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Information ⬇

Editors

MikaMuhonen
TuulaHannila-Handelberg
HannaNohynek
TuijaLeino

Vaccinations

Essentials

  • Vaccinations aim at the protection of the whole population, a defined risk group or an individual against significant infectious diseases.
  • Complete protection cannot be provided for everybody.
  • A prerequisite for the inclusion of a vaccine in the national immunization programme is that the benefits involved are greater than the potential harms and that the widespread use of the vaccine is cost-effective at the national level.
  • Notice that the national immunization programme described in this article is based on the Finnish programme. Important country-specific differences may apply with regard to e.g. the vaccines included in such a programme, the schedule and target groups of vaccines, as well as the vaccine preparations. While much of the provided information is general, always consult local (national/regional) official policies and instructions as well.
  • Sources for more information on immunization coverage and programmes as well as vaccinations in different countries are available below here.

Schedule

Basic rules

  • Protection as early as possible
  • Immunization is done according to a schedule that causes as few problems as possible (need to consider neutralizing antibodies from the mother, and the child's own immunological maturity).
  • The target of a national immunization programme is to cover the whole population or a defined high-risk part of the population in which vaccination is sufficiently cost-effective.
  • National policies vary, but usually the vaccinations included in the national immunization programme are voluntary and free of charge.

Deviations from the schedule

  • If vaccination series was interrupted, it should be continued, no need to restart.
  • It is hardly worthwhile to shorten the recommended intervals between vaccinations as it usually would weaken the efficacy of the vaccination in short- or long-term.
  • Yet, if the child has clearly passed the recommended age for vaccination, the second dose (or booster) can be given after an interval shorter than usual (does not apply to rotavirus vaccine).
  • The minimum interval between two injections of the same vaccine is usually at least one month.
  • Several vaccinations can be given at the same time.
    • Use different vaccination sites to avoid interference and to recognize local reactions.
  • Vaccines containing inactivated microbes or their purified antigens can be given together with each other or with vaccines containing live attenuated microbes at the same visit or by any schedule in relation to each other.
  • Two injectable vaccines both containing live attenuated microbes should be given at the same visit or at an interval of at least one month.
    • Do not give immunoglobulin simultaneously with MMR, varicella or yellow fever vaccination
      • Vaccine should be given 3 to 4 weeks before immunoglobulin or 6 to 12 weeks after it.

Finnish national immunization programmeVaccines for Preventing Rotavirus Diarrhoea: Vaccines in Use, Pneumococcal Conjugate Vaccines for Preventing Invasive Pneumococcal Disease and Pneumonia in Children Under Two Years of Age

National immunization programme in Finland as of September 1, 2017

Target groupAgeVaccine
Whole population2 monthsRotavirus
3 monthsDTaP-IPV-Hib, PCV, rotavirus
5 monthsDTaP-IPV-Hib, PCV, rotavirus
6 months - 6 yearsInfluenza (1. time 2 doses at one month interval [does not apply to nasal spray vaccine], then 1 dose yearly)
12 monthsDTaP-IPV-Hib, PCV, MMR
18 monthsChickenpox (vaccinations during the transition period: see more details in text below)
4 yearsDTaP-IPV
6 yearsMMRV (MMR for those who have had chickenbox)
10-12 yearsHPV 2 doses
14-25 yearsdtap
45-65 yearsdT (every 10 years after the age of 65)
≥ 65 yearsInfluenza annually
Risk groupsBCG, dtap, HBV, HAV, influenza, pneumococcus, meningococcustick-borne encephalitis

