What is the cost of the vaccine?

All 3 doses of Hepatitis B costs $50.00 for children under 16 yrs. old. For older children the cost is $35.00 per dose

Measles, Mumps, Rubella (MMR)

This vaccine immunizes against Measles, Mumps, and Rubella. It is given at 12-15 months, and at 4-6 years. It should either be given with the VZ (chickenpox vaccine) or at least one month before or after. If you miss a dose or get behind schedule, get the next dose as soon as you can. There is no need to start over.

The diseases MMR prevents are:

• Measles virus cause rash, cough, runny nose, eye irritation, and fever. It can lead to ear infection, pneumonia, seizures, brain damage, and death.
• Mumps virus cause fever, headache, and swollen glands. It can lead to deafness, meningitis, painful swelling of the testicles or ovaries, and, rarely, death.
• Rubella (German Measles) virus cause rash, mild fever, and arthritis (mostly in women). If a woman gets rubella while she is pregnant, she could have a miscarriage, or her baby could be born with serious birth defects.

These diseases are spread by being around someone who has them. They spread from person to person through the air. They can be spread before a person realizes they are sick. Sometimes a person may have such a mild illness that it is never diagnosed, and the person thinks they just had a cold. Reactions to the MMR are very uncommon.

Mild reactions:

• Fever (1 out of 6)
• Mild rash (1 out of 20)
• Swelling of glands in the groin or neck (rare)

If these problems occur, it is usually 7-12 days after the shot. They occur less often after the second dose.

Moderate reactions:

• Seizure caused by fever (1 out of 3,000 doses)
• Temporary pain and stiffness in the joints, mostly in teens or adults (1 out of 4)
• Temporary low platelet count, which can cause a bleeding disorder (1 out of 30,000)

Severe reactions:

• Serious allergic reaction (<1 out of a million)

Some people should not get the MMR or should wait:

• Children who have ever had a life-threatening allergic reaction to gelatin, the antibiotic neomycin, or a previous dose of MMR vaccine.
• Pregnant women should wait until after they have given birth. Women should not get pregnant for 3 months after getting the MMR.
• Anyone with a disease that affects the immune system (like cancer, HIV/AIDS)
• Anyone taking drugs that affect the immune system (like steroids)
• Anyone taking cancer treatment with x-rays or drugs
• Anyone who has had a low platelet count (a blood disorder)
• Anyone who has recently had a transfusion or were given other blood products.
• Children who have received the Chicken pox vaccine (VZ) less than a month ago. The MMR and VZ should either be given at the same time or at least one month apart.
• Children who are moderately or severely ill at the time the shot is scheduled should usually wait until they recover before getting the MMR.

Varicella Zoster (Chicken Pox) Vaccine

Before use of the vaccine, about 4 million cases of chickenpox occurred each year in the US.

• about 11,000 hospitalizations occurred each year in the US.
• about 100 people died each year from chickenpox and its complications.
• Half of these deaths were in children, most of whom were previously healthy.

The most common complications of chickenpox is bacterial superinfection of the skin and soft tissues. Chickenpox is a major risk factor for strep toxic shock syndrome and necrotizing fasciitis (flesh eating disease). Other complications include 

• acute cerebellar ataxia, encephalitis, pneumonitis, and overwhelming viremia. 
• seizure caused by fever
• decreased platelet count (thrombocytopenia).

Varicella is much more likely to be severe or complicated in adults. Although adults make up only about 10% of cases, they account for more than half the deaths.

Varicella vaccine is a live, attenuated viral vaccine, meaning it is a weakened strain of the virus (like the MMR).

Studies done before licensing the vaccine found that it is was generally well tolerated with only local reactions, such as pain or swelling at the shot site, and these were mild and self-limited. 

Since licensure, more experience has been gained. As of April 1999, 16.1 million vaccine doses have been given. 

Of these, there have been 1,349 reports (less than 0.0001%) of children who developed a rash within 6 weeks after vaccination. Of 97 children with vesicular lesions available for analysis, the virus type was identified in 62 cases. 38 of these were the wild-type VZ showing that these children had already been infected with chickenpox before vaccination. These children averaged about 100 lesions and got sick 1-24 days (mean of 8 days) after vaccination. The 24 identified as the vaccine strain of VZ averaged about 50 lesions and became sick 5-42 days (mean of 21 days) after vaccination.

Chickenpox is caused by varicella-zoster virus. Zoster is a herpes type virus and all herpes viruses can stay dormant in the body, especially in the dorsal root and sensory ganglia (spinal nerves). Years or decades later, the virus can reactivate as zoster (shingles), usually when the person becomes elderly or immunocompromised.

