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.
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. 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. 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.
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. 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. 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. Since the mid-1980s, many vaccines have been added to the schedule. As of 2009[update], 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. The use of combination vaccine products means that, as of 2013[update], 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.
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. 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.
|Hepatitis B||Bodily fluids||5,700,000 (acute)||105,000||Yes||Yes||Yes||Yes1||Yes1||Yes||Yes||Yes||Yes||Yes1||Yes||Yes|
|Airborne droplet||2,000,000–3,000,000 ||386,000||Yes||Yes||Yes||Yes||Yes||Yes||Yes||Yes||Yes|
|Polio||Fecal-oral||1,606 ||Unknown||OPV||OPV||IPV||IPV||IPV||IPV||IPV, OPV||OPV||OPV||OPV||IPV||OPV||OPV|
|Hepatitis A||Fecal-oral||1,400,000 ||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|
|Pneumococcus||Airborne droplet||14,500,000 ||826,000||Yes||Yes||Yes||Yes||Yes1||Yes|
|Typhoid fever||Fecal-oral||22,000,000 ||216,000||Yes||Yes1|
|Yellow fever||Mosquito||200,000 ||30,000||Yes|
|Japanese encephalitis||Mosquito||50,000 ||15,000||Yes1||Yes||Yes|
- ^ At risk groups or certain populations only. See reference for more details.
- ^ Incidence and deaths noted are for cervical cancer. Nearly 100% of cervical cancer is caused by HPV.
Country Specific Schedules
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.
|Vaccine||Birth||2 mo.||4 mo.||6 mo.||12 mo.||18 mo.||4 yrs||10–13 yrs||15–17 yrs||≥65 yrs|
|Diphtheria, pertussis, and tetanus||DTPa||DTPa||DTPa||DTPa||dTpa|
|Haemophilus influenzae type b||Hib||Hib||Hib||Hib|
|Polio vaccine (inactivated)||IPV||IPV||IPV||IPV|
|Measles, mumps, and rubella||MMR||MMR|
|Human papillomavirus vaccine||HPV1|
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
The United Kingdom childhood vaccination schedule is recommended by the Department of Health and National Health Service, and uses combination immunisations where available.
|Vaccine||2 mo.||3 mo.||4 mo.||12 mo.||3–4 yrs||12–13 yrs||13–18 yrs|
|Diphtheria, pertussis, and tetanus||DTaP +
|Polio vaccine (inactivated)|
|Haemophilus influenzae type b||Hib +
|Meningococcus||MenC||MenC (13-15 yrs)|
|Rotavirus (from July 2013)||Rotavirus||Rotavirus|
|Measles, mumps, and rubella||MMR||MMR|
|Human papillomavirus vaccine||HPV x31|
^1. Females only 3 vaccinations over 12 months
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."
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.
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.
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.
|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|
|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 doses1|
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.
^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.
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