, at least 4 weeks apart; second dose after 18 months of age, but should be given no later than around school entry.
Table 2 - Footnote F
Varicella: 2 doses, at least 3 months apart; second dose after 18 months of age, but should be given no later than around school entry. A minimum interval of 6 weeks between doses may be used if rapid, complete protection is required.
Table 2 - Footnote G
Measles-mumps-rubella-varicella: 2 doses, at least 3 months apart; second dose after 18 months of age, but should be given no later than around school entry. A minimum interval of 6 weeks between doses may be used if rapid, complete protection is required.
Table 2 - Footnote H
Hepatitis B: 3 doses - months 0, 1 and 6 (first dose = month 0) with at least 4 weeks between the first and second dose, 2 months between the second and third dose, and 4 months between the first and third dose.
Table 2 - Footnote I
Influenza: 2 doses, at least 4 weeks apart.

* For abbreviations and brand names of vaccines refer to Contents of Immunizing Agents Available for Use in Canada in Part 1.

DTaP-IPV-Hib
or
DTaP-IPV
Footnote A   Footnote A   Footnote A   Footnote A Footnote [B]
Pneu-C-13 Footnote [C]   Footnote [C]        
Men-C-C Footnote D            
MMR Footnote E Footnote E          
Var Footnote F     Footnote F      
OR
MMRV Footnote G     Footnote G      
HB Footnote [H] Footnote [H]       Footnote [H]  
Inf Footnote I Footnote I          

Table 3: Recommended Immunization Schedule, Children (7 to 17 years of age), NOT Previously Immunized

Table 3: Recommended Immunization Schedule, Children (7 to 17 years of age), NOT Previously Immunized
Vaccine* 1st visit Time after first visit 6-12 mos after last dose 10 yrs after last dose
4 weeks 6 weeks 8 weeks 3 mos 6 mos
Table 3 - Footnote A
Tetanus toxoid- reduced diphtheria toxoid- reduced acellular pertussis- inactivated polio (Tdap-IPV): 2 doses, 8 weeks apart; third dose 6-12 months after second dose
Table 3 - Footnote B
Tetanus toxoid- reduced diphtheria toxoid- reduced acellular pertussis: 10 years after last dose of Tdap-IPV
Table 3 - Footnote C
Meningococcal conjugate monovalent: 7-11 years of age – consider 1 dose.
Table 3 - Footnote D
Meningococcal conjugate monovalent or quadrivalent: 12-17 years of age – 1 dose, even if meningococcal conjugate vaccine received at a younger age. Vaccine chosen depends on local epidemiology and programmatic considerations
Table 3 - Footnote E
Measles-mumps-rubella: 2 doses, at least 4 weeks apart.
Table 3 - Footnote F
Varicella (chickenpox): 7-12 years of age – 2 doses, at least 3 months apart. A minimum interval of 6 weeks between doses may be used if rapid, complete protection is required. 13 years of age and older – 2 doses, at least 6 weeks apart.
Table 3 - Footnote G
Measles-mumps-rubella-varicella: 7-12 years of age – 2 doses, at least 3 months apart. A minimum interval of 6 weeks between doses may be used if rapid, complete protection is required.
Table 3 - Footnote H
Hepatitis B: 7-17 years of age - 3 doses, months 0, 1 and 6 (first dose = month 0) with at least 4 weeks between the first and second dose, 2 months between the second and third dose, and 4 months between the first and third dose. 11-15 years of age – two doses; schedule depends on the product used.
Table 3 - Footnote I
Human papillomavirus (HPV): Girls, 9-14 years of age - HPV bivalent (HPV2) or HPV quadrivalent (HPV4) vaccine - months 0 and 6-12 (first dose = month 0). Boys, 9-14 years of age HPV4 vaccine - months 0 and 6-12 (first dose = month 0). For a 2 dose schedule, the minimum interval between doses is 6 months. A 3 dose schedule may be used.
Table 3 - Footnote J
Human papillomavirus: Girls, 15-17 years of age: HPV2 vaccine - months 0, 1 and 6 (first dose = month 0) or HPV4 vaccine - months 0, 2 and 6 (first dose = month 0). Boys, 15-17 years of age: HPV4 vaccine - months 0, 2 and 6 (first dose = month 0). In individuals who received the first dose between 9-14 years of age, a 2 dose schedule can be used with the second dose administered at least 6 months after the first dose.
Table 3 - Footnote K
Influenza: children less than 9 years of age - 2 doses, at least 4 weeks apart. Children 9 years of age and older - 1 dose.

