question and answer
Immunization
March 2012
Immigrants don’t always know what vaccines they’ve received. Should I assume that they haven’t been vaccinated at all? When did Canada create a universal program? What vaccines were given in those early years? Elizabeth Chiu, MD, Toronto, ON

Immunization of immigrants is a challenging area as in many cases there may be no records and in others the quality of immunizations (schedule completion, vaccine preparation and administration, appropriate age) may be questioned. This is not just an issue for immigrants from low-income countries as rates of immunization for common vaccine preventable diseases are very low in many highly developed, high-income countries. Non-immunized individuals should be immunized with an age-appropriate primary series for all vaccines as per the recommended schedule in Canada (see Canadian Immunization Guide available at: www.phac-aspc.gc.ca/naci-ccni/). Where documentation is uncertain or questioned, one approach is to perform serologic testing to (i.e. tetanus, rubella, measles, varicella zoster, hepatitis B) to assess for prior exposure with immunization with a primary series if negative and boosting as appropriate otherwise. Generally speaking, it’s preferable to err on the side of caution — “re-immunization” rather than “under-immunization.” Keep in mind that immigrants may also be at risk for a number of other infectious diseases. Screening for hepatitis C, HIV, tuberculosis and other diseases may be appropriate.

Regarding a universal vaccine program, Canada doesn’t have a federal universal immunization program, as vaccination has been a provincial jurisdiction (albeit with federal recommendations and funding in some cases). As a result, vaccines have been introduced at various times and with different schedules among the provinces and territories.

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