Frequently Asked Questions: Manitoba’s School Immunization Program - For Parents
As part of Manitoba’s Recommended Routine Immunization Schedule, immunizations are offered during the school year in certain grades. Immunization is one of the most effective ways to protect your children, your community and yourself from vaccine-preventable diseases. Below are some of the frequently asked questions from parents seeking information about the program.
- What vaccines will my child be getting as part of the school immunization program and when are they offered?
- How many needles will my child be getting?
- Who gives the immunizations (needles) to the children?
- How do vaccines work?
- Will my child get sick after or have any serious reactions?
- What happens after my child gets immunized at school? Are they monitored?
- Is it safe to have more than one vaccine at one time?
- Why are two or more doses needed for some vaccines and not others?
- Which vaccines are important to get?
- What if my child misses the school immunization program? Can they still get the immunizations?
- What if I have missed a dose of vaccine? Do we need to start over?
- How is it decided which age and grade gets the vaccines? Why one grade and not the other?
- What ingredients, additives and preservatives are in vaccines and why are they used?
- Is consent required for my child(ren) to be immunized?
- If my child has had the Twinrix vaccine, do they still need to get the Hepatitis B vaccine?
- How long does the Hepatitis B vaccine last?
- My child recently had her/his tetanus vaccine (Td) because of an injury, should s/he still get the Tdap vaccine that is being offered in school that also has tetanus in it?
- What if my child’s doctor wants to immunize my child on a different schedule than what is being offered in the school immunization program?
- Why do the recommendations on what vaccines to get change so often?
- What is human papilloma virus?
- How long do bacteria and viruses that cause disease survive when exposed to air or rest on a surface?
- Does HPV vaccine have more side effects than other vaccines?
- What are some reliable resources of vaccine information?
What vaccines will my child be getting as part of the school immunization program and when are they offered?
Manitoba’s School Immunization Program is offered to students in grade 6, and again in grade 8 or 9.
The immunizations offered as part of Manitoba’s Immunization Schedule include:
Grade 6:
- Human Papilloma Virus (HPV) vaccine – two doses
- Hepatitis B Vaccine – two doses
- Meningococcal conjugate quadrivalent (Men-C-ACYW-135) vaccine – one dose
Grade 8 or 9:
- Tetanus, diphtheria and pertussis (Tdap) vaccine (or Tetanus, diphtheria, pertussis and polio (Tdap-IPV) vaccine, if needed) – one dose
When a vaccine requires more than one dose (e.g. HPV vaccine), those doses are given over a period of time. The first dose is typically given in the fall and the second dose is provided the following spring. The time between doses is based on recommendations approved by Health Canada and national and international immunization experts.
For the grade 8 or 9 program, each regional health authority manages the operations of the immunization program and depending on the school structures within the health region, they identify which grade is most appropriate to conduct the program. Many of the health regions have moved to offering the immunizations in grade 8 instead of grade 9.
Fact sheets on the school immunization program and the vaccines that are offered can be found on the School Immunization Program website.
How many needles will my child be getting?
Based on Manitoba’s recommended routine immunization schedule, multiple vaccines may be given at one time.
Grade 6:
- 1st visit in the fall includes – total 3 needles
- Human Papilloma Virus (HPV) vaccine – 1 needle
- Hepatitis B Vaccine – 1 needle
- Meningococcal conjugate quadrivalent (Men-C-ACYW-135) vaccine – 1 needle
- 2nd visit in the spring includes – total 2 needles
- Human Papilloma Virus (HPV) vaccine – 1 needle
- Hepatitis B Vaccine – 1 needle
When a vaccine requires more than one dose (e.g. HPV vaccine), those doses are given over a period of time. The first dose is typically given in the fall and the second dose is provided the following spring. The time between doses is based on recommendations approved by Health Canada and national and international immunization experts. If a dose is missed in the fall, it may be offered at a catch-up clinic or at the second visit in the spring, depending on regional program plans.
Grade 8 or 9:
- Only one visit is typically required unless additional immunizations are being offered to those who have missed some vaccines:
- Tetanus, diphtheria and pertussis (Tdap) vaccine (or Tetanus, diphtheria, pertussis and polio (Tdap-IPV) vaccine, if needed) – 1 needle
Who gives the immunizations (needles) to the children?
