Publicly Funded Immunization Schedules for Ontario August 2011

Publicly funded vaccines may be provided only to eligible persons and must be free of charge.

SCHEDULE 1. Routine Schedule for Children Beginning Immunization in Early Infancy (Starting at 2 months of age)
Age at vaccination:
Completed months and years

DTaP-IPV1-Hib2

Pneu-C-133

Rot-14

Men-C-C5

MMR6

Var 7

MMRV8

Men-C-ACYW9

HB10

HPV-411

Tdap12

Inf 13

2 months old
4 months old
6 months old
12 months old

15 months old
18 months old
4-6 years old

Grade 7 students

Grade 8 females

14-16 years old (10 years

after 4-6 year old booster)

Every year (in autumn)

**

*DTaP-IPV preferably given at 4 years of age; administer to children <6 years old, see Schedule 3. For Pneu-C-13 high risk schedule, see Table 3. MMRV preferably given at 4 years of age. Administered
through school-based program. See Schedule 4 for adult Td immunization. **Previously unimmunized children <9 years receive 2 doses of Inf 4 weeks apart.

Notes:
High risk: For high risk eligibility criteria, please see
page 3.
Catch-up: for catch-up schedules, please refer to
Schedules 2 and 3.
Interruption of a vaccine series does not require
restarting the series, regardless of the length of time
elapsed since the last dose.
Up to date immunization records or valid exemptions
are required for attendance at school (Immunization of
School Pupils Act) and licensed daycare centres (Day
Nurseries Act) in Ontario.

Vaccine Administration:
Never mix and administer different vaccines
together in the same syringe unless indicated in the
product monograph.
Route of administration:
Intramuscular (IM): DTaP-IPV-Hib, DTaP-IPV, Tdap,
Td, HA, HB, HPV-4, Men-C-C, Men-C-ACYW, Inf, and
Pneu-C-13.
Subcutaneous (SC): MMR, Var, MMRV, and IPV
(if given as a separate antigen).
IM or SC: Pneu-P-23
Oral (PO): Rot-1

Refer to the Canadian Immunization Guide (CIG), 7th edition (2006) (or as current) for additional information regarding
recommendations for immunocompromised individuals.

Site: For site of administration go to:

http://www.cdc.gov/vaccines/pubs/pinkbook/
downloads/appendices/D/vacc_admin.pdf

(Available online at: http://www.phac-aspc.gc.ca/publicat/cig-gci/pdf/cig-gci-2006_e.pdf; Guide errata and clarifications, March 2008. Available at: http://www.phac-aspc.gc.ca/publicat/cig-gci/errarta-eng.php)

Needle Length: The appropriate size and length of

needle for vaccine administration should be based on
the age and size of the individual. For IM injections:
infants <6 months use 7/8 inch (2.2 cm) needle
children 6 months use 1 inch (2.5 cm) needle
adolescents and adults use 1 inch to 1 inch
(2.5cm to 3.8 cm) needle

For vaccines not publicly funded, please refer to NACI statements, and the individual product monographs for indications and usage.
Available at: http://www.phac-aspc.gc.ca/naci-ccni/recs-eng.php

For more information and to report adverse events following immunization (AEFIs) contact your local public health unit at:

1. Diphtheria, Tetanus and Acellular Pertussis

vaccine Inactivated Poliovirus Vaccine,
(DTaP-IPV)

Routine: The 4-6 year (5th) or school entry dose

of DTaP-IPV in Schedules 1 and 2 is not
necessary if the 4th dose was given after the
4th birthday. For the infant/primary series, the
series should start no earlier than 6 weeks of
age. DTaP-IPV (Quadracel) should not be
given to children >6 years of age.
Catch-up: Tdap plus IPV should be given separately to
children who missed their 4-6 year booster
dose of DTaP-IPV.