Vaccines used in the Finnish national immunization programme

AbbreviationVaccineAdministration
BCGTuberculosis vaccine (Bacillus Calmette-Guérin), contains live attenuated bacteriai.d.
DTaP-IPV-HibDiphtheria (D), tetanus (T), acellular pertussis (aP), polio (IPV), and Haemophilus influenzae type b (Hib) vaccinei.m.
DTaP-IPVDiphtheria (D), tetanus (T), acellular pertussis (aP), and polio (IPV) vaccinei.m.
dtapDiphtheria (d), tetanus (t), and acellular pertussis (ap) vaccinei.m.
DTDiphtheria (D) and tetanus (T) vaccinei.m.
dTDiphtheria (d) and tetanus (T) vaccinei.m.
HibHaemophilus influenzae type b (Hib) vaccine, contains purified antigens (bacterial surface polysaccharides conjugated with toxoid)i.m./s.c.
IPVPolio vaccine containing inactivated type 1, 2, and 3 virusess.c./i.m. depending on the preparation
PCVPneumococcal conjugate vaccines (children < 6 years PCV10, adults PCV13), contain purified antigens (bacterial surface polysaccharides conjugated with a carrier protein). The number indicates the number of serotypes.i.m.
MMRMeasles (morbilli, M), mumps (M), and rubella (R) vaccine, contains live attenuated virusess.c./i.m. depending on the preparation
MMRVMeasles (morbilli, M), mumps (M), rubella (R) and chickenpox (varicella, V) vaccine, contains live attenuated virusess.c./i.m.
HAVHepatitis A vaccine, contains inactivated (killed) virusesi.m. (exceptionally s.c.)
HBVHepatitis B vaccine, contains purified surface antigeni.m. (exceptionally s.c.)
HAV and HBVHepatitis A and hepatitis B vaccinei.m. (exceptionally s.c.)
HPVPapillomavirus vaccine, contains surface proteins of the virusi.m.
InfluenzaInfluenza vaccine, contains purified surface antigens, or virus fragments from four different influenza virus strains, or live attenuated virusesi.m./s.c. or nasal spray depending on the product
RotaRotavirus vaccine, contains live attenuated virusesp.o.
ChickenpoxChickenpox (Varicella) vaccine, contains live attenuated viruses.i.m./s.c.
TBETick-borne encephalitis vaccinei.m.
PPVPneumococcal polysaccharide vaccinei.m.
Markings describing different amounts of antigens in the vaccines
D, T, PHigher amount of antigens
d, t, pLower amount of antigens

Chickenpox (varicella) vaccine in the national immunization programme Live Attenuated Varicella Vaccine for Healthy Children, Vaccines for Post-Exposure Prophylaxis Against Varicella (Chickenpox) in Children and Adults, Vaccines for Measles, Mumps and Rubella and Varicella in Children

  • Included as of the 1st of September 2017 in the national immunization programme in Finland. Chickenpox vaccine is offered to all children who were born in 2006 or later and who have not had chickenpox.
    • Patient history regarding earlier chickenpox suffices. It does not need to be established by blood tests.
  • Chickenpox vaccine contains live attenuated viruses.
  • Contraindications
    • Severe immunodeficiencies
    • Pregnancy
      • Getting pregnant should be avoided for 1 month after the vaccination
    • Neomycin has caused anaphylaxia

Human papillomavirus (HPV) vaccine in the national immunization programme

  • The HPV vaccine contains surface proteins of human papillomavirus. Does not contain inner structures of the virus. The products also contain aluminium-based adjuvants. The vaccine is available free of charge to all children aged 10-12 years (5th and 6th school grades).
  • If, for any reason, a child has not been vaccinated against HPV in the elementary school, they can still get the vaccination free of charge during the later school years or, the latest, before 18 years of age.
  • The vaccine prevents those HPV infections that most commonly lead to cancer.
  • When given below 15 years of age, the vaccionation series consists of two doses given at an interval of at least 5 months, but the interval may well be a year. If the series is started only at the age of 15, 3 doses are included. The second dose is given not earlier than 1 month after the dose, and the third dose is given no earlier than 5 months after the second dose.
  • In many European countries, Australia, and the United States, the vaccine is included in the national immunization programme for boys as well http://vaccine-schedule.ecdc.europa.eu/Scheduler/ByDisease?SelectedDiseaseId=38&SelectedCountryIdByDisease=-1.

Vaccinations for special groups in the national immunization programme

  • Those at risk are offered vaccination protection against specific diseases tailored to their needs. These vaccinations are also part of the national vaccination programme and are free of charge.

Vaccinations for stem cell transplant recipients

BCG vaccine BCG Vaccine in the Prevention of Tuberculosis, Does the Efficacy of BCG Vaccine Decline with Time?

