Adult vaccination in Quebec - everything you need to know

Vaccination isn't just for children. Adults need vaccine updates, vaccines adapted to their age group, and in some cases vaccines that their childhood schedule didn't include. The list of vaccines recommended for adult Quebecers is longer than most people realize - and the consequences of some vaccine-preventable diseases are far more serious in adults than in the collective imagination.

Shingles can be disabling for weeks at a time, leaving chronic neuropathic pain for months or even years. Pneumococcal pneumonia kills apparently healthy adults aged 65 and over. Influenza hospitalized and killed thousands of Canadians every year before vaccination rates rose. HPV causes cancer - of the cervix, oropharynx, anus, penis - in adults who were never vaccinated because the vaccine didn't exist or wasn't offered when they were of school age.

This guide presents the recommended vaccination schedule for adult Quebecers in 2026 - what's covered by the RAMQ, what's not, the costs of private vaccines, and how to get your vaccines at Clinique Omicron.

Vaccines recommended for all adult Quebecers

Certain vaccines are recommended for all adult Quebecers, regardless of age or specific risk factors. These vaccines form the basis of the adult vaccination program, and most are covered by the RAMQ under the conditions defined by the Québec Immunization Program.

The influenza vaccine is recommended annually for all adults. The influenza virus mutates every year - the composition of the vaccine is revised annually by the World Health Organization according to the anticipated circulating strains for the coming season. For this reason, the previous year's vaccine does not provide effective protection against the following season's strains. Flu vaccination is particularly important for people aged 60 and over, pregnant women, people with chronic illnesses - diabetes, heart disease, lung disease, kidney failure, immunosuppression - and healthcare workers. For these priority groups, the vaccine is covered by the RAMQ. For healthy adults under 60 not in risk groups, the vaccine is available in pharmacies at low cost, or free of charge in certain contexts. Annual vaccination is recommended in the fall, ideally before November, before the start of the flu season.

Vaccination against tetanus and diphtheria - the Td booster - is recommended every ten years for all adults. Tetanus is a serious bacterial infection caused by Clostridium tetani, whose spores are present in the environment - soil, dust, animal feces. Even a minor wound is enough to inoculate the bacterium. The protection afforded by doses received in childhood diminishes over time - a ten-yearly booster maintains protection at an effective level. Although diphtheria is rare in Quebec thanks to high vaccination rates, it is still present throughout the world, and can affect non-immune adults. The Td booster is covered by the RAMQ. If you can't remember your last tetanus booster, consult a Clinique Omicron physician - we can check your vaccination history and administer the booster if indicated.

The COVID-19 vaccine is now part of the regular adult vaccination schedule in Quebec, with formulation updates based on circulating variants. Booster dose recommendations evolve according to the guidelines of the Ministère de la Santé et des Services sociaux - vulnerable adults, immunosuppressed individuals and people aged 60 and over are generally given priority for each vaccine update. RAMQ coverage status follows the guidelines in effect at the time of vaccination - checking current recommendations with your doctor or on the MSSS website is the most reliable approach.

The hepatitis B vaccine is recommended for adults who were not vaccinated as children - a significant proportion of Quebec adults over the age of 40 did not receive this vaccine, which was not yet on the universal calendar for their generation. Hepatitis B is transmitted through blood and body fluids - sexual relations, sharing injection equipment, occupational exposures in the healthcare field. Chronic hepatitis B infection is a major cause of cirrhosis and liver cancer. The hepatitis B vaccine is covered by the RAMQ for unvaccinated adults with documented risk factors - healthcare professionals, multiple sexual partners, intravenous drug users, travelers to endemic areas. For adults with no identified risk factors who want full protection, the vaccine is available privately.

Recommended vaccines by age

Beyond the basic vaccines recommended for all adults, some vaccines become relevant to specific age groups - because the risk of disease increases with age, because the consequences of infection are more severe in the elderly, or because the immune response to disease becomes less effective over time.

The shingles vaccine - Shingrix - is recommended for all adults over the age of 50, whether or not they have had chickenpox or a previous outbreak of shingles. Shingles is caused by reactivation of the varicella-zoster virus (VZV), which lies dormant in nerve ganglia after a primary varicella infection and can reactivate decades later, often without any identifiable triggering factor. Reactivation produces a characteristic painful rash on a dermatome, accompanied by neuropathic pain that can be severe. The most frequent and disabling complication is postherpetic neuralgia - neuropathic pain that persists for months after the rash has resolved, can last for years and often resists standard analgesic treatments. The risk of shingles and postherpetic neuralgia increases significantly with age and with any form of immunosuppression.