Generally speaking, Manitoba’s regional health authorities are responsible for running the school immunization program and their nursing staff provide the immunizations. All of the nursing staff are trained and certified to administer vaccines.
How do vaccines work?
Vaccines protect you from disease by introducing a part of a bacterium or weakened virus into your body to trigger an immune response, as if you had been exposed to the disease naturally.
Vaccines trick your body into thinking it is being attacked by the actual disease, so it produces antibodies to protect you. The virus or bacteria in a vaccine won’t make you sick. Instead, the vaccine prepares your body with a defense (the antibodies) that protects against the disease and the potential complications that can be caused by that disease.
After being immunized, will my child get sick after or have any serious reactions?
After being immunized your child may have little to no reaction. As with any other drug, there is the potential for side effects after being immunized. These side effects vary with each person and each vaccine. It is much safer to get the vaccine than to get the diseases that it protects against.
The most common reactions in children are some arm pain/soreness and redness at the injection site. Having your child move his/her arm often can help reduce the pain. Children may also have a mild fever or upset stomach, which can be treated with acetaminophen (e.g., Tylenol). Serious reactions rarely occur.
Getting a vaccine helps the body learn what to do if and when it is exposed to that disease or infection. When a body is exposed to a bacteria or a virus, its reaction can be to have a mild fever, muscle aches and pain, or upset stomach to start to fight against the “intruder”. When these reactions occur after being immunized, it is the body creating the appropriate response. This is a good thing. The body is doing what it needs to do to be prepared. Typically, any fever or feelings of being unwell are mild enough that it should not require them to miss school, or can be managed with the use of acetaminophen (e.g. Tylenol).
For more information on potential side effects after immunization, visit the vaccine specific fact-sheets: www.manitoba.ca/health/publichealth/cdc/div/vaccines.html
On rare occasions, serious reactions may occur and these are referred to as Adverse Events Following Immunization (AEFI). An AEFI is defined as an unexpected reaction to an immunization. If you are concerned about a reaction that your child may be having to an immunization, please consult your health care provider or local public health nurse to discuss. There are provincial and national systems in place to monitors these serious side effects (www.manitoba.ca/health/publichealth/cdc/div/aefi.html).
To find out more information about Canada’s system to track vaccine safety check out www.caringforkids.cps.ca/handouts/vaccine_safety.
What happens after my child gets immunized at school? Are they monitored?
Anyone who receives a vaccine must remain in the area with health care providers to be monitored for 15 minutes. This ensures that trained staff are on hand with appropriate medications, in the event of an allergic reaction that requires immediate attention.
Is it safe to have more than one vaccine at one time?
Yes, having more than one vaccine at one time is safe.
Every day, our bodies come into contact with millions of germs, causing our immune systems to work continuously to protect us. Therefore, when we are exposed to the particles of weak or dead viruses or bacteria that are contained in vaccines, it is easily handled by our immune systems.
Why are two or more doses needed for some vaccines and not others?
As the characteristics of each bacterium and virus are unique, the number of doses required to ensure the body creates the best immune response may vary. Some vaccines need two or three doses before they can offer full protection.
Your body produces antibodies in the blood when exposed to natural infection and vaccination. Antibodies prepare the body to fight. Over time, the level of antibodies in the body may decline over time but your body remembers the exposure and stores it into memory. Most vaccines produce a memory that lasts a very long time, if not for life.
Which immunizations are important to get?
All immunizations that are part of Manitoba’s Recommended Routine Immunization Schedule, including the immunizations offered as part of the School Immunization Program, are important.
The routine childhood immunization schedule is based on scientific evidence recommended by national vaccine experts. This includes the National Advisory Committee on Immunization and is supported by Manitoba’s Provincial Vaccine Advisory Committee.
The recommended schedule is designed to protect children before they are exposed to vaccine-preventable diseases. The earliest and safest time for your child’s routine immunizations to begin is at the age of two months. Some vaccines need two or three doses before they can offer full protection, so it is important to begin early to provide the best protection.
