(updated: November 2021)

Table 2: Summary of WHO Position Papers - Recommended Routine Immunizations for Children
Doses in Interval Between Doses
Antigen Age of 1st Dose Primary Booster Dose Considerations
(see footnotes for details)
Series 1st to 2nd 2nd to 3rd 3rd to 4th
Recommendations for all children
Birth dose and HIV; Universal vs selective
BCG 1 As soon as possible after birth 1 vaccination; Co-administration; Vaccination
of older age groups; Pregnancy
As soon as possible after birth 4 weeks (min) with 4 weeks (min) with
Option 1 3 Premature and low birth weight
(<24h) DTPCV1 DTPCV2
Hepatitis B 2 Co-administration and combination vaccine
As soon as possible after birth 4 weeks (min) with 4 weeks (min) with 4 weeks (min),with High risk groups
Option 2 4
(<24h) DTPCV1 DTPCV2 DTPCV3

bOPV 6 weeks (min) 5 bOPV 4 weeks (min) bOPV birth dose

bOPV 4 weeks (min)
bOPV + IPV (3 bOPV with DTPCV2 Type of vaccine
with DTPCV3
IPV 14 weeks (min) and 2 IPV) Fractional dose IPV
IPV 4 months (min)
Alternative early IPV schedule
Polio 3 IPV / bOPV 1-2 IPV
8 weeks (IPV 1 ) st
4-8 weeks 4-8 weeks 4-8 weeks Transmission and importation risk
Sequential 2 bOPV

IPV booster needed for early schedule (i.e.

IPV 8 weeks 3 4-8 weeks 4-8 weeks (see footnote)
first dose given <8 weeks)

3 Boosters
12-23 months (DTP-
containing vaccine); Delayed/ interrupted schedule
4 weeks (min) - 8
DTP-containing vaccine 4 6 weeks (min) 3 4 weeks (min) - 8 weeks 4-7 years (Td/DT Combination vaccine; Maternal
weeks
containing vaccine), immunization
see footnotes; and
9-15 yrs (Td)
4 weeks (min) with 4 weeks (min) with Single dose if >12 months of age
Haemophilus Option 1 3 (see footnote)
6 weeks (min) DTPCV2 DTPCV3 Not recommended for children > 5 yrs
influenzae type
59 months (max) Delayed/ interrupted schedule
b5 Option 2 2-3
8 weeks (min) if only 2 doses 4 weeks (min) if 3 At least 6 months
4 weeks (min) if 3 doses doses (min) after last dose Co-administration and combination vaccine

Option 1 Schedule options (3p+0 vs 2p+1)

6 weeks (min) 3 4 weeks (min) 4 weeks
Pneumococcal 3p+0 Vaccine options
(Conjugate) 6 Option 2 HIV+ and preterm neonate booster
6 weeks (min) 2 8 weeks (min) 9-18 months Vaccination in older adults
2p+1
2 or 3 For three dose series
4 weeks (min) with
Rotavirus 7 6 weeks (min) with DTP1 depending on – 4 week (min) with Not recommended if >24 months old
DTPCV2
product DTPCV3

9 or 12 months 4 weeks (min) Co-administration live vaccines; Combination

Measles 8 2
(6 months min, see footnote) (see footnote) vaccine; HIV early vaccination; Pregnancy

Achieve and sustain 80% coverage

9 or 12 months with measles
Rubella 9 1 Co-administration and combination
containing vaccine
vaccine; Pregnancy

Target 9-14 year old girls; Temporary

suspension of multi-age cohort
As soon as possible from 9
6-12 months vaccination; Off-label use of extended
HPV 10 years of age 2
(min 5 months) interval of 3-5 years; Pregnancy; Older
(females only)
age groups > 15 years 3 doses; HIV and
immunocompromised
Refer to https://www.who.int/teams/immunization-vaccines-and-biologicals/policies/position-papers for table & position paper updates.

This table summarizes the WHO vaccination recommendations for children.The ages/intervals cited are for the development of country specific schedules and are not for health workers.

National schedules should be based on local epidemiologic, programmatic, resource & policy considerations. While vaccines are universally recommended, some children may have contraindications to particular vaccines.
P.1 / 11
 (updated
Table 2: Summary of WHO Position Papers - Recommended Routine Immunizations for Children November 2021)
Doses in Interval Between Doses
Antigen Age of 1st Dose Primary Booster Dose Considerations
(see footnotes for details)
Series 1st to 2nd 2 nd
to 3 rd
3
rd
to 4 th

Recommendations for children residing in certain regions

Inactivated
2
Vero cell- 6 month 4 weeks (generally)
generally
derived Co-administration live vaccines;
Japanese Vaccine options and manufacturer’s
Live
Encephalitis 11 8 months 1 recommendations; Pregnancy;
attentuated
Immunocompromised
Live
9 months 1
recombinant
9-12 months with measles
Yellow Fever 12 1 Co-administration live vaccines
containing vaccine
≥ 1 yr FSME-Immun and 1-3 months FSME-Immun and 5-12 months FSME-Immun
At least 1 Definition of high-risk
Encepur Encepur and Encepur
Tick-Borne Encephalitis 13 3 every 3 years Vaccine options
≥ 3 yrs TBE_Moscow and 1-7 months TBE-Moscow and 12 months TBE-Moscow and
(see notes) Timing of booster
EnceVir EnceVir EnceVir

Recommendations for children in some high-risk populations

TCV (Typbar) >6 months 1 Definition High Risk; Vaccine options
Vi PS 2 years (min) 1 Every 3 years Definition of high risk
Typhoid 14
Capsules 5 years (min) (see 3 or 4 (see
Ty21a 1 day 1 day 1 day Every 3-7 years Definition of high risk
footnote) footnote)

Dukoral (WC- 3 (2-5 years) ≥ 7 days (min) < 6 weeks ≥ 7 days (min) < 6 weeks Every 6 months
2 years (min)
rBS) 2 (≥6 years) (max) (max) Every 2 years
Minimum age
Cholera 15 Shanchol, Definition of high risk
Euvchol and 1 year (min) 2 14 days After 2 years
mORCVAX
Definition of high risk; Vaccine
MenA
9-18 months (5µg) 1 options; 2 doses if < 9 months with
conjugate
8 week interval
2-11 months 2 8 weeks After 1 year
Meningococcal 16 MenC Definition of high risk; Vaccine
conjugate ≥12 months 1 options

Quadrivalent 9-23 months 2 12 weeks Definition of high risk; Vaccine

conjugate ≥2 years 1 options

Level of endemicity; Vaccine

Hepatitis A 17 1 year At least 1 options; Definition of high risk
groups
Rabies 18 As required 2 7 days (see footnote) PrEP vs PEP; Definition of high risk

Dengue (CYD-TDV) 19 9 years (min) 3 6 months 6 months Pre-vaccination screening

Recommendations for children receiving vaccinations from immunization programmes with certain characteristics
12-18 months with measles 1 month (min) to school Coverage criteria > 80%;
Mumps 20 2
containing vaccine entry Combination vaccine
Priority risk groups, especially
Revaccinate
Seasonal influenza (inactivated 2 ( <9 years) pregnant women
6 months (min) 4 weeks annually: 1 dose only
tri- and qudri-valent) 21 1 ( ≥ 9 years) Lower dosage for children 6-35
(see footnotes)
months

4 weeks to 3 months Achieve & sustain ≥ 80% coverage

Varicella22 12-18 months 1-2 per manufacturer Pregnancy
recommendations Co-admin with other live vaccines

