Immunization Reporting

Every time your child gets an immunization from their health care provider, you need to notify Public Health. Your health care provider does not report these records for you.

The Immunization of School Pupils Act requires that Public Health maintain the immunization records of all students in all grades at private, public and Catholic schools in Waterloo Region. For more information visit the School Immunization page.

Reporting immunizations

To report to Public Health, make sure you have an updated copy of your child's "yellow card" or a printout of your child's immunization record from their health care provider.

There are three ways you can report your child's immunizations. Please choose only one of the following methods:

Personal Health Information: By completing the online reporting form, you are consenting to the collection and use of your personal health information by Region of Waterloo Public Health and Emergency Services to maintain the provincial immunization database. For further information about this, please contact us at 519-575-4400.

Frequently asked questions about immunizations

I cannot update my child's record online using ICON

Possible reasons why you cannot access ICON

  1. Your child’s Health Card Number is not on file with Region of Waterloo Public Health
  2. Have you moved in the last five years? It could be that the postal code entered does not associate with the postal code registered on your child’s Health Card with Service Ontario

Possible solutions

  1. Fax the record to 519-885-7260
  2. Email the information to immunizationservices@regionofwaterloo.ca
  3. Call Region of Waterloo Public Health at 519-575-4400 ext. 5001 to obtain your child’s Ontario Immunization ID (OID) and to set-up a temporary pin in order to access ICON
I received a letter from Public Health

What is Immunization Surveillance?

Under the Immunization of School Pupils Act (ISPA) and Child Care and Early Years Act, children attending school and childcare in Ontario are required to be vaccinated against specific diseases or have a valid exemption.

Parents are required to report their child's immunization information to Public Health on an ongoing basis, if the child attends school or childcare in the Region of Waterloo. The information reported is stored in a confidential electronic province wide database called Panorama.

Every year, Region of Waterloo Public Health reviews the immunization records of all children attending childcare and schools in the Region of Waterloo to make sure the information is up-to-date. Updates on immunizations are crucial information to protect the health of children during an infectious disease outbreak, such as measles.

Why is Immunization Surveillance important?

Immunization is a simple and effective way to protect your child against vaccine preventable diseases. By maintaining an up to date record, Public Health can quickly determine which children are protected and which are at risk in the event of an outbreak.

Public Health can then take the necessary steps to protect everyone from vaccine preventable disease. Sometimes this means that children who are not adequately immunized must be excluded from school or childcare until the outbreak is over.

What does the Immunization Surveillance process look like?

  1. Upon enrolment in school, parents are asked to submit their child's immunization records to Public Health through online submission, phone, fax or email
  2. Public Health inputs immunization records into the provincial immunization database
  3. Records are screened for up-to date status or valid exemption on file
  4. Students/parents are notified if a record is not up-to-date with Public Health by a letter
  5. Several months later, Public Health will issue an Order of Suspension to students whose records are still not-up-to date or do not have a valid exemption on file
  6. Public Health will provide each principal with a list of students receiving an Order of Suspension
  7. Once a principal receives notification of an Order of Suspension for a student, the student MUST be suspended from attending school as of the date on the Order, until either 20 school days have elapsed, or the principal receives notice from Public Health that the Order has been cancelled

Why did I receive a letter from Region of Waterloo Public Health?

There are several common reasons for receiving a letter requesting that you update your child's immunization record:

  • Your child is missing one or more required vaccines and does not meet the Ontario immunization requirements for child care or for school attendance
  • Your child might be up to date with all of the required immunizations, however the most recent information has not been updated with Public Health. Schools and your family physician do not report this information to Public Health
  • Public Health does not have an immunization record for your child
  • Your child may have received invalid immunization doses that do not comply with the immunization requirement of Child Care and Early Years Act (CCEYA) or Immunization of School Pupils Act (ISPA)
  • Public Health has not received a Ministry approved standardized exemption form for your child to be exempted from receiving immunizations

What should I do next?