  • BCG vaccination is recommended for children below 7 years of age if the child
    • lives in the same household as a person who has a history of diagnosed tuberculosis
    • was born in a country with a significant prevalence of tuberculosis
    • lives in the same household as a person born in a country with a significant prevalence of tuberculosis
    • is within one year moving for more than one month to a country with a significant prevalence of tuberculosis
    • lives in the same household as a person who is a frequent and regular visitor to a country with a significant prevalence of tuberculosis.
  • See e.g. http://cdn.who.int/media/docs/default-source/hq-tuberculosis/who_globalhbcliststb_2021-2025_backgrounddocument.pdf for global incidence rates and local guidance on what is considered significant in this context.
  • In some cases a child may benefit from BCG vaccination even if he/she does not belong to any of the risk groups mentioned above. Based on an assessment by the treating doctor, a child under 7 years of age should be offered BCG vaccination also if the child has any other regular and close contact with a person
    • from a country with a significant prevalence of tuberculosis
    • who has contracted tuberculosis
    • who is known to have had a significant exposure to tuberculosis
    • who cares for persons with pulmonary tuberculosis or otherwise has regular and significant occupational exposure to tuberculosis.
  • It is important that a community health nurse at the maternity clinic assesses the need of the expected child for BCG vaccination before the delivery by interviewing the pregnant mother during a follow-up visit. The need for vaccination of a newborn infant may also be assessed at the maternity hospital. After birth, children are screened for severe mixed immunodeficiency (SCID). A child with an abnormal result is not vaccinated.
  • One dose of the vaccine is administered as intradermal injection in the left upper arm.
  • Usually newborn babies are vaccinated but the vaccine may be given to children up to the age of 7 years.
  • When vaccinating a child older than 6 months of age, it must be ensured before vaccination that the child does not have tuberculosis and has not received BCG vaccination. Ruling out tuberculosis Diagnosing Tuberculosis is primarily done by the IGRA test (see local guidance for details). Alternatively, the Mantoux or tuberculin test can be used.
  • Contraindications to BCG vaccination
    • Positive IGRA or Mantoux/tuberculin test.
    • Congenital immunodeficiency or immunodeficiency caused by disease or its treatment, as vaccination may cause severe local or systemic infection
    • The child has tuberculosis.
  • Take also into account
    • the mother's biological medication during pregnancy
    • rules on the timing of administration of live attenuated vaccines.

Hepatitis A and B combination vaccine

  • The hepatitis combination vaccine is given free of charge to the following groups as part of the programme.
    • People with bleeding disorder who are receiving regular treatment
    • Injecting drug users and their close ones, such as family members, live-in partners and sexual partners
    • Men who have sex with men
  • The vaccine can be given to people aged 1 year and over; paediatric preparation for those aged 1-15 years and adult preparation for those aged 16 years and over.
  • The vaccine series consists of 3 doses given at 0, 1 and 6 months. In exceptional circumstances, vaccines can be administered in persons aged 16 years and over at 0, 7 and 21 days, and a 4th dose at 1 year.
  • In high and long term risk individuals, it is recommended to confirm hepatitis B immunity about 2 months after the third dose Vaccines for Preventing Hepatitis B in Health-Care Workers.
  • See article on viral hepatitis Viral Hepatitis.

Hepatitis A vaccine Hepatitis A Immunisation in Persons Not Previously Exposed to Hepatitis A

  • Hepatitis A vaccine is given free of charge as a part of the national programme to the target groups listed below.
    • People with bleeding disorder who are receiving regular treatment
    • Injecting drug users and their close ones, such as family members, live-in partners and sexual partners
    • Men who have sex with men
  • According to current knowledge, two doses of the vaccine provide a life-long protection against hepatitis A. The age of the vaccinee has to be at least 12 months at the time of the first dose. The second dose is given 6-12 months after the first one.

