Category: Immunization Schedules

Immunization Schedules from Other Countries

The latest immunization schedule from the CDC and AAP.
The latest immunization schedule from the CDC and AAP.

Why does the United States give so many more vaccines than other countries?

The easy answer might be that we want to protect kids from more vaccine-preventable diseases. Of course, it is much more complicated than that.

But why does it matter?

It still matters because Jenny McCarthy has pushed the idea that we have an ‘autism epidemic‘ in the United States because “other countries give their kids one-third as many shots as we do.”

And some folks still believe her.

They also believe anti-vaccine myths and misinformation linking giving more vaccines to having higher infant mortality rates.

Immunization Schedules from Other Countries

Which vaccines a country routinely gives often depends on the risk a diseases poses to the people that live there. For example, some countries routinely give the BCG and Japanese encephalitis vaccines, but only give the hepatitis B vaccine in high risk situations.

And while many folks still push the myth that the United States gives many more vaccines than other developed countries, you just have to look at their immunization schedules to see that it isn’t true.

Remember that in the United States, children typically get:

  • 36 doses of 10 vaccines before starting kindergarten that protect them against 14 vaccine-preventable diseases
  • at least three or four more vaccines as a preteen and teen, including a Tdap booster and vaccines to protect against HPV and meningococcal disease, plus they continue to get a yearly flu vaccine

So by age 18, that equals about 57 dosages of 14 different vaccines to protect them against 16 different vaccine-preventable diseases. While that sounds like a lot, keep in mind that 33% of those immunizations are just from your child’s yearly flu vaccine.

Immunization Schedules from Europe

How do immunization schedules from European countries differ from the United States?

Austria's immunization schedule for 2017 includes all of the same vaccines as the US schedule.
Austria’s immunization schedule for 2017 includes all of the same vaccines as the US schedule, plus the vaccine for Japanese encephalitis (if high risk).

Surprisingly, they don’t differ by that much, despite what you may have heard or read.

And in many European countries, even if you don’t get more vaccines overall, you do get more dosages at an earlier age, often with two dosages of MMR and the chicken pox vaccine by the time your child is 15 to 24 months old.

The latest immunization schedule from Germany.
The latest immunization schedule from Germany.

Some vaccines, like hepatitis A and chicken pox aren’t routine in every European country, like Iceland and Sweden, but many countries give vaccines that we don’t, like BCG and MenC. And even Iceland and Sweden have recently added the HPV vaccine to their schedule and Sweden may soon add the rotavirus vaccine too.

Immunization Schedules from Other Countries

Many countries, in addition to those in Europe, have vaccine schedules that are very similar to the one that is used in the United States.

The 2017 Immunization Schedule for South Korea includes all of the US vaccines, plus BCG and Japanese encephalitis vaccines.
The 2017 Immunization Schedule for South Korea includes all of the US vaccines, plus BCG and   Japanese encephalitis vaccines.

Just look at the immunization schedules for Australia, Canada, Israel, South Korea, or Taiwan, etc.

What about Japan? They must give fewer vaccines than we do in the United States, right? After all, aren’t they the country that banned the use of the HPV vaccine?

Although that myth is still pushed by many anti-vaccine websites, the HPV vaccine is not banned in Japan. It was removed as a vaccine that is actively recommended in 2013, but it still available and is still on the Japanese immunization schedule.

The 2016 routine and voluntary immunization schedule in Japan.
The 2016 routine and voluntary immunization schedule in Japan.

All of our other vaccines are also on the Japanese immunization schedule. In addition, they give infants the BCG and Japanese encephalitis vaccines.

What to Know About Immunization Schedules from Other Countries

Many countries use a similar immunization schedule and give the same types of vaccines as we do in the United States.

More On Immunization Schedules from Other Countries

Catch-Up Immunization Schedules

It is surprisingly easy to get behind on your child’s immunizations, even if you are trying to stay on schedule.

How do you miss a shot?

Your child could have been sick when they were supposed to get their vaccines, your pediatrician might have been out of one or more vaccines, or you might have simply missed one of your child’s well checkups.

