Canadian Immunization Guide
Seventh Edition - 2006

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Part 3
Recommended Immunization

Immunization of Children and Adults with Inadequate Immunization Records

Many people present to health care providers and public health officials with inadequate immunization records. In the absence of a standardized approach to their management, they may be under- or over-immunized. The concern with over-immunization relates to vaccination against diphtheria, pertussis or tetanus because of the potential for a higher incidence of local adverse reactions. Local reactions increase with the number of doses administered. These local reactions can include large swelling at the injection site, but pain is generally limited, and such reactions are not a contraindication to continuing the recommended schedule. Recent studies have indicated that tetanus and diphtheria booster doses given in a combination product with acellular pertussis and administered at intervals of less than 5 years do not result in increased local reactions in adolescents.

In every instance, an attempt should be made to obtain the person's immunization records from his or her previous health care provider. Written documentation of immunization is preferred for both children and adults. In some instances, information obtained by telephone from the health care provider with the exact dates of immunization may be accepted. For children, parental recall of prior immunization, in the absence of documentation provided by the administrator of the vaccine, correlates poorly with immunizations received and should not be accepted as evidence of immunization. Adults without immunization records should also be considered unimmunized. Additional information on the immunization of people who have newly arrived in Canada can be found in the chapter entitled Immunization of Persons New to Canada.

Routine serologic testing to determine immunity of children and adults without records is generally not practical. Instead, the following approach is recommended:

• All children and adults lacking written documentation of immunization should be started on a primary immunization schedule as appropriate for their age. For more information, please refer to the Recommended Immunization Schedules chapter.
• Measles, mumps, and rubella (MMR), polio, Haemophilus influenzae type b conjugate, pneumococcal conjugate, meningococcal conjugate, hepatitis B and A, varicella and influenza vaccines can be given, if indicated, on the basis of age and/or risk factors without concern about prior receipt of these vaccines. This is acceptable because adverse effects of repeated immunization with these vaccines have not been demonstrated.
• Persons who develop a serious adverse local reaction after administration of vaccines containing tetanus, diphtheria and pertussis should be individually assessed before they receive additional doses of these vaccines. The benefit of continuing the series needs to be weighed against the risk of further adverse reactions. Serologic testing for diphtheria and tetanus antitoxin levels may demonstrate immune status and guide the need for continued immunization. There are no established serologic correlates for protection against pertussis.
• Pneumococcal polysaccharide vaccine should be given, if indicated when a record cannot be found, since in most studies local reaction rates after revaccination have been similar to rates following initial vaccination. For more information, please refer to the Pneumococcal Vaccine chapter.

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