WHY ARE VACCINES IMPORTANT TO ENABLE HEALTHY AGEING?
Vaccines are important throughout your life, and especially as you get older, to maintain your health and independence.
YOUR IMMUNITY NATURALLY WEAKENS AS YOU AGE
As you grow older, your immune system naturally weakens, putting you at an increased risk of severe outcomes from infectious diseases.
VACCINATION HELPS PREPARE YOUR BODY TO FIGHT VACCINE-PREVENTABLE INFECTIONS
When a new virus or bacteria enters your body for the first time, it takes a while for your immune system to be able to fight it. Vaccines tell your immune system how to prepare for viruses or bacteria, allowing your body to respond more quickly before an infection causes more serious problems.
VACCINATION HELPS YOU PROTECT OTHERS
When more people are vaccinated, it makes it difficult for viruses or bacteria to spread and infect others. This helps protect those who are not able to get vaccinated and those whose bodies can’t develop a strong immune response to a vaccine.
VACCINES HAVE ELIMINATED CERTAIN DEADLY DISEASES
Vaccines have worked so well that we have been able to eliminate certain conditions in Canada. For example, Canadians no longer need to be vaccinated against smallpox.
YOUR ACQUIRED PROTECTION CAN WEAKEN OVER TIME
Over time, the protection vaccines provide may decrease for certain infectious diseases. Receiving booster doses can help strengthen your immunity against them.
VACCINES ARE A SAFE OPTION
Vaccines go through a lot of testing and are consistently monitored, which means they are very safe! Side effects are usually mild and only last a few days.
WHICH VACCINES ARE IMPORTANT FOR OLDER CANADIANS?
In order to allow you to maintain your independence and promote healthy ageing, it is recommended that you get vaccinated against the following infectious diseases:
- COVID-19
- Influenza (flu)
- Respiratory Syncytial Virus (RSV)
- Pneumococcal disease (pneumonia)
- Shingles
- Tetanus and diphtheria
If you are planning on travelling, you may benefit from getting vaccinated against additional diseases (e.g., hepatitis A & B, yellow fever or rabies).
You should discuss your need for different vaccine options with your health care provider as they will be able to determine which vaccines are needed and the best time to administer them.
TIP: It might be a good idea to use your birthday as a reminder to check in with your primary health care provider about what vaccines and other preventable health measures you might be eligible for!
HOW MANY OLDER CANADIANS HAVE RECEIVED THEIR RECOMMENDED VACCINES?
One of Canada’s national vaccination coverage goals is to ensure that at least 80% of older Canadians have received both the pneumococcal vaccine and the annual flu shot. According to the latest Canadian Health Survey on Seniors, current vaccination rates remain far too low among older Canadians:
COVID-19 VACCINE
WHAT IS COVID-19?
COVID-19 is an infectious disease that is caused by the SARS-CoV-2 virus. Some of the common symptoms include runny nose, sneezing, sore throat
and headaches.
Older adults may present with symptoms differently (e.g., fever with lower temperatures) or have less common symptoms (e.g., nausea, congestion,
diarrhea, vomiting, falls, dehydration and delirium).
COVID-19 infection can lead to severe symptoms, including difficulty breathing or severe shortness of breath. If you experience these symptoms,
seek medical attention.
WHY SHOULD I GET THIS VACCINE?
The risk of hospitalization for severe illness and death from COVID-19 is significantly higher among older adults, with those aged 60 years and older
accounting for 92% of Canada’s COVID-19 deaths to date.
The new COVID-19 vaccines are expected to provide a better response against current SARS-CoV-2 strains, compared to earlier vaccines, and improve protection against severe disease that might have reduced since a person’s last COVID-19 vaccination or SARS-CoV-2 infection.
WHICH VACCINES ARE RECOMMENDED?
Canada’s National Advisory Committee on Immunization (NACI) recommends older Canadians receive one dose of the new XBB.1.5-
containing mRNA COVID-19 vaccine (Moderna or Pfizer-BioNTech). The table on the next page notes when it is recommended to receive the one
dose of the new XBB.1.5-containing mRNA COVID-19 vaccine, based on vaccination and infection history.
