These vaccines need to be prioritized for catch-up...
Written by | Medical White
Recently, the epidemic situation in various places has rebounded, and the number of infected people in various places has surged, and parents are afraid that the baby will accidentally be recruited because of the planned vaccination when he goes out, and the gain will outweigh the loss; I am afraid of missing the best time for vaccination and am very anxious. Today we will take a look at how long the planned vaccine can be postponed and how to catch up.
Table 1 National immunization program children table (can be enlarged)[1]
BCG
The BCG vaccination schedule is given as soon as possible after birth. If vaccination is delayed for various reasons, it is enough to complete the vaccination before the age of 4.
▌How to replant?
Children < 3 months of age can be directly vaccinated. If you are not vaccinated beyond 3 months of age, you need to undergo a skin test first. Children aged 3 months ~ 3 years old who have a negative test for tuberculin pure protein derivatives or BCG protein derivatives should be given catch-up. Children aged ≥ 4 years old will not be vaccinated. Children who have been vaccinated with BCG will not be given catch-up vaccination even if the scar has not formed. Considering the safety and efficacy of BCG, vaccination should be completed at 1 year of age if possible.
Hepatitis B vaccine
Hepatitis B vaccine (HepB) vaccination is administered from 0 to 1 to 6 months of age, i.e. 1 dose within 24 hours of birth, 1 month of age and 1 dose of 6 months of age.
▌How to replant?
Try to complete 3 doses before 12 months of age, with an ≥interval of 28 days between the first and second doses and 60 days between the second and third doses, ≥ 60 days. For those who have not completed the full immunization process over 12 months of age, catch-up vaccination as soon as possible is required to make up for the number of unvaccinated doses.
Poliovirus vaccine
The poliovirus (PV) vaccination schedule is a basic dose at 2-3-4 months of age and a booster dose at 4 years of age.
▌How to replant?
After the vaccination conditions are restored, priority will be given to catch-up vaccination of this vaccine. For children who are late or missed, the corresponding dose can be given by catch-up, and there is no need to restart the full vaccination. Children aged < 4 years old who have not reached 3 doses (including supplementary immunization, etc.) should complete 3 doses of supplementary vaccination; Children aged ≥ 4 years old who have not reached 3 doses (including supplementary immunization, etc.) should complete 4 doses of catch-up vaccination. The interval between two doses of polio vaccine ≥ 28 days at catch-up vaccination.
Acellular diphtheria, tetanus, and pertussis vaccine
The vaccination schedule for acellular diphtheria-tetanus-pertussis (DTaP) is a basic dose at 3-4-5 months of age and a booster dose at 18 months of age.
▌How to replant?
After the vaccination conditions are restored, priority will be given to catch-up vaccination of this vaccine. Children aged 3 months ~ 5 years old who have not completed the prescribed dose of diphtheria, tetanus, and pertussis need to be vaccinated with an interval of 28 days between the first three doses and ≥≥ 6 months between the fourth dose and the third dose.
Children aged ≥ 6 years old who received a cumulative < 3 doses of DTP and DTP vaccine, 3 doses of DTP vaccine; The interval between the second dose and the first dose is 1~2 months, and the interval between the third dose and the second dose is 6~12 months.
A group C flow brain polysaccharide vaccine
The vaccination schedule of group A flow cerebral polysaccharide vaccine (MPSV-A) is 1 dose at 6 and 9 months of age. The vaccination procedure of group A and C group flow brain polysaccharide vaccine (MPSV-AC) is 1 dose for 3 years old and 1 dose for the fourth grade of primary school.
▌How to replant?
< 24-month-old children were given a dose of group A flow cerebral polysaccharide vaccine, with an interval of ≥ 3 months. ≥ 24-month-old children were supplemented with A and C group brain polysaccharide vaccine doses, and no longer received group A flow brain polysaccharide vaccine.
The first dose of group A and C flow brain polysaccharide vaccine and the second dose of group A flow brain polysaccharide vaccine were ≥ 12 months apart. The interval between the two doses of group A and C flow brain polysaccharide vaccine ≥ 3 years, and repeated vaccination should be avoided within 3 years.
For children aged ≤ 18 months, if they have received the prescribed dose according to the instructions of the flow brain conjugate vaccine, it can be regarded as completing the primary immunization of the flow brain vaccine; Booster immunization should be given 1 dose of flow brain polysaccharide vaccine at 3 years of age and 1 dose of flow brain polysaccharide vaccine in the fourth grade of primary school.