To find your local public health unit, go to:

www.health.gov.on.ca/English/public/contact/phu/phuloc_mn.html

Health Protection and Promotion Act

The National AEFI reporting form and User Guide are available at:
http://www.phac-aspc.gc.ca/im/aefi-form-eng.php
For more detailed vaccine information, consult the manufacturers product monograph, Canadian Immunization Guide,
or the National Advisory Committee on Immunization website at:
http://www.phac-aspc.gc.ca/naci-ccni/index.html
References:
National Advisory Committee on Immunization. Statement on Seasonal Trivalent Inactivated Influenza Vaccine (TIV) for 2010-2011, CCDR, Volume 36,
ACS-6; August 2010.
National Advisory Committee on Immunization. Statement on Human Papillomavirus Vaccine, CCDR, Volume 33, ACS-2: February 15, 2007.
National eligible, due, and overdue guidelines for immunization registries: Draft recommendations from the Canadian Immunization Registry Network Data
Standards Task Group. CCDR 15 March 2004 Volume 30 Number 06. Available at: http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/04vol30/dr3006e.html

2. Haemophilus influenzae type b Vaccine (Hib)

Catalogue No. 016551 (Print) July 2011 Queens Printer for Ontario

A physician, a member of the College of Nurses of Ontario or a member of the Ontario College of Pharmacists who,
while providing professional services to a person, recognizes the presence of a reportable event and forms the opinion that it may
be related to the administration of an immunizing agent shall, within seven days after recognizing the reportable event, report thereon
to the medical officer of health of the health unit where the professional services are provided.

DTaP-IPV-Hib (Pediacel) or monovalent Hib. Hib

vaccine is not routinely recommended for children 5
years of age.

3. Pneumococcal Conjugate 13-valent Vaccine

(Pneu-C-13)

Routine: 3-dose schedule at 2, 4 months with a

booster dose at 12 months of age for all low
risk children <2 years of age.
Catch-up: Unimmunized children <5 years of age remain
eligible for Pneu-C-13. See Schedule 2.
One time catch-up for 2011 only: The following
children who have completed a primary series of
Pneu-C-10 and/or Pneu-C-7 are eligible to receive an
additional single dose of Pneu-C-13:
low risk children <3 years old;
high risk children <5 years old;
Aboriginal children <5 years old; or
children attending group day care <5 years old.

4. Rotavirus ORAL Vaccine (Rot-1)

Routine: 2-dose schedule at 2 and 4 months. 2 doses

at least 4 weeks apart should be completed
by 24 weeks of age. Although the vaccine
manufacturer has indicated that the first dose
may be administered as early as 6 weeks and
as late as 20 weeks of age, NACI recommends
that the first dose be administered between
6 weeks and <15 weeks of age as the safety of
providing the first dose of rotavirus vaccine in
older infants is not known.

5. Meningococcal Conjugate C Vaccine (Men-C-C)

Routine: Children aged 1 year old should receive a

single dose.
Catch-up: Unimmunized persons remain eligible for a
single dose of Men-C-C if they were:
1 year of age on or after Sept. 2004; or
born between 1986 and 1996.

6. Measles, Mumps, Rubella Vaccine (MMR)

The 1st dose of MMR should be given on or after the 1st
birthday. The 2nd dose of MMR vaccine should be given
as MMRV at 4-6 years of age.
MMR is a live virus vaccine. MMR and varicella
vaccine must be given on the same day or at least
28 days apart.
Adults born prior to 1970 are assumed to have naturally
acquired immunity to measles and mumps. Adults born
in 1970 or later without evidence of immunity to measles
or mumps should receive 1 dose of MMR.
A 2nd dose of MMR is recommended for young adults
(18-25 years), post secondary students, persons who
received killed measles vaccine (1967-1970), health care
workers and those who plan to travel internationally.
All women of reproductive age should have at least
1 documented dose of rubella vaccine or serologic
evidence of immunity.

7. Varicella Vaccine (Var)

Routine: Children 15 months of age should receive

the 1st dose. The 2nd dose should be given as
MMRV at 4-6 years of age.
Catch-up: Children born on or after Jan. 1, 2000 and
who are at least 1 year of age are eligible
for 2 doses of varicella vaccine.
Varicella is a live virus vaccine. Varicella and
MMR vaccine must be given on the same day or
at least 28 days apart.

