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William Russell Blog - Guide on vaccinations for expat children - banner close up of needle about to go in arm

Sharon Clarkson

Medical Insurance Nurse

If you and your family have moved to another country, it’s important to make sure your children are kept up-to-date with their vaccinations. Childhood immunisation schedules vary from country to country. Here, we answer some of the most common questions about vaccinating expat children.

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What are childhood vaccination schedules?

What are vaccines?

Whilst the concept of vaccination has been around for centuries, it’s only since the late 1800s that systematic mass immunisation has come about. Vaccines are there to help our bodies provide immunity against preventable illnesses and diseases by stimulating our antibody response. When done at a mass scale they can even help eradicate diseases altogether.

When will kids get COVID vaccine?

So far, COVID-19 vaccinations are only being used on adults and older teenagers.

Covid vaccine could be rolled out to children by autumn 2021. Trials are currently under way to test the Pfizer, Moderna, and Oxford-AstraZeneca vaccines in children.

As of 7 April 2021, a trial of the Oxford-AstraZeneca Covid vaccine on children has stopped giving out jabs while the UK’s medicines regulator investigates a possible link with rare blood clots in adults.

What about vaccination schedules?

Today, most countries have implemented ‘schedules’ for their vaccination programmes from a young age. This is to ensure all the correct doses of a vaccine have been administered at effective intervals.

As an expat the first thing you should know is that these schedules vary from one country to another. That’s because different countries face different health challenges. In some areas, the risk of certain diseases may be higher than in others, and this is reflected in the childhood vaccination schedules. As a case study, consider the differences in vaccination schedules between three locations in Asia – Dubai, Hong Kong and Thailand:

Dubai Hong Kong Thailand
Tuberculosis (BCG) At birth At birth At birth
Diphtheria, Pertussis, Tetanus Yes Yes Yes
Haemophilus Influenzae B (HIB) Yes No No
Polio Yes Yes Yes
Pneumococcal (PPV) Yes Yes No
Measles, Mumps, Rubella (MMR) Yes Yes Yes
Varicella (Chickenpox) Yes Yes No
Hepatitis B At birth Yes Yes
Japanese encephalitis No No Yes

 

Before moving abroad, you’ll need to know which vaccines your child requires and at what stage of their lives. If you live in the EU, there’s a handy tool for finding out when your child’s vaccinations are due. It shows immunisation schedules in different EU countries.

Will my child not be vaccinated for some diseases?

If the odds of a particular disease in a certain region are low, your child is unlikely to be offered a routine vaccine. On the other hand, if a particular disease is prevalent in one region, your child may be offered new types of vaccines. This will usually be at the discretion of your vaccine provider, family doctor or healthcare provider.

One example of this is the BCG vaccine for tuberculosis (TB). This is administered as close to birth as possible in numerous countries but is only offered to babies or children thought to be at an increased risk in the UK, where the risk of TB is much lower.

What’s the childhood immunisation schedule where I live?

Vaccination schedule in the UK

In the UK the National Health Service (NHS) offers a schedule of vaccinations for babies and children. This is offered free of charge for residents of the UK. If your child was born in the UK, it’s likely they would have received at least the first round of immunisations.

Picture source: www.nhs.uk

Expectant mothers in the UK are also offered a Whooping cough vaccine (to provide protection to their unborn child before their first jab) and a Flu jab during Flu season (protecting both mother and baby). UK hospitals issue a personal child health record book (PCHR, also known as the ‘Red book’) to keep track of your childs vaccinations, general health checks and development.

Here are the vaccinations the NHS recommends according to your child’s life stage:

Here are the vaccinations the NHS recommends for Babies in the UK (under one year old). It’s worth noting that the NHS typically uses a 6-in-1 vaccine to cover Diphtheria, Hepatitis B, Hib, Polio, Tetanus and Whooping cough, although other healthcare providers may not offer this combined inoculation.