As of April, 1999, 16.1 million vaccine have been given. Of these, there have been 205 reports of zoster after vaccination. However, the rate of reported (not necessarily confirmed) zoster after vaccination is much lower than that occurring after natural disease.

A large-scale study in the elderly is underway to see if the vaccine may prevent zoster. This is based on the fact that zoster occurs when a person’s cell-mediated immunity decreases and since the vaccine causes an increase in cell-mediated immunity, it is possible that vaccinating the elderly may boost their immunity and decrease their rate of zoster.

As of April, 1999, 16.1 million vaccines given:

92 reports of possible secondary transmission occurring 10-15 days after vaccination of the primary child. Of 29 specimens obtained, 18 revealed wild-type virus, and only 3 confirmed the vaccine strain. All 3 cases occurred in children who developed a vesicular rash after vaccination. No cases occurred if the vaccinated child developed no rash. Each of the transmitted cases were mild.

How contagious a vaccinated child is depends on: whether a rash develops, how extensive the rash is, and the extent of the contact (household contacts are at much higher risk than casual contacts). So, do you vaccinate a child living with an immunocompromised or pregnant woman? Yes, because without vaccination the child may acquire natural chickenpox which would be a much greater risk for his contacts than the chances of developing a rash after vaccination.

More than 95% of children 12 years of age and younger respond to a single dose of vaccine. Among persons 13 years of age and older, only about 80% respond. This age group should receive 2 varicella vaccines 4-8 weeks apart. This dosing gives a greater than 95% response.

About 1-4% of vaccinated children per year develop "breakthrough" disease when exposed to naturally occurring chickenpox. This occurs in children with low antibody levels after vaccination. Their disease tends to be mild with fewer skin lesions, lower fevers, and a faster recovery.

86% effective against all forms of chickenpox disease and 100 % effective against moderate to severe disease.

Since licensure 6 years ago, the incidence of chickenpox has decreased in all age groups, including unimmunized persons. This suggests herd immunity. The vaccine works–we just need to vaccinate more children.

Antibody levels have been followed for at least 10 years in children given the currently licensed vaccine, and for more than 20 years in children given earlier formulations. Nearly all children maintain antibody levels for as long as 20 years.

As more and more children are vaccinated, less and less wild-type disease will occur. Unvaccinated people will be less likely to acquire natural disease and will grow up to be susceptible adults. The only way to prevent this from occurring is to vaccinate all appropriate children 1 year of age and older and all susceptible persons at high risk for exposure or transmission.

Pre-exposure:

All children 12-18 months of age who have not had chickenpox. Two doses of vaccine- a second dose at 4` to 6 yrs. of age

Older children who have not had chickenpox - preferably before 11-12 years of age. Two doses of vaccine - at least 3 months apart.

If there is any question as to whether a person has had chicken pox or not, it is best to give the VZ vaccine. There is no harm in receiving the vaccine even if you've already had the disease.

Susceptible adults: Persons who live or work in high-risk environments (preschool teachers, child-care givers, etc), Persons who live or work in moderate-risk environments (college students, inmates, military personnel, etc), non-pregnant women of child-bearing age, adolescents and adults living in households with children, international travelers. Persons 13 years of age and older should receive two doses 4-8 weeks apart.

Post-exposure:

Vaccination within 72 hours (and still may help as late as 5 days after exposure) of being exposed to chickenpox may limit or prevent disease, but may not always be protective (child may have been exposed earlier than suspected).

• Children who have ever had a life-threatening allergic reaction to gelatin, the antibiotic neomycin, or a previous dose of VZ vaccine.
• Pregnant women should wait until after they have given birth. Women should not get pregnant for 1 month after getting the VZ.
• Anyone with a disease that affects the immune system (like cancer, HIV/AIDS)
• Anyone taking drugs that affect the immune system (like steroids)
• Anyone taking cancer treatment with x-rays or drugs
• Anyone who has had a low platelet count (a blood disorder)
• Anyone who has recently had a transfusion or were given other blood products.
• Children who have received the MMR less than a month ago. The VZ and MMR should either be given at the same time or at least one month apart.
• Children who are moderately or severely ill at the time the shot is scheduled should usually wait until they recover before getting the VZ.

The vaccine is free for 1 yr. olds and children who need a second dose and were born after Jan. 1, 2000.

Meningococcal B and C Vaccines

Meningococcal Disease

Meningococcal disease is caused by the Neisseria meningitidis bacteria. These bacteria can cause meningitis and blood infection. About 10% of people with the disease will die. There are 5 different serogroups (or types) of these bacteria: A, B, C, W135 and Y.

What is the difference between serogroups?

Serogroup B and C cause most cases of meningococcal disease in Canada. Serogroup C is most likely to cause outbreaks. Serogroup A is common in countries like Africa and a risk for travellers. There are vaccines for serogroups A and C, Y and W-135.Currently MenB is the most common strain at present.