* For abbreviations and brand names of vaccines refer to Contents of Immunizing Agents Available for Use in Canada in Part 1.

Tdap-IPV
Tdap
Footnote A     Footnote A     Footnote A Footnote B
Men-C-C Footnote [C]
7-11 years of age
             
OR
Men-C-C
or
Men-C-ACYW
Footnote D
12-17 years of age
             
MMR Footnote E Footnote E            
Var Footnote F       Footnote F      
OR
MMRV Footnote G
7-12 years of age
      Footnote G      
HB Footnote H Footnote [H]       Footnote H    
HPV Footnote I
9-14 years of age
        Footnote I    
OR
HPV Footnote J
15-17 years of age
Footnote J   Footnote J    
Inf Footnote K
7-8 years of age
Footnote K            
OR
Inf Footnote K
9-17 years of age
             

Table 4: Additional Recommended Immunizations, Children (birth to 17 years of age), Considered AT RISK due to Underlying Medical Conditions

Table 4: Additional Recommended Immunizations, Children (birth to 17 years of age), Considered AT RISK due to Underlying Medical Condition
Vaccine* Age
Birth 2 mos 6 mos 12 mos 15 mos 18 mos 23 mos 2 years 3 years 5-8 yrs 9-17 yrs
Table 4 - FootnoteA
Haemophilus influenzae type b (Hib): 5 years of age and older with increased risk of invasive Hib disease - 1 dose regardless of prior history of Hib vaccination and at least 1 year after any previous dose.
Table 4 - FootnoteB
Pneumococcal polysaccharide 23-valent: children 2 years of age or older at high risk of invasive pneumococcal disease (IPD) - 1 dose. Children at highest risk of IPD including those with functional or anatomic asplenia or sickle cell disease; hepatic cirrhosis; chronic renal failure; nephrotic syndrome; HIV infection; and immunosuppression related to disease or therapy - 1 booster dose after 5 years. If pneumococcal conjugate 13-valent (Pneu-C-13) vaccine is also required, it should be provided first, followed by Pneu-P-23 vaccine, at least 8 weeks later.
Table 4 - FootnoteC
Pneumococcal conjugate 13-valent: infants at high risk of IPD - in addition to the doses at 2, 4, and 12 months of age, give an extra dose at 6 months to make a 4 dose primary series. Children aged 3 years and older at high risk of IPD who have not previously received Pneu-C-13 vaccine - 1 dose
Table 4 - FootnoteD
Meningococcal conjugate quadrivalent (Men-C-ACYW): infants and children at high risk of invasive meningococcal disease (IMD): 2-11 months of age - 2 or 3 doses of Men-C-ACYW-CRM vaccine, 8 weeks apart with another dose between 12-23 months of age and at least 8 weeks after the previous dose; 12-23 months of age - 2 doses of Men-C-ACYW-CRM vaccine ,8 weeks apart; 24 months of age and older - 2 doses of any Men-C-ACYW vaccine, 8 weeks apart. Give additional booster doses every 3 to 5 years if last vaccinated at 6 years of age and younger and every 5 years if last vaccinated at 7 years of age and older.
Table 4 - FootnoteE
Multicomponent meningococcal (4CMenB): infants and children at high risk of IMD should be considered for immunization: 2-11 months of age - 2 or 3 doses of 4CMenB vaccine, 8 weeks apart with another dose between 12-23 months of age and at least 8 weeks after the previous dose; 1-10 years of age- 2 doses of 4CMenB vaccine, 8 weeks apart; 11 years of age and older - 2 doses of 4CMenB vaccine, at least 4 weeks apart. The need for and timing of 4CMenB vaccine booster doses have not yet been determined.
Table 4 - FootnoteF
Hepatitis A: 12 months of age and older in high-risk groups: 2 doses, given 6-36 months apart (depending on product used).
Table 4 - FootnoteG
Hepatitis B: 3 or 4 doses of higher dose of monovalent hepatitis B vaccine recommended for those with certain immunocompromising conditions, chronic renal failure and dialysis. Premature infants weighing less than 2,000 grams at birth born to HB infected mothers: 4 doses.
Table 4 - FootnoteH
Influenza: recommended annually for all individuals 6 months of age and older without contraindications, with focus on children at risk of influenza-related complications. Children 6 months-less than 9 years of age receiving influenza vaccine for the first time: 2 doses, at least 4 weeks apart. Children 6 months-8 years of age, previously immunized with influenza vaccine and children 9 years of age and older: 1 dose.

