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Fewer Canadian children are getting the immunizations they need, putting themselves and others at much greater risk of contracting and spreading vaccine-preventable diseases. However, immigrant children are doing much better, according to new research from Ontario’s Institute for Clinical Evaluative Sciences (ICES).

In a system such as Canada’s with universal access to all primary care services and high visit rates by children, the ICES study shows immunization coverage is less than ideal, under 67%. The results were based on two year old children born between July 1, 1997 and June 30, 1998 in Ontario. This time frame allowed researchers to capture universally funded routine vaccines while allowing for two years of follow-up prior to the 2001 approval of newer vaccines, funded in 2004. These children were linked via their mothers’ records to a federal Landed Immigrant Database. ICES researchers examined the relationship of region of origin, period of immigration and refugee status. “This is a good-news bad-news story” says lead author and senior scientist Astrid Guttmann, “On the one hand, immigrant mothers are accessing immunizations for their children at a higher rate than non-immigrant mothers. This is particularly important since immigrant families may have increased risk of exposure to vaccine-preventable diseases from travel to, or visitors from, endemic regions of the world. On the other hand, overall rates of up-to-date coverage are too low.”


  • The study looked at 98,123 children of whom 66.5% had complete immunization coverage.
  • Children of immigrant mothers were more likely to be completely immunized 69.0% vs. non immigrant kids at 65.9%.
  • Those from South and Northeast Asia were most likely to be completely immunized.
  • Children of immigrant mothers with lower education, low neighbourhood income or who were refugees were less likely to be completely immunized.
  • There was a 3% better coverage rate among children of immigrant mothers; improved coverage, especially at such low levels, is clinically important in the context of herd immunity.

“We can’t say why many Canadian children are missing vital vaccinations,” says Guttmann. “It’s likely in part because our primary healthcare system does not have systematic ways of reminding parents and physicians when children are missing vaccinations. Our study suggests this is no more the case for children of immigrant mothers, which is significant. What we do know is that vaccines are important because they prevent illnesses, some of which are life threatening. Parents need to understand how important it is to vaccinate a child for both the health of the public and for the child.”

Vaccines are used to create immunity in the body. They are used particularly for the many types of childhood illnesses that were common in the past. They produce immunities in the body and children then don’t get sick with these illnesses anymore. Canadian guidelines recommend a number of vaccines to protect children against diseases like measles, polio, mumps, chicken pox and others.

The study “Immunization coverage among young children of urban immigrant mothers: findings from a universal healthcare system" appears in the May issue of Ambulatory Pediatrics.

Author affiliations: ICES (Drs. Guttmann, Manuel, Stukel, Cernat, Glazier); Division of Paediatric Medicine, The Hospital for Sick Children, Department of Paediatrics, University of Toronto (Dr. Guttmann); Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto (Drs. Guttmann, Stukel, Glazier); Department of Public Health Sciences, University of Toronto (Drs. Manuel, Glazier); Public Health Agency of Canada (Ms. DesMeules); Centre for Research on Inner City Health, St. Michael’s Hospital (Dr. Glazier); Department of Family and Community Medicine, University of Toronto (Dr. Glazier) — Ontario.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canadaand abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.


Read the Journal Article