Manitoba Health, Healthy Living and Seniors Manitoba Annual Immunization Surveillance Report, 2012 and 2013 Epidemiology & Surveillance Public Health Branch Public Health and Primary Health Care Division Manitoba Health, Healthy Living and Seniors January 1, 2012 to December 31, 2013 with 5-year average comparison (January 1, 2007 to December 31, 2011)
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Manitoba Health, Healthy Living and Seniors Annual Immunization Manitoba Health, Healthy Living and Seniors Surveillance Report, 2012 and 2013 Epidemiology & Surveillance Public Health
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Manitoba Health,
Healthy Living and Seniors
Manitoba Annual Immunization Surveillance Report, 2012 and 2013
Epidemiology & Surveillance
Public Health Branch
Public Health and Primary Health Care Division Manitoba Health, Healthy Living and Seniors
January 1, 2012 to December 31, 2013 with 5-year average comparison (January 1, 2007 to December 31, 2011)
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MANITOBA ANNUAL IMMUNIZATION SURVEILLANCE REPORT, 2012 and 2013
TABLE OF CONTENTS
Acknowledgments .............................................................................................................................. 1 Executive Summary ............................................................................................................................ 2 What to Expect in This Report .......................................................................................................... 3 Report Overview ................................................................................................................................. 4
Section A: Immunizations in Manitoba ........................................................................................ 4
Section B: Immunization Rates by RHA ....................................................................................... 4
Section C: Residency and Immunization Rates ......................................................................... 5
Section D: Overview of All Immunization Rates by RHA ......................................................... 6
About Manitoba Immunization Monitoring System (MIMS) Data .......................................... 6
Key Elements in Graphs ................................................................................................................ 7
Immunizations at Age 1 ...................................................................................................................... 8 Manitoba Immunization Rates, Age 1 .......................................................................................... 9
Diphtheria, Tetanus, Pertussis, and Haemophilus influenzae type b ................................... 11
Continuous versus Non-continuous Residency, Age 1 .......................................................... 16
Immunizations at Age 2 .................................................................................................................... 19 Manitoba Immunization Rates, Age 2 ........................................................................................ 20
Diphtheria, Tetanus, Pertussis, and Haemophilus influenzae type b ................................... 22
Measles, Mumps, Rubella, and Varicella ................................................................................. 27
Meningococcal C Conjugate ...................................................................................................... 30
Continuous versus Non-continuous Residency, Age 2 .......................................................... 31
Immunizations at Age 7 .................................................................................................................... 34 Manitoba Immunization Rates, Age 7 ........................................................................................ 35
Diphtheria, Tetanus, and Pertussis ............................................................................................ 37
Measles, Mumps, and Rubella .................................................................................................... 40
Continuous vs. Non-continuous Residency, Age 7 ................................................................. 42
Immunizations at Age 11 .................................................................................................................. 45 Manitoba Immunization Rates, Age 11 ...................................................................................... 46
Meningococcal C Conjugate ...................................................................................................... 48
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MANITOBA ANNUAL IMMUNIZATION SURVEILLANCE REPORT, 2012 and 2013
Hepatitis B ....................................................................................................................................... 49
Continuous vs. Non-continuous Residency, Age 11 ............................................................... 50
Immunizations at Age 17 .................................................................................................................. 53 Manitoba Immunization Rates, Age 17 ...................................................................................... 54
Tetanus, Diphtheria, and Pertussis ............................................................................................ 56
Continuous vs. Non-continuous Residency, Age 17 ............................................................... 58
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MANITOBA ANNUAL IMMUNIZATION SURVEILLANCE REPORT, 2012 and 2013
LIST OF FIGURES
Figure 1: Manitoba Immunization Rates by RHA, Age 1 .............................................................. 9 Figure 2: Manitoba Immunization Rates by Immunogens, Age 1 ............................................ 10 Figure 3: Diphtheria Immunization Rates by RHA, Age 1 ......................................................... 11 Figure 4: Tetanus Immunization Rates by RHA, Age 1 ............................................................... 12 Figure 5: Pertussis Immunization Rates by RHA, Age 1 ............................................................. 12 Figure 6: Haemophilus influenzae type B Immunization Rates by RHA, Age 1 ...................... 13 Figure 7: Polio Immunization Rates by RHA, Age 1 .................................................................... 14 Figure 8: Pneumococcal Conjugate 13 valent Immunization Rates by RHA, Age 1 ............. 15 Figure 9: Continuous and Non-continuous Resident Status, Age 1 ......................................... 16 Figure 10: Continuous Resident Status by RHA, Age 1 .............................................................. 17 Figure 11: Non-Continuous Resident Status by RHA, Age 1 ..................................................... 17 Figure 12: Manitoba Immunization Rates by RHA, Age 2 ......................................................... 20 Figure 13: Manitoba Immunization Rates by Immunogens, Age 2 .......................................... 21 Figure 14: Diphtheria Immunization Rates by RHA, Age 2 ....................................................... 22 Figure 15: Tetanus Immunization Rates by RHA, Age 2 ............................................................ 23 Figure 16: Pertussis Immunization Rates by RHA, Age 2 .......................................................... 23 Figure 17: Haemophilus influenzae type b Immunization Rates by RHA, Age 2 ................... 24 Figure 18: Polio Immunization Rates by RHA, Age 2 .................................................................. 25 Figure 19: Pneumococcal conjugate 13 valent Immunization Rates by RHA, Age 2 ........... 26 Figure 20: Measles Immunization Rates by RHA, Age 2 ............................................................ 27 Figure 21: Mumps Immunization Rates by RHA, Age 2 ............................................................. 