Age Diseases to vaccinate against
8 weeks Diphtheria
Hepatitis B
Hib (Haemophilus influenzae type b)
Polio
Tetanus
Whooping cough
Rotavirus
Meningococcal infections (Meningitis and sepsis)
12 weeks Diphtheria (second dose)
Hepatitis B (second dose)
Hib (Haemophilus influenzae type b) (second dose)
Polio (second dose)
Tetanus (second dose)
Whooping cough (second dose)
Pneumonia
Rotavirus ( second dose)
16 weeks Diphtheria (third dose)
Hepatitis B (third dose)
Hib (Haemophilus influenzae type b) (third dose)
Polio (third dose)
Tetanus (third dose)
Whooping cough (third dose)
Meningococcal infections (Meningitis and sepsis) (second dose)

The NHS uses combinations of vaccines throughout childhood. The MMR vaccine combines inoculations for Measles, Mumps and Rubella. The 4-in-1 pre-school booster offers further protection against Diphtheria, Tetanus and Whooping cough. The teenage booster or Td/IPV vaccine offers additional immunity against tetanus, Diphtheria and Polio. The MenACWY vaccine is recommended for students going to university and immunises against Meningitis and Septicaemia. However, not all healthcare providers will use combined vaccines.

Age Diseases to vaccinate against
1 Year Meningitis C
Measles
Mumps
Rubella
Pneumonia (second dose)
Meningococcal infections (Meningitis and sepsis) (third dose)
2 to 10 years Flu (each year)
3 years and 4 months Measles (second dose)
Mumps (second dose)
Rubella (second dose)
Diphtheria (booster)
Tetanus (booster)
Whooping cough (booster)
Polio (booster)
12 to 13 years Human papillomavirus
14 years + Tetanus (booster)
Diphtheria (booster)
Polio (booster)
Meningitis
Septicaemia (second dose)

 

Vaccination schedule in Hong Kong

Hong Kong provides a free and comprehensive childhood vaccination programme.

The Childhood Immunisation Programme (HKCIP) is administered by the Maternal and Child Health Centres (MCHCs) up until the age of 5. After that, the Department of Health typically carries out further vaccinations at primary schools.

As with the UK, other common vaccines that aren’t included in the national programme – such as Rotavirus and Influenza vaccines – are available at private clinics.

Here are the vaccinations the Department of Health in Hong Kong recommends:

Here are the vaccinations the Department of Health recommends for under 5’s in Hong Kong.

Age vaccine or diseases
Newborn BCG vaccine*
Hepatitis B
1 month Hepatitis B (second dose)
2 months DTaP-IPV**
Pneumococcal***
4 months DTaP-IPV** (second dose)
Pneumococcal  (second dose)
6 months DTaP-IPV** (third dose)
Hepatitis B  (third dose)
12 months MMRV****
Pneumococcal  (booster dose)
Varicella
18 months DTaP-IPV  (booster dose)
MMRV**** (second dose)

 

*The BCG vaccine protects against Tuberculosis (also known as TB).
**DTaP- IPV Vaccine protects against Diphtheria, Tetanus, acellular Pertussis & Poliovirus (inactivated in this vaccine). Two doses required.
***Pneumococcal vaccines protect against the bacterium Streptococcus pneumonia. They can prevent some cases of pneumonia, meningitis, and sepsis.
****Measles, Mumps, Rubella & Varicella vaccine. Children born on or after 1.7.2018 receive MMRV vaccine at 18 months old in Maternal and Child Health Centres. Children born between 1.1.2013 and 30.6.2018 receive MMRV vaccine in Primary 1.

Here are the vaccinations the Department of Health’s outreach school immunisation teams administer to Hong Kong’s primary school children.

