Immunizations

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Immunizations

Overview

What are immunizations?

Immunizations help protect you or your child from disease. They also help reduce the spread of disease to others and prevent epidemics. Most are given as shots. They are sometimes called vaccines, or vaccinations.

In many cases when you get a vaccine, you get a tiny amount of the organism that causes the disease. This amount is not enough to give you the actual disease. But it is enough to cause your immune system to make antibodies that can recognize and attack the organism if you are ever exposed to it.

Sometimes a vaccine does not completely prevent the disease, but it will make the disease much less serious if you do get it.

Some immunizations are given only once. Others require several doses over time.

Why should you get immunized?

  • Immunizations protect you or your child from dangerous diseases.
  • They help reduce the spread of disease to others.
  • Vaccines have very few serious side effects.
  • They are often needed for entrance into school or daycare.

If you are a woman who is planning to get pregnant, talk to your doctor about what immunizations you have had and what you may need to protect your baby. And if you live with a pregnant woman, make sure your vaccines are up-to-date.

Travelling to other countries may be another reason to get immunized. Talk with your doctor at least 6 weeks before you leave to see if you need any shots.

What immunizations are recommended for children?

Childhood immunization schedules may vary in each province and territory. Ask your doctor what shots your child should get. Your doctor may recommend other shots too, if your child is more likely to have certain health problems.

The Canadian National Advisory Committee on Immunization (NACI) recommends a specific childhood immunization schedule, but recommendations may also come from the Canadian Paediatric Society (CPS) or your provincial or territorial ministry of health. Commonly recommended immunizations include:1

  • Chickenpox.
  • Diphtheria, tetanus, and pertussis (also known as whooping cough).
  • Flu (influenza). The flu vaccine is not given to children younger than 6 months.
  • H1N1 influenza (swine flu). This vaccine is not given to children younger than 6 months.
  • Haemophilus influenzae type b disease, or Hib disease.
  • Hepatitis B.
  • HPV (human papillomavirus).
  • Measles, mumps, and rubella.
  • Meningococcal disease.
  • Pneumococcal disease.
  • Polio.
  • Rotavirus.

Immunizations begin right after birth and are given throughout a baby's first 23 months. Booster shots are usually given between the ages of 4 and 6. Booster shots are the later doses of any vaccines that need to be repeated over time.

Fewer immunizations are needed after age 6. But a child older than 6 who has never been vaccinated should be. Also, teens who have been vaccinated as children may need additional or booster shots. Talk with your doctor about the specific vaccines that your child or teenager may need. Some shots are given during adulthood (such as a tetanus shot).

It is important to keep good records, including a list of any reactions to the vaccines. You may need to show proof of immunizations when you enrol your child in daycare or school.

Talk to your doctor if you or your child plans to be in a group living situation, like a university dormitory or summer camp. You may want certain shots, like those for the flu or meningitis.

What vaccines are recommended for adults?

The vaccines you need as an adult depend not only on your gender, age, lifestyle, overall health, pregnancy status, and travel plans but also on who you are in close contact with and what vaccines you had as a child.

Talk to your doctor about which vaccines you need. Depending on your situation, you may need vaccines for:

  • Chickenpox.
  • Influenza (flu).
  • Hepatitis A and/or B.
  • HPV (human papillomavirus).
  • Measles, mumps, and rubella.
  • Pneumococcal disease.
  • Polio.
  • Shingles.
  • Tetanus, diphtheria, and pertussis.

What are the side effects of vaccines?

Most side effects from vaccines are minor, if they occur at all. Your doctor will explain the reactions that could occur. They may include:

  • Redness, mild swelling, or soreness where the shot was given.
  • Slight fever.
  • Drowsiness, crankiness, and poor appetite.
  • A mild rash 7 to 14 days after chickenpox or measles-mumps-rubella shots.
  • Temporary joint pain after a measles-mumps-rubella shot.

Severe reactions, such as a fever over 40.5°C (104.5°F) or trouble breathing, are rare. If you or your child has an unusual reaction, call your doctor.

It is much more dangerous for a child to risk getting the diseases than it is to risk having a serious reaction to the vaccine.

Can vaccines cause other problems?

Some parents questioned whether vaccines that contain thimerosal, a chemical that contains mercury and is used as a preservative, might cause autism. Studies have not found a link between vaccines with thimerosal and autism.2 Today, none of the routine childhood vaccines made for use in Canada contain thimerosal. Only some flu vaccines and one form of the hepatitis B vaccine contain thimerosal.3

Some people worry that the shot for measles, mumps, and rubella can cause autism in children. This is because symptoms of autism are first noticed around 1 year of age, which is around the same time children receive their first shot for measles. Many studies have been done, and no link has been found between this vaccine and autism.2, 4

Frequently Asked Questions

Learning about immunizations:

Types of immunizations:

What are the immunization recommendations for:

Common concerns:

Ongoing concerns:

Health Tools Health Tools help you make wise health decisions or take action to improve your health.

Health Tools help you make wise health decisions or take action to improve your health.


Decision Points focus on key medical care decisions that are important to many health problems. Decision Points focus on key medical care decisions that are important to many health problems.
  Flu Vaccines: Should I Get a Flu Vaccine?
  HPV: Should My Daughter Get the Vaccine?