28 Figure 22: Rubella Immunization Rates by RHA, Age 2 ............................................................. 28 Figure 23: Varicella Immunization Rates by RHA, Age 2 .......................................................... 29 Figure 24: Meningococcal C Conjugate Immunization Rates by RHA, Age 2....................... 30 Figure 25: Continuous and Non-Continuous Resident Status, Age 2 ...................................... 31 Figure 26: Continuous Resident Status by RHA, Age 2 .............................................................. 32 Figure 27: Non-Continuous Resident Status by RHA, Age 2 ..................................................... 32 Figure 28: Manitoba Immunization Rates by RHA, Age 7 ......................................................... 35 Figure 29: Manitoba Immunization Rates by Immunogens, Age 7 .......................................... 36 Figure 30: Diphtheria Immunization Rates by RHA, Age 7 ....................................................... 37 Figure 31: Tetanus Immunization Rates by RHA, Age 7 ............................................................ 38 Figure 32: Pertussis Immunization Rates by RHA, Age 7 .......................................................... 38 Figure 33: Polio Immunization Rates by RHA, Age 7 .................................................................. 39 Figure 34: Measles Immunization Rates by RHA, Age 7 ............................................................ 40 Figure 35: Mumps Immunization Rates by RHA, Age 7 ............................................................. 41 Figure 36: Rubella Immunization Rates by RHA, Age 7 ............................................................. 41 Figure 37: Continuous and Non-Continuous Resident Status, Age 7 ...................................... 42 Figure 38: Continuous Resident Status by RHA, Age 7 .............................................................. 43 Figure 39: Non-Continuous Resident Status by RHA, Age 7 ..................................................... 43 Figure 40: Manitoba Immunization Rates by RHA, Age 11 ....................................................... 46 Figure 41: Manitoba Immunization Rates by Immunogens, Age 11........................................ 47 Figure 42: Meningococcal C Conjugate Immunization Rates by RHA, Age 11 .................... 48 Figure 43: Hepatitis B Immunization Rates by RHA, Age 11 ..................................................... 49 Figure 44: Continuous and Non-Continuous Resident Status, Age 11 .................................... 50 Figure 45: Continuous Resident Status by RHA, Age 11 ............................................................ 51 Figure 46: Non-Continuous Resident Status by RHA, Age 11 ................................................... 51 Figure 47: Manitoba Immunization Rates by RHA, Age 17 ....................................................... 54
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Figure 48: Manitoba Immunization Rates by Immunogens, Age 17........................................ 55 Figure 49: Diphtheria Immunization Rates by RHA, Age 17 ..................................................... 56 Figure 50: Tetanus Immunization Rates by RHA, Age 17 .......................................................... 57 Figure 51: Pertussis Immunization Rates by RHA, Age 17 ........................................................ 57 Figure 52: Continuous and Non-Continuous Resident Status, Age 17 .................................... 58 Figure 53: Continuous Resident Status by RHA, Age 17 ............................................................ 59 Figure 54: Non-Continuous Resident Status by RHA, Age 17 ................................................... 59
LIST OF TABLES Table 1: Doses Required to be Complete for Age by Immunogen, 2012 and 2013 .............. 5 Table 2: Recommended Immunization Schedule, Age 1 ............................................................ 8 Table 3: Counts and Percentages for All Immunogens by RHA, Age 1, 2012, 2013 & 5-year
average (2007-2011) ......................................................................................................................... 18 Table 4: Recommended Immunization Schedule, Age 2 .......................................................... 19 Table 5: Counts and Percentages for All Immunogens by RHA, Age 2, 2012, 2013 & 5-year
average (2007-2011) ......................................................................................................................... 33 Table 6: Recommended Immunization Schedule, Age 7 .......................................................... 34 Table 7: Counts and Percentages for All Immunogens by RHA, Age 7, 2012, 2013 & 5-year
average (2007-2011) ......................................................................................................................... 44 Table 8: Recommended Immunization Schedule, Age 11 ........................................................ 45 Table 9: Counts and Percentages for All Immunogens by RHA, Age 11, 2012, 2013 & 5-
year average (2007-2011) ............................................................................................................... 52 Table 10: Recommended Immunization Schedule, Age 17 ...................................................... 53 Table 11: Counts and Percentages for All Immunogens by RHA, Age 17, 2012, 2013 & 5-
year average (2007-2011) ............................................................................................................... 60
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MANITOBA ANNUAL IMMUNIZATION SURVEILLANCE REPORT, 2012 and 2013
Acknowledgments Manitoba Annual Immunization Surveillance Report (2012 and 2013) is a result of the
ongoing efforts of a dedicated team of individuals throughout the province of Manitoba
including public health nurses, immunization coordinators, physicians, and other primary
health care providers. Their combined efforts and expertise in the area of immunization
is necessary to produce this valuable report.
Citation Government of Manitoba. Manitoba Health, Healthy Living and Seniors. Public Health and
Primary Health Care Division. Public Health Branch. Epidemiology and Surveillance.
(2014). Manitoba Annual Immunization Surveillance Report - 2012 and 2013. Retrieved from
(URL).
Let us know what you think. We appreciate your feedback! If you would like to comment
on any aspect of this report, please send an email to: [email protected]
MANITOBA ANNUAL IMMUNIZATION SURVEILLANCE REPORT, 2012 and 2013
Executive Summary
Manitoba Health, Healthy Living and Seniors (MHHLS) is pleased to present the Manitoba
Annual Immunization Surveillance Report, 2012 and 2013. This report is intended to
provide an overview of the immunization coverage of children from 2 months of age to
<17 years of age for the years 2012 and 2013. Below are a few selected highlights from
the report:
Immunizations at Age 1
Overall, 78.0% and 78.2% (for 2012 and 2013, respectively) of one year old
Manitobans were considered complete for age for all the required vaccinations.
In 2012, both Interlake-Eastern Regional Health Authority (RHA) and Prairie
Mountain RHA had the highest percentages of one year old children complete for
age (both had 81.2% vaccinated) while Southern RHA had the lowest (69.8%). The
corresponding estimates in 2013 showed similar trend.
Immunizations at Age 2
63.3% and 60.1% of two year olds in Manitoba were complete for age in 2012 and
2013, respectively.
In 2012 and 2013, Northern RHA had the highest percentage of two year-olds
complete for age (68.0% in 2012 and 67.0% in 2013) while Southern RHA had the
lowest (55.0% in 2012 and 54.4% in 2013).
Immunizations at Age 7
In Manitoba, 59.6% of seven year old children had received the immunizations
required to be complete for age in 2012. In 2013, the corresponding rate slightly
increased (62.3%).
In 2012, Prairie Mountain RHA had the highest percentage of children vaccinated
(69.5%) whereas Winnipeg RHA had the lowest (56.2%). In 2013, Northern RHA
had the highest complete for age rates (72.9%) and Winnipeg RHA again had the
lowest (58.4%).
