Child & Infant Immunization Schedule

This page gives the following information on the children and infant immunization schedule:

  • What are the childhood diseases that can be prevented by immunization - to read more about these, click here.
  • What is the childhood immunization schedule for different countries, including the US, UK, Canada, South Africa, India, Australia and New Zealand? - to read more about the country specific immunisation schedules for children and babies, click here.

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Information will also be given on how many times a vaccine needs to be given - some vaccines need to be given more than once to produce a required amount of immunity and many will also require a booster dose at a later age. The child and infant immunization schedules take account of this.

To read about the how immunizations work, click here.

What diseases can be prevented by childhood immunizations?

In this section, you can read about diseases that can be prevented by the following your country's child and infant immunization schedule. Not all countries will immunise against all these diseases as part of the routine infant immunization schedule- it will depend on how common the disease is without immunisation and other country-specific factors - to check what is available on the child and infant immunization schedule in your country, click here.

Hepatitis B

The Hepatitis B virus causes inflammation of the liver (hepatitis). Children with hepatitis become yellow (jaundiced), have tummy pain, nausea and vomiting and are generally unwell. There is no specific treatment.

If you are infected you can become a chronic carrier of the disease and spread it to others (through blood, semen or vaginal secretions). Carriers are at risk of long term liver problems (cirrhosis) and liver cancer as a result of the infection.

The disease can be passed from a pregnant woman to her new baby and so many countries immunise all newborn babies against Hepatitis B infection. Others just give immunization to babies whose mothers are carriers.

Look for Hep B on the immunization schedule. Usually there are 3 doses needed to gain immunity.

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Diptheria

Diptheria is caused by a type of bacteria called Corynebacterium diptheriae. It is passed from person to person by droplets in a sneeze or cough. It causes a sore throat and large lymph glands. The bacteria form a membrane which can cover the airway and cause a blockage - this can lead to asphyxia and death.

Although many countries no longer have diptheria, it is still seen in places like Russia and Pakistan. Given the mobility of people these days, it is safer to be immunised than not and so it remains on the infant immunization schedule.

Diptheria is given combined with Tetanus and Pertussis, so you will see DTaP or DTP on the infant immunization schedule. Usually there are 3-4 doses to gain immunity given in the first year of life and then booster doses later in childhood.

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Tetanus

Tetanus is caused a bacteria which forms spores, called Clostridium tetani. The spores can stay in the ground for many years and people usually get infections through contaminated cuts and other wounds. Infection causes stiffness of the muscles and can cause paralysis - there is a high mortality rate (so many infected people die) especially in babies.

Everyone should have up to date tetanus protection. If you have an open injury as an adult, you will be given a booster.

Tetanus is given combined with Diptheria and Pertussis, so you will see DTaP or DTP on the infant immunization schedule.

In older children and adults, smaller doses of diptheria and pertussis are given with tetanus - so dTp or dTap will be seen on the immunization schedule. Usually there are 3-4 doses to gain immunity given in the first year of life and then booster doses later in childhood.

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Pertussis (Whooping cough)

Pertussis or whooping cough as it is more commonly known is caused by a bacteria called Bordetella pertussis. It is spread by droplets from coughs and sneezes and also from contact with secretions.

Initially, an infected child will have symptoms of a cold with a runny nose but then coughing will develop. The cough comes in paroxysms (so cough, cough, cough, cough, cough, cough......) and then there is a characteristic "whoop" sound. In babies, they may not "whoop" but they may stop breathing and go blue. Adults tend to have less severe symptoms but are still able to spread the disease.

Whooping cough can cause serious complications, including pneumonia, seizures and swelling of the brain. It can also cause death, particularly in the very young, which is why pertussis immunization starts early in life and is one of the first vaccines on the infant immunization schedulej. Even without serious complications, babies with whooping cough are distressed with the frequent bouts of coughing that often prevent them from feeding well. Studies have shown that babies who are late with their immunizations are 4 - 6 times as likely to be admitted with whooping cough compared to those who had their immunisations on time.

In the past, there has been concern that pertussis immunization caused unwanted side effects, although these side effects did not occur as often or as severely as if your baby got the actual disease. However, there is now a new acellular Pertussis vaccine which is much less likely to cause any side effects. Most countries now use the acellular vaccine, which is abbreviated as aP (or ap for lower dose pertussis given in adults) on the child and infant immunization scehdule.

Pertussis is given combined with Diptheria and Tetanus, so you will see DTaP or DTP on the infant immunization schedule. Usually there are 3-4 doses to gain immunity given in the first year of life and then booster doses later in childhood.

Some countries give the parents of newborn babies the pertussis immunization to make sure they don’t pass pertussis (whooping cough) to the new baby, who won’t have any protection until a few weeks of age after the first DTP or DTaP immunization.