  1. Locate your child's immunization record - Find all the documents with your child's past immunization information. In Ontario, most children are given a yellow immunization booklet at the first immunization visit. However, any proof of immunization can help us update your child's record. This may require that you contact your child’s Health Care Provider
  2. Review the immunization information on the Letter - Box 1 lists the immunization information that is missing in your child’s record at Public Health or was given at a different time than recommended in the Ontario schedule. Box 2 lists the immunization information Public Health currently has on record for your child
  3. Update Public Health - If your child has received the missing immunization(s) indicated in Box 1 (and it is not listed in Box 2), simply update Public Health. If your child is missing the immunization(s) indicated in Box 1, make an appointment with your local Health Care Provider to receive the immunization(s) and update Public Health

Click here to update immunization records online or call 519-575-4400 ext. 5001.
Where can I have my child immunized? 
Your child can receive immunizations at:
  • Family Doctor's office / Health Care Provider. Call ahead of your visit to make sure that the vaccine is available.

Or at a:

Children, who are new to Canada, are International students or who do not have an Ontario Health Card can call Public Health at 519-575-4400 ext. 5003 to book an appointment.

If you need help in finding a family doctor, check out Health Care Connect to register.
My child does not have an Ontario Health Card (OHIP). How can I get my child immunized? 

Children, who are new to Canada, are International students or who do not have an Ontario Health Card can call Public Health at 519-575-4400 ext. 5003 to book an appointment.
I do not have a copy of my child’s immunization record. What are my options? 

If your child had immunizations in the past, contact your current or past health care providers and request a copy of their immunization record.

If you moved from another city, you may be able to contact your previous health unit to obtain the records that they have on file.

If your family doctor has retired, Contact the Ontario College of Physicians and Surgeons or call 416-967-2603.

If you do not have any records of your child's immunizations, it is recommended that your child complete a catch-up schedule. Re-immunization is not harmful and highly recommended. This will ensure that your child is adequately protected against vaccine preventable diseases.

For more information on the recommended schedule and catch up schedules, please visit the Publicly Funded Immunization Schedules for Ontario.
Why are my child’s records not automatically submitted to Public Health from my doctor or school? 

Under the Immunization of School Pupil’s Act, parent(s)/legal guardian(s) are responsible for updating Public Health every time their child receives an immunization.

Your child's health care provider and school are not mandated to report your child's immunization to Public Health. In some cases, your health care provider may tell you that your child's immunization is up-to date. However, the information may not have been reported to Public Health. It is recommended that you obtain a copy of the record and submit it to Public Health every time your child receives immunizations. 
Why is Public Health asking for a vaccine that my child has already received? 
Some immunizations that your child receives require multiple doses given at specific ages and intervals in order to develop adequate immunity. For this reason, Public Health may ask you for dates of immunizations administered several years ago. 
Why did I receive a suspension letter? My child received the required vaccine. 
There are several common reasons for receiving a suspension letter:

The immunization information has not been reported to Public Health. Parent(s)/legal guardian(s) are responsible for updating Region of Waterloo Public Health every time their child receives immunization.

The information you provided was submitted after the suspension orders were printed. A suspension order is automatically generated for your child if Public Health has not received the required information in time. Contact Public Health and speak with a nurse by calling 519-575-4400 ext. 5003.

Your information has not yet been processed. Please note that if you submit the requested information online or via fax, it can take up to five business days for the information to be processed and for your child's record to be updated. You can expect to receive a follow up phone call if your child's record is still not up-to-date. Otherwise, please contact Public Health and speak with a nurse by calling 519-575-4400 ext. 5003. 
What if I do not want my child to receive vaccines for philosophical reasons? 

In order to receive an exemption for non-medical reasons, parents/guardians must:

  1. Complete the immunization education session required by law and offered by Public Health to receive a certificate of completion; call Public Health to book an appointment
  2. Complete the Statement of Conscience or Religious Belief Form that is signed, and sworn or affirmed before a Commissioner for Taking Affidavits; and
  3. Return both the certificate of completion and the Statement of Conscience or Religious Belief form to Public Health
What if my child hasn’t been immunized due to health reasons? 
Book an appointment with your child’s Health Care Provider to obtain a legal medical exemption completed by a Medical Doctor (Physician) or Nurse Practitioner. 
Which immunizations are mandatory for child care centres and schools? 

Immunization requirements for child care registration

Upon registration at a licensed child care centre, parent(s)/guardian(s) must provide a copy of their child's immunization record to the child care provider and to Public Health (OPH).