Immunizations at Age 11
24.8% and 27.6% of age 11 children received the vaccines available to them to be
considered for complete for age (in 2012 and in 2013, respectively). Low
immunization coverage could be due to that, in 2012 and 2013, one dose of
varicella was a requirement to be considered complete for age at 11 years while
this was not a requirement for complete for age criteria previously.
In both 2012 and 2013, Prairie Mountain RHA had the highest percentage of
children vaccinated (32.8% and 36.0%, respectively) whereas Northern RHA had
the lowest (20.7% and 22.8%, respectively).
Immunizations at Age 17
In Manitoba, 45.8% and 46.4% of the 17 year olds (in 2012 and in 2013,
respectively) were considered complete for age for all the required vaccinations.
Prairie Mountain RHA had the highest levels of complete for age rates in both
years (61.9% in 2012 and 62.3% in 2013), compared to the Winnipeg RHA having
the lowest complete for age rates during both years (39.2% in 2012 and 40.5% in
2013).
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MANITOBA ANNUAL IMMUNIZATION SURVEILLANCE REPORT, 2012 and 2013
What to Expect in This Report
Our goal is to provide data in a user-friendly manner that allows the reader to quickly
access the required information. This year, we present a joint report showing the
immunization coverage information for both 2012 and 2013. In all graphs, the 2012 and
2013 information is presented side-by-side for easy comparison. In many graphs, the 5-
year average from 2007 to 2011 is also provided. In some instances, the results presented
in previous years’ reports may differ slightly from the results presented in the current
report due to use of a live immunization surveillance database, which is subject to change
from time to time. Slight differences may also result from changes in the analyses of
complete for age criteria in previous years versus this year’s report.
What you will see in this report:
Graphs and figures to provide visual representations of data,
Highlights of the recommended immunization schedules by age,
Details of the recommended immunizations for each age by regional health
authority (RHA),
A tabular overview of all immunizations in the summary section of each chapter,
Highlighted elements of the report in bright text boxes, and
Supporting text to provide context to the data.
Note that this report does not provide data:
by First Nation status - The level of accuracy in this self-reported variable is felt to
be too low to provide consistent and reliable data for health care policy and
planning purpose.
on influenza vaccinations - It is presented in the Manitoba annual influenza report (see: http://www.gov.mb.ca/health/publichealth/surveillance/influenza/index.html).
on human papillomavirus vaccination (HPV) - The first cohort received the HPV
vaccine in 2008 (grade 6 females only), and therefore, did not fulfill the complete
for age at 17 years criteria in 2012 and 2013, but will fulfill the criteria in 2015.
on the vaccinations recommended for individuals 18 years and older (e.g.
pneumococcal polysaccharide 23).
NOTE on Winnipeg RHA: The Winnipeg RHA contains the combined information for both
Winnipeg and Churchill.
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Report Overview Each chapter represents a specific age period that corresponds with the immunization
schedule (ages 1, 2, 7, 11, and 17). Within each chapter, there are four sections that further
describe immunizations from a provincial and regional perspective:
Section A: Immunizations in Manitoba Presents the immunization schedule containing the vaccines required to be complete
for age.
Describes the key vaccines required to be complete for age.
Provides an overview of the proportion of children vaccinated by RHA.
Contains an overall snapshot of immunizations in the province for the age group.
Section B: Immunization Rates by RHA The proportion of children who are complete for age for particular vaccinations are
summarized graphically. Only those vaccines required to be complete for age are
detailed.
Complete for age refers to a child who has received all of the recommended doses of a
given immunogen, by a specified age, according to the schedule given in Table 1. For
example, to be considered complete for age at 17 years, a child must have received: six
doses of diphtheria, tetanus, and pertussis; four doses of polio; two doses of measles; one
dose of mumps and rubella; and three doses of hepatitis B.
The proportion of children who are complete for age is calculated with a denominator of mid-
year population count in the specified age group, in Manitoba, who have active Manitoba Health,
Healthy Living and Seniors (MHHLS) Personal Health Information Numbers (PHIN), and a
numerator containing the count of individuals who have received all required doses of
immunogen(s), as shown in Table 1. For example, at age 17, an individual requires six doses of
tetanus to be considered complete for age, for that immunogen. If, at age 17, the count for an
individual shows five doses (or less) of tetanus, that individual would not be considered
complete for age and would therefore not be included in the numerator count. For some
instances, a percentage greater than 100 occurs due to use of denominator containing the mid-
year population of the reported year (June 1st) and use of numerator containing the count of
individuals who have received all required doses of immunogen(s) as of December 31st of the
report year.
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MANITOBA ANNUAL IMMUNIZATION SURVEILLANCE REPORT, 2012 and 2013
Born in Manitoba and registered with MHHLS
Moved away from Manitoba
Returned to Manitoba Registered with MHHLS
by December 31st
Born outside of Manitoba Moved to Manitoba Registered with MHHLS by
December 31st
Table 1: Doses Required to be Complete for Age by Immunogen, 2012 and 2013
Ag
e
Dip
hth
eria
(D)
Te
tan
us
(T)
Pe
rtus
sis
(aP
)
Ha
em
op
hilu
s
influ
en
za
typ
e b
(Hib
)
Po
lio (IP
V)
Pn
eu
mo
co
cc
al
Co
nju
ga
te 1
3 v
ale
nt
(Pn
eu
-C-1
3)
Me
as
les
(M)
Mu
mp
s (M
)
Ru
be
lla (R
)
Va
ric
ella
(V)
Me
nin
go
co
cc
al C
Co
nju
ga
te
(Me
n-C
-C)
He
pa
titis B
(HB
)
1 3 3 3 3 2 2 0 0 0 0 0 0
2 4 4 4 4 3 3 1 1 1 1 1 0
7 5 5 5 0 4 0 2 1 1 1 0 0
11 5 5 5 0 4 0 2 1 1 1 1 3
17 6 6 6 0 4 0 2 1 1 0 0 3
Doses required to be complete for age by each immunogen is generated based on
Manitoba’s Recommended Immunization Schedule in each reported year. For example, in
2012 and 2013, one dose of varicella was a requirement to be considered complete for age
at 11 years while receiving varicella was not a requirement for complete for age definition
during 2007 to 2011.
Combined vaccines (e.g. diphtheria, tetanus, pertussis, polio [DTaP-IPV]) are most frequently
used to vaccinate children in Manitoba. In some instances, the data shows that complete for age
rates by immunogen vary slightly. This may be for reasons such as personal choice (e.g. a
parent chooses not to vaccinate a child with a particular immunogen), coding errors, or vaccine
supply. For this reason, we have chosen to provide rates by immunogen.
