New immunization programs in 2004 and 2005

A key strategy for controlling communicable disease in British Columbia is the immunization of children and high-risk groups against vaccine-preventable disease.

The BC Ministry of Health Services, in partnership with the BC Centre for Disease Control and provincial health authorities, are pleased to provide information about newly introduced vaccine programs, as well as those that have been recently implemented in BC.

Meningococcal C conjugate vaccine

Invasive meningococcal disease usually presents as meningitis and/or septicemia. Invasive disease may progress rapidly to purpura fulminans, shock, and death. Case fatality ranges from 8% to 15%. In addition, 10% to 20% of survivors will suffer long-term sequelae including mental retardation, hearing loss, and loss of limb use. For these reasons, three new programs will be introduced:

• For infants: Starting 1 June 2005 infants at 2 months of age will be eligible for publicly funded meningococcal C conjugate vaccine. Since July 2003, vaccine has been provided to infants at 12 months of age. The addition of a dose at 2 months of age will provide protection at the earliest possible age.

• For grade 9 students: In the fall of 2004, all grade 9 students became eligible for meningococcal C conjugate vaccine. This program will run for 2 years.

• For grade 12 students: Starting this fall (2005–2006) all grade 12 students who have not previously been vaccinated with meningococcal C conjugate vaccine will be offered the vaccine. This will be a 2-year catch-up program. This age group has been selected because an elevation in risk of meningococcal disease has been observed in the United States and the United Kingdom among students living in dormitory accommodation and in young adults in general. A school-based grade 12 immunization program reaches this at-risk age group in a very efficient manner and protects them before they leave secondary school.

Varicella (chickenpox) vaccine

Varicella-zoster virus causes significant morbidity every year in BC: up to 47500 cases of chickenpox, 17 000 physician visits, 172 hospitalizations, and 1 to 2 deaths. Two-thirds of the hospitalizations due to varicella are in children less than 10 years of age. Zoster/shingles occurs in up to 10 000 BC residents each year, causing an additional 17 000 MD visits, 524 hospitalizations, and 25 to 30 deaths annually. Hospitalization as a result of varicella is at its highest level between the ages of 0 to 11 years. This high level of hospitalization in young children makes vaccination a primary prevention measure at this early age. For these reasons, two new programs will be introduced to protect children in British Columbia against varicella-zoster virus:

• Susceptible infants at 12 months of age: As of 1 January 2005 all infants born on or after January 2004 are eligible for varicella vaccine.

• Susceptible children 18 to 48 months of age: Starting 1 April 2005 and lasting one year only, all children 18 to 48 months of age who present at public health clinics or family physician offices will be offered varicella vaccine.

• Susceptible women of childbearing age: Starting immediately varicella vaccine will be publicly funded for all susceptible women of childbearing age. By immunizing women of childbearing age, we will prevent congenital varicella syndrome and severe disease in newborns. Congenital varicella syndrome occurs in 2% of infants born to mothers exposed prior to 20 weeks’ gestation. Varicella infection can be fatal for an infant if the mother develops varicella from 5 days before to 2 days after delivery. It is expected that physicians will primarily give the vaccine. The vaccine should not be given to pregnant women.

• In September 2004 two school-based varicella vaccine programs were introduced for susceptible kindergarten and grade 6 students.

Susceptible is defined as:

• Persons less than 13 years of age with no history of disease or varicella immunization.

• Persons 13 years of age with negative or unknown history of prior varicella infection and on testing are VZV IgG negative.

These new vaccination programs have been made possible through the National Immunization Strategy, a federal funding initiative.

—Karen Pielak, RN, MSN
Nurse Epidemiologist
Epidemiology Services, BC Centre for Disease Control