No 2 - 2011

Adaption to the danish childhood vaccination programme

DTP and OPV

In most non-European countries, vaccination programmes have at their core DTP (Diphtheria-Tetanus-Pertussis) and polio vaccines which are administered concomitantly, and at times in combination.

The initial vaccination is often placed earlier and the intervals may be shorter than in the Danish Childhood Vaccination Programme (DCVP). Also, in some cases, there may be doubt whether vaccines have been correctly stored.

Against this background, it is recommended that a child who has started a vaccination programme abroad should be given a total of four diphtheria, tetanus, pertussis (whooping cough) and polio vaccinations in the primary vaccination series, as well as one revaccination against diphtheria, tetanus, pertussis and polio.
Revaccination is recommended 4-5 years after the end of primary vaccination, usually at the age of 5 years.

When planning the individual vaccination programme, only vaccinations for which satisfactory documentary or verbal evidence is available should be taken into account. All vaccine components are considered separately, even if given as part of a combined vaccine.

Uncertain vaccination status

Children below the age of 5 years

Children for whom definite information about prior vaccination is lacking are started afresh in the DCVP, using the Danish intervals, i.e. 2 months between the first and second and at least 6 months between the second and third vaccination.

In case of substantial local reactions, antibodies against diphtheria and tetanus should be measured after 1 month.

Children aged 5 years or more

To determine if the child has received sufficient primary vaccination, a DTaP-IPV booster is administered and one month hereafter antibodies against diphtheria and tetanus are measured.

Antibody levels < 0.1 IU/ml for either diphtheria or tetanus suggest that the child may not have had primary vaccination. Three DTaP-IPV vaccinations should thus be given at the same intervals as in the DCVP. The DTaP-IPV vaccine can also be used for older children.

Antibody levels > 0.1 IU/ml for both diphtheria and tetanus imply that the child has probably had primary vaccination. In such case, the duration of protection depends on antibody levels, EPI-NEWS 7/04 (pdf).

Reliable vaccination status

The child should be vaccinated in accordance with the below recommendations, taking into account the minimum intervals stipulated for each vaccine.

DTP

Missing DTP vaccinations are supplemented with DTaP-IPV vaccinations.
Children who have received:

• 1 x DTP: should receive three doses of DTaP-IPV at the same intervals as in the DCVP
• 2 x DTP: should receive two doses of DTaP-IPV at a minimum interval of six months
• 3 x DTP: should receive one dose of DTaP-IPV at least 6 months after the previous DTP dose.

DTaP-IPV revaccination is recommended 4-5 years after primary vaccination has been completed, usually at the age of 5 years.
Subsequently, a DT-booster is recommended every tenth year.

Polio

OPV (Oral Polio Vaccine) and IPV (Inactivated Polio Vaccine) are equally efficient with regard to achieving polio immunity.

In children who have previously received OPV, only vaccinations given after the age of 6 weeks are counted. IPV can be given as a monocomponent vaccine, but can usually be given as part of the DTaP-IPV vaccination.
Children who have received:

• OPV x 1: should receive three doses of IPV at the same intervals as for DTaP-IPV
• OPV x 2: Should receive two doses of IPV at a minimum interval of 6 months
• OPV x 3: Should receive one dose of IPV at least 6 months after the previous polio vaccination.
• OPV x 4: Are considered to have received primary vaccination.

Revaccination with IPV is given 4-5 years after the end of primary vaccination, usually at the age of 5 years.

Hib

All prior Hib vaccinations are counted no matter when they were given. As children gradually acquire natural immunity, the number of doses should be reduced with increasing age.

• Children under 5 months who have not been Hib-vaccinated are given three vaccinations at the usual intervals
• Children aged 5-12 months who have not been Hib-vaccinated are given two doses at a 2-month interval
• Children aged 1-5 years who have not been Hib-vaccinated are given only one vaccination

Children aged 6 years or above usually have natural immunity and should not be vaccinated. However, Hib vaccination is recommended for splenectomized children up to the age of 15 years.

Pneumococcus

All children below the age of 2 years may be offered free vaccination with conjugated pneumococcal vaccine (PCV).

Children below the age of 1 year should receive three vaccines. The minimum intervals are as follows: one month between the first and second vaccine, and 2 months between the second and third vaccine.

Children who are older than 1 year at the initial vaccination should be given two vaccinations at a minimum interval of 2 months, EPI-NEWS 37/07  (pdf).

MMR

Vaccinations given before the age of 12 months are not counted. If the child has only been vaccinated against one of the illnesses (usually measles), the usual two vaccinations are given. The minimum interval between two MMR vaccinations is 1 month, EPI-NEWS 7/07 (pdf).

HPV

Girls aged 12-15 years are offered three HPV vaccinations. The same HPV vaccine should be used for all three vaccinations.
The minimum interval between the first and second vaccination is 1 month, and the second and third vaccination should be given at a minimum interval of 3 months, EPI-NEWS 35/08 (pdf).

Hepatitis B

Many countries include hepatitis B in their childhood vaccination programme. Children who have initiated hepatitis B vaccination should conclude such vaccination if they belong to a risk group, i.e. if their mother is chronically infected, EPI-NEWS 41/05 (pdf), or if there are other persons with chronic hepatitis B in the household, EPI-NEWS 33/06 (pdf).
In such cases, the vaccine is covered by the National Health Insurance.
It may be expedient to complete the vaccination in other cases in which children have initiated vaccination, but in such cases parents are required to cover the costs.

BCG

Some children have been BCG-vaccinated. This vaccine does not form part of the Danish programme, and revaccination has no documented effect.
(Vaccination Team, Department of Epidemiology)

Individually notifiable diseases and selected laboratory diagnosed infections (pdf)

12 January 2011