P.2 / 11
Summary Table 2 - Notes • Moderate-to-late preterm infants (gestational age > 31 weeks) and low birth weight infants (<
2500 g) who are healthy and clinically stable can receive BCG vaccination at birth, or at the
• Refer to http://www.who.int/immunization/documents/positionpapers for the most recent latest, upon discharge.
version of the tables and position papers.
• The attached table summarizes the recommendations for vaccine administration found in the
WHO position papers which are published in the Weekly Epidemiological Review. Its purpose is
to assist planners to develop an appropriate immunization schedule. Health care workers should
2
Hepatitis B
refer to their national immunization schedules. While vaccines are universally recommended, • Position paper reference: Weekly Epid. Record (2017, 92:369-392) [pdf 2.4MB]
some children may have contraindications to particular vaccines.
• Hepatitis B vaccination is recommended for all children worldwide. Reaching all children with
• Vaccines can generally be co-administered (i.e. more than one vaccine given at different at least 3 doses of hepatitis B vaccine should be the standard for all national immunization
sites during the same visit). Recommendations that explicitly endorse co-administration are programmes. Since perinatal or early postnatal transmission is the most important source of
indicated in the table, however, lack of an explicit co-administration recommendation does chronic HBV infection globally, all infants (including low birth weight and premature infants)
not imply that the vaccine cannot be co-administered; further, there are no recommendations should receive their first dose of hepatitis B vaccine as soon as possible after birth, ideally
against co-administration. within 24 hours.
• Doses administered by campaign may or may not contribute to a child’s routine immunization • The birth dose should be followed by 2 or 3 additional doses to complete the primary series.
schedule depending on type and purpose of campaign (e.g. supplemental versus routine/pulse Both of the following options are considered appropriate: (i) a 3-dose schedule with the first
campaign for access reasons). dose (monovalent) being given at birth and the second and third (monovalent or as part of
• For some antigens, recommendations for the age of initiation of primary immunization series a combined vaccine) given at the same time as the first and third doses of DTP-containing
and/or booster doses are not available. Instead, the criteria for age at first dose must be vaccine; or (ii) 4 doses, where a monovalent birth dose is followed by 3 (monovalent or
determined from local epidemiologic data. combined vaccine) doses, usually given with other routine infant vaccines; the additional dose
does not cause any harm. The interval between doses should be at least 4 weeks.
• If a catch-up schedule for interrupted immunization is available, it is noted in the footnotes.
• A birth dose of hepatitis B vaccine can be given to low birth weight (<2000g) and premature
• Other vaccines, such as varicella and pneumococcal polysaccharide vaccines, may be of infants. For these infants, the birth dose should not count as part of the primary 3-dose series;
individual benefit but have not been generally recommended for routine immunization. See the the 3 doses of the standard primary series should be given according to the national vaccination
specific position papers for more details. schedule.
• For further background on immunization schedules refer to “Immunological Basis for • For catch-up of unvaccinated individuals, priority should be given to younger age groups since
Immunization” series which is available at http://www.who.int/immunization/documents/ the risk of chronic infection is highest in these cohorts. Catch-up vaccination is a time-limited
immunological_basis_series/en/index.html opportunity for prevention and should be considered based on available resources and priority.
Unvaccinated individuals should be vaccinated with a 0, 1, 6 month schedule.
• Vaccination of groups at highest risk of acquiring HBV is recommended. These include patients
1
BCG who frequently require blood or blood products, dialysis patients, diabetes patients, recipients
of solid organ transplantation, person with chronic liver disease including those with Hepatitis C,
• Position paper reference: Weekly Epid. Record (2018, 93:73-96) [pdf 660KB] person with HIV infection, men who have sex with men, persons with multiple sexual partners,
• Universal BCG vaccination at birth is recommended in countries or settings with a high incidence as well as health care workers and others who may be exposed to blood, blood products or
of TB and/or high leprosy burden. A single dose of BCG vaccine should be given to all healthy other potentially infectious body fluids during their work.
neonates at birth, ideally together with Hepatitis B birth dose.
• Countries with low TB incidence or leprosy burden may choose to selectively vaccinate neonates
in high-risk groups.
3
Polio
• BCG vaccination is also recommended for unvaccinated TST- or IGRA-negative older children, • A revised Polio Vaccine Position Paper is forthcoming in 2022. Position paper reference: Weekly
adolescents and adults from settings with high incidence of TB and/or high leprosy burden, Epid. Record (2016, 9:145-68)[pdf 611KB] and Meetings of the Strategic Advisory Group of
those moving from low to high TB incidence/ leprosy burden settings and persons at risk of Experts on immunization: Conclusions and Recommendations. Weekly Epid. Record (2021,
occupational exposure in low and high TB incidence areas (e.g. health-care workers, laboratory 96:133-144) [pdf 448KB], Weekly Epid. Record (2020, 95: 585 - 607) [pdf 468.8Kb], Weekly
workers, medical students, prison workers, other individuals with occupational exposure). Epid. Record (2020, 95: 241-256) [pdf 480.8Kb]

• BCG vaccination is not recommended during pregnancy. OPV plus IPV

• If HIV-infected individuals, including children, are receiving ART, are clinically well and • All countries that currently administer three bOPV and one IPV dose should add a 2nd IPV dose
immunologically stable (CD4% >25% for children aged <5 years or CD4 count ≥200 if aged in their routine immunization schedule. (Oct 2020 SAGE Meeting Report)
>5 years) they should be vaccinated with BCG. Neonates born to women of unknown HIV • Regardless of the 2 dose IPV schedule used, introduction of the second IPV dose does not
status should be vaccinated as the benefits of BCG vaccination outweigh the risks. Neonates of reduce the number of bOPV doses (three) used in the routine immunization schedule. (Oct 2020
unknown HIV status born to HIV infected women should be vaccinated if they have no clinical SAGE Meeting Report)
evidence suggestive of HIV infection, regardless of whether the mother is receiving ART. For
neonates with HIV infection confirmed by early virological testing, BCG vaccination should be • The preferred schedule is to administer the first IPV dose at 14 weeks of age (with DTPCV3/
delayed until ART has been started and the infant confirmed to be immunologically stable (CD4 Penta3), and to administer the second IPV dose at least 4 months later (possibly coinciding
>25%). with other vaccines administered at 9 months of age). This schedule provides the highest

