ALBERTA IMMUNIZATION POLICY GUIDELINES

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1 ALBERTA IMMUNIZATION POLICY GUIDELINES Diphtheria, Tetanus, Pertussis, Polio and Hib Vaccines. Diphtheria-Tetanus-Acellular Pertussis-Polio-Haemophilus influenzae type b Conjugate Combined Vaccine (DTaP-IPV- Hib) Please refer to the vaccine product monograph and the Canadian Immunization Guide for further information. Product monographs are available on the Health Canada website: Trade Name/Manufacturer INFANRIX -IPV/Hib 3 - GlaxoSmithKline Inc PEDIACEL - Sanofi Pasteur Indications for use of provincially funded vaccine Dose 0.5 ml Primary immunization of children months up to and including 59 months of age who need diphtheria, tetanus, acellular pertussis, polio and Hib vaccines. Children younger than 5 years of age who sustain a wound injury and have not received the recommended number of tetanus doses for their age and at least one dose of Hib vaccine at 5 months of age or older. Route Schedule Intramuscular injection (IM) Routine immunization for infants: Dose months Dose 4 months Dose 3 6 months Dose 4 8 months *If a dose is missed or delayed for any reason, the series does not have to be started again

2 General Contraindications Known severe allergy (anaphylaxis) to any component of the vaccine. Anaphylaxis or other severe allergic reaction to a previous dose of vaccine containing diphtheria, tetanus, pertussis, polio or Hib. Some Possible Adverse Events Following Immunization Local reactions: Redness, swelling or tenderness at the injection site, generally mild and short-lasting. Persistent nodules at the site of injection may occur. Other reactions: Decreased activity, decreased appetite, fussiness, crying, fever, diarrhea and vomiting. References 3 National Advisory Committee on Immunization. (0. Canadian immunization guide (Evergreen ed.). Ottawa, ON: Public Health Agency of Canada. Retrieved from Sanofi Pasteur Limited. (0, April). PEDIACEL : Diphtheria and tetanus toxoids and acellular pertussis vaccine adsorbed combined with inactivated poliomyelitis vaccine and Haemophilus b conjugate vaccine (tetanus Protein conjugate). Product Monograph. GlaxoSmithKline Inc. (0, August6). INFANRIX -IPV/Hib: Combined diphtheria,tetanus,acellualr pertussis vaccine, inactivated poliomyelitis and Haemophilus influenze type b vaccine. Product Monograph.

3 . Diphtheria-Tetanus-Acellular Pertussis-Polio Combined Vaccine (DTaP-IPV) Refer to the vaccine product monograph and the Canadian Immunization Guide for further information. Product monographs are available on the Health Canada website: Trade Name/Manufacturer BOOSTRIX -POLIO GlaxoSmithKline Inc. Indications for use of provincially funded vaccine Routine reinforcing dose for children between 4 and 6 years of age. Primary vaccine series or completion of a vaccine series for children 7 years of age up to 7 years of age. Wound management for children younger than 7 years of age. Refer to the Canadian Immunization Guide Guide to Tetanus Prophylaxis in Wound Management. Dose Route Schedule 0.5 ml Intramuscular injection (IM) Routine booster for children 4 to 6 years of age: One dose Unimmunized children 7 up to and including 7 years of age: Dose day 0 Dose 4 to 8 weeks after dose Dose 3 6 to months after dose 3

4 General Contraindications Known severe allergy (anaphylaxis) to any component of the vaccine. Anaphylaxis or other severe allergic reaction to a previous dose of vaccine containing tetanus, diphtheria, pertussis or polio antigens. Some Possible Adverse Events Following Immunization Local reactions: Tenderness, redness and swelling at the injection site, generally mild and short-lasting. Severe local reactions occur rarely and may be associated with high levels of circulating tetanus antitoxin. Other reactions: Decreased activity, decreased eating, fussiness, crying, fever, diarrhea and vomiting. References National Advisory Committee on Immunization. (0. Canadian immunization guide (Evergreen ed.). Ottawa, ON: Public Health Agency of Canada. GlaxoSmithKline Inc. (0, July). BOOSTRIX -POLIO: Combined diphtheria, tetanus, acellular pertussis (adsorbed) and inactived poliomyelitis vaccine. Product Monograph. 4

