Manitoba Health

Recommended Immunization Schedules for Individuals NOT Previously Immunized

Updated February 2020

It is never too late to be immunized against vaccine preventable diseases. The following immunization schedules can be used for those who:

have never been immunized or do not have a record of immunization,
have been partially immunized and need to be caught up with vaccines that they may be missing

Those who meet the criteria within these schedules can receive the vaccines free-of-charge as part of Manitoba's Immunization Program. The schedules do not address all possible scenarios. Catch up schedules for partially immunized individuals must be created in accordance with the current Canadian Immunization Guide and the Vaccines Offered Free-of-Charge (Eligibility Criteria for Publicly-Funded Vaccines). Review of relevant product monographs is strongly recommended.

Children < 7 Years of Age NOT Immunized in Early infancy
Children ≥ 7 Years of Age and < 18 Years of Age NOT Immunized in Early Childhood
Adults ≥ 18 Years of Age NOT Immunized in Childhood

For a printer friendly version of Manitoba's Immunization Schedule for those Not Previously Immunized, click here.

Children less than 7 years of age NOT previously immunized as infants

Vaccine	1st visit	Time after 1st visit					6 - 12 mos. after last dose	4 - 6 years of age
Vaccine	1st visit	4 weeks	6 weeks	8 weeks	4 mos.	6 mos.	6 - 12 mos. after last dose	4 - 6 years of age
DTaP-IPV-Hib	♦			♦	♦		♦
Tdap-IPV								(♦)
Pneu-C-13	♦			(♦)	(♦)
Men-C-C	♦
Inf	♦	(♦)
MMR	♦	Generally at 4-6 years ♦
Var	(♦)	Generally at 4-6 years (♦)
OR
MMRV	(♦)	Generally at 4-6 years (♦)

() Brackets indicate that these doses may not be required

Diphtheria - tetanus - acellular pertussis- inactivated polio- Haemophilus influenzae type b (DTaP-IPV-Hib): Four doses required of a DTaP-IPV-containing vaccine. With no DTaP-IPV vaccine available in Canada, DTaP-IPV-Hib is to be used for all doses.

Tetanus - reduced diphtheria - reduced acellular pertussis- inactivated polio (Tdap-IPV): The dose at 4-6 years of age is not required if the fourth dose of DTaP-IPV-Hib vaccine was given after the fourth birthday.

Pneumococcal conjugate 13-valent (Pneu-C-13): 2-11 months of age at first visit – 3 doses. 12-23 months of age at first visit – 2 doses. 24-59 months of age (fifth birthday) at first visit – 1 dose. A minimum of 8 weeks is required between doses. Those with high risk medical conditions and/or who live in First Nations communities may require an additional dose. For those partially immunized please refer to the Canadian Immunization Guide for the appropriate number of doses required (https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-4-active-vaccines/page-16-pneumococcal-vaccine.html)

Meningococcal conjugate monovalent (Men-C-C): One dose at or after 12 months of age.

Measles, Mumps, Rubella (MMR): MMR can be used if not immunizing against varicella. Two doses are required at least 4 weeks apart. First dose given at or after 12 months of age and second dose generally given between 4-6 years of age.

Varicella (Var): If susceptible to varicella - 2 doses at least 3 months apart. First dose is given at or after 12 months of age and second dose generally given between 4-6 years of age. If rapid protection is required, a minimum interval of 4 weeks may be used. Susceptibility of varicella should be evaluated prior to vaccination (see below for susceptibility considerations).

Susceptibility and Immunity to Varicella
(www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-4-active-vaccines/page-24-varicella-chickenpox-vaccine.html)

Individuals who have ANY of the following are considered immune to varicella:

Documented evidence of immunization with 2 doses of a varicella-containing vaccine
Laboratory evidence of immunity

If varicella occurred after 2004, a self-reported history or health care provider diagnosis cannot be considered a reliable correlate of immunity because one-dose immunization programs had a marked impact on the prevalence of wild-type varicella. A self-reported history or diagnosis of varicella or herpes zoster by a health care provider is not considered to be acceptable evidence of immunity for:

immunocompromised individuals

Recipients of a hematopoietic stem cell transplant (HSCT) should be considered susceptible in the post-transplantation period, regardless of a pre-transplant history of vaccination, positive serologic results, or varicella or herpes zoster disease. For the purposes of post-exposure prophylaxis, an immunosuppressed person with a negative antibody test should be considered susceptible.

Measles, Mumps, Rubella and Varicella (MMRV): Susceptibility to varicella should be evaluated prior to vaccination (see above). If still susceptible to varicella - 2 doses at least 3 months apart. If rapid protection is required, a minimum interval of 4 weeks may be used. First dose given at or after 12 months of age and second dose generally given between 4-6 years of age.

Influenza (Inf): Recommended annually for children. Children 6 months to less than 9 years of age receiving Inf vaccine for the first time – 2 doses, at least 4 weeks apart.

