COVID-19 safety measures across the country have impacted many aspects of care delivery, including access to routine immunizations for patients of all ages. In infants and toddlers especially, immunizations are essential to preventing vaccine-preventable disease outbreaks.
August is National Immunization Awareness Month, an occasion that highlights the importance of vaccination to protect patients of all ages. As a physician, you are a critical part of informing patients in their health decisions. As we head into flu season, you are ideally suited to provide them with evidence-based information on how vaccines work and recommendations for their specific immunization needs.
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Here are some resources on immunizations selected by Joule’s Ask a Librarian team using a variety of tools included with a CMA membership.
Clinical summary from DynaMed
Immunizations in Adults
Overview and Recommendations
- For all adults:
- An annual influenza vaccination is recommended for all adults (Strong recommendation).
- Give Tetanus, diphtheria, and acellular pertussis (Td/Tdap) every 10 years (Strong recommendation).
- For patients with lacerations that are more severe than clean minor wounds, give if it has been > 5 years from the last dose (Strong recommendation).
- Give 1 dose of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine to pregnant women (with each pregnancy) and to other adults if Tdap had not been previously received (Strong recommendation).
- Varicella vaccine is indicated for all adults without evidence of immunity to varicella; pregnant women who need immunization should be immunized as soon as they are no longer pregnant (Strong recommendation).
- Give measles, mumps, and rubella (MMR) vaccination to all adults without immunity to MMR, including all adults born in 1957 or later who do not have documentation of ≥ 1 dose of MMR vaccine. Pregnant women who need immunization (especially to rubella) should be immunized as soon as they are no longer pregnant (Strong recommendation).
Immunizations in pregnancy
- Give tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) to pregnant women during each pregnancy at 27-36 weeks, regardless of the patient history of receiving Tdap (Strong recommendation).
- Give inactivated or recombinant influenza vaccine (Strong recommendation).
- Give pneumococcal vaccine, hepatitis B, hepatitis A, or meningococcal vaccine if specific risk factors are present (Strong recommendation).
Immunizations in Children and Adolescents
Overview and Recommendations
- Recommended immunizations for children under the age of 18 years routinely change because they are based on patterns of emerging disease, evolving vaccine science, surveillance data of vaccine side effects, and identification of variable vaccine product line availability.
- All childhood vaccines have a minimum age to initiate the vaccine series, and all vaccine products have stipulated minimum time intervals between doses in the series.
- Once the minimum time interval between any 2 given doses in a vaccine series has passed, there is no maximum time interval to continue the vaccine series without needing to restart the series.
- Many childhood vaccines must be administered before a specific age, either to achieve the maximum protective benefit for the patient, or because of safety concerns if it is administered above a certain age.
- In the United States, the Advisory Committee on Immunization Practices (ACIP) is charged with making public health recommendations about the specific combination of vaccines that should be administered to children under the age of 18 years.
- Working with the United States Federal Government’s Centers for Disease Control and Prevention (CDC), the ACIP’s panel of experts makes an annual revision to the Recommended Schedule of Childhood Vaccinations.
- The World Health Organization also makes recommendations for immunization schedules with annual revisions.
Clinical Overviews and Book Chapters via ClinicalKey (CMA members only)
ClinicalKey drives better care by delivering fast, concise answers, and deep access to evidence whenever, wherever you need it. ClinicalKey includes access to 1,000+ textbooks, 600 full-text journals, images, videos and customizable patient handouts across 30+ medical specialties
In: Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, Chapter 316, 3771-3812.e5
Plotkin's Vaccines, Seventh Edition, 2018.
In: Conn's Current Therapy 2020, 1343-1348
Childhood and Adolescent Immunizations
In: Ferri's Clinical Advisor 2021, 1922-1971.
Clinical Practice Guidelines via CPG Infobase and other sources
CPG Infobase contains approximately 1,200 evidence-based Canadian clinical practice guidelines (CPGs) developed or endorsed by authoritative medical or health organizations in Canada.
Guidance for influenza vaccine delivery in the presence of COVID-19, Government of Canada, Published on: 2020-08-05
Interim guidance on continuity of immunization programs during the COVID-19 pandemic, National Advisory Committee on Immunization, Public Health Agency of Canada, Published on: 2020-05
Update on COVID-19 epidemiology and impact on medical care in children: April 2020, Canadian Paediatric Society, Published on: 2020-04
More Canadian Clinical practice guidelines on Immunization in the CPG Infobase.
Articles via CMAJ/ CMAJ Open
Vaccination debates may obscure access issues, Sandani Hapuhennedige, CMAJ August 10, 2020 192 (32) E935-E936
Challenges in evaluating SARS-CoV-2 vaccines during the COVID-19 pandemic, Bahaa Abu-Raya, Soren Gantt and Manish Sadarangani, CMAJ July 09, 2020 cmaj.201237
Perinatal health care providers’ approaches to recommending and providing pertussis vaccination in pregnancy: a qualitative study, Hana Mijović, Devon Greyson, Emily Gemmell, Marie-Ève Trottier, Maryline Vivion, Janice E. Graham, Ève Dubé, and Julie A. Bettinger, cmajo 8:E377-E382; published online May 15, 2020
Association between media attention and presentation of vaccination information on Canadian chiropractors’ websites: a prospective mixed-methods cohort study, Yechan Kim, Adeel M. Akhtar, Shane Natalwalla, Anna Goshua, Kumanan Wilson, and Jason W. Busse, cmajo 8:E338-E345; published online May 5, 2020
Increasing vaccination rates requires a better understanding of vaccine hesitancy, Joshua P. Bennett, CMAJ October 21, 2019 191 (42) E1167-E1168
Five things to know about …: Vaccination in adults with autoimmune rheumatic diseases, Timothy S.H. Kwok, Michael Libman and Shirley L. Lake, CMAJ September 09, 2019 191 (36) E1005
Health Services: Effectiveness and cost-effectiveness of vaccination against herpes zoster in Canada: a modelling study, Mélanie Drolet, Zhou Zhou, Chantal Sauvageau, Philippe DeWals, Vladimir Gilca, Rachid Amini, Élodie Bénard and Marc Brisson, CMAJ August 26, 2019 191 (34) E932-E939
Free information sources
Immunize Canada – No date, Accessed August 12, 2020.
Influenza Resource Centre – CanadianHealthcareNetwork.ca (requires free registration). Accessed August 14, 2020.
Vaccines and immunization – Government of Canada, Updated April 16, 2020, Accessed August 12, 2020.
Immunization – caring for kids – Canadian Pediatric Society, No date, Accessed August 12, 2020.
Need more information or have a more focused clinical question on immunization or any other clinical topic of interest? Contact the Ask a Librarian team to request a literature search.
This material is for informational purposes only. It is not intended to be a substitute for professional medical advice and should not be relied on as health or personal advice. The opinions stated by the authors are made in a personal capacity and do not necessarily reflect those of the Canadian Medical Association and its subsidiaries including Joule.
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