Catch up Immunisations

    • When children have missed their scheduled doses of immunisation a "catch-up" schedule should be commenced.
    • If uncertain about how to plan a catch-up schedule - contact the immunisation nurses on ext 6599 or  page 5562.
    • If in doubt, immunise with overdue vaccines, and organize follow-up in the immunisation clinic to arrange further immunisations.

    Principles

    • Inadvertent additional vaccination with DTP, MMR, poliomyelitis and Hib vaccines is unlikely to cause serious adverse events. If in doubt - immunise.
    • All children lacking a convincing history of vaccination should be restarted on a full course of vaccination appropriate for their age.
    • Interrupted vaccine doses
      • If the recommended intervals between doses are exceeded, there is no need to recommence the schedule or give additional doses.
      • If the process of administration of vaccine is interrupted, eg. by syringe/needle disconnection, the whole dose should be repeated.
    • For incomplete vaccination or overdue vaccinations, build on previous documented doses. Don't start the schedule again.
    • If more than one vaccine is overdue, it is appropriate to give all the missed vaccines at one visit.
      • Live and inactive vaccines can be safely given on the same day.
      • MMR and varicella should be given on the same day, or one month or more apart.
      • Any combination of inactive vaccines is OK
    • The next catch-up visit should be scheduled after an interval of 4 weeks (or more). Eg DTPa doses can be given 4 weeks apart - see below.

    See Immunisation Handbook 9th edition for details

    Table 1.3.6: Minimum intervals between vaccine doses for NIP vaccines for children <8 years of age, a guide for planning catch-up schedules

    Vaccine

    Minimum interval between doses

     

    Dose 1& 2     

    Doses 2&3   

    Doses 3&4    

    DTPa*

    4 weeks

    4 weeks

    6 months

    Poliomyelitis (IPV)

    4 weeks

    4 weeks

    4 weeks†

    Hep B

     

    If first dose given at birth

    or at <7 days after birth‡

    4 weeks

    8 weeks

    8 weeks

    If first dose is not given

    at birth or at >7 days after birth§

    4 weeks

    8 weeks

    NA

    Hib (PRP-OMP)

    See table 1.3.8

     Hib (PRP-T)

    Pneumococcal (7vPCV)

    See table 1.3.9

    See table 1.3.10

    See table 1.3.11

     

    Men CCV¤

    MMR#4 weeksNANA
    Rotavirus** (Rotarix)4 weeksNANA

                        (Rotateq)

    4 weeks

    4 weeksNA

    Varicella

    4 weeks

     

    NA= not applicable

    *If DTPa is only available in combination with other antigens (e.g DTPa-IPV, DTPa-hepB-IPV-Hib or DTPa-HepB-IPV), these formulations can be used where necessary for primary course or catch-up doses in children <8 years of age. 

    † If the 3rd dose of IPV is given after 4 years of age, a 4th dose is not required.  However, if using a combination vaccine, it is acceptable to receive a 4th dose.

    ‡ If dose given at birth or within 7 days of birth (considered dose 1 for this table), then 3 subsequent doses should be given.

    § If dose 1 is not given at birth or within 7 days of birth, then it should be given at 2 months of age, followed by a further 2 doses.

    ¤ The schedule is a single dose given at 12 months of age.  Alternative schedules are available for children <12 months of age (see below).

    # MMR vaccine may be given from 9 months of age if in contact with case, but dose must be repeated at 12 months of age.

    ** Consult Chapter 3.18, Rotavirus, Table 3.18.1 for upper age limits for administration of rotavirus vaccines.  Catch up is not recommended.

    Conjugate meningococcal C vaccine (NeisVac C®)

    Age at first dose

    Number of doses required

    2 - 4 months

    3

    4 - 11 months

    2

    >  12 months 

    Optimal interval > 4 weeks 

    Varicella vaccine (Varilrix®)

    Age at first dose

    Number of doses required*

    1 - 13 years

    1

    > 14 years*

    2  

    Optimal interval > 2 months  

    * Serology should be performed in patients > 14 years with a negative history of clinical varicella to confirm the need for vaccination 

    7-valent conjugate pneumococcal vaccine (Prevenar®)

    Age at first dose

    Number of doses required

    2 - 6 months

    3

    7 - 17 months

    2

    18 months - 5 years

    Optimal interval > 2 months