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Children 7 to 17 Years of Age NOT Immunized in Early Childhood

Vaccine	1st visit	Time after first visit					6-12 mos. after last dose	10 years after last dose
Vaccine	1st visit	4 weeks	6 weeks	8 weeks	3 mos.	6 mos.	6-12 mos. after last dose	10 years after last dose
Tdap-IPV or Tdap	♦			♦			♦	♦
IPV	(♦)			(♦)			(♦)
Men-C-C	♦ 7-10 years old
Men-C-C or Men-C-ACYW-135	♦ 11-17 years old
HB	♦ 11-17 years old	(♦)				♦
HPV	♦ 11-17 years old			(♦)		♦
Inf	♦ (♦)
MMR	♦	♦
Var	(♦)				(♦)
OR
MMRV	(♦) 7-12 years old				(♦)

() Brackets indicate that these doses may not be required

Tetanus, Diphtheria, acellular pertussis and inactivated polio (Tdap-IPV) or Tetanus, diphtheria, and acellular pertussis (Tdap): If no previous history of tetanus-containing or polio-containing vaccines, the first three doses of the series should be with Tdap-IPV vaccine and the booster dose with Tdap provided in the grade 8 or 9 school immunization program (13-15 years of age). If the series is started after grade 8 or 9, the Tdap booster dose should be administered 10 years after the last Tdap-IPV dose. Tdap is also recommended for pregnant women in every pregnancy. Optimal timing is between 27 and 32 weeks gestation, although Tdap vaccine may be given at any time during pregnancy.

Inactivated Polio Vaccine (IPV): Only required if already received tetanus and pertussis-containing vaccine series resulting in the need for protection against polio only. Should receive two doses of IPV-containing vaccine, given 4 to 8 weeks apart, followed by a third dose administered 6 to 12 months after the second dose.

Meningococcal conjugate type c (Men-C-C): Those aged 7-10 years of age and not previously immunized against meningococcal type c: 1 dose; Meningococcal conjugate quadrivalent vaccine will also be offered as part of the grade 6 school immunization program. Those born between 1995 and 2007 who missed the grade 4 school program – 1 dose.

Meningococcal conjugate quadrivalent (Men-C-ACYW-135): Those born during or after January 2008, if not received as part of the grade 6 school immunization program: 1 dose. Those aged 7-10 years of age see Meningococcal conjugate type c.

Measles, Mumps, Rubella (MMR): MMR can be used if not immunizing against varicella (Note: MMRV is not authorized for use in those 13 years of age and older). Two doses are required at least 4 weeks apart.

Varicella (Var): Those 7-12 years of age – 2 doses at least 3 months apart if they have not had any previous varicella immunization and are still susceptible. If rapid protection is required, a minimum interval of 4 weeks between doses may be used. Those aged 13-17 years – 2 doses at 6 weeks apart. If rapid protection is required, a minimum interval of 4 weeks may be used. Susceptibility to varicella should be evaluated prior to vaccination (see below for susceptibility considerations).

Documented evidence of immunization with 2 doses of a varicella-containing vaccine
Laboratory evidence of immunity

healthy pregnant women with significant exposure to varicella
immunocompromised individuals, and

Measles, Mumps, Rubella and Varicella (MMRV): Those 7-12 years of age – 2 doses, at least 3 months apart. If 13-17 years of age, separate MMR and V vaccines are to be used as MMRV is only authorized for use in those under 13 years of age. Susceptibility to varicella should be evaluated prior to vaccination (see above for susceptibility considerations). If rapid protection is required, a minimum interval of 4 weeks between doses may be used.

Hepatitis B (HB): Those 11-17 years of age – 2 or 3 doses depending on age at immunization and product used. Those 11 to 16 years of age – 2 doses of Recombivax HB® 1.0mL at 0, 4-6 months OR Engerix®-B 1.0mL at 0, 6 months. Those 16 to less than 19 years of age – 3 doses of Recombivax HB® 0.5ml OR Engerix®-B 0.5ml at 0, 1, 6 months.

Refer to Table 3: Recommended Dosages and Schedules for Hepatitis B-Containing Vaccines of the Canadian Immunization Guide for product-specific recommendations by age/medical condition.

Human papillomavirus (HPV): Those 11-14 years of age: preferred 2-dose schedule - months 0 and 6 (first visit = month 0). Individuals 15 years of age and older, immunocompromised individuals, and those at increased risk: 3 doses (months 0, 2 and 6). Please see Eligibility Criteria for Publicly funded Vaccines for the listing of high-risk criteria.

Influenza (Inf): recommended annually for all children. Children 6 months to less than 9 years of age receiving Inf vaccine for the first time – 2 doses, at least 4 weeks apart. Children 9 years of age and older – 1 dose (regardless of previous influenza immunization history).