Section C: Residency and Immunization Rates
This section describes immunization rates by comparing data on continuous
residents to non-continuous residents for Manitoba by year (2007 to 2013) and for each RHA (2012, 2013, and 5-year average [2007 to 2011]). A continuous resident is
defined as an individual with an uninterrupted registration with MHHLS from birth to December 31st of the year in question (i.e., 2012 or 2013, etc.). A non-continuous
resident has lived outside of Manitoba for a period of time, but was registered with
MHHLS by December 31st of the year in question. Non-continuous residents may
have been born in Manitoba but left for a period of time and then returned to
Manitoba (see example 1), or they may have been born outside of the province and
then moved to Manitoba (see example 2):
Example 1:
Example 2:
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MANITOBA ANNUAL IMMUNIZATION SURVEILLANCE REPORT, 2012 and 2013
Manitoba Immunization Monitoring System (MIMS) database is linked to the
Insurance Registry at MHHLS. As such, MIMS is dependent on the presence of an
active PHIN in order to collect immunization data. Residency impacts the
interpretation of vaccination rates substantially and thus, it is important to track and
understand population trends.
Some reasons for the variations in rates may include: 1) non-continuous residents are
requested to provide MHHLS with vaccination records upon re-entry to Manitoba.
These records may be incomplete or unavailable, or may not be submitted to the
local public health office; 2) the immunization schedules in other provinces or
countries may be substantially different than in Manitoba; and, 3) the vaccination
records provided by non-continuous residents may not have been inputted into
MIMS before the end of the year. Thus, it is likely that the rates for non-continuous
residents are an underrepresentation of actual complete for age rates. However,
without all the data available, a better estimate is not available.
Section D: Overview of All Immunization Rates by RHA The final section is a table containing all of the immunization rates for each vaccine
by RHA.
About Manitoba Immunization Monitoring System (MIMS) Data We used the Manitoba’s MIMS database to identify each individual’s immunization
coverage. The MIMS is population-based province-wide electronic immunization registry
that has been recording virtually all immunizations administered to Manitoba residents
since 1988. Information, including vaccine type and date of immunization, is captured for
each immunization event either through direct data entry for vaccines administered by
public health staff in each RHA or using physician claims data for vaccines administered
by physicians.
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Key Elements in Graphs
78.9% 81.4%
70.7%
82.0% 82.2% 73.7%
79.3% 82.9%
69.6% 77.9%
83.6% 75.4%
79.1% 81.1%
71.1%
77.2% 75.4%
84.2%
0%
20%
40%
60%
80%
100%
MANITOBA WRHA Southern Health-
Santé Sud
Interlake-Eastern Prairie Mountain Northern
2012 2013 2007-2011
A note about antigens, immunogens and vaccines:
An antigen is any molecular agent that binds to components of the immune response (including
lymphocytes and their receptors) antibodies and the t-cell receptor. Note: not every antigen can
evoke an immune response. An immunogen is any antigen capable of inducing an immune response.
Vaccines are a preparation of dead or inactivated organisms, purified products, or live attenuated
organisms that contain one or more immunogens, and are administered to produce or artificially
increase immunity to a particular disease
In this report, we use vaccine names to describe the immunization schedule and in specific reference
throughout the interpretation. Immunogens are more frequently used and describe single antigens.
The programming queries that produce the annual statistics use all of the current and historical
immunogens that contribute to the immunization schedule. This means that in some instances, we are
counting different immunogens because of product changes. For example, the pneumococcal
conjugate vaccine currently in use in Manitoba is the 13-valent product, which replaced the 7-valent
product starting in July 2010. The 13-valent product is currently the only pneumococcal conjugate
vaccine used in Canada, but the 7-valent and potentially the 10-valent product is still used in some
countries, so some non-continuous residents may have received it. A separate tariff code is assigned to
each product to clinically identify the products, but both products are counted equally in complete for
age calculations. A child would complete the series with either one product or the other, and is
considered complete for age when the full series was given on schedule.
Each bar represents the proportion of children complete for age by RHA (the left bar represents 2012; the right bar represents 2013). The bold number in the centre of the bar denotes the exact percentage.
This bar represents the provincial average of children complete for age in 2013.
This bar represents the provincial average of children complete for age in 2012.
This line represents the average percent of children complete for age by RHA, calculated using data from the previous 5 years (2007-2011). The number above corresponds to the numerical value.
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MANITOBA ANNUAL IMMUNIZATION SURVEILLANCE REPORT, 2012 and 2013
Immunizations at Age 1
Section A: Immunizations in Manitoba Table 2: Recommended Immunization Schedule, Age 1
Vaccine Age
2
months
4
months
6
months
DTaP-IPV-Hib
Diphtheria, Tetanus, Pertussis, Polio,
Haemophilus influenzae type b
♦ ♦ ♦
Pneu-C-13^
Pneumococcal Conjugate 13 valent ♦ ♦
♦ A single dose given with one needle. ^ As of July 2012, children with high risk medical conditions and children living in First Nations communities are
recommended to follow a 4 dose schedule at 2, 4, 6, and 18 months. A catch-up dose is provided to children ≤
59 months of age who have NEVER received a dose of Pneu-C-13.
At age one, Manitoba’s universal childhood immunization program provides protection
against the following bacterial pathogens: diphtheria, tetanus, pertussis, haemophilus
influenzae type b, and streptococcus pneumoniae. The age one program also provides
protection against viral polio infection.
The immunization status of children aged one year in 2012 represents those who were
born in 2011 and who turned one year old in 2012 (2011 birth cohort); the immunization
status of children aged one year in 2013 represents those who were born in 2012 and
who turned one year old in 2013 (2012 birth cohort).
The data reported is for children who are complete for age: they have received all of the
scheduled doses of vaccines as shown in Table 2. In order to be considered complete for
age at one year, children need to have three doses of diphtheria, tetanus, pertussis, and
haemophilus influenzae type b (Hib), and two doses of polio and Pneu-C-13 (for an
overview of immunogens required to be complete for age refer to Table 1).
Immunizations given after the age of one (measles, mumps, rubella, varicella [shortly
named MMRV] and Pneu-C-13 doses at 12 months of age) are not included in this one
year old section; rather, data for these immunizations are provided in the two year old
section.