8. Measles, Mumps, Rubella, Varicella Vaccine

(MMRV)

Routine: 1 dose of MMR at 12 months, 1 dose of Var

at 15 months and 1 dose of MMRV at 4-6
years of age (preferably prior to school
entry).
Catch-up: Children 7-11 years of age who have not
received any doses of MMR or varicella may
receive 2 doses of MMRV.
MMRV is a live virus vaccine. MMRV and
varicella must be given 3 months apart and
MMRV and MMR must be given 6 weeks apart.

9. Meningococcal Conjugate ACYW-135 Vaccine

(Men-C-ACYW)

Routine: Students in grade 7 are eligible to receive a

single dose of Men-C-ACYW.
Catch-up: Since 2009, students who were eligible
in grade 7 and have not yet received the
vaccine; remain eligible for a single dose of
Men-C-ACYW.

10. Hepatitis B Vaccine (HB)

Routine: 2-dose schedule for grade 7 students, given

4-6 months apart depending on the product
used.
Catch-up: Any Grade 7 student who missed 1 or both
doses of HB is eligible to complete the series
by the end of Grade 8.

11. Human Papillomavirus Vaccine (HPV-4)

Routine: All female Grade 8 students receive 3 doses

given at 0, 2 and 6 months.
One time catch-up for 2010/2011 school year only:
Female students who received at least
1 dose of HPV-4 in their Grade 8 year or
before the 1st day of grade 9 may complete
the series in Grade 9.

12. Diphtheria, Tetanus and Acellular Pertussis

Vaccine (Tdap)/Inactivated Poliovirus Vaccine
(IPV)

Routine: A single dose of Tdap is recommended for all

adolescents between the ages of 14-16 years
old (with eligibility until 18 years of age) and
10 years after the 4-6 year old booster.
Catch-up: Unimmunized children/adolescents
beginning their primary series at 7 years of
age or older should receive 3 doses of Tdap
plus IPV (2 separate injections). The 14-16
year old booster dose should be given at
least 5 years after the third dose.

13. Seasonal Influenza Vaccine (Inf)

All individuals aged 6 months and older who live,
work or attend school in Ontario are eligible to receive
seasonal influenza vaccine.
Previously unimmunized children 6 months to <9 years
of age require 2 doses of trivalent inactivated influenza
vaccine (TIV), given 4 weeks apart. Children <9 years
of age who have received 1 or more doses of TIV in
preceding seasons are recommended to receive 1 dose
per season thereafter.

Vaccine Antigen Abbreviations: DTaP = diphtheria, tetanus, acellular pertussis; IPV = inactivated poliovirus; Hib = haemophilus influenzae type b; Pneu-C-13 = pneumococcal
conjugate-13 valent; Rot-1 = rotavirus ORAL; MMR = measles, mumps, rubella; MMRV = measles, mumps, rubella, varicella; Men-C-C = meningococcal conjugate C;
Men-C-ACYW = meningococcal conjugate ACYW-135; Var = varicella zoster; HA = hepatitis A; HB = hepatitis B; Tdap = tetanus, diphtheria, acellular pertussis ;
Td = tetanus, diphtheria; Inf = seasonal influenza; HPV-4 = human papillomavirus quadrivalent; Pneu-P-23 = pneumococcal polysaccharide-23 valent

Publicly Funded Immunization Schedules for Ontario August 2011

Publicly Funded Immunization Schedules for Ontario August 2011

Publicly funded vaccines may be provided only to eligible persons and must be free of charge.

Publicly funded vaccines may be provided only to eligible persons and must be free of charge.

