Routine Childhood Immunizations

For children and youth there are nine diseases (diphtheria, tetanus, polio, pertussis, meningococcal disease, measles, mumps, rubella, and varicella) for which vaccination coverage is required to attend school in Ontario under the Immunization of School Pupils Act (ISPA). ISPA-required immunizations are publicly-funded and primarily given by community health care providers except for ones given by public health as part of the school-based immunization program.

Under ISPA, routine childhood immunizations administered by community providers are to be reported to public health by families. OPH sends notice letters to parents and caregivers of children missing one or more ISPA vaccines according to their immunization records, on an annual basis. These notices inform parents and caregivers which vaccines are missing on their child's record, remind them to get their child immunized, and to report the immunizations to OPH.

Children aged 7, 12, 13, and 17 are assessed by Public Health Ontario (PHO) for up-to-date immunization coverage, which is estimated as the percent who have received the recommended number of doses of a vaccine or have evidence of immunity at a given point in time (Table 1, Table 2Table 3) [1-5]. Many children who are not up-to-date have received some, but not all, recommended doses in a vaccine series. The National Immunization Strategy's immunization coverage goals, updated in 2017, set coverage targets based on international standards and best practices [8]. Note that coverage estimates are limited to vaccinations reported to public health.

  • In the 2022-23 school year, the immunization coverage rate among 7-year-old students in Ottawa was approaching the national goal of 95% coverage for rubella and Meningococcal C conjugate (MCC) and it was below the national goal for other diseases (Table 1). [5]
  • In the 2022-23 school year, the immunization coverage rate among 17-year-old students in Ottawa reached the national goal of 95% coverage for rubella, was approaching the goal for measles, mumps and polio, and was below the goal for diphtheria, tetanus and pertussis (Table 2). [5]
  • The COVID-19 pandemic resulted in declines in immunization coverage between 2019-20 and 2021-22 in Ottawa. From 2021-22 to 2022-23, increases in coverage were observed for all childhood vaccines, with the exception of rubella, Hib and MCC (Table 1, Table 2, Table 3). [1-5]

Vaccine  2016-17  2017-18† 2018-19 2019-20‡ 2020-21‡ 2021-22‡ 2022-23 National Goal
Measles  94.5 89.3 86.7 87.1 66.3 61.4 80.3 95
Mumps  94.4 89.2 86.6 87.0 66.1 61.2 80.0 95
Rubella 98.4  98.5 98.7 98.3 96.7 93.5 92.8 95
Diphtheria 87.3 87.6 85.5 86.4 65.7 61.1 79.4 95
Tetanus 87.3 87.6 85.5 86.4 65.7 61.1 79.3 95
Polio 87.8   88.2 85.9 86.7 65.7 61.5 79.9 95
Pertussis 87.3 87.5 85.4 86.3 65.6 61.0 79.3 95
Haemophilus influenzae type b (Hib)* 84.3 84.8 86.3 88.4 86.9 84.5 83.7 95
Pneumococcal* 83.7 76.2 80.4 81.0 80.4 79.5  80.0 95
Meningococcal C conjugate (MCC) 96.9 97.4 97.5 97.3 95.5 91.8 90.9 95
Varicella† 57.9 85.6 83.3 85.2 61.2 57.8 78.3 -

Data Notes and Sources for Table 1 

Notes:

  • Coverage estimates are limited to vaccinations reported to public health.

*     Not an ISPA-designated disease. Coverage may be underestimated. 

†     Added as an ISPA-designated disease in 2014, applicable to children born in 2010 or later.

†     First school year where children 7 years of age under assessment were vaccinated for MMR according to the new routine two-dose varicella schedule (second MMR dose given with varicella at ages 4-6 years). Thus, immunization coverage estimates for measles and mumps are not directly comparable with previous school years 

‡     Coverage estimates reflect catch-up activities occurring after the end of the 2019-20 to 2021-22 school years, including immunizations administered and entered into the DHIR by August 31, 2023.

Sources:

  • Ontario Agency for Health Protection and Promotion (Public Health Ontario). Immunization coverage report for school pupils: 2013-14, 2014-15 and 2015-16 school years. Toronto, ON: Queen’s Printer for Ontario; 2017. 
  • Ontario Agency for Health Protection and Promotion (Public Health Ontario). Immunization coverage report for school pupils in Ontario: 2016-17 school year. Toronto, ON: Queen’s Printer for Ontario; 2018. 
  • Ontario Agency for Health Protection and Promotion (Public Health Ontario). Immunization coverage report for school pupils in Ontario: 2017–18 school year. Toronto, ON: Queen’s Printer for Ontario; 2019. 
  • Ontario Agency for Health Protection and Promotion (Public Health Ontario). Immunization coverage report for school pupils in Ontario: 2018–19 school year. Toronto, ON: Queen’s Printer for Ontario; 2020.
  • Ontario Agency for Health Protection and Promotion (Public Health Ontario). Immunization coverage report for school pupils in Ontario: 2019-20 to 2022-23 school years. Toronto, ON: King's Printer for Ontario; 2024. 
  • Ontario Agency for Health Protection and Promotion (Public Health Ontario). Technical appendix: immunization coverage report for school pupils in Ontario: 2019-20 to 2022-23 school years. Toronto, ON: King's Printer for Ontario; 2024. 