Individuals who are immunocompromised are recommended to receive between one to two doses of the new XBB.1.5-containing mRNA COVID-19 vaccine, based on their previous COVID-19 vaccination status. These individuals may also be given doses sooner after a recent COVID-19 vaccination or infection.
UPDATE: Starting in the spring of 2024, NACI recommends older Canadians, individuals who are immunocompromised, adult residents of long-term care homes and other congregate living settings for older adults may recieve an additional dose of XBB.1.5-containing mRNA COVID-19 vaccine.
The Moderna and Pfizer-BioNTech mRNA vaccines are the preferred COVID-19 vaccines, with the original Novavax vaccine recommended to be used for those who are unwilling or unable to receive mRNA vaccines. The Novavax XBB.1.5-containing COVID-19 vaccine approved in December 2023 is currently under review by NACI so that they can provide further guidance on how to best use this vaccine.
HOW MUCH DO THESE VACCINES COST?
COVID-19 vaccines are available free of charge to all Canadians.
WHERE DO I GET THIS VACCINE?
Depending on your province or territory, vaccines are widely available through public health clinics, primary care and some speciality care clinics, pharmacies and hospitals. COVID-19 vaccines can be safely given at the same time, or at any time before or after other vaccines. Please talk to your health care provider to learn more.
INFLUENZA (FLU) VACCINE
WHAT IS INFLUENZA?
Influenza infections can occur throughout the year, but are more common during “flu season,” which typically occurs over the fall and winter from November to April.
Symptoms can include fever, headache, muscle aches, fatigue, sore throat, chills, coughing and loss of appetite. Most people recover within seven to 10 days, but some may experience more serious outcomes such as worsening of medical conditions, hospitalization or death.
WHY SHOULD I GET THIS VACCINE?
Older Canadians are more likely to experience serious outcomes (e.g., pneumonia, heart attack and death). Other high-risk populations include those
living with chronic health conditions, pregnant people, people living in longterm care homes or other chronic care settings, and Indigenous peoples. Together with pneumonia, influenza ranked as the eighth-leading cause of death in Canada, with 90% of these deaths occurring among an estimated
5,375 older Canadians in 2022.
WHICH VACCINES ARE RECOMMENDED?
There are eight influenza vaccines available for older Canadians across two categories: inactivated influenza vaccines (IIV) and a recombinant
influenza vaccine (RIV). Most of these vaccines protect against four strains of influenza, with the IIV having different vaccine options, standard dose
influenza vaccines, or enhanced influenza vaccines e.g., Fluzone High-Dose Quadrivalent (high-dose) or Fluad (adjuvant included). There is only one RIV available, Supemtek, which is also an enhanced influenza vaccine.
NACI recommends Canadians get the influenza vaccine each year as the specific strains in the vaccines often change each year to better match the current influenza viruses and our body’s immune response may not persist beyond a year.
NACI recommends that older adults should be offered one of the three enhanced influenza vaccines: Fluzone High-Dose Quadrivalent, Fluad or Supemtek. These vaccines provide an increased benefit without any difference in safety. If these vaccines are not available, any of the other influenza vaccines should be used.
HOW MUCH DO THESE VACCINES COST?
Not all vaccines may be available in your region; however, the ones that are available are provided free of charge to all older adults. Alberta, Manitoba, New Brunswick, Nova Scotia, Ontario, Prince Edward Island, Saskatchewan and Yukon provide Fluzone High-Dose Quadrivalent free of charge for community-dwelling older adults. British Columbia and Ontario provide Fluad free of charge for community-dwelling older adults. Across the rest of Canada, the Fluzone High-Dose Quadrivalent and Fluad enhanced vaccines are mostly available as an out-of-pocket expense, although some specific groups may have coverage. Supemtek is only available as an out-of-pocket expense in Canada.
WHERE AND WHEN DO I GET THIS VACCINE?