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MANITOBA ANNUAL IMMUNIZATION SURVEILLANCE REPORT, 2012 and 2013
Manitoba Immunization Rates, Age 1
Overall, 78.0% and 78.2% (for 2012 and 2013, respectively) of one year old Manitobans
received the vaccines available to them (Figure 1). This percentage is calculated with a
denominator of all one year olds in Manitoba, who have active MHHLS PHINs
(n2012=15,904 and n2013=16,449), and a numerator containing the children who received
all of their required vaccinations (n2012=12,398 and n2013=12,860). The number of
vaccinated one year olds did vary by RHA. In 2012, both Interlake-Eastern RHA and
Prairie Mountain RHA had the highest percentages of one year old children complete for
age (both had 81.2% vaccinated) while Southern RHA had the lowest (69.8%). In 2013,
Prairie Mountain RHA had the highest percentage of one year old children vaccinated
(82.7%) while Southern RHA had the lowest (68.3%).
Figure 1: Manitoba Immunization Rates by RHA, Age 1
Percent of children who are complete for age by RHA, 2012, 2013, and 5-year average (2007-2011)
75.1%
82.7%
77.1%
68.3%
81.4%
78.2%
73.4%
81.2%
81.2%
69.8%
80.4%
78.0%
70.0%
81.4%
74.7%
72.0%
78.2%
76.3%
0% 20% 40% 60% 80% 100%
Northern
Prairie Mountain
Interlake-Eastern
Southern
Winnipeg
MANITOBA
2007-2011 2012 2013
In Manitoba, almost 8 out of 10 children at age one year
received all the vaccine doses necessary to be considered
complete for age in both 2012 and 2013.
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MANITOBA ANNUAL IMMUNIZATION SURVEILLANCE REPORT, 2012 and 2013
In their first year, children receive a combined vaccine which offers protection against
diphtheria, tetanus, pertussis, Hib, and polio referred to as the DTaP-IPV-Hib. Three
doses are required, at ages two, four, and six months, to be considered complete for age
for diphtheria, tetanus, pertussis, and Hib. However, children only require two doses of
the polio vaccine to be complete for age. The third dose of polio is acceptable to give as
an additional dose in a combination vaccine for convenience of administration; this
results in a difference in immunization rates between polio and the other immunogens in
the vaccine (Figure 2). For example, if a child missed one booster and, therefore, only
had two doses of DTaP-IPV-Hib, s/he would not be considered complete for age for
diphtheria, tetanus, pertussis, or Hib but would be complete for age for polio. Polio
vaccination rates are typically higher for this reason (Figure 2). In addition to the DTaP-
IPV-Hib, two doses of pneumococcal conjugate 13 valent are required to be considered
complete for age one.
As represented in Figure 2, overall, complete for age rates for all vaccines required at
age one was slightly higher in 2013 as compared to complete for age rates in 2012 and in
2007 to 2011.Corresponding rates in 2012 was slightly lower as compared to the previous
5-year (2007-2011), with the exception of pneumococcal conjugate 13 valent. This is
because the number of required doses for pneumococcal conjugate 13 valent changed in
July 2012, from four doses required at two, four, six, and 18 months of age to only three
doses required at two, four, and 12 months of age.
Figure 2: Manitoba Immunization Rates by Immunogens, Age 1
Percent of children who are complete for age for diphtheria, tetanus, pertussis, haemophilus
influenzae type b, polio, and pneumococcal conjugate 13 valent, 2012, 2013 & 5-year average (2007-
2011)
* Children require 2 doses of polio. As they typically receive 3 boosters given as a combined product the uptake
rate is higher than the other immunogens in the combined vaccine.
78.9% 78.9% 78.8% 78.6% 88.7% 87.9%
79.3% 79.3% 79.3% 79.0% 89.1% 87.4%
79.1% 79.1% 79.0% 78.8%
89.3% 76.9%
0%
20%
40%
60%
80%
100%
Diphtheria Tetanus Pertussis Haemophilus
influenzae
type b
Polio* Pneumococcal
Conjugate 13
valent
2012 2013 2007-2011
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Section B: Immunization Rates by RHA, Age 1
Diphtheria, Tetanus, Pertussis, and Haemophilus influenzae type b Figure 3 shows the percentages of children at age one year receiving three doses of the
diphtheria immunogen. In Manitoba, 78.9% and 79.3% of one year old children were
complete for age for diphtheria vaccine (given as DTaP-IPV-Hib vaccine) in 2012 and
2013, respectively. In 2012, Prairie Mountain RHA had the highest percentage of one year
old children vaccinated (82.2%), with Interlake-Eastern RHA a close second (82.0%),
whereas Southern RHA had the lowest (70.7%). Similarly, in 2013, Prairie Mountain RHA
had the highest percentage of one year old children complete for age (83.6%) while
Southern RHA had the lowest (69.6%). A similar trend was observed for complete for age
rates for tetanus (Figure 4), pertussis (Figure 5), and Hib (Figure 6) immunogens. This is
due to these immunogens being most commonly given (with polio) as the combined
vaccine DTaP-IPV-Hib.
Figure 3: Diphtheria Immunization Rates by RHA, Age 1
Percent of children who are complete for age, 2012, 2013 & 5-year average (2007 - 2011)
MANITOBA ANNUAL IMMUNIZATION SURVEILLANCE REPORT, 2012 and 2013
Figure 6: Haemophilus influenzae type B Immunization Rates by RHA, Age 1 Percent of children who are complete for age, 2012, 2013 & 5-year average (2007-2011)
At age two, Manitoba’s universal childhood immunization program provides added
protection (sometimes described as boosting) against the following bacterial pathogens:
diphtheria, tetanus, pertussis, haemophilus influenzae type b, and streptococcus
pneumoniae. The age two program also provides protection against the following viral
infections: measles, mumps, rubella, varicella (chickenpox), and polio. MHHLS sends
reminder letters to parents of children aged 15 months and 20 months, who are missing
recommended immunizations, encouraging them to ensure their children’s
immunizations are up-to-date.
