Recommended Immunization Schedules for Individuals NOT Previously Immunized
Updated May 2024
It is never too late to be immunized against vaccine-preventable diseases. The following immunization schedules can be used for those who:
- have never been immunized or do not have a record of immunization,
- have been partially immunized and need to be caught up with vaccines that they may be missing.
Those who meet the criteria within these schedules can receive the vaccines free of charge as part of Manitoba's Immunization Program. The schedules do not address all possible scenarios. Catch-up schedules for partially immunized individuals must be created in accordance with the current Canadian Immunization Guide and the Vaccines Offered Free-of-Charge (Eligibility Criteria for Publicly-Funded Vaccines). A review of relevant product monographs is strongly recommended.
- Children < 7 Years of Age NOT Immunized in Early infancy
- Children ≥ 7 Years of Age and < 18 Years of Age NOT Immunized in Early Childhood
- Adults ≥ 18 Years of Age NOT Immunized in Childhood
Children less than 7 years of age NOT previously immunized as infants
|
Vaccine |
1st visit |
Time after 1st visit |
6 - 12 mos. after |
4 - 6 years of age |
||||
4 |
6 |
8 |
4 |
6 |
||||
DTaP-IPV-Hib* |
♦ |
♦ |
♦ |
♦ |
||||
Tdap-IPV* |
(♦) |
|||||||
IPV* |
(♦) |
(♦) |
(♦) |
|||||
Pneu-C-15 |
(♦) |
(♦) |
(♦) |
|||||
Men-C-ACYW† |
♦ |
|||||||
Inf |
♦ |
(♦) |
||||||
MMR |
♦ |
Generally at 4-6 years ♦ |
||||||
Var |
(♦) |
Generally at 4-6 years (♦) |
||||||
OR |
||||||||
MMRV |
(♦) |
Generally at 4-6 years (♦) |
||||||
() Brackets indicate that these doses may not be required
*Note for polio: Individuals lacking adequate documentation of IPV immunization should be considered unimmunized and started on an immunization schedule appropriate for their age and risk factors. Individuals who have received only OPV vaccine after April 1, 2016 without following receipt of at least two doses of IPV, should receive IPV-containing vaccine.
Diphtheria - tetanus - acellular pertussis- inactivated polio- Haemophilus influenzae type b (DTaP-IPV-Hib): Four doses required of a DTaP-IPV-containing vaccine. With no DTaP-IPV vaccine available in Canada, DTaP-IPV-Hib is to be used for all four doses to complete the primary series for tetanus, diphtheria and pertussis up to age seven.
Tetanus - reduced diphtheria - reduced acellular pertussis- inactivated polio (Tdap-IPV): The dose at 4-6 years of age is not required if the fourth dose of DTaP-IPV-Hib vaccine was given after the fourth birthday.
Inactivated Polio Vaccine (IPV): If the child does not require the additional antigens in the combination vaccines (i.e., up to date for diphtheria, tetanus, pertussis and Hib but not for polio), IPV only would be appropriate to complete the series.
Pneumococcal conjugate vaccine (Pneu-C-15): check the Pneumococcal vaccine chapter in the Canadian Immunization Guide for the recommended schedule based on age and vaccination history (Pneumococcal vaccines: Canadian Immunization Guide - Canada.ca).
Meningococcal conjugate quadrivalent vaccine (Men-C- ACYW): One dose at or after 12 months of age.
† Note for Meningococcal Vaccine Men-C-ACYW: Nimenrix® is the recommended product if the pneumococcal vaccine is also being administered as Nimenrix® does not decrease the immune response to the pneumococcal vaccine (Pneu-C-15)
Influenza (Inf): Recommended annually for children. Children six months to less than nine years of age receiving Inf vaccine for the first time – two doses, at least four weeks apart.
Measles, Mumps, Rubella (MMR): Individuals born during or or after 1985 - 2 doses, at least 4 weeks apart.
Varicella (Var): If susceptible to varicella - Two doses at least three months apart. First dose is given at or after 12 months of age and second dose generally given between four to six years of age. If rapid protection is required, a minimum interval of four weeks may be used. Susceptibility of varicella should be evaluated prior to vaccination (see below for susceptibility considerations).