Hepatitis B vaccine Vaccines for Preventing Hepatitis B in Health-Care Workers, Hepatitis B Immunisation in Persons Not Previously Exposed to Hepatitis B or with Unknown Exposure Status

  • For the following groups, hepatitis A and B combination vaccine (see above) can be given instead of the hepatitis B vaccine.
    • People with bleeding disorder who are receiving regular treatment
    • Injecting drug users and their close ones, such as family members, live-in partners and sexual partners
    • Men who have sex with men
  • Hepatitis B vaccine is given free of charge as a part of the national programme to the target groups listed below.
    • Newborn infants of HBsAg carriers (mother or father) at the age of 0, 1, 2 and 12 months. If the mother is a carrier, the child is also given one dose (125 IU) of HB immunoglobulin before the first vaccination Hepatitis B Immunization for Newborn Infants of Hepatitis B Surface Antigen-Positive Mothers.
    • People who are sexual partners or live in the same household with persons with hepatitis B infection or with asymptomatic HBsAg-positive persons
    • Sex workers
    • Students at risk of HBV infection during work placements
    • In the case of needlestick and other blood-borne incidents, where a risk assessment indicates that protection is necessary and the case is not covered by occupational health care Occupational Exposure to Blood and Body Secretions. Victims of sexual offences may also be included in this category.
    • Children under 5 years of age attending a day-care centre with an HBsAg-positive child
    • Children born locally when at least one parent comes from a country where hepatitis B is prevalent
    • Newborn infants whose mother has hepatitis C infection
  • Given at 0, 1 and 6 months, however, to newborn infants and in any case of high-risk exposure at 0, 1, 2 and 12 months. In newborns, make particularly sure that the whole hepatitis B vaccination schedule is completed because an infection in a small child leads to life-long infection in up to 90% of cases. In exceptional cases in people aged 16 years or older the vaccination may be given at 0, 7 and 21 days, and a fourth dose at 1 year.
  • In people at high and long-term risk, hepatitis B immunity should be confirmed approximately 2 months after the third dose.
  • See article Viral hepatitis Viral Hepatitis.

Influenza vaccine Influenza Vaccination in Asthma: Efficacy and Side Effects, Influenza Vaccine for Patients with Chronic Obstructive Pulmonary Disease, Protection Against Influenza after Annually Repeated Vaccination, Vaccines for Preventing Influenza in Healthy Adults, Influenza Vaccines for Preventing Cardiovascular Disease

  • The national recommendations for influenza vaccination are yearly reviewed. Free vaccination against seasonal influenza is recommended to those for whom influenza would pose an essential health risk or whose health would significantly benefit from the vaccination.
  • Additionally, influenza vaccine is available free of charge for
    • professionals who work in direct contact with customers in health care, social care or pharmaceutical services
    • people in near contact with persons particularly susceptible to severe influenza.
  • The same inactivated injectable vaccine is used regardless of age. For children aged 2-6 years, also a nasal spray vaccine is available.
  • The efficacy of the vaccine significantly varies from season to season. The protective effect is also influenced by the vaccine product, the age of the vaccinee, underlying diseases and medication. The vaccine can prevent up to 50-80% of influenza cases in children and working-age adults. The effectiveness is weaker in people over 65 years of age. Vaccination reduces the need for hospitalization of elderly people Vaccines for Preventing Influenza in the Elderly.

Meningococcal conjugate vaccine (MCV)

Polio vaccine (IPV)

  • Booster vaccination for people aged 14 years or older is only necessary in special circumstances (consider for travellers to countries where poliovirus is still present).

Tick-borne encephalitis (TBE) vaccine

  • Tick-borne encephalitis vaccine containing inactivated viruses is included in the national immunization programme for residents aged 3 years and above in high risk zones (includes permanent home or holiday aparment that is used for longer periods). The high risk zones are defined separately.
  • The vaccine is more necessary the more one stays and moves around in green areas in high risk zones during the unfrozen period.
  • Under certain circumstances, a vaccine is recommended also outside the high risk zones.
  • Basic protection against tick-borne encephalitis includes 3 i.m. injections at months 0, 1-3 and 9-12. The timing of the third dose (as defined here) differs from that of the summary of product characteristics of Ticovac® .
  • The first booster dose is recommended to be given after 3 years. Subsequently, the boosters are administered as follows:
    • to those who received the booster when aged under 50, the next booster dose is given after 10 years
    • to those who received the booster when aged 50 to 60, boosters are given every 5 years
    • to those who received the booster when aged over 60, the next booster doses are given every 3 years
    • to persons with weakened immune system due to treatment or an illness, a booster dose should be administered every 3 years.
  • The boosters are not included in the national immunization programme.