Depending on your province or territory, flu shots are available at primary care and some speciality care clinics, pharmacies or public health clinics. Even though you can get the influenza vaccine any time during the fall/winter season, every older Canadian should try to receive their annual dose as early in the season as possible. Most influenza vaccines can be safely given at the same time, or any time before or after other vaccines are given. Please talk to your health care provider to learn more.
RSV VACCINE (NEW IN 2023)
WHAT IS RESPIRATORY SYNCYTIAL VIRUS (RSV)?
RSV is a virus that infects people’s airways and lungs, causing infection in the upper and lower parts of their respiratory systems. The transmission of
RSV infections in Canada follows a seasonal winter pattern, beginning in October/November and ending in April/May.
RSV infections generally cause a mild illness with cold-like symptoms (e.g., runny nose, coughing, sneezing, wheezing, fever, decrease in appetite and
energy). Individuals usually recover in one to two weeks, but complications can include lower respiratory tract disease (e.g., pneumonia), worsening of
health conditions, hospitalizations and deaths.
As individuals only develop temporary immunity against RSV, one may experience repeat RSV infections at any age.
WHY SHOULD I GET THIS VACCINE?
Groups at risk for severe outcomes from RSV infections include older adults, individuals with chronic lung disease, heart disease, compromised
immune systems and those living in long-term care settings. Among adults, hospitalization rates have been found to be higher as age increases, with
annual rates being eight times higher among individuals 80 years and older when compared to the overall rate.
Older adults have the highest mortality rate attributable to RSV infections, more than six times higher than the overall mortality rate. Similar to
influenza and COVID-19, 85% of deaths among hospitalized patients with RSV were among older adults.
WHICH VACCINES ARE RECOMMENDED?
There is currently one RSV vaccine, Arexvy, available in Canada for adults 60 years and older.
While NACI recommendations will not be released until 2024, the United States Centers for Disease Control and Prevention Advisory Committee on Immunization Practices (CDC ACIP) recently recommended that adults 60 years and older may receive one dose of RSV vaccines, based on an informed decision-making process between individuals and their health care providers.
HOW MUCH DO THESE VACCINES COST?
Currently, these vaccines are only available as an out-of-pocket expense in Canada, apart from Ontario which funds Arexvy for adults 60 years and older living in long-term care homes, Elder Care Lodges and for certain retirement home residents. If you have a private drug plan, it may cover the cost of this vaccine.
WHERE AND WHEN DO I GET THIS VACCINE?
Depending on your province or territory, vaccines are being made available through primary care and some speciality care clinics and pharmacies. Please speak to your health care provider about which vaccines may be given at the same time.
PNEUMOCOCCAL VACCINE
WHAT ARE PNEUMOCOCCAL DISEASES?
Pneumococcal diseases are a group of diseases caused by the bacteria called Streptococcus pneumoniae (S. pneumoniae). They may cause
infections of the lungs, ear, sinuses and more rarely the bloodstream or central nervous system.
Pneumonia, a lung infection, is the most common serious form of pneumococcal disease. Symptoms may include difficulty breathing,
coughing, fever, sweating, chills, fatigue, nausea and vomiting, chest pain, faster than normal heartbeat, confusion or delirium, lower than normal body temperature and diarrhea. Thousands of mostly older Canadians experience more serious outcomes.
WHY SHOULD I GET THIS VACCINE?
Older Canadians are at a higher risk of severe outcomes, making up the majority of pneumonia-related hospitalizations and deaths each year in Canada. Other groups that are at higher risk include those living with certain chronic conditions (e.g., heart disease, lung disease, liver disease or diabetes), those who are immunocompromised (e.g., HIV infection, transplant recipients), and with certain behavioural/social factors (e.g.,
smoking, homelessness).
Together with influenza, pneumonia ranked as the 10th leading cause of death in Canada in 2021.
WHICH VACCINES ARE RECOMMENDED?
There are two types of pneumococcal vaccines administered in Canada:
– Pneumococcal polysaccharide vaccine (PPV23)
– Pneumococcal conjugate vaccine (PCV10, PCV13, PCV15, PCV20)
The number within each vaccine’s name indicates how many types of S. pneumoniae bacteria it protects against.