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Adults 18 years of age and older, NOT previously immunized

Vaccine	1st visit	Time after 1st visit				6-12 mos. after last dose	Every 10 years after last dose
Vaccine	1st visit	4 weeks	6 weeks	8 weeks	6 mos.	6-12 mos. after last dose	Every 10 years after last dose
Tdap	♦
Td				♦ (after Tdap dose)		♦	♦
HB	♦	♦			♦
MMR	♦	(♦)
Var	(♦)	(♦)
Pneu-P-23	♦
Men-C-C	♦
HPV	♦			♦	♦
Inf	♦

() Brackets indicate that these doses may not be required

Tetanus, Diphtheria and acellular pertussis (Tdap): If no previous history of any tetanus-containing vaccines, first dose of tetanus vaccine series should be completed with Tdap vaccine, followed by two doses of Td vaccine. If previous history of tetanus vaccines is available but no pertussis-containing vaccine in adulthood, Tdap can be given when the 10 year tetanus booster is due, if known. There is no minimum interval between Td and Tdap. Tdap is also recommended for pregnant women in every pregnancy. Optimal timing is between 27 and 32 weeks gestation, although Tdap vaccine may be given at any time during pregnancy.

Tetanus and Diphtheria (Td): If no previous history of any tetanus-containing vaccines, first dose of tetanus vaccine series should be Tdap. Two additional doses of tetanus-containing vaccine (Td) are required (2 months after Tdap and then 6-12 months after the last dose). A dose is then given every 10 years after the primary series (3 doses of tetanus-containing products) is completed.

Hepatitis B (HB): Those born on or after January 1, 1989 who missed the school immunization program: 3-dose schedule – months 0, 1 and 6 (first visit = month 0) with at least 4 weeks between the first and second doses, 2 months between the second and third doses, and 4 months between the first and third doses.

Refer to Table 3: Recommended Dosages and Schedules for Hepatitis B-Containing Vaccines of the Canadian Immunization Guide for product-specific recommendations by age/medical condition.

Measles, Mumps, Rubella (MMR): Individuals born during or after 1985 - 2 doses, at least 4 weeks apart. Adults born between 1970 and 1984 – 1 dose. Exceptions: non-immune health care workers and students – 2 doses, at least 4 weeks apart. Adults born before 1970 can be assumed to have acquired natural immunity to measles and mumps and do not need MMR vaccination. Exceptions: non-immune health care workers - 2 doses, at least 4 weeks apart; non-immune students – 1 dose. Rubella-susceptible adults, regardless of age – 1 dose.

Susceptibility and Immunity to Rubella

Individuals who have one or more of the following are considered immune to rubella. Individuals who do not have ANY of the following are considered susceptible to rubella:

Documented evidence of immunization with a rubella-containing vaccine on or after the first birthday
A history of laboratory confirmed rubella infection
Laboratory evidence of immunity

Varicella (Var): Those born between January 1, 1995 and December 31, 2007 who have not had any previous varicella immunization and are susceptible – 2 doses at least 4 weeks apart. Susceptibility to varicella should be evaluated prior to vaccination.

Susceptibility and Immunity of Varicella
(www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-4-active-vaccines/page-24-varicella-chickenpox-vaccine.html)

Individuals who have ANY of the following are considered immune to varicella:

Documented evidence of immunization with 2 doses of a varicella-containing vaccine
Laboratory evidence of immunity

If varicella occurred before 2004, a self-reported history or health care provider diagnosis is considered a reliable correlate of immunity for healthy individuals, including pregnant women without significant exposure to varicella, and health care workers (HCW) who are currently or have previously been employed in a Canadian health care setting. In general, healthy adults 50 years of age and older, are presumed to be immune to varicella, even if the person does not remember having had chickenpox or herpes zoster.

healthy pregnant women with significant exposure to varicella
immunocompromised individuals, and
HCW who are newly hired into the Canadian health care system.

Recipients of a hematopoietic stem cell transplant (HSCT) should be considered susceptible in the post-transplantation period, regardless of a pre-transplant history of vaccination, positive serologic results or varicella or herpes zoster disease. For the purposes of post-exposure prophylaxis, an immunosuppressed person with a negative antibody test should be considered susceptible.

Pneumococcal polysaccharide 23-valent (Pneu-P-23): Adults 65 years of age and older, adults with high risk medical conditions, residents of long term care facilities, homeless, and illicit drug users – 1 dose. A booster dose after 5 years may be required for those at highest risk. Please see Eligibility Criteria for Publicly-funded Vaccines for the listing of high risk medical conditions and eligibility for a booster dose.

Meningococcal conjugate monovalent (Men-C-C): Adults born between 1995 and 2007 who missed the grade 4 school immunization program – 1 dose.

Human papillomavirus (HPV): Females born on or after January 1, 1997 and males born on or after January 1, 2002 - 3-doses - months 0, 2 and 6 (first visit = month 0).

Influenza (Inf): Recommended for all adults– 1 dose annually.

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