Under the Child Care and Early Years Act, 2014 (CCEYA), children attending childcare in Ontario are required to be vaccinated against:

  • Diphtheria
  • Tetanus
  • Pertussis (Whooping Cough)
  • Polio
  • Haemophilus Influenza Type B (Hib)
  • Measles
  • Mumps
  • Rubella
  • Varicella (Chickenpox)
  • Invasive Pneumococcal Disease (IPD)
  • Meningococcal Disease

Visit our Immunizations and Vaccines page for more information.

Immunization requirements for school attendance

Under the Immunization of School Pupils Act (ISPA), children attending school in Ontario are required to be vaccinated against:

  • Diphtheria
  • Tetanus
  • Pertussis (Whooping Cough)
  • Polio
  • Measles
  • Mumps
  • Rubella
  • Meningococcal Disease
  • Varicella (Chickenpox) - for children born in 2010 or later

Visit our Immunizations and Vaccines page for more information.
Is it okay if my child receives multiple immunizations at the same time? 

Yes. Multiple immunizations can be received at the same time. Your child's immune system can safely and effectively handle more than one immunization at a time. Most common side effects are mild (such as low grade fever and tenderness on the injection site) and will last for only a day or two.

Why does my child need another Measles/Mumps/Rubella (MMR) vaccine. He/she already received it. 

Children require two doses of Measles and Mumps vaccine and one dose of Rubella vaccine after their first birthday. You may have received a letter for the MMR vaccine due to any of the following reasons:

  1. Your child might have received the first dose before one year of age, however when your child is seven years old the second dose of MMR is required for school attendance. It is possible that Public Health only has one dose on record if one of the doses was not reported to Public Health.
  2. The MMR vaccine is invalid because it was given too soon after another live vaccine. Receiving the MMR vaccine too early or too soon after another live vaccine causes the dose to be invalid because it may not provide your child with adequate protection against the diseases. Confirm the date with your health care provider and update immunization records online with Public Health. Knowing the brand name of the vaccine will also be helpful so it can be accurately recorded in your child's file. 
Why does my child need Varicella vaccine? He/she already received it. 

Children born in 2010 or later are required to have two doses of Varicella vaccine after their first birthday. As recommended by the National Advisory Committee on Immunization (NACI), two doses of Varicella vaccine can reduce varicella disease incidence, increase herd immunity, potentially decrease disease outbreaks, as well as minimize the number of cases occurring in adolescents and adults.

You may have received a letter for varicella due to any of the following reasons:

  1. Your child might have received the first dose before one year of age, however when your child is seven years old the second dose of Varicella is required for school attendance. It is possible that Public Health only has one dose on record if one of the doses was not reported to Public Health.
  2. The Varicella vaccine is invalid because it was given too soon after another live vaccine. Receiving the Varicella vaccine too early or too soon after another live vaccine causes the dose to be invalid because it may not provide your child with adequate protection against the disease. Your child may also receive Varicella in the form of MMRV vaccine where the Varicella vaccine is combined with protection against Measles, Mumps and Rubella. MMRV vaccine is for children between 1 to 12 years old. Confirm the date with your health care provider and update immunization records online with Public Health. Knowing the brand name of the vaccine will also be helpful so it can be accurately recorded in your child's file.

You have to report to Public Health if your child born in 2010 or later has had previous infection of chickenpox on or after one year of age. 
Why does my child need Polio vaccine? He/she already received it.  

Polio is a series vaccine, meaning that it requires multiple doses at specific ages and intervals to provide adequate protection.

You may have received a letter for Polio due to any of the following reasons:

  1. Your child is missing one or more doses of their Polio series. Please note that all children require their final dose of Polio vaccine to be on or after their fourth birthday and before their seventh birthday.
  2. A dose of Polio immunization could be invalid if the minimal interval between Polio immunizations was not respected.
  3. Your child might be on a catch-up schedule and is now overdue to receive immunization(s).

Confirm with your health care provider if your child has completed the series in correct intervals (time between vaccines) and update the immunization record with Public Health. Knowing the brand name of the vaccine will also be helpful so it can be accurately recorded in your child's file. 
Why does my child need Diphtheria, Tetanus and/or Pertussis vaccine? He/she already received these. 

Diphtheria, Tetanus and Pertussis are given in a series, meaning that they require multiple doses at specific ages and intervals to provide adequate protection. In Ontario, these vaccines are not available on their own. The Pertussis vaccine always includes Tetanus and Diphtheria, and these are always available together.