Childhood Immunizations

Recommended immunizations

Childhood immunization recommendations and schedules may vary by province and territory. Immunizations are recommended because they protect against diseases (give immunity) or make a disease less severe if your child does get it. These schedules outline the immunizations and booster shots needed from birth to age 18 and when catch-up immunizations should be given.

Many immunizations require more than one dose, given at varying intervals. Although your child does not need to restart the series if a scheduled dose is missed, the immunization should be given as soon as possible. Consult your doctor or public health unit if your child missed an immunization or to find out whether your child needs a specific immunization.

The schedule for a premature infant is the same as for a full-term infant, except for hepatitis B vaccine.

The Canadian National Advisory Committee on Immunization (NACI) recommends a specific childhood immunization schedule, but recommendations may also come from the Canadian Paediatric Society (CPS) or your provincial or territorial ministry of health. Commonly recommended immunizations include:1

Chickenpox (varicella)

This shot protects against chickenpox.

Who should get it?

  • All children 12 months of age and older who have not had chickenpox should get one dose at 12 to 18 months of age. Another dose may be given at a later time in some provinces.

The combination MMRV (Priorix-Tetra) shot can be given in place of the chickenpox vaccine. The vaccines for chickenpox, measles, mumps, and rubella are all in this one shot. Many provinces require that children entering daycare or school get immunized against chickenpox unless they can show proof of immunity (having had chickenpox or blood test results). Not all provincial or territorial health plans cover the cost of the chickenpox shot. You may have to pay for it.

Diphtheria, tetanus, and pertussis (DTaP)

The shots (immunizations) protect against diphtheria, tetanus, and whooping cough (pertussis).

Who should get it?

  • Five doses are given to all children—one at age 2 months, one at 4 months, one at 6 months, one at 18 months, and one at 4 to 6 years.
  • Children age 7 or older who have not been immunized, or it is not known if they have, may get the Tdap vaccine, which is the adult formulation used for people 7 and older.

Flu (influenza)

This immunization helps protect against the flu. Flu viruses are always changing, so the flu vaccines are updated every year.

Who should get it?

  • Your province or territory may have different recommendations about who should get a yearly flu vaccine. Flu vaccines are not given to children younger than 6 months of age. The National Advisory Committee on Immunization (NACI) and the Canadian Paediatric Society (CPS) suggest that everyone older than 6 months have a flu vaccine once a year. But it is especially important that people who have a high risk of having complications from the flu get one each year. People who have a high risk of having complications from the flu include:5, 6
    • All children 6 through 23 months of age.
    • Children 24 months and older, especially those with certain medical conditions (such as asthma, chronic heart or lung disorders, or an impaired immune system).
    • Close contacts, including household contacts and out-of-home caregivers, of children 23 months of age and younger and of children 24 months and older who are at high risk for complications from the flu.

Healthy children age 2 and older may be able to get the nasal spray form of the flu vaccine (FluMist) instead of the flu shot, if it is available. Protection lasts up to a year for both vaccine types.

If your child is not high risk, you may have to pay for the flu vaccine.

For more information about the flu, see the topics Influenza (Seasonal Flu) and H1N1 Influenza (Swine Flu). For the most current Public Health Agency of Canada guidelines, go to www.fightflu.ca.

Haemophilus influenzae type b (Hib)

This immunization protects against a bacteria that can cause an infection in the covering of the brain (meningitis) or lungs (pneumonia), skin and bone infections, and other serious illnesses in young children. It does not protect against viral influenza (flu).

Who should get it?

  • All children need three or four doses, starting at 2 months of age and ending by 18 months of age.
  • Children who are older than 5 years and have certain health conditions may also need this shot.

Hepatitis B (Hep B)

The shots protect against hepatitis B.

Who should get it?

  • All babies need three doses. The first dose may be given right after birth (before leaving the hospital) or at age 2 months. If the mother has tested positive for hepatitis B it is given within 12 hours of birth. The remaining doses are given by about 6 months of age. Children who have not been immunized for hepatitis B and are age 18 or younger can get the shots over a period of about 6 months.

Measles, mumps, and rubella (MMR)

The shots protect against measles, mumps, and rubella.

Who should get it?

  • All children need one dose at 12 months of age and a second dose after 15 months. To make it easy on parents, some provinces and territories may recommend that the second shot is given with other vaccines: at 18 months or between 4 and 6 years of age, before starting school.

There is a measles, mumps, rubella, and varicella (MMRV, or Priorix-Tetra) shot that also protects against chickenpox (varicella). Talk to your child's doctor about the pros and cons of the MMRV shot. It can be given to children ages 12 and younger.

Meningococcal disease

This shot protects against meningitis and blood infections (sepsis).

Who should get it?

  • Children at 2, 4, and 6 months of age, or at the ages recommended by your doctor, need this shot. Also, if this vaccine is given to a child younger than 12 months, a booster dose should be given between 12 and 24 months.7
  • In children ages 1 to 4 years, a single dose can be given, and it may be considered for children age 5 and older who have not been immunized.8

Children 2 and older who have a high risk for getting and having severe problems from meningitis should also have another type of meningococcal vaccine. These children include those who have a damaged or missing spleen or who have certain immune system problems.

Pneumococcal infections

The shots (called PCV or Prevnar) protect against meningitis, blood infections (sepsis), pneumonia, and ear infections.9

Who should get it?

