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Human Papillomavirus Vaccine (HPV) protects against: Gardasil 9 covers HPV strains 6, 11, 16, 18, 31, 33, 45, 52, and 58 and is indicated to protect against: ● Cervical, vulvar, vaginal, and anal cancers caused by strains 16, 18, 31, 33, 45, 52, and 58. ● Genital warts caused by strains 6 and 11. ● Precancerous lesions caused by strains 6, 11, 16, 18, 31, 33, 45, 52, and 58 Who should get the vaccine: In British Columbia, the HPV vaccine is provided to children as part of their grade 6 routine immunization program. The series starts between the ages of 9 and 14 years for all children. However, routine and catch-up vaccinations are recommended through age 26, for males and up to age 45 for females. In addition to Grade 6 students, the vaccine is indicated and provided free in BC to the following individuals: ● Those who do NOT commence a series in grade 6 are eligible to initiate a series prior to age 19 (for males, born in 2006 or later), but not thereafter. ○ A series commenced prior to age 19 may be completed with publicly funded HPV vaccine prior to the 26th birthday. ● HIV positive individuals 9-26 years of age (inclusive) who have not received a completed series of HPV vaccine ● Males 9-26 years of age (inclusive) at the time of series commencement who are: ○ Men who have sex with men (including those who are not yet sextually active and are questioning their sexual orientation) ○ Street involved ● Males 9-18 years of age (inclusive) in the care of the Ministry of Children and Family Development ● Males in youth custody services centers ● Transgender individuals 9-26 years of age (inclusive) The vaccine is also recommended but NOT provided free in BC for: ● Women 19-45 years of age ● Males 9-26 years of age (Who are not indicated above) ● Males 27 years of age and older who are men who have sex with men Administration: ● Immunocompetent individuals 9-14 years of age (inclusive): 2 doses given as 0.5 mL intramuscularly, separated by at least 6 months ○ Those initiating immunization prior to their 15th birthday should be immunized using a 2-dose series ○ If the interval in a 2-dose schedule is less than 5 months (150 days), a 3rd dose should be given at least 24 weeks after the 1st dose and 12 weeks after the 2nd dose. ● Immunocompromised individuals 9-14 years of age (inclusive): 3 doses given as 0.5 mL intramuscularly at 0, 2, and 6 months ● Individuals 15 years of age and older: 3 doses given as 0.5 mL intramuscularly at 0, 2, and 6 months HPV Vaccine Tolerability: Most common adverse events are: ● Injection site pain (82% to 92%) ● Swelling (24% to 44%) ● Redness (24% to 48%) More than 95% of reactions are mild to moderate and resolve within a few days. Fainting may happen and is more common among adolescents and younger adults. Key Points to Remember: ● Since sexual touching can spread the virus, early vaccination at a young age is important to ensure immunity ● Avoid use during pregnancy, due to lack of data, and if a woman becomes pregnant during the vaccine series, delay future injections until after delivery ● Vaccination is most effective when given prior to becoming sexually active in males and females under the age of 26 years ○ In older women up to 45 years of age, vaccination may be about 47% effective for HPV infection, genital warts, and precancerous lesions regardless of prior HPV exposure or about 88% effective in those without prior HPV exposure Not sure if you are eligible for publicly-funded Gardasil-9 or wondering if you are private insurance pay for it? Call us at 604-971-5163 and find out! Reference: Communicable Disease Control Manual June 2019 Chapter 2: Immunization Part 4 - Biological Products

Indications: The vaccine is indicated for individuals 55 years of age and older. At this time, people between the age of 55 to 65 years old (inclusive) living in the Fraser Health and the Vancouver Coastal Health regions can get the AstraZeneca/COVISHIELD COVID-19 vaccine at eligible participating community pharmacies. *** Please note: Some European Countries stopped using the AstraZeneca vaccine while looking into a small number of reports of serious blood clots after vaccination. These events, although very rare, happened primarily among women under the age of 55. Until more information is available, British Columbia has paused the use of this vaccine in younger populations. Administration: 2 doses given as 0.5mLs intramuscularly, 112 days (=16 weeks) apart (an acceptable range for administration of the second dose is 12 weeks to 4 months after the first dose). Effectiveness: Around 60% effective >15 days after second dose. It is important to note that no cases of severe COVID-19 (hospitalization or death) occurred in individuals who received both doses of the vaccine. How the Vaccine Work: The vaccine has a harmless virus as a delivery system (there is no risk of causing the actual COVID-19 infection). This virus is not the virus that causes the COVID-19 disease. When a person is given the vaccine, the vector virus within the vaccine produces the SARS-CoV-2 spike protein which is a protein found