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Opportunity for Immunization in all Health Care Settings

The responsibility of all health care providers

The best way to reduce vaccine-preventable diseases is to have a highly immune population. Immunization programs in Canada have been very successful in decreasing the incidence of communicable diseases. Challenges remain, particularly in the areas of missed opportunities for immunization and improving immunization rates for subgroups of Canadians who are not being fully immunized.

A missed opportunity for immunization is a health care encounter in which a person is eligible to receive a vaccination but is not vaccinated or is incompletely vaccinated. Missed opportunities occur in all health care settings. Missed opportunities for immunization occur during adult and childhood visits to a health care provider and are just as likely to occur whether the visit is related to acute illness or chronic illness.

A significant portion of Canadian adults (≥ 18 years of age) are vulnerable to vaccine-preventable diseases. In addition to the routine vaccines recommended for all individuals, there are also vaccines recommended for individuals with different risk factors arising from occupation, underlying illness, lifestyle, and age. Both adults and children may live in situations that make accessing immunizations at health units or physician’s offices difficult.

Individuals may be seen in a variety of health care settings (e.g., emergency departments, hospital wards, walk-in clinics, physician offices, outpatient clinics, or specialized clinics). For patients without regular sources of care or those followed in specialized clinics, the only opportunities for immunization may be during visits to these settings. For example, chronic kidney disease clients are seen regularly at their renal clinic and it is recommended that they receive all recommended vaccines, including hepatitis B vaccine. Taking an immunization history from those seen in emergency or admitted to hospital provides an important opportunity to maintain up-to-date immunization for all patients.

At each hospital admission, the vaccination record should be reviewed and, before discharge from the hospital, all patients should receive the vaccines for which they are eligible based on age, health status, or lifestyle risk factors. If vaccines are not available at the health care setting, the client should be referred to their regular immunization provider for immunization follow up.

Immunizations frequently indicated in the hospital setting include:

  • Routine immunization of infants in special care nurseries.
  • Routine immunization of long stay pediatric patients in pediatric units.
  • Td vaccine for individuals eligible for a booster dose of tetanus-diphtheria containing vaccine.
  • Influenza vaccine for all eligible individuals.
  • Pneumococcal vaccine for unvaccinated patients ≥ 65 years of age and those eligible for whom immunization is recommended.
  • MMR vaccine for post-partum women who are susceptible to rubella.
  • Varicella vaccine for post-partum women who are susceptible to varicella.

Residents of long term care facilities should receive all routine immunizations appropriate for their age and individual risk status. Annual influenza immunization is essential. All residents of intermediate or extended care facilities are eligible for pneumococcal immunization. Every resident should be assessed for prior pneumococcal immunization at time of admission. Those residents who have not received pneumococcal vaccine or who are eligible for a single booster dose should be immunized as soon as possible.

In both acute-care and long-term care settings, it is important that immunization planning be part of organized care plans within each department, with clear accountability for program planning, implementation, and evaluation.

(Adapted from the BC CDC Immunization Manual )

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