  • All children need a total of three doses at ages 2, 4, and 12 to 15 months. Depending on what is recommended in your province, an additional dose may be given at 6 months of age.

Polio

This shot protects against polio.

Who should get it?

  • Four doses are given to all children—one at age 2 months, one at 4 months, one at 6 to 18 months, and one at 4 to 6 years.

Rotavirus vaccine

This immunization (called RotaTeq) protects against rotavirus infection.

Who should get it?

  • The rotavirus vaccine is recommended for children younger than 32 weeks. Children should get a total of 3 doses, at around 2, 4, and 6 months of age. It is swallowed rather than given as a shot.

What to think about

Some immunizations require more than one dose given at varying intervals. Although your child does not need to restart the series if a scheduled dose is missed, the immunization should be given as soon as possible.

Ask your health professional or local health unit for detailed information about whether your child needs a specific immunization and for the schedule used in your province or territory.

Other immunizations

Your child's doctor may recommend other immunizations, depending on whether your child is at higher risk than other children for certain health problems. Some of these other immunizations may include:

Hepatitis A (Hep A)

This shot protects against hepatitis A.

Who should get it?

  • Anyone 1 year of age or older who lives in a community where there is increased risk for hepatitis A or who will travel to a foreign country where hepatitis A is common. Hepatitis A vaccines are licensed in Canada for people age 1 and older. But studies show that the vaccines are safe and work in infants 6 months and older.10, 11

Combination vaccines may be preferred to separate shots because they reduce the number of needle pricks and protect your child from more diseases without delay. One example is Pentacel, which combines the vaccines for diphtheria, tetanus, pertussis, polio, and Haemophilus influenzae type b.

Keeping good immunization records

It is important to keep accurate records of immunizations, including any reactions to the vaccines. You may need to show proof of immunizations when you enrol your child in daycare or school.

  • Know when each immunization should be scheduled and put reminder notes on your calendar. You also may want to ask your health professional to send you notices when immunizations are due.
  • Make sure your health professional goes over your child's immunization record with you during each office visit.
  • Keep the record in a safe place and never throw it away. These are an important part of your child's permanent medical records.

For a form you can use to track your child's immunizations, see the National Childhood Immunization Record (What is a PDF document?), the Alberta childhood immunization record (What is a PDF document?), or the British Columbia Childhood Immunization Record (What is a PDF document?).

Immunization safety

Many parents worry that immunizations are dangerous if given when their child has a cold or other minor illness. Talk to your health professional if you have concerns about the timing of immunizations. Keep in mind that immunizations can usually still be given during a mild illness, while medications are being taken, and in other situations where a child may not be in perfect health. There are very few valid reasons for not getting your child immunized.

Some parents also fear that the measles-mumps-rubella (MMR) vaccine may cause their child to develop autism. Misleading stories about the MMR shot and autism have circulated through Web sites, the media, and word of mouth. However, scientific studies investigating these claims have found no connection between autism and the vaccine.2

Adolescent Immunizations

Recommended immunizations

The importance of continued immunizations between ages 11 and about 21 years (adolescence) is not always recognized. Teenagers need to continue their immunization series and receive booster shots for continued protection (immunity) against diseases. Also, many teens were born after the current recommendations for certain vaccines, such as for hepatitis B, were established. So they may not have received all their needed shots (injections) in early childhood.

The Canadian National Advisory Committee on Immunization (NACI) recommends a specific immunization schedule for children and adolescents.12 This schedule outlines the vaccinations or booster shots needed during adolescence as well as when catch-up vaccinations should be given. Immunization schedules may vary in each province and territory.

Immunizations given to teens usually include:

Tetanus, diphtheria, and pertussis booster (Tdap)

This shot protects against tetanus, diphtheria, and whooping cough (pertussis).

Who should get it?

  • All teenagers between 14 to 16 years of age.

Teens who only received the booster for tetanus and diphtheria (Td) should wait about 2 to 5 years before getting the Tdap booster.

Human papillomavirus (HPV)

The vaccines Cervarix and Gardasil protect against two types of human papillomavirus (HPV) that cause cervical cancer. Gardasil also protects against two types of HPV that cause genital warts. And it protects against some uncommon cancers, such as vaginal cancer.

Who should get it?

  • Girls 9 to 13 years old, before they become sexually active, need three shots of HPV vaccine, given over 6 months.13
  • Females ages 14 to 26, even if they are already sexually active, have had an abnormal Pap test, or have had an HPV infection should get the shot.
  • Males ages 9 to 26 can get three Gardasil shots to reduce the chance of getting genital warts.

Gardasil is approved for use in girls and women ages 9 to 45 years. Talk to your doctor to see if this vaccine is right for you.

Provincial health plans may not yet cover the cost of these immunizations outside of school-based vaccination programs. You may have to pay for the vaccine.

If you or your child already has HPV infection, talk with your doctor about whether to get immunized. The shot has not been shown to help existing HPV infection, but it may protect against other HPV infections.13

For help deciding if the HPV vaccine is right for your daughter, see:

Click here to view a Decision Point. HPV: Should My Daughter Get the Vaccine?

Meningococcal vaccine

This shot protects against meningitis and blood infections (sepsis). There are different meningococcal vaccines that protect people against certain strains of meningitis bacteria: conjugate and polysaccharide.

Who should get it?

