AFMC Student Portal Immunization and Testing

Key Messages | Immunization Form | Guideline | FAQS
 

Key Messages

  • If a student submits a visiting medical elective application to a Canadian medical school the student must include the AFMC Student Portal Immunization and Testing Form (“Form”). Some exemptions may apply e.g. Quebec students applying to Quebec schools. Please check the Host Institutions' Institution Profiles to confirm. 
     
  • Transitioning to the new form: Students applying for electives in January 2018 must use the 2018 form with one exception: students who have previously submitted an application with the 2017 form and will be submitting another application must use the 2017 form with the 2017/18 Transition Addendum that includes new testing and immunization requirements. Grace period: students can submit the 2017 form without the addendum until January 10, 2018. Date may vary by school. The addendum is not required for students who are using the 2018 form.
     
  • The Form must be completed by an appropriate health care professional (HCP). Students may complete only designated sections of the Form. Close family members and postgraduate residents are not permitted to complete any part of the Form.
     
  • A student should make every attempt to ensure all sections are complete prior to submitting the Form. It may take several months to complete all immunization and testing requirements.
     
  • The Form is available on the Association of Faculties of Medicine of Canada (AFMC) Student Portal website. The completed form should be printed, completed, then scanned and uploaded with necessary appendices (as a single PDF file) according to the instructions on the AFMC Student Portal for the school where the student is applying.
     
  • A student does not need to attach additional documentation (e.g., immunization or testing records) to the Form except where noted.
     
  • In addition to submitting the completed Form as part of the application, students are strongly encouraged to bring a copy of the Form along when traveling to another medical school.
     

Immunization Form

AFMC Student Portal Immunization and Testing Form 2018 

Note: McMaster University class of 2020 should not download or complete the form, your home school will complete the form for you.

2017/18 Transition Addendum (Only for use by students who have previously submitted the 2017 form at ANY faculty of medicine in Canada. Students in this situation will send the 2017 form and the Addendum.

Schools requiring a recent Tuberculin Skin Test (TST)

 All schools require a baseline TB assessment upon entry into medical school, as outlined on the AFMC Form. In addition, the following schools have extra requirements at the present time: 

University of Ottawa: If the most recent TST was given over 12 months prior to the elective start date, a single TST will be required for students attending an elective at the University of Ottawa. 

Western University: If a student answers “Yes” to any of the three TB exposure questions found in Section F. Tuberculosis (TB) of the AFMC Form, Western University requires a repeat TST. The TST must be performed eight or more weeks after the last known possible contact with infectious TB disease (e.g., return from an international elective). 

For each of the above schools: the TST does not need to be submitted until the elective is officially approved. 

Students with a documented contraindication to a TST do not need to have a repeat TST (e.g. previous positive TST).

Additional Western University requirement with regards to repeat chest X-rays

All schools require students with a positive TST documented or any other positive TB history to have a chest X-ray dated subsequent to the positive TST or other positive TB history. A routine repeat or recent chest X-ray is not required unless there is a medical indication (e.g., symptoms of possible TB disease), with the following exception: Western University requires students with a positive TB history to submit a recent chest X-ray within six months of entry into medical school (i.e., on or after this date). Attach the report (or letter from a TB physician specialist or TB clinic report describing the film). A repeat chest X-ray does not need to be obtained until the elective is officially approved. The requirement for a repeat chest X-ray does not apply to the following situations:
  • Students who submit documentation showing adequate treatment for latent TB infection or active TB disease
  • Students with a positive TST but negative interferon gamma release assay (IGRA), regardless of treatment history (note: this is the only situation where Western University will accept an IGRA result)
  • Students who are currently pregnant


Guideline

AFMC Student Portal Immunization and Testing Guideline 2018

FAQS

  1. General

Question 1: How do I know that my personal health information is kept confidential?

Answer: The Canadian medical schools are obligated by law to keep your personal health information confidential, and the minimal number of individuals required at each medical school will access and use the information provided.
 

Question 2: Can I just attach documentation of my immunizations and tests without having the Form completed, if the information is the same?

Answer: No. All students must submit the Form; it is not acceptable to submit other documentation. This ensures that every student is following the requirements set by the medical schools and that no documentation is missing. Submitting other documentation risks submitting incomplete information. It is also not necessary to attach original immunization and testing documentation (e.g., serology reports) to the Form other than when requested on the form.
 

Question 3: If I have records of previous immunizations will these count, or do I need to have these immunizations repeated?

Answer: Discuss this with the HCP assessing your immune status. In general previous records will count so long as the immunization is properly documented, and respects the minimal age and spacing intervals of that particular immunization series.
 

Question 4: I had immunizations administered previously but the records are not available. What should I do?