Table 2: Recommended Routine Immunization for Children (updated November 2021) P.3 / 11
 immunogenicity and may be carried out using full dose IPV or fractional intradermal IPV (fIPV) 4
DTP-containing vaccine (Diphtheria, Tetanus and Pertussis)
without loss of immunogenicity. (Oct SAGE 2020 Meeting Report). Sabin-IPV (sIPV) may be
used interchangeably with wIPV, but sIPV is not recommended to be used as a fractional dose • Position paper reference: Diphtheria - Weekly Epid. Record (2017, 92:417-436) [pdf 526KB];
due to current lack of evidence. (March 2021 SAGE Meeting Report) Tetanus - Weekly Epid. Record (2017, 92: 53-76) [pdf 636KB]; Pertussis - Weekly Epid. Record
(2015, 90: 433-460) [pdf 667KB]
• Based on local epidemiology, programmatic implications and feasibility of delivery, countries
may choose an alternative early IPV schedule starting with the first dose at 6 weeks of age • The need for early infant vaccination with DTP-containing vaccine (DTPCV) is principally to
(with DTP1/Penta1) and the second dose at 14 weeks (with DTPCV3/Penta3). This alternative ensure rapid protection against pertussis, because severe disease and death from pertussis is
schedule offers the advantage of providing early-in-life protection; however, there is a lower almost entirely limited to the first weeks and months of life.
total immunogenicity achieved. If this schedule is chosen, full dose IPV (for both wIPV and sIPV)
should be used rather than fIPV due to lower immunogenicity of fIPV at early ages. (Oct 2020 • A primary series of 3 doses of DTP-containing vaccine is recommended, with the first dose
SAGE Meeting Report) administered as early as 6 weeks of age. Subsequent doses should be given with an interval of
at least 4 weeks between doses. The third dose of the primary series should be completed by
• In polio-endemic countries and in countries at high risk for importation and subsequent spread 6 months of age if possible.
of poliovirus, WHO recommends a bOPV birth dose (zero dose) followed by a primary series of
3 bOPV doses and at least 2 IPV doses. (2016 PP; adjusted for 2 IPV doses) • If either the start or the completion of the primary series has been delayed, the missing doses
should be given at the earliest opportunity with an interval of at least 4 weeks between doses.
• The zero dose of bOPV should be administered at birth, or as soon as possible after birth, to
maximize seroconversion rates following subsequent doses and to induce mucosal protection. • 3 booster doses of diphtheria toxoid-containing vaccine should be provided during childhood
(2016 PP) and adolescence. The diphtheria booster doses should be given in combination with tetanus
toxoid using the same schedule, i.e at 12–23 months of age, 4–7 years of age, and 9–15 years
• Both OPV and IPV may be co-administered concurrently and both may be given with other of age, using age-appropriate vaccine formulations. Ideally, there should be at least 4 years
infant vaccines. (2016 PP) between booster doses.
• For infants starting the routine immunization schedule late (age >3 months) the IPV dose should • Tetanus - To ensure lifelong protection against tetanus in all people should receive 6 doses (3
be administered at the first immunization contact along with bOPV and the other routinely primary plus 3 booster doses) of tetanus toxoid-containing vaccine (TTCV) through routine
recommended vaccines. (2016 PP) childhood immunization schedules.
• The implementation of 3 bOPV doses + 2 IPV doses does not replace the need for supplementary • The 3 TTCV booster doses should be given at: 12–23 months of age; 4–7 years of age; and
immunization activities (SIAs). (2016 PP) 9–15 years of age. Ideally, there should be at least 4 years between booster doses.
• Countries that delayed the introduction of IPV or experience stock-outs should provide catch-up • National vaccination schedules can be adjusted within the age limits specified above to
vaccination to all children who were missed as soon as the vaccine becomes available. (2016 enable programmes to tailor their schedules based on local epidemiology, the objectives of
PP) the immunization programme, any particular programmatic issues and to better align tetanus
vaccination with the immunological requirements of other vaccines (particularly for pertussis
Sequential IPV–OPV schedule and diphtheria).
• In countries with high vaccination coverage (e.g. 90%–95%) and low importation risk • Opportunities for tetanus vaccination may be taken at the second year of life contacts for
(neighbouring countries and major population movement all having similarly high coverage) alternative PCV schedule 2 +1, MCV second dose, and meningococcal A-containing vaccines, as
an IPV–bOPV sequential schedule can be used when VAPP is a significant concern. (2016 PP) well as pre-adolescence and adolescence contacts including for HPV vaccination.
• The initial administration of 1 or 2 doses of IPV should be followed by ≥2 doses of bOPV to • To provide and sustain both tetanus and diphtheria immunity throughout the life course and for
ensure both sufficient levels of protection in the intestinal mucosa and a decrease in the burden both sexes, age-appropriate combinations of tetanus and diphtheria toxoids should be used. For
of VAPP. (2016 PP) children <7 years of age DTwP or DTaP combinations may be used. For children aged 4 years
• For sequential IPV–bOPV schedules, WHO recommends that IPV be given at 2 months of age and older Td containing vaccine may be used and is preferred. Link
(e.g. a 3-dose IPV–bOPV–bOPV schedule), or at 2 months and 3–4 months of age (e.g. a • From 7 years of age only Td combinations should be used. Age-appropriate combinations
4-dose IPV–IPV–bOPV–bOPV schedule) followed by at least 2 doses of bOPV. Each of the doses containing pertussis vaccine with low-dose diphtheria antigen are also available.
in the primary series should be separated by 4–8 weeks depending on the risk of exposure to
poliovirus in early childhood. (2016 PP) • If tetanus vaccination is started during adolescence or adulthood, a total of only 5 appropriately
spaced doses are required to obtain lifelong protection.
IPV-only schedule
• Pregnant women and their newborn infants are protected from birth-associated tetanus if the
• In the current epidemiological context and as a general principle, SAGE expressed the need for mother received either 6 TTCV doses during childhood or 5 doses if first vaccinated during
regions or countries to be cautious about moving from a bOPV + IPV schedule to an IPV-only adolescence/adulthood (documented by card, immunization registry and/or history) before the
schedule in their routine immunization programmes and recommended that instead they take time of reproductive age. Vaccination history should be verified in order to determine whether
a gradual approach, by first introducing a second dose of IPV into their routine immunization a dose of TTCV is needed in the current pregnancy.
schedules. (March 2020 SAGE Meeting Report)
• WHO confirms its earlier recommendation to shift from the use of single-antigen TT to
• An IPV-only schedule may be considered in countries with sustained high vaccination coverage combinations containing diphtheria toxoid, i.e. DT or Td vaccines, which has not yet been
and very low risk of both WPV importation and transmission. (2016 PP) implemented in many countries despite the negligible price differential between TT and DT/Td
• A primary series of 3 doses of IPV should be administered beginning at 2 months of age. If the vaccines. Countries and partners are urged to take steps to accelerate this shift.
primary series begins earlier (e.g. with a 6, 10 and 14-week schedule) then a booster dose • TTCVs can be used in immunocompromised persons including HIV-infected individuals, but
should be given after an interval of ≥6 months (for a 4-dose schedule). (2016 PP)

