VACCINE

Birth

6w-2m

3m-4m

5m-6m

6m-7m

12m

12m-15m

18m

19m-23m

2yr-3yr

4yr-6yr

BCG

Hep B

DTaP/IPV

HiB

Rotavirus

PneumoC

Influenza

MMR

Chicken pox

Hep A

MeningoC

BCG

(intradermal)

BCG – Bacille Calmette-Guerin (live bacterial vaccine from bovine tubercle bacillus)

Prevent against Mycobacterium tuberculosis (TB) – 1^st dose to be given at birth

Check for scar at 7 years of age – if no scar, to revaccinate

Hep B

(intramuscular)

Prevent against hepatitis B infection.

1^st dose at birth, 2^nd and 3^rd dose in combination with DTaP/IPV/Hib + Hep B (Hexa) or given separately at 1mth(2^nddose) and 5-6mths(3^rd dose)

DTaP/IPV/HiB

(intramuscular)

DTaP – Diphtheria, tetanus toxoid, acellular pertussis/Inactivated polio/HiB vaccine Prevent against diphtheria, tetanus, pertussis, polio and haemophillus influenza B inf

DTaP/IPV- 1^st booster at 18mths and 2^nd booster at 4-6 years old

HiB conjugate vaccine – Only need 1^st booster at 18mths

Rotavirus

(oral)

Prevent against rotavirus infection

1^st and 2^nd doses to be given 1-2mths apart

1^st dose should not be administered after the age of 6mths

PneumoC

(intramuscular)

Prevent against pneumococcal infection

PCV(pneumococcal conjugate vaccine) – recommended for all children < 5 years old

Administer 1 dose of PCV for children >2 years old

Influenza

(intramuscular)

Prevent against common cough/cold viruses

Administer 2 doses (separate by at least 4weeks) to children age younger than 9 who are receiving influenza vaccine for the first time then yearly interval

MMR

(subcutaneous)

Prevent against MMR (measles, mumps and rubella) infections

Minimum age 12mths except in Sabah (at 6mths of age)

2 dose (booster) at age 4 – 6 years old

Chicken pox

(subcutaneous)

Prevent against chicken pox/varicella infection

Minimum age 12mths; can be given at the same time with MMR vaccine

2 dose (booster) at age 4 – 6 years old

Hep A

(intramuscular)

Prevent against hepatitis A infection

1^st dose at 19-23mths and 2dose to be given 6mths apart

MeningoC

(subcutaneous/

(intramuscular)

Prevent against meningococcal infection

Minimum age 2 years old

Recommended especially for high risk groups eg: complement deficiency, functional or anatomical asplenia(absence of spleen) etc…

BCG

Rash, fever, local induration, pain and lymphadenopathy (enlarged lymph nodes)

Local reaction with papules (1-2weeks) and later ulcer (2-6 weeks) is normal. Healing occurs in about 12 weeks. Keloid may form.

Local complications – uncommon (1-2%) – persistent ulcer and regional lymphadenitis which normally resolved spontaneously.

Systemic reactions – rarely osteitis (long born infection) and extremely rare disseminated BCG infection normally in impaired immunity such as HIV infected infants.

Hep B

Generally well tolerated. Mild reactions include transient/minor soreness and redness at injection site, low grade fever, nausea, dizziness, tiredness, rash and influenza-like syndrome, myalgia and arthritis. These reactions occur less frequently in infants and children than in adults. These normally resolved within 24-48 hours of vaccine administration. The frequency of reactions decreases with subsequent doses of vaccine.

Severe anaphylactic reaction occurs very rarely (usually in adults).

DTaP/IPV/HiB

Local reactions – erythema(redness), pain and induration at injection sites are common, usually mild and require no treatment.

Systemic reactions – fever, malaise/lethargy/fatigue, exaggerated local reaction (intense painful swelling and induration) are sometimes encountered. The use of acellular pertussis (DTaP) in replacing the whole cell pertussis (DTwP) vaccine reduces both the local and systemic inflammatory reactions.