You may have received a letter for Diphtheria, Tetanus and/or Pertussis due to any of the following reasons:

  1. Your child is missing one or more doses of their Diphtheria, Tetanus and Pertussis series. Please note that all children require a booster dose of Diphtheria, Tetanus and Pertussis vaccine on or after their fourth birthday (generally between the ages of four and six), and then every ten years (with the first booster dose generally between the ages of fourteen and sixteen).
  2. A dose of Diphtheria, Tetanus and Pertussis immunization could be invalid if it was given too early or if the minimal interval between Diphtheria, Tetanus and Pertussis immunizations was not respected.
  3. Your child might be on a catch-up schedule and is now overdue to receive their next Diphtheria, Tetanus and Pertussis immunization(s).

Confirm the dates with your health care provider and update the immunization record with Public Health. Knowing the brand name of the vaccine will also be helpful so it can be accurately recorded in your child's file. 
Can my child receive Pertussis only if he/she has already received Tetanus and Diphtheria? 

A Pertussis-only vaccine is not available in Canada. If your child requires a Pertussis immunization, they will receive a combined Diphtheria, Tetanus and Pertussis vaccine.

Some health care providers administer Diphtheria and Tetanus (Td) only vaccine during an emergency procedure. There is no harm in receiving a Diphtheria, Tetanus and Pertussis (DTaP/Tdap) vaccine for the added protection against Pertussis. Confirm with your healthcare provider if a Diphtheria and Tetanus (Td) or a Ddiphtheria, Tetanus and Pertussis (DTaP/Tdap) vaccine was given and update the immunization record with Public Health. Knowing the brand name of the vaccine will also be helpful so we can accurately record it in your child's file. 
Why does my child need Men-C-C? He/she already received it.  

All children in Grade 6 or below require one dose of Men-C-C vaccine received on or after their first birthday.

You may have received a letter for Men-C-C due to any of the following reasons:

  1. Your child might have received a dose of Men-C-C before one year of age. Receiving Men-C-C too early is considered invalid and may not provide adequate protection against the disease. Even if your child has received more than one dose prior to one year of age, a booster dose after their first birthday is still required to ensure adequate protection.
  2. A dose of Men-C-C could be invalid if the minimal interval between Meningococcal C-strain immunizations was not respected.
  3. The Men-C-C vaccine your child received was never reported to Public Health.

Confirm the dates with your health care provider and update the immunization record with Public Health. Knowing the brand name of the vaccine will also be helpful so it can be accurately recorded in your child's file. 
Why does my child need Men-C-ACYW135? He/she already received it. 

All children in Grade 7-12 require one dose of men-C-ACYW135.

You may have received a letter for Men-C-ACYW135 due to any of the following reasons:

  1. Your child might have received a dose of Men-C-ACYW135 before one year of age. It is recommended that children receive this vaccine at twelve years of age for the vaccine to provide adequate protection against Meningococcal disease, regardless of previous doses received.
  2. A dose of Men-C-ACYW135 could be invalid if the minimal interval between meningococcal vaccines was not respected.
  3. Your child was absent during the immunization clinic at school.

The Men-C-ACYW135 vaccine is offered in schools in Grade 7 and is a mandatory vaccine. All children in Grade 7 or older must have received one Men-C-ACYW135 vaccine.

Any child born on or after 1997 remains eligible to receive a dose of Men-C-ACYW135 through school-based clinics (if in Grade 7-12), your health care provider, or walk-in clinic. 

What is the age of consent in Ontario? 

The Health Care Consent Act, 1996 of Ontario, states that there is no minimum age for consent to health care. If the student is deemed by the nurse to be able to consent, they can sign their own consent form.

Region of Waterloo Public Health requires consent from a parent of legal guardian when providing services at school. Please call Public Health at 519-575-4400 ext. 5003 to speak to a Nurse if you have any concerns about consent.

School Immunization Clinics - Questions/Answers for Parents/Guardians

Who gives the vaccines in school clinics? 
Our Public Health Nurses receive specific immunization training. All our nursing staff are licensed with the College of Nurses of Ontario. They administer thousands of vaccines annually and have great knowledge and experience at putting anxious children at ease. 
How will the school clinics run? 

Students will be called down by class to the school clinic to receive their vaccines.

