Latest Ministry Updates Including Provincial Outbreak Immunization Information

Hepatitis A

Current Situation

The Ministry of Health and Long Term Care is monitoring a recent increase in cases of hepatitis A in men who have sex with men (MSM). Some recent cases have also reported experiencing homelessness and/or use of illicit drugs.

Travel history for Ontarians is also an important consideration as there are currently several large international outbreaks of hepatitis A in MSM in Europe, New York City, Chile and Brazil. As well, outbreaks in homeless individuals and/or those who use illicit drugs are being reported in the United States.

Ontario’s Immunization Program:

Hepatitis A vaccine is recommended and publicly funded for:

  • men who have sex with men,
  • people who use intravenous drugs, and
  • those with chronic liver disease, including hepatitis B and C.

The hepatitis A vaccine is also recommended (however not publicly-funded in Ontario) for other groups including those who use non-injectable illicit drugs, individuals living in communities at high risk for hepatitis A outbreaks and travellers. See the Canadian Immunization Guide for additional groups recommended to receive the hepatitis A vaccine. Two doses of hepatitis A vaccine are recommended at least six months apart.

Measles, Mumps and Rubella (MMR) Vaccine for Adults - two doses for those born in 1970 or later

Current Situation

Ontario is currently experiencing increased mumps activity; between January 1 and September 30, 2017, a total of 209 cases of mumps were reported in Ontario. Approximately 59% of cases were between 25 and 47 years of age. Among the 134 cases with known immunization status, 40% received only one dose of mumps-containing vaccine, and 22% are unimmunized. Additional information on recent mumps activity is available on  Public Health Ontario’s website.

Ontario’s Immunization Program:

Two doses of MMR vaccine have been routinely given to children in Ontario since the mid-1990s.  Adults born in 1970 or later who are unimmunized or are unsure of their immunization status can receive up to 2 doses of publicly funded MMR vaccine if they are healthcare workers, post-secondary students, planning travel outside of North America, or based on the healthcare provider’s clinical judgment. In the setting of increased mumps activity, individuals who have not received two doses of MMR should be encouraged to be vaccinated. Due to changes in Ontario’s immunization schedule over time, individuals born between approximately 1970 and 1992 (who are currently between 25 and 47 years of age) likely received only one dose of MMR vaccine and are therefore more susceptible to disease than those who are fully vaccinated. If a patient’s immunization record is unavailable, immunization is preferred, rather than ordering serology to determine immune status. There should be at least a four-week interval between doses of MMR.

Influenza vaccine –  quadrivalent vaccine for children and adolescents (6 months to <18 years of age) and trivalent vaccine for all adults

Current Situation

Children and adolescents 6 months to <18 years of age are recommended to receive a quadrivalent influenza vaccine for their annual vaccination. In addition to the A(H3N2) and A(H1N1) strains, the quadrivalent vaccine contains two B strains, one from the Victoria lineage and one from the Yamagata lineage. Having both lineages of influenza B in the quadrivalent vaccine helps to ensure broader protection than the trivalent vaccine; the trivalent vaccine only contains one B strain that may not match the circulating virus. Influenza B protection is particularly important for children and adolescents as this age group has a higher burden of influenza B disease than among adults. Trivalent vaccine should only be used for children and adolescents if the quadrivalent vaccine is not available. Trivalent influenza vaccine is publicly- funded for adults, including those 65 years of age and over.

Ontario’s Immunization Program:

Available quadrivalent products in Ontario for children and adolescents

Vaccine

Administration / Formulation

Age group for Ontario program

FluLaval Tetra®

Injectable inactivated quadrivalent influenza vaccine

6 months to <18 years of age without contraindications

Fluzone® Quadrivalent

Injectable inactivated quadrivalent influenza vaccine

6 months to <18 years of age without contraindications

Flumist® Quadrivalent

Live attenuated influenza vaccine

given by nasal spray

2 to <18 years of age without

contraindications

Children 6 months to <9 years of age who have never received an influenza vaccine in their life should receive two doses of vaccine given at least four weeks apart.

Available trivalent products for adults, including those 65 years of age and over:

  • Fluviral®
  • Influvac®

Additional information about influenza vaccine recommendations is available as follows:

In addition to the above vaccines, keeping up-to-date with all routine immunizations will help prevent infections at all ages.  Ontario’s immunization schedule provides detailed information about vaccination for all age groups, as well as for those with high-risk medical conditions.

Last Updated: November 3, 2017