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Haemophilus Influenzae Type B (Hib)

Haemophilus Influenzae Type B (Hib) is a bacteria that causes invasive infections, particularly in infants and toddlers. It is usually spread by droplets in coughs and sneezes. It causes serious disease in young children, including:

  • pneumonia - to read more on pneumonia, click here
  • epiglottitis - a rapidly progressive disease that causes obstruction of the airway and can lead to death - the principle symptom is stridor which is a harsh noise on breathing in
  • meningitis - to read more on meningitis, click here
  • septic arthritis - an infection of a joint, often the knee or hip
  • cellulitis - infection of the skin. If it involves the orbit, it can have serious complications

Before the introduction of the Hib immunization into the infant immunization schedule, I saw many children with serious illness due to Haemophilus influenzae type B and now I hardly ever see these diseases caused by Hib. Immunization really does mean that there are less of the nasty illnesses that it caused.

You will see Hib on the infant immunization schedule of most countries because it is so successful. Sometimes the Hib vaccine is combined with other vaccines, such as DTaP or Hep B, to reduce the number of injections your child needs. Usually there are 2-3 doses in the first year and a booster dose in the second year.

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Poliomyelitis

Poliomyelitis or polio as it is more commonly known is caused by the poliovirus - there are 3 different types. The virus is passed in the stool so transmission occurs via the fecal-oral route, so usually someone doesn't wash their hands and the virus passes to the mouth. The symptoms are fever, headache, muscle pains and paralysis. As a result of the paralysis, polio sufferers have long-lasting damage to the spinal cord causing weakness and deformity of one of the legs which causes difficulty with walking.

The polio vaccine can be given orally (OPV) which is a live vaccine or by injection (IPV) which is an inactivated vaccine. Many countries now prefer the inactivated polio (IPV) as the oral vaccine (live polio virus) can still lead to cases of polio (although they are usually not so severe) as the virus will be excreted in the poop (poo). If your baby has had the oral polio vaccine, make sure you wash your hands after changing the diaper (nappy).

To reduce the number of injections required, IPV is often given combined with other vaccines on the infant immunization schedule, such as DTaP. Usually there are 3 doses in the first year of life and a booster doses later in childhood.

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Measles

Measles is caused by the measles virus and is spread by droplet in coughs and sneezes or by contact with secretions. It is a highly contagious disease that can cause serious illness and death. To read more about measles and view the rash, click here.

The vaccine is given combined with mumps and rubella (german measles) as one injection (MMR - measles mumps rubella). The first dose is usually given after 1 year of age (except in high risk areas where it is given at 9 months of age) with a booster later in childhood.

Because of poor immunization rates, many developed countries still experience epidemics of measles. I have seen children in Ethiopia die in measles epidemics - it is a serious disease and I believe you should protect your child from it if you can. To read more on measles, click here.

There has been much talk about a possible link between MMR vaccine and autism. The research convincingly shows that there is no causal link between MMR and autism. To read more on autism and MMR immunization, click here

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Mumps

Mumps is a viral illness that causes swelling of the parotid glands - these are found in front of the ear. Although most children who get mumps do not have serious disease, it can cause deafness and other problems in some children. More importantly, mumps can cause inflammation of the testes in post-pubertal boys and men which can lead to infertility. Women can also get inflammation of the ovaries.

Because of the serious implications if an adolescent or adult gets mumps, it is believed that immunization of everyone as a child is is the best option so mumps has become part of the routine childhood and infant immunization schedule.

The mumps vaccine is given as part of the MMR vaccine and is usually given twice on the infant immunization schedule (at about 15 months with a booster later in childhood).

In rare instances, there may be a reaction to the vaccine with swelling of glands in the cheeks or neck, usually within 7-12 days after the shot.

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Rubella (German Measles)

Rubella is a virus that causes a mild illness with fever and a fine red rash. It can also cause joint swelling and pain.

However, if a pregnant woman gets rubella (in the first 8 trimester), the virus can damage the developing fetus causing birth defects, such as cataracts, deafness, heart abnormalities and mental retardation. To prevent babies being born with these defects, immunization against rubella is necessary. Only girls were immunized before the 1990's which meant there was still virus around as boys could get rubella and so pregnant women may still be exposed to the virus.

Since the 1990's, rubella vaccine has been combined with measles and mumps (MMR) and given after the age of 1 year with a booster later in childhood.

Adding the rubella vaccine to the measles and mumps ones in the MMR vaccine, means all children regardless of their sex get immunity to rubella. This means there is less illness with rubella around and so less chance of pregnant women getting infected, so vaccination means you are protecting unborn babies against rubella.

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Tuberculosis

Tuberculosis (or TB as it is known) is caused by Mycobacterium Tuberculosis. It usually affects the lungs but can affect the bones, kidneys and brain as well and can be serious enough to cause death. It is spread by droplets in coughs, sneezes and with speaking, singing and laughing, so it often seen where there is overcrowding.

Protection for high risk infants is given with the BCG immunization which is usually given in the first 8 weeks of life.

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Influenza

The influenza viruses that usually cause disease are types A and B. However, there are many strains of each of these. To read more on influenza in children, click here.

Every year, an influenza vaccine (flu jab) is developed that takes account of the likely strains of influenza that are circulating.

In the US, the flu jab (influenza immunization) is given to all children over the age of 6 months until the age of 18 years – it is given annually. In other countries, influenza vaccine is usually only given to children with underlying diseases (including asthma, cystic fibrosis, heart disease, diabetes) so it is not routinely seen on the infant immunization schedule in all countries. Only one injection per year is needed.

