Section IA-Introduction
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1 Immunizatin Prgrams and Vaccine Preventable Diseases Service 655 West 12th Avenue Vancuver, BC V5Z 4R4 Tel Fax Date: May 15, 2017 Administrative Circular: 2017:07 ATTN: Medical Health Officers and Branch Offices Public Health Nursing Administratrs and Assistant Administratrs Hlders f Cmmunicable Disease Cntrl Manuals Re: Update t Cmmunicable Disease Cntrl Manual, Chapter 2 - Immunizatin Prgram, Sectin IA-Intrductin, Sectin IIA-Immunizatin Schedules, Sectin IIB-Cntraindicatins and Precautins fr Immunizatin & Sectin VII- Bilgical Prducts Sectin IA-Intrductin 11.0 Histry f Immunizatin in BC The table has been updated t include that Gardasil 9 replaces Gardasil fr all indicatins in May Please remve page number: 29 dated September 2016 Please add new page number: 29 dated May 2017 Sectin IIA-Immunizatin Schedules Vaccine Abbreviatins and Vaccines HPV4 has been remved frm the table as this vaccine is n lnger being supplied in BC. 2.3 Schedule C & 2.4 Schedule D Please remve page number: 1 dated August 2016 Please add new page number: 1 dated May 2017 All references t the quadrivalent human papillmavirus vaccine (HPV4) have been remved as this vaccine is n lnger being supplied in BC. Nnavalent human papillmavirus vaccine (HPV9) has replaced HPV4 fr all indicatins. Please remve page numbers: 6-9 dated January & August 2016 Please add new page numbers: 6-9 dated May 2017 Page 1 f 5
2 3.1 Minimum Intervals Between Vaccine Dses Table Gardasil has been remved frm HPV vaccines. Nimenrix has been added t meningcccal quadrivalent cnjugate vaccines. Please remve page number: 12 dated February 2017 Please add new page number: 12 dated May 2017 Sectin IIB-Cntraindicatins and Precautins fr Immunizatin 4.1 Latex Cntent in Vaccines Gardasil, Meningitec, Menmune and Zstavax have been remved as these vaccines are n lnger supplied in BC. Nimenrix has been added t the list f prducts that d nt cntain latex. Please remve page number: 6 dated August 2016 Please add new page number: 6 dated May 2017 Sectin VII-Bilgical Prducts Hepatitis A Vaccine (Havrix 1440 and Havrix 720 Junir) The cncentratin f the adult presentatin has been crrected t indicate 1440 ELU/1.0 ml. Please remve page number: 8 dated February 2017 Please add new page number: 8 dated May 2017 Human Papillmavirus Vaccine [Nnavalent (6, 11, 16, 18, 31, 33, 45, 52, and 58)] All references t the quadrivalent human papillmavirus vaccine (HPV4/Gardasil ) have been remved as this vaccine is n lnger being supplied in BC. Nnavalent human papillmavirus vaccine (HPV9/Gardasil 9) has replaced HPV4/Gardasil fr all indicatins. DOSES AND SCHEDULE has been revised t include the dse and schedule infrmatin fr immuncmprmised individuals (including thse with HIV infectin) 9-14 years f age (inclusive), as this cntent was previusly cntained within a ftnte. Cntent related t the timing f the initiatin f the series has been mved t Ftnte D. CONTRAINDICATIONS has been revised t indicate a histry f an anaphylactic reactin t a previus dse f any HPV vaccine r t any cmpnent f GARDASIL 9. Please remve page numbers: 24a-24c dated Nvember 2016 Please add new page numbers: 24a & 24b dated May 2017 Page 2 f 5
3 Meningcccal Quadrivalent Cnjugate Vaccines (Grups A, C, Y, W-135) Nimenrix, supplied by Pfizer Canada Inc., has been added t the prduct list. DOSES AND SCHEDULE has been updated t indicate that Nimenrix is recmmended fr individuals 2 years f age and lder. Ftnte related t the transitin f Menve frm Nvartis Vaccines and Diagnstics Inc. t GlaxSmithKline Inc. has been remved as this transitin is cmplete. Ftnte F has been revised t indicate that a secnd dse f meningcccal quadrivalent cnjugate vaccine may als be indicated fr high risk individuals. ADMINISTRATION has been updated t indicate that Nimenrix needs t be recnstituted. CONTRAINDICATIONS has been revised t indicate a histry f anaphylactic reactin t a previus dse f any meningcccal vaccine r any cmpnent f the specific vaccine t be given. PRODUCT COMPONENTS has been updated t include Nimenrix prduct cmpnents. ADVERSE EVENTS has been updated t include fatigue, irritability and lss f appetite. Please remve page numbers: dated July 2016 & December 2015 Please add new page