Pneumococcal vaccine

COVID-19 vaccine and Mpox vaccine

COVID-19 vaccine

Mpox vaccine

  • Jynneos® vaccine contains a live attenuated virus closely related to smallpox virus.
  • Mpox vaccination is recommended for people aged 18 years and over in the groups listed below.
    • Men who have sex with men and have had several casual sexual partners in the last six months
    • Men who have sex with men and are taking HIV preventive medication (prep)
    • Men waiting for prep treatment who have sex with men
    • Based on individual assessment to people exposed to mpox and to close contacts of people with mpox infection
  • Vaccination may also be given to persons travelling to African mpox epidemic areas who are at particular risk of exposure when other protective measures are not sufficient.
  • The vaccination series for people at risk includes 2 doses at least 4 weeks apart. Exposed persons and close contacts should receive one dose as soon as possible after exposure, but no later than at 14 days.

Staff vaccinations for the protection of patients

  • Legislation on infection control may require that personnel working in specific settings within social and health care is vaccinated or has naturally acquired immunity against certain diseases. Find out about local legislation regarding such requirements.
  • In Finland, sfaff members and students working in social and health care must be protected against
    • measles and chickenpox (disease in the past or vaccination)
    • influenza (vaccination)
    • Pertussis in persons continuously providing care to infants (vaccination)
  • The employer must define the client and patient premises in social and health care units where clients or patients who are medically assessed as being at risk of serious consequences of communicable diseases are treated.

Pertussis vaccine

  • Protection against pertussis (vaccine) is required if one is continuously caring for children under 12 months of age.
    • As a general rule, hospital staff treating infants
    • Staff of maternity and child welfare clinics
    • Laboratory staff who mainly take samples from paediatric patients
  • Vaccinations may be carried out using the dtap vaccine of the national immunization programme.
    • The vaccine contains toxoids of diphtheria, tetanus and pertussis bacteria and surface structures of pertussis bacteria; it does not contain live pathogens.
    • It can be administered after 2 years from the previous dT vaccination.
    • Protection should be boosted every 5 years.

Influenza vaccine

  • Protection against influenza (vaccine) is required if one is treating people at risk of serious consequences of influenza, such as
    • patients whose immune system is significantly compromized due to illness or its treatment
    • pregnant persons
    • persons under 1 year of age or over 65 years of age.
  • Influenza vaccine; see Vaccines for special groups > Influenza vaccinehere

Measles vaccine

  • Protection against measles (history of the disease or a vaccine) is required if one is treating people at risk of serious consequences of measles, such as
    • patients with a significantly impaired immune system due to an illness or its treatment
    • pregnant persons
    • children under 1 year of age.
  • Measles vaccine
    • The vaccine contains live, attenuated measles, mumps and rubella viruses.
    • The vaccines contain neomycin only as a residue. The vaccines do not contain an adjuvant substance.
  • Contraindications
    • Pregnancy
      • Pregnancy should be avoided for 1 month after vaccination.
    • Immunosuppression; see contraindications to vaccination in here.

Chickenpox vaccine

  • Protection against chickenpox (history of the disease or vaccination) must be available if one is treating people at risk of serious consequences of chickenpox, such as
    • patients whose immune system is significantly impaired as a result of an illness or its treatment
    • pregnant persons
    • persons under 1 year of age or over 65 years of age.
  • Chickenpox vaccine: see above here.
  • Contraindications
    • Severe immunodeficiency states
    • Pregnancy
      • Pregnancy should be avoided for 1 month after vaccination.
    • History of neomycin-induced anaphylaxis

Use of vaccines outside the national immunization programme Vaccines for Preventing Malaria, Vaccines for Herpes Zoster in Older Adults, Vaccination Against Mycobacterium Leprae, Vaccines for Preventing Smallpox, Vaccines for Preventing Pneumococcal Infection in Adults

Pneumococcal conjugate vaccine (PCV) Pneumococcal Vaccines for Preventing Otitis Media, Pneumococcal Conjugate Vaccines for Preventing Invasive Pneumococcal Disease and Pneumonia in Children Under Two Years of Age