* For abbreviations and brand names of vaccines refer to Contents of Immunizing Agents Available for Use in Canada in Part 1.

Hib                   Footnote A
1 dose
Pneu-P-23               Footnote B
1 dose + 1 booster dose if at highest risk
Pneu-C-13     Footnote C           Footnote [C]
If not previously received
Men-C-ACYW   Footnote D
2, 3 or 4 doses + additional booster doses
 
4CMenB   Footnote E
2, 3 or 4 doses + additional booster doses
HA       Footnote F
2 doses
HB Footnote G
3 or 4 doses
Inf     Footnote H
1 or 2 doses
Recommended annually
Footnote H
1 dose
Recommended annually

Table 5: Recommended Immunization Schedule, Adults (18 years of age and older), NOT Previously Immunized

Table 5: Recommended Immunization Schedule, Adults (18 years of age and older), NOT Previously Immunized
Vaccine* 1st visit Time after 1st visit 6-12 mos after last dose 10 years after last dose
4 weeks 6 weeks 8 weeks 6 mos
Table 5 - Footnote A
Tetanus toxoid- reduced diphtheria toxoid- reduced acellular pertussis- inactivated polio (Tdap-IPV): 1 dose for pertussis protection
Table 5 - Footnote B
Tetanus toxoid- reduced diphtheria toxoid- inactivated polio (Td-IPV): first dose, 8 weeks after the dose of Tdap-IPV vaccine; second dose, 6-12 months after the previous dose of Td-IPV vaccine.
Table 5 - Footnote C
Tetanus toxoid- reduced diphtheria toxoid (Td): 10 years after last dose of Td-containing vaccine.
Table 5 - Footnote D
Measles-mumps-rubella (MMR): adults born in or after 1970 - 1 dose, except - travellers, health care workers, students in post-secondary educational settings, and military personnel - 2 doses, at least 4 weeks apart. Adults born before 1970 can be presumed to have acquired natural immunity to measles and mumps and do not need MMR vaccination except - non-immune military personnel or health care workers (2 doses, at least 4 weeks apart), non-immune travellers (1 dose), non-immune students in post-secondary educational settings (consider 1 dose). Rubella-susceptible adults, regardless of age - 1 dose.
Table 5 - Footnote E
Varicella (chickenpox): adults 18-49 years of age - 2 doses, at least 6 weeks apart; adults 50 years of age and older are generally presumed to be immune.
Table 5 - Footnote F
Herpes zoster (shingles): adults 50-59 years of age - may receive 1 dose; adults 60 years of age and older - 1 dose.
Table 5 - Footnote G
Pneumococcal polysaccharide 23-valent: adults 65 years of age and older - 1 dose; immunocompetent residents of long-term care facilities 18-64 years of age - 1 dose.
Table 5 - Footnote H
Meningococcal conjugate monovalent or quadrivalent: adults less than 25 years of age - 1 dose (vaccine chosen depends on local epidemiology).
Table 5 - Footnote I
Human papillomavirus (HPV): recommended for women up to and including 26 years of age, may be given to women 27 years of age and older at ongoing risk of exposure: HPV bivalent (HPV2) vaccine - months 0, 1 and 6 (first dose = month 0) or HPV quadrivalent (HPV4) vaccine - months 0, 2 and 6 (first dose = month 0). Recommended for men up to and including 26 years of age, may be given to men 27 years of age and older at ongoing risk of exposure: HPV4 vaccine - months 0, 2 and 6 (first dose = month 0).
Table 5 - Footnote J
Influenza: 1 dose recommended for adults without contraindications, with focus on: adults at high risk of influenza-related complications (including pregnant women, adults 65 years of age and older); adults capable of transmitting influenza to individuals at high risk; adults who provide essential community services; and people in direct contact during culling operations with poultry infected with avian influenza.