on the surface of the virus that causes COVID-19. This protein will NOT make you sick. Throughout this process the body builds a strong immune response against the spike protein without exposing you to the virus that causes COVID-19. Duration of immunity: We do not know how long immunity lasts after vaccination at this point as trials are still ongoing. We need more time and data to predict how long the immunity will last. Vaccine Possible Side Effects: The adverse events with all four available COVID-19 vaccines are similar and it is not unusual to experience some side effects with ANY vaccine. Side effects are typically mild to moderate and will usually go away on their own. These can include: · Local pain, swelling, redness, or pruritus · Systemic side effects include: fatigue, headache, myalgia, chills, arthralgia, fever, tiredness, nausea These side effects usually disappear within two to three days, if they do occur. Key Points to Remember: It is important to note that all patients must wait at the clinic for 15 minutes after receiving the vaccine. For those with a history of severe allergic reaction, they are required to be monitored for up to 30 minutes. - For now, continue to follow provincial guidance on which patients and age groups are eligible for the AstraZeneca vaccine - All vaccines approved in Canada and available in B.C. are safe and effective and will help protect you against COVID-19. It is important to understand that COVID-19 vaccine safety is top priority for approving agencies such as FDA and Health Canada. - Based on research, those who had received a vaccine were significantly less likely to become sick with COVID-19. While some people may still get COVID-19 after they have been vaccinated, all vaccines have been shown to have a high level of protection against serious illness and death. - B.C. recommends you take the vaccine that you are offered, so you are protected as soon as possible. Getting vaccinated means that you protect your friends, family, co-workers, and close contacts from getting COVID-19. COVID-19 vaccine is one important tool in the toolbox to end the pandemic. - The sooner people have been immunized in our community, the harder it becomes for the virus to spread. That protects us all. - Given the serious health consequences of COVID-19, the low likelihood of a serious reaction to a vaccine is outweighed by the benefits to you and your loved ones. For more information, please refer to www.covid-19.bccdc.ca for the most up-to-date information.

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. What is shingles? Shingles is an infection caused by the varicella zoster virus, the same virus that causes chickenpox. The infection usually present itself as a painful skin rash with blisters on one side of the body. How do people get shingles? Who is at risk? 1 out of every 3 Canadians will develop shingles in their lifetime. Anyone who has recovered from chickenpox may develop shingles, since the virus remains dormant in their body and can be reactivated years later. Direct contact with fluid from active shingles may cause the virus to spread to someone who had never had chickenpox or received chickenpox vaccine. Shingles may occur at any age, but the risk of shingles increases as you age (Most patients are 50 or older). People with weakened immune system due to medical conditions or medications also have greater risk of developing shingles. What are the symptoms of shingles? Shingles cause a painful rash to develop on one side of the face or body. Before the rash appears, patients may experience pain, itching, or tingling in the affected area. The rash often occurs in one strip along with small blisters, which will scab over in 1 to 2 weeks. The entire healing process usually takes 2 to 4 weeks. Other symptoms of shingles include fever, headache, chills, and upset stomach. What are the complications of shingles? The severity of shingles and its complications increase with age. The most common complication is called postherpetic neuralgia (PHN). Approximately 10% of all shingles patients will experience PHN, which involve severe pain in affected body areas, even after the rash clears up. The pain can be debilitating and may last from a few weeks to many years. Shingles may also lead to complications such as scarring, secondary infections, and vision loss (if the infection involved the eye). What is the best prevention against shingles? Vaccination is the best protection against shingles. The most recommended vaccine is called Shingrix. It is a privately funded vaccine that is more than 90% effective at preventing shingles and long-term nerve pain. The vaccine consists of 2 inactive doses given 2 to 6 month apart. Since shingles can be recurrent, it is recommended to get shingrix even if you have experienced shingles in the past. What is the treatment for shingles? Antiviral medication may be prescribed to reduce the severity and duration of an active shingles infection. Please Contact your family doctor as soon as possible if you experience symptoms of shingles. For more information on the new Shingles vaccine, refer to Shingrix.ca