Mumples vaccine
Hemp vaccines include leprosy vaccine (MR) and mump-measse vaccine (MMR). The former was vaccinated at 8 months of age, while the latter received 1 dose each at 18 months and 6 years of age. According to the Notice on the Adjustment of the Immunization Procedures of the National Immunization Program for Polio Vaccine and Measles-Containing Vaccine, the 8-month-old leprosy vaccine will be changed to the leprosy and mumps vaccine, and the provinces will gradually implement it.
▌How to replant?
If vaccination is not available in time according to the immunization schedule, it is recommended that the first dose be completed at any time before 12 months of age;
The second dose of catch-up vaccination should be 28 days ≥ interval from the previous dose, and if you are > 14 years old, you will not be vaccinated; The third dose of catch-up vaccination should be ≥ 1 year after the previous dose, and if you are > 14 years old, you will not be revaccinated;
It can be vaccinated at the same time and at different parts with other countries' immunization program vaccines, especially hepatitis A vaccine and diphtheria-tetanus-pertussis vaccine, etc. that have crossed the age of immunization;
If multiple vaccines are required but cannot be completed at the same time, the mumps vaccine is given priority; If it is not possible to be vaccinated at the same time as other injectable live attenuated vaccines, an interval of ≥28 days is required;
Immunoglobulin recipients should be vaccinated with mumps ≥ 3 months apart and avoid using immunoglobulin for 2 weeks after vaccination.
Live attenuated Japanese encephalitis vaccine
The vaccination procedure of live attenuated Japanese encephalitis vaccine (JE-L) is two doses, one dose at 1 year old (8 months in some areas) and one dose at 2 years old.
▌How to replant?
If vaccination is not available in time according to the immunization schedule, it is recommended to complete 1 dose of live attenuated JE vaccine at any time before 24 months of age.
Hepatitis A inactivated vaccine
The hepatitis A inactivated vaccine (HepA-I) vaccination schedule is two doses, one dose each at 18 and 24 months of age.
▌How to replant?
≤ 14-year-old children who have not received hepatitis A vaccine, 2 doses should be supplemented, and the interval between vaccinations ≥ 6 months. If you have received 1 dose of hepatitis A inactivated vaccine, but you are unconditional on the second dose of hepatitis A inactivated vaccine, you can receive 1 dose of live attenuated hepatitis A vaccine to complete catch-up vaccination.
In the current situation, if vaccination is not received in time according to the immunization schedule, it is recommended to complete 1 dose of hepatitis A vaccination at any time before 24 months of age.
Class II vaccines
13-valent pneumococcal polysaccharide conjugate vaccine
The recommended vaccination procedure for 13-valent pneumococcal polysaccharide conjugate vaccine (PCV13) in mainland China is 3 doses of primary immunization at the age of 2, 4 and 6 months, and 1 dose of booster immunization at the age of 12~15 months.
The first dose of primary immunization can be given at the earliest 6 weeks of age, and the interval between each dose is recommended to be 4~8 weeks.
▌How to replant?
At present, except for Beijing, Guangdong and Hainan provinces, other regions are recommended to carry out supplementary vaccination according to the instructions.
Beijing can complete 3 basic doses within 12 months of age;
Guangdong Province and Hainan Province recommend that those who have started vaccination within 6 months of age but have not completed 3 doses of primary immunization can be vaccinated as soon as possible according to the 3+1 procedure;
Those who have not been vaccinated at the age of 7~11 months can be vaccinated as soon as possible according to the 2+1 procedure;
1 dose of booster immunization at 12~15 months of age. There is an interval of at least 28 days between doses of primary immunization and ≥at least 2 months between booster doses and the last dose of primary immunization.
Live attenuated oral rotavirus vaccine
At present, the mainland market includes monovalent oral live rotavirus vaccine and oral pentavalent recombination rotavirus live attenuated vaccine (RV5). The former procedure is 2 months ~ 3 years old oral 1 dose per year; The latter is fully immunized with a total of 3 doses, the first oral dose is started at 6~12 weeks of age, each dose is given 4~10 weeks apart, and the third dose should not be later than 32 weeks of age.
▌How to replant?