Susceptibility and Immunity of Varicella
Individuals who have ANY of the following are considered immune to varicella:
- Documented evidence of immunization with 2 doses of a varicella-containing vaccine
- Laboratory evidence of immunity
If varicella occurred before 2004, a self-reported history or health care provider diagnosis is considered a reliable correlate of immunity for healthy individuals, including pregnant women without significant exposure to varicella, and health care workers (HCW) who are currently or have previously been employed in a Canadian health care setting. In general, healthy adults 50 years of age and older, are presumed to be immune to varicella, even if the person does not remember having had chickenpox or herpes zoster.
If varicella occurred after 2004, a self-reported history or health care provider diagnosis cannot be considered a reliable correlate of immunity because one-dose immunization programs had a marked impact on the prevalence of wild-type varicella. A self-reported history or diagnosis of varicella or herpes zoster by a health care provider is not considered to be acceptable evidence of immunity for:
- healthy pregnant women with significant exposure to varicella
- immunocompromised individuals, and
- HCW who are newly hired into the Canadian health care system.
Recipients of a hematopoietic stem cell transplant (HSCT) should be considered susceptible in the post-transplantation period, regardless of a pre-transplant history of vaccination, positive serologic results or varicella or herpes zoster disease. For the purposes of post-exposure prophylaxis, an immunosuppressed person with a negative antibody test should be considered susceptible.
Measles, Mumps, Rubella and Varicella (MMRV): Susceptibility to varicella should be evaluated prior to vaccination (see above). If still susceptible to varicella - two doses at least three months apart. If rapid protection is required, a minimum interval of four weeks may be used. First dose given at or after 12 months of age and second dose generally given between four to six years of age.
Children 7 to 17 Years of Age NOT Immunized in Early Childhood
|
Vaccine |
1st visit |
Time after first visit |
6-12 mos. after last dose |
10 years after last dose |
||||
4 |
6 |
8 |
3 |
6 |
||||
Tdap-IPV* or Tdap |
♦ |
|
|
♦ |
♦ |
♦ |
||
IPV* |
(♦) | (♦) | (♦) | |||||
Men-C-ACYW |
♦ |
(♦) | ||||||
HB |
♦ |
(♦) |
♦ |
|
|
|||
HPV |
♦ |
|
|
(♦) |
|
♦ |
|
|
Inf |
♦ (♦) |
|||||||
MMR |
♦ |
♦ |
|
|
|
|
|
|
Var |
(♦) |
|
|
(♦) |
|
|
|
|
OR |
||||||||
MMRV |
(♦) |
(♦) |
||||||
() Brackets indicate that these doses may not be required
*Note for polio: Individuals lacking adequate documentation of IPV immunization should be considered unimmunized and started on an immunization schedule appropriate for their age and risk factors. Individuals who have received only OPV vaccine after April 1, 2016 without following receipt of at least two doses of IPV, should receive IPV-containing vaccine.
Tetanus, Diphtheria, acellular pertussis and inactivated polio (Tdap-IPV) or Tetanus, diphtheria, and acellular pertussis (Tdap): If no previous history of tetanus-containing or polio-containing vaccines, the first three doses of the series should be with Tdap-IPV vaccine and the booster dose with Tdap provided in the grade 8 or 9 school immunization program (13-15 years of age).
If the series is started after grade 8 or 9, the Tdap booster dose should be administered 10 years after the last Tdap-IPV dose. Tdap is also recommended for pregnant women in every pregnancy. Optimal timing is between 27 and 32 weeks gestation, although Tdap vaccine may be given at any time during pregnancy.
Inactivated Polio Vaccine (IPV): If the child does not require the additional antigens in the combination vaccine (i.e., up to date for diphtheria, tetanus, pertussis and Hib but not for polio), IPV would be appropriate to complete the series. They should receive two doses of IPV-containing vaccine, given 4 to 8 weeks apart, followed by a third dose administered 6 to 12 months after the second dose.
Meningococcal conjugate quadrivalent (Men-C-ACYW):
Individuals born before Dec 31, 2019 who are between 7-9 years old are eligible for one dose IF they never received a dose of Men-C-C vaccine as part of the 12-month program. Individuals born on or after January 1, 2008, are eligible to receive a dose if they are 10 years of age and older, regardless of Men-C-C or Men-C-ACYW immunization history.