NACI recommends all adults aged 65 years and older get the Prevnar 20 (PCV20) vaccine, regardless of whether or not they have previously received a pneumococcal vaccination. As an alternative, those who have never received a pneumococcal vaccination may get Vaxneuvance (PCV15) followed by Pneumovax 23 (PPV23) a year later.
For older adults who have received Pneumovax 23 alone or together with Prevnar 13 (PCV13), NACI recommends Prevnar 20 should be given after five years. For older adults who have received Prevnar 13 alone, NACI recommends Prevnar 20 may be given after one year.
NACI still supports the continued use of Prevnar 13 and Pneumovax 23 in adults only when Vaxneuvance and/or Prevnar 20 are unavailable or inaccessible.
HOW MUCH DO THESE VACCINES COST?
The Pneumovax 23 vaccine is provided free of charge to all adults aged 65 years and older across Canada, with the Prevnar 13 vaccine varying in coverage. The Vaxneuvance and Prevnar 20 vaccines are currently only available as an out-of-pocket expense in Canada, apart from Quebec which funds Prevnar 20 for specific high-risk groups. If you have a private drug plan, it may cover the cost of this vaccine.
WHERE AND WHEN DO I GET THIS VACCINE?
Depending on your province or territory, vaccines are available at primary care and some speciality care clinics, pharmacies or public health clinics. Pneumococcal vaccines can be safely given at the same time with some of the other vaccines discussed in this pamphlet. Please talk to your health care provider to learn more.
SHINGLES VACCINE
WHAT IS SHINGLES?
Shingles (herpes zoster) is an infection caused when the chickenpox virus is reactivated. Shingles infection often presents as a painful, blistering rash,
accompanied by headache and fever.
Beyond these symptoms, people can also experience serious outcomes, including prolonged, severe pain known as post-herpetic neuralgia which
lasts for more than 90 days and sometimes for years. Other complications can include nerve paralysis, vision loss and problems with hearing or balance.
WHY SHOULD I GET THIS VACCINE?
Anyone who has had chickenpox can develop shingles. However, most cases occur in those older than 50 years of age and often present more severely in this age group. Other high-risk groups include those who have weakened immune systems or are living with chronic conditions.
WHICH VACCINES ARE RECOMMENDED?
There is currently one shingles vaccine, Shingrix, available in Canada. The Shingrix vaccine requires two doses, which are recommended to be given across a two- to six-month period.
In clinical trials, the Shingrix vaccine has demonstrated over 90% efficacy in preventing shingles among adults aged 50 years and older.
NACI recommends that Canadians aged 50 years and older get the Shingrix vaccine, including those who have been previously vaccinated with the older Zostavax II vaccine and those who have had a previous episode of shingles.
HOW MUCH DO THESE VACCINES COST?
Alberta, Ontario, Prince Edward Island, Quebec, Yukon, the First Nations Health Authority in British Columbia and federal government programs for First Nations and Inuit peoples, veterans and those in custody, currently provide the Shingrix vaccine free of charge for certain older and other high-risk populations.
If you have a private drug plan, it may cover the cost of this vaccine.
WHERE AND WHEN DO I GET THIS VACCINE?
Depending on your province or territory, the Shingrix vaccine is available at primary care and some speciality care clinics, pharmacies or public health clinics. The Shingrix vaccine can be safely given at the same time with most of the other vaccines discussed in this pamphlet. Please talk to your health care provider to learn more.
TETANUS AND DIPHTHERIA VACCINE
WHAT ARE TETANUS AND DIPHTHERIA?
Both tetanus (lockjaw) and diphtheria are rare but severe diseases that can be fatal.
Tetanus causes painful muscle spasms and difficulty swallowing, which can later lead to serious outcomes (e.g., fractures, death).
Diphtheria can cause numerous symptoms including mild fever, trouble swallowing, skin infections, sore throat, uneasiness and loss of appetite. At times these can lead to serious outcomes impacting the entire body, including central nervous system effects and heart failure.
