Vaccination schedule

Example Polish call for vaccination against Diphtheria and Tetanus.

A vaccination schedule is a series of vaccinations, including the timing of all doses, which may be either recommended or compulsory, depending on the country of residence. This topic can cause much controversy over whether or not it could impact health after dosage at an early age

A vaccine is an antigenic preparation used to produce active immunity to a disease, in order to prevent or reduce the effects of infection by any natural or "wild" pathogen.^[1] Many vaccines require multiple doses for maximum effectiveness, either to produce sufficient initial immune response or to boost response that fades over time. For example, tetanus vaccine boosters are often recommended every 10 years.^[2] Vaccine schedules are developed by governmental agencies or physicians groups to achieve maximum effectiveness using required and recommended vaccines for a locality while minimizing the number of health care system interactions. Over the past two decades, the recommended vaccination schedule has grown rapidly and become more complicated as many new vaccines have been developed.^[3]

Some vaccines are recommended only in certain areas (countries, subnational areas, or at-risk populations) where a disease is common. For instance, yellow fever vaccination is on the routine vaccine schedule of French Guiana, is recommended in certain regions of Brazil but in the United States is only given to travelers heading to countries with a history of the disease.^[4] In developing countries, vaccine recommendations also take into account the level of health care access, the cost of vaccines and issues with vaccine availability and storage. Sample vaccination schedules discussed by the World Health Organization show a developed country using a schedule which extends over the first five years of a child's life and uses vaccines which cost over $700 including administration costs while a developing country uses a schedule providing vaccines in the first 9 months of life and costing only $25.^[5] This difference is due to the lower cost of health care, the lower cost of many vaccines provided to developing nations, and that more expensive vaccines, often for less common diseases, are not utilized.

In 1900, the smallpox vaccine was the only one administered to children. By the early 1950s, children routinely received three vaccines, for protection against diphtheria, pertussis, tetanus and smallpox, and as many as five shots by two years of age.^[3] Since the mid-1980s, many vaccines have been added to the schedule. As of 2009, the US Centers for Disease Control and Prevention (CDC) now recommends vaccination against at least fourteen diseases. By two years of age, U.S. children receive as many as 24 vaccine injections, and might receive up to five shots during one visit to the doctor.^[3] The use of combination vaccine products means that, as of 2013, the United Kingdom's immunization program consists of 9 injections by the age of two, rather than 22 if vaccination for each disease was given as a separate injection.^[6]

Worldwide

The World Health Organization monitors vaccination schedules across the world, noting what vaccines are included in each country's program, the coverage rates achieved and various auditing measures.^[7] The table below shows the types of vaccines given in example countries. Current vaccination schedules for all WHO member states can be accessed here. Additional vaccines are given to individuals that are much more likely to come into contact with certain diseases due to their occupation or travel to regions where the disease is present (including members of the military), or only after potentially infectious exposure. Examples include rabies vaccine, anthrax vaccine, cholera vaccine and smallpox vaccine.^[8][9]

Characteristics of Vaccine Preventable Disease and Schedules for Example Countries^[8]