Vaccine  2016-17 2017-18 2018-19 2019-20‡ 2020-21‡ 2021-22‡ 2022-23 National Goal
Measles  97.2 97.3 97.3  96.7 96.3 94.8 92.9 95
Mumps 97 97.0 97.2  96.5 96.2 94.6 92.7 95
Rubella 98.5 98.6 98.5  98.3 97.9 96.4 95.0 95
Diphtheria 77.5 77.2 76.1  84.1 80.6 66.2 68.4 90
Tetanus 77.5 77.2 76.1  84.1 80.6 66.2 68.4 90
Polio  94.8 94.9 95.0  94.1 94.0 92.1 90.7 95
Pertussis 71.8 71.0 72.4 84.6 81.3 66.6 68.5 90

Data Notes and Sources for Table 2

  •  Coverage estimates are limited to vaccinations reported to public health. 

‡   Coverage estimates reflect catch-up activities occurring after the end of the 2019-20 to 2021-22 school years, including immunizations administered and entered into the DHIR by August 31, 2023. 

Sources:

  • Ontario Agency for Health Protection and Promotion (Public Health Ontario). Immunization coverage report for school pupils: 2013-14, 2014-15 and 2015-16 school years. Toronto, ON: Queen’s Printer for Ontario; 2017. 
  • Ontario Agency for Health Protection and Promotion (Public Health Ontario). Immunization coverage report for school pupils in Ontario: 2016-17 school year. Toronto, ON: Queen’s Printer for Ontario; 2018. 
  • Ontario Agency for Health Protection and Promotion (Public Health Ontario). Immunization coverage report for school pupils in Ontario: 2017–18 school year. Toronto, ON: Queen’s Printer for Ontario; 2019. 
  • Ontario Agency for Health Protection and Promotion (Public Health Ontario). Technical appendix: immunization coverage report for school pupils in Ontario: 2019-20 to 2022-23 school years. Toronto, ON: King's Printer for Ontario; 2024.

There are three vaccines which are part of Ontario’s publicly funded school-based immunization program, typically delivered by public health to grade 7 students (~12-year-olds): hepatitis B, human papilloma virus (HPV), and quadrivalent meningococcal conjugate C (MCV4). Only MCV4 is required under ISPA.

  • In the 2022-23 school year, the immunization coverage rate for school-based vaccines in Ottawa was approaching the 90% national goal for MCV4 and was below the goal for hepatitis B and HPV (Table 3). [5

Vaccine  2016-17 2017-18  2018-19 2019-20‡  2020-21‡  2021-22‡  2022-23  National Goal 
Hepatitis B 74.3 73.2 75.0 54.3 68.1 77.4 67.6 90
MCV4 86 86.4 88.0 90.1 81.4 87.7 83.4 90
HPV (girls 13 years of age) 65 - - - - - - 90
HPV (12 years of age)* 59.9 62.7 66.7 39.8 59.3 70.3 57.8 90

 Data Notes and Sources for Table 3

Notes:

  • In the 2016-17 school year, the HPV immunization program expanded to include boys as well as girls and was delivered in grade 7 instead of grade 8. 

     Coverage estimates reflect catch-up activities occurring after the end of the 2019-20 to 2021-22 school years, including immunizations administered and entered into the DHIR by August 31, 2023. 

Sources:

  • Ontario Agency for Health Protection and Promotion (Public Health Ontario). Immunization coverage report for school pupils: 2013-14, 2014-15 and 2015-16 school years. Toronto, ON: Queen’s Printer for Ontario; 2017. 
  • Ontario Agency for Health Protection and Promotion (Public Health Ontario). Immunization coverage report for school pupils in Ontario: 2016-17 school year. Toronto, ON: Queen’s Printer for Ontario; 2018. 
  • Ontario Agency for Health Protection and Promotion (Public Health Ontario). Immunization coverage report for school pupils in Ontario: 2017–18 school year. Toronto, ON: Queen’s Printer for Ontario; 2019. 
  • Ontario Agency for Health Protection and Promotion (Public Health Ontario). Immunization coverage report for school pupils in Ontario: 2018–19 school year. Toronto, ON: Queen’s Printer for Ontario; 2020.
  • Ontario Agency for Health Protection and Promotion (Public Health Ontario). Technical appendix: immunization coverage report for school pupils in Ontario: 2019-20 to 2022-23 school years. Toronto, ON: King's Printer for Ontario; 2024. 

Exemptions for one or more ISPA-designated diseases can be issued on medical or non-medical grounds. A medical exemption can be granted in the case where a child has documented immunity or has a medical contraindication (e.g., immunosuppression, Guillain-Barré syndrome). Non-medical exemptions can be issued on religious or philosophical grounds.  

  • In Ottawa in school year 2023-24, less than 2% of 7- and 17-year-old students had a medical or philosophical exemption according to their immunization record. [12] 

  • In Ottawa, the COVID-19 pandemic substantially disrupted access to routine childhood and school-based immunizations. The closure of primary care offices and schools, the shift to virtual care, stay-at-home orders, early retirement of health care providers, and the diversion of public health resources to COVID-19 activities all impacted vaccination rates. [7]
  • The estimated total number of doses of routine immunizations missed between 2020 and 2022 among children and youth in Ottawa was over 40,000. Of these, approximately 15,000 were missed doses of vaccines which protect against measles. [7]
  • In addition, the COVID-19 pandemic also impacted reporting of immunizations to public health. Between March 2020 until school year 2022-23, OPH’s ISPA surveillance activities (e.g., notice letters) to remind families to report their child(ren)’s immunizations were paused. As a result, many children have incomplete immunization records which limits the accuracy of coverage estimates[7] 

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