WHY SHOULD I GET THIS VACCINE?
Infants and older adults are more likely to have severe outcomes from these diseases, with those aged 60 years and older having the highest risk of
death from tetanus.
It has also been found that the level of protection against these diseases decreases over time after vaccination, highlighting the need to receive additional doses as we age.
WHICH VACCINES ARE RECOMMENDED?
In Canada, vaccines for tetanus and diphtheria are not given separately, but together in one dose.
NACI recommends that fully immunized adults receive a booster dose of the tetanus and diphtheria (Td) vaccines every 10 years.
For those who have not been immunized in adulthood, one dose of the Tdap vaccine (which also protects against pertussis [whooping cough]) is recommended first. For adults who have never received these vaccines at all, one dose of the Tdap-IPV vaccine (Tdap plus polio prevention), along with two doses of any Td-containing vaccine (e.g. Td, Tdap, Tdap-IPV) is recommended first. Your health care provider can help you determine the right sequence of vaccinations for you.
HOW MUCH DO THESE VACCINES COST?
Only some provinces and territories publicly fund the Td vaccines every 10 years. However, most of the jurisdictions provide coverage for the Tdap vaccines.
WHERE AND WHEN DO I GET THIS VACCINE?
Depending on your province or territory, vaccines are available at primary care and some speciality care clinics, pharmacies or public health clinics. These vaccines can be safely given at the same time with all of the other vaccines discussed in this pamphlet. Please talk to your health care provider to learn more.
HOW CAN I CHECK WHICH VACCINES I HAVE ALREADY RECEIVED?
1) Contact your primary health care provider as they should have a record of your vaccinations
2) Contact your local public health office where you received vaccinations as a child, as most maintain a registry
3) If you are not able to confirm your vaccination history, talk to your health care provider, as there are other ways to try to determine this
MAINTAINING A RECORD OF YOUR IMMUNIZATIONS
You can keep track of your vaccines through one of the following ways:
1) Download and print the next page. Ask your health care provider to log each vaccine you receive in this chart. Keep this record in a safe place with your other important health documents.
2) Ask your health care provider or public health office for a card or booklet to keep track of your immunizations
3) Use the FREE CANImmunize Website and App to track your vaccines through your computer, phone or tablet.
– Securely store and access your immunization record
– Receive reminders when to vaccinate
– Get facts about vaccination specific to your region
WHERE CAN I FIND MORE INFORMATION?
The Public Health Agency of Canada has created various public resources:
- Not Just for Kids: An Adult Guide to Vaccination
- Vaccines For Covid-19
- Flu (Influenza)
- Vaccine Safety and Possible Side Effects
- Vaccine Preventable Diseases (Causes, Symptoms, Risks, Treatment, etc.)
- Provincial and Territorial Routine Vaccination Programs for Healthy, Previously Immunized Adults
- Immunization Information (Websites and Schedules) by Province and Territory
AUTHORS
Dr. Samir K. Sinha, MD, DPhil, FRCPC, FCAHS, AGSF
Director of Geriatrics Sinai Health and University Health Network;
Director of Health Policy Research, National Institute on Ageing;
Professor, Departments of Medicine, Family and Community Medicine, Health Policy, Management and Evaluation, University of Toronto
Arushan Arulnamby, MPH
Policy Analyst, National Institute on Ageing, Toronto Metropolitan University
EXPERT REVIEWERS
We gratefully acknowledge our contributors who provided expert guidance on the content in this pamphlet.
Dr. Jennie Johnstone, MD, PhD, FRCPC
Medical Director, Infection Prevention and Control, Sinai Health;
Infectious Diseases Departmental Division Director, University of Toronto;
Associate Professor, Department of Laboratory Medicine and Pathobiology, University of Toronto
Ms. Sabina Vohra-Miller, MSc
Founder of Unambiguous Science
Modified: 2024-02
We would like to thank the following for their support of our Education Resources to Support Healthy Ageing Initiative