Vaccine Target	Transmission	Worldwide incidence (2004)[10]	Worldwide deaths (2004)[11]	Chile	Cuba	USA	UK	Finland	Germany	Saudi Arabia	Ethiopia	Botswana	India	Australia	China	Japan
Diphtheria	Saliva	34,000	5,000	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Pertussis	Airborne droplet	18,387,000	254,000	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Tetanus	Penetrating injury	251,000	163,000	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Hepatitis B	Bodily fluids	5,700,000 (acute)	105,000	Yes	Yes	Yes	Yes^1	Yes^1	Yes	Yes	Yes	Yes	Yes^1	Yes	Yes
Haemophilus influenzae type b	Airborne droplet	2,000,000–3,000,000 [12]	386,000	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes			Yes
Measles	Airborne	27,000,000	424,000	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Tuberculosis	Airborne	7,782,000	1,464,000	Yes	Yes		Yes^1	Yes^1		Yes	Yes	Yes	Yes		Yes	Yes
Polio	Fecal-oral	1,606 [13]	Unknown	OPV	OPV	IPV	IPV	IPV	IPV	IPV, OPV	OPV	OPV	OPV, IPV	IPV	OPV	OPV
Hepatitis A	Fecal-oral	1,400,000 [14]	Unknown			Yes	Yes^1	Yes^1		Yes				Yes^1	Yes
Human papillomavirus	Sexual contact	493,000 ^2	247,000 ^2			Yes	Yes	Yes	Yes					Yes
Influenza (seasonal)	Airborne droplet	3,000,000–5,000,000	250,000–500,000	Yes^1	Yes^1	Yes^1	Yes^1	Yes^1	Yes^1					Yes		Yes^1
Meningococcus	Airborne droplet	Unknown	340,000		Yes	Yes	Yes	Yes^1	Yes	Yes^1				Yes	Yes
Mumps	Airborne droplet	544,000	Unknown	Yes	Yes	Yes	Yes	Yes	Yes	Yes				Yes	Yes
Pneumococcus	Airborne droplet	14,500,000 [15]	826,000	Yes		Yes	Yes		Yes	Yes^1				Yes
Rotavirus	Fecal-oral		527,000 [16]			Yes	Yes[17]	Yes						Yes
Rubella	Airborne droplet	Unknown	196,000	Yes	Yes	Yes	Yes	Yes	Yes	Yes				Yes	Yes	Yes
Typhoid fever	Fecal-oral	22,000,000 [18]	216,000		Yes					Yes^1
Varicella	Airborne	Unknown	Unknown			Yes			Yes	Yes
Yellow fever	Mosquito	200,000 [19]	30,000									Yes
Tick-borne encephalitis	Tick	5,000–7,000[20]	Unknown					Yes^1
Japanese encephalitis	Mosquito	50,000 [21]	15,000										Yes^1		Yes	Yes

1. ^ At risk groups or certain populations only. See reference for more details.
2. ^ Incidence and deaths noted are for cervical cancer. Nearly 100% of cervical cancer is caused by HPV.^[22]

Country-specific

Australia

The Immunise Australia Program implements the National Immunisation Program (NIP) Schedule. All vaccines available under the Australian immunisation schedule are free of charge under the Pharmaceutical Benefits Scheme.^[23]

Australia Vaccine Schedule: 2015^[24]

Vaccine	Birth	2 mo.	4 mo.	6 mo.	12 mo.	18 mo.	24 mo.	4 yrs	10–15 yrs	15-64 yrs	≥65 yrs
Hepatitis A					HepA^[1]
Hepatitis B	HepB	HepB	HepB	HepB	[25]				[26]
Diphtheria, pertussis, and tetanus		DTPa	DTPa	DTPa	[25]			DTPa	dTpa
Haemophilus influenzae type b		Hib	Hib	Hib	Hib	[25]
Polio vaccine (inactivated)		IPV	IPV	IPV	[25]			IPV	[26]
Pneumococcal		13vPCV	13vPCV	13vPCV	13vPCV^[1]			23vPPV		23vPPV^[2]	23vPPV
					13vPCV
					[25]
Rotavirus		RV	RV	RV
Measles, mumps, and rubella					MMR	MMR	[25]		[26]
Varicella						Varicella	[25]		Varicella
Meningococcus					MenCCV	[25]			[26]
Human papillomavirus vaccine									HPV^[3]
Influenza											Yearly
Recommended ages for everyone.   Recommended range of additional vaccinations for Aboriginals and Torres Strait Islanders.   Recommended ages for certain other high-risk groups.   Recommended ages for catch-up immunization or for people who lack evidence of immunity (e.g., lack documentation of vaccination or have no evidence of prior infection). [1] ^1 ^2 In high-risk areas. [2] ^1 50 years and older if otherwise low risk [3] ^1 12–13 years, females only Further details at Australian Government, Department of Health website

Canada

In Canada, publicly-funded immunization schedules may vary from province or territory.

Alberta

Alberta Vaccine Schedule: 2015^[27]

Vaccine	Birth	2 mo.	4 mo.	6 mo.	12 mo.	18 mo.	4 yrs	10–13 yrs	15–17 yrs	≥65 yrs
Hepatitis B							HB
Rotavirus
Diphtheria, Tetanus and Pertussis		DTaP	DTaP	DTaP		DTaP	DTaP		Tdap
Haemophilus influenzae type b		Hib	Hib	Hib		Hib
Pneumococcal		Pneu-C-13	Pneu-C-13		Pneu-C-13
Polio vaccine (inactivated)		IPV	IPV	IPV		IPV	IPV
Measles, mumps, and rubella					MMRV		MMRV
Varicella
Meningococcus			Men-C		Men-C				Men-C-A CYW135
Human papillomavirus vaccine								HPV	HPV (boys only)
Influenza				Yearly	Yearly	Yearly	Yearly	Yearly	Yearly	Yearly