Table 2: Recommended Routine Immunization for Children (updated November 2021) P.4 / 11
 the immune response may be lower than in fully immunocompetent persons. All HIV-infected • In countries where the peak burden of severe Hib disease occurs in young infants, providing 3
children should be vaccinated against tetanus following the vaccine recommendations for the doses of vaccine early in life may confer a greater benefit.
general population.
• In some settings (e.g. where the greatest disease morbidity and mortality occur later, or where
• Pertussis vaccine: Both aP-containing and wP-containing vaccines have excellent safety records. rate reductions of disease are not fully sustained after the routine use of Hib vaccine), it might
be advantageous to give a booster dose by following either a 2p+1 or 3p+1 schedule.
• Available evidence indicates that licensed aP and wP vaccines have equivalent initial effectiveness
in preventing disease in the first year of life, but that there is more rapid waning of immunity, • The interval between doses should be at least 4 weeks if 3 primary doses are given, and at least
and possibly a reduced impact on transmission, with aP relative to wP vaccines. 8 weeks if 2 primary doses are given. Booster doses should be administered at least six months
after completion of the primary series.
• National programmes currently administering wP vaccination should continue to use wP vaccines
for primary vaccination series. Surveillance and modelling data suggest that the use of aP • If the vaccination course has been interrupted, the schedule should be resumed without
vaccines may result in a resurgence of pertussis after a number of years. repeating the previous dose. Children who start vaccination late, but are aged under 12
months, should complete the vaccination schedule (e.g. have 3 primary doses or 2 primary
• National programmes currently using aP vaccine may continue using this vaccine but should doses plus a booster).
consider the need for additional booster doses and strategies to prevent early childhood
mortality such as maternal immunization in case of resurgence of pertussis. • When a first dose is given to a child older than 12 months of age, only one dose is recommended.
• Only aP-containing vaccines should be used for vaccination of persons aged ≥7 years. • Hib vaccine is not required for healthy children after 5 years of age.
• Pertussis containing booster - A booster dose is recommended for children aged 1–6 years, • The Hib conjugate vaccine is contraindicated in people with known allergies to any component
preferably during the second year of life (≥6 months after last primary dose), unless otherwise of the vaccine. There are no other known contraindications or precautions.
indicated by local epidemiology; the contact could also be used to catch up on any missed doses
of other vaccines. This schedule should provide protection for at least 6 years for countries
using wP vaccine. For countries using aP vaccine, protection may decline appreciably before 6
years of age.
6
Pneumococcal (Conjugate)
• Vaccinating pregnant women and household contacts - Vaccination of pregnant women is likely • Position Paper Reference: Weekly Epid. Record (2019, 94: 85-104) [pdf 444KB]
to be the most cost-effective additional strategy for preventing disease in infants too young to
be vaccinated and appears to be more effective and favourable than cocooning. • Currently available PCVs are safe and effective and are therefore recommended for the inclusion
in childhood immunization programmes worldwide.
• National programmes may consider the vaccination of pregnant women with 1 dose of Tdap
(in the 2nd or 3rd trimester and preferably at least 15 days before the end of pregnancy) as a • Use of pneumococcal vaccine should be complementary to other disease prevention and control
strategy additional to routine primary infant pertussis vaccination in countries or settings with measures, such as appropriate case management, promotion of exclusive breastfeeding for the
first 6 months of life and reducing known risk factors such as indoor air pollution and tobacco
high or increasing infant morbidity/ mortality from pertussis.
smoke.
• Delayed or interrupted DTP-containing series - For children whose vaccination series has been
• For administration of PCV to infants, WHO recommends a 3-dose schedule administered either
interrupted, the series should be resumed without repeating previous doses. Children aged 1 to
as 2p+1 or as 3p+0, starting as early as 6 weeks of age.
< 7 years who have not previously been vaccinated should receive 3 doses of vaccine following
a 0, 1, 6 month schedule. Two subsequent booster doses using Td or Tdap combination vaccines • If the 2p+1 schedule is selected, an interval of ≥8 weeks is recommended between the 2 primary
are needed with an interval of at least 1 year between doses. doses the booster dose should be given at 9–18 months of age, according to programmatic
considerations; there is no defined minimum or maximum interval between the primary series
• Health-care workers should be prioritized as a group to receive pertussis vaccine.
and the booster dose.
• If the 3p+0 schedule is used, a minimum interval of 4 weeks should be maintained between
doses.
5
Haemophilus influenzae type b (Hib)
• Previously unvaccinated or incompletely vaccinated children who recover from invasive
• Position paper reference: Weekly Epid. Record (2013, 88: 413-428) [pdf 209KB] pneumococcal disease (IPD) should be vaccinated according to the recommended age-
appropriate regimens. Interrupted schedules should be resumed without repeating the previous
• The use of Hib vaccines should be part of a comprehensive strategy to control pneumonia
dose.
including exclusive breastfeeding for six months, hand washing with soap, improved water
supply and sanitation, reduction of household air pollution, and improved case management at • Both PCV10 and PCV13 have substantial impacts against pneumonia, vaccine-type IPD and
community and health facility levels. NP carriage. The choice of product to be used in a country should be based on programmatic
characteristics, vaccine supply, vaccine price, the local and regional prevalence of vaccine
• WHO recommends that any one of the following Hib immunization schedules may be followed:
serotypes and antimicrobial resistance patterns.
3 primary doses without a booster (3p); 2 primary doses plus a booster (2p+1); and 3 primary
doses with a booster (3p+1). • Once a PCV vaccination programme has been initiated, product switching is not recommended
unless there are substantial changes in the epidemiological or programmatic factors that
• Because serious Hib disease occurs most commonly in children aged between 4 months and determined the original choice of product, e.g. an increasing burden of serotype 19A. If a series
18 months, immunization should start from 6 weeks of age, or as early as possible thereafter. cannot be completed with the same type of vaccine, the available PCV product should be used.
• The number of primary doses should be set after consideration of the local epidemiology, vaccine Restarting a series is not recommended, even for the primary series.
presentation (Hib conjugate monovalent vaccine versus Hib conjugate vaccine in combination • Wherever possible, catch-up vaccination at the time of introduction of PCV should be used to
with other antigens) and how this fits into the overall routine immunization schedule.

