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Protective inoculation

★Definition
Preventive inoculation is a means of preventing or ameliorating the effects of infection by a pathogen through the administration of antigenic material/antibody to achieve immunity to a specific disease. Based on the attribute and source of antigen, preventive inoculation can be divided into two primary types: active and passive. Active preventive inoculation involves the introduction of an antigen to stimulate the host’s immune system to evoke a lasting immune response; examples include diphtheria antigen and Sabin vaccination. In contrast, passive preventive inoculation works by presenting antibody (i.e. immunoglobulin) directly to one’s body to offer temporary protection. It is similar to the temporary immunity that infants acquire from their mothers’ body. 

★Active and Passive Immunity
Active Immunity
Active immunity involves the stimulation of immunity response in the human body that somewhat resembles infection by injecting a vaccine (inactivated, live-attenuated, toxoids or subunit) directly to the human body or animal in order for the immune system to produce antibodies. This technique is known as active preventive inoculation and it works through the generation of neutralizing antibodies/antitoxins or evoking an immunity response to fend off the invading microorganism.
Passive Immunity

Passive Immunity works by achieving immunity through the introduction of a foreign antibody. For example, a fetus could acquire the protection of the mother’s antibodies through the placenta and newborns could acquire immunoglobulin from their mother’s milk (especially colostrums) and gain immunity. The immunoglobulin is similar to the antibody extracted from the blood of donors with a strong immunity. 

★Types of vaccination
Live-attenuated vaccines
Live-attenuated vaccines work like a weakened natural infection that does not lead to illness. The immunity achieved through a live-attenuated vaccination usually lasts longer with better results. However, on rare occasions, it might lead to cases of pseudo-natural infection. And as such, this type of vaccination comes with certain safety concerns. In addition, the vaccination is also more susceptible to influence by the introduction of other foreign antibodies. The most commonly administered live, attenuated vaccines include the B.C.G. vaccine, the oral polio vaccine, measles vaccine, rubella vaccine, MMR vaccine, chickenpox vaccine, yellow fever vaccines and so forth.
Inactivated vaccines

Since inactivated vaccines do not cause infections, the associated safety concern is relatively small. However, since the resulting immune response tends to be weaker compared to live-attenuated vaccines, booster shots are generally required to reinforce the immune response. Presently, the most commonly administered inactivated vaccines include diphtheria antigen, tetanus antigen, pertussis vaccine, DPT vaccine, Tdap vaccine, Japanese Encephalitis vaccine, IPV, flu vaccine, hepatitis A vaccine, hepatitis B vaccine, Haemophilus influenzae b, Meningococcal vaccine, pneumococcus vaccine, rabies vaccine, cholera vaccine and so forth. 

Comparison between Live-attenuated Vaccines and Inactivated Vaccines
Characteristics Live-attenuated Vaccines Injected
Dosage and related expenses Low High
No. of dosages needed Single dose for most vaccines Multiple doses
Booster shots Not required Required
Duration of the immune response Long Short
Recovery of virulence Rare None
Heat instability More sensitive Less sensitive
Storage in environs below 0℃ Can be stored at temperatures below 0℃ Affects strength


Table of intervals for various preventive inoculations
                                                                                                                                                                                                                                                                                                                    Last revised on December 17, 2008

