Canada guidelines only





    • Live Vaccines

      Meales Mumps Rubella (MMR)

      Rotavirus (for infants 2-7mo)



      Yellow Fever


      Oral Polio (persons living with immunocompromized pt, should not receive)


    Pediatric Vaccinations



    Toronto Public Health Number

    If any questions about immunizations or to get the immunization record:

    Toronto Public Healh 416-392-1250

    Ask for Public Health Nurse



    • Can cause orchitis (testicular swelling) also parotid swelling etc...  Can cause reduced fertility in men.
    • New guideline: two doses
    • Before 1970: assumed immune through natural infection.
    • Those born betwen 1970-1992 only had one dose.

    Varicella Zoster

    • Zostavax
    • Varicella vaccine prevents chicken pox, while Zostavax prevents reactivation Herpes Zoster
    • Zostavax is not a substitute for varicella vaccine and should not be used in children
    • Indications:
      • Low-Level immunosuppressed >60yo
    • Live Vaccine - Be careful with immunosuppression!
    • Contraindications

      "Highly Immunocompromized"

      as per IDSA Guidelines 2014

      OK to receive

      "Low Immunocompromise"

      • Acquired or congenital defects of immune function
        (IF affects cellular immunity)
      • HIV with symptoms OR CD4 < 200, OR CD4 < 15%
      • Chemotherapy
      • Stem Cell or Solid Organ Transplant (in prev 2 months)
      • Sickle Cell Disease
      • Surgical Asplenia
      • Chronic Steroids (≥20mg/day prednisone equivalent for ≥ 2w)
      • Recombinant human immune mediators/modulators
        (i.e. TNF agents)
      • Controlled HIV CD4 > 200
      • Primary Immunocompromized
        (ONLY IF normal T-cell function)
      • Long-Term Low-Dose Immunosuppressants
        (<20mg/day prednisone)


    • Source:


    • Two types:
      • Inactivated Vaccine
      • Live attenuated (do not administer to immunocompromized)
    • Indications:
      • Yearly
      • Immunocompromised patients >6mo (except those that are unlikely to respond - see below)
    • Contraindicated in:
      • Unlikely to respond (intenstive chemotherapy, anti-B-cell antibodies in last 6mo)
    • Source:



    • Recommended 9-26yo Females
    • Free for grade 8 girls
    • Licensed, but not publicly funded, for males 9-26yo (Ontario)
    • Most effective prior to sexual contact.

    Meningococcal C-conjugate vaccine (Menjugate)

    Meningococcal vaccine (Serogroups A, C, Y, and W135).  In Canada only C.
    • Recommended for high risk:
      • Military recruits
      • College students
      • Asplenic patients
      • Terminal complement deficiencies
    • Problems:
      • Only against Group C
      • Titres drop after 3 years of a single dose.
      • Hence, B/C incidence is low, not recommended as routine.


    Twinrix (Hep A/B)




    • Types:
    • Pneumococcal 23-valent?  in canada only C?
      • >65yo
      • Chronic Disease:
        • Cardiovascular
        • Pulmonary
        • Liver
        • DM
        • Sickle cell
        • Asplenic: Functional Asplenia or Splenectomy.
        • Immunosuppression
      • IM Injection... protect for 5-10 years.


    Pneumococcal Vaccine

    • Protect against pneumococcal disease
    • Two types:
      • 13-valent pneumococcal conjugate
      • 23-valent pneumococcal polysaccharide  (PPSV23)
    • IPV - Invasive Pneumococcal Disease
    • All high risk patients >18yo should get pneumococcal vaccine (should get 2 doses if you are <65yo and are considered high risk). ​
    • "High Risk" based on:

        Non- Immunocompromising Conditions: 

        • Chronic CSF Leak
        • Chronic neurologicl condition that may impair oral secretion clearance
        • Cochlear implants
        • Chronic Disease:
          • Heart
          • Diabetes
          • Kidey
          • Lung (including asthma requiring medical care in last 12mo)
          • Liver (cirrhosis due to any cause)


        Immunocompromising conditions:

        • Sickle Cell Disease
        • Asplenia
        • Congenital immunodeficiencies (involving any part!)
        • Immunocompromising therapy
        • HIV Infection
        • Hematopoietic stem cell transplant recipient
        • Malignant neoplasms (incl leukemia/lymphoma)
        • Nephrotic Syndrome
        • Solid organ or island transplant (candidate or recipient)
    • Who should get the vaccine? 

    • Pneumococcal.png

    • Source:


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