  • The first-choice pneumococcal vaccine since its protective effect has been shown more reliably. Revaccination is not required.
  • Available preparations
    • PCV13 (Prevenar 13® ), registered for children and adults
    • PCV15 (Vaxneuvance® ), registered for children and adults
    • PCV20 (Apexxnar® ), registered for people 18 years and over
  • For children over 5 years of age and adults belonging to high risk groups who due to their age, living conditions, illness or medication are at risk of acquiring severe pneumococcal infection or its complication http://thl.fi/en/web/infectious-diseases-and-vaccinations/vaccines-a-to-z/pneumococcal-vaccines/pneumococcal-vaccinations-for-at-risk-groups. The vaccine must by payed for by the unit providing treatment or by the patient him/herself. Such diseases and patient groups include e.g.
    • immunocompromized people, e.g. with organ transplant or immunosuppressive medication
      • Severely immunocompromised persons under 75 years of age are covered by the national immunization programme.
    • chronic heart disease, heart failure
    • chronic lung disease
      • COPD patients aged 65-84 years are covered by the national immunization programme.
    • diabetes
    • liver failure
    • splenectomy patients
    • alcoholism
    • people in permanent institutional care.
  • At the physician's discretion, the vaccine can also be given to other people aged 5 years or older, but especially to people over 65 years of age.
  • Pneumococcal risk groups in the national immunization programme: see http://thl.fi/en/topics/infectious-diseases-and-vaccinations/vaccines-a-to-z/pneumococcal-vaccines/pneumococcal-vaccinations-in-the-national-vaccination-programme

Pneumococcal polysaccharide vaccine (PPV)

  • Pneumococcal polysaccharide vaccine contains purified antigens (23 surface polysaccharides).
  • The vaccine is usually used as a booster and additional vaccine for certain groups at risk of severe pneumococcal disease Vaccines for Preventing Pneumococcal Infection in Adults. In this case, the person is first given the conjugate vaccine and only then, as considered necessary, the polysaccharide vaccine.
  • One vaccine dose is sufficient. Revaccinations are usually not required. Patients with splenectomy or splenic insufficiency can be given a booster dose after 5 years. If the person has earlier received a pneumococcal conjugate vaccine, there should be at least an 8-week and preferably a 12-month interval between the vaccinations.
  • The vaccination is not given to children under 2 years of age because of the poor immunogenicity of the vaccine in this age group.
  • The protective effect has only been demonstrated against invasive pneumococcal diseases.

Hib vaccineConjugate Vaccines for Preventing Haemophilus Influenzae Type B Infection

  • The Hib vaccine is recommended outside the national programme for unvaccinated patients aged 5 years and over who are missing a spleen or have undergone an organ transplant.
  • The vaccine is given in a single dose.

Hepatitis A and B combination vaccineHepatitis A Immunisation in Persons Not Previously Exposed to Hepatitis A

  • Hepatitis A and B combination vaccine contains hepatitis B virus surface structures and killed whole hepatitis A viruses.
  • The vaccine can be given to people aged 1 year and over. A paediatric formulation is available for children aged 1-15 years and an adult formulation for people aged 16 years and over.
  • The vaccine series consists of 3 doses given at 0, 1 and 6 months. In exceptional circumstances for people aged 16 years and over, vaccines can be given at 0, 7 and 21 months and a 4th dose at 1 year.
  • In high and long-term risk individuals, it is recommended to confirm hepatitis B immunity about 2 months after the third dose.
  • See the article Viral hepatitisViral Hepatitis.

Hepatitis A vaccine Hepatitis A Immunisation in Persons Not Previously Exposed to Hepatitis A

Hepatitis B vaccine , Hepatitis B Immunisation in Persons Not Previously Exposed to Hepatitis B or with Unknown Exposure Status, Vaccines for Preventing Hepatitis B in Health-Care Workers