Vaccination type Minimum interval
Inactivated vaccines ★HepB
★DTwP
★DTaP
★Tdap
★DT
★Td
★IPV
★JE
★HepA
★Hib
★Flu
★Rabies
★MPSV4
★PCV
★PPV
★HPV
★HepA-HepB
★DTaP-IPV-Hib
★DTaP-IPV-HepB-Hib
★The interval between JE vaccination and DTwP/DTaP (including DTaP-IPV-Hib and DTaP-IPV-HepB-Hib) vaccination should be no less than one month. 
★Other inactivated vaccines can be inoculated simultaneously (at different parts of the body) or inoculated at any interval.
Live-attenuated vaccines ★B.C.G.
★OPV
★MMR
★Yellow fever
★Varicella (chickenpox)
★Rota
★Similar vaccines can be inoculated at the same time; the inoculation of different types of vaccines should be given with an interval of no less than one month. For example, an active oral antitoxin vaccine can be administered jointly with other active injected antitoxin vaccine or at any interval.
★OPV and Rota vaccines should be inoculated with an interval of two weeks. 
★Those receiving intramuscular immunoglobulin treatment or HBIG should only receive their MMR or Varicella vaccines after a period of 3 months.
★Those who received blood transfusion or blood products through IV injection are recommended to wait for a period of six months before receiving their MMR or Varicella vaccines (not required for Washed RBCs).
★Those who received high dosages (≧1g/kg) of immunoglobulin treatment are recommended to wait for a period of eleven months before receiving their MMR or Varicella vaccines.
Inactivated vaccines and life-attenuated vaccines (A combination of vaccines of those listed above) ★Inoculation of cholera vaccine and yellow fever vaccine should be given separately by an interval of no less than 3 weeks.
★Other vaccines may be administered simultaneously (at different parts of the body)/or at any interval. 

★ Routine vaccinations for children

  1. B.C.G.
  2. Hepatitis B vaccine
  3. DPT vaccine
  4. Oral poliomyelitis vaccine
  5. MMR vaccine
  6. Japanese Encephalitis
  • Presently, senior citizens above 65 years of age and infants above six months and below two years may receive a free flu vaccination during the designated period of annual flu vaccination.

 

★Vaccinations not covered by the National Health Insurance presently available in Taiwan

  • DTaP (commonly known as the new type or 2nd generation combined vaccine).

The traditional DTP vaccine is produced by the inactivation of the pertussis pathogen to create killed bacterial vaccine. Specific ingredients of DTP are known to cause adverse effects, such as fever. The new type (2nd gen) DTaP improves upon the previous variation by using selected antigens of the pertussis pathogen to eliminate the harmful antigens while keeping the vaccination effective to evoke sufficient immunity. After continued research and improvement, the DTaP is proven to cause substantially fewer side effects such as fever, which the DTP is known for inducing. One may opt to be immunized with the DTaP vaccine (which is not covered by the National Health Insurance) at out of pocket expense. Some pharmaceutical companies have developed a combined vaccine featuring their DTaP vaccine and Hib vaccine into one single vaccination.

 

★Hib vaccine
The H. influenzae b virus is one of the leading causes of bacterial infection for children under the age of 5. It is known as the lead to serious complications such as otitis media, epiglottitis, pneumonia, meningitis, pericarditis, arthritis, sepsis and so forth. Young children are recommended to receive one basic dosage of the Hib vaccine at 2, 4 and 6 months of age respectively (2 basic dosages for vaccine developed by specific pharmaceutical companies) and another additional dosage at 12-15 months of age. The number of dosages needed varies depending on the age of the child receiving the vaccination. For instance, a child between the ages of 15 months and 5 years and has never received the inoculation would only require 1 dosage of vaccination. Children over the age of 5 and rarely suffer from the virus tend to have minor symptoms in the event of infection. Generally speaking, children over the age of 5 should do fine without the vaccination.
★Flu vaccine and pneumococcus vaccine
Generally speaking, physicians will advise groups at high-risk for immunodeficiency or respiratory illnesses to be immunized for the two types of diseases. The flu vaccine is only effective towards symptoms caused by the flu virus and it is not capable of preventing all types of flu. Since infants under the age of 6 months are not capable of producing adequate immunity, they are not suited for flu vaccinations. Incidentally, the 23-valent pneumococcal polysaccharide vaccine available in the domestic market is also not suited for children under the age of two. Children should be administered conjugated pneumococcal vaccines, such as the 7-valent conjugated vaccine.
★Combined vaccines (also known as many-in-one vaccines)
In light of the increasing number of different vaccinations, in an effort to reduce the number of vaccinations given to children while maintaining the effectiveness and safety of existing vaccines, the competent authority has approved the launch of combined vaccines against different diseases that can be administered in one single dosage. Examples of combined vaccines currently available in the market include the 4-in-1/5-in-1/6-in-1 vaccine for DTaP, IPV, Hib vaccine and Hep B vaccine. Some are already launched in markets around the world while others are currently undergoing vigorous clinical tests. It is very likely that more combined vaccines would be developed and approved for market launch in the near future.

