modernization of canada’s yellow fever vaccination program
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Modernization of Canada’s Yellow Fever Vaccination Program. Manitoba 6th Annual Travel Health Conference Dr. Denise H. Werker Migration and Travel Health. Modernization of Canada’s Yellow Fever Vaccination Program. Objectives: Meet obligations of International Health Regulations (2005) - PowerPoint PPT PresentationTRANSCRIPT
Modernization of Canada’s Yellow Fever Vaccination Program
Manitoba 6th Annual Travel Health Conference
Dr. Denise H. WerkerMigration and Travel Health
Modernization of Canada’s Yellow Fever Vaccination Program
Objectives:
• Meet obligations of International Health Regulations (2005)
• Better address Canadian context
• Facilitate entry and exit of Canadians requiring proof of yellow fever vaccination at international borders
International Health Regulations (2005)
Purpose and scope • Prevent, protect against and control the
spread of disease • Provide a public health response to the
international spread of disease restricted to public health risks
• Avoid unnecessary interference with international traffic and trade
International tourist arrivals by region, 1950-2006International Tourist Arrivals by Region
1950-2006
0
100
200
300
400
500
600
700
800
900
1950 1985 1995 2005
Year
Millions o
f pers
ons
Middle East
Europe
Asia and the Pacific
Americas
Africa
Sources: World Tourism Organization. 2006. Tourism Market Trends, 2006 Edition – Annex. and World Tourism Organization. World Tourism Barometer. 5(3) October 2007.
International Health Regulations (2005)
• Currently, yellow fever is only disease for which proof of vaccination can be required for travellers as a condition of entry into a country
But
• Other requirements for vaccination/prophylaxis could be added to Annex 7
• Temporary recommendations for vaccination/prophylaxis in context of public health emergency of international concern
“State Parties shall designate specific yellow fever vaccination centres within their territories in order to ensure the quality and safety of the procedures and materials employed.”
IHR(2005): Annex 7, paragraph 2f
International Health Regulations (2005)
“Persons undergoing vaccination or other
prophylaxis under these Regulations shall
be provided with an international certificate
of vaccination or prophylaxis…”
IHR(2005): Annex 6, paragraph 2
International Health Regulations (2005)
International Health Regulations (2005)
Country may require a traveller coming from an area with risk of yellow fever transmission to be quarantined or placed under surveillance:
• Traveller is unable to produce a valid certificate of vaccination against yellow fever
• Until the certificate becomes valid• Until a period of not more than six days
Vaccination contraindicated on medical grounds:• Health care practitioner should provide person
with documented reasons• Authorities on arrival should take into account
Canadian Context
• Obligations of IHR(2005) are shared F/P/T responsibility
• Canada must designate yellow fever vaccination centres
• Purpose of designation is to ensure quality and safety of procedures and materials
• Existing mechanisms help achieve this purpose – Federal Food and Drugs Act and Regulations– P/T regulation of health care workers and
provision of health care services
Canadian Context
• No national or provincial/territorial standards for training and certification in travel health
• Provision of travel vaccines is an uninsured health service in all provinces and territories
• Only one yellow fever vaccine authorized for sale
Changing Canadian Environment
• More Canadians travel more frequently to destinations previously considered exotic
• More health care clinics staffed with multidisciplinary teams rather than solo medical practitioners
• Scopes of practice of health care professionals have evolved
Canadian tourists returning from countries other than the United States, 1972-2006
Canadian Tourists Returning from Countries Other than the United States
1972-2006
0
1000
2000
3000
4000
5000
6000
7000
8000
1972 1989 2006
Year
Pers
on
s (
00
0s)
Source: Statistics Canada. 2007. CANSIM TABLE 427 044
Modernization of Canada’s Yellow Fever Vaccination Program
Short term• Interim designation process that meets
IHR(2005) requirements but better addresses current Canadian context
Long term• Development and implementation of a pan-
Canadian approach to yellow fever vaccination in collaboration with P/T and other stakeholders
Designation of Yellow Fever Vaccination Centres in Canada
Interim Process
Requirements for initial designation:• Nominated health care practitioner
– License to practice is in good standing– Authorized to administer yellow fever vaccine– Responsible for policies/procedures related to safe and
appropriate administration of yellow fever vaccine• Appropriate and current reference resources
available• Capacity to maintain cold chain• Receipt of completed application form and other
documents
Designation of Yellow Fever Vaccination Centres in Canada
Interim Process
Requirements to maintain designation:• Nominated health care practitioner• Restrict use of PHAC-issued International
Certificates of Vaccination or Prophylaxis and PHAC stamps
• Appropriately complete International Certificates of Vaccination or Prophylaxis and documentation for medical contraindication
• Annual submission of completed application form and other documents
• Inform PHAC of any administrative changes
Yellow Fever Vaccination Centres in Canada by Province/Territory*
March 2008
*Excludes DND clinics
0
10
20
30
40
50
60
70
80
90
100
AB BC MB NB NF NS NT NU ON PE QC SK YK
Province/Territory
Number
N=241
International Certificate of Vaccination or Prophylaxis
Certificate of Medical Contraindication to Vaccination
Challenges International Certificate
of Vaccination or Prophylaxis
• No international guidelines for completion • New information needed for completion
– Nationality– National identification document
“Any amendment, or erasure, or failure to complete any part of it, may render it invalid”
IHR(2005): Annex 7
ChallengesCountry Entry Requirements
• WHO information does not constitute an endorsement or confirmation that requirements are in accordance with provisions of IHR (2005)
• May be triggered by visa requirements– Political or economic considerations
• Government capacity and intradepartmental coordination– Foreign Affairs, Health, Border Control
Yellow Fever VaccinationRequirements and Recommendations
• Prevent international spread of disease by protecting countries from risk of importing or spreading yellow fever virus– Mandatory requirements established by
country• Protect individual travelers who may be
exposed to yellow fever infection
Lack of country requirement ≠ Lack of risk
WHO. 2008. International Travel and Health
Map: Countries at risk for yellow fever transmission
WHO. 2008. International Travel and Health
Risk of Transmission of Yellow Fever
Simplified Risk Analysis*
RISK OF YELLOW FEVER
YES NO
COUNTRYENTRYREQUIREMENT
YES Benefit of vaccine
outweighs risk
Risk of vaccine outweighs
benefit
NO Vaccinerecommended
Vaccine not recommended
*Individual risk assessment always needed!
Moving Forward
On-going partnership with stakeholders to:• Secure continued access to yellow fever vaccine• Provide up-to-date, reliable and verified information
about country entry requirements• Define yellow fever vaccination centres in a
Canadian context• Establish processes for efficient introduction of other
vaccines or prophylaxis as required under IHR (2005)• Establish best practices in the implementation of
required vaccination or prophylaxis under IHR (2005)
Serious Adverse Events
Neurologic• Encephalitis• Guillain-Barré syndrome
Viscerotropic• Febrile multiple organ system failure• Onset 2 to 5 days after vaccination• 0.3 to 0.4 per 100,000 vaccinated
persons
Reported Adverse Events Following Yellow Fever Vaccine in Canada
January 1, 1987 – September 30, 2007
390 reports• 166 (43%) following yellow fever vaccine alone• Mostly mild and self-limiting• 2 cases of Guillain-Barré syndrome• 8 cases of anaphylaxis• 0 deaths