5 3. Diphtheria-Tetanus-Acellular Pertussis Combined Vaccines (dtap) Refer to the vaccine product monograph and the Canadian Immunization Guide for further information. Product monographs are available on the Health Canada website: Trade Name/Manufacturer Indications for use of provincially funded vaccine Dose ADACEL - Sanofi Pasteur BOOSTRIX 3 - GlaxoSmithKline Inc. Children 7 years of age up to and including 7 years of age: With an uncertain or no history of a primary series or those who have not completed a primary series. Previously immunized against tetanus/diphtheria and due for a reinforcing dose of tetanus/diphtheria (routinely given to Grade 9 students in Alberta). Who sustain a wound. Notes: Diphtheria-tetanus-acellular pertussis combined vaccine is not usually provided to acute care emergency departments or urgent care centres. Children (7 to 7 years of age) needing tetanus prophylaxis for wound management should be referred to public health professionals for the age-appropriate tetanuscontaining vaccine. Not recommended for use in children younger than 7 years of age. Adults 8 years and older who are: Initiating (unknown/uncertain or no history of a primary series).¹ 0.5 ml Adults previously immunized against tetanus/diphtheria when they present for a reinforcing dose of tetanus/diphtheria. Health care workers who provide care to children younger than months of age. Some transplant candidates and recipients. 5

6 Route Schedule Intramuscular injection (IM) Series: Dose day 0 Dose 4 to 8 weeks after dose. Dose 3 6 to months after dose. Reinforcing dose: Grade 9 students or for wound management in children 7 to 7 years of age. Students who have received a dose of tetanusdiphtheria-acellular pertussis containing vaccine at years of age or older do not require the routine BOOSTRIX / ADACEL booster in Grade 9. General Contraindications Some Possible Adverse Events Following Immunization Known severe allergy (anaphylaxis) to any component of the vaccine. Anaphylaxis or other severe allergic reaction to a previous dose of vaccine containing tetanus, diphtheria or Pertussis antigens. Local reactions: Pain, redness and swelling at the injection site, usually mild and short-lasting.,3 Severe local reactions occur rarely and may be associated with high levels of circulating tetanus antitoxin.,3 Other reactions: Dizziness, fever, headache, malaise, fatigue and vomiting.,3 References 3 National Advisory Committee on Immunization. (0) Canadian Immunization Guide (Evergreen ed.). Ottawa, ON: Public Health Agency of Canada. Sanofi Pasteur Limited. (0, June). ADACEL : Tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine adsorbed. Product Monograph. GlaxoSmithKline Inc. (03, Jan). BOOSTRIX : Combined diphtheria, tetanus, and acellular pertussis (adsorbed) vaccine for booster vaccination. Product Monograph. 6

7 4. Tetanus and Diphtheria Combined Vaccine (Td ADSORBED) Refer to the vaccine product monograph and the Canadian Immunization Guide for further information. Product monographs are available on the Health Canada website: Trade Name/Manufacturer Indications for use of provincially funded vaccine Dose Route Schedule Td ADSORBED - Sanofi Pasteur Individuals 8 years of age and older: Primary or reinforcing immunization. Wound management. Refer to the Canadian Immunization Guide Guide to Tetanus Prophylaxis in Wound Management. 0.5 ml Intramuscular injection(im) Primary vaccine series: Dose : day 0 Dose : 4 to 8 weeks after dose. Dose 3: 6 to months after dose. Note: Adults needing a primary series of tetanus/diphtheria vaccine should receive dtap to replace the first dose of Td in the series. Reinforcing doses are recommended at 0-year intervals. Note: For health care workers who provide care to children younger than months of age, and adults presenting for a tetanus-diphtheria booster, one reinforcing dose of tetanusdiphtheria-acellular pertussis containing vaccine is recommended in adulthood. General Contraindications Known severe allergy (anaphylaxis) to any component of the vaccine. Anaphylaxis or other severe allergic reaction to a previous dose of vaccine containing tetanus or diphtheria antigens. 7

