Supplement - Canadian National Report on Immunization, 2006

Table of Contents

Preface

1. Canada’s National Immunization Strategy: Progress Highlights

   1.1 Development of national goals and recommendations for immunization programs
   1.2 Immunization program planning
   1.3 Vaccine safety
   1.4 Vaccine supply
   1.5 Immunization registry network
   1.6 Immunization research
   1.7 Professional and public education
   1.8 Vaccine-preventable disease surveillance
   1.9 Conclusions

2. Vaccine Coverage

   2.1 Background and objectives
   2.2 Methodology
   2.3 Results
   2.4 Discussion

3. Vaccine-Preventable Disease Surveillance Systems

   3.1 Notifiable Diseases Reporting System
   3.2 Enhanced measles surveillance
   3.3 Enhanced invasive meningococcal disease surveillance
   3.4 FluWatch
   3.5 Immunization Monitoring Program, ACTive
   3.6 Canadian Paediatric Surveillance Program
   3.7 International Circumpolar Surveillance

4. Update on the Epidemiology of Selected Vaccine-Preventable Diseases

   4.1 Invasive Haemophilus influenzae type b disease
   4.2 Hepatitis B
   4.3 Influenza
   4.4 Measles
   4.5 Invasive meningococcal disease
   4.6 Mumps
   4.7 Pertussis
   4.8 Invasive pneumococcal disease
   4.9 Poliomyelitis and acute flaccid paralysis surveillance
   4.10 Rubella
   4.11 Congenital rubella syndrome and congenital rubella infection
   4.12 Varicella

5. Vaccine Safety: Surveillance of Adverse Events Following Immunization

   5.1 Introduction and historical background
   5.2 Methodology
   5.3 Results
   5.4 Discussion

References
Annex 1: Provincial and Territorial Immunization Programs
Annex 2: List of Abbreviations and Acronyms

Acknowledgements

We acknowledge the continuing contribution of our immunization program and surveillance partners, including, but not limited to, the following groups and organizations: provincial and territorial epidemiologists, public health and immunization experts; the Canadian Nursing Coalition for Immunization; National Microbiology Laboratory, Winnipeg; National Centre for Streptococcus, Edmonton; provincial public health laboratories; members of the Immunization Monitoring Program, ACTive; the Canadian Paediatric Society and physicians contributing to the Canadian Paediatric Surveillance Program; Canadian members of the International Circumpolar Surveillance Invasive Bacterial Diseases Working Group; the FluWatch network of sentinel physicians and the College of Family Physicians of Canada.

Staff members of the Immunization and Respiratory Infections Division, Centre for Infectious Disease Prevention and Control, Public Health Agency of Canada, Ottawa, Ontario, Canada, contributed to determining the content, writing and editing of the report.

The artwork on the cover - an original drawing by Christian Morin from École Dagenais in Macamic, Quebec - was selected as the National Winner of the Canadian Immunization Poster Competition for grade 6 students. The competition was organized by the Immunization and Respiratory Infections Division and the Canadian Coalition for Immunization Awareness & Promotion, in conjunction with the sixth Canadian Immunization Conference in December 2004. The theme was "Give Us Your Best Shot".

Preface

Since the publication of the 1998 Canadian National Report on Immunization, the landscape of public health in Canada has changed considerably, foremost with the creation of the Public Health Agency of Canada and the Pan-Canadian Public Health Network in 2004. This was preceded by the acceptance of the National Immunization Strategy (NIS) by the Conference of Federal, Provincial and Territorial (F/P/T) Deputy Ministers of Health and a commitment of $45 million over 5 years in the 2003 Federal Budget to strengthen national collaboration on immunization. In Budget 2004, the Government of Canada provided $300 million directly to the provinces and territories (P/T) to support the introduction of four new childhood and adolescent vaccines.

In the context of these significant changes, the purpose of this report is to cover progress in immunization, including current P/T programs and the results of the National Immunization Coverage Surveys, and to provide an update since 1998 on trends in select vaccine-preventable diseases and in adverse events following immunization. While major highlights of the progress of the NIS are discussed in a feature section of this report, there have been many milestones for immunization in the past several years that are worth emphasizing here:

• continued low disease rates for many vaccine preventable diseases and limited spread of import related measles and rubella cases, signalling the elimination of these diseases in Canada;
• the expansion of routine immunization programs to include childhood pneumococcal conjugate vaccine and adolescent acellular pertussis programs in all provinces and territories, as well as childhood meningococcal and varicella zoster vaccine programs in 12 jurisdictions;
• improvements over time in vaccine coverage estimates among 2-year-olds for a single dose of the measles, mumps and rubella vaccine and for four doses of diphtheria, pertussis, tetanus, polio and Haemophilus influenzae type b combination vaccines;
• a dramatic decline in the reported frequency of specific adverse events since the switch from whole-cell to acellular pertussis vaccines in childhood immunization programs in 1997-98;
• the first national consensus conference of national goals and recommendations for vaccine preventable diseases held in June 2005;
• the first national research priorities workshops on influenza and on human papillomavirus vaccines, held in the fall of 2005, to identify knowledge gaps and ways to address these gaps;
• new collaborations forged between public health and experts in immunization, sexually transmitted diseases, and cancer prevention and management to design effective immunization strategies for the newly approved human papillomavirus vaccine;
• establishment of a pandemic influenza vaccine readiness contract with our domestic supplier in 2001, the first country to achieve this, and the Canadian Pandemic Influenza Plan, published in 2004, to facilitate national coordination in preparedness and response activities;
• the release of the 7th edition of the Canadian Immunization Guide in 2006;
• the provision of cutting-edge information on immunization science, policy, programs and practice and a forum for networking and knowledge-sharing among the many disciplines working in immunization through the biennial Canadian Immunization Conference. The December 2006 instalment is aptly entitled, Celebrating Immunization in Canada: Achievements and Opportunities.

Despite these achievements, however, there have been sporadic outbreaks of measles, mumps and rubella in several jurisdictions, which serve to remind us that Canada will experience ongoing importations of vaccine-preventable diseases and that there are pockets of non-immunized or under-immunized populations vulnerable to the introduction of such infectious agents. The spread of poliovirus to 11 previously polio-free countries in Africa and southeast Asia during late 2004 and 2005 illustrates the necessity for constant vigilance in immunization coverage and disease surveillance if we are to minimize the impact of vaccine-preventable diseases both in Canada and abroad. The outbreak of Severe Acute Respiratory Syndrome (SARS) in 2003 highlighted the need to strengthen our public health infrastructure, including immunization programs, and our capacity to conduct rapid vaccine research and development for emerging infections.

Where do we go from here? Given the current development in vaccine technology and research, it is expected that new vaccines will have a major impact on the delivery of immunization programs and the epidemiology of vaccine-preventable diseases in the coming years. A number of new vaccines are expected on the horizon, and innovative collaborative approaches are expected to continue in the future to facilitate vaccine program design and implementation, and to address security of supply. It will be important to monitor our progress closely, identify and address challenges, and report on our accomplishments.

Theresa Tam, MBBS (UK), FRCPC, FAAP
Director
Immunization and Respiratory Infections Division
Centre for Infectious Disease Prevention and Control
Public Health Agency of Canada
Ottawa, Ontario

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