School grade vaccine or diseases
Primary 1 MMRV** (second dose)
DTaP-IPV*  (booster dose)
Primary 5 Human papillomavirus***
Primary 6 dTap-IPV****  (booster dose)
Human papillomavirus (second dose)

 

*DTaP- IPV Vaccine protects against Diphtheria, Tetanus, acellular Pertussis & Poliovirus (inactivated in this vaccine). Two doses required.
**Measles, Mumps, Rubella & Varicella vaccine. Children born on or after 1.7.2018 receive MMRV vaccine at 18 months old in Maternal and Child Health Centres. Children born between 1.1.2013 and 30.6.2018 receive MMRV vaccine in Primary 1.
***Starting from the 2019/20 school year, eligible female students will receive the first dose of the 9-valent HPV vaccine at Primary 5. They will receive the second dose when they reach Primary 6 in the next school year.
****Diphtheria (reduced dose), Tetanus, acellular Pertussis (reduced dose) & Inactivated Poliovirus vaccine

 

Vaccination schedule in the USA

Are vaccines compulsory in the USA?

Vaccinating children is compulsory in all 50 states in order to enrol children into a public school. Exceptions are made for children in some states where parents cite religious reasons (e.g. California and Maine), and another 16 states allow parents to decline vaccination for personal reasons.

How much do childhood vaccines cost in the USA?

Vaccinations for children in the USA aren’t free. Prices range from around $25 to well over $250 for a single dose. Most medical insurance plans cover the cost of these. However, if your insurance doesn’t cover them or the out-of-pocket cost is unaffordable, there is a program that can help.

The Vaccines for Children (VFC) program provides all recommended vaccines at no cost for children under age 19 who:

  • Qualify for Medicaid
  • Don’t have insurance or can’t afford out-of-pocket insurance costs for vaccines
  • Are Native American or Alaskan Native

Alternatively, local health centres and state health departments can help advise you on where to go for free or low-cost vaccines.

What is the childhood immunization schedule in the USA for 2021?

Whilst the specific vaccines required can differ from state to state, the childhood vaccination schedule recommended by The Centre for Disease Disease Control and Prevention (CDC) recommended the below for 2021:

Age vaccine or diseases
Newborn Hepatitis B
1-2 months Hepatitis B (second dose)
2 months Rotavirus (RV1 or RV5)
DTaP <7 years
Hib
PCV13
IPV <18 yrs
4 months Rotavirus (second dose)
DTaP <7 yrs (second dose)
Hib (second dose)
PCV13 (second dose)
IPV <18 yrs (second dose)
6 months Rotavirus (third dose if RV5)
DTaP <7 yrs (third dose)
Hib (third dose if part of 4 dose series)
PCV13 (third dose)
6-15 months Hepatitis B (third dose)
IPV <18 yrs (third dose)
Influenza (IIV or LAIV4) annual jab
12-15 months Hib (third or fourth dose) jab
PCV13 (fourth dose)
MMR
Varicella
Hepatitis A (if 2 dose series)
15 months DTaP <7 yrs (fourth dose)

 

Age vaccine or diseases
18 months Hepatitis B (third dose)
DTaP <7 years (fourth dose)
IPV <18 yrs (third dose)
18-23 months Hepatitis A (second dose)
4-6 years DTaP <7 years (fifth dose)
IPV <18 yrs (fourth dose)
MMR (second dose)
Varicella (second dose)
11-12 years Tdap ≥7 yrs
Meningococcal
11-12 years Meningococcal (second dose)
Annual Influenza (IIV or LAIV4)

 

 

Vaccination schedule in the UAE

In the UAE, childhood vaccinations are mandatory, with their vaccination schedule starting when the child is born up until the 11th grade.

Some health insurance policies will cover mandated vaccines, whilst others classify them as preventative medicine (which is typically excluded). If it’s not covered by your policy, the cost can vary from one clinic to another but can range between Dh800 to Dh1,500 for the first jabs (carried out at eight weeks).

