Health Professionals Update – Vol. 19, No. 1

From:
Dr. Hetal Patel, MD, MPH, CCFP, FRCPC, Associate Medical Officer of Health

In this issue

• Immunization of School Pupils Act (ISPA)
• Reminders about meningococcal, varicella and polio vaccines

Key messages 

• Suspension orders are being mailed to students in Grades 2 to 6 and Grades 9 to 12 who have not submitted updated immunization records.
• Men-C-ACYW135 (Menactra/NIMENRIX/ MenQuadfi) can be ordered for overdue high school students. High school students should not be charged for the vaccine.
• Students with past varicella infection may seek a medical exemption or vaccination.
• Reminder: Polio is not enforced under ISPA for the 2025-2026 school year, continue assessing OPV history.
• Anticipate increased vaccine demand, review your supply and order accordingly.

Immunization of School Pupils Act (ISPA)

Suspension orders are being mailed to students in Grades 2 to 6 and Grades 9 to 12 who have not submitted updated immunization records as outlined in the Immunization of School Pupils Act (ISPA). These orders will be issued from January through April 2026.

Immunization requirements align with the Publicly Funded Immunization Schedules in Ontario. The minimum age and spacing between doses must be followed to meet the ISPA requirements.

If a student presents with a suspension order

• Check your records for the student’s immunization history. If the student has already received the vaccines listed on the form, provide this information to the parent or guardian.
• If the student has not received the vaccines, administer the vaccines and provide documentation to the parent or guardian.
• Remind parents and guardians to report their child's vaccinations online or by calling Peel Public Health at 905-799-7700 or toll free at 1-888-919-7800.

Vaccines received out of Ontario should be considered valid if there is written documentation of administration of vaccine at ages and intervals comparable with the Ontario Publicly Funded Schedule. The record for these vaccines should be in English or translated by you, your patient or a relative to be considered valid.

ISPA reminders

Meningococcal vaccine requirements

Students in JK to Grade 6 require one dose of Men-C-C vaccine (Menjugate/NeisVacC). Routinely given on or after their first birthday.

Students in Grades 7 to 12 require one dose of Men-C-ACYW135 (Menactra/NIMENRIX/MenQuadfi). Routinely given in Grade 7 as part of the school vaccination program. 

If the individual is immunized with Men-C-ACYW, in or after Grade 7, Men-C-C is no longer recommended.

Peel physicians can order Men-C-ACYW135 (Menactra/NIMENRIX/MenQuadfi) for high school students who received a letter indicating that Men-C-ACYW is overdue. They should not be charged for the vaccine.

Varicella requirements

Students born on or after January 1, 2010, require 2 doses of varicella vaccine:

• First dose routinely given at 15 months.
• Second dose routinely given as MMRV at 4 to 6 years.

Students with a history of varicella infection can:

• Submit a medical exemption with documentation from a healthcare provider (diagnosis after 12 months of age) or serology results.
• Receive 2 doses of the varicella vaccine.

Children who had a varicella infection before 12 months require 2 doses of vaccine due to the higher risk of reinfection. Parents can contact 905-799-7700 or 1-888-919-7800 (toll free) for information on medical exemptions.

Updated polio vaccine guidance for children with oral polio vaccine (OPV) history

As shared in September 9, 2025, Vol. 18, No. 23, there is updated guidance related to OPV history. Polio is not included in ISPA enforcement for the 2025-2026 school year.

Polio immunization recommendations

• Continue to review the student’s polio immunization history even if polio is not listed in the screening letter.
• Presume that any recorded doses of OPV administered on or after April 1, 2016, are invalid.
• Administer an age-appropriate series of IPV or IPV-containing vaccine, which covers all three poliovirus types as per the Publicly Funded Immunization Schedules for Ontario.

Preparing for increased vaccine demand

A significant increase in demand for routine vaccines is expected through the end of the school year. Ensure you have at least a one-month supply on hand. Continue to monitor your vaccine inventory and refrigerator capacity closely, and place orders as needed to maintain adequate stock. Order vaccines.

Contact us

The Health Professionals Update (HPU) is distributed to physician offices in Peel region via fax or email. Share this update with other health professionals in your clinic.

More information:

• Review past HPUs.
• Subscribe to HPU emails.
• For questions about this update, email us.