Delaying vaccines is not recommended and can be risky to your child’s health. Vaccines work best when they are given on time, including all recommended doses.
For example, meningitis disease is most common in infants, children 15-19 years of age and those 60 years of age and older. As a result, Manitoba offers immunization against meningitis at 12 months of age and again in Grade 6 (11-12 years of age) in order to best protect them before they are most vulnerable.
What if my child misses the school immunization program? Can they still get the immunizations?
Yes. If your child misses an immunization, Manitoba has a Once Eligible, Always Eligible policy allowing them to be immunized at a later time. You can also connect with your primary health care provider or public health office to set up an appointment to get the immunization that was missed.
Getting immunized at the scheduled times offers the best protection. If your child misses a dose, it is still important that they get immunized.
If my child missed a dose of vaccine, does my child need to start over?
No, not usually. But every vaccine is different, so it is best to speak with a health care provider to determine whether re-starting a series is required.
It is important to follow the dosing schedule set out by Manitoba’s Immunization Schedule and to have the right time between doses to ensure optimal disease protection.
How is it decided which age and grade gets the vaccines? Why one grade and not the other?
The recommended schedule is designed to protect children before they are exposed to vaccine-preventable diseases. Many factors go into determining when immunizations are offered. The School Immunization Program is based on the optimal time for a person to be best protected, and this can be disease specific.
Scientific evidence is analyzed regularly to review the safety, effectiveness and cost of all immunization programs or new immunizations that may be available. Those factors, along with competing provincial priorities, can affect eligibility of vaccines for one population or age group over another.
What ingredients, additives, and preservatives are in vaccines and why are they used?
The ingredients found in vaccines all have an important role to play in making sure the vaccine remains effective and safe. The ingredients within vaccines have small quantities, are found naturally in foods we eat, and/or occur naturally in the environment around us.
The main ingredients of a vaccine are dead or weakened viruses or bacteria.
Vaccines may also contain:
- Adjuvants: a substance that helps boost the body’s immune system to respond better to vaccines
- Additives and preservatives: to help maintain the quality and effectiveness of the vaccine
Additives and preservatives are added to vaccines to maintain the vaccine’s quality and effectiveness.
Below are examples of some of the ingredients that may be found in vaccines and why they are added.
Additives: help vaccines stay effective during storage.
- Example: Gelatin
Some vaccines contain gelatin to protect them against freeze-drying or heat. Gelatin is also used as a stabilizer in live vaccines. However, the use of gelatin in vaccines as an additive has been reduced, even though the incidence of allergic reactions is currently very low.
Preservatives: help keep multi-dose vaccine vials from getting contaminated with germs that could cause infections.
- Example: Thimerosal
Thimerosal is a preservative used only in multi-dose vials of vaccines, and not in single-dose vials or syringes. It contains mercury that is converted into ethylmercury in the body, which is then removed. It does not build up in the body or cause health concerns. Nevertheless, since March 2001, no vaccine in Canada used as part of the routine schedule in children contains thimerosal, with the exception of some influenza vaccines. DTaP, polio and Hib vaccines have not contained this preservative since 1997-98. The MMR vaccine used in Canada has never contained thimerosal.
Adjuvants: help the body create a better immune response to a vaccine. Without adjuvants such as aluminum salts and squalene added to vaccines, people would need more frequent doses of vaccines to be protected against viruses and bacteria.
- Example: Aluminum salts
Aluminum salts (aluminum hydroxide, aluminum phosphate, or potassium aluminum sulfate) are used to enhance and strengthen the immune system’s response. Aluminum is naturally present in our environment, including in the air, food, earth, and water, and presents little risk to people. The safety of aluminum salts has been established over the past 70 years, with millions of people being vaccinated with aluminum-containing vaccines.
- Example: Squalene
Squalene is a naturally occurring substance often found in plants, animals and humans, as well as foods and cosmetics. It is a compound produced by the liver and circulates freely throughout the bloodstream. Squalene has been added as an adjuvant to some seasonal influenza vaccines in Canada to increase the immune response and improve their efficacy for certain age groups.
Vaccine residuals are substances that are added as part of the production process to make the vaccine, but are removed from the final product.