Hepatitis B (HB): Those 11 to 17 years of age – two or three doses depending on age at immunization and product used. Those 11 to 16 years of age – two doses of Recombivax HB® 1.0mL at 0, four to six months OR Engerix®-B 1.0mL at zero, six months. Those 16 to less than 19 years of age – three doses of Recombivax HB® 0.5ml OR Engerix®-B 0.5ml at zero, one, six months.
Refer to Table 3: Recommended Dosages and Schedules for Hepatitis B-Containing Vaccines of the Canadian Immunization Guide for product-specific recommendations by age/medical condition.Human papillomavirus (HPV): Those 11 to 14 years of age: preferred two-dose schedule - months zero and six (first visit = month zero). Individuals 15 years of age and older, immunocompromised individuals, and those at increased risk: three doses (months zero, two and six).
Measles, Mumps, Rubella (MMR): MMR can be used if not immunizing against varicella (Note: MMRV is not authorized for use in those 13 years of age and older). Two doses are required at least four weeks apart.
Influenza (Inf): Recommended annually for all children. Children six months to less than nine years of age receiving Inf vaccine for the first time – two doses, at least four weeks apart. Children nine years of age and older – one dose (regardless of previous influenza immunization history).
Varicella (Var): Those seven to 12 years of age – two doses at least three months apart if they have not had any previous varicella immunization and are still susceptible. If rapid protection is required, a minimum interval of four weeks between doses may be used. Those aged 13 to 17 years – two doses six weeks apart. If rapid protection is required, a minimum interval of four weeks may be used. Susceptibility to varicella should be evaluated prior to vaccination (see below for susceptibility considerations).
Susceptibility and Immunity of Varicella
- Documented evidence of immunization with 2 doses of a varicella-containing vaccine
- Laboratory evidence of immunity
If varicella occurred before 2004, a self-reported history or health care provider diagnosis is considered a reliable correlate of immunity for healthy individuals, including pregnant women without significant exposure to varicella, and health care workers (HCW) who are currently or have previously been employed in a Canadian health care setting. In general, healthy adults 50 years of age and older, are presumed to be immune to varicella, even if the person does not remember having had chickenpox or herpes zoster.
If varicella occurred after 2004, a self-reported history or health care provider diagnosis cannot be considered a reliable correlate of immunity because one-dose immunization programs had a marked impact on the prevalence of wild-type varicella. A self-reported history or diagnosis of varicella or herpes zoster by a health care provider is not considered to be acceptable evidence of immunity for:
- healthy pregnant women with significant exposure to varicella
- immunocompromised individuals, and
- HCW who are newly hired into the Canadian health care system.
Recipients of a hematopoietic stem cell transplant (HSCT) should be considered susceptible in the post-transplantation period, regardless of a pre-transplant history of vaccination, positive serologic results or varicella or herpes zoster disease. For the purposes of post-exposure prophylaxis, an immunosuppressed person with a negative antibody test should be considered susceptible.
Measles, Mumps, Rubella and Varicella (MMRV): Those seven to 12 years of age – two doses, at least three months apart. If 13 to 17 years of age, separate MMR and V vaccines are to be used as MMRV is only authorized for use in those under 13 years of age. Susceptibility to varicella should be evaluated prior to vaccination (see above for susceptibility considerations). If rapid protection is required, a minimum interval of four weeks between doses may be used.
Adults 18 years of age and older, NOT previously immunized
|
Vaccine |
1st visit |
Time after 1st visit |
6-12 mos. after |
Every 10 years after |
|||
4 |
6 |
8 |
6 |
||||
Tdap |
♦ |
||||||
Td |
♦ (after Tdap dose) |
♦ |
♦ |
||||
HB |
♦ |
♦ |
♦ |
|
|||
MMR |
♦ |
(♦) |
|||||
Var |
(♦) |
(♦) |
|
||||
Pneu-P-23 |
♦ |
||||||
Men-C-ACYW |
(♦) |
||||||
HPV |
♦ |
|
|
♦ |
♦ |
|
|
Inf |
♦ |
||||||
() Brackets indicate that these doses may not be required
Tetanus, Diphtheria and acellular pertussis (Tdap): If no previous history of any tetanus-containing vaccines, first dose of tetanus vaccine series should be completed with Tdap vaccine, followed by two doses of Td vaccine. If previous history of tetanus vaccines is available but no pertussis-containing vaccine in adulthood, Tdap can be given when the 10 year tetanus booster is due, if known. There is no minimum interval between Td and Tdap. Tdap is also recommended for pregnant women in every pregnancy. Optimal timing is between 27 and 32 weeks gestation, although Tdap vaccine may be given at any time during pregnancy.