TABLE 3: Detailed HIGH RISK schedule for Pneumococcal Conjugate-13 vaccine depending on age at first dose

SCHEDULE 2. Catch-up Schedule for Children Starting Immunization at 1-6 years of age
Timing

DTaP-IPV -Hib

Pneu-C-13

( )

Men-C-C

MMR

Var

MMRV

Men-C-ACYW

HB

HPV-4

10

Tdap

11

12

Age at first dose

First visit, if child is <4 years of age

First visit, if child is 4 years of age

( )

Primary series

Age at Booster dose

2-6 months

3 doses, 2 months apart

15 months

7-11 months

2 doses, 2 months apart

15 months

12-23 months

2 doses, 2 months apart

None

24-59 months

1 dose

None

Inf

13

Second visit, if child is <4 years

of age: 1 mos after 1st visit
Second visit, if child is 4 years
of age: 1 mos after 1st visit

Children 2 years of age, at high risk of invasive pneumococcal disease, should also receive a dose of Pneu-P-23 at least 8 weeks after the Pneu-C-13.

Third visit: 1 mos after 2nd visit

( )

( )

TABLE 4: Detailed schedule for Varicella vaccine for HIGH RISK persons depending on age

Fourth visit: 2 mos after 3 visit

rd

Age at first dose

Fifth visit: 6-12 mos after 4th visit

4-6 years old

( )*

Grade 7

12 months-12 years

2 doses, 3 months apart

13 years and older

2 doses, 1 month apart

Special considerations/restrictions are required for the immunocompromised (see Canadian Immunization Guide, 7th ed, 2006). Available at: http://www.phac-aspc.gc.ca/publicat/cig-gci/pdf/cig-gci2006_e.pdf Guide errata and clarifications, March 2008. Available at: http://www.phac-aspc.gc.ca/publicat/cig-gci/errarta-eng.php

Grade 8 females

TABLE 5: Reimmunization with Pneumococcal Polysaccharide vaccine

14-16 years old (10 years after the

4-6 year old booster)

Criteria for Reimmunization

Every year (in autumn)

Timing

**

A single revaccination with Pneumococcal Polysaccharide vaccine is

appropriate for those 2 years of age and older with:
functional or anatomic asplenia or sickle cell disease
hepatic cirrhosis
chronic renal failure or nephrotic syndrome
HIV infection
immunosuppression related to disease or therapy

( ) Depending on age of child, dose may not be needed. *If 4th dose of DTaP-IPV is given on or after the 4th birthday, the 4-6 year old booster dose is not needed. Administer Hib to children <5 years of age.

Administer Pneu-C-13 to children <5 years of age. Children between 4-11 years of age are eligible to receive MMRV. Administered through school-based program. **Previously unimmunized children <9
years receive 2 doses of Inf 4 weeks apart.

SCHEDULE 3. Schedule for Unimmunized Children/Adolescents Aged 7-17 years

Timing

Tdap12

Td

IPV

MMR6

Var7

MMRV8

Men-C-ACYW9

HB10

HPV-411

Inf13

First visit, if child is <12 years

First visit, if child is 12 years

( )*

Second visit, if child is 12 years: 2 mos after 1st visit

Pneumococcal Conjugate Vaccine and/or

Pneumococcal Polysaccharide Vaccine (depending on age)

( )*

Third visit: 6-12 mos after 2nd visit

Grade 7

1. Pneumococcal Conjugate Vaccine: All children <5 years of age should be vaccinated
with Pneu-C-13 vaccine as per Schedules 1 and 2.

Grade 8 females

10 years after the third visit

Every year (in autumn)

( ) Depending on age of child, dose may not be needed. *Administer Var to children born on or after January 1, 2000. Administered through school-based program. Students who missed a dose who were
previously in Grade 7 in or after 2009 remain eligible for Men-C-ACWY. Those born in 1996 or before should receive Men-C-C. Previously unimmunized children <9 years receive 2 doses of Inf 4 weeks apart.

