Suspensions could be on the way for tens of thousands of students in the Greater Toronto Area who haven’t submitted updated information about their vaccinations.

In Toronto alone, 45,000 elementary and high school students are about to get notices that they are being suspended because they either haven't had all their vaccinations or because their parents have yet to submit the paperwork showing they are up to date.

Thousands more students are facing the same fate in the Halton and Peel regions.

Under Ontario’s Immunization of School Pupils Act, all students in the province must be immunized against six diseases -- diphtheria, tetanus, polio, measles, mumps, and rubella -- in order to stay in school.

“It is a legal requirement in this province,” said Ontario Health Minister Hoskins said.

Parents can apply for exemptions from vaccines based on conscience or religious grounds, but they must still fill out and submit the proper paperwork.

The minister said parents get plenty of notice and should not put off getting the shots or submitting proof of the vaccinations to the relevant authorities.

Most children get these vaccines when they’re babies and toddlers, but teens also need booster shots against diphtheria, tetanus and pertussis when they’re between the ages of 14 and 16.

It is up to parents -- not their children’s doctors -- to alert their local public health units when their children receive new vaccinations.

When parents fail to complete the paperwork, health departments will send out notices in the mail to inform parents of their need to update their child’s vaccinations or their records.

If parents fail to comply after several of these letters, the children can be suspended -- although this step is usually taken only after months of mailed notification letters.

NDP health critic France Gelinas blames the province’s lack of e-health capabilities for the huge number of students now facing suspension.

“For a lot of it, it’s simply paperwork gone wrong,” she said. “If the system had been in place so that no matter where you get your vaccines it is recorded and it is kept for you, those kids would not be facing the hardship that they are facing right now.”

Since 2014, public health units in Ontario have manually inputted immunization updates into a vaccination records database called Panaroma.

But the database is behind schedule in becoming linked to all health departments, leading to bureaucratic headaches. In 2014, the province’s auditor general said the system could be improved by allowing health care providers to directly input updates.

In December 2015, the province released a long-term vaccination plan called Immunization 2020, in which it promised to look at ways to streamline the reporting process.

On Monday, told reporters he’s hoping the streamlining changes are approved soon.

“I understand, being a father myself, that it can sometimes be challenging, not to get immunized at the right time, but to follow the paper trail, if you will,” he told reporters while touring the Peter Munk Cardiac Centre in downtown Toronto.

Parents whose children are missing vaccines are advised to act fast. Public health units have to check every vaccination record with schools manually, one at a time. And with a backlog of tens of thousands of students, it may take months to sort out who is able to stay in school and who will be suspended.

Public health departments across the GTA are holding vaccination clinics so parents can get their children’s shots up to date.

With a report from Queen’s Park Bureau Chief Paul Bliss