* For abbreviations and brand names of vaccines refer to Contents of Immunizing Agents Available for Use in Canada in Part 1.

Tdap-IPV
Td-IPV
Td
Footnote A     Footnote B   Footnote B Footnote C
MMR Footnote [D]            
Var Footnote [E]
18-49 years of age
  Footnote [E]        
OR
HZV Footnote [F]
50 years of age and over
           
Pneu-P-23 Footnote [G]            
Men-C-C
or
Men-C-ACYW
Footnote [H]
18-24 years of age
           
HPV Footnote I
3 doses
   
Inf Footnote J
Annually

Table 6: Recommended Immunizations, Adults (18 years of age and older), Previously Immunized

Table 6: Recommended Immunizations, Adults (18 years of age and older), Previously Immunized
Vaccine* Age
18-26 years 27-49 years 50-59 years 60 years 65 years and older
Table 6 - Footnote A
Tetanus toxoid- reduced diphtheria toxoid: 1 booster dose every 10 years.
Table 6 - Footnote B
Tetanus toxoid- reduced diphtheria toxoid- reduced acellular pertussis (Tdap): 1 dose in adulthood for pertussis protection regardless of interval since last dose of tetanus toxoid- and diphtheria toxoid-containing vaccine. In special circumstances, such as an outbreak situation, all pregnant women who are 26 weeks gestation or more may be offered Tdap vaccination irrespective of their immunization history.
Table 6 - Footnote C
Pneumococcal polysaccharide 23-valent: adults 65 years of age and older – 1 dose
Table 6 - Footnote D
Herpes zoster (shingles): 50-59 years of age – may receive 1 dose; 60 years of age and older: 1 dose. If dose given before 60 years of age, additional dose at 60 years of age or older is not currently recommended.
Table 6 - Footnote E
Influenza: recommended for all adults without contraindications, with focus on: adults at high risk of influenza-related complications (including pregnant women, adults 65 years of age and older); adults capable of transmitting influenza to individuals at high risk; adults who provide essential community services; and people in direct contact during culling operations with poultry infected with avian influenza. One dose annually.

* For abbreviations and brand names of vaccines refer to Contents of Immunizing Agents Available for Use in Canada in Part 1.

Td Footnote A
1 dose every 10 years
Tdap Footnote B
1 dose
Pneu-P-23         Footnote C
1 dose
HZV       Footnote D
1 dose
Inf Footnote E
Anually

Table 7: Additional Recommended Immunizations, Adults (18 years of age and older), Considered AT RISK