Table 2: Recommended Routine Immunization for Children (updated November 2021) P.5 / 11
 accelerate its impact on disease in children aged 1–5 years, particularly in settings with a high chronic gastrointestinal disease, and spina bifida or bladder exstrophy. Vaccination may be
disease burden and mortality. If there is limited availability of vaccine or of financial resources postponed in case of ongoing acute gastroenteritis or fever with moderate to severe illness.
for catch-up vaccination, the youngest children (e.g. <2 years of age) should be prioritized to
receive catch-up doses of PCV because of their higher risk for pneumococcal disease.
• Catch-up vaccination can be done with a single dose of vaccine for children ≥24 months. 8
Measles
• Unvaccinated children aged 1–5 years who are at high risk for pneumococcal infection because
• Position paper reference: Weekly Epid. Record (2017, 92:205-228) [pdf 600KB].
of underlying medical conditions, such as HIV infection or sickle-cell disease, should receive at
least 2 doses separated by at least 8 weeks. • Reaching all children with 2 doses of measles vaccine should be the standard for all national
immunization programmes. In addition to the first routine dose of MCV1, all countries should
• HIV-positive infants and pre-term neonates who have received their 3 primary vaccine doses
add a second routine dose of MCV2 to their national immunization schedules regardless of the
before 12 months of age may benefit from a booster dose in the second year of life.
level of MCV1 coverage.
• Co-administration for programmatic reasons appears to be acceptable.
• In countries with ongoing transmission in which the risk of measles mortality remains high,
• WHO does not currently have recommendations on the use of PCV in individuals over 5 years MCV1 should be given at age 9 months. MCV2 should be given between 15-18 months, as
of age. [pdf 373KB] providing MCV2 in the 2nd year of life reduces the rate of accumulation of susceptible children
and the risk of an outbreak. The minimum interval between MCV1 and MCV2 is 4 weeks.
• For considerations for pneumococcal vaccination in older adults see concept note: Weekly Epid.
Record (2021, 96 (23), 217 – 228) [pdf 373KB] • Because many cases of measles occur in children aged >12 months who have not been
vaccinated, routine delivery of MCV1 should not be limited to infants aged 9–12 months and
• Introduction of PCV into national childhood immunization programmes and measures to sustain routine delivery of MCV2 should not be limited to infants 15 to 18 months of age. Every
high coverage in children should be prioritized over initiating a pneumococcal vaccination opportunity (e.g. when children come into contact with health services) should be taken to
programme for older adults. vaccinate all children that missed one or both MCV routine doses, particularly those under 15
• In countries that have a mature childhood pneumococcal immunization programme, decisions years of age. Policies which prohibit use of vaccine in children >1 year of age, older children and
about initiating such a programme in adults, using either PPV23 or PCV13, should take into teenagers should be changed to allow these individuals to be vaccinated.
account the local disease burden and cost-effectiveness considerations. • In countries with low levels of measles transmission (i.e. those that are near elimination or
verified as having eliminated endemic measles virus transmission) and therefore the risk of
measles virus infection among infants is low, MCV1 may be administered at 12 months of age
7
Rotavirus to take advantage of the higher seroconversion rates achieved at this age. In these countries,
the optimal age for delivering MCV2 is based on programmatic considerations to achieve the
• Position paper reference: Weekly Epid. Record (2021, 96: 301-320) [pdf 515KB] highest coverage of MCV2 and, hence, the highest population immunity. Administration of
• Rotavirus vaccines should be included in all national immunization programmes. MCV2 at 15-18 months of age ensures early protection of the individual, slows accumulation of
susceptible young children, and may correspond to the schedule for other routine immunizations
• The use of rotavirus vaccines should be part of a comprehensive strategy to control diarrhoeal (for example, a DTP-containing booster, PCV, or meningococcal vaccines). This measure also
diseases with the scaling up of both prevention (promotion of early and exclusive breastfeeding, supports the establishment of a policy on immunization and other health interventions in the
handwashing, improved water supply, and sanitation) and treatment packages (low osmolarity second year of life. If MCV1 coverage is high (>90%) and school enrolment is high (>95%),
ORS and zinc). administration of routine MCV2 at school entry may prove an effective strategy for achieving
high coverage and preventing outbreaks in schools.
• The first dose of rotavirus vaccine be administered as soon as possible after 6 weeks of age.
• For programmatic reasons (e.g. to reduce cold storage needs and vaccine wastage), it is
• If a child <24 months of age misses a rotavirus dose or series for any reason, WHO recommends
recommended that the same vaccine formulation is used for both routine doses of MCV.
rotavirus vaccination for that child. Because of the typical age distribution of RVGE, rotavirus
vaccination of children >24 months of age is not recommended. • In the following situations, a supplementary dose of MCV should be given to infants from 6
months of age: (1) during a measles outbreak as part of intensified service delivery; (2) during
• The rotavirus vaccination series for each child should be completed with the same product
campaigns in settings where the risk of measles among infants < 9 months of age remains
whenever feasible. However, if the product used for a prior dose is unavailable or unknown, the
high (e.g. in endemic countries experiencing regular outbreaks); (3) for internally displaced
series should be completed with any available licensed product.
populations and refugees, and populations in conflict zones; (4) for individual infants at high
• For a mixed series or a series with any unknown vaccine products, a total of 3 doses of rotavirus risk of contracting measles (e.g. contacts of known measles cases or in settings with increased
vaccine should be administered for a complete vaccination series. risk of exposure during outbreaks such as day-care facilities); (5) for infants travelling to
countries experiencing measles outbreaks; (6) for infants known to be HIV-infected or exposed
• Rotavirus vaccinations may be administered simultaneously with other vaccines of the childhood (i.e. born to an HIV-infected woman).
immunization programme.
• MCV administered before 9 months of age should be considered a supplementary dose and
• WHO prequalified rotavirus vaccines are safe and well tolerated. A small potential risk of recorded on the child’s vaccination record as “MCV0”. Children who receive MCV0 should also
intussusception after rotavirus vaccination remains. receive MCV1 and MCV2 at the recommended ages according to the national schedule.
• Rotavirus vaccine should not be given to children with prior history of intussusception, severe • Given the severe course of measles in patients with AIDS, measles vaccination should be
allergic reaction (e.g. anaphylaxis) after a previous dose, or severe immunodeficiency, including routinely administered to potentially susceptible, asymptomatic HIV infected children and
severe combined immunodeficiency.
adults. Vaccination may even be considered for those with symptomatic HIV infection if they
• Precautions include altered immunocompetence other than severe combined immunodeficiency, are not severely immunosuppressed according to conventional definitions. In areas where there

Table 2: Recommended Routine Immunization for Children (updated November 2021) P.6 / 11
 is a high incidence of both HIV infection and measles, an initial dose of MCV may be offered RCV and YF vaccines.
as early as age 6 months (recorded as MCV0). The 2 routine doses of MCV (MCV1 and MCV2)
should then be administered to these children according to the national immunization schedule. • Rubella vaccination should be avoided in pregnancy because of a theoretical (but never
demonstrated) risk of teratogenic outcomes. Women planning a pregnancy are advised to avoid
• An additional dose of MCV should be administered to HIV-infected children receiving HAART pregnancy for 1 month after rubella vaccination.
following immune reconstitution If CD4+ T lymphocyte counts are monitored, an additional
dose of MCV should be administered when immune reconstitution has been achieved, e.g. • WHO recommends that people who receive blood products wait at least 3 months before
vaccination with RCV, and, if possible, avoid administration of blood products for 2 weeks after
• when the CD4+ T lymphocyte count reaches 20–25%. Where CD4+ T lymphocyte monitoring vaccination.
is not available, children should receive an additional dose of MCV 6–12 months after initiation
of HAART.
• A supplementary dose of MCV (recorded as MCV0) should be considered for infants known to
be exposed (i.e. born to an HIV-infected woman) or soon after diagnosis of HIV infection in
10
Human Papillomavirus (HPV)
children older than 6 months who are not receiving HAART and for whom the risk of measles • Position paper reference : Weekly Epid. Record (2017, 92:241-268) [pdf 2.9MB] and SAGE
is high, with the aim of providing partial protection until they are revaccinated after immune Meeting, October 2019: conclusions and recommendations: Weekly Epid. Record (2019, 94:
reconstitution with HAART. 541-560) [pdf 484KB]
• Mild concurrent infections are not a contraindication to vaccination. As a precautionary measure, • Recommended target population for the prevention of cervical cancer: females aged 9–14
measles vaccine – alone or in combination with other vaccines – should be avoided during years, prior to becoming sexually active.
pregnancy. MCVs should not be given to individuals with a history of anaphylactic reactions or
severe allergic reactions to any component of the vaccine (e.g. neomycin or gelatin) or those • HPV vaccines should be introduced as part of a coordinated strategy to prevent cervical cancer.
with any form of severe immunosuppression. • A 2-dose schedule with a 6-12 month interval between doses is recommended for individuals
• As a general rule, live vaccines should be given either simultaneously or at intervals of 4 receiving the first dose before 15 years of age. Those aged ≥15 years at the time of the second
weeks. An exception to this rule is OPV, which can be given at any time before or after measles dose are also adequately covered by 2 doses.
vaccination without interference in the response to either vaccine. • The initial vaccination of multiple cohorts of girls aged 9-14 is recommended when the vaccine
is first introduced.
• If the interval between doses is shorter than 5 months, then a third dose should be given at
9
Rubella least 6 months after the first dose.
• Position paper reference: Weekly Epid. Record (2020, 95: 301-324) [pdf 772KB] • A 3-dose schedule (0, 1-2, 6 months) should be used for all vaccinations initiated ≥15 years
of age, including in those younger than 15 years know to be immunocompromised and/or HIV
• Countries that have not yet introduced RCV into their immunization programmes should do so
infected (regardless of whether they are receiving antiretroviral therapy). It is not necessary to
if they can achieve a coverage level of 80% or greater, through either routine immunization or
screen for HPV infection or HIV infection prior to HPV vaccination.
campaigns. While opportunities should not be missed, the decision to introduce rubella vaccine
in combination with MCV needs careful consideration related to the sustainability of maintaining • These schedule recommendations apply to all bivalent, quadrivalent, and nonavalent vaccines.
high RCV coverage into the future.
• All three HPV vaccines can be co-administered with other live and non-live vaccines using
• Introduction of RCV into childhood immunization programmes implies a long-term commitment separate syringes and different injection sites.
to achieving and maintaining sufficient immunization coverage to ensure sustained population
immunity. • Data on the safety of HPV vaccination in pregnancy are limited, and HPV vaccination of pregnant
women should be avoided.
• The age-specific incidence decreases in all age groups when vaccination coverage is high
enough (generally estimated to be ≥80%). • Vaccination of secondary target populations, e.g. females aged ≥15 years or males, is
recommended only if this is feasible, affordable, cost-effective, and does not divert resources
• It is recommended that RCV be provided in combination with measles vaccine, and measles from vaccination of the primary target population or from effective cervical cancer screening
elimination requires ≥95% coverage, the goal for rubella vaccination coverage should also be programmes.
≥95%.
• In the context of limited global supply of HPV vaccine, in 2019 SAGE recommended the following
• The recommended vaccination strategy is to begin with an MR vaccination campaign targeting additional strategies:
both sexes and a wide age range (e.g. 9 months–15 years), based on the susceptibility profile
by birth cohort when possible, followed immediately by introduction of MR or MMR vaccine into • All countries should temporarily pause implementation of boy, older age group (>15
the routine immunization programme. The campaign should target males as well as females in years) and multi-age cohort (MAC) HPV vaccination strategies until vaccine supply
order to reduce the likelihood of creating immunity gaps. allows equitable access to HPV vaccine by all countries.