Catching Up On Vaccines

A catch-up immunization schedule
A catch-up vaccination schedule program can help you figure out when to get the vaccines your child has missed.

If your child gets behind and misses one or more vaccines, be sure to get caught up as soon as possible.

If your child needs to get caught up quickly, like to start daycare or school, to travel out of the country, or because of a disease outbreak in your area, you can even use an accelerated immunization schedule, using minimum intervals between doses.

Depending on your child’s age, you might even be able to skip a few doses or vaccines.

For example, with rotavirus vaccines, vaccination should not be started if an infant is already 15 weeks old and the final dose must be given by 8 months of age.

And if your child gets their first dose of Hib after they are 15 months old, they don’t need any more doses. And they wouldn’t need any doses at all if they are already 5 years old.

Prevnar, IPV, and DTaP might also need to given on an alternative schedule when given on a catch-up schedule.

Specifically, your child might be able to skip:

  • the fifth dose of the DTaP vaccine, if the fourth dose was given at age 4 years or older.
  • the fourth dose of the IPV vaccine, if the third dose was given at age 4 years or older.
  • one or more doses of Prevnar, depending on when the other doses were given

Is this a good way to get out of getting some doses or vaccines?

Of course not. In addition to missing out on those vaccines, your child is missing out on the protection from those vaccines.

For More Information on Catch-Up Immunization Schedules

Vaccines in Special Situations

800px-infant_with_cochlear_implant
Children with a cochlear implant need the Pneumovax 23 vaccine.

In addition to getting routine vaccines, there are some special situations in which kids need extra vaccines or extra dosages of vaccines.

Traveling out of the country and being pregnant are almost certainly the most common special situation when it comes to vaccines.

Vaccines for High Risk Conditions

Other special situations include children with high risk conditions, such as:

  • complement component deficiencies – MenHibrix or Menveo (infants), MenB
  • chronic heart disease – PPSV23
  • chronic lung disease (not including asthma) – PPSV23
  • diabetes mellitus – PPSV23
  • CSF leaks – PPSV23
  • cochlear implants – PPSV23
  • chronic liver disease – PPSV23
  • cigarette smoking – PPSV23
  • sickle cell disease – PPSV23
  • congenital or acquired asplenia – MenHibrix or Menveo (infants), PPSV23, MenB
  • congenital or acquired immunodeficiencies – PPSV23
  • HIV infection – PPSV23
  • chronic renal failure – PPSV23
  • nephrotic syndrome – PPSV23
  • leukemia – PPSV23
  • lymphoma – PPSV23
  • hodgkin disease – PPSV23
  • iatrogenic immunosuppression – PPSV23
  • solid organ transplant – PPSV23
  • multiple myeloma – PPSV23

In general,  the 23-valent pneumococcal polysaccharide vaccine, PPSV23 or Pneumovax 23, should be given when a high risk child is at least 2 years old and at least 4 weeks after their last dose of Prevnar 13. Some will need an additional booster dose of Pneumovax 23 after five years.

Remember, most children routinely get 4 doses of Prevnar 13 when they are 2, 4, 6, and 12-15 months old.

And while most kids just get one dose of PPSV23, others, especially those with any type of immunosuppression, get a repeat dose every five years.

Getting Revaccinated

Are there ever situations when kids need to get revaccinated?

While it might be hard to believe, there are more than a few reasons that kids get revaccinated.

The most obvious is when kids lose their vaccine records, although checking vaccine titers might help avoid repeating some or all of your child’s vaccines.

Children who have had a hematopoietic cell transplant (HCT) should routinely get revaccinated:

  • starting with inactivated vaccines six months after the transplant, including a 3-dose regiment of Prevnar 13, followed by PPSV23, a 3-dose regiment of Hib, and a yearly flu shot and other inactivated vaccines
  • continuing with a dose of MMR 24 months after the transplant if they are immunocompetent and possibly the chicken pox vaccine

Children who are adopted in a foreign country also often need to repeat all or most of their vaccines. Again, titers can often be done to avoid repeating doses.