SCHEDULE 4. Schedule for Unimmunized Adults Aged 18 years and Older

Timing

Tdap12

Td

IPV

First visit, if adult is 18 to 64 years

( )*

First visit, if adult is 65 years

( )*

Second visit: 2 months after 1 visit

( )*

Third visit: 6-12 months after 2nd visit

( )*

st

MMR6

Inf 13

Pneu-P-23

( )

Every 10 years thereafter

Every year (in autumn)
A single dose at 65 years
( ) Depending on immune status and age of adult, dose may not be needed. *Unimmunized adults or those with unknown polio immunization history who may be exposed to imported wild polio cases and
health care workers should receive 2 doses of IPV (4-8 weeks apart) with a 3rd dose 6-12 months later. For recommendations related to travel, go to the PHAC Travel Health page at: http://www.phac-aspc.
gc.ca/tmp-pmv/catmat-ccmtmv/index-eng.php A 2nd dose of MMR is recommended for young adults (18-25 years), post secondary students, persons who received killed measles vaccine (1967-1970), health
care workers and those who plan to travel internationally.

Detailed Information for the Administration of Specific Vaccines

Primary series

Age at Booster dose

2-6 months

3 doses, 2 months apart

15 to 18 months

7-11 months

2 doses, 2 months apart

15 to 18 months

12-14 months

1 dose

15 to 18 months

15-59 months

1 dose

None

1. All residents of nursing homes, homes for the aged and chronic care facilities
or wards.
2. All persons 65 years of age and older regardless of medical condition.

Meningococcal Vaccines
A. Meningococcal Conjugate C Vaccine (1-10 yrs)
1. All persons with functional or anatomic asplenia.
2. All persons with complement, properdin, factor D deficiency or primary antibody
deficiencies3.
3. Cochlear implant recipients (pre/post implant).
B. Meningococcal Conjugate ACYW-135 Vaccine (2-55 yrs)
1. All persons with functional or anatomic asplenia.
2. All persons with complement, properdin, factor D deficiency or primary antibody
deficiencies3.
3. Cochlear implant recipients (pre/post implant).

The Hib booster dose should be given at least 2 months after the previous dose.

TABLE 2: Detailed LOW RISK schedule for Pneumococcal Conjugate-13 vaccine depending on age at first dose
Primary series

Age at Booster dose*

2-6 months

2 doses, 2 months apart

12 months

7-11 months

2 doses, 2 months apart

12 to 15 months

12-23 months

2 doses, 2 months apart

None

24-59 months

1 dose

None

Age at first dose

2. Pneumococcal Polysaccharide Vaccine: For children <5 years old, the Pneu-P-23
vaccine should be given at least 8 weeks after the Pneu-C-13 vaccine1. All persons 2
years of age with the medical conditions listed below should receive one dose of the
Pneu-P-23 vaccine:
Chronic respiratory disease (excluding asthma, except those treated with highdose corticosteroid therapy1,2)
Chronic cardiac disease
Chronic liver disease (including hepatitis B and C, and hepatic cirrhosis due to any
cause)
Chronic renal disease, including nephrotic syndrome
Diabetes mellitus
Chronic cerebrospinal fluid leak
Chronic neurologic condition that may impair clearance of oral secretions
Asplenia (functional or anatomic), splenic dysfunction, sickle-cell disease and
other sickle cell haemoglobinopathies
Primary immune deficiency
Congenital immunodeficiencies involving any part of the immune system, including
B-lymphocyte (humoral) immunity, T-lymphocyte (cell) mediated immunity,
complement system (properdin, or factor D deficiencies), or phagocytic functions
Other conditions associated with immunosuppression (e.g., malignant neoplasms,
including leukemia and lymphoma)
Immunosuppressive therapy including use of long-term systemic corticosteroid,
chemotherapy, radiation therapy, post-organ transplant therapy, certain antirheumatic drugs and other immunosuppressive therapy
HIV infection
Hematopoietic stem cell transplant (candidate or recipient)
Solid organ or islet cell transplant (candidate or recipient)
Cochlear implant recipients (pre/post implant)

Pneumococcal Polysaccharide Vaccine

TABLE 1: Detailed schedule for Haemophilus influenzae type b Conjugate vaccine

Age at first dose

1 dose after 5 years for those 11 years of age or older at the

time of initial immunization
OR
1 dose after 3 years for those 10 years of age or less at the
time of initial immunization

High-Risk Eligibility Criteria

Second visit, if child is <12 years: 2 mos after 1st visit

Number of doses

Note: Children should receive Men-C-ACYW at least 1 month from receiving

Men-C-C vaccine.

