PGME Immunization Requirements

The Postgraduate Medical Education Office adheres to the Immunization Policy of the Council of Ontario Faculties of Medicine, as outlined in the following document:

• COFM Immunization Policy

Documentary proof of current immunization against specific diseases must be submitted to the Postgraduate Medical Education Office with the learners’ Letter of Appointment (LOA). Learners cannot start clinical practice without completing the immunization requirements. The specific immunization requirements for all learners are:

Tuberculosis

Documentation of a baseline two-step Mantoux Tuberculin Skin Test (TST) is required for all learners without a positive TB history. Each test is implanted and then read 2-3 days later; the two tests are completed 1-4 weeks apart.

If you have a positive TB test, both the positive TB test result and chest x-ray must be provided. BCG vaccination is not a contraindication to having a TST. You may not provide a chest x-ray as alternative to the TST.

Annual TB testing (1-step Mantoux or IGRA) is a requirement for all learners who have previously tested negative. You must submit an annual TB test that is valid through your training start date.

Hepatitis B

Hepatitis B immunization is a series of 2-3 injections. Lab evidence of immunity (Hepatitis B Antibody) with the date the titre was drawn is required to fulfill this immunization requirement.

Individuals who are non-immune (i.e. do not have antibodies against HBsAg or no prior history of immunization) must be screened for the surface antigen (HBsAg). If the HBsAg result is positive, a further screen for e-antigen (HBeAg) must be performed. Those who are non- immune and HBsAg negative must undergo a second series of HBV immunization and provide their evidence of immunity after the series is completed.

Registration status for HBV carriers is CONDITIONAL until the Expert Panel on Infection Control reviews their case.

• Procedural Memorandum for Hepatitis B Carriers
• Blood Body Fluid Exposure Policy (Needlestick Injury Procedural Guideline)
• SHEA Guideline for HepB,C and HIV

Measles, Mumps, Rubella (MMR)

Documentation of at least 2 MMR vaccines OR lab evidence of immunity (positive IgG antibody). Each dose/vaccine given at least 28 days apart.

Chicken Pox/Varicella

Lab evidence of immunity (positive IgG antibody) OR documentation of 2 Varicella vaccines. Each dose/ vaccine given at least 28 days apart. A reported childhood illness is not sufficient evidence of immunity for varicella.

Diphtheria, Tetanus, Acellular Pertussis & Polio

Immunization against diphtheria and tetanus is generally valid for ten years. Booster shots for Tdap is strongly recommended. Vaccination with acellular pertussis as an adolescent or adult is recommended. A single dose of Tdap (tetanus, diphtheria, and acellular pertussis) is sufficient and can be taken without waiting 10 years between diphtheria/tetanus boosters. Primary immunization against polio is sufficient.

Mask Fit

Hospitals/training sites affiliated with the University of Toronto, Faculty of Medicine have respiratory protection policies and procedures to follow when at risk of exposure to airborne infectious agents, specifically tuberculosis. To protect the health and safety of our learners, patients and staff, learners must comply with the assigned sites’ respective policies, including the Ministry of Labor orders issued under the Occupational Health and Safety Act regarding the use of N95 respirators/masks.

• Mask Fit Policy
• Mask Fit Accommodation Form

New learners training for 1 year or more have 60 days from their start date to complete the mask-fit test and provide documentation to the PGME Office. Your mask fit test should be completed at your training sites Occupational Health Office. It is not required for registration.

New learners training for less than 1 year must submit their mask fit prior to starting training.

Returning learners must ensure their mask fit remains up to date for the duration of their training. As per PGME Respiratory Protection Policy, mask fit tests are valid for two years.

The PGME Full Immunization Form (with instructions) and Mask Fit Form are to be completed, signed and returned to the PGME Office within the designated time period.

Learners are required to complete an annual TB Test (1-step Mantoux or IGRA), using the Returning TB Test Form. If your previous TB test was positive you do not require an annual TB test.

Returning learners should ensure their annual TB test and mask fit are valid for their next academic year. If they expire before the next academic year they should be renewed and uploaded.

Fully registered learners with the PGME Office may have their annual TB test and mask fit completed at their training sites’ Occupational Health Office.

All immunization documentation (full immunization record, annual TB test and N95 mask fitting) should be uploaded via the PGME Form Site. Please do not email your records.