Interim guidance on continuity of immunization programs during the COVID-19 pandemic

As a public health emergency of international concern, the coronavirus disease 2019 (COVID-19) pandemic (caused by the novel SARS-CoV-2 virus) has already impacted many aspects of healthcare delivery. Within Canada, all provinces and territories have initiated a range of public health measures to mitigate the transmission of SARS-CoV-2 and reduce the impact of the outbreak on healthcare systems; in some cases, this includes deferral of non-essential medical visits. Immunizations, particularly in infants and toddlers, are essential. If capacity is not sufficient to maintain all routine programs, emphasis should be put on the primary series and booster doses for children aged less than two years.
Disruption of immunization services, even for short periods, will result in an accumulation of susceptible individuals, and a higher likelihood of vaccine-preventable disease (VPD) outbreaks. Such outbreaks may result in VPD-related deaths and an increased burden on healthcare systems already strained by the response to the COVID-19 outbreak. Moreover, once COVID-19 public health measures are relaxed and international borders are re-opened, risk for VPDs may increase as people start to travel or congregate again in settings where diseases are readily transmitted.
There is evidence that some individuals who miss routine immunizations at the scheduled time might not catch up later. Those who do seek catch-up immunization will add to increased volumes and pressures on the healthcare system during extended pandemic recovery phases, when other clinic visits will be resuming more actively. In addition, those seeking catch-up immunization could be subject to prolonged wait times and vaccine availability issues.
Some of the risks of COVID-19 transmission at immunization visits can be mitigated by basic precautions to protect both healthcare providers and the public. These include child and parent screening prior to visits, non-medical masks for parents, physical distancing between patients at the clinic, scheduling considerations, and personal protective equipment for healthcare providers in ambulatory settings according to provincial, territorial or national guidelines which may change with transmission risk over the course of the pandemic. Immunization clinics for healthy individuals can occur early in the day, before appointments for sick patients, or having healthy child and sick child visits at separate locations. Vaccines should not be administered by health professionals without training, as this could result in immunization errors.
This guidance was prepared by the Public Health Agency of Canada in consultation with the National Advisory Committee on Immunization and the Canadian Immunization Committee, and should be considered in concert with provincial and territorial policies on continuity of immunization programs during the COVID-19 pandemic, and as routine services begin to resume.