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Meningococcal Disease

Meningococcal Disease is caused by a bacteria called Neisseria meningitides (meningococcus) - there are several types (including A, B, C). Infants are particularly susceptible to meningococcal disease because the bacteria has a polysaccharide (sugar) coating and the immune system in young children is not very good at fighting bacteria who protect themselves with this type of coating.

Meningococcus is spread by droplets in coughing and sneezing. It may cause meningitis or blood poisoning (septicemia). When it causes septicemia it progresses very rapidly there is a high death rate in children who get this disease. Children who survive may be left with limb amputations. An early clue is the appearance of a petechial rash which is a red or purple rash (that can start as just a small dot) that doesn't blanch (go white) when pressed on. Read more

Some countries routinely immunise against meningococcus - for example, the UK infant immunization schedule has routine meningococcus type C cover which is given to babies – see Men C on the childhood immunization schedule.

Some countries just vaccinate when there is an epidemic - for example, New Zealand had the MeNZ B campaign (against meningococcus type B) given to babies and older children to control an epidemic.

In the US, there is a vaccine that covers multiple types of meningococcus but it is reserved for high risk groups and given after the age of 2 years – see MCV on the schedule.

Usually 3-4 doses are needed for protection.

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Pneumococcal Disease

This is caused by a bacteria called Streptococcus pneumoniae (pneumococcus). This bacteria causes otitis media (ear infections) but can also cause pneumonia and meningitis.

Babies are particularly susceptible because the bacteria protects itself with a sugar outer coating and infants don't have the immune system to fight that – so babies can get severe pneumococcal disease that can cause death.

When pneumococcal vaccine is given as part of the infant immunization schedule, it is usually given as 3 doses with a booster later in life. Look for PCV or Pneumococcal on the childhood immunization schedule.

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Human Papilloma Virus (HPV)

Human papilloma virus is the virus that has been found to cause cervical cancer. As all sexually active people are susceptible to HPV infection, many countries are now offering the vaccine as part of the routine immunization schedule for children. It is given to girls aged from 11years who are not yet sexually active. 3 doses of HPV vaccine are required.

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Varicella (Chicken Pox)

Varicella zoster (Human Herpes Virus type 3) is the cause of chicken pox. It is spread by droplets in coughs and sneezes or by contact with weeping blisters. To read more on chicken pox and view the rash, click here.

Some countries, like the US, have varicella as a routine part of the infant immunization schedule. Before the varicella vaccine was introduced, about 1 in 50 children died every year of chicken pox. One dose of vaccine is required.

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Rotavirus

Rotavirus causes gastroenteritis so diarrhea and/or vomiting. To read more about gastroenteritis, click here. The rotavirus vaccine (RV on the infant immunization schedule) is oral so given by mouth. The first dose must be given after 6 weeks of age but before 15 weeks of age. Usually 2 -3 doses are required. It is given as routine on the US infant immunization schedule.

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Hepatitis A

Hepatitis A causes inflammation of the liver – hepatitis causes jaundice (your child will look yellow and have dark urine), tummy pain and general unwellness. Spread is via the fecal-oral route, so occurs when there is poor hand washing. Hepatitis A is usually given to those at high risk and is not a routine part of the immunization schedule for children in most countries except the United States, where it is given routinely to children between the ages of 1 – 2 years. Look for Hep A on the childhood immunization schedule. The first dose is given after the age of 1 year with a second dose 6 months later.

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General Measures for Preventing Childhood Infection

Remember to:

  • cover your nose and mouth when sneezing or coughing
  • discard of all used paper tissues
  • wash your hands frequently, especially when unwell

Child and Infant Immunization Schedules

Each country has its own recommendations for toddler and infant immunizations based on the diseases that are most problematic. Some immunizations, like tetanus, diphtheria, whooping cough, measles, mumps, rubella and Hib (Haemophilus influenzae type B) are universal on the infant immunization schedule while others will only be available routinely in some countries.

Links to different country schedules for toddler and infant immunizations are given below:

  • To read about the United States immunization schedule, click here
  • To read about the Canadian immunization schedule, click here
  • To read about the Australian immunisation schedule, click here
  • To read about the New Zealand immunisation schedule, click here
  • To read about the British immunisation schedule, click here
  • To read about the South African immunisation schedule, click here
  • To read about the Indian immunisation schedule, click here


References

  • CDC
  • NHS
  • Offit et al. Addressing Parents' Concerns: Do Multiple Vaccines Overwhelm or Weaken the Infant's Immune System? Pediatrics Jan 2002.109:124-129

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To go to the top of the Infant Immunization Schedule page, click here

To read about immunization side effects, click here

To read about how immunisations work, click here

To go to the main Immunization page, click here

To go to the Infections page, click here

To return Home, click here


Last reviewed 17 August 2010

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Dr Maud MD

Dr Maud MD (MBChB, FRACP, FRCPCH), a specialist pediatrician, provides health information and medical advice for parents of babies and toddlers. Read more about Dr Maud.



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