C. Meningococcal Polysaccharide ACYW-135 Vaccine (>55 yrs)

1. Persons with functional or anatomic asplenia.
2. Persons with complement, properdin or factor D deficiency.
3. Cochlear implant recipients (pre/post implant).

Varicella Vaccine
1. Susceptible children and adolescents given chronic salicylic acid therapy (consider
stopping treatment for 6 weeks after vaccination, see product monograph).
2. All persons with cystic fibrosis.
3. Susceptible household contacts of immunocompromised persons.
4. Susceptible persons receiving low dose steroid therapy or inhaled/topical steroids.
5. Immunocompromised persons,2,3,5 see the CIG, 7th ed. (or as current) for varicella
vaccination recommendations regarding specified susceptible immunocompromised
individuals.
For the recommended number of doses for susceptible high risk persons, see CIG, 7th ed.

Hepatitis B Vaccine
1. Infants born to HBV-positive carrier mothers.
2. Household and sexual contacts of chronic carriers and acute cases.
3. Persons on renal dialysis and those with diseases requiring frequent receipt of blood
products (e.g., haemophilia) (second and third doses only).
4. Persons awaiting liver transplants (second and third doses only).
5. Injection drug users.
6. Men who have sex with men, individuals with multiple sex partners, history of a
sexually transmitted infection.
7. Those having needle stick injuries in a non-health care setting.
8. Children <7 years old whose families have immigrated from countries of high
prevalence for hepatitis B, and who may be exposed to hepatitis B carriers through
their extended families.
9. Persons with chronic liver disease including hepatitis C.

Hepatitis A Vaccine
1. Persons with chronic liver disease (including hepatitis B and C).
2. Persons engaging in intravenous drug use.
3. Men who have sex with men.
Note: for post exposure immunization with hepatitis A vaccine, consult with your local
public health unit on the appropriate requirements based on age and/or immunization
history.

Haemophilus influenzae type b Vaccine4

1. Persons with functional or anatomic asplenia.
2. All immunocompromised persons related to disease or therapy.
3. Hematopoietic stem cell transplantation (or bone marrow or solid organ transplant)
recipients.
4. All lung transplant recipients.
5. Cochlear implant recipients (pre/post implant).
6. All persons with primary antibody deficiencies.3
Note: Case and Contact Management
For all vaccine preventable diseases: Consult with your local public health unit on the
case and contact management of vaccine preventable diseases.

N
 ational Advisory Committee on Immunization. Update on the use of conjugate pneumococcal vaccines in childhood. Canada Communicable Disease Report Volume 36, November
2010. Available at: http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/10vol36/acs-12/index-eng.php
2
C
 ompendium of Pharmaceuticals and Specialties, 2005: the Canadian drug reference for health professionals
3
N
 ational Advisory Committee on Immunization. Update on the invasive meningococcal disease and meningococcal vaccine conjugate recommendations. Canada Communicable
Disease Report. Volume 36, April 2009. Available at: http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/09vol35/acs-dcc-3/index-eng.php
4
N
 ational Advisory Committee on Immunization. Canadian Immunization Guide (CIG), 2006, 7th edition. Public Health Agency of Canada, 2006. Available at: http://www.phac-aspc.
gc.ca/publicat/cig-gci/pdf/cig-gci-2006_e.pdf Guide errata and clarifications, March 2008. Available at: http://www.phac-aspc.gc.ca/publicat/cig-gci/errarta-eng.php
5
N
 ational Advisory Committee on Immunization. Updated recommendations for the use of Varicella and MMR Vaccines In HIV-infected Individuals. Communicable Disease Report.
Volume 36; ACS-7 September 2010.

* The Pneu-C-13 booster dose should be given at least 2 months after the final dose of the primary series.

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