Answer: An attempt should be made to obtain immunization records from the previous clinician, facility, or public health unit. If this is not possible then in general the immunizations should be repeated. Parental recall of prior immunization is known to correlate poorly with vaccines received and should not be accepted as evidence of immunization. Serological testing for immunity has a very limited role in this area and for most immunizations is not recommended. The Canadian Immunization Guide states:

“Routine serologic testing to determine the immunity of children and adults without immunization records is generally not practical. The following approach is recommended: Children and adults lacking adequate documentation of immunization should be considered unimmunized and started on an immunization schedule appropriate for their age and risk factors unless known to be immune by serologic testing.”

Discuss this with the HCP assessing your status and completing your forms. If you are missing immunizations it is recommended you have this addressed early enough to permit you enough time to complete a series. For example, a complete routine adult polio series will take a minimum of seven months to complete if no previous doses are documented.
 

Question 5: Do I need to provide documentation of other immunizations other than what is listed?

Answer: No. You need to provide documentation of only the specific immunizations and tests listed. For example, you do not need to provide documentation of Bacillus Calmette–Guérin (BCG), monovalent hepatitis A, meningococcal, pneumococcal, or rabies vaccines as part of this process.
 

Question 6: Due to a medical condition I cannot receive a specific immunization or test. Do I need to mention the specific condition when I submit the Form?

Answer: If you are not able to meet the requirements for a medical or health condition it is necessary for the HCP completing the Form to provide specific details; either in Section C of the Form, or by attaching relevant information from a physician. In addition, you would need to complete the Exceptions and Contraindications to Immunization and Testing Requirements, Self-Declaration Form (Appendix A), to acknowledge that you understand you may not be fully protected, and also that you may be subjected to additional precautions or restrictions during the proposed elective placement.
 

Question 7: I am infected with a bloodborne pathogen. What do I need to do?

Answer: Students who have infection with hepatitis B virus, human immunodeficiency virus (HIV), and/or hepatitis C virus must familiarize themselves with the policies of the medical schools where they wish to apply. All schools will require reporting of hepatitis B virus, since all students need to have hepatitis B surface antigen (HBsAg) test results documented by a HCP on the Form.
 

  1. Tetanus, Diphtheria, Pertussis, Polio

Question 8: Why do I need a tetanus/diphtheria/acellular pertussis (Tdap) immunization if I received one previously in adolescence?

Answer: All adult health care workers should receive a single dose of tetanus diphtheria acellular pertussis (Tdap) vaccine for pertussis protection, if not previously received in adulthood (age 18 years or greater), even if the individual is not due for a tetanus/diphtheria booster. The adult dose is in addition to the routine adolescent Tdap booster.
 

Question 9: Do I need a polio booster dose?

Answer: No. All students require a complete primary polio immunization series documented. For the purposes of satisfying the requirements listed on the Form students who have a primary polio immunization series documented do not require an adult booster dose of polio vaccine.
 

  1. Influenza

Question 10: Do I need to get an influenza immunization?

Answer: An up-to-date seasonal influenza immunization is required for electives occurring during November to June inclusive for the following medical schools: Dalhousie University, McMaster University, Memorial University, McGill University, Northern Ontario School of Medicine, Queen’s University, University of Manitoba, University of Ottawa, University of Toronto, and Western University. The University of British Columbia requires either documented influenza or a mask be worn for electives November to June inclusive. All other medical schools highly recommend influenza vaccination.
 

  1. Tuberculosis

Question 11: I had a two-step tuberculin skin test (TST) to check for latent tuberculosis infection when I entered medical school. Do I need a repeat TST?

Answer:  Only two schools require a Recent Tuberculin Skin Test (TST) from Elective Students. 

University of Ottawa: If the most recent TST was given over 12 months prior to the elective start date, a single TST will be required for students attending an elective at the University of Ottawa.

Western University: If a student answers “Yes” to any of the three TB exposure questions found in Section F. Tuberculosis (TB) of the AFMC Form, Western University requires a repeat TST. The TST must be performed eight or more weeks after the last known possible contact with infectious TB disease (e.g., return from an international elective). 

For each of the above schools: the TST does not need to be submitted until the elective is officially approved. 

Students with a documented contraindication to a TST do not need to have a repeat TST (e.g. previous positive TST). 
 

Question 12: I had a positive tuberculin skin test (TST) a few years ago, and I had a chest X-ray right afterwards. Do I need a repeat chest X-ray?

Answer: Not necessarily. You would need to have a HCP document on the Form your positive TST and chest X-ray (attaching the chest X-ray report). You will also need to complete and submit the Tuberculosis Awareness, and Signs and Symptoms Self-Declaration Form (Appendix B) (to be completed by the student). If abnormalities are noted on the chest X-ray or in your symptom review then a repeat chest X-ray may be necessary, at the discretion of the HCP. However, most students will not have any abnormalities noted, and therefore they would not require a repeat chest X-ray. 