The childhood vaccination schedule for the UAE is currently as follows:

Age Vaccination
Newborn BCG, Hep B
2 months DTaP, Hib, Hep B, IPV, PCV
4 months DTaP, Hib, Hep B, IPV, PCV
6 months DTaP, Hib, Hep B, OPV, PCV
12 months MMR, varicella
18 months DTaP, Hib, OPV, PCV

Age Vaccination
Grade 1 DTaP, OPV, MMR, Varicella
Grade 9 Rubella (females)
Grade 11 Tdap, OPV, HPV (females)

 

Are there other types of child vaccinations I should know about?

Different countries face different health challenges. In some areas, the risk of certain diseases may be higher than in others and this is reflected in the child vaccination schedule. Therefore, it may be a good idea to look into additional vaccinations if you are planning to move abroad or are already living in a region facing particular health challenges.

Some common illnesses you may encounter, which can be effectively vaccinated against, include:

  • Yellow fever
  • Hepatitis A
  • Typhoid
  • Tick-borne encephalitis
  • Japanese encephalitis
  • Cholera
  • Rabies

If you’re in the UK, some of these vaccines may be available at your GP surgery. Otherwise, you and your child will need to get them from a private health provider.

 

How do I get my children vaccinated while living abroad?

The best place to start is by asking your family doctor. If you don’t have one, try asking your employer or speaking to authorities in your local area. They should be able to point you in the right direction.

In principle, if the country you are living in has a state-supported healthcare system, and if you are resident paying taxes, your child should automatically qualify for a state-funded immunisation programme and development checks.

Many of these vaccination programmes visit children in their schools, so you may not need to do anything.

However, rules about access to medical services and facilities are country-specific, so you may need to verify your entitlement and check what you need to do to ensure your child receives their inoculations on time.

If you decide to have vaccinations and checks carried out privately, keep a detailed record of all examinations and injections.

Frequently asked questions about childhood vaccinations

As always, this is up to the authorities in the country, state or region you’re living in.

Many countries around the world have a mandatory vaccination programme, which means children will only be allowed to attend school if they are up-to-date with their inoculations.

Some countries are quite fierce about defending this policy, with fines given to parents who do not keep up with their child’s inoculation schedule.

If the country you live in has a state-funded vaccination programme, and you are a resident who pays taxes, you probably won’t need to go to a private healthcare provider. This applies even in many countries that have an out-of-pocket (i.e. entirely self-funded) healthcare model.

Many countries are even supported by UNICEF and the World Health Organization (WHO) to help them vaccinate everyone living in the country.

However, if you would prefer to get your child vaccinated through private means, or if this is the only option for you, you’ll be glad to know that many expatriate family healthcare plans include vaccinations.

That said, you should check the wording of your own plan before consulting a medical professional to make sure your child fits the necessary criteria for coverage.

Learn more about our plans

Not necessarily. The simple reason for this is that some diseases cannot be vaccinated against.

Two examples of diseases that currently have no widely available vaccines are malaria and dengue fever. Both of these diseases are spread by mosquitos and are known throughout South and Southeast Asia, Central Africa and South America.

The best ways to avoid catching these diseases include wearing sensible clothing and insect repellent, sleeping under mosquito nets and avoiding areas with standing water, especially in the evenings when mosquitos tend to feed.

These are just two examples of diseases that your child may not be able to receive a vaccination for, so be sure to learn as much as you can about the area you will be living in, including uncommon diseases you may encounter.

If you return to the UK often and are thinking of going to a GP for your child’s inoculations, you may be able to get your child’s vaccinations through the NHS.

If your child was born in the UK or has previously received NHS treatment, they should have been given an NHS number. This number is valid for life.

If your child was not born in the UK and does not have an NHS number, you may need to register them as a temporary resident after arriving in the UK. You will then need to register your child with a GP surgery. Bear in mind that there is no guarantee that your local GP surgery will accept you, especially if they are already over-subscribed.

So far, COVID-19 vaccinations are only being used on adults and older teenagers. Countries are running COVID-19 vaccination programmes with an order of priority for different age groups, health conditions and occupations.