- Example: Formaldehyde
Formaldehyde is sometimes used in the manufacturing process of vaccines to inactivate viruses and toxins. However, it is mostly removed during the purification process. Formaldehyde occurs naturally in the human body and helps with metabolism. There is approximately ten times the amount of formaldehyde in a baby’s body at any time than there is in one dose of a vaccine. Formaldehyde is also found naturally in many foods including fruits, vegetables, and meats.
Is consent required for my child to be immunized?
Yes. Consent is required from a parent or legal guardian of a child before immunization. At the beginning of each school year, the regional health authority creates information packages that are sent home to the families of children who will be part of the school immunization program. These packages typically include a letter to the parents or guardians, a consent form for them to review, sign, and return to the school, and fact sheets on the immunizations being offered.
If any consent forms are not completed or returned to the school, public health nurses will contact the parents or legal guardians to seek verbal consent.
Age of Consent:
- Children 16 years and younger can get an immunization without their parents consent if the health care provider determines that the child is competent to make the decision on their own with all the information provided to them.
- Children 16 years of age and older can get an immunization without a parent’s consent unless a health care provider determines that the child is not competent to make their own decisions.
Does my child still need the Hepatitis B vaccines being offered if my child has had the Twinrix vaccine?
Manitoba’s school immunization program offers hepatitis B vaccine. However, if a child completes the full series of Twinrix vaccines before the school immunization program for travel purposes, then the hepatitis B vaccine offered at school may not be required. If all the required doses of Twinrix are received, a person should have long-term protection against both hepatitis A and hepatitis B infections.
If you receive a consent form for Hepatitis B vaccine for the school immunization program and your child has received the Twinrix vaccine, contact your public health office to advise them of the dates when the Twinrix doses were administered and the provider who administered them. The public health nurse will review Manitoba’s Immunization Registry to ensure the doses are on your child’s immunization record. If the doses are not on his/her record, the doses will be added or additional information may be requested.
How long does the Hepatitis B vaccine last?
Based on current evidence, once a full Hepatitis B immunization series is completed, a person may be considered protected for life. However, each person is different and the length of protection can be affected by certain medical conditions or exposure risks. Speak with your health care provider to determine whether booster doses are required.
My child recently had her/his tetanus vaccine (Td) because of an injury, should s/he still get the Tdap vaccine that is being offered in school that also has tetanus in it?
Yes. Even if a recent dose of Td vaccine was provided for an injury, it is recommended to still get the Tdap vaccine. The Td vaccine protects against tetanus and diphtheria, while Tdap vaccine also protects against pertussis (whooping cough). It is extremely important to be protected against whooping cough and it is safe to have the two doses as there is no minimum timeframe required between doses.
Many hospitals offer the Tdap vaccine in the event of an injury so if Tdap vaccine was already provided recently then an additional dose is not required.
Please speak with your local public health office if you have any questions or concerns.
What if my child’s doctor wants to immunize my child on a different schedule than what is being offered in the school immunization program?
We recommend following Manitoba’s Recommended Routine Immunization Schedule as it is based on scientific evidence and follows national recommendations. The immunization schedule in Manitoba is based on the optimal timing to be immunized in order to prevent disease, and conducting it within the school immunization program is cost-effective and ensures all children have access to immunizations.
However, there may be specific reasons for a health care provider to modify an immunization schedule, such as a child’s medical conditions. It is important to have discussions with your health care provider to understand why they have chosen to modify the schedule for your child.
Why do the recommendations on what vaccines to get change so often?
Immunization is an area of science that is constantly undergoing research and where new products are developed or improved. New evidence and improvements in immunization technology can result in changes to immunization programs. All changes that Manitoba makes to the immunization program are based on evidence, approved by Health Canada and reviewed by vaccine expert committees, such as the National Advisory Committee on Immunization.
Canadian networks watch for changes in how often many infectious diseases are occurring within Canada and throughout the world. If diseases begin to occur even with a particular immunization program in place, the network responds by adjusting the immunization programs appropriately.