  • Adolescents should get a meningococcal conjugate at around age 12, even if they received it as a child. The NACI does not recommend the polysaccharide vaccine for teens, unless they:
    • Have an increased chance of becoming infected during an outbreak.
    • Have a damaged spleen or have had the spleen removed.
    • Live in or travel to areas of the world where meningococcal disease is common, such as to certain parts of Africa or to Saudi Arabia during the Hajj.
    • Are military recruits.

Other immunizations

Some teens may need or want additional immunizations. Some immunizations may be required for situations that increase a person's risk for exposure to disease, such as being in group living situations (when attending university or summer camp) or travelling to foreign countries. These immunizations may include:

Chickenpox (varicella), if not previously received

This is important if your child never had chickenpox or never got this shot.

This shot protects against chickenpox.

Who should get it?

  • Teens and adults who are not already immune to the chickenpox virus should get this shot. Anyone who has this shot at 13 years of age or older should have two shots at least 4 weeks apart.

Chickenpox infection can be very serious when it occurs after childhood.

Not all provincial or territorial health plans cover the cost of chickenpox immunizations. You may have to pay for them yourself.

Flu (influenza)

This immunization helps protect against the seasonal flu. Flu viruses are always changing, so the flu vaccines are updated every year. Protection lasts up to a year.

Who should get it?

  • The National Advisory Committee on Immunization (NACI) suggests everyone 6 months and older have a yearly flu vaccine.
  • Teens with certain health conditions, such as asthma, chronic heart or lung disorders, or an impaired immune system, should get a yearly flu vaccine.
  • Siblings or close contacts of all children 23 months of age and younger and of anyone who is in a high-risk category for complications of the flu should be immunized each year.

A new flu vaccine (FluMist) that is given as a spray in the nose may be available in Canada for the 2010–2011 flu season. Because this flu vaccine uses live flu virus, it is not recommended for children younger than 2 years, pregnant women, or people with some health conditions. For more information, talk with your doctor.

If you or your child is not high risk, you may have to pay for the flu vaccine.

For more information about the flu, see the topics Influenza (Seasonal Flu) and H1N1 Influenza (Swine Flu). For the most current Public Health Agency of Canada guidelines, go to www.fightflu.ca.

Hepatitis A (Hep A)

This shot protects against hepatitis A.

Who may need it?

Hepatitis B (Hep B), if not previously received.

This is important if your child never got this shot.

This shot protects against hepatitis B.

Who should get it?

  • Anyone 18 years of age or younger who has not had this shot should get three doses over a period of about 6 months.

Hep B immunization may also be recommended before entering university if not already given earlier.

Measles, mumps, and rubella (MMR), if not previously received

This is important if your child never got this shot.

This shot protects against measles, mumps, and rubella. There is a measles, mumps, rubella, and varicella (MMRV, or Priorix-Tetra) shot that also protects against chickenpox (varicella). It can be substituted for either or both doses of MMR in children ages 1 to 12 years.

Who should get it?

  • Any child who did not get two doses after the age of 1 year needs to get it by age 11 or 12.

University students and international travellers may need written documentation that shows evidence of immunity, such as having two doses of MMR vaccine.

Pneumococcal polysaccharide vaccine (PPV)

This shot protects against meningitis, pneumonia, and blood infections (sepsis).

Who should get it?

  • Teens with certain chronic diseases, such as diabetes or heart disease, need this shot.

Immunization safety

Most side effects from vaccines—if they occur at all—are minor. The doctor may have your child stay in the office for up to 15 minutes after the shots are given, to watch for any reactions.

Many parents worry that immunizations are dangerous if given when their child has a cold or other minor illness. Talk to your child's doctor if you have concerns about the timing of immunizations. But keep in mind that shots can usually still be given during a mild illness, while medicines are being taken, and in other situations where a child may not be in perfect health. There are very few reasons for which doctors suggest that a person postpone or not get an immunization.

Adult Immunizations

Recommended immunizations

Your need for immunizations does not end when you reach adulthood. The specific shots (injections) you need as an adult depend not only on your gender, age, lifestyle, overall health, pregnancy status, and travel plans but also on who you are in close contact with and what vaccines you had as a child. Tetanus and diphtheria immunizations need to be repeated (booster shots) every 10 years throughout adulthood in order to maintain immunity. The Canadian National Advisory Committee on Immunization (NACI) recommends immunization schedules for the general adult population and adults with medical conditions (including pregnancy).12

Your doctor will consider your medical and immunization history (and documentation) when deciding which shots you need.

To see what shots you may need, ask your health professional or local health unit. You may also be able to find the immunization schedule on the Web site of your province's or territory's ministry of health.

Immunizations given during adulthood may include:

Chickenpox (varicella)

This shot protects against chickenpox. Chickenpox infection can be very serious when it occurs after childhood.

Who should get it?

  • Adults who are not already immune to the chickenpox virus need two doses, given at least 4 weeks apart.

Pregnant women and people with immune system problems should not receive this shot.

Not all provincial or territorial health plans cover the cost of chickenpox shots for adults. You may have to pay for them yourself.

Flu (influenza)

This immunization helps protect against the seasonal flu. Flu viruses are always changing, so the flu vaccines are updated every year.

Who should get it?