Table 7: Additional Recommended Immunizations, Adults (18 years of age and older), Considered AT RISK
Vaccine* Age
18 years of age and older
Table 7 - Footnote A
Haemophilus influenzae type b (Hib): adults with increased risk of invasive Hib disease - 1 dose regardless of prior history of Hib vaccination and at least 1 year after any previous dose.
Table 7 - Footnote B
Inactivated polio: 1 booster dose for adults at increased risk of exposure to polio.
Table 7 - Footnote C
Measles-mumps-rubella (MMR): adults born in or after 1970 - 1 dose, except - travellers, health care workers, students in post-secondary educational settings, and military personnel - 2 doses, at least 4 weeks apart. Adults born before 1970 can be assumed to have acquired natural immunity to measles and mumps and do not need MMR vaccination except - non-immune military personnel or health care workers (2 doses, at least 4 weeks apart), non-immune travellers (1 dose), non-immune students in post-secondary educational settings (consider 1 dose). Rubella-susceptible adults, regardless of age - 1 dose.
Table 7 - Footnote D
Pneumococcal conjugate 13-valent (Pneu-C-13): adults with HIV or immunocompromising conditions (except hematopoietic stem cell transplant recipients [HSCT]) - 1 dose of Pneu-C-13 vaccine followed 8 weeks later by 1 dose of pneumococcal polysaccharide 23-valent (Pneu-P-23) vaccine. Administer Pneu-C-13 vaccine dose at least 1 year after any previous dose of Pneu-P-23 vaccine.
Table 7 - Footnote E
Pneumococcal polysaccharide 23-valent: adults at high risk of invasive pneumococcal disease (IPD), including adults with alcoholism, smokers, and persons who are homeless - 1 dose. One dose should be considered for adults who use illicit drugs. Adults at highest risk of IPD, including those with functional or anatomic asplenia or sickle cell disease; hepatic cirrhosis; chronic renal failure; nephrotic syndrome; HIV infection; and immunosuppression related to disease or therapy - 1 booster dose at least 5 years from first vaccination with Pneu-P-23 vaccine.
Table 7 - Footnote F
Meningococcal conjugate quadrivalent: in previously unimmunized adults at high risk of invasive meningococcal disease (IMD) - 2 doses, 8 weeks apart. In previously immunized adults -booster dose every 3 to 5 years if last vaccinated at 6 years of age and younger and every 5 years for those last vaccinated at 7 years of age and older
Table 7 - Footnote G
Multicomponent meningococcal (4CMenB): adults at high risk of IMD should be considered for immunization - 2 doses of 4CMenB vaccine, at least 4 weeks apart.
Table 7 - Footnote H
Hepatitis A: adults in high risk groups - 2 doses, 6-36 months apart (depending on product used).
Table 7 - Footnote I
Hepatitis B (HB): adults in high risk groups - 3 or 4 dose schedule (depending on product used). Higher dose of monovalent HB vaccine recommended for those with certain immunocompromising conditions, chronic renal failure and dialysis.
Table 7 - Footnote J
Hepatitis A-hepatitis B: adults without chronic renal failure and immunocompromising conditions: combined vaccine preferred if both hepatitis A and standard dosage hepatitis B vaccines are recommended - 3 or 4 dose schedule.
Table 7 - Footnote K
Influenza: recommended for all adults, with focus on adults at high risk of influenza-related complications - 1 dose annually.
Table 7 - Footnote L
Typhoid: adults with ongoing or intimate exposure to a chronic carrier of Salmonella typhi - 1 dose injectable typhoid vaccine or 4 doses oral typhoid vaccine; re-immunization recommended if at continuing risk.
Table 7 - Footnote M
Bacille Calmette-Guérin: 1 dose may be considered in exceptional circumstances for adults at high risk of repeated exposure to tuberculosis.
Table 7 - Footnote N
Rabies: adults at high risk of close contact with rabid animals - 3 doses for pre-exposure immunization. Periodic serologic testing and booster doses (if required) for those at continuing high risk.

* For abbreviations and brand names of vaccines refer to Contents of Immunizing Agents Available for Use in Canada in Part 1.

Hib Footnote A
1 dose
IPV Footnote B
1 booster dose
MMR Footnote C
Second dose
Pneu-C-13 Footnote D
1 dose
Pneu-P-23 Footnote E
1 dose + 1 booster dose if at highest risk
Men-C-ACYW Footnote F
2 doses + booster doses
4CMenB Footnote G
2 doses
HA Footnote H
2 doses
HB Footnote I
3 or 4 doses
OR
HAHB Footnote J
3 or 4 doses
Inf Footnote K
Annually
Typh-I Footnote L
1 dose + booster doses if at ongoing risk
OR
Typh-O Footnote L
4 doses + booster doses if at ongoing risk
BCG Footnote M
1 dose
Rab Footnote N
3 doses + booster doses if required

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