MEDICAL HEALTH OFFICERS’
NEWSLETTER
No. 265
Office of the
Chief Medical
Health Officer
Immunization Update July 2015
This letter will highlight some recent additions to the provincial public immunization
program as well as clarify some common immunization issues that have been raised
recently by immunizers. If you have further questions about immunization, please
consult the Island Health immunization website
(http://www.viha.ca/immunize/professionals/), the provincial ImmunizeBC.ca
website, or call your local public health unit or Medical Health Officer.
HPV Program Expansion to High Risk Males
Public funding for the human papilloma vaccine (HPV) has been expanded to include
high risk males as of this September. B.C.’s publicly funded HPV vaccination program,
which is provided to girls, will be extended to high-risk boys and young men up to age
26 – including those who have sex with males or who are street-involved.
NORTH ISLAND
250.331.8591
Charmaine Enns MD MHSc FRCPC
355-11th Street
Courtenay, BC V9N 1S4
CENTRAL ISLAND
250.739.6304
Paul Hasselback MD MSc FRCPC
3rd Floor, 6475 Metral Drive
Nanaimo, BC V9T 2L9
SOUTH ISLAND
250.519.3406
Richard Stanwick, CMHO
MD MSc FRCPC FAAP
Murray Fyfe MD MSc FRCPC
Dee Hoyano MD FRCPC CCFP
430-1900 Richmond Avenue
Victoria, BC V8R 4R2
After Hours On Call
1.800.204.6166
HPV immunization will be provided by public health units, physicians and through
specialized clinics and programs for street-involved youth. Further information about
the vaccination program expansion, including guidelines for immunization providers
and where patients can access vaccine will be available later this summer.
Pneumococcal Indications
Pneumococcal Polysaccaride Vaccine (PPV23 or Pneumo23TM) Booster doses of
pneumococcal polysaccharide vaccine are not routinely required for most adults. A
one-time booster dose should be given 5 years following the first vaccination for the
following patients only: those with asplenia, sickle cell disease, immunosuppressive
disease including HIV, immunosuppression due to therapy, congenital
immunodeficiency states, chronic kidney and liver disease. Multiple booster doses of
PPV23 can commonly result in large, painful local Arthus reactions and should be
avoided. If a patient has received PPV23 doses prior to age 65, no further doses are
required.
Pneumococcal Conjugate Vaccine (PCV13)
The pneumococcal conjugate vaccine (PCV13 or Prevnar®13) has been in use for a
number of years in the pediatric immunization schedule. Adult indications for the
vaccine have recently expanded following a National Advisory Council on
Immunization (NACI) review. In BC, PCV13 is now funded for adults who are
hematopoeitic stem-cell transplant recipients (HSCT) or HIV-positive. At this time,
NACI has concluded that there is only fair or insufficient evidence to recommend the
vaccine for other immunocompromising conditions. As new data become available,
these recommendations will be reviewed and updated. Note that this
recommendation differs from guidance from other national jurisdictions, including
American guidelines.
Hepatitis B vaccine
In BC, Hepatitis B vaccine is routinely given in the first year of life, as well as to older children as part of a
catch-up program since 1992 (birth cohort 1980 and younger). The routine series is 3 doses in infancy, or
2 doses in Grade 6 (pre-adolescence). Hepatitis B vaccine is also given to adults at higher risk including
health care workers, and people who may be in regular contact with blood or blood products due to
health condition, occupational or behavioral risks.
Booster doses are not routinely required for children or adults, with the exception of patients with chronic
kidney disease or HIV, who should be monitored annually for antibody levels. Immunity should be
presumed for healthy patients with a complete series of Hepatitis B vaccine. Hepatitis B antibody testing in
a healthy patient is not indicative of immune status nor need for a booster dose, and should not be
ordered to confirm immune status.
Local Reactions to Immunizations
An expected reaction to vaccines, particularly tetanus-toxoid containing vaccines, is a local reaction
occurring shortly after a vaccination, usually within 48 hours, characterized by redness, swelling and heat
to the area surrounding the injection site. Pain or soreness can accompany the swelling but not always.
Symptoms resolve quickly, within a few days. It can be distinguished from cellulitis, as cellulitis is intensely
painful, erythematous, and can be indurated. Cellulitis following immunization is much less common than
local reaction. Management of local reactions is supportive, including analgesia and cold compresses.
A new Vaccine Storage and Handling Course for physicians, medical office assistants and pharmacists
Is now available online through the BC Centre for Disease Control (BCCDC). The purpose of this course is to
learn and/or refresh one’s knowledge regarding how to appropriately handle and store vaccines based on
our provincial guidelines. It is intended for all health unit aids, medical office assistants, public health
nurses, pharmacists and physicians who deliver vaccines, but is open to all interested individuals. The
course takes approximately 30 minutes to complete and upon successful completion of the post-test,
individuals will be issued a certificate of completion. This free course is available online through
bccdclearning.ca and can be accessed via the following link:
http://www.bccdc.ca/imm-vac/ForHealthProfessionals/ImmunizationCourses/default.htm.
Immunization remains one of the most effective interventions for improving and protecting the health of
our community. Thank you for your continued interest in promoting and providing immunization to your
patients.
Yours in health,
Richard Stanwick, MD MSc FRCPC FAAP
Chief Medical Health Officer