Severe allergic reactions such as generalized urticaria and anaphylaxis are very rare.

Deferment may be advised if patient had fever > 38.5C, history of progressive neurological or epileptic disorders or severe allergic reactions following a previous dose.

Rotavirus

Mild reactions – fever, vomiting, diarrhea and irritability were common side effects

Uncommon and rare events – hoarseness of voice, rhinorrhea, otitis media, rash, bloody stool and bronchospasm.

Serious reaction – both vaccines did not increase the risk of intussusception relative to placebo.

PneumoC

Local reactions – pain, redness and induration – usually last < 48hrs.

Systemic reactions – fever, restlessness, rash, myalgia and headache are uncommon.

Severe allergic reactions such as anaphylaxis have rarely been reported.

Influenza

Local reactions – soreness at the injection site- may last up to 2 days.

Systemic reactions – Fever, non specific or urticarial rash, malaise, myalgia, arthralgia, arthritis, chest pain and shortness of breath can occur and most often affect persons who have had no exposure to the influenza virus antigen (eg: children).

Allergic reactions – urticaria, angioedema, allergic asthma and systemic anaphylaxis rarely occur after influenza vaccination.

MMR

Adverse reactions are generally mild and transient. Local reactions include burning or stinging sensation at injection site. General reactions following measles vaccination include fever, lymphadenopathy, diarrhea, transient rashes and febrile seizure. The risk of encephalitis (brain inflammation) is ~ 1:3 million doses, far lower than the incidence following natural measles. Hypersensitivity reactions occur rarely. The vaccine is produced in cell culture media and contains egg-related antigens. Children with egg allergy are at low risk of anaphylaxis ie ~ 1:20,000 to 1:1 million doses.

The rubella virus component causes a rash, transient arthralgia/arthritis and the mumps virus component sometimes causes mild parotitis (inflammation of the parotid gland) and on rare occasions, benign aseptic meningitis or orchitis (inflammation of the testes).

Long term prospective studies have found no association between MMR vaccination with inflammatory bowel diseases, autism or SSPE (subacute sclerosing panencephalitis)

Chicken pox

Mild reactions – usually minor and include fever and soreness at injection site. Mild varicella-like rash occurs ~ 5% of recipients within 2-6 weeks after vaccination.

Allergic reactions – erythema multiforme and anaphylaxis have been reported. Reaction may be due to any of the vaccine components including antibiotics. Hypersensitivity reaction may occur immediately after vaccination or by the following day with the appearance of rash, pruritus (itchiness) and fever.

The risk of transmission from vaccine recipients to other persons appear < 1.0% and occur only if the vaccine develops a rash. Such contact usually develop a very mild illness.

Hep A

Local reactions – pain and induration at the injection site ~ 20-50% of recipients.

Systemic reactions – fever, fatigue, vomiting, diarrhea, myalgia (muscle ache), arthralgia (joint pain) and headache in ~ 5-10% of recipients.

Anaphylaxis reactions to vaccine components and convulsions have been reported. Rare events reported include jaundice, erythema multiforme and syncope.

MeningoC

Local reactions – mild and infrequent – consist of erythema and pain that last for 1-2 days.

Systemic reactions – low grade fever, malaise and irritability. Fever > 38.5C occurs in 1-4% of vaccines.

BCG

Prevent against tuberculosis (TB). TB is a contagious disease cause by Mycobacterium tuberculosis that usually enters the lung through inhaling infected sputum droplets from a person with TB. Symptoms include prolong cough, loss of appetite, loss of weight, difficulty in breathing, night sweat and blood stain sputum. The disease gradually damages the lung and may spread to other organs including the brain. BCG vaccine protects children from lung TB ~ 50-80% and other form of serious infections such as miliary TB (generalized TB) and TB meningitis (TB of the brain)

Hep B

Hepatitis B can be transmitted to newborn babies by mothers who are carriers of the virus. Infection may also be transmitted from person to person through contaminated needles, blood products and intimate social or sexual contact. Hepatitis B carriers are 200 times more common to develop chronic liver disease or liver cancer than normal people, though it may take many years. Newborn babies of hepatitis B carrier mother should in addition to 3 doses of hepatitis B vaccination, also receive hepatitis B antibody (immunoglobulin) at birth to increase the protection to the babies.

