I am in the process of completing the requirements on my Health Screening Record but I won’t be finished by the submission deadline date. Do I wait and hand everything in at once or submit what I have?
Please complete as much of the requirements as you can and be sure to submit your Health Screening forms on time. We may be able to grant a provisional clearance when certain requirements such as vaccinations cannot be completed until after your submission date. If this is the case, please make note of it on your forms and then submit the documentation once completed.
I had serologic testing in the past which showed immunity. Do I have to have this repeated?
Once you have serology showing immunity for measles, mumps, rubella and/or varicella, it should not be repeated. Positive anti-HBs serology tested after a documented vaccination series should not be repeated. Positive serology for Hepatitis B immunity (anti-HBs) alone is not considered proof of immunity if documented vaccines are missing or incomplete and should be repeated after completion of a documented series.
I had all my childhood vaccines but they are not in English. Will you accept them?
Yes but please provide a translation with your documentation.
I am an international visiting elective student or postgraduate fellow and the vaccines required are not available in my home country. What do I do?
The vaccines must be completed after you arrive in Canada. Please leave sufficient time to complete the requirements before your start date. International Postgraduate Medical students can visit McMaster's Student Wellness Centre for a fee. Please contact email@example.com for further information.
Do I need a single TB skin test (TST) or a two-step TST before starting my program?
All students without a previously documented positive TST or other positive TB history need to provide a fully documented two-step TST. A two-step TST is two separate tests, requiring four visits to your health care provider, ideally 7-28 days apart, but may be up to 12 months apart. A TST must be given either before or at least 4 weeks after a live vaccine (e.g. MMR, Varicella). A two-step TST from any time in the past is accepted and does not need to be repeated. The only exception is that we will accept IGRA serology for international visiting elective students and fellows in lieu of a two-step TST who cannot access a TST in their home country.
Year One students: An additional single TST is required if the two-step TST was completed more than six months prior to your program start date.
Postgraduate Medicine students:
An additional single TST is required if a negative two-step TST was completed more than 12 months ago. Exception: Visiting elective students from Canadian Universities need to complete a TB exposure questionnaire and have a TST eight or more weeks post-exposure if the most recent negative TST was more than 12 months ago .
I have never had a two-step TB skin test but I had a single TST in the past. Do I just need a single-step test now?
If the single TST was less than 12 months ago, you just need another single TST now. If the single TST was more than 12 months ago, a full two-step TST is required.
What if I had a previous positive TST or other positive TB history?
Do not have any more TSTs; once you are positive it will never change.
The positive test must be fully documented with mm induration and date, and you also need to provide a chest x-ray report dated after the positive TST. If the chest x-ray is negative and you do not have symptoms of active TB disease, you will be cleared for clinical activities without restrictions.
What if I am exposed to TB after I start my program?
- Undergraduate and Graduate students: Students with previous negative TB screening who are exposed to active (infectious) TB disease during their program are required to have a single TST eight or more weeks post-exposure and to submit a Post-Exposure TB Update Form to the Health Screening Office. If your TST converts from negative to positive during your program, you need to withdraw from clinical activities and report to your Program Manager. You will be cleared to return to clinical activities with no restrictions if you have a negative chest x-ray and no symptoms of active TB disease.
- Postgraduate Medicine Students: Students should report to the hospital Employee Health Services; documentation is not required by the Health screening Office.
Do I need to have a repeat TST during my program?
- Undergraduate and Graduate students: If you have previously reported negative TB screening, you will need to complete the Annual Previous Negative TB Update form each year
of your program. This form is prefaced with a risk assessment questionnaire and you will need to have a single TST only if you have had significant exposure to an individual with active TB disease or if you have worked in a health care facility at high risk for exposure to active TB disease (NOTE: some placement sites may require a more recent TST; students are responsible to be aware of their placement site’s requirements). If you previously reported a positive TST or other positive TB history, you will need to complete the Annual Previous Positive TB Update form each year of your program to verify that you do not have symptoms of active TB disease.
- Postgraduate Medicine students: Repeat screening is not required by the Health Screening Office unless you are returning to McMaster as a new trainee after an absence of 12 months or more.
How do I know if I have been in a clinical placement in a health care facility at high risk for exposure to active TB disease?
At Hamilton hospitals, usually the Public Health or Occupational Health Department would have been involved and you would have been contacted; if this has not been the case, then you can answer “No” to the questions on the risk assessment questionnaire. For placements at hospitals outside Hamilton, you should check with the site to see if it is a high-risk facility.
What if I am under 18 years old – do I still need the adult pertussis vaccine?
If you are under age 18 years when the Year One Health Screening Record is completed, you are required to document an adolescent Tdap vaccine (tetanus-diphtheria-pertussis) given age 14-17 years. A booster dose of vaccine will be required after you turn 18 years old. This only applies to students entering the Midwifery and Nursing Basic Stream A programs.
I am over 18 years old but I had a pertussis booster when I was 14 and my doctor said it is good for ten years. Do I still need the adult pertussis vaccine?