Shingrix is a non-live, adjuvanted subunit vaccine administered in two doses two to six months apart. Its efficacy against shingles is greater than 90 % in adults aged 50 and over - making it one of the most effective vaccines in the adult schedule. Local and systemic side effects are more common than with many other vaccines - injection site pain, fatigue, headache, myalgia in the days following vaccination - but are temporary and reflect a robust immune response, not a problem. Shingrix is covered by RAMQ for adults aged 65 and over starting in 2023. For adults aged 50 to 64, the vaccine is private fee - the cost per dose is around $200 to $240, or approximately $400 to $480 for both doses. Given the vaccine's efficacy and the potential consequences of postherpetic neuralgia, this cost is medically justifiable for the vast majority of adults aged 50 and over.

The pneumococcal vaccine protects against Streptococcus pneumoniae, a bacterium responsible for pneumonia, meningitis and bacteremia - serious infections whose morbidity and mortality increase with age. There are two types of pneumococcal vaccine available for adults in Quebec. The 20-valent conjugate vaccine - Prevnar 20 - covers 20 pneumococcal serotypes and is recommended for adults aged 65 and over, as well as for younger adults with high-risk medical conditions - asplenia, immunosuppression, significant chronic heart, lung or kidney disease, insulin-dependent diabetes. The 23-valent polysaccharide vaccine - Pneumovax 23 - covers 23 serotypes and can be used as an adjunct according to specific recommendations. Both vaccines are covered by the RAMQ according to the indications and age groups defined by the Programme québécois d'immunisation. Your Clinique Omicron physician can assess your pneumococcal vaccination status and determine which vaccine and sequence are appropriate for your age and medical conditions.

For pregnant women, pertussis vaccine - administered as a dTap combination vaccine - is recommended for every pregnancy between 26 and 32 weeks' gestation, regardless of previous vaccinations. Vaccination during pregnancy enables the transfer of antibodies to the newborn before birth, protecting the infant for the first few weeks of life, before he or she is old enough to receive the first dose of vaccine. This vaccine is covered by the RAMQ for pregnant women.

Vaccines not covered by RAMQ for adults

Many vaccines recommended for adult Quebecers are not covered by the public health insurance plan, or are covered only for certain at-risk groups. For the rest of the adult population, these vaccines are available in private clinics or pharmacies at variable cost.

The human papillomavirus - HPV - vaccine is one of the most important vaccines available for adults who were not vaccinated as children or in the school curriculum. HPV is the most common sexually transmitted virus, and certain high-risk serotypes - HPV 16 and 18 - cause the majority of cervical cancers, a significant proportion of oropharyngeal cancers, and cancers of the anus, penis and vulva. The Gardasil 9 vaccine covers nine HPV serotypes - the two high-risk oncogenic serotypes and several serotypes responsible for genital warts. It is covered by RAMQ for young people in the school program, but not for adults outside the program. For adults aged 26 to 45 who have not been vaccinated, the vaccine is medically recommended and available privately. The cost is in the order of $200 to $240 per dose - three doses for adults over 15, for a total cost of $600 to $720. For adults aged 27 to 45, a discussion with the physician on individual benefits according to serological status and risk factors is indicated before making a decision.

The combined hepatitis A and hepatitis B vaccine - Twinrix - is particularly recommended for adults traveling to countries where hepatitis A is endemic, men who have sex with men, people with chronic liver disease, and adults with other risk factors for hepatitis. Hepatitis A is transmitted by fecal-oral route - contaminated water or food - and can cause severe acute hepatitis in adults, sometimes fulminating. Vaccination against hepatitis A alone or combined with hepatitis B offers effective protection. Twinrix is administered in three doses at 0, 1 and 6 months. It is covered by RAMQ for certain documented risk groups. For adults with no specific risk factors who want full protection for travel or as a preventive measure, the vaccine is available on a private-fee basis - the cost per dose is around $80 to $100.

The meningococcal vaccine protects against Neisseria meningitidis, the bacterium responsible for bacterial meningitis and meningococcemia - potentially fatal infections within hours. Conjugate vaccines are available to cover ACWY serogroups and a vaccine against serogroup B - Bexsero. ACWY conjugate vaccines are recommended for adults traveling to areas of high meningococcal endemicity - sub-Saharan Africa in the meningitis belt, Saudi Arabia for pilgrims - and for certain high-risk situations. Bexsero is recommended for adults living in communities - university residences, military personnel - and people with asplenia or complement deficiency. These vaccines are covered by RAMQ for defined risk groups. For adults outside these groups who require travel protection, costs vary from $100 to $200 per dose, depending on the vaccine.

