According to Public Health’s records, your student is missing a vaccine that is required to attend school in Ontario. The reason you are receiving this letter is likely for one of four reasons:

1. Your student received the required vaccine(s), but the record has not been submitted to Public Health.
   
   
2. Your student has not received the required vaccine(s).
   
   
3. Your student received the vaccine, but the dose given did not meet the requirements of Ontario’s Routine Immunization Schedule. This may be because:
   
   • The vaccine was given too early before the student reached the required minimum age.
   • The space of time between two doses in a series was too short (for example, given too many days earlier than recommended).
   • The type of vaccine received did not match the required vaccine for the student’s age.
     
     To get the best protection possible, the type of vaccine and age that a vaccine is given is important, as is the timing between vaccines. For example, all children must have two doses of the MMR (measles, mumps, and rubella) vaccine given on or after their first birthday and with the two doses at least four weeks apart.
     
     
4. A valid medical or non-medical exemption has not been submitted to Region of Waterloo Public Health. 

Following the vaccines that children receive in early childhood (before 2 years of age), there are three key times during elementary and secondary school that students require additional vaccines according to Ontario’s routine immunization schedule:

1. Between 4 and 6 years old, students should receive the following vaccines:
   • Tetanus, diphtheria, pertussis (whooping cough) and polio in a 4-in-1 vaccine called the Tdap-IPV vaccine
   • Measles, mumps, rubella and varicella (chickenpox) in a 4-in-1 vaccine called the MMRV vaccine
   • A student is considered overdue for these vaccines if they have not received them by their 7^th birthday.
     
     
2. In grade 7, students should receive the following vaccines:
   • Meningococcal conjugate
   • Students may also receive vaccines for hepatitis B and human papillomavirus (HPV), though these are not required under the Immunization of School Pupil’s Act
     
     
3. Between 14 and 16 years old, students should receive the following vaccine:
   • Tetanus, diphtheria and pertussis (whooping cough) in a 3-in-1 vaccine called the Tdap vaccine
   • A student is considered overdue for this vaccine exactly 10 years after their dose received between 4 to 6 years old. For example, if a student received a dose at age 4, they will be due for their next dose at age 14.

While immunization is the best way to protect your child against vaccine preventable diseases, under the Immunization of School Pupils Act, your child can be exempted from immunization:

• for medical reasons
• due to conscience or religious belief

If you received a Request for Vaccination Record letter, Public Health does not have a valid vaccine exemption on file for your student.

The process to get an exemption is different for medical and non-medical reasons. Visit vaccine exemptions for more information. 

If your student does not have an Ontario Health card or access to a health care provider, an appointment can be booked at a Public Health clinic to get the required vaccines for free.

When Public Health assessed the records on file for your student, one or more vaccines were missing. The letter indicates which records are missing (on the first page) and which vaccines we have on record (on the second page). Please review your own records to determine if a vaccine is needed, or if your student has received the vaccine and it just needs to be reported to Public Health.

There is also a period of time between when letters are generated by Public Health and when they are received in the mail. The date the letter was generated is noted in the first paragraph of the letter. If you submitted records after this date, it would not be reflected in the letter. You will receive confirmation from Public Health once the submitted records have been processed. This confirmation will inform you whether your student is now up to date for their age or if further vaccinations are required.

If a vaccine is needed, arrange for your student to get the required vaccine from your health care provider, at a walk-in clinic (call ahead) or at a Public Health clinic. Once the missing vaccine has been received, report it to Public Health. 

An unspecified vaccine means that when the record of vaccination was reported to Public Health, the exact antigen details for the vaccine were not provided. In some circumstances, this may impact whether the vaccine is considered a valid dose. If an unspecified vaccine on the record is one of the required doses missing from your student’s record listed on page 1 of the letter, please call Public Health at 519-575-4400 for further instruction.

An invalid vaccine means that a dose was given in a way that does not meet the requirements of Ontario’s routine immunization schedule. This may be due to:

• A vaccine given too early before the student reached the required minimum age
• The space of time between two doses in a series was too short (for example, given too many days earlier than recommended).
• The type of vaccine given did not match the required vaccine for the student’s age

If a dose is marked as invalid, the student will likely need to receive that vaccine again. Please call Public Health at 519-575-4400 for further instruction.

The vaccines missing from your student’s record are listed as individual diseases on page 1 of the letter, however some can be combined into a single vaccine, and multiple vaccines can be given at the same time.

 For example:

• Tetanus, diphtheria, pertussis are given in a 3-in-1 vaccine called the Tdap vaccine, or with polio in a 4-on-1 vaccine called the Tdap-IPV vaccine
• Measles, mumps, rubella are given in a 3-in-1 vaccine called the MMR vaccine, or with varicella in a 4-in-1 vaccine called the MMRV.

If your student requires many vaccines for their record to be up to date, they can receive multiple vaccines in a single clinic visit – this is a standard, safe, and effective practice. Healthcare providers will typically administer separate injections in different limbs (such as one shot in each arm) or space them out properly if given in the same arm.