Update on Provincial Vaccine Preventable Disease Outbreaks and Recommended Vaccines

Advisory Alert

November 6, 2017

* Cette information est seulement disponible en anglais.

Dear Colleagues:

I am writing today to provide you with information on the recommended use of hepatitis A and mumps vaccines for select populations, given increasing hepatitis A and mumps activity across the province. Additionally, as influenza season is upon us, this alert will provide an overview of available influenza vaccines in Ontario with a particular emphasis on influenza vaccine recommendations for children. Please assess the vaccination status of your patients and vaccinate eligible persons in accordance with their age and risk factors, and in consideration of the context outlined below.

Hepatitis A

In Ontario there has been a recent increase in the number of hepatitis A infections among men who have sex with men (MSM). Some recent cases have also reported risk factors such as homelessness; use of illicit drugs; and travel to an area experiencing an outbreak. There are currently several large international outbreaks of hepatitis A among MSM in Europe, New York City, Chile and Brazil. The United States is experiencing an increased number of hepatitis A cases among homeless individuals and in persons who use illicit drugs.
In Ontario two doses of hepatitis A vaccine, administered six months apart, are recommended and publicly-funded for:

men who have sex with men,
people who use intravenous drugs, and
people with chronic liver disease, including hepatitis B and C

The hepatitis A vaccine is also recommended, but is not publicly funded, for individuals who use non-injectable illicit drugs, individuals living in communities at high risk for hepatitis A outbreaks and travellers. Refer to the Canadian Immunization Guide for further information.

Mumps

Mumps infections are also increasing across the province. From January 1 to September 30, 2017 a total of 209 cases have been reported. Approximately 59% of cases were between 25 and 47 years of age. Among the 134 cases with known immunization status, 40% received only one dose of mumps-containing vaccine, and 22% were unimmunized.

In Ontario two doses of MMR vaccine, administered at least four weeks apart, are recommended and publicly funded for:

Children (1 year of age and older)
Persons born in 1970 or later who are healthcare workers, post-secondary students, and persons planning travel outside of North America
Persons based on a healthcare provider’s clinical judgement

In the setting of increased mumps activity, individuals who have not received two doses of MMR should be encouraged to be vaccinated. Due to changes in Ontario’s immunization schedule over time, individuals born between approximately 1970 and 1992 (who are currently between 25 and 47 years of age) likely received only one dose of MMR vaccine and are therefore more susceptible to disease than those who are fully vaccinated. If a patient’s immunization record is unavailable, vaccination is preferred over serologic testing of immune status.

Influenza

The burden of influenza B disease is higher among children under 18 years than among adults. To provide protection against influenza B virus the quadrivalent influenza vaccine (QIV) is recommended and publicly funded for children from 6 months to 17 years of age. QIV provides protection against both B strains of influenza virus that may be circulating in the community, as compared to the trivalent vaccine (TIV) which contains just one B strain. While licensed for use in children, TIV is recommended for adults, and should only be used in children if QIV is not available. The table below provides a summary of publicly funded influenza vaccines and recommendations for use.

Product Name	Influvac®	Fluviral®	Fluzone Quadrivalent®	FluLaval Tetra®	FluMist® Quadrivalent
Vaccine Preparation	TIV	TIV	QIV	QIV	QIV
Vaccine Type	Inactivated, surface antigen subunit	Inactivated, split virus	Inactivated, split virus	Inactivated, split virus	Live attenuated
Route of Administration	IM	IM	IM	IM	Intranasal spray
Dosage	0.5 mL	0.5 mL	0.5 mL	0.5 mL	0.2 mL (0.1 mL in each nostril)
Publicly Funded Ages for Use*	Recommended for adults Can be used in children ≥3 years only if quadrivalent vaccine is not available	Recommended for adults Can be used in children ≥6 months only if quadrivalent vaccine is not available	≥ 6 months to 17 years of age	≥ 6 months to 17 years of age	2 to 17 years
*Children 6 months to ˂ 9 years of age who have not received previous influenza vaccine should be given two doses, four weeks apart.

Should you have any questions, please contact the immunization program as per below.

For all reporting, inquiries or comments, please contact: Sudbury & District Health Unit at 705.522.9200, ext. 301.

Sincerely,

Penny Sutcliffe, MD, MHSc, FRCPC

Medical Officer of Health

This item was last modified on November 7, 2017