The only exception to this is Western University, which requires students with a positive TB history to submit a recent chest X-ray within six months of entry into medical school (i.e., on or after this date). Attach the report (or letter from a TB physician specialist or TB clinic report describing the film). A repeat chest X-ray does not need to be obtained for Western University until the elective is officially approved. Western University’s requirement for a repeat chest X-ray does not apply to the following situations:
  • Students who submit documentation showing adequate treatment for latent TB infection or active TB disease 
  • Students with a positive TST but negative interferon gamma release assay (IGRA), regardless of treatment history (note: this is the only situation where Western University will accept an IGRA result) 
  • Students who are currently pregnant
     

Question 13: I had a positive TST. Do I need to be treated for latent tuberculosis infection (LTBI)? Do I require an interferon gamma release assay (IGRA) test?

Answer: For the purpose of the Form treatment for LTBI and/or an IGRA test is not required. If either of these services were provided documentation of such does not need to be included with an application. Please see question #12 for more information on the requirements for a student with a positive TST.
 

  1. Measles, Mumps, Rubella, Varicella

Question 14: I had two doses of measles vaccine documented, but then my measles serology (immunoglobulin G [IgG]) was tested and was negative. Do I need a third dose of measles vaccine?

Answer: Generally the answer is no, but discuss this situation with the HCP offering you services. For measles, mumps, rubella and varicella post-immunization serology is not necessary and should not be performed for the purposes of occupational health requirements. The HCP assessing you should ensure that the measles immunizations were properly documented and spaced (two doses given a minimum of four weeks apart, starting on or after the first birthday). The negative measles serology most likely represents a false negative and in most cases can be ignored.
 

Question 15: I had chickenpox as a child, and I am certain about this. Do I need to have serology tested for chickenpox (varicella)?

Answer: Yes. It is possible that a history of chickenpox infection is not accurate. A test for varicella antibodies (immunoglobulin G [IgG]) is necessary to verify that a student is indeed immune. If the test is positive, no further action is required for varicella. If the test is negative, a student will require two doses of varicella vaccine administered ideally six or more weeks apart (minimum four or more weeks apart).
 

Question 16: I had a single dose of varicella vaccine as a child and I was informed this was a complete series. What do I need to do?

Answer: In the past a single dose of varicella vaccine provided to a child between ages 12 months and 12 years was considered a complete series. Canadian guidelines have changed and now recommend such individuals receive one more dose of varicella vaccine to complete a two-dose series. Varicella serology should not be tested before or after the second varicella immunization.
 

  1. Hepatitis B

Question 17: What do I need to do if I do not have documentation of my hepatitis B immunizations, but I had serology showing immunity to hepatitis B?

Answer: On the Form you are asked to have both your hepatitis B immunizations and your hepatitis B serology documented by a HCP. Positive hepatitis B antibodies (anti-HBs) alone is not considered adequate proof of immunity. The Canadian Immunization Guide states:

Evidence of long term protection against HB has only been demonstrated in individuals who have been vaccinated according to a recommended immunization schedule. Independent of their anti-HBs titres, children and adults lacking adequate documentation of immunization should be considered susceptible and started on an immunization schedule appropriate for their age and risk factors.” 

Regardless of a student’s antibody (anti-HBs) titres, those lacking adequate documentation of immunization should be considered susceptible and started on a hepatitis B immunization schedule, with serology (anti-HBs) repeated one or more months after the final dose.
 

Question 18: I already had positive antibodies to hepatitis B. Why do I need to be tested for hepatitis B surface antigen?

Answer: All health care workers should be tested for antibody to hepatitis B surface antigen (anti-HBs) to ensure immunity to hepatitis B. It is also a good idea to test for hepatitis B surface antigen (HBsAg), to determine which individuals may be chronic carriers of the hepatitis B virus; this has been made a requirement on the Form. It is possible that a chronic carrier of hepatitis B will be positive for both anti-HBs and HBsAg (this occurs in about 5% of chronic carriers). Testing for both anti-HBs and HBsAg will permit a student’s specific status to be determined. Some students who were not tested for HBsAg will need to have this test performed now. If a student previously had a test for anti-HBs and was positive (immune), the test for anti-HBs should not be repeated when testing for HBsAg occurs (false-negative anti-HBs results are possible in this situation and may lead to unnecessary booster doses).
 

  1. Additional Information

Question 19: Whom can I contact if I have additional questions or concerns about this area?

Answer: Questions about the Form, requirements, or process followed can be referred to your home medical school, the school(s) to which you are applying, or the HCP completing the Form for you.
 

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