July 2014

What's Up in Family Medicine: Immunization

"Back to school" in Ontario this year includes new immunization-related requirements

To help our members prepare for the changes, the OCFP asked Dr. Kieran Moore to answer key questions.

School Immunization: Q&A with Dr. Moore

Dr. Moore and Kathy Hatch, registered practical nurse at KFL&A

Dr. Kieran Moore is Associate Medical Officer of Health for Kingston, Frontenac and Lennox & Addington Public Health, and Associate Professor of Medicine at Queen's University. He is shown here with Kathy Hatch, Registered Practical Nurse, at a KFL&A Public Health immunization clinic.

Q. How are the school immunization changes likely to affect family doctors and how can they best prepare?

A. There are likely to be two impacts. The first will be information requests. Parents will be reminded by their local Public Health Unit and their child’s school that the requirements have changed and that their child may be suspended from school if the records are not up to date. This will likely trigger calls to family doctors for immunization record information.

When this happens an appointment may be necessary to review immunization information. In general, parents should be encouraged to keep immunization records in a safe place.

The second activity will be providing catch-up shots for patients with gaps in their immunization history. There will likely be a second wave of both activities when the enforcement letters go out. Exactly when that happens will vary by school board.

Children may be temporarily suspended from school if Public Health does not have updated records of immunization, or a valid exemption, on file.

Q. What are the major changes now in effect? Where are the gaps likely to be?

A. The changes to the Immunization of School Pupils Act that came into force in July 2014 include three new immunizations, as well as updating the number of doses for several others.

The new requirements are immunizations for meningococcal disease, pertussis and varicella. (Varicella for those born in 2010 or later.) The dosages for tetanus, diphtheria, polio, and mumps vaccines have also been updated.

The biggest gap will likely be those who did not receive two doses of varicella vaccine and those 14-16 years old who may require Tdap (diphtheria, tetanus, and acellular pertussis).

The complete immunization requirements for school attendance can be downloaded from the Ministry of Health here.

Q. Who is responsible for reporting immunizations to Public Health Units and what information will they need?

A. Parents are responsible for reporting immunization information to Public Health. Some physicians choose to send monthly or weekly listings of immunizations provided to Public Health to reduce calls and visits related to suspensions as these lists aid in maintaining the immunization record on an ongoing basis. 

It would be best to confirm what information is required locally by contacting the local Public Health Unit. As well as name, sex and date of birth, the required information may include OHIP number, vaccine provider, lot #, date of vaccination and physician name.

Q. Do all students have to be immunized?

A. All parents are encouraged to have their children immunized and should be counselled about the risks of not vaccinating. There are also resources available to explain the evidence supporting the benefits.

Medical exemptions continue to exist for documented prior disease or immunity as well as medical contraindications. Parents seeking other types of exemptions, such as religious or philosophical, should be advised to contact their local Public Health Unit.

As in the past, the mandatory requirement for school attendance is documentation of the immunizations or valid exemptions. 

Q. Where should family physicians direct their questions about local vaccine supplies, dosages, contraindications, immunization clinics etc.?

A. Health-care providers can contact their local Public Health Unit for information on immunizations and for assistance in determining catch-up immunization schedules for children who are behind on immunization.

Immunization Info Update

Fast Facts

  • Students who are already up to date with the routine immunization schedule will not require additional immunizations to comply with the changes related to school attendance. The requirements align with Ontario’s existing publicly funded immunization schedule.

  • More than 70 per cent of students are already immunized against the three newly designated diseases.
  • Providing an immunization record is included as part of the insured service for immunization and cannot be billed to a client.

  • Most of the vaccines required can be ordered through existing processes for ordering publicly funded vaccines. One exception is the meningococcal ACYW-135 vaccine for adolescents.
    (See: Changes to immunization requirements for school attendance: Q&A for health care providers for details).

Waiting Room and Patient Resources

The Ontario Ministry of Health provides online and downloadable resources including:

School immunization checklist poster/handout

Childhood Vaccination Myths & Facts infographic
Multilingual Resources
Cool Tool

Immunization schedule from the Ministry of Health and Long-Term Care

Other Useful Links

Still have questions? Ask an expert!

Send your immunization questions to 

Ask an Expert

  • How should we proceed with a patient who has received two doses of the hepatitis A vaccine but is not showing any immunity on titre?

  • What is the immunization expectation for children who have had the "wild" chickenpox?

  • Do students entering school for the first time require both varicella shots? Or only their 15 months and then varicella between 4-6 years of age?

  • Is there any current recommendation for Prevnar 13 in the immunocompromised over 50 in Ontario?