Similar vaccines from different manufacturers are routinely authorized for use in Canada. Circumstances such as vaccine shortages, contraindication to a specific vaccine, changes in product availability, or migration across jurisdictions may necessitate giving vaccines from different manufacturers to the same individual over time. Because immunization schedules and specific products used vary across provinces and territories and among countries, questions about vaccine interchangeability may arise when evaluating the immunization status of persons new to Canada or people who have moved between jurisdictions.
The following recommendations for vaccine interchangeability are applicable only to vaccines with the same indications and authorization for use in the same populations.
The routine primary immunization series of diphtheria toxoid, tetanus toxoid, pertussis, poliomyelitis, Haemophilus influenzae type b-containing vaccine should be completed with an appropriate combination vaccine from the same manufacturer whenever possible. However, if the original vaccine is unknown or unavailable, an alternative combination vaccine from a different manufacturer may be used to complete the primary series. On the basis of expert opinion, an appropriate product from any manufacturer can be used for booster doses. Refer to vaccine-specific chapters in Part 4 for additional information.
Monovalent hepatitis A (HA) vaccines may be used interchangeably. Any HA-containing vaccine indicated for the age of the vaccine recipient will provide an effective booster dose after a first dose of vaccine from a different manufacturer. Refer to Hepatitis A Vaccine in Part 4 for additional information.
Monovalent hepatitis B vaccines may be used interchangeably, using the dosage and schedules recommended by the manufacturer for the vaccine recipient’s age group. Hepatitis A and hepatitis B combination vaccine can be used to complete the hepatitis B primary series. Refer to Hepatitis A Vaccine and Hepatitis B Vaccine in Part 4 for appropriate schedules.
Whenever possible, the same Human papillomavirus (HPV) vaccine should be used to complete the vaccine series. If the vaccine used for previously received doses is not known, any of the HPV vaccines authorized for use in Canada may be used to complete the series. All HPV vaccines provide protection against HPV types 16 and 18, and will likely achieve protective antibody levels against these HPV types if the vaccines are interchanged. HPV2 vaccine is not authorized for use in boys and men. Refer to Human Papillomavirus Vaccine in Part 4 for additional information.
If a child (aged less than 9 years) requires 2 doses of influenza vaccine in the same influenza season, it is preferable to use the same type of vaccine (trivalent inactivated [TIV], quadrivalent inactivated [QIV], or live attenuated influenza [LAIV]) for both doses. However, if the child is eligible for TIV, QIV or LAIV, and the type of vaccine used for the first dose is not available; TIV, QIV or LAIV may be used for the second dose. If the vaccine provider administers TIV or QIV for both doses, vaccines from different manufacturers can be used for the first and second dose.
On the basis of expert opinion, the measles-mumps-rubella (MMR) vaccines authorized for use in Canada may be used interchangeably.
There are no published data regarding the interchangeability of monovalent meningococcal conjugate vaccines, but the vaccines have been safely interchanged without a noticeable decrease in efficacy. When possible, the infant series should be completed with the same vaccine. Any of the quadrivalent meningococcal conjugate vaccines may be used for re-vaccination when indicated, regardless of which meningococcal vaccine was used for initial vaccination. Refer to Meningococcal Vaccine in Part 4 for additional information.
For routine infant immunization, pneumococcal conjugate 13-valent (Pneu-C-13) vaccine is the product of choice. Infants who have started an immunization schedule with a vaccine containing fewer serotypes should have their series completed with Pneu-C-13 . Refer to Pneumococcal Vaccine in Part 4 for additional information.
Wherever possible, a rabies vaccine series should be completed with the same product. However, if it is not feasible, rabies vaccines are considered interchangeable. People who require a booster dose of rabies vaccine for pre-exposure prophylaxis can be given either formulation of rabies vaccine, regardless of the vaccine used for the initial vaccination series.
There are no data on safety, immunogenicity, or efficacy when monovalent rotavirus (Rot-1) vaccine is administered as the first dose and pentavalent rotavirus (Rot-5) vaccine is used as the second dose or vice versa. Given that the two vaccines differ in composition and schedule, the vaccine series should be completed with the same product whenever possible. However, in the event that the product used for a previous dose(s) is unknown, the series should be completed with the available product. If any dose in the series was Rot-5 vaccine, a total of 3 doses of vaccine should be administered.
For a 2 dose schedule, it is recommended that the same manufacturer’s univalent varicella vaccine or measles-mumps-rubella-varicella (MMRV) vaccine be used to complete the schedule, unless there are unavoidable barriers (for example, the vaccine used for the first dose is not available). All varicella-containing vaccines authorized for use in Canada contain the Oka strain of live attenuated varicella virus. Refer to Varicella (Chickenpox) Vaccine in Part 4 for additional information.
Ideally, as new vaccines become available, clinical trials should be conducted evaluating interchangeability with existing products. To date, most of the available information regarding vaccine interchangeability has been gathered as a result of vaccine shortages or new product purchases resulting from negotiation of new contracts. Given the importance of this issue and the limited data available regarding the interchangeability of vaccines, further research in this area should be encouraged.