It is recommended to complete catch-up vaccination before the rotavirus infection season.
Inactivated enterovirus 71 vaccine
The EV71 vaccine approved for marketing before enterovirus 71 inactivated vaccine (EV71) was divided into two types: Vero cells and human diploid cells, and their immunization procedures were 2 doses at 6 months old ~ 3 years old and 6 months old ~ 5 years old, with an interval of 1 month.
Severe HFMD caused by EV71 is highly common in children aged 1~2 years, so it is recommended that susceptible children aged ≥ 6 months should be vaccinated as soon as possible and complete 2 doses of immunization before the age of 12 months to play a protective role as soon as possible.
▌How to replant?
After the vaccination conditions are restored, catch-up vaccination should be given as soon as possible, with an interval of 2 doses ≥ 28 days at the time of catch-up vaccination.
Live attenuated varicella vaccine
（varicella vaccine， live， VarV）
The recommended immunization procedure is mostly 1 dose over 1 year old, and the specific immunization procedure refers to the vaccination plan issued by the provincial health administrative department or different vaccine instructions.
▌How to replant?
It is recommended that children who have reached the age of 12~18 months after the vaccination conditions are restored (refer to the provincial vaccination plan for the specific starting month age), and children under 4 years old who have not yet received chickenpox vaccine should be vaccinated with the first dose as soon as possible; It is recommended that children aged 4~12 should complete 2 doses, with at least 3 months between the two doses.
Flu vaccine
For inactivated vaccine, children aged 6~8 years who receive influenza vaccine for the first time should receive 2 doses with an interval of ≥ 4 weeks.
Children who have received 1 dose or more of influenza vaccine in 2021-2022 or before are recommended to receive 1 dose.
For live attenuated vaccines, regardless of whether influenza vaccination has been received or not, only 1 dose is given.
Children 9 years and older and adults; Only 1 dose is required.
▌How to replant?
Usually after 2~4 weeks of influenza vaccination, antibodies can be produced, so it can be vaccinated before the peak of influenza every year. The inactivated influenza vaccine can be given at the same time as the new crown vaccine.
Which vaccines are not recommended for delay?
Newborns with the first dose of hepatitis B vaccine and BCG need to be given as soon as possible after birth, especially in newborns whose mothers are HBsAg-positive.
What are the characteristics of vaccination fever?
Fever occurs more than a few hours to 24h after vaccination, generally lasting 1~2 days, rarely more than 3 days, mostly low-grade or moderate fever, rarely high-fever. Most are in good spirits. If the repeated high fever does not subside, accompanied by other symptoms, and the spirit is not good, it is necessary to see a doctor in time.
Some live attenuated vaccines present with mild disease manifestations, such as transient influenza-like manifestations after receiving live attenuated influenza vaccine; Fever and transient rash after receiving live attenuated measles vaccine.
For vaccine reactions, patients with fever are advised to drink more hot boiled water, physical cooling can also be performed, and oral antipyretics can be taken for those with high fever.
Bibliography:
[1] National immunization program vaccine childhood immunization procedure and description (2021 edition)[J].Chinese Journal of Virological Diseases,2021,11(04):241-245.)
[2] WANG Lin,BAI Yunhua,FANG Jiefeng,JIANG Huiyun,XIE Lu. Safety and efficacy analysis and vaccination recommendations of delayed vaccination of immunization program during the epidemic of novel coronavirus pneumonia (first edition)[J].Chinese Journal of Child Health,2020,28(03):242-246+260.)
[3]Safety and efficacy analysis and recommendations for delayed vaccination of non-immunization program vaccines during the epidemic of novel coronavirus pneumonia[J].Chinese Journal of Pediatrics,2020(04):263-264-265-266-267-268.)
[4] Immunization procedures and instructions for children of national immunization program vaccine(2021 edition)[J].Chinese Journal of Virological Diseases,2021,11(04):241-245.)
[5] Fang Feng. Common adverse reactions and treatment of childhood vaccination[J].Chinese Journal of Practical Pediatrics,2016,31(05):336-340.)
Source: Pediatrics Channel of Medical Professions
Responsible editor: Song Kunlun
*The "medical community" strives to publish content professionally and reliably, but does not make any commitment to the accuracy of the content; Relevant parties are requested to check separately when adopting or using it as a basis for decision-making.
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