Who gets Meningococcal Disease?

In Canada, infants less than 12 months are at highest risk of this infection, followed by children 1 to 5 years of age and adolescents 15 - 19 yrs. old. Recent epidemics of serogroup B in Canada have involved children, adolescents and young adults. Individuals with the following conditions are also at high risk:
Those without a spleen, with certain immunodeficiencies (e.g. HIV) and Sickle cell disease

What Meningococcal Vaccines are available?

Bexsero and Trumenba are vaccines to protect against MenB. Menjugate™ and Neis Vac-C are vaccines that protect against serogroup C disease. Menactra and Menveo protects against serogroups C, A .Y and W-135. Menactra and Menveo can be given to children older than 2 yrs.

Who Should Get Meningococcal Vaccine?

Bexsero can be given to infants as young as 2 months as well as children and adolescents.Trumenba is indicated for children over 10 years of age.Canada's National Advisory Committee on Immunization recommends Meningococcal C Vaccine for: Infants and children up to 2 years of age and adolescents. Menactra and Menveo can also be considered for children 2 to 3 years of age and up who have not yet reached adolescence. Menactra or Menveo is recommended for adolescents even if they received MenC vaccine as an infant or toddler.

What are the side effects of Meningococcal vaccines?

Up to 50% of vaccine recipients complain of mild pain and redness at the injection site. 5% of vaccinees, particularly infants, experience transient fever. No serious side effects have been reported.

Can Meningococcal Vaccines be given at the same time as other vaccines?

Menincgoccal B and C vaccines can be given at the same time as other childhood vaccines, using a separate syringe at a separate site.

Is this the same vaccine that travellers get?

No. Travellers to areas such as Africa and Saudi Arabia need to get Menactra or Menveo, vaccines that protect against 4 serogroups of N. meningitidis: A, C, Y, and W-135. This vaccine is not recommended for use in Canadian infants and children under 2 yrs. old.

What is the schedule for Meningococcal B and C Vaccines?

For Bexsero vaccine the age at first dose is 2-4 mos. A second dose is given 2 mos apart and a booster dose at 12 -15 mos. of age. If started at 24 mos and older, only 2 doses are needed for Bexsero. Protection is known to last for at least 3 to 4 years. MenC vaccine is given at one year of age. A meningococcal vaccine containing 3 additional serotypes, A, Y and W-135 (Menactra) is recommended for adolescents (given at school for grade 7 students).

What is the cost of the vaccine?

Each dose of Meningococcal B vaccine costs $150.00. MenC vaccine will be free for infants who are 1 yr. old. Menactra will be free only for all grade 7 students.

Influenza Vaccine

What is influenza?

Influenza (commonly known as “the flu”) is a serious, acute respiratory disease that is caused by a virus.  People who get influenza have a cough, fever, chills, sore throat, headache, muscle aches and fatigue.  People of any age can get influenza.  Most people who get influenza are ill for 2 to 7 days, although the cough may last for weeks.  However, some persons can get much sicker, and need to go to the emergency room or to the doctor’s office.  Influenza can lead to pneumonia, hospitalization, and even death in some people, particularly the elderly and those with chronic medical conditions, such as heart or lung problems.
Influenza spreads easily from infected persons to the nose and throat of others through coughing and sneezing. It is also spread through direct contact with surfaces and objects which have been contaminated by the influenza virus.

How well does influenza vaccine protect against the flu?

Protection from the vaccine develops about two weeks after the shot, and may last up to a year. The vaccine is 70% to 90% effective in preventing influenza illness in healthy adults. Persons who receive the vaccine can still get influenza, but if they do, it is usually milder than it would have been without the shot.

Who should get a flu shot?

Anyone over six months of age who wants to avoid getting the flu this season should consider getting the influenza vaccine. People at risk of getting severely ill from influenza disease or its complications, and people in close contact with them should consider themselves a priority for influenza immunization. The vaccine is considered safe for women at all stages of pregnancy, and for breastfeeding mothers.

Who should not get the influenza vaccine?

People in the following groups should not get the influenza vaccine:

Steps to reduce needle pain in babies:

• 1. Cuddle your baby on your lap during the immunization.
• 2. If you are breastfeeding, feed your baby before, during and after the needle. Breastfeeding calms and comforts both the baby and mother and can reduce baby’s pain.
• 3. If you are not breastfeeding, sugar water can be given to infants less than 12 months. To make sugar water, mix one packet of sugar (1 teaspoon) with 10 ml of water (2 teaspoons). Give it to your baby with a cup, spoon or syringe just before the needle and discard the unused portion. DO NOT use sugar at home to calm upset or crying babies.
• 4. Allow your baby to suck when receiving the needle.