  • Flu immunization is recommended once a year for everyone age 6 months and older.
    • A yearly flu vaccine is especially important for anyone who has a high risk of complications from the flu. This includes adults 65 years of age and older, women who are pregnant or breast-feeding, and those with chronic health conditions, such as asthma, chronic heart or lung disorders, or an impaired immune system.
    • The flu vaccine should be given each year to household contacts or out-of-home caregivers of all children 23 months of age and younger and to close contacts of others who are at high risk for complications of the flu.5

A new flu vaccine (FluMist) that is given as a spray in the nose may be available in Canada for the 2010–2011 flu season. Because this flu vaccine uses live flu virus, it is not recommended for children younger than 2 years, pregnant women, or people with some health conditions. For more information, talk with your doctor.

If you or your child is not high risk, you may have to pay for the flu vaccine.

For more information about the flu, see the topics Influenza (Seasonal Flu) and H1N1 Influenza (Swine Flu). For the most current Public Health Agency of Canada guidelines, go to www.fightflu.ca.

If you are not high risk, you may have to pay for the flu shot.

For help deciding if the flu shot is right for you, see:

Click here to view a Decision Point. Flu Vaccines: Should I Get a Flu Vaccine?
Myths About the Flu Vaccine.

Hepatitis A (Hep A)

The shots protect against hepatitis A.

Who should get it?

  • Adults who live in communities where outbreaks of hepatitis A have recently occurred need the shots.
  • Adults who live in a community where there is increased risk for hepatitis A.
  • Adults who will be travelling to certain foreign countries, such as those in Central or South America also need the shots.
  • Adults who have certain risk factors, such as long-term (chronic) liver disease, should also be immunized.

Two doses are needed for long-lasting protection.

Hepatitis B (Hep B)

This shot protects against hepatitis B.

Who should get it?

  • Adults who have not received the vaccine series for hepatitis B need this shot when their work, travel, health condition, or lifestyle increases their risk of exposure.14

Three doses are needed over at least 4 months.

A hepatitis combination vaccine is recommended for those who are at risk for both hepatitis A and hepatitis B. A reduced-dose formulation is available for those 15 years of age or younger.15

Human papillomavirus (HPV)

The vaccines Cervarix and Gardasil protect against two types of human papillomavirus (HPV) that cause cervical cancer. Gardasil also protects against two types of HPV that cause genital warts. And it protects against some uncommon cancers, such as vaginal cancer.

Who should get it?

  • Females ages 14 to 26, even if they are already sexually active, have had an abnormal Pap test, or have had an HPV infection should get the shot.
  • Males ages 9 to 26 can get three Gardasil shots to reduce the chance of getting genital warts.

Gardasil is approved for use in girls and women ages 9 to 45 years. If you or your child already has HPV infection, talk with your doctor about whether to get immunized. The shot has not been shown to help existing HPV infection, but it may protect against other HPV infections.13

Provincial health plans may not yet cover the cost of these immunizations outside of school-based vaccination programs. You may have to pay for the vaccine.

Measles, mumps, and rubella (MMR)

This shot protects against measles, mumps, and rubella.

Who should get it?

  • Adults born after 1970 may need MMR vaccination if they do not have evidence of immunity.

Women should avoid becoming pregnant for 28 days after getting the MMR shot. Women who are known or suspected to be pregnant and people who have impaired immune systems should not receive the MMR vaccine.16

Pneumococcal polysaccharide (PPV)

This shot protects against meningitis, pneumonia, and blood infections (sepsis).

Who should get it?

  • All people 65 years of age and older need this shot.
  • People ages 2 to 64 who have a chronic disease (such as heart, liver, or lung disease), do not have a spleen, or have a damaged spleen also need this shot.
  • People who smoke or are dependent on alcohol should also get the vaccine.

This vaccine is different than the pneumococcal conjugate vaccine (PCV) that is recommended for children. Most adults only need one dose of PPV for protection. Some people might need to get a booster shot after 5 years.

Shingles (herpes zoster)

This shot (called Zostavax) protects against shingles.

Who should get it?

Adults age 60 and older need one dose, whether or not they've had shingles before. Zostavax is not a substitute for the chickenpox shot (Varivax).

Tetanus, diphtheria, and pertussis (Tdap)

This shot protects against tetanus, diphtheria, and whooping cough (pertussis).

Who should get it?

  • All adults need Td boosters every 10 years throughout life.
  • Adults up to 54 years of age who did not get the booster dose of Tdap as a teen should get one instead of Td (tetanus and diphtheria) vaccine.

If you recently had a Td booster, you should wait 2 to 5 years before getting a booster dose of Tdap.17, 18 The more vaccines you get in a short time frame, the more likely you are to react with arm swelling and redness at the site of the shot. But it may be worth a mild reaction in order to protect an infant from getting pertussis.

Other immunizations

You may need or want additional immunizations if certain situations raise your chance for exposure to disease. Or, you may have missed shots when you were younger or if a vaccine wasn't offered when you were younger. These immunizations may include:

Meningococcal

This shot protects against meningitis and blood infections (sepsis).

Who should get it?

  • Anyone 2 years of age and older should be considered for the meningococcal vaccine if they:
    • Have an increased risk of becoming infected during an outbreak.
    • Have a damaged spleen or have had the spleen removed.
    • Live in or travel to areas of the world where meningococcal disease is common, such as to certain parts of Africa or to Saudi Arabia during the Hajj.
    • Are a military recruit.