Other Special Situations

Other special situations in which your child might need to get vaccinated off the standard immunization schedule might include:

  • missing one or more vaccines and needing to catch-up
  • getting exposed to rabies (cats, dogs, raccoons, skunks, bats, foxes, and coyotes)
  • having a wound that is not considered clean and minor (usually “wounds contaminated with dirt, feces, soil, and saliva; puncture wounds; avulsions; and wounds resulting from missiles, crushing, burns, and frostbite”) if it has been more than five years since their last dose of tetanus vaccine (or a clean and minor wound and it has been more than 10 years)
  • getting exposed to chicken pox (or shingles) or measles and not being fully vaccinated (two doses of the chicken pox and two doses of the MMR vaccines) or naturally immune, as a vaccine within 72 hours may decrease their risk of getting sick

Do your kids have a medical condition that might put them at high risk for a vaccine-preventable disease?

Do they need a vaccine that other kids don’t routinely get?

For More Information on Vaccines in Special Situations

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Translating Foreign Language Immunization Schedules

It can be hard to enough to read an immunization schedule if you don’t have a medical degree, what with all of the acronyms and all.

DTaP, MMR, and lot numbers, etc.

But what if the immunization schedule is in a foreign language?

foreign-language-immunization-schedules
A Chinese to English immunization record to help make translating records easier.

How much luck will you have reading it then?

Fortunately, there is help for English speakers who get an immunization schedule in Spanish, French, Chinese, or Arabic, etc. And you don’t need your own translator.

Check out the resources below.

More on Translating Foreign Immunization Records:

Updated September 13, 2017

Immunization Schedules

Each year, since 1995, the Advisory Committee on Immunization Practices (ACIP) of the CDC has reviewed the recommended immunization schedule, and it has then been approved by ACIP, the American Academy of Pediatrics, the American Academy of Family Physicians, and the American College of Obstetricians and Gynecologists.

Before 1995, in 1994, 1989, and 1983, an immunization was simply published as part of the ACIP’s general recommendations.

Looking for an alternative to the ACIP immunization schedule?

According to the American Academy of Pediatrics:

No alternative vaccine schedules have been evaluated and found to provide better safety or efficacy than the recommended schedule, supported by the Advisory Committee on Immunization Practices of the CDC and the Committee on Infectious Diseases of the AAP (the committee that produces the Red Book).

Pediatricians who routinely recommend limiting the numbers of vaccines administered at a single visit such that vaccines are administered late are providing care that deviates from the standard evidence-based schedule recommended by these bodies.

Again, there are no alternative immunization schedules.

For more information:

Vaccines for Adults

Adults need to get vaccines, just like kids. Of course, they don’t get as many vaccines as kids, since many adults are either already immune or are no longer at risk to many vaccine-preventable diseases.

Adults do get:

They can also get most other vaccines, except Rotavirus and DTaP (they get Tdap instead), that they need because they lack immunity. Although it is not on the immunization schedule, adults can get the polio vaccine if necessary.

Another question that comes up concerning adult vaccines is why so adults and children get the same vaccines. In other words, are vaccines calibrated taking into account a child’s weight and age?

Donald Trump often says that he is against vaccines because we give “one massive dose for a child,” going on to say that they should get smaller dosages in a more spread out schedule. Some others agree, claiming that infants shouldn’t get the same dose of vaccine as an adult.

But do they?

Not always. There are pediatric versions of the influenza, hepatitis A, hepatitis B, and DTaP (vs Tdap) vaccines.

It doesn’t necessarily matter though. Unlike medications you take, like Tylenol or an antibiotic, vaccines don’t go through your whole body to work, so your size doesn’t matter.

For more information on why this isn’t a real issue:

Vaccines in Pregnancy

Can children get vaccinated when their mother is pregnant?

Yes.

The CDC states that “pregnancy of recipient’s mother or other close or household contact” is not a contraindication to getting vaccinated, even for live vaccines like MMR or Varivax.

Vaccines for Pregnant Women

Since infants can't get a flu shot until they are 6 months old, they rely on their pregnant mothers to get vaccinated and to pass on their protection to them.
Since infants can’t get a flu shot until they are 6 months old, they rely on their pregnant mothers to get vaccinated and to pass on their protection to them.