• The first dose of RCV can be delivered at 9 or 12 months, depending on the level of measles • Countries can adopt an extended interval of 3-5 years between the 2 doses. This
virus transmission. RCV should be used in all subsequent follow-up campaigns. strategy constitutes off-label use of the vaccine.

• RCV’s can be administered concurrently with inactivated vaccines.

• Live vaccines should be given either simultaneously with RCV’s, or at least 4 weeks apart. An
exception to this is oral polio vaccine, which can be given at any time before or after RCV’s
without interfering in the response to either vaccine. WHO recommends co-administration of

Table 2: Recommended Routine Immunization for Children (updated November 2021) P.7 / 11
11
Japanese Encephalitis (JE) and severe immunodeficiency.

• Position paper reference: Weekly Epid. Record (2015, 90: 69-88) [pdf 950 KB]. • Preventive mass vaccination campaigns are recommended for inhabitants of areas at risk of
YF where there is low vaccination coverage. Vaccination should be provided to everyone aged
• JE vaccination should be integrated into national immunization schedules in all areas where JE ≥ 9 months, in any area with reported cases. Noting that YF is a live vaccine, a risk-benefit
is recognized as a public health priority. assessment should be undertaken for all pregnant and lactating women.
• The most effective immunization strategy in JE endemic settings is a one-time campaign in the • Vaccine should be offered to all unvaccinated travelers aged ≥ 9 months, travelling to and
primary target population, as defined by local epidemiology (typically children aged <15 years), from at-risk areas, unless they belong to the group of individuals for whom YF vaccination is
followed by incorporation of JE vaccine into the routine childhood immunization programme. contraindicated.
• The following vaccine dosing schedules and age of administration are recommended. The need • YF vaccine may be administered simultaneously with other vaccines. As a general rule, any live
for a booster dose in endemic settings has not been clearly established for any of the vaccines vaccine may be given either simultaneously or at an interval of 4 weeks. Oral polio vaccine may
listed below: be given at any time in relation to YF vaccination.
• Inactivated Vero cell-derived vaccine: Primary series according to manufacturer’s
recommendations (these vary by product), generally 2 doses at 4-week intervals starting
the primary series at ≥6 months of age in endemic settings 13
Tick-Borne Encephalitis (TBE)
• Live attenuated vaccine: Single dose administered at ≥8 months of age
• Position paper reference: Weekly Epid. Record (2011, 86: 241-256) [pdf 318KB]
• Live recombinant vaccine: Single dose administered at ≥9 months of age
• Since the incidence of tick-borne encephalitis may vary considerably between and even within
• Preferably, inactivated mouse brain-derived vaccines should be replaced by the newer generation geographical regions, public immunization strategies should be based on risk assessments
JE vaccines discussed in this position paper. Inactivated mouse brain-derived vaccines may conducted at country, regional or district level, and they should be appropriate to the local
continue to play a role in combatting JE in some countries, but overall these products have endemic situation. Therefore, establishing case reporting of the disease is essential before
a less favourable safety profile due to their increased reactogenicity compared to newer JE deciding on the most appropriate preventive measures to be taken.
vaccines. Other disadvantages include the variability of manufacturing, the cost, the higher
• In areas where the disease is highly endemic (that is, where the average prevaccination
number of doses required and the need for boosters.
incidence of clinical disease is ≥5 cases/100 000 population per year), implying that there is a
• Despite a lack of comprehensive immunogenicity/effectiveness and safety data for all possible high individual risk of infection, WHO recommends that vaccination be offered to all age groups,
combinations of JE and other routine vaccines, co-administration for programmatic reasons including children.
seems acceptable, even in the context of mass campaigns. As a general rule, any live vaccine
• Because the disease tends to be more serious in individuals aged >50–60 years this age group
may be given either simultaneously or at an interval of 4 weeks.
constitutes an important target for immunization.
• Inactivated JE vaccine can be used in immunocompromised persons including HIV-infected
• Where the prevaccination incidence of the disease is moderate or low (that is, the annual average
individuals, but the immune response may be lower than in fully immunocompetent persons.
during a 5-year period is <5/100 000) or is limited to particular geographical locations or certain
Inactivated Vero cell-derived vaccines should be used preferentially over live attenuated or live
outdoor activities, immunization should target individuals in the most severely affected cohorts.
recombinant vaccines in immunocompromised persons. HIV testing is not a prerequisite for
vaccination. • People travelling from non-endemic areas to endemic areas should be offered vaccination if
their visits will include extensive outdoor activities.
• If the JE risk is sufficient to warrant vaccination of pregnant women, inactivated Vero cell-
derived vaccines should be used preferentially over live attenuated or live recombinant vaccines • Vaccination against the disease requires a primary series of 3 doses; those who will continue to
based on the general precautionary principle against using live vaccines in pregnant women be at risk should probably have ≥1 booster doses.
especially if alternative types of vaccines are available. Pregnancy testing is not a prerequisite
for JE vaccination. Inadvertent administration of live attenuated or live recombinant JE vaccine • Within the considerable range of acceptable dose intervals, the relevant national authorities
to a pregnant woman is not an indication for termination of the pregnancy. should select the most rational primary schedule for their national, regional or district
immunization programmes.
• Although there is a strong indication that the spacing of boosters could be expanded
12
Yellow Fever considerably from the intervals currently recommended by the manufacturers (every 3-5
years), the evidence is still insufficient for a definitive recommendation on the optimal frequency
• Position paper reference: Weekly Epid. Record (2013, 88: 269-284) [pdf 1.24MB] and number of booster doses. Countries should therefore continue to recommend the use
of vaccines in accordance with local disease epidemiology and current schedules until more
• WHO recommends that all endemic countries should introduce YF vaccine into their routine definitive information becomes available.
immunization programmes.
• For the vaccines manufactured in Austria and Germany (FSME-Immun and Encepur;) that can
• A single dose of YF vaccine is sufficient to confer sustained life-long protective immunity against be given starting from > 1year of age an interval of 1–3 months is recommended between the
YF disease; a booster dose is not necessary. first 2 doses, and 5–12 months between the second and third doses. When rapid protection is
• It is recommended that YF vaccine be given to children at age 9-12 months at the same time required, for example for people who will be travelling to endemic areas, the interval between
as the measles vaccine. the first 2 doses may be reduced to 1–2 weeks.