Yes. The Ontario Hospital Association requires that all adult health care workers (age 18 years or older) receive a single dose of pertussis vaccine (Tdap), if not previously received in adulthood, even if not due for a booster. The interval between the adolescent tetanus diphtheria booster and the adult Tdap vaccine does not matter.
I had a pertussis booster when 17 years and 11 months old. Do I still need the adult pertussis vaccine?
Yes. Even though you are nearly 18 years old you must be 18 years or older.
What if I can’t find my childhood vaccination records for tetanus/diphtheria/polio?
You must complete a fully documented vaccination series (three doses each). All previous documented vaccinations count towards the total. Make sure the final two vaccinations are spaced at least six months apart.
The vaccination series may be in process at the time you start your program.
Should I get serology tests for immunity to measles, mumps and rubella?
We recommend you have two MMR vaccinations spaced at least 28 days apart, regardless of age. Serologic testing for immunity (IgG antibody) either before or after vaccination is not recommended.
I had chickenpox as a child, do I still need the varicella vaccine?
We do not accept a history of chickenpox or shingles as proof of immunity to Varicella. You need to have serologic testing for immunity (Varicella IgG antibody). If you are not immune you must receive two doses of Varicella vaccine spaced at least 28 days apart.
What if I do not remember if I ever had chicken pox?
Your doctor may choose to test for immunity first (Varicella IgG antibody) or administer the vaccine without testing first. If you are not immune, you must receive two doses of Varicella vaccine, spaced at least 28 days apart. Remember it can take a few weeks to get the serology test results back and then another month to have the vaccines completed.
I had one Varicella vaccination as a child, do I need another varicella vaccine?
You must have a second vaccination now.
The interval from the first vaccine does not matter. Serology for immunity is not recommended either before or after the second vaccine. Note the cost of the vaccine is covered by the Ontario health plan for students born after Jan 1, 2000.
Hepatitis B (vaccination and anti-HBs serology):
What if I have never been immunized for Hepatitis B?
If you have chronic Hepatitis B infection or are immune due to previous natural infection, you are not required to be immunized. Otherwise, you must complete a fully documented Hepatitis B vaccination series (three doses) plus serology for immunity (anti-HBs) at least 28 days after the series is completed. The vaccination series may be in process at the time you start your program.
What if the anti-HBs serology is positive but my immunization records are missing or incomplete?
You are considered susceptible to infection. You should complete a fully documented vaccination series plus repeat anti-HBs serology at least 28 days after the series is completed. All documented doses of vaccine count towards the total series as long as minimum spacing requirements are met.
What do I do if I am not immune to Hepatitis B (anti-HBs < 10 IU/L)?
If you have not documented a Hepatitis B vaccination series, this needs to be completed first, plus repeat anti-HBs serology at least 28 days after the series is completed. All documented doses of vaccine count towards the total series as long as minimum spacing requirements are met. If you are not immune after one documented vaccination series, you will need up to three booster doses vaccine plus repeat anti-HBs serology.
What if I am not immune to Hepatitis B after one documented vaccination series?
If the series was completed more than six months ago, you need ONE booster plus repeat anti-HBs serology one month later. If not immune after the first booster, you need TWO additional boosters spaced five months apart plus repeat anti-HBs serology one month after the third booster. If the series was completed between one and six months ago, you need a second series (three doses given at 0, 1, 6 months) plus repeat anti-HBs serology one month after completion of the second series.
What if I am not immune to Hepatitis B after two documented vaccination series?
You are considered a vaccine non-responder and are unlikely to benefit from further immunizations. Repeat serology is not required. It is possible that a person who does not respond to the vaccine may already be infected with Hepatitis B, therefore testing for HBsAg (Hepatitis B surface antigen) is recommended.
Do I need a flu shot?
The flu shot is the best defence to protect you and your patients from infection with influenza virus. Annual influenza immunization for clinical placements occurring between November and June is mandatory. The McMaster Student Wellness Centre and most pharmacies provide the flu vaccine at no cost. Provide proof of immunization directly to your placement site.
Blood borne viruses Hepatitis B (HBsAg), Hepatitis C, and HIV:
Do I need to have testing for blood borne viruses?
Year One students:
Only students in the Midwifery, Physician Assistant and Undergraduate Medicine programs are required to have testing for blood borne viruses prior to starting their program. Note, test for Hepatitis B infection (HBsAg = Hepatitis B surface ANTIGEN) is a different test than the test for immunity (anti-HBs = Hepatitis B surface ANTIBODY) and is required even if you are immune. You must report positive test results to your Associate Dean before you start your program.
Postgraduate Medicine students: Postgraduate medicine students must comply with the CPSO Blood Borne Viruses Policy and report any infection to the CPSO and Associate Dean of Postgraduate Medical Education before you start your program; you do not need to report results to the Health Screening Office.
I am in the Midwifery, Physician Assistant or Undergraduate Medicine program. When do I need to have testing for blood borne viruses?
HBsAg is tested at least 28 days after a documented Hepatitis B primary vaccination series (and within six months of your program start if a documented series is still in process). Tests for HIV and Hepatitis C are required within six months prior to your program start and are valid for four years.