What about pregnant women?

Are vaccines safe or necessary for them?

While they shouldn’t get live vaccines, like MMR, Varivax, Flumist, or the yellow fever vaccine, or the HPV vaccine, it is safe and necessary for pregnant women to get most other vaccines.

In fact, all pregnant women should get:

Getting vaccinated during pregnancy helps protect newborn babies and infants against the flu and pertussis (whooping cough).

Are Vaccines During Pregnancy Really Safe?

What about the idea that vaccines have never been tested for safety or effectiveness in pregnancy?

“Health care providers and patients should be aware that the reassuring safety data for use of the aforementioned vaccines in pregnancy are compelling, and there is no link to vaccine administration and miscarriage.”

ACOG on Vaccines Routinely Recommended during Pregnancy

The seasonal flu and Tdap vaccines, the two most commonly recommended are safe and effective in pregnancy. And so are the others that are not contraindicated.

In fact, the Vaccine Safety Datalink has published 14 studies “related to pregnancy and vaccination during pregnancy” and is “also able to use data to study the health of children born to women who were vaccinated during pregnancy.”

What About the Association of Flu Shots with Miscarriages?

You may have seen the headlines about a new study in which “Researchers find hint of a link between flu vaccine and miscarriage.”

Published in the journal Vaccine, the study did find that having a miscarriage “was associated with influenza vaccination in the preceding 28 days.”

The “modest” association only held during the 2010-12 flu seasons though and only if:

  • the mother had also received an H1N1 flu vaccine the previous year
  • the flu vaccine was given early in her pregnancy

The association was found by comparing two small groups of women who were pregnant during flu season, including one whose pregnancy ended in a miscarriage. They then compared the two groups to find differences. And the main difference they found was that the group with the miscarriages were more likely to have had a flu shot the previous year. So that is the link, association, or maybe more appropriately named – the correlation.

“This study does not quantify the risk of miscarriage and does not prove that flu vaccine was the cause of the miscarriage.”

CDC on Flu Vaccination & Possible Safety Signal

Interestingly, the study found no association between having a flu shot during the same season and having a miscarriage. The pregnant women in the control group were just as like to have flu shots, even early in their pregnancy.

It is also important to note that several other studies have not found an association between miscarriages and flu shots, including an almost identical study that looked at the 2005-07 flu seasons!

“A recent publication has reported a safety signal concerning influenza vaccination when given very early in the first trimester. In this study, influenza vaccination, when given in very early pregnancy, was associated with an increased risk of a pregnancy loss within the first 28 days following vaccination. Scientifically, it is unclear why this would occur. There was no association seen with a pregnancy loss more than 28 days after vaccination. In the same study, when vaccination was given either later in the first trimester or in the second or third trimester, there was no association seen with pregnancy loss or any other adverse pregnancy outcomes. Additional studies are needed to address the concern raised by this study.”

ACOG statement It is Safe to Receive Flu Shot During Pregnancy

So it is still safe to get a flu shot while you are pregnant, as this possible association continues to be studied. There are already ongoing studies looking at flu shots and pregnancy during the 2012 through 2015 flu seasons that will be completed next year.

“Two other medical journals rejected the article before a third, Vaccine, accepted it. Dr. Gregory Poland, Vaccine’s editor-in-chief, said it was a well-designed study that raised a question that shouldn’t be ignored. But he doesn’t believe flu shots caused the miscarriages. “Not at all,” said Poland, who also is director of vaccine research at the Mayo Clinic.

Though this study may cause worry and confusion, it is evidence “of just how rigorous and principled our vaccine safety monitoring system is,” said Jason Schwartz, a Yale University vaccine policy expert.”

AP report Study prompts call to examine flu vaccine and miscarriage

While most experts don’t think that getting a flu shot while you are pregnant is harmful, even considering this new study, they do know that getting the flu is.

What To Know About Vaccines During Pregnancy

When you are pregnant, getting your Tdap and flu vaccines can help keep you and your baby safe and healthy.

More Information on Vaccines During Pregnancy:

Updated September 13, 2017