• The vaccine is contraindicated in children aged <6 months and is not recommended for those • With the vaccines manufactured in the Russian Federation (TBE-Moscow and EnceVir) the
aged 6-8 months, except during epidemics when the risk of infection with the YF virus is very recommended intervals are 1–7 months between the first 2 doses, and 12 months between the
high. Other contraindications for YF vaccination are severe hyper-sensitivity to egg antigens second and third doses. Booster doses are recommended every 3 years for those at continued

Table 2: Recommended Routine Immunization for Children (updated November 2021) P.8 / 11
 risk of exposure. • In cholera-endemic countries, vaccination of the entire population (throughout a country
regardless of risk) is usually not warranted. Vaccination policies and strategies should be guided
• The currently recommended booster interval should be maintained until more data have been by an assessment of the risk of cholera and targeted to cholera hotspots. Strategies targeting
obtained on the duration of protection induced by the Russian vaccines. specific age groups at higher risk of disease may be considered.
• Regardless of the duration of the delay, interrupted schedules should be resumed without • For control of cholera outbreaks vaccination should be considered to help prevent the spread
repeating previous doses. to new areas. For vaccination campaigns, a single-dose strategy using WC vaccines (Shanchol,
Euvchol or mORCVAX) could be considered in areas experiencing cholera outbreaks.
• During humanitarian emergencies with a risk of cholera, but without a current cholera outbreak,
14
Typhoid vaccination with OCV should be considered as an additional preparedness measure for outbreak
prevention, depending on the local infrastructure (capacity to organize a vaccination campaign).
• Position paper reference: Weekly Epid. Record (2018, 93: 153-172) [pdf 297KB].
• Pregnant and lactating women and HIV infected individuals should be included in OCV campaigns
• Typhoid vaccination programmes should be implemented in the context of other efforts to since there is a high potential benefit and minimal risks.
control the disease, including health education, water quality and sanitation improvements, and
training of health professionals in diagnosis and treatment.
• Among the available typhoid vaccines, TCV is preferred at all ages in view of its improved
immunological properties, use in younger children and expected duration of protection.
16
Meningococcal
Countries may consider the routine use of ViPS vaccine in individuals 2 years and older, and • Position paper reference: Weekly Epid. Record (2011, 86: 521-540) [pdf 1.1MB] and Update for
Ty21a vaccine for individuals more than 6 years of age. MenA conjugate Weekly Epid Record (2015, 90: 57-68) [pdf 852KB]
• TCV - for infants and children from 6 months of age and in adults up to 45 years. Administration • Conjugate vaccines are preferred over polysaccharide vaccines due to their potential for herd
of TCV at the same time as other vaccine visits at 9 month of age or in the second year of life is protection and their increased immunogenicity, particularly in children <2 years of age.
encouraged. ViPS – single dose from 2 years of age. Ty21a – 3-doses to be administered orally
every second day from 6 years of age. • Both conjugate and polysaccharide vaccines are efficacious and safe when used in pregnant
women.
• Catch-up vaccination with TCV up to 15 years of age is recommended when feasible and
supported by epidemiological data. • MenA conjugate vaccine (5µg) a 1-dose schedule is recommended at 9-18 months of age based
on local programmatic and epidemiologic considerations. The vaccine should be administered
• Typhoid vaccination is recommended in response to confirmed outbreaks of typhoid fever and by deep intramuscular injection, preferably in the anterolateral aspect of the thigh. There is no
may be considered in humanitarian emergency settings depending on the risk assessment in reason to expect interference when co-administered with other vaccines. The need for a booster
the local setting. dose has not been established.

• The potential need for revaccination with TCV is currently unclear. Revaccination is recommended • If in a specific context there is a compelling reason to vaccinate infants younger than 9 months,
every 3 years for ViPS, and every 3-7 years for Ty21a. a 2-dose schedule should be used starting at 3 months of age, with an interval of at least 8
weeks between doses.
• Use of the live attenuated Ty21a vaccine during pregnancy should be avoided because of
theoretical safety concerns about potential adverse effects. • For monovalent MenC conjugate vaccine one single intramuscular dose is recommended for
children aged ≥12 months, teenagers and adults. Children 2-11 months require 2 doses
administered at an interval of a least 2 months and a booster about 1 year after. If the primary
series is interrupted, vaccination should be resumed without repeating the previous dose.
15
Cholera • Quadrivalent conjugate vaccines (A,C,W135,Y-D and A,C,W135,Y-CRM) should be administered
• Position paper reference: Weekly Epid. Record (2017, 92:477-500) [pdf 676KB] as one single intramuscular dose to individuals ≥ 2 years. A,C,W135,Y-D is also licensed for
children 9-23 months of age, and given as a 2-dose series, 3 months apart beginning at age 9
• Appropriate case management, WaSH interventions, surveillance and community mobilization months. If the primary series is interrupted, vaccination should be resumed without repeating
remain the cornerstones of cholera control. Vaccination should be implemented in relevant the previous dose.
settings as part of comprehensive cholera control strategies or while other activities are being
developed. • Meningococcal polysaccharide vaccines are less, or not, immunogenic in children under 2 years
of age.
• WC vaccines (Shanchol, Euvchol, and mORCVAX) 2 doses should be given 14 days apart to
individuals ≥1 year of age. For WC-rBS vaccine (Dukoral) 3 doses should be given to children • Meningococcal polysaccharide vaccines can be used for those ≥ 2 years of age to control
2-5 years of age, and 2 doses to children aged ≥6 years and adults, with an interval of 1-6 outbreaks in countries where limited economic resources or insufficient supply restrict the
weeks between doses in both groups. use of meningococcal conjugate vaccines. Polysaccharide vaccines should be administered to
individuals ≥ 2 years old as one single dose. One booster 3-5 years after the primary dose may
• Revaccination is recommended where there is continued risk of V. cholerae infection. For WC be given to persons considered to be a continued high risk of exposure, including some health
vaccines revaccination is recommended after 3 years. For WC-rBS vaccine: children age 2-5 workers. See position paper for details.
years revaccination is recommended within 6 months. If less than 6 months have passed, 1
dose for revaccination. If more than 6 months have passed, the primary series of 3 doses
should be repeated. For those aged ≥6 years of age, if less than 2 years have passed, 1 dose
for revaccination. If more than 2 years have passed, the primary series of 2 doses should be
repeated.