Polio (IPV)

This shot protects against polio.

Who should get it?

  • Adults whose jobs or travel puts them at increased risk for exposure to polio need this shot.

Routine polio immunization is not recommended for adults (age 18 and older) who live in Canada.

Consult your doctor or public health unit if you missed an immunization or to find out whether you need a specific immunization.

Immunizations and pregnancy

Before you become pregnant, it is best to discuss your immunization history with your health professional. If you need the chickenpox or measles, mumps, and rubella (MMR) shots, wait at least 4 weeks after the immunization before becoming pregnant.

The NACI recommends the inactivated flu shots for all women who are or who plan to be pregnant during the flu season or who will be in close contact with people that are considered high risk for complications from the flu. Pregnant women should not receive the nasal spray flu vaccines.

Also, pregnant women should not receive the HPV vaccine.

Pregnant women who are due for their tetanus booster can get immunized with the Td vaccine. Because no studies have been done to see the effect of Tdap on fetuses, the NACI recommends that pregnant women wait until they have had their babies to get Tdap.

If you are pregnant, your children should still get their immunizations on schedule. You do not need to speed up or delay your other children's immunizations.

Travel Immunizations

Recommended immunizations

Talk with your health professional months in advance of a trip to determine whether any immunizations are recommended. Certain factors, such as your age and health, where you are going, and the length of your stay, affect your risk of disease and need for immunization.

Your age and health

People with certain medical conditions, such as immune system problems, may have different immunization recommendations than healthy people. In addition, young children may need to receive their routine vaccinations sooner than outlined in the recommended immunization schedule.

Where you travel

In most developed countries (including the United States, Australia, New Zealand, Japan, and western and northern European countries), the risk of exposure to serious diseases is generally no greater than it is in Canada.

The risk for exposure to serious disease may be much higher in developing countries (such as those in most parts of Africa and Asia and many parts of South and Central America) than it is in most developed countries. This is especially true for areas with poor sanitation (for example, poor water and food handling). For example:

The need for these vaccines depends on your immunization history, the specific area you plan to visit, the time of year, and whether any outbreaks of disease have recently occurred.

How you travel and types of activities

Certain activities or modes of travel increase your risk of exposure to disease. These include:

  • Exploring rural areas or those off the usual tourist route.
  • Backpacking trips.
  • Visiting another country.

Length of stay

The longer you stay in a country, the more exposure you have to local pathogens that could cause harm.

Other immunizations

You can get information about travel immunizations by:

  • Contacting your local health unit. If your health unit does not give immunizations for travellers, ask for the name of a travel clinic near you.
  • Visiting the Travel Health Web site of the Public Health Agency of Canada at www.phac-aspc.gc.ca/tmp-pmv/index-eng.php.

In Canada and some other countries, an oral vaccine (Dukoral) against cholera and E. coli bacteria that cause some forms of traveller's diarrhea is available for anyone age 2 or older.

For more information on immunizations and health related to travel, see the topic Travel Health.

Bioterrorism and Immunizations

The Canadian government has developed plans on how to respond to possible bioterrorism threats. Certain diseases have been identified that pose the greatest threat to the Canadian public. At this time, vaccines are available for only anthrax and smallpox. These immunizations are not currently available to or recommended for the general public. But the government has advised vaccination for people at high risk of exposure to anthrax or smallpox, such as health care workers specifically designated to respond to a bioterrorism emergency. Some of these recommendations are listed below.

Anthrax vaccine

This shot protects against anthrax.

Who should get it?

  • People who are at high risk of exposure, such as certain lab workers, people who work with imported animals where preventive standards are lacking (such as veterinarians who travel to work in other countries), and certain military members should get this shot.

Six shots are given over 18 months. Booster shots are needed each year thereafter for continued protection (immunity).

Smallpox vaccine

This shot protects against smallpox.

Who should get it?

  • Certain health care and public health workers, infection-control specialists, public health personnel, and military personnel need this shot.

This shot is given once as several quick punctures on the upper arm, using a special prong device. Immunity after a first-time vaccination is likely to be 3 to 5 years. If you have been vaccinated in the past, successful revaccination may extend your immunity.

The Government of Canada has enough smallpox vaccine to vaccinate Canadians in an emergency.19

More information about these immunization recommendations can be found on the Public Health Agency of Canada's Emergency Preparedness Web site at www.phac-aspc.gc.ca/ep-mu/index-eng.php or the U.S. Centers for Disease Control and Prevention (CDC) Web site at www.bt.cdc.gov/index.asp.

For more general information about bioterrorism issues, see the topic Disasters and Other Public Health Threats.

When to Call a Doctor

Call 911 or other emergency services if you or your child develops any of the following symptoms:

Call your doctor if:

  • Redness and swelling at the site of the shot (injection) last longer than 48 hours.
  • A fever lasts for more than 48 hours after getting a shot.
  • Any unusual reaction occurs.

If a fever develops after an immunization, see one of the following topics to find out if you need to call your doctor:

Talk with your doctor about whether you need special immunizations because you:

  • Are in close contact with people who have an infectious disease.
  • Have planned international travel, especially to developing countries.
  • Live with or visit a pregnant woman or a baby.
  • Live with someone who has an impaired immune system.