Tetanus and Diphtheria (Td): If no previous history of any tetanus-containing vaccines, first dose of tetanus vaccine series should be Tdap. Two additional doses of tetanus-containing vaccine (Td) are required (2 months after Tdap and then 6-12 months after the last dose). A dose is then given every 10 years after the primary series (3 doses of tetanus-containing products) is completed.
Hepatitis B (HB): Those born on or after January 1, 1989 who missed the school immunization program: 3-dose schedule – months 0, 1 and 6 (first visit = month 0) with at least 4 weeks between the first and second doses, 2 months between the second and third doses, and 4 months between the first and third doses.
Refer to Table 3: Recommended Dosages and Schedules for Hepatitis B-Containing Vaccines of the Canadian Immunization Guide for product-specific recommendations by age/medical condition.
Measles, Mumps, Rubella (MMR): Individuals born during or after 1985 - 2 doses, at least 4 weeks apart. Adults born between 1970 and 1984 – 1 dose. Exceptions: non-immune health care workers and students – 2 doses, at least 4 weeks apart. Adults born before 1970 can be assumed to have acquired natural immunity to measles and mumps and do not need MMR vaccination. Exceptions: non-immune health care workers - 2 doses, at least 4 weeks apart; non-immune students – 1 dose. Rubella-susceptible adults, regardless of age – 1 dose.
Susceptibility and Immunity to Rubella
Individuals who have one or more of the following are considered immune to rubella. Individuals who do not have ANY of the following are considered susceptible to rubella:
- Documented evidence of immunization with a rubella-containing vaccine on or after the first birthday
- A history of laboratory confirmed rubella infection
- Laboratory evidence of immunity
Varicella (Var): Those born between January 1, 1995 and December 31, 2007 who have not had any previous varicella immunization and are susceptible – 2 doses at least 4 weeks apart. Susceptibility to varicella should be evaluated prior to vaccination.
Susceptibility and Immunity of Varicella
(www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-4-active-vaccines/page-24-varicella-chickenpox-vaccine.html)
Individuals who have ANY of the following are considered immune to varicella:
- Documented evidence of immunization with 2 doses of a varicella-containing vaccine
- Laboratory evidence of immunity
If varicella occurred before 2004, a self-reported history or health care provider diagnosis is considered a reliable correlate of immunity for healthy individuals, including pregnant women without significant exposure to varicella, and health care workers (HCW) who are currently or have previously been employed in a Canadian health care setting. In general, healthy adults 50 years of age and older, are presumed to be immune to varicella, even if the person does not remember having had chickenpox or herpes zoster.
If varicella occurred after 2004, a self-reported history or health care provider diagnosis cannot be considered a reliable correlate of immunity because one-dose immunization programs had a marked impact on the prevalence of wild-type varicella. A self-reported history or diagnosis of varicella or herpes zoster by a health care provider is not considered to be acceptable evidence of immunity for:
- healthy pregnant women with significant exposure to varicella
- immunocompromised individuals, and
- HCW who are newly hired into the Canadian health care system.
Recipients of a hematopoietic stem cell transplant (HSCT) should be considered susceptible in the post-transplantation period, regardless of a pre-transplant history of vaccination, positive serologic results or varicella or herpes zoster disease. For the purposes of post-exposure prophylaxis, an immunosuppressed person with a negative antibody test should be considered susceptible.
Pneumococcal polysaccharide 23-valent (Pneu-P-23): Adults 65 years of age and older – 1 dose.
Meningococcal conjugate quadrivalent (Men-C-ACYW): Individuals born between 1995 and 2007 are eligible to receive a dose if they have no previous history of receiving a Men-C-C vaccine.
Human papillomavirus (HPV): Females born on or after January 1, 1997 and males born on or after January 1, 2002 - 3 doses - months 0, 2 and 6 (first visit = month 0).
Influenza (Inf): Recommended for all adults– 1 dose annually. Adults aged 65 years and older are eligible for the high-dose influenza vaccine.