DTaP/IPV/HiB

DTaP – diphtheria, tetanus and pertussis

Diphtheria – highly contagious bacterial infection in children which may cause high grade fever, swollen neck, thick grayish-white membrane on the tonsils and throat causing difficulty in swallowing, hoarse voice and breathing difficulty which may lead to death if untreated. Three primary doses of DTaP and booster doses are required to effectively prevent the disease.

Tetanus – Cause by bacteria that are widely present in earth, soiled nails and animal faeces. Tetanus bacteria infect wounds and release toxins into the blood stream. The toxin cause severe painful muscle spasm and convulsion. Three primary doses of DTaP and booster doses are required to effectively prevent the disease. Pregnant mothers who have not previously received tetanus vaccine should receive at least 2 doses of tetanus vaccine to prevent tetanus in themselves and their newborn babies.

Pertussis – also known as whooping cough is caused by bacteria that are transmitted through minute droplets from the nose and throat. Symptoms include severe paroxysmal cough (usually persist for 2-3 months) which may precipitate vomiting, bleeding around the eyes and small infants may turn blue, develop fits or stop breathing. Severe disease may lead to death from pneumonia or brain damage.   Three primary doses of DTaP and booster doses are required to effectively prevent the disease.

Polio is highly contagious disease caused by a virus that spread through stools and saliva of an infected person. Polio causes fever, vomiting, loose stools, headache, muscle ache followed by paralysis. Paralysis may be confined to one limb or may affect the entire body. Inactivated polio vaccine (IPV) is very effective in preventing polio and can be given via orally (polio drops) or injection (combined with DTaP). Both routes are effective and full protection is achieved only after 3 or more doses.

Haemophillus influenza B (HiB) – is a contagious infection caused by bacteria that spread through respiratory droplets. It may cause infection of the blood stream (bacteraemia), brain infection (meningitis), lung infection (pneumonia) and infection of the vocal cord (epiglottitis). HiB vaccine is very effective in protecting infants against all form of HiB diseases. 3 primary doses + 1 booster dose are needed to prevent the disease.

Rotavirus

Rotavirus – the commonest virus that causes diarrhea in children. Rotarivus is discharged by the billions from the infected stools of a patient and may contaminate garments, toys, bedding, food and in fact everything that is in contact with the patient. Hence, it is difficult to prevent transmission of the virus despite strict hygiene. The disease will present as fever, diarrhea, vomiting and abdominal pain which may lead to severe dehydration and can cause death. Rotavirus vaccine is given by mouth and can protect children from rotavirus infection. Two vaccines are available and are equally effective. Rotarix is given as 2 doses (1-2 months apart) and Rotateq is given as 3 doses (1-2 months apart). The duration of protection is a least 2 years.

PneumoC

Pneumococcal – bacteria that are commonly found in the throat of young children. There are about 100 types of pneumococci, of which about 7-15 types are most important. Pneumococcal infection can cause middle ear infection (otitis media), lungs infection (pneumonia), brain infection (meningitis) and blood stream infection (septicaemia). Pneumonia, meningitis and septicaemia are serious life-threatening infections with mortality rate about 30%. There are 2 types of pneumococcal vaccines available and a minimum of 3 doses of vaccines is given to children under 1 year, 2 doses to children between 1-2 years and 1 dose to children 2-9 years old.

Influenza

Influenza – is a common flu virus of the respiratory tract. It is highly contagious and spread through respiratory droplets. In temperate countries, influenza epidemics occur during the winter months but in tropical countries like Malaysia, influenza occurs throughout the year with peak seasons in April to June and October to December. Because of the potential complication in the very young and the elderly, vaccination against influenza is targeted at these age groups. The virus mutates every year and therefore annual vaccinations with new strains are necessary.