Covid vaccine could be rolled out to children by autumn 2021. Trials are currently under way to test the Pfizer, Moderna, and Oxford-AstraZeneca vaccines in children.

The University of Oxford has temporarily paused the study on 7 April 2021 until more data on rare blood clots in adults following vaccination is available.

How to Get a COVID Vaccine If You’re An Expat

You may also want to make sure your child is receiving regular development checks. These are to ensure their body and organs are growing and developing in the right way.

As well as numerous tests which will be conducted at birth, your child will need subsequent regular checks for hip dysplasia, sight, hearing, speech and cognitive development, as well as to check their height and weight, until they are around two years old.

Speak to your doctor or healthcare provider about these checks, but bear in mind that timings for routine examinations and the types of inspections carried out will differ from country to country. Ask for clarification if you need it, and whether any particular specialists may be recommended.

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Top tips for getting through childhood vaccinations

1/ Keep a record of your child’s vaccinations

Whilst each country makes efforts to ensure vaccine schedules are spaced out at appropriate intervals for maximum efficacy – it’s up to the parents to keep track of their own child’s immunisations. Most parents will be able to keep track of their child’s vaccinations through their local family doctor. However, as an expat this can be a challenge.

Some countries (like the UK) issue a health record book at birth, but there are also handy logbooks available to buy online too. Whichever option you choose is fine, so long as it easy for you to keep track of, and of course, portable should you move or travel. Plus it’ll make a handy record to pass onto your child when they eventually move onto their adult vaccination schedules.

2/ Keep calm at the appointments

Children are very instinctive and can sense parents anxiety a mile away. Whilst it’s natural to worry, the calmer you are, the calmer your child is likely to be. It’s a good idea to explain to your child what they should expect if possible, in simple language.

It’s equally important to allow plenty of time to get to your appointment to avoid any undue stress.

3/ Dress babies and children in easy to remove clothing

Babies often need injections in the thigh(s) and children and toddlers usually need injections in the upper arm, You can make the process smoother by dressing your child in easy to move/remove clothing such as a sleepsuit for babies or short-sleeved tops for older children.

4/ Bring their favourite treat or distraction

Whilst it’s (almost) always inevitable to get a few tears at these appointments, a good way to minimise the stress is to bring along something to distract your child. It could be as simple as bringing a bottle of milk to the appointment to give a young baby at the end, or letting your child have a little extra time on their handheld console whilst the jab is being done.

5/ Join a local parent and child group

Being a new parent is challenging no matter which country you are in, and some healthcare systems are more “on the ball” than others. That’s why it’s always a good idea to reach out to other parents, especially local people, for help, friendly advice and support.

Thankfully, parent and baby groups are typically well established in most large, cosmopolitan cities, from Dubai to Bangkok. Try searching on social media or ask your family doctor for help finding connections.

6/ Speak to a medical professional about your child’s individual schedule

If you have questions about a certain vaccine, or if you are going to be travelling to other countries on a regular basis, it’s a good idea to discuss your child’s proposed immunisation plan at an early stage with a medical professional.

In many countries, additional vaccines may be available by request. In Thailand, for instance, you can ask for your child to be inoculated for influenza, Pneumococcal, Rotavirus and Human Papillomavirus (HPV), subject to discussion with your paediatrician.

You may also want to think about other questions to ask your healthcare provider, such as:

  • Could you add certain vaccines to your schedule?
  • Is a particular treatment recommended?
  • Is the vaccine available in your host country or would you need to travel back to the UK to receive it?
  • What costs would be involved, and what will be covered by your expat medical insurance?
  • Could your current paediatrician administer the injection?
  • How would a joint immunisation schedule work in terms of recommended timings and combinations?
  • Are there any possible side effects associated with a particular vaccination?

At William Russell, we urge everyone living abroad to always seek the advice of a qualified healthcare professional before undertaking any immunisation programme or resuming one already in progress.

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