Toronto – Experts and parents believe that the vaccination calendars should be harmonized in the Canadian provinces, when an epidemic of measles takes place.
The Canadian Pediatric Society wishes to adjust the vaccine calendar nationally since 1997, the year of the publication of an article on the subject.
Its relevance has resurfaced while the country strives to strengthen public health messages in the face of the measles epidemic, which threatens to end the elimination status that Canada had reached in just a few months.
Each province and territory has its own vaccination calendar, depending on factors such as the moment when a child benefits from higher immunity thanks to the vaccine and infant vaccines that can be grouped.
In the context of an epidemic of measles that led to nearly 5,000 cases in the country, some parents could notice that the second dose of transmitted disease vaccine is administered at 18 months in certain places, and between four and six years in others.
Moving from Ontario to New Brunswick not only forced Jade Medeiros to adapt to a new province with two babies: she also had to develop a new vaccination program.
When her family moved to Moncton in 2020, she learned that her two and three years old children were already late in their routine vaccinations, because the New Brunswick calendar is different from that of Ontario.
“She had to receive several vaccines at the same time, while in Ontario, it is more spaced,” said Medeiros, speaking of her younger daughter.
Parents and health experts also fear that confusion surrounding the vaccination calendars and poor resistance of files can contribute to the decline in vaccination rates, especially due to growing skepticism with regard to vaccines in North America.
Child vaccination rates have dropped in recent years, distrust and disinformation on vaccination that took over during the COVVI-9 pandemic.
In Canada, only 76 % of seven -year -old children received the two doses of the measles vaccine in 2023, compared to 86 % in 2019. It takes 95 % to obtain collective immunity.
The elimination of obstacles to children’s vaccination has long been considered an essential way to eliminate vaccination preventable diseases, such as measles. An easy to understand and follow vaccination calendar can simplify this process for families.
“I am absolutely convinced that it must be harmonized for all vaccines,” said Jade Medeiros.
Vaccination calendars
In most provinces and territories, the vaccine against measles, rubella, mumps and chickenpox (Rro-Var) is administered at 12 and 18 months.
This is the case in Alberta, Saskatchewan, Quebec, New Brunswick, Nova Scotia, Prince Edward Island, in Newfoundland and Labrador, in the Northwest Territories and Nunavut.
However, in British Columbia, babies receive RRO vaccines and against separate chickenpox at 12 months, then the Rro-Var combined vaccine towards the age of their entry into school, between four and six years.
In Yukon, they receive distinct doses of Rro and against chickenpox at 12 months, then a second dose of the two vaccines between four and six years.
In Ontario, the RRO vaccine is administered at 12 months, followed by a chickenpox vaccine at 15 months, then a Rro-Var combined vaccine between four and six years.
Why different calendars from one province to another?
The vaccination calendar of each province has evolved according to the trends and the distribution of the disease within a population, explained the Dre Arlene King, a former chief hygienist doctor of Ontario.
When Ms. King was a chief doctor of Ontario, the province changed the children’s vaccination calendar. The National Immunization Advisory Committee (CCNI) has recommended an additional chickenpox vaccine for better protection, and a Rro-Var combined vaccine has been introduced.
At the time, the second dose in Ontario was administered at 18 months, regardless of the chickenpox vaccine. But in 2011, the province added an Rro-Var combined dose between four and six years old, in addition to the chickenpox vaccine administered to infants.
“The advantage of administering the vaccine between four and six years old, the second dose is that we know that there will be complete protection against the disease in an environment where there are many possibilities of transmission, for example at school,” pointed out the King.
Dr. Vinita Dubey, assistant hygienist in Toronto, said that there are probably more scientific data in favor of spacing the two doses against measles, which gives the body more time to develop solid immunity before the second dose.
“Particularly in children, infants and toddlers, their immune system develops more with age,” said Dre Dubey.
But it is also proven that a tighter calendar will protect the youngest and most vulnerable members of the population against the disease. This is because some infants do not respond to the first dose, said Dr. Joan Robinson, a pediatric infectiologist in Edmonton.
“If this is the case, administering a second dose as soon as possible after the first could protect a larger percentage of children,” noted DRE Robinson.
She added that no one really knows which calendar is the best, because Canada only introduced the second dose against measles in 1996 and that its disposal status was only reached in 1998.
“Since then, we have not had enough measles in the country to be able to determine what is the best calendar,” added the doctor.
Shared files, a “distant dream”
The Canadian Pediatric Society has repeatedly called for a harmonized vaccination strategy, as is the case in the United States and the United Kingdom. These two countries adopt an approach similar to that of Ontario, by vaccinating children with a second dose towards the age of their entry to school.
A 1997 position of position, taken up in a 2011 call for action, warned the risk of children pass between the mesh of the net due to a disharmonized vaccination calendar.
“A certain diversity between provincial and territorial vaccination programs would be harmless if all the administrations had and shared complete systems for the holding of files easily accessible to suppliers,” wrote the DRE Noni Macdonald, pediatrician and member of the committee of infectious diseases and immunization at the time.
“For most administrations, such systems are just a distant dream.”
His words, written almost 30 years ago, are still relevant.
Dr. Jeffrey Pernica, co -president of the Ontario Immunization Advisory Committee, strongly insisted on the need for an electronic vaccination register, which would keep children’s vaccination information, determine the deadline for vaccination and alert parents in advance.
The federal government’s website lists six provinces that have vaccination registers, Alberta, British Columbia, Manitoba, Nova Scotia, Quebec and Saskatchewan. None of these systems are interconnected.
“Ideally, the structure of the health system should be such that everyone receives a reminder before their vaccination,” he said.
In Alberta, public health nurses use the vaccination register to identify children late in their vaccines. These children receive a personalized letter and a consent form that parents must sign, which allows them to catch up with school vaccination.
The other provinces are counting on family doctors, parents or local public health offices to ensure follow -up, a disjointed system that makes some parents say they are lost to find their own.
Dr. Pernica stresses that millions of people in Ontario do not have a family doctor, and even those who have one does not necessarily receive a recall when it is time to be vaccinated, because doctors do not always have the necessary time or resources.
“The main beneficiaries of a vaccination register are not even public health. I think the main advantage would be for people who do not know if they or their children are up to date in their vaccines, “he said.
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