MMR

MMR – Measles, mumps and rubella vaccine

Measles – is a serious and contagious viral infection that is transmitted through droplets from the nose and throat of the infected persons. It causes high fever, sore throat, red eyes, a distressing cough, rashes that started from face/neck and spread to the rest of the body. The child will look miserable, fretful and refuse to eat/drink. Complications such as lung infection (pneumonia), dehydration, eye infection and brain infection (encephalitis) which may lead to permanent brain damage can occur. First dose of MMR vaccine is given at 1 year of age. To ensure full protection, second dose of vaccine is recommended at age 4-6 years old.

Mumps – is a contagious viral infection that is transmitted through saliva. It causes fever, and painful swelling of the salivary glands on one or both sides of the face and neck. About 20% of adult males may develop inflammation of the testes. Occasionally, mumps may cause infertility, nerve deafness and brain inflammation (encephalitis).   First dose of MMR vaccine is given at 1 year of age. To ensure full protection, second dose of vaccine is recommended at age 4-6 years old.

Rubella – is a highly contagious viral infection that is transmitted through droplets from the nose and throat of infected persons. It causes fever, swollen lymph glands of the neck and back of head/ear, joint pain and rashes on the face and body. The infection is most serious if a pregnant mother transmits the infection to her unborn baby. About 90% of babies infected in the first 10 weeks after conception will have serious birth abnormalities such as blindness, brain damage, heart defects and progressive deafness.   First dose of MMR vaccine is given at 1 year of age. To ensure full protection, second dose of vaccine is recommended at age 4-6 years old. Women must ensure that they are not pregnant when receiving the vaccine. They should also avoid pregnancy for at least 1 month following vaccination.

Chicken pox

Chicken pox – is a contagious disease caused by a virus that is transmitted through nasal droplets and fluid from vesicles of persons with chicken pox or herpes zoster (shingles) infection. The child may have mild fever, minor cough, red spots and blisters on the body which are very itchy. These spots gradually dry up and scab drop off in 10-14 days, usually with minor or no scarring. In a few individuals, keloid may form over the healed pox marks. Although chickenpox is usually mild in children, complications such as high fever, secondary skin bacterial infection, dehydration and unsteady gait (cerebellitis) may occur. Chickenpox is more serious in adolescents, adults and pregnant women. Overall death from chickenpox infection is 20 times higher in adults than in children. Chicken pox vaccine is effective in preventing and modifying the disease. About 75% of the recipients are fully protected. In the rest, a minor illness occurs in which fewer than 50 spots appear which are less infectious to other people. Children need only one dose and a booster dose is optional. Persons over 12 years of age and adult who have not been previously vaccinated should receive 2 doses of vaccine.   Women must ensure that they are not pregnant when receiving the vaccine. They should also avoid pregnancy for at least 1 month following vaccination.

Hep A

Hepatitis A – is caused by a virus that is spread through food or drinks which have been contaminated by faecal material from an infected person. Undercooked seafood such as oysters, clams and cockles are common sources of infection. It can cause mild fever, severe nausea, vomiting, loss of appetite, lethargy followed by jaundice. The eye, skin and urine become progressively more yellow and the stools may turn pale. The liver is swollen and may cause pain and discomfort in the upper quadrant of the abdomen. The disease usually improves within 4-8 weeks. Death from hepatitis A is very uncommon. Hepatitis A vaccine is very effective in protecting against hepatitis A infection and to ensure prolonged protection, two doses 6 months apart are required.

MeningoC

Meningococcal – is a bacteria that is transmitted through person to person spread via infected respiratory droplets. It is initially presents wit subtle symptoms such as fever, irritability, loss of appetite and vomiting. Children older than 5 years of age may complain of headache. In meningococcaemia (invading into the blood stream), the illness may deteriorate dramatically and patient may present with sepsis (cold hand/feet), shock, drowsiness, labored breathing, fits, haemorrhagic rash and impaired consciousness. For children 2 years and older, a single 0.5mls dose of vaccine given by subcutaneous or intramuscular injection provides protection against serotypes A, C,Y,W 135 meningococcal disease.