Immunization for Children

The following is a recommended schedule for immunizing children.  There is room for variation in the exact timing of the immunizations. In general, the dosing interval between vaccines should not be shortened, but the length of time between doses can be lengthened somewhat without compromising immunity.  If you have not been following this exact schedule, you can discuss how to complete your child’s immunization with any of the nurses or doctors at The CIWEC Clinic Travel Medicine Center.

Birth Hepatitis B1
1 month Hepatitis B2
2 months DTaP1; HIB1; PCV1
IPV1, RV1
4 months DTaP2; HIB2; PCV2, IPV2, RV2
6 months DTaP3; HIB3; PCV3, IPV3; Hepatitis B3
12 months MMR1, Varicella1
Hepatitis A 1
15 months DTaP4; HIB4;  PCV4
12 – 24 months Consider Japanese Encephalitis vaccine
(please read details below)Hepatitis A2, 6-12mths after first dose
24 months Typhoid (Typhim Vi), Meningococcal meningitis vaccine
24 months to 36 months Consider Rabies Preimmunization
4-5 Years (pre-school)
2 visits suggested to complete immunizations
DTaP5; IPV4; MMR2; Varicella2;
Typhoid (Typhim Vi) booster
Skin test for tuberculosis (optional)
Adolescent girls and boys (11-12 years) Human Papillomavirus Vaccine (HPV) given as a 3 dose series (0,2 and 6mths)Tdap booster

DTaP = Diphtheria, Tetanus and acellular Pertussis
HIB = Hemophilus Influenza type B
IPV = Inactivated Polio Vaccine
MMR = Measles, Mumps, and Rubella
PCV = Pneumococcal Conjugate Vaccine
RV = Rotavirus vaccine (Rotarix)
Varicella = Chicken Pox
Tdap = Tetanus, diphtheria and acellular pertussis

DTaP

The three vaccines against diphtheria, tetanus and pertussis or whooping cough given together induce a better protective response in your child than each one given separately. Acellular pertussis causes less reactions than the original DTP. Please let the nurse know if your child has had a bad reaction to this vaccine.

Hepatitis A vaccine

This inactivated vaccine against hepatitis A is given as a series of 2 injections with long lasting immunity. Currently, there are no recommendations for booster injections after the primary series.

Hepatitis B vaccine

It is given at birth, one month, and six months, but can be started at any time.  Hepatitis B is a potentially serious form of hepatitis that can be acquired from mother-child transmission, non-sterile needles, or sexual activity. We recommend this vaccine for all children.

HIB

Hemophilus influenza is a bacteria which can cause serious infections like meningitis or epiglottitis in children. Routine immunization has drastically decreased the incidence of these diseases.  If your child did not receive this vaccine according to schedule, please discuss with a nurse how you can give it.

Influenza or the flu

Influenza vaccine is recommended annually for all persons >6months of age, particularly in children up to 5 years of age due to high risk of complications in this age group. Children 6 months through 8 years of age should have 2 doses of the flu vaccine if they are getting it for the first time.

Japanese Encephalitis vaccine

Japanese encephalitis (JE) is a viral infection of the brain, that is found in the Terai and in Kathmandu valley in the high risk months of late July to early October, that can be prevented with the vaccine. At CIWEC, we stock live attenuated SA14-14-2 vaccine produced by Chengdu Institute in China. It has an excellent safety profile and over 200 million doses have been used in Asia. Side effects are minimal and single dose is protective for about 5 years. Manufacturers recommend 2 doses 1 year apart in children starting at 9 months of age. We do not stock other JE vaccines like Ixiaro at CIWEC.

MMR

Measles, mumps, and rubella are all caused by viruses and each has the potential to cause a serious illness with complications, and rubella infection in a pregnant woman can cause serious birth defects.  The vaccine utilizes live viruses that have been changed so that they induce immunity but can’t cause disease themselves.  2 doses of the vaccine are recommended to induce long lasting immunity.

Meningococcal Meningitis

This is a very safe and highly effective vaccine against bacteria that causes meningitis or sepsis. The vaccine is a single shot that has to be repeated every two years in children under 5, then once every 3-5 years. We currently stock the A &C vaccine and the quadrivalent vaccine consisting of A, C,Y and W135. For Nepal, A&C is sufficient. Quadrivalent vaccine is needed for the Hajj, travel to parts of Africa and for college entry in USA.

Polio Vaccine

We stock the inactivated polio vaccine for childhood immunization and do not stock the oral vaccine. Nepal has had no cases of polio since 2011.

Pneumococcal Conjugate vaccine (Prevnar 13)

This vaccine protects against pneumococcal infections like pneumonia and meningitis in infants and children. Mild pain and redness at the injection site or a low grade fever can occur in a small number of children receiving this vaccine.

Rabies Vaccine

Rabies vaccine can be given before one is bitten by a potentially rabid animal (pre-exposure immunization).  Pre-exposure immunization greatly simplifies the post-exposure treatment if one is bitten by an animal. We feel that all children should be pre-immunized with the rabies vaccine, because they may not always tell you when they have been around stray animals.  The pre-immunization series consists of three injections on days 0, 7, and 21 or 28.  We recommend beginning the series for children at around 24-36 months. In children under 5 years, we recommend a booster in three years and boosters every ten years thereafter. The vaccine is very well tolerated.

Rotavirus (RV) vaccine

Rotavirus causes severe gastroenteritis in children. The RV vaccine is a live virus vaccine given orally at 2 and 4 months of age for Rotarix and a 3rddose is given at 6 months of age for Rota Teq. First dose may be given as early as 6 weeks and last dose should be given by 8 months of age and no later. No increased risk of  intussusception (a kind of bowel blockage that was found with the earlier rotavirus vaccines) have been noted in large scale trials with the new vaccines.

Typhoid Vaccine

Typhoid fever is an infection caused by bacteria Salmonella typhi and paratyphi. The disease is highly endemic in Nepal, and is acquired through eating contaminated food or water. Typhim Vi is a highly purified typhoid vaccine which can be given from age 2 in children. One injection is effective for 2 years, and side effects are minimal. This vaccine does not protect against  paratyphi infections.

Varicella (chicken pox)

It is usually a mild, short lived disease in small children but can be severe if it occurs in adolescents, adults or pregnant women. Varicella vaccine is a live-virus vaccine that is given at one year of age at the same time as the MMR vaccine, and 2 doses are recommended for full protection. First dose is given at 12-15 months of age and second dose between 4-6 years. Side effects from the vaccine are very few and mild that may include redness or pain at injection site, low grade fever or rash.

Human Papillomavirus Vaccine (HPV)

This vaccine is recommended for girls as well as boys aged 11-12 years as a 3 dose series at 0, 2 and 6 months. It can be started as early as 9 years and catch up vaccination is recommended for females from 13-26 years of age and men 13-21 years of age who were previously not immunized. The vaccine helps to protect against HPV that could cause cervical, penile, vaginal and oropharyngeal cancers. This vaccine is currently available at CIWEC.

About BCG

Vaccination with BCG turns the familiar TB skin test positive but this reaction will gradually wane over the years. The incidence of TB among expatriates in Nepal is very low, despite the widespread prevalence of TB in Nepal.  We prefer to screen children with the TB skin test (PPD), and offer treatment to those whose skin test turns from negative to positive. PPD screening or Tuberculin testing is recommended every 2 years. We do not offer the BCG vaccine at CIWEC.