Home Treatment

Help your child handle immunizations

Many immunizations are given as shots (injections). Your child may experience brief pain as the needle penetrates the skin or muscle, and some vaccines cause more discomfort than others. In general, you can help decrease your child's discomfort by making sure he or she is physically comfortable and well rested before getting immunized. You can use home treatment measures to help relieve some of the common minor reactions to immunizations.

Relieve mild reactions to immunizations

You can help relieve some of the common, temporary, mild reactions to immunizations with basic home care.

  • Fever. A slight fever may occur after you or your child gets a shot. Acetaminophen (such as Tylenol) may help lower a fever. Follow the package instructions carefully. If you give medicine to your baby, follow what your doctor has told you about the amount to give. Check with your doctor first if you are not sure your young baby's fever is related to getting immunizations. Do not give ASA to anyone younger than age 20 because of the risk of Reye syndrome. For more information on fevers, see the topic Fever, Age 11 and Younger or Fever, Age 12 and Older.
  • Swelling or redness. The area around the injection site may become red and swollen. Apply a wrapped ice pack or cool compress to the area for about 10 to 20 minutes. If this does not reduce the symptoms, acetaminophen may help relieve the discomfort. Follow the package instructions carefully.
  • Fretfulness and poor appetite. For a few hours after getting the DTaP, your baby may be fretful and drowsy and may refuse to eat. Plan quiet activities at home for the evening after your child receives an immunization. Hold and cuddle your child when needed. Keep your home at a comfortable temperature; your child is more likely to be fretful if he or she gets too warm.
  • Skin rash. Your child may have a mild skin rash 7 to 14 days after getting the chickenpox or measles, mumps, and rubella (MMR) shots. These types of rashes can last several days and go away without treatment.

For more information about reactions to immunizations, see the When to Call a Doctor section of this topic.

Other Places To Get Help

Organizations

Canadian Immunization Awareness Program
Canadian Coalition for Immunization Awareness and Promotion (CCIAP)
Web Address: www.immunize.cpha.ca/en/default.aspx
 

The Canadian Coalition for Immunization Awareness and Promotion (CCIAP) is a coalition of national organizations committed to promotion and education on immunization. Its Web site includes information on immunizations, diseases, and vaccines for adults and children.


National Advisory Committee on Immunization (NACI)
Web Address: www.phac-aspc.gc.ca/naci-ccni/index-eng.php
 

The National Advisory Committee on Immunization (NACI) is a national committee of recognized experts in the fields of pediatrics, infectious diseases, immunology, medical microbiology, internal medicine, and public health. NACI makes recommendations for the use of vaccines currently or newly approved for use in Canada. All NACI recommendations on vaccine use in Canada are published every four years in the Canadian Immunization Guide, which is available on the NACI Web site. The site also includes immunization and disease statistics and general information about vaccines.


Public Health Agency of Canada (PHAC)
130 Colonnade Road
A.L. 6501H
Ottawa, ON  K1A 0K9
Phone: Telephone numbers for PHAC vary by region. For your regional number, go to the listing on the PHAC website at www.phac-aspc.gc.ca/contac-eng.php.
Web Address: www.phac-aspc.gc.ca/index-eng.php
 

The Public Health Agency of Canada (formerly the Population and Public Health Branch of Health Canada) is primarily responsible for policies, programs, and systems relating to disease prevention, health promotion, disease surveillance, community action, and disease control.


Travel Health Information (Canada)
Public Health Agency of Canada
Web Address: www.phac-aspc.gc.ca/tmp-pmv/index-eng.php
 

The Public Health Agency of Canada's Travel Health Web site provides travel health information for persons travelling outside Canada, including current information on international disease outbreaks, immunization recommendations for international travel, general health advice for international travellers, and disease-specific treatment and prevention guidelines. Information can be accessed 24 hours a day through the Travel Health Web site.


World Health Organization—International Travel and Health Subsite
Web Address: www.who.int/ith
 

The World Health Organization provides current information on health risks travellers may face, vaccine-preventable diseases in countries around the world, and a comprehensive listing of recommended and required vaccines for different countries. The information can be accessed by disease, by country, and by geographical region.