numbers: dated May 2017 Rabies Vaccine fr Pst-Expsure Prphylaxis The supplier fr RabAvert has been revised t GlaxSmithKline Inc. INDICATIONS has been revised as fllws: The cntact infrmatin regarding with whm cnsultatin is available has been changed frm Cmmunicable Disease Preventin and Cntrl Services, BCCDC t BCCDC. Administer RabIg n day 0 f vaccine series has been remved as this infrmatin is cntained in DOSES AND SCHEDULE. DOSES AND SCHEDULE cntent has been re-rganized fr clarity; the cntent remains unchanged. ADMINISTRATION has been revised as fllws: Cntent related t the preferred administratin site as per the client s age has been remved as this infrmatin is cntained in Sectin IV-Administratin f Bilgical Prducts, and fr cnsistency with ther bilgical prduct pages. Pertinent infrmatin related t the recnstitutin f the prducts has been mved frm RECONSTITUTION and SPECIAL CONSIDERATIONS t ADMINISTRATION. Cntent related t the rabies vaccine and RabIg nt being administered in the same anatmical site, as well as the use f separate needles and syringes fr each prduct, has been mved frm CONTRAINDICATIONS t ADMINISTRATION. Cntent related t the immediate use f the vaccine fllwing recnstitutin has been mved frm SPECIAL CONSIDERATIONS t ADMINISTRATION. RECONSTITUTION sectin has been remved as this infrmatin is cntained in Sectin IV-Administratin f Bilgical Prducts, and fr cnsistency with ther bilgical prduct pages. Page 3 f 5
4 SEROLOGICAL TESTING AND RE-VACCINATION: assciated ftnte A has been updated t indicate that testing is cnducted at the Natinal Micrbilgy Labratry. PRODUCT COMPONENTS has been updated. ADVERSE EVENTS has been updated t include myalgia, arthralgia, malaise and fever fr IMOVAX Rabies, and fatigue fr RabAvert. Rabies Vaccine fr PRE-EXPOSURE Prphylaxis The supplier fr RabAvert has been revised t GlaxSmithKline Inc. INDICATIONS has been revised t mirrr the indicatins in the CD Manual, Chapter 1: Rabies, alng with the additin f bat bilgists t thse fr whm the vaccine is recmmended but nt prvided free. DOSES AND SCHEDULE cntent has been re-rganized fr cnsistency with ther bilgical prduct pages. ADMINISTRATION has been revised as fllws: Cntent related t the preferred administratin site as per the client s age has been remved as this infrmatin is cntained in Sectin IV-Administratin f Bilgical Prducts, and fr cnsistency with ther bilgical prduct pages. Pertinent infrmatin related t the recnstitutin f the prducts has been mved frm RECONSTITUTION and SPECIAL CONSIDERATIONS t ADMINISTRATION. Cntent related t the immediate use f the vaccine fllwing recnstitutin has been mved frm SPECIAL CONSIDERATIONS t ADMINISTRATION. RECONSTITUTION sectin has been remved as this infrmatin is cntained in Sectin IV-Administratin f Bilgical Prducts, and fr cnsistency with ther bilgical prduct pages. SEROLOGICAL TESTING AND RE-VACCINATION: assciated ftnte B has been updated t indicate that testing is cnducted at the Natinal Micrbilgy Labratry. PRODUCT COMPONENTS has been updated. Cntent related t the cnsideratin f an alternate administratin rute and dse vlume in the event f a rabies vaccine shrtage has been mved frm ADMINISTRATION t SPECIAL CONSIDERATIONS. ADVERSE EVENTS has been updated t include myalgia, arthralgia, malaise and fever fr IMOVAX Rabies, and fatigue fr RabAvert. Please remve page numbers: 55-58b dated May 2014 Please add new page numbers: 55-58b dated May 2017 Please als remve the Table f Cntents fr Sectin VII-Bilgical Prducts dated February 2017 and replace with the enclsed updated Table f Cntents dated May Page 4 f 5
5 If yu have any questins r cncerns, please cntact Christine Halpert, Senir Practice Leader, BCCDC (telephne: / christine.halpert@bccdc.ca) r Stephanie Meier, Public Health Resurce Nurse, BCCDC (telephne: / stephanie.meier@bccdc.ca.) Sincerely, Mnika Naus MD MHSc FRCPC FACPM Medical Directr Immunizatin Prgrams and Vaccine Preventable Diseases Service BC Centre fr Disease Cntrl pc: BC Ministry f Health: Dr. Perry Kendall Prvincial Health Officer Dr. Bnnie Henry Deputy Prvincial Health Officer Craig Thmpsn Directr, Prvincial Immunizatin Services Warren O Briain Executive Directr, Public Health Services & Office f Abriginal Health Page 5 f 5
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