Students will be supervised for at least 15 minutes post-vaccine.

Severe reactions are rare and most occur within 15 minutes of getting the vaccine. The nurses will stay at the school for at least 15 minutes after the last vaccine is given. 

What will happen if my child has a reaction after the nurses have left? 

Most reactions occur within the first 15 minutes after receiving the vaccine. Public Health Nurses are always available at the school for at least 15 minutes after the last vaccine is given. Before leaving, the nurse provides the school with first aid instructions should a reaction occur. This may include referring the student to their family physician or emergency
services (if indicated).

Report any reactions that occur after nurses have left, to Public Health at 519-575-4400 ext. 5003 
Who can I contact if I have questions or if I did not get a consent form?  
Consent forms can be obtained by calling our Vaccine Information Line at 519-575-4400 ext. 5003. 
My Grade 7 child missed a school clinic. Where can he/she get the vaccines and when? 

At your child's next school immunization clinic (if available)

Public Health has school clinics twice a year, in the fall and then again in the spring (currently paused due to COVID-19).

  • A signed consent form or verbal consent is needed for your child to receive the vaccines at school
  • Your child will bring the consent form home the first week of school
  • Send the signed consent form with your child on the day of the school clinic
  • You may call in your verbal consent to Public Health if unable to send the signed form with your child

At a Public Health clinic

Your child can come to a Public Health clinic all year, including the summer (currently paused due to COVID-19).

  • If your child missed both school clinics in Grade 7 or
  • If your school does not have an immunization clinic (e.g. small private school) or
  • If your child is homeschooled

Call 519-575-4400 ext. 5003 to make an appointment

At your doctor's office

School program vaccines are also available through local health care providers.

Parents/students can access immunization records and submit immunization information via Immunization Connect Ontario (ICON).

Students without a health card or those needing assistance can call Public Health at 519-575-4400 ext. 5001.
I have questions about Hepatitis B vaccine 

My child received three doses of Hepatitis B vaccine as an infant. How do I sign the consent form? 
The three doses of Hepatitis B your child received as a baby should provide lifetime immunity. The National Advisory Committee for Immunization (NACI) does not recommend a booster dose for healthy individuals. Check off “no” on the consent form and sign. Check off the vaccine given and list dates (if known) on the consent form. 
Is Twinrix a Hepatitis B vaccine? 
Twinrix® or Twinrix®Junior is a vaccine that contains both Hepatitis B and Hepatitis A vaccine. Some people purchase these vaccines when they are planning to travel to countries where Hepatitis B and/or Hepatitis A are common. 
My child received two doses of Twinrix Junior when he/she was small. Should I sign consent for my
child to receive Hepatitis B vaccine in Grade 7 at school? 

It is recommended that you discuss with your doctor (or the office where you received your vaccine) to see if your child needs another dose of the vaccine. Public Health recommends that you complete the third dose of Twinrix® Junior at your doctor's office if needed. There will be a charge for Twinrix® Junior at your doctor's office because it is not publicly funded in Ontario.

If you prefer to have your child receive publicly funded Hepatitis B vaccine, they will then be complete for their Hepatitis B vaccines, but may require a final dose of Hepatitis A vaccine from the doctor's office to be completely protected against both Hepatitis B and Hepatitis A. Please ensure that your child's record is updated with the correct dates of the vaccines. 
My child received two doses of Twinrix® vaccine in Quebec when he/she was in Grade 4. Does he/she still need more Hepatitis B vaccine? 
No. Research has recently shown that students who received two doses of adult Twinrix® vaccine, six months apart have shown an equivalent antibody response to those who received all three doses of Twinrix® Junior. For this reason, they are considered to have completed their Hepatitis B and Hepatitis A series so they don't need to receive another Hepatitis B vaccination. Please ensure that your child's record is updated with the correct dates of the vaccines. 
My child was born in another province and received three doses of DTaP-IPV-HB-Hib vaccine (Diphtheria, Tetanus, Pertussis, Polio, Hepatitis B and Haemophilus influenzae type B) as an infant. Does he/she need another dose of Hepatitis B for a booster dose? 

