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Vaccination schedule

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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.

Example Polish call for vaccination against Diphtheria and Tetanus.

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 vaccinations 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 four vaccines, for protection against (diphtheria, pertussis, tetanus, polio, 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 10 injections by the age of two, rather than 25 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 Yes1 Yes1 Yes Yes Yes Yes Yes1 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 Yes1 Yes1 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 OPV OPV
Hepatitis A Fecal-oral 1,400,000 [14] Un­known Yes Yes1 Yes1 Yes Yes1 Yes
Human papillomavirus Sexual contact 493,000 2 247,000 2 Yes Yes Yes Yes
Influenza (seasonal) Airborne droplet 3,000,000–5,000,000 250,000–500,000 Yes1 Yes1 Yes1 Yes1 Yes1 Yes1 Yes Yes1
Meningococcus Airborne droplet Un­known 340,000 Yes Yes Yes Yes1 Yes Yes1 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 Yes1 Yes
Rotavirus Fecal-oral 527,000 [16] 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 [17] 216,000 Yes Yes1
Varicella Airborne Un­known Un­known Yes Yes Yes
Yellow fever Mosquito 200,000 [18] 30,000 Yes
Tick-borne encephalitis Tick 5,000–7,000[19] Un­known Yes1
Japanese encephalitis Mosquito 50,000 [20] 15,000 Yes1 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.[21]

Country Specific Schedules

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.[22]

Australia Vaccine Schedule: 2010[23]
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 HepB
Rotavirus RV RV RV
Diphtheria, pertussis, and tetanus DTPa DTPa DTPa DTPa dTpa
Haemophilus influenzae type b Hib Hib Hib Hib
Pneumococcal 7vPCV 7vPCV 7vPCV 23vPPV
Polio vaccine (inactivated) IPV IPV IPV IPV
Measles, mumps, and rubella MMR MMR
Varicella Varicella
Meningococcus MenCCV
Human papillomavirus vaccine HPV1
Influenza Yearly
  Range of recommended ages except certain high-risk groups. See references for more details including "catch-up" immunizations, and recommendations for high-risk groups
  1. ^ 12–13 years, females only

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. Changes were made in December 2010,[24] and in April 2013 the moving of the 3rd MMR from aged 4 months to adolescence, and the introduction of rotavirus vaccine at 2 and 3 months.[25]

United Kingdom Vaccine Schedule: 2010[24]
Vaccine 2 mo. 3 mo. 4 mo. 12 mo. 3–4 yrs 12–13 yrs 13–18 yrs
Diphtheria, pertussis, and tetanus DTaP DTaP DTaP DTaP Td
Polio vaccine (inactivated) IPV IPV IPV IPV IPV
Haemophilus influenzae type b Hib Hib Hib Hib
Meningococcus MenC MenC MenC
(13-15 yrs)
Rotavirus Rotavirus Rotavirus
Pneumococcal PCV PCV PCV
Measles, mumps, and rubella MMR MMR
Human papillomavirus vaccine HPV x31
  1. ^ Females only

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.[26]

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.[27]

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.[28]

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.[29]

United States Vaccine Schedule: 2012[30][31][32][needs update]
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 HepB HepB Complete 3-dose series 3 doses
Rotavirus RV RV RV
Diphtheria, pertussis, and tetanus DTaP DTaP DTaP DTaP DTaP DTaP, 1 dose DTaP DTaP, 1 dose Td (every 10 years) Td or Tdap
Haemophilus influenzae type b Hib Hib Hib Hib
Pneumococcal PCV PCV PCV PCV PPSV PPSV
Polio vaccine (inactivated) IPV IPV IPV IPV IPV, complete 3-dose series
Influenza Influenza (yearly)
Measles, mumps, and rubella MMR MMR Complete 2-dose series 1 or 2 doses 1 dose
Varicella (chickenpox) Varicella Varicella Complete 2-dose series Addition of shingles vaccine
Hepatitis A HepA, dose 1 HepA Series Complete 2-dose series
Meningococcus MCV Dose 1 Booster at 16 1 or more doses
Human papillomavirus vaccine 3 doses Complete 3-dose series[note]
  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. ^ back 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

References

  1. ^ "What Is a Vaccine". NIAID. Retrieved 2010-05-04.
  2. ^ "Tetanus: Prevention" (Document). Mayo Clinic. 2006-09-21. {{cite document}}: Unknown parameter |accessdate= ignored (help); Unknown parameter |url= ignored (help)
  3. ^ a b c "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. ^ a b "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). Retrieved 2010-05-04. [dead link]
  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. ^ 2009 data"WHO | Diarrhoeal Diseases (Updated February 2009)". Retrieved 2010-06-08.
  18. ^ "WHO Yellow fever". Retrieved 2010-06-08.
  19. ^ Suss J (2008). "Tick-borne encephalitis in Europe and beyond – the epidemiological situation as of 2007". Euro Surveill. 13 (26). PMID 18761916. {{cite journal}}: Unknown parameter |month= ignored (help)
  20. ^ "WHO Vector-Borne Viral Infections". Retrieved 2010-06-08.
  21. ^ "HPV and Cervical Cancer in the World 2007 Report" (PDF). Retrieved 2010-06-08.
  22. ^ "Immunise – About the Program". Retrieved 2010-05-05.
  23. ^ "National Immunisation Program Schedule" (PDF). Australian Government. Retrieved 2010-05-05.
  24. ^ a b Department of Health and National Health Service. "Immunisation schedule". National Health Service. Retrieved 2010-05-05. [dead link]
  25. ^ >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.
  26. ^ "Immunisation – FAQs – Will I need more boosters in the future?". Retrieved 2010-05-05. [dead link]
  27. ^ "Immunisation – FAQs – How often will I need this vaccine?". Retrieved 2010-05-05. [dead link]
  28. ^ "Immunisation – Having the vaccination – Who is the vaccine for?". Retrieved 2010-05-05. [dead link]
  29. ^ "Vaccine Information Statements: Instructions" (PDF). Retrieved 2010-05-05.
  30. ^ "FIGURE 1: Recommended immunization schedule for persons aged 0 through 6 years—United States, 2012" (PDF). CDC. Retrieved 2012-06-29.
  31. ^ "FIGURE 2: Recommended immunization schedule for persons aged 7 through 18 years—United States, 2012" (PDF). CDC. Retrieved 2012-06-29.
  32. ^ "Recommended Adult Immunization Schedule — United States, 2012" (PDF). CDC. Retrieved 2012-06-29.
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