The immunization status of children at age two in 2012 represents those who were born in
2010 and who turned two years old in 2012 (2010 birth cohort); the immunization status of
children at age two in 2013 represents those who were born in 2011 and turned two years
old in 2013 (2011 birth cohort). The data reported is for children who have received all of
their scheduled doses, as shown in Table 4, in addition to the doses recommended at age
one, if applicable. In order to be considered complete for age at two years, children
need to have four doses of diphtheria, tetanus, pertussis, and Hib; three doses of polio
and Pneu-C-13; and one dose of measles, mumps, rubella, varicella, and Men-C-C (for an
overview of immunogens required to be complete for age, refer to Table 1). If a child
missed one of these immunogens, s/he was not considered complete for age at 2 years.
Therefore, overall complete for age estimates is expected to be lower than the
immunogen-specific complete for age estimates.
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MANITOBA ANNUAL IMMUNIZATION SURVEILLANCE REPORT, 2012 and 2013
Manitoba Immunization Rates, Age 2
In Manitoba, 63.3% and 60.1% of two year olds were complete for age in 2012 and 2013,
respectively (Figure 12). This percentage is calculated with a denominator of all two year
olds in Manitoba, with active MHHLS PHINs (n2012=16,190 and n2013=16,136) and a
numerator containing all two year olds who had received their required vaccinations
(n2012=10,247 and n2013=9,704). The percentage of children complete for age two did vary
by RHA. In 2012 and 2013, Northern RHA had the highest percentage of two year-olds
complete for age (68.0% in 2012 and 67.0% in 2013) while Southern RHA had the lowest
(55.0% in 2012 and 54.4% in 2013). During 2007 to 2011, the corresponding estimates
were the highest in Prairie Mountain RHA (65.3%), and the lowest in Southern RHA
(55.0%).
Figure 12: Manitoba Immunization Rates by RHA, Age 2
Percent of children who are complete for age by RHA, Age 2, 2012, 2013 & 5-year average (2007-
2011)
67.0%
64.5%
63.7%
54.4%
59.0%
60.1%
68.0%
66.8%
64.4%
55.0%
64.2%
63.3%
59.9%
65.3%
57.8%
55.0%
61.2%
60.2%
0% 20% 40% 60% 80% 100%
Northern
Prairie Mountain
Interlake-Eastern
Southern
Winnipeg
MANITOBA
2007-2011 2012 2013
In 2012 and 2013, about 6 out of 10 two year old Manitobans were considered complete for age for all required vaccines.
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MANITOBA ANNUAL IMMUNIZATION SURVEILLANCE REPORT, 2012 and 2013
As shown in Figure 13, in both 2012 and 2013, just under three quarters (7 in 10) of
Manitoba’s two year olds received all recommended doses for diphtheria, tetanus,
pertussis, and Hib. Roughly, between eight and nine out of ten children were complete
for age for polio, Pneu-C-13, measles, mumps, rubella, and varicella (MMRV), and Men-
C-C vaccines.
Complete for age estimates for these immunogens were somewhat higher than the
corresponding estimates for diphtheria, tetanus, pertussis, and Hib. Possible reasons for
this are: one less dose of polio vaccine is required to be considered complete for age,
compared to tetanus, diphtheria, pertussis, and Hib; Pneu-C-13, MMRV, and Men-C-C
vaccines were scheduled to be given at 12 months while tetanus, diphtheria, pertussis,
and Hib were scheduled to be given at 18 months. This provides longer time period (i.e.,
12 months) for Pneu-C-13, MMRV, and Men-C-C to be received before at age two as
compared to only 6 months for tetanus, diphtheria, pertussis, and Hib.
Figure 13: Manitoba Immunization Rates by Immunogens, Age 2
Percent of children who are complete for age for diphtheria, tetanus, pertussis, haemophilus
influenzae type B, polio, pneumococcal conjugate 13 valent, measles, mumps, rubella, varicella, and
meningococcal C conjugate, 2012, 2013 & 5-year average (2007-2011)
70
.1%
70
.1%
70
.1%
69
.5%
87
.8%
86
.0%
86
.5%
86
.4%
86
.4%
81
.6%
83
.6%
69
.6%
69
.6%
69
.6%
69
.2%
87
.2%
85
.4%
81
.2%
81
.1%
81
.1%
77
.6%
83
.8%
70.9% 70.9% 70.8% 70.4%
87.7% 67.9%
86.6% 86.5% 86.5%
78.4% 35.0%
0%
20%
40%
60%
80%
100%
2012 2013 2007-2011
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MANITOBA ANNUAL IMMUNIZATION SURVEILLANCE REPORT, 2012 and 2013
Section B: Immunization Rates by RHA, Age 2
Diphtheria, Tetanus, Pertussis, and Haemophilus influenzae type b By the end of two years of age, children who are complete for age would have received
four doses of diphtheria, tetanus, acellular pertussis, and haemophilus influenzae type b,
typically given (with polio) in a combined vaccine (DTaP-IPV-Hib) at two, four, six, and
18 months. As shown in Figures 14 to17, complete for age rates for two year olds in
Manitoba was fairly consistent over time, hovering around the 70% mark. As vaccines are
typically given in a combined vaccine, the rates for the different immunogens are very
similar. Across the province, in both 2012 and 2013, Southern RHA had the lowest
complete for age rates for all four immunogens. Prairie Mountain RHA had the highest
complete for age rates in 2012, 2013 and over the 5-year average (2007 – 2011), for all
four immunogens.
Figure 14: Diphtheria Immunization Rates by RHA, Age 2
Percent of children who are complete for age, 2012, 2013 & 5-year average (2007-2011)
In 2012 and 2013, roughly 8 out of 10 two year old Manitobans had
received the meningococcal C conjugate vaccine.
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MANITOBA ANNUAL IMMUNIZATION SURVEILLANCE REPORT, 2012 and 2013
Section C: Residency and Immunization Rates
Continuous versus Non-continuous Residency, Age 2
From 2007 to 2013, approximately two-thirds of continuous residents were complete for
age at two years compared to around one-quarter of non-continuous residents (Figure
25). Explanations for the differences in rates between continuous and non-continuous
residents can be found on page 6. Complete for age rates for both continuous and non-
continuous residents slightly increased from 2007 to 2013. For example, the
corresponding rate among non-continuous residents was 17.5% in 2007 and increased to
24.9% in 2013.