No, another dose of Hepatitis B vaccination is not needed. The three doses of DTaP-IPV-HB-Hib that your child received as a baby should provide lifetime immunity. The National Advisory Committee for Immunization (NACI) does not recommend a booster dose for healthy individuals. 
I have questions about Meningococcal C-ACWY135 
My child received a Meningococcal vaccine after age one. Why is another one needed in Grade 7?  

The Meningococcal vaccine that your child most likely received after one year of age was a vaccine that covers one Meningococcal disease strain - the C strain. The protection from that vaccine decreases over time and a booster dose is needed. Studies show that youth and young people from ages 14 to 25 are at an increased risk for Meningococcal disease.

Meningococcal conjugate - ACWY-135 (Menactra®, Menveo®, or Niminrix®) protects against four of the dangerous strains of Meningococcal disease so it is recommended that youth and young adults receive at least one dose during the teen-age years. In Ontario, it is provided during Grade 7. 
My child received meningococcal conjugate-ACWY-135 before age 11. Is another dose needed in Grade 7? 

It is recommended that you consult with your doctor to see if waiting might be the best option for your child. Public Health knows that Meningococcal conjugate-ACWY-135 can offer protection for approximately five years so your child may still be getting protection from the dose given before age 11. Your child will remain eligible to receive one dose of the publicly funded vaccine from Grade 7 until the end of Grade 12.

It is important to note that if your child received one dose of Meningococcal C-ACYW135 after the age of nine months, they are considered up-to-date under the Immunization of School Pupils Act (ISPA).

I have questions about the HPV vaccine 

Through the School Immunization Program, all students attending Grade 7 in Ontario are eligible to receive publicly-funded doses of HPV9 until the end of Grade 12 for female clients and until the end of Grade 10 for male students. 

Is it true that HPV is also publicly funded for young men age 26 or under? 
Yes. As part of the High Risk HPV Immunization Program HPV9 is publicly funded for men who have sex with men (MSM) who are 26 years of age or younger, who identify as gay, bisexual, as well as some individuals who identify as trans, and who have not started their HPV vaccine series before September 5, 2017. 
My child received HPV4 (Gardasil®) last year but needs one more dose to complete the series. Can my child receive HPV9? 
Yes. Your child can complete their HPV series with HPV9. This is aligned with the National Advisory Committee on Immunization (NACI) recommendations and guidance, which allows for the use of HPV9 vaccine to complete an HPV4 series, if it is not possible to complete the series with the HPV4 vaccine. 

I have questions about how the school immunization program works 
If my child needs to complete their Grade 7 vaccines in Grade 8, do I need to sign a new consent form? 
If you signed a consent, or called in a verbal consent to Public Health in Grade 7, you will not need to sign a new consent form. That consent, whether written or verbal, is good for 12 months or until the series is complete. 
My child has an exemption on file for a vaccination, how can I be sure that he/she won't receive the vaccine at a school clinic? 

Exemptions are in place according to the Immunization of School Pupil’s Act, which is not part of the Grade 7 school program. To be sure that your son or daughter is not immunized, check off “No” on the consent and return with your signature.

It is a good idea to speak with your child ahead of time to let them know that they should not be receiving a vaccine at the school clinic. 
 

My child is on special medications for an underlying health condition. Is it safe for him/her to receive the school immunization program vaccines? 
Very few underlying health conditions would prevent a child from receiving vaccines. Consult with your doctor and/or contact Public Health at 519-575-4400 ext. 5003 to speak with a nurse about your child's specific situation. The nurse can answer your questions and provide you with information about what options are available for your child to receive the publicly funded vaccinations. 

My child has a serious needle phobia. What are my options to ensure that publicly funded vaccines are received? 
Needle anxiety is common in teens. Our nurses in the school clinics have dealt with many anxious children and have developed several techniques to make the process as anxiety-free as possible, for example:
  • Distracting the student
  • Allowing the student to listen to music
  • Using ice or a local anesthetic like EMLA® or Ametop® to numb the injection site (this must be provided by the parent and applied by the student 30 minutes before the vaccination)

Tips for you:

  • Ensure you send your child to school well fed
  • Pack an extra drink or snack to avoid fainting

If your child knows ahead of time that they are prone to fainting, please have them notify the nurse prior to getting their needle. 

My question is not answered here 
If you have questions, please contact Public Health to speak with a nurse at 519-575-4400 between 9 a.m. and 4 p.m. Monday through Friday excluding statutory holidays.  

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