Health Professionals Update – Vol. 19, No. 14

April 30, 2026

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

In this issue

Enhanced monitoring of Chikungunya live attenuated vaccine Adverse Events Following Immunization (AEFIs).
Management of brain-heart multimorbidity: a clinical practice guideline by the Canadian Cardiovascular Harmonized National Guideline Endeavour (C-CHANGE).
Reminder: Transition to email only delivery of HPUs.

Key messages

Health care providers are requested to report AEFIs for the chikungunya live attenuated vaccine (CHIK-LAV).
A new clinical practice guideline integrates cardiovascular, neurologic, and mental health evidence for managing brain–heart comorbidity.
Influenza, pneumococcal and shingles vaccination should routinely be offered, especially to people aged 65 and over, to help prevent stroke, heart attack, and vascular cognitive impairment.

Enhanced monitoring of Chikungunya live attenuated vaccine Adverse Events Following Immunization (AEFIs)

On April 1, 2026, Public Health Ontario issued an enhanced surveillance directive for adverse events following immunization (AEFI) related to the chikungunya live attenuated vaccine (CHIK-LAV).

To support vaccine safety surveillance, health care providers are requested to report any suspect AEFIs for CHIK-LAV to Peel Public Health as soon as possible by fax 905-565-0426.

CHIK-LAV (trade name IXCHIQ) is a single-dose live attenuated vaccine authorized for use in Canada. It is not publicly funded in Ontario and is available through private purchase.
The Committee to Advise on Tropical Medicine and Travel (CATMAT) in Canada advises that the vaccine may be considered following an individualized assessment for people aged 18 to 64 years who are at high risk of infection (e.g., travel to an area experiencing a chikungunya outbreak). Travellers 65 years of age and older are not recommended to be vaccinated.
Post-marketing surveillance has identified serious AEFIs with CHIK-LAV in Europe, the United States, and Canada, mostly among persons 65 years or older and those with pre-existing health conditions. Reported serious adverse events have included hospitalizations with chikungunya-like illness and three deaths, including one death directly attributable to the vaccine.
CHIK-LAV AEFIs are being closely monitored nationally by the Public Health Agency of Canada (PHAC) and Health Canada as well as globally.

Management of brain-heart multimorbidity

A clinical practice guideline by the Canadian Cardiovascular Harmonized National Guideline Endeavour (C-CHANGE)

Published in the Canadian Medical Association Journal (CMAJ), the brain-heart guideline is the first to combine evidence from cardiology, neurology and mental health research to guide care for people living with both heart and brain conditions, a common reality for patients with chronic disease.

A practical recommendation for primary care professionals, subspecialists, allied health teams, and patients with cardiovascular risk factors include the following:

Routinely offering influenza, pneumococcal and shingles vaccination, especially to people 65 years and older, to help prevent stroke, heart attack, and possibly dementia.

For additional information:

Publicly funded immunization programs for adults 65 years and older

Influenza
One dose every fall.

Pneumococcal (Prevnar 20)

Individuals 65 years and older.
1 dose only for those that have not previously received Pneumovax-23.

Shingles (Shingrix)

Individuals 65 to 70 years of age.
2-dose series should be completed prior to 71st birthday.

For additional information: Publicly Funded Immunization Schedules for Ontario

Reminder: Transition to email only delivery of HPUs

As part of our commitment to improving efficiency and reducing reliance on fax technology, we are gradually transitioning to email-only delivery of Health Professionals Updates (HPUs).

What this means for you

If you have already provided consent to receive HPUs by email, no action is required.
If you have consented to receive HPUs by both fax and email, starting June 2026, HPUs will be sent by email only.
If you receive HPUs by fax only, provide us with an email address to ensure you continue receiving these important updates.
- Send the full name you used to sign up and email address to healthprofessionals@peelregion.ca.
- HPUs will continue to be sent by fax while we support the transition to email.
- If we do not receive an email address from you, you will no longer be able to receive HPUs via fax after December 2026.

Contact us

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

More information:

For questions about this update, email healthprofessionals@peelregion.ca