Table 2: Recommended Routine Immunization for Children (updated November 2021) P.9 / 11
17
Hepatitis A • For both PEP and PrEP, vaccines can be administered by either the ID or IM route. One ID dose
is 0.1 mL of vaccine; one IM dose is 0.5 mL or 1.0 mL depending on the product.
• The indication and procedure for PEP depend on the type of contact with the suspected rabid
• Position paper reference: Weekly Epid. Record (2012, 87: 261-276) [pdf 1.24 MB] animal and immunization status of the patient. For category I exposures, no PEP is required; for
• Hepatitis A vaccination is recommended for inclusion in the national immunization schedule category II, immediate vaccination is recommended; for category III, immediate vaccination is
for children ≥ 1 year if indicated on the basis of incidence of acute hepatitis A, change in the recommended, and administration of RIG, if indicated.
endemicity from high to intermediate, and consideration of cost-effectiveness. • PrEP schedule: 2-site ID vaccine administered on days 0 and 7. If IM administration is used,
• In highly endemic countries almost all persons are asymptomatically infected with HAV in WHO recommends a 1-site IM vaccine administration on days 0 and 7.
childhood, which effectively prevents clinical hepatitis A in adolescents and adults. In these • If any doses are delayed, vaccination should be resumed, not restarted. A change in the route of
countries, large-scale vaccination programmes are not recommended. administration or in vaccine product during a PEP or PrEP course is acceptable if such a change
• Countries with improving socioeconomic status may rapidly move from high to intermediate is unavoidable.
endemicity. In these countries, a relatively large proportion of the adult population is susceptible • No further PrEP booster doses following a primary series of PrEP or PEP are required for
to HAV and large-scale hepatitis A vaccination is likely to be cost-effective and therefore is individuals living in, or travelling to, high-risk areas.
encouraged.
• Professionals who are at continual or frequent risk of exposure through their activities should
• For individual health benefit targeted vaccination of high-risk groups should be considered in have regular serological monitoring. If VNA levels fall to <0.5 IU/mL, a 1-site ID or a 1-site
low and very low endemicity settings. Those at increased risk of hepatitis A include travelers IM PrEP booster vaccination is recommended. If serological testing is not available for those at
to areas of intermediate or high endemicity, those requiring life-long treatment with blood continual or frequent occupational risk, a periodic 1-dose (ID or IM) PrEP booster vaccination
products, men who have sex with men, workers in contact with non-human primates, and can be considered based on the assessment of relative risk.
injection drug users. In addition, patients with chronic liver disease are at increased risk for
fulminant hepatitis A and should be vaccinated.
• Inactivated HAV vaccine is licensed for intramuscular administration in a 2-dose schedule with
the first dose given at the age of 1 year or older. The interval between the first and second
19
Dengue (CYD-TDV)
dose is flexible (from 6 months up to 4-5 years) but is usually 6-18 months. Countries may
• Position paper reference: Weekly Epid. Record (2108, 93, 457-76) [pdf 513KB]. This paper is
consider a 1-dose schedule as this option seems comparable in terms of effectiveness, and is
currently under revision.
less expensive and easier to implement. However, in individuals at substantial risk of contracting
hepatitis A and in immunocompromised individuals, a 2-dose schedule is preferred. Inactivated • Vaccination should be considered as part of an integrated dengue prevention and control
HAV vaccines produced by different manufacturers, including combined hepatitis A vaccines, strategy.
are interchangeable. Apart from severe allergic reaction to the previous dose, there is no
contraindication to their use. These vaccines can be co-administered simultaneously with other • Countries should consider introduction of the dengue vaccine CYD-TDV only if the minimization
routine childhood vaccines, and should be considered for use in pregnant women at definite risk of risk among seronegative individuals can be assured.
of HAV infection.
• For countries considering vaccination as part of their dengue control programme, pre-vaccination
• Live attenuated HAV vaccine is administered as a single subcutaneous dose to those ≥ 1 year screening is the recommended strategy.
of age. Severe allergy to components included in the live attenuated hepatitis A vaccine is a
• If pre-vaccination screening is not feasible, vaccination without individual screening could be
contraindication to their use. As a rule, live vaccines should not be used in pregnancy or in
considered in areas with recent documentation of seroprevalence rates of at least 80% by age
severely immunocompromised patients. There is no information available on co-administration
9 years.
of live attenuated hepatitis A vaccines with other routinely used vaccines.
• Decisions about implementing a seroprevalence criterion based vaccination strategy without
• Vaccination against hepatitis A should be part of a comprehensive plan for the prevention and
control of viral hepatitis, including measures to improve hygiene and sanitation and measures individual screening will require serosurveys at high resolution, i.e. at district and sub-district
for outbreak control. level.
• Screening tests would need to be highly specific to avoid vaccinating truly seronegative persons

18
Rabies
• Position paper reference: Weekly Epid. Record (2018, 93: 201-220) [pdf 370 KB].
20
Mumps
• Production and use of nerve-tissue vaccines should be discontinued and replaced by vaccines • Position paper reference: Weekly Epid. Record (2007, 82: 49-60) [pdf 311KB]
based on RABV grown in cell culture or embryonated eggs (CCEEVs).
• Recommended for use in high performing immunization programmes with the capacity to
• There are two main immunization strategies for the prevention of human rabies: (i) PEP which maintain coverage over 80% and where mumps reduction is a public health priority.
includes extensive and thorough wound washing at the RABV-exposure site, together with
RIG administration if indicated, and the administration of a course of several doses of rabies • If implemented, a combination vaccine of measles, mumps and rubella is recommended.
vaccine; (ii) PrEP which is the administration of several doses of rabies vaccine before exposure
to RABV. PrEP is recommended for individuals at high risk of RABV exposure. These include
sub-populations in highly endemic settings with limited access to timely and adequate PEP,
individuals at occupational risk, and travellers who may be at risk of exposure.

Table 2: Recommended Routine Immunization for Children (updated November 2021)P.10 / 11

21
Seasonal Influenza (Inactivated Vaccine)
• Position paper reference: Weekly Epid. Record (2012, 87: 461-476) [pdf 1.9 MB]
• For countries considering the initiation or expansion of programmes for seasonal influenza
vaccination, WHO recommends that pregnant women should have the highest priority. Children
aged < 6 months are not eligible to receive currently licensed influenza vaccines and should be
protected against influenza through vaccination of their mothers during pregnancy and through
ensuring vaccination of close contacts.
• Additional risk groups to be considered are children aged 6-59 months, elderly persons ≥ 65
years of age, individuals with specific chronic medical conditions, and health-care workers.
Countries with existing influenza vaccination programmes targeting any of these additional
groups should continue to do so and should incorporate immunization of pregnant women into
such programmes.
• A single dose is appropriate for those ≥ 9 years of age, including pregnant women. Inactivated
influenza vaccine is safe to give throughout pregnancy.
• Children aged 6-59 months should receive 2 doses at least 4 weeks apart. Children aged 6-35
months should receive a pediatric dosage.
• Annual vaccination (or re-vaccination, if the vaccine strains are identical) is recommended.
Previously vaccinated children 6-59 months require only one-dose.

22
Varicella
• Position paper reference: Weekly Epid. Record (2014, 89: 265-288) [pdf 889KB]
• Countries where varicella is an important public health burden could consider introducing
varicella vaccination in the routine childhood immunization programme. However, resources
should be sufficient to ensure reaching and sustaining vaccine coverage ≥ 80%. Decision-
making on childhood varicella vaccination should also include consideration of the possible
impact on herpes zoster.
• Depending on the goal of the vaccination programme, 1-2 doses should be given with the first
dose administered at 12-18 months of age. The minimum interval between doses should be as
recommended by the manufacturer, ranging from 4 weeks to 3 months.
• Countries with a high average age (≥ 15 years) of acquisition of infection could consider
alternative vaccination strategies such as vaccination of adolescents and adults without evidence
of varicella immunity. This strategy requires a 2-dose schedule.
• Varicella vaccination is contraindicated during pregnancy and pregnancy should be delayed for
4 weeks after vaccination. Termination of pregnancy is not indicated if vaccination was carried
out inadvertently during pregnancy.
• Varicella vaccine can be administered concomitantly with other vaccines. Unless given together
with other live viral vaccines (measles, MR, MMR), it should be administered at a minimum
interval of 28 days.
• Countries should consider vaccination of potentially susceptible health-care workers (i.e.
unvaccinated and with no history of varicella) with 2 doses of varicella vaccine.

Table 2: Recommended Routine Immunization for Children (updated November 2021)P.11 / 11