8 Some Possible Adverse Events Following Immunization Local reactions: Pain, swelling and redness at the injection site, usually short-lasting. Persistent nodules at the site of injection may occur. Following reinforcing doses, local redness and swelling are not uncommon. Systemic reactions: Fever, chills, and sore or swollen joints. References National Advisory Committee on Immunization. (0). Canadian immunization guide (Evergreen ed.). Ottawa, ON: Public Health Agency of Canada. Sanofi Pasteur Limited. (0, October). Td ADSORBED: Tetanus and diphtheria toxoids adsorbed. Product Monograph. 8

9 5. Haemophilus influenzae type b (Hib) Conjugate Vaccine Refer to the vaccine product monograph and the Canadian Immunization Guide for further information. Product monographs are available on the Health Canada website: Trade Name/Manufacturer Indications for use of provincially funded vaccine Dose Route Schedule Act-HIB - Sanofi Pasteur Limited HIBERIX ³ - GlaxoSmithKline Inc. Children months up to and including 59 months of age: Routinely given as part of combined vaccine (DTaP-IPV-Hib) Unimmunized individuals 5 years of age and older with specified chronic health conditions: Have no spleen (surgical removal) or severe dysfunction of the spleen. Hodgkin s disease. HIV. Cochlear implant recipients. Some transplant recipients. 0.5 ml Intramuscular injection (IM) Routine: Dose : months of age Dose : 4 months of age Dose 3: 6 months of age Dose 4: 8 months of age All doses in the routine schedule are administered as combined vaccine. Fewer doses are required for infants beginning immunization at seven months of age or older. Consult with your local public health service area for scheduling information. Older individuals with chronic health conditions: One dose 9

10 General Contraindications Known severe allergy (anaphylaxis) to any component of the vaccine. Anaphylaxis or other severe allergic reaction to a previous dose of vaccine containing Hib antigens. Some Possible Adverse Local reactions: Events Following Immunization Pain, redness, swelling or induration at the injection site. Reactions generally occur early and are shortlasting. Systemic reactions: Fever, irritability, drowsiness, prolonged or abnormal crying, loss of appetite and vomiting have occurred after immunization. References National Advisory Committee on Immunization. (0). Canadian immunization guide (Evergreen ed.). Ottawa, ON: Public Health Agency of Canada. Sanofi Pasteur Limited. (0, May). Act-HIB : Haemophilus b conjugate vaccine (tetanus protein conjugate). Product Monograph. ³ GlaxoSmithKline Inc. (03, April). HIBERIX. Haemophilus influenzae type b conjugate vaccine (tetanus protein conjugate). Product Monograph 0

11 6. Polio Vaccine Refer to the vaccine product monograph and the Canadian Immunization Guide for further information. Product monographs are available on the Health Canada website: Trade Names/Manufacturers IMOVAX Polio (Vero Cell Origin) Sanofi Pasteur Indications for use of provincially funded vaccine Children 4 years of age and older who were previously immunized with diphtheria, pertussis or tetanus-containing vaccines only. Laboratory workers handling specimens that may contain poliovirus and who have not received polio immunization in the past. Health care workers and students training in health care occupations who have not received polio immunization in the past. Some transplant recipients Note: Polio vaccine is not recommended for routine immunization of adults living in Canada either as a primary series or reinforcing doses. Dose Route Schedule 0.5 ml Subcutaneous injection 4 years of age and older: Dose day 0 Dose 4 to 8 weeks after dose Dose 3 6 to months after dose Reinforcing doses are not necessary. Note: Although the IMOVAX Polio product is licensed for use in children of all ages, combination vaccines (e.g., DTaP- IPV-Hib and DTaP-IPV) are the products of choice for most infants and young children. Provincially funded IMOVAX Polio is provided for the indicated age group above. General Contraindications Known severe allergy (anaphylaxis) to any component of the poliomyelitis vaccine. Anaphylaxis or other severe allergic reaction to a previous dose of vaccine containing polio antigens.

12 Some Possible Adverse Events Following Immunization Local reactions: Redness, pain and swelling at the injection site, usually mild and transient in nature. Fever. References National Advisory Committee on Immunization. (0). Canadian immunization guide (Evergreen ed.). Ottawa, ON: Public Health Agency of Canada. Sanofi Pasteur Limited. (0, April). IMOVAX Polio: Inactivated poliomyelitis vaccine (Vero cell origin). Product Monograph.

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