Figure 25: Continuous and Non-Continuous Resident Status, Age 2
Percent of children who are complete for age, 2007-2013
61.4% 63.8% 64.9% 63.8%
61.4%
66.0% 62.4%
17.5%
22.5% 24.3% 22.8% 21.7% 24.1%
24.9%
0%
20%
40%
60%
80%
100%
2007 2008 2009 2010 2011 2012 2013
Continuous Non-continuous
In Manitoba, the percentage of two year olds considered complete for
age is over two times higher for continuous residents in comparison to
non-continuous residents.
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MANITOBA ANNUAL IMMUNIZATION SURVEILLANCE REPORT, 2012 and 2013
The complete for age rates by RHA for continuous and non-continuous residents are
presented in Figure 26 and Figure 27, respectively. Among continuous residents, while
Southern RHA had the lowest complete for age rates for 2012 (56.2%) and 2013 (55.4%),
the highest rate during same years were noted in Winnipeg RHA (68.7%) and in Northern
RHA (66.8%), respectively (Figure 26). The corresponding estimates followed different
trend among non-continuous residents (Figure 27); while Winnipeg RHA had the lowest
complete for age rates for 2012 (14.4%) and 2013 (15.3%), the highest rate were noted in
Interlake-Eastern RHA in 2012(55.8%) and in Northern RHA in 2013 (76.9%).
Figure 26: Continuous Resident Status by RHA, Age 2
Percent of children who are complete for age, 2012, 2013 & 5-year average (2007-2011)
Figure 27: Non-Continuous Resident Status by RHA, Age 2
Percent of children who are complete for age, 2012, 2013 & 5-year average (2007-2011)
66.8%
65.6%
64.0%
55.4%
62.9%
62.4%
68.4%
68.3%
64.6%
56.2%
68.7%
66.0%
59.8%
67.4%
58.9%
57.4%
65.4%
63.1%
0% 20% 40% 60% 80% 100%
Northern
Prairie Mountain
Interlake-Eastern
Southern
Winnipeg
MANITOBA
2007-2011 2012 2013
76.9%
47.4%
50.0%
32.1%
15.3%
24.9%
52.5%
45.0%
55.8%
32.2%
14.4%
24.1%
49.9%
40.5%
27.6%
25.7%
13.0%
21.8%
0% 20% 40% 60% 80% 100%
Northern
Prairie Mountain
Interlake-Eastern
Southern
Winnipeg
MANITOBA
2007-2011 2012 2013
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MANITOBA ANNUAL IMMUNIZATION SURVEILLANCE REPORT, 2012 and 2013
Section D: Overview of All Immunization Rates by RHA, Age 2 Table 5: Counts and Percentages for All Immunogens by RHA, Age 2, 2012, 2013 & 5-year average
(2007-2011)
Immunogens MANITOBA Winnipeg Southern Interlake-
Eastern
Prairie
Mountain Northern
2007-2011
Population 77,475 38,581 13,476 6,884 10,179 8,355
MANITOBA ANNUAL IMMUNIZATION SURVEILLANCE REPORT, 2012 and 2013
Section C: Residency and Immunization Rates
From 2007 to 2013, 70% to 76% of continuous residents were complete for age seven
compared to only 22% to 35% of non-continuous residents (Figure 37). Explanations on
the reasons for these differences in rates can be found on page 6. Annual complete for
age rates among continuous residents slightly decreased from 75.6% in 2007 to 69.8% in
2013,while the corresponding rates were more stable among non-continuous residents
during the same period.
Continuous vs. Non-continuous Residency, Age 7 Figure 37: Continuous and Non-Continuous Resident Status, Age 7
Percent of children who are complete for age, 2007-2013
75.6% 75.4% 75.4% 74.0%
62.4%
67.3% 69.8%
30.3% 29.3%
34.7% 32.9%
21.6%
27.8% 30.3%
0%
20%
40%
60%
80%
100%
2007 2008 2009 2010 2011 2012 2013
Continuous Non-continuous
In Manitoba, the percentage of seven year olds considered complete
for age was substantially higher for continuous residents in
comparison to non-continuous residents.
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MANITOBA ANNUAL IMMUNIZATION SURVEILLANCE REPORT, 2012 and 2013
Figures 38 and 39 show, for seven year old children, all RHAs had higher complete for
age rates for continuous resident rates compared to non-continuous resident rates.
Winnipeg RHA experienced a large difference between continuous and non-continuous
resident rates while Northern RHA experienced only a small difference.
Figure 38: Continuous Resident Status by RHA, Age 7
Percent of children who are complete for age, 2012, 2013 & 5-year average (2007-2011)
Figure 39: Non-Continuous Resident Status by RHA, Age 7
Percent of children who are complete for age, 2012, 2013 & 5-year average (2007-2011)
73.3%
77.2%
63.0%
65.4%
70.3%
69.8%
61.9%
76.3%
61.9%
65.9%
67.7%
67.3%
64.2%
80.7%
70.1%
76.2%
71.5%
72.6%
0% 20% 40% 60% 80% 100%
Northern
Prairie Mountain
Interlake-Eastern
Southern
Winnipeg
MANITOBA
2007-2011 2012 2013
68.1%
50.2%
36.5%
47.1%
19.3%
30.3%
53.8%
45.4%
32.5%
42.5%
17.0%
27.8%
54.2%
45.2%
35.4%
52.1%
16.1%
29.8%
0% 20% 40% 60% 80% 100%
Northern
Prairie Mountain
Interlake-Eastern
Southern
Winnipeg
MANITOBA
2007-2011 2012 2013
In Manitoba, for seven year olds, all RHAs experienced a higher
complete for age rates among continuous residents as compared to
non-continuous residents in both 2012 and 2013.
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MANITOBA ANNUAL IMMUNIZATION SURVEILLANCE REPORT, 2012 and 2013
Section D: Overview of All Immunization Rates by RHA, Age 7 Table 7: Counts and Percentages for All Immunogens by RHA, Age 7, 2012, 2013 & 5-year average
Note. Hib = haemophilus influenzae type b; Pneu-C-13 = pneumococcal conjugate 13 valent; Men-C-C = meningococcal C conjugate.
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MANITOBA ANNUAL IMMUNIZATION SURVEILLANCE REPORT, 2012 and 2013
Immunizations at Age 11
Section A: Immunizations in Manitoba Table 8: Recommended Immunization Schedule, Age 11
Vaccine Age
Grade 4
Men-C-C
Meningococcal C Conjugate ♦
Hepatitis B ♦ ♦ ♦
♦ A single dose given with one needle.