The reinforced dTap vaccine - tetanus-diphtheria-acellular pertussis booster for adults - is useful for adults who have never received a dose of pertussis vaccine as adults, and who are in regular contact with infants. Pertussis is dangerous, even fatal, in infants too young to be vaccinated - vaccination of adults in contact with infants - parents, grandparents, caregivers - is a cocooning strategy that reduces the risk of transmission to vulnerable infants. This vaccine is covered by the RAMQ in certain specific indications. Outside covered indications, the cost is in the order of $50 to $80.

Getting vaccinated at Clinique Omicron

Adult vaccination is one of the services available at Clinique Omicron. The process begins with a medical or nursing consultation, depending on the type of vaccine and the clinical context - some vaccines can be administered directly after verification of immunization status and absence of contraindications, while others are part of a broader medical consultation for a check-up or follow-up of a chronic condition.

Nurse triage allows you to check your immunization status from your vaccination record or the Registre de vaccination du Québec - if you don't have your record, the provincial registry can be consulted for vaccinations recorded since its inception. The doctor or nurse determines which vaccines are up to date, which are overdue, and which are recommended based on your age, medical conditions and personal risk factors.

RAMQ-covered vaccines are administered at no extra cost to eligible patients as part of a covered medical consultation. Private-fee vaccines are clearly priced before administration - the fee schedule is available on cliniqueomicron.ca. Clinique Omicron does not charge an administration fee separate from the cost of the vaccine for private vaccines - the cost quoted includes the supply of the vaccine and its administration.

A fully updated vaccination record is recommended for all adults who are unsure of which vaccinations they have received and when. A documented, up-to-date vaccination status is useful medical information - it protects you, the vulnerable people in your life, and makes it easier to take the necessary steps in many contexts: international travel, health professions, pregnancy, hospitalization.

Appointments for vaccination consultations can be made online at cliniqueomicron.ca, with availability within 24 to 72 hours in Brossard and Saint-Hubert. For patients who require a full medical consultation, including a review of vaccination status as part of an annual check-up, vaccination can be integrated into the same consultation when vaccines are available and consultation time permits.

Frequently asked questions

I'm 55 and I've never had chickenpox. Should I get the shingles vaccine?

If you've never had chickenpox or been vaccinated against it, you're not protected against the varicella-zoster virus. In this case, a serological test can be carried out to check whether you have antibodies - a past infection may have occurred without you remembering it, and even sub-clinical infections confer immunity. If serology confirms the absence of immunity, varicella vaccination is indicated before Shingrix. If you have had chickenpox, or if serology is positive, Shingrix is recommended for people over 50 to prevent reactivation of the virus in the form of shingles. Consult a Clinique Omicron physician to assess your situation.

Is the Shingrix vaccine really necessary if I feel healthy at 60?

Yes, shingles can affect perfectly healthy adults - general health is not a reliable protective factor against reactivation of the virus. The incidence increases with age, regardless of perceived health. Postherpetic neuralgia - the main complication - is potentially disabling for months to years. The efficacy of Shingrix exceeds 90 % - a very high level of protection for an adult vaccine. The decision not to vaccinate means accepting a real risk of disabling disease, to avoid the temporary inconvenience and cost of an effective vaccine.

My employer requires me to be vaccinated against influenza. Is this covered by RAMQ?

The influenza vaccine is covered by the RAMQ for healthcare professionals and workers in contact with vulnerable clienteles. For other professional contexts, coverage depends on the documented indication. In practice, influenza vaccine is inexpensive even outside RAMQ coverage, and is available at low cost from pharmacies. Clinique Omicron can administer the vaccine during a medical consultation and verify your eligibility for RAMQ coverage based on your profile.

I'm 35 and I've never been vaccinated against HPV. Is it too late?

No. Efficacy data for the HPV vaccine in adults up to the age of 45 are documented and have led to the extension of recommendations for this age group. Efficacy is greatest before any contact with the serotypes covered - which is more likely in younger people - but a significant proportion of adults aged 35 to 45 have not been exposed to all the serotypes covered by Gardasil 9 and may benefit from vaccination. A discussion with your doctor will help you assess the individual benefit according to your situation. The vaccine is available on a private-fee basis for adults outside the program.

How do I know which vaccines I've had if I don't have my vaccination record?

The Quebec Vaccination Registry compiles vaccinations recorded since its inception. Your Clinique Omicron physician can consult this register and provide you with a documented record of your vaccination status. For vaccinations received abroad or before the registry was set up, the most reliable source is the original documentation - vaccination booklet, vaccination record from your country of origin. In the absence of documentation, doctors may recommend vaccination without prior serological titration for certain vaccines - repeating a dose of vaccine for which you may already be protected is not dangerous for almost all adult vaccines.

 

Vaccination services - Clinique Omicron