References

Citations

  1. National Advisory Committee on Immunization (NACI) (2006). Recommended immunization. In Canadian Immunization Guide, 7th ed. Ottawa: Public Health Agency of Canada. Also available online: http://publications.gc.ca.
  2. National Advisory Committee on Immunization (NACI) (2007). Thimerosal: Updated statement. Canada Communicable Disease Report, 33(ACS-6): 1–13. Also available online: http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/07pdf/acs33-06.pdf.
  3. National Advisory Committee on Immunization (NACI) (2005). Updated recommendation on the use of thimerosal-containing vaccines in Canada. Canada Communicable Disease Report, 31(ACS-12): 1–4. Also available online: http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/05vol31/asc-dcc-12/index.html.
  4. Demicheli V, et al. (2007). Vaccines for measles, mumps and rubella in children. Cochrane Database of Systematic Reviews (1).
  5. National Advisory Committee on Immunization (NACI) (2009). Statement on influenza vaccination for the 2009–2010 season. Canada Communicable Disease Report, 35(ACS-6): 1–41. Also available online: http://origin.phac-aspc.gc.ca/publicat/ccdr-rmtc/09vol35/acs-dcc-6/index-eng.php.
  6. Canadian Paediatric Society (2004). Recommendation for the use of influenza vaccine for children. Paediatrics and Child Health, 9(7): 283–284. Also available online: http://www.cps.ca/english/statements/ID/ID04-01.htm.
  7. National Advisory Committee on Immunization (NACI) (2007). Meningococcal C conjugate vaccination recommendations for infants. Canada Communicable Disease Report, 33(ACS-11): 1–12.
  8. National Advisory Committee on Immunization (NACI) (2006). Menningococcal vaccine. In Canadian Immunization Guide, 7th ed., pp. 237–250. Ottawa: Public Health Agency of Canada.
  9. Pneumococcal vaccine (Prevnar) for otitis media (2003). Medical Letter on Drugs and Therapeutics, 45 (W1153B): 27–28.
  10. Troisi CL, et al. (1997). Immunization of seronegative infants with hepatitis A vaccine (HARRIX; SKB): A comparative study of two dosing schedules. Vaccine, 15(15): 1613–1617.
  11. Dagan R, et al. (2000). Immunization against hepatitis A in the first year of life: Priming despite the presence of maternal antibody. Pediatric Infection Disease Journal, 19(11): 1045–1052.
  12. National Advisory Committee on Immunization (NACI) (2006). Canadian Immunization Guide, 7th ed., pp. 1–372. Ottawa: Public Health Agency of Canada. Also available online: http://publications.gc.ca.
  13. National Advisory Committee on Immunization (2007). Statement on human papillomavirus vaccine. Canada Communicable Disease Report, 33(ACS-2): 1–32.
  14. National Advisory Committee on Immunization (NACI) (2006). Hepatitis B vaccine. In Canadian Immunization Guide, 7th ed., pp. 189–204. Ottawa: Public Health Agency of Canada.
  15. National Advisory Committee on Immunization (NACI) (2006). Hepatitis vaccines combined. In Canadian Immunization Guide, 7th ed., pp. 205–208. Ottawa: Public Health Agency of Canada.
  16. National Advisory Committee on Immunization (NACI) (2006). Recommended immunization: Immunization in pregnancy and breast-feeding. In Canadian Immunization Guide, 7th ed., pp. 107–112. Ottawa: Public Health Agency of Canada.
  17. National Advisory Committee on Immunization (NACI) (2006). Pertussis vaccine. In Canadian Immunization Guide, 7th ed., pp. 257–266. Ottawa: Public Health Agency of Canada. Also available online: http://publications.gc.ca.
  18. Naus M, et al. (2005). Interval between administration of vaccines against diphtheria, tetanus, and pertussis. Canada Communicable Disease Report, 31(ACS-9): 1–6. Available online: http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/05vol31/acs-dcc-8-9/9_e.html.
  19. Public Health Agency of Canada (2004). Emergency preparedness: Smallpox. Available online: http://www.phac-aspc.gc.ca/ep-mu/smallpox-eng.php.

Other Works Consulted

  • Atkinson W, et al., eds. (2007). Epidemiology and Prevention of Vaccine-Preventable Diseases, 10th ed. (The Pink Book). Washington, DC: Public Health Foundation. Also available online: http://www.cdc.gov/vaccines/pubs/pinkbook/default.htm. [Errata and updates available online: http://www.cdc.gov/vaccines/pubs/pinkbook/pink-errata.htm.]
  • Centers for Disease Control and Prevention (2006). General recommendations on immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR, 55(RR-15): 1–48. Also available online: http://www.cdc.gov/mmwr/PDF/rr/rr5515.pdf.
  • Centers for Disease Control and Prevention (2006). Preventing tetanus, diphtheria, and pertussis among adolescents: Use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR, 55(RR-3): 1–44. Also available online: http://www.cdc.gov/mmwr/PDF/RR/RR5503.pdf.
  • Centers for Disease Control and Prevention (2007). Prevention of varicella: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR, 56(RR-4): 1–48. Also available online: http://www.cdc.gov/mmwr/PDF/rr/rr5604.pdf.
  • Dear KB G, et al. (2006). Vaccines for preventing pneumococcal infection in adults. Cochrane Database of Systematic Reviews (1). Oxford: Update Software.
  • National Advisory Committee on Immunization (NACI) (2010). Statement on measles-mumps-rubella-varicella vaccine. Canada Communicable Disease Report, 36(ACS-9): 1–22. Also available online: http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/10vol36/acs-9/index-eng.php.
  • National Advisory Committee on Immunization (NACI) (2010). Update on the use of conjugate pneumococcal vaccines in childhood. Canada Communicable Disease Report, 36(ACS-12): 1–21. Also available online: http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/10vol36/acs-12/index-eng.php.
  • National Advisory Committee on Immunization (NACI) (2010). Varicella vaccination two-dose recommendations. Canada Communicable Disease Report, 36(ACS-8): 1–26. Also available online: http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/10vol36/acs-8/index-eng.php.
  • Weller PF (2005). Health advice for international travelers. In DC Dale, DD Federman, eds., ACP Medicine, Clinical Essentials, chap. 7. New York: WebMD.

Credits

By Healthwise Staff
Primary Medical Reviewer Adam Husney, MD, MD - Family Medicine
Specialist Medical Reviewer Brian D. O'Brien, MD - Internal Medicine
Last Revised August 24, 2011

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information.