British Columbia

British Columbia Vaccine Schedule: 2015^[27]

Vaccine	Birth	2 mo.	4 mo.	6 mo.	12 mo.	18 mo.	4 yrs	10–13 yrs	15–17 yrs	≥65 yrs
Hepatitis B		HepB	HepB	HepB
Rotavirus		RV	RV
Diphtheria, Tetanus and Pertussis		DTaP	DTaP	DTaP			DTaP		Tdap
Haemophilus influenzae type b		Hib	Hib	Hib		Hib
Pneumococcal		Pneu-C-13	Pneu-C-13		Pneu-C-13
Polio vaccine (inactivated)		IPV	IPV	IPV		IPV	IPV
Measles, mumps, and rubella					MMR		MMRV
Varicella								Varicella
Meningococcus		MenCCV			MenCCV
Human papillomavirus vaccine								HPV (girls only)
Influenza				Yearly	Yearly	Yearly	Yearly	Yearly	Yearly	Yearly

New Brunswick

New Brunswick Vaccine Schedule: 2015^[27]

Vaccine	Birth	2 mo.	4 mo.	6 mo.	12 mo.	18 mo.	4 yrs	10–13 yrs	15–17 yrs	≥65 yrs
Hepatitis B	HepB	HepB		HepB
Rotavirus
Diphtheria, Tetanus and Pertussis		DTaP	DTaP	DTaP		DTaP	DTaP		Tdap
Haemophilus influenzae type b		Hib	Hib	Hib		Hib
Pneumococcal		Pneu-C-13	Pneu-C-13		Pneu-C-13
Polio vaccine (inactivated)		IPV	IPV	IPV		IPV	IPV
Measles, mumps, and rubella					MMR-Var	MMR-Var
Varicella
Meningococcus					MenCCV				Men-C-A CYW135
Human papillomavirus vaccine								HPV (girls only)
Influenza				Yearly	Yearly	Yearly	Yearly	Yearly	Yearly	Yearly

New Zealand

New Zealand Immunisation Schedule: 1 July 2014^[28]

Vaccine	6 wk.	3 mo.	5 mo.	15 mo.	4 yrs	11 yrs	12 yrs	45 yrs	≥65 yrs
Rotavirus	RV5	RV5	RV5
Diphtheria, Tetanus and Pertussis	DTaP + IPV + HepB + Hib	DTaP + IPV + HepB + Hib	DTaP + IPV + HepB + Hib		DTaP + IPV	Tdap		Td	Td
Polio vaccine (inactivated)
Hepatitis B
Haemophilus influenzae type b				Hib
Pneumococcal	PCV13	PCV13	PCV13	PCV13
Measles, mumps, and rubella				MMR	MMR
Human papillomavirus vaccine							HPV4 (girls only)
Influenza									Yearly

Major additions, replacements and removals from the New Zealand Immunisation Schedule include:^[29]

• 1958 – First Schedule: DTwP and DT
• 1961 – Polio (OPV) added
• 1971 – Measles, rubella and tetanus toxoid added
• 1979 – Rubella changed to girls only
• 1988 – HepB added
• 1990 – MMR replaced measles and rubella
• 1994 – Hib added; Td replaced tetanus toxoid
• 1996 – DT dropped
• 1997 – Influenza added
• 2000 – DTaP replaced DTwP
• 2002 – IPV replaced OPV
• 2006 – MeNZB and Tdap added
• 2008 – MeNZB dropped, PCV7 added, HPV4 added for females only
• 2011 – PCV10 replaced PCV7
• 2014 – RV5 added, PCV13 replaced PCV10

United Kingdom

The United Kingdom childhood vaccination schedule is recommended by the Department of Health and National Health Service, and uses combination immunisations where available.