Japanese encephalitis vaccine

Yellow fever vaccine

Tick-borne encephalitis vaccineVaccines for Preventing Tick-Borne Encephalitis

  • TBE vaccine is recommended for permanent and periodic residents who move around in the nature in areas with significant risk of acquiring tick-born encephalitis (TBE). The vaccine may be considered for travellers who stay or spend a lot of time in the nature in endemic areas. Consult national and regional recommendations.
  • TBE is endemic in many countries, e.g. the Baltic countries, Northern, Central and Eastern Europe, and in Asia. See also http://www.who.int/health-topics/tick-borne-encephalitis http://www.who.int/teams/immunization-vaccines-and-biologicals/policies/position-papers/tick-borne-encephalitis.
  • TBE vaccine may be given to children aged 1 year or older and to adults.
  • Basic protection against TBE includes 3 injections i.m. at months 0, 1-3 and 9-12. The instruction for the timing of the third dose differs from the Ticovacin® summary of product characteristics.
  • For schedule of booster doses and accelerated programme: see TBE vaccination in the national immunization programme here.

Typhoid fever vaccine Vaccines for Preventing Typhoid Fever, Oral Vaccines for Preventing Cholera

Cholera vaccine

Meningococcal conjugated vaccine

Rabies vaccine

Chickenpox vaccine

  • Chickenpox vaccination is recommended outside the national vaccination programme for all persons born before 2006 (the year when the vaccination was included in the national programme in Finland: this is likely to vary in different countries) who have not had chickenpox and have not been vaccinated. This applies in particular to the groups listed below.
    • Those planning pregnancy. Pregnancy should be avoided for one month after vaccination.
    • In association with pre-employment medical examination of women under 45 years of age involved in work in day care and schools
    • People travelling abroad
    • Healthy close contacts of severely immunocompromized people who cannot be vaccinated themselves
    • Patients for whom treatment causing severe immunodeficiency, such as transplantation, is planned.

Zoster vaccine

  • There are two different vaccines in use.
    • Zoster vaccine containing live attenuated viruses is administered as a single dose.
      • Must not be used in immunocompromized persons.
    • The usual vaccination series of zoster vaccine containing purified antigen and an adjuvant includes 2 doses.
    • If a person has had herpes zoster (shingles), it acts like a vaccine by boosting immunity. The timing of vaccination after herpes zoster has not yet been determined.
  • Indicated for the prevention of herpes zoster and particularly of the prolonged pain syndrome (postherpetic neuralgia) associated with it.
  • From the age 50 years upwards
    • The vaccine containing purified antigen (Shingrix® ) may be administered also to people who have turned 18 and are at an increased risk of acquiring zoster.

Vaccination techniques

  • S.c. (subcutaneously)
    • Outer side of the thigh or upper arm
  • I.m. (intramuscularly)
  • I.d. (intradermally; BCG)
    • Left upper arm (BCG)
    • A pale wheal should appear after successful vaccination.
  • P.o. (orally)
  • Nasal spray
    • The vaccine is sprayed in both nostrils (live attenuated influenza virus).

Vaccines in general use

Adverse effects Adverse Events after Immunisation with Aluminium-Containing Vaccines

  • Some vaccinations cause adverse reactions, the majority of which are mild and self-limiting local reactions. Severe reactions are rare. An anaphylactic reaction is almost the only situation where rapid actions are required.

Local reactions

  • Erythema, swelling, pain, warmth at the site of vaccination are common.
  • Treatment: immobilization of the site of vaccination (e.g. swaddling), cold compress
  • Symptomatic medication (analgesics, antihistamines)
  • Routine prophylactic administration of an analgesic or antipyretic drug is not recommended as it may decrease the immunological response to the vaccine.

Generalized reactions

  • Fever, itching rash, irritability
    • Symptomatic treatment
  • Anaphylactic reaction Anaphylaxis
    1. Adrenaline 1:1 000 (1 mg/ml) i.m. 0.1 ml/10 kg(for an adult 0.5 ml i.m.)
    2. Adequate follow-up

Avoidance, follow-up and compensation of adverse effects

  • Ask about allergy to eggs or vaccine components Hypersensitivity to Drugs.
  • For contraindications see below.
  • Record adverse reactions accurately.
  • Inform health authorities according to local policies when a severe and unexpected adverse reaction is suspected.
  • The associations between vaccinations and adverse reactions are nowadays investigated by combining register data (epidemiological methods). Reporting about individual cases of suspected adverse effects is still an important means of getting information about new suspected adverse reactions (signal detection).
  • Depending on how vaccine related liability issues have been agreed upon, countries have different practices for compensation of adverse effects of vaccines.