- An example of this is the chicken pox (varicella) immunization. When the chicken pox vaccine was first released, only one dose was recommended. The number of cases and hospitalizations fell dramatically. Over several years of monitoring, chicken pox began to appear in those who had been immunized. After analysis of this issue, it was determined that a second dose, a booster, was required to provide better protection against chicken pox. In 2014, Manitoba added the second dose to the chicken pox (varicella) immunization program.
- Another example is the HPV vaccine. As part of the clinical trial process, three doses were recommended to provide the best protection against HPV related infections. After release of the vaccine and 3-dose programs began, studies continued to occur to determine whether two doses would provide similar protection as three doses and how long that protection would last. After review by Health Canada and the other regulators in countries throughout the world, the product was approved for a 2-dose schedule in healthy populations. In 2015, Manitoba changed to a 2-dose program for the school immunization program once the evidence was sufficient to allow for a change in the program.
A real world example of program changes is the historical use of seat belts. Many years ago there was no law requiring the use of seat belts. After analysis of the evidence, number of deaths, and best practice evidence it was identified that in order to best protect people in motorized vehicles, seat belts were required. This change occurred over time and evolved to what is in place today where everyone is required to be in a seat belt and babies and toddlers must be in certified child and booster seats based on their age and size as per Manitoba Public Insurance and Government of Manitoba (www.gov.mb.ca/health/hep/injury/booster.html).
What is human papilloma virus?
Human papilloma virus, also known as HPV, is a common virus with over 150 subtypes, each designated by its own number. It is transmitted by skin to skin contact with someone who is infected with HPV. Often, transmission is through sexual contact but other means of contact can result in transmission.
There are high-risk and low-risk types of this virus, and HPV can cause a number of infections. According to CancerCare Manitoba, over 80 per cent of Canadians will have at least one HPV infection in their lifetime.1
Most HPV infections (nine out of ten) go away by themselves within two years. However, HPV infections sometimes last longer, and later in life can lead to cancers in both men and women.
The HPV vaccine protects against many of the high-risk types of HPV infection. You can protect your child from ever developing these infections or cancers by ensuring they get the HPV vaccine as early as possible.
If an HPV vaccine is received before exposure, it is almost 100 per cent effective in preventing infection. HPV vaccine is recommended at ages 11 to 12 to ensure children are protected before they are potentially exposed to the virus.
1CancerCare Manitoba: Human Papilloma Virus (HPV) & the Vaccine: www.cancercare.mb.ca/screening/cervix. Accessed May 24, 2019
How long do bacteria and viruses that cause disease survive when exposed to air, or when they rest on a surface?
All bacteria and viruses are different, and survive for different lengths of time when exposed to air or surfaces. In addition, not all viruses and bacteria transmit disease through the air or live on surfaces.
The best way to avoid contracting a virus or bacteria is to be immunized when a vaccine is available.
Does HPV vaccine have more side effects than other vaccines?
No. The HPV vaccine is very safe for males and females, as are all vaccines. The most common side effect is pain or discomfort at the site of the injection. Millions of doses have been given all over the world and extensive research and surveillance has shown that HPV vaccine does not increase the risk for any serious condition.
What are some reliable resources of vaccine information?
It can be difficult to know where to locate reliable information on questions you may have on immunization. It is always best to speak to your health care provider or local public health nurse about any questions you may have about immunizations.
Health care providers are dependable sources of information. They have access to the most current health and vaccine information and they are there to serve the best interests of your family.
There are also reliable online sources of information on vaccines and immunization, including:
- Government of Manitoba: www.gov.mb.ca/health/publichealth/cdc/div/index.html
- Immunize Canada: www.immunize.ca/
- 411 Vaccines: https://vaccines411.ca/en/
- Government of Canada: www.canada.ca/en/public-health/topics/immunization-vaccines.html
- Caring for Kids-Canadian Pediatric Society: www.caringforkids.cps.ca/
Unfortunately, there is also a lot of misinformation online. The Canadian Pediatric Society has developed a list of questions that can help you rule out websites that are sources of misinformation. For more information, visit:
www.caringforkids.cps.ca/handouts/health_information_on_the_internet
Visiting a website or getting information online should never replace a visit with a health care provider.
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