United Kingdom Vaccine Schedule: 2013^[30]

Vaccine	2 mo.	3 mo.	4 mo.	12 mo.	3–4 yrs	12–13 yrs	13–18 yrs
Diphtheria, pertussis, and tetanus	DTaP + IPV + Hib	DTaP + IPV + Hib	DTaP + IPV + Hib		DTaP + IPV		Td + IPV
Polio vaccine (inactivated)
Haemophilus influenzae type b				Hib + MenC
Meningococcus		MenC					MenC (13-15 yrs)
Rotavirus (from July 2013)	Rotavirus	Rotavirus
Pneumococcal	PCV		PCV	PCV
Measles, mumps, and rubella				MMR	MMR
Human papillomavirus vaccine						HPV x3^1
^1. Females only 3 vaccinations over 12 months

Non-routine vaccinations

Some children may receive vaccines in addition to those listed in the table:

• BCG vaccine is given at birth "to babies who are more likely to come into contact with Tuberculosis than the general population."
• Hepatitis B vaccine is given at birth "to babies whose mothers are hepatitis B positive."

Adult vaccinations

The five scheduled childhood tetanus vaccinations are thought to generally confer lifelong immunity; thus, no routine booster doses are given in adulthood. Those adults at risk of contaminated cuts (e.g., gardeners) may have booster tetanus vaccination every ten years.^[31]

Pneumococcal vaccinations (pneumococcal polysaccharide vaccine/PPV) are recommended for those over 65 and for people without a functional spleen (asplenia), either because the spleen has been removed or does not work properly.^[32] Also, it should be noted that current CDC guidelines recommend that if not previously vaccinated, administer PCV13 first and give PPSV23 6–12 months after, but if previously received PPSV23, administer PCV13 ≥12 months after ^[33]

Flu vaccine is recommended for anyone who is aged 65 years and over, people with certain long-term medical conditions, health and social care professionals and poultry workers.^[34]

United States

The most up-to-date schedules are available from CDC's National Center for Immunization and Respiratory Diseases. In the US, the National Childhood Vaccine Injury Act requires all health-care providers to provide parents or patients with copies of Vaccine Information Statements before administering vaccines.^[35]

United States Vaccine Schedule: 2014^[36][37]

Vaccine	Birth	1 month	2 mo.	4 mo.	6 mo.	9 mo.	12 mo.	15 mo.	18 mo.	19-23 mo	2-3 yrs	4–6 yrs		7-10 yrs	11–12 yrs	13-18 yrs	19–26 yrs	27-59 yrs		60–64 yrs	≥65 yrs
Hepatitis B (HepB)	1st	2nd			3rd												3 doses
Rotavirus			1st	2nd
Diphtheria, pertussis, and tetanus			DTaP	DTaP	DTaP			DTaP				DTaP			Tdap		Td (every 10 years)
Haemophilus influenzae type b (Hib)			1st	2nd			3rd or 4th										1 or 3 doses
Pneumococcal			1st PCV	2nd PCV	3rd PCV		4th PCV						PPSV								PPSV
Polio vaccine, inactivated (IPV)			1st	2nd	3rd							4th
Influenza					Annual vaccination (IIV only)						Annual vaccination (IIV or LAIV)
Measles, mumps, and rubella (MMR)							1st					2nd					1 or 2 doses		1 dose
Varicella (chickenpox)							1st					2nd								Addition of shingles vaccine
Hepatitis A							2-dose series
Meningococcus						MCV									Dose 1	Booster at 16	1 or more doses
Human papillomavirus vaccine															3 doses	3 doses^1
Range of recommended ages for everyone. See references for more details.   Range of recommended ages for certain high-risk groups. See references for more details.   Range of recommended ages for catch-up immunization or for people who lack evidence of immunity (e.g., lack documentation of vaccination or have no evidence of prior infection). CDC provides more detailed information in catch-up immunizations. ^1. Note on HPV vaccine: Males who have not yet received 3 doses of HPV4 are generally recommended to have done so through age 21. HPV4 is recommended for men who have sex with men through age 26 years who did not get any or all doses when they were younger.