Contraindications

  • The following conditions are not contraindications for vaccination:
    • a history of the disease against which the vaccination is aimed at
    • incubation period of an infectious disease
    • an infectious disease with mild symptoms (e.g. rhinitis, otitis media or diarrhoea)
    • antimicrobial medication (typhoid fever is an exception, see local guidance)
    • local glucocorticoids or a small dose of systemic glucocorticoids (for doses, see local guidance)
    • atopic diseases (atopic rhinitis, asthma, dermatitis)
    • dermatites, limited skin infections
    • history of convulsions in the family
    • stable neurological disease
    • Down's syndrome, developmental disability
    • chronic cardiac, liver, lung, or renal disease, rheumatoid arthritis or diabetes
    • neonatal jaundice
    • pre-term infant, small for date
    • malnutrition
    • breast-feeding (yellow fever vaccine is usually not recommended during breastfeeding, see local guidance)
    • pregnancy of the mother (the child of a pregnant woman can be vaccinated).

True contraindications for vaccination

  • True contraindications are very rare. Almost all people can get the vaccines they need. Only very rarely are there situations where the vaccine cannot be given. In most cases, the situation can be resolved by rescheduling the vaccination.
  • An infection with fever: all vaccines
    • Vaccination is given as soon as the patient has recovered.
    • If the vaccination is being given because of an ongoing epidemic, an infection with fever is not a contraindication.
  • Immunodeficiency
    • Vaccination with vaccines containing inactivated microbes and their purified antigens is safe.
    • Vaccines containing live attenuated bacteria or viruses are contraindicated, with a few exceptions.
    • Live attenuated vaccines in HIV infected patients
      • MMR can be given based on an individual assessment
      • BCG vaccination must not be given to any patient with HIV infection, including asymptomatic patients.
  • Severe adverse reaction from an earlier vaccination with the same vaccine
    • Anaphylaxis or shock, encephalitis, encephalopathy, convulsions
    • A disease of the central nervous system without some other known aetiology
      • Requires case-by-case assessment concerning the benefits and possible harms.
    • Febrile convulsions are not a contraindication: provide antipyretics after the vaccination
  • A neurological disorder or disease that is under investigation
    • Consider postponing vaccines.
    • Vaccination must not be done if a progressive CNS disease is suspected.
    • Vaccinations are continued when a diagnosis has been made or the symptoms have stabilized.
  • Pregnancy: vaccinations are not usually recommended, with the exception of situations where pregnancy predisposes to a severe disease (influenza, COVID-19), vaccination of the pregnant mother may provide protection to the newborn (influenza, tetanus, pertussis, COVID-19) or when vaccination is warranted by the epidemiological situation (polio, meningococcus, yellow fever, pertussis, influenza).
    • An accidental MMR or varicella vaccination is not an indication for termination of pregnancy.
  • Hypersensitivity to some vaccine constituent
    • Hypersensitivity to eggs
      • If food containing eggs causes anaphylactic symptoms:
        • vaccines that are produced in fertilised eggs (influenza and yellow fever vaccines) may usually be given safely, but the patient should be monitored for an hour after the vaccination
        • vaccines that are produced in the skin cells of a chick embryo (MMR and TBE vaccines) may be given normally.
    • Mild hypersensitivity to eggs (eggs cause skin or intestinal symptoms): may be vaccinated normally. Allergic symptoms are possible when giving vaccines that are produced in fertilised eggs.
    • Severe hypersensitivity to antimicrobial drugs (a history of systemic symptoms)
      • Neomycin: rabies (depending on preparation) and varicella vaccines. A specialist in allergology decides about MMR vaccine.

Related Keywords ⬆

ATC Code:

J07BG01

J07BC01

J07BF03

J07BL01

J07AL01

J07BM02

J07CA02

J07CA06

J07BD52

J07AP01

J07BC20

J07BA02

J07BB01

J07BB02

J07BB03

J07BK01

J07AE01

J07BA01

J07AN01

J07AP03

J07BB02

J07AL01

J07AL02

J07AL52

L03AX03

J07BC02

J07AL52

J07AM51

J07AJ52

J07AL02

J07BK02

Primary/Secondary Keywords