At age 11, Manitoba’s universal childhood immunization program provides protection
against the bacterial pathogen meningococcal type C and the viral infection of hepatitis
B. The immunization status of children at age 11 in 2012 represents those who were born
in 2001 and who turned 11 years old in 2012 (2001 birth cohort); the immunization status
of children at age 11 in 2013 represents those who were born in 2002 and who turned 11
years old in 2013 (2002 birth cohort). The data reported is for children who received all
of the scheduled doses, as shown in Table 8, in addition to the doses recommended at
earlier ages.
In order to be considered complete for age at 11 years, children need to have five doses
of diphtheria, tetanus, and pertussis; four doses of polio; three doses of hepatitis B; two
doses of measles; and one dose of mumps, rubella, varicella and Men-C-C (for an
overview of immunogens required to be complete for age, refer to Table 1). In 2004,
MHHLS began publicly-funding the Men-C-C vaccine for all children in grade 4; then in
2009, the Men-C-C vaccine began being offered to infants at 12 months. Only one dose of
Men-C-C is currently recommended to be considered complete for age at 11 years.
Furthermore, Manitoba’s Hepatitis B Immunization Program was introduced in 1998 for
children born on or after January 1, 1989. A total of three doses of hepatitis B are required
by age 11 to be considered complete for age.
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MANITOBA ANNUAL IMMUNIZATION SURVEILLANCE REPORT, 2012 and 2013
Manitoba Immunization Rates, Age 11 Figure 40 shows the percentage of 11 years old children in Manitoba who are complete
for age in 2012, 2013, and 5-year average of 2007-2011 by RHA. This percentage is
calculated with a denominator of all 11 year olds, in Manitoba, with active MHHLS PHINs
(n2012=15,805 and n2013=15,725), and a numerator containing all the children who
received the required vaccinations (n2012=3,923 and n2013=4,340).
In Manitoba, 24.8% and 27.6% of age 11 children received the vaccines available to them
to be considered for complete for age (in 2012 and in 2013, respectively). The 2012 and
2013 complete for age rates are about half the 5-year average (2007-2011) rate (53.2%). This could be due to that, in 2012 and 2013, one dose of varicella was a requirement to be
considered complete for age at 11 years while receiving varicella was not a requirement
for complete for age definition during 2007 to 2011.
The percentage of children considered complete for age at 11 years varied by RHA; in
both 2012 and 2013, Prairie Mountain RHA had the highest percentage of children
vaccinated (32.8% and 36.0%, respectively) whereas Northern RHA had the lowest
(20.7% and 22.8%).
Figure 40: Manitoba Immunization Rates by RHA, Age 11
Percent of children who are complete for age by RHA, Age 11, 2012, 2013 & 5-year average (2007-
2011)
22.8%
36.0%
27.6%
24.3%
27.5%
27.6%
20.7%
32.8%
28.5%
23.7%
23.4%
24.8%
47.2%
67.5%
54.1%
60.5%
48.2%
53.2%
0% 20% 40% 60% 80% 100%
Northern
Prairie Mountain
Interlake-Eastern
Southern
Winnipeg
MANITOBA
2007-2011 2012 2013
In Manitoba, fewer than 3 out of 10 eleven year olds received the
vaccines available to them to be considered for complete for age in both
2012 and 2013.
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MANITOBA ANNUAL IMMUNIZATION SURVEILLANCE REPORT, 2012 and 2013
Section B: Immunization Rates by RHA, Age 11
Figure 41 shows that the complete for age 11 rates for Men-C-C were slightly higher than
those for hepatitis B in both 2012 and 2013; this is because only one dose of Men-C-C was
required to be considered complete for age 11 while three doses of hepatitis B were
required. The complete for age rates for 2012 and 2013 were similar within each
immunogen. For Men-C-C, the complete for age rates were 77.4% in 2012 and 78.7% in
2013. For hepatitis B, the corresponding rates were 70.6% in 2012 and 71.8% in 2013.
Figure 41: Manitoba Immunization Rates by Immunogens, Age 11
Percent of children who are complete for age for Meningococcal C Conjugate and Hepatitis B, 2012,
2013 & 5-year average (2007-2011)
77.4% 70.6%
78.7% 71.8%
78.3%
72.5%
0%
20%
40%
60%
80%
100%
Meningococcal C Conjugate Hepatitis B
2012 2013 2007-2011
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MANITOBA ANNUAL IMMUNIZATION SURVEILLANCE REPORT, 2012 and 2013
Meningococcal C Conjugate Figure 42 presents the complete for age rates for meningococcal C conjugate
immunogen by RHA. In Manitoba, the complete for age rates by RHA ranged from 74.2%
(Southern RHA) to 83.5% (Prairie Mountain RHA) in 2012, and from 73.0% (Southern RHA)
to 84.8% (Prairie Mountain RHA) in 2013. With the exception of Winnipeg RHA and
Interlake-Eastern RHA, the complete for age rates at 11 years in 2012 and 2013 were
slightly lower than the previous 5-year average (2007-2011).
Figure 42: Meningococcal C Conjugate Immunization Rates by RHA, Age 11
Percent of children who are complete for age, 2012, 2013 & 5-year average (2007-2011)
MANITOBA ANNUAL IMMUNIZATION SURVEILLANCE REPORT, 2012 and 2013
Hepatitis B
In Manitoba, during 2012 and 2013, about 70% of 11 year olds received the hepatitis B
vaccine series (three doses) required to be complete for age (Figure 43). The complete for age rates in 2012 ranged from 58.0% (Northern RHA) to 78.1% (Prairie Mountain
RHA). Similarly, the complete for age rates for hepatitis B in 2013 ranged from 61.3%
(Northern RHA) to 77.8% (Prairie Mountain RHA).
Figure 43: Hepatitis B Immunization Rates by RHA, Age 11
Percent of children who are complete for age, 2012, 2013 & 5-year average (2007-2011)
* (November 2012) HPV vaccine publicly-funded for females 18 to ≤ 26 years of age with an increased risk of HPV
infection, as determined by a health care provider. ** (July 2012) Tdap is publicly-funded for adults due for a Td booster who have never received an acellular Pertussis
vaccine; OR, primary caregivers of newborn infants who have never previously received an acellular Pertussis vaccine,
regardless of when their last Td vaccine was given.
***Influenza vaccine is offered to all Manitobans.