See also

• Influenza vaccine
• H5N1 clinical trials
• 2009 flu pandemic vaccine

References

1. "What Is a Vaccine". NIAID. Retrieved 2010-05-04.
2. "Tetanus: Prevention". Mayo Clinic. 2006-09-21. Retrieved 2008-07-17.
3. "History of Vaccine Schedule | The Children's Hospital of Philadelphia". Retrieved 2010-05-04.
4. Update on Yellow Fever in the Americas, http://www.paho.org/english/SHA/be_v21n2-yellowfever.htm, the Epidemiological Bulletin, Vol. 21 No. 2, June 2000, Pan American Health Organization, accessed July 18, 2007
5. State of the World's Vaccines and Immunizations (pdf) from the World Health Organization (2003 edition)
6. "Immunisation schedule". Retrieved 2013-03-22.
7. "WHO Vaccine Preventable Diseases Monitoring System". World Health Organization. 22 December 2006. Retrieved 2007-01-02.
8. "WHO World Health Organization: Immunization, Vaccines And Biologicals". WHO vaccine-preventable diseases: monitoring system 2010 global summary – National vaccines schedules. Retrieved 2010-06-08.
9. "Vaccines: VPD-VAC/List of VPDs". Retrieved 2010-06-08.
10. Unless noted"GDP Report Disease incidence, prevalence and disability" (PDF). Retrieved 2010-05-04.
11. Unless noted "Deaths and DALYs 2004: Annex tables" (PDF). Retrieved 2010-05-04.
12. "WHO Haemophilus influenzae type b (Hib)". Retrieved 2010-05-04.
13. "Wild Poliovirus Cases 2009" (PDF). Archived from the original (PDF) on July 11, 2009. Retrieved 2010-05-04.
14. "WHO Hepatitis A". Retrieved 2010-06-08.
15. 2000 data"WHO: Streptococcus pneumoniae( Pneumococcus)". Retrieved 2010-06-08.
16. "Rotavirus Homepage CDC Rotavirus". Retrieved 2010-06-08.
17. >Department of Health and National Health Service (30 April 2013). "Important changes to the national immunisation programme in 2013-14, and introduction of rotavirus vaccination for babies at two and three months" (pdf). National Health Service. Retrieved 2013-06-03.
18. 2009 data"WHO | Diarrhoeal Diseases (Updated February 2009)". Retrieved 2010-06-08.
19. "WHO Yellow fever". Retrieved 2010-06-08.
20. Suss J (June 2008). "Tick-borne encephalitis in Europe and beyond – the epidemiological situation as of 2007". Euro Surveill. 13 (26). PMID 18761916.
21. "WHO Vector-Borne Viral Infections". Retrieved 2010-06-08.
22. "HPV and Cervical Cancer in the World 2007 Report" (PDF). Retrieved 2010-06-08.
23. "Immunise – About the Program". Retrieved 2010-05-05.
24. "National Immunisation Program Schedule". 2015-04-20. Retrieved 2016-04-06.
25. "Immunisation Calculator". Government of South Australia. Retrieved 2016-05-02.
26. "Victorian immunisation catch-up tool for 10 to 19 year olds" (PDF). Western Victoria Primary Health Network. January 2016
27. Public Health Agency of Canada http://www.phac-aspc.gc.ca/im/iyc-vve/is-cv-eng.php. Retrieved 2015-02-01. Missing or empty |title= (help)
28. "The National Immunisation Schedule" (PDF). Ministry of Health (New Zealand). Retrieved 19 April 2015.
29. "Appendix 1: The history of immunisation in New Zealand". Ministry of Health. Retrieved 3 November 2015.
30. Department of Health and National Health Service. "Vaccination schedule". National Health Service. Retrieved 2013-06-04.
31. "Immunisation – FAQs – Will I need more boosters in the future?". Archived from the original on January 14, 2010. Retrieved 2010-05-05.
32. "Immunisation – FAQs – How often will I need this vaccine?". Retrieved 2010-05-05.
33. "Immunization Schedules". Center for Disease Control. center for disease control and prevention. Retrieved 4 November 2014.
34. "Immunisation – Having the vaccination – Who is the vaccine for?". Archived from the original on February 18, 2009. Retrieved 2010-05-05.
35. "Vaccine Information Statements: Instructions" (PDF). Retrieved 2010-05-05.
36. "FIGURE 1: Recommended immunization schedule for persons aged 0 through 18 years" (PDF). CDC. Retrieved 2014-02-08.
37. "Recommended Adult Immunization Schedule — United States, 2014" (PDF). CDC. Retrieved 2014-02-08.

External links

• National Center for Immunization and Respiratory Diseases. "CDC National Immunization Program". (U.S.) Centers for Disease Control and Prevention. Retrieved 2008-06-14.
  • CDC 2013 Recommended Immunizations for Children from Birth Through 6 Years Old
• UK National Health Service. "The UK immunisation schedule". National Health Service. Retrieved 2006-11-03.
• UN World Health Organisation. "Reported immunization schedule by regions/countries/antigens" (CFM). World Health Organisation. Retrieved 2010-05-07.