 

★Reminders when receiving preventive inoculation

  • It is recommended that children receive their inoculations according to the given schedule based on the type of vaccination they are receiving in order to achieve the optimal results for the vaccination. When you bring your children for vaccination, be sure to bring their Health Handbook for verification and registration purposes. The Immunization Record Form should be safely stored and preserved for your children’s health record inspection in the future for occasions such as elementary school enrollment, leaving the country for study/work abroad or immigration.
  • For mothers who have been diagnosed to be highly infectious Hep B carriers (with an e-antigen positive/surface antigen valence ≧2560), their newborns should be injected with a dose of Hep B immunoglobulin (no later than 24 hours) after birth.
  • The DT (combined vaccine for diphtheria and tetanus) is available for children who are not suited for a pertussis vaccine (i.e. those who have shown adverse reactions after receiving the DTP vaccine) so that they may be protected against diphtheria and tetanus.
  • Patients that meet one of the following two conditions are not suitable for the administration of OPV. They are required to ask for a diagnosis statement and subscription from their physician before they may proceed to their local public health bureau to collect their IPV after completing the relevant application forms (they are required to have refrigeration equipment at their residence to store the vaccine).
  1. Patients suffering from immunodeficiency syndromes: this include patients diagnosed to be AIDS positive or suffering from primary immunodeficiency disorder, leukemia or with malignant tumors such as lymphoma and patients currently receiving medical treatment for their immunodeficiency disorders.
  1. Healthy infant and children from families with members suffering from one of the aforementioned illnesses.
  • Based on the resolution passed by the DOH"s Advisory Committee on Immunization Practices, in light of the fact that children who are receiving combined vaccinations without IPV may not have sufficient gastrointestinal tract immunity (which might mitigate the overall immunization benefits), it is recommended that children receive more than two doses of IPV or combined vaccine with IPV and keep up with various schedules for other vaccination. In addition, these children should at least be administered to 2 doses of OPV and receive the third dose of OPV when they enroll in elementary schools as required by the existing standard vaccination schedule.
  • Presently, eligible recipients of the free Hep A vaccination include: (1) children above the age of two and under the age of 12 (grade 6) born in mountain indigenous townships; (2) children above the age of two and under preschool age who born in the nine plain districts identified as Hep A prevalent areas that neighbor the indigenous mountain townships; (3) children over the age of 2 and below the age of 12 in Kinmen and Lienchiang County.
  • Children over 12 months of age born after Jan 2003 are eligible for the Varicella vaccine.

 

★Under what circumstances should one avoid vaccination?
It is a common practice for parents to delay their children’s vaccination when their children are suffering from a series of minor illnesses. Actually, with the exception of high fever or contraction of acute diseases (where the physician would advise against vaccination due to considerations of the potential reactions from the vaccination that might aggravate the children’s illnesses), it is actually alright for children to receive their vaccination if they have made it to the recovery stage of their illnesses (i.e. with only a runny nose from a flu). If parents are still concerned about the safety of their children, they should ask their physician to assess the situation. Those who experience serious adverse reactions from previous inoculation of specific vaccines or untreated TB patients should definitely refrain from receiving vaccinations. In addition, it is important to note that one should not receive live-attenuated vaccines (including OPV, measles, MMR, varicella and so forth) if he/she meets any of the following descriptions:

  • Suffering from immunodeficiency disorder or currently receiving treatment for immunodeficiency disorder;
  • Suffering from weakened immune system due to contraction of serious illnesses or malnutrition;
  • Woman in pregnancy
  • Those who have received transfusion of blood derivatives should note the following intervals before receiving their measles/MMR/varicella vaccination:
  1. One should receive the vaccination no less than 3 months after they have received intramuscular injection of immunoglobulin or Hep B immunoglobulin.
  1. One should receive the vaccination no less than 6 months after a blood transfusion.
  1. One should receive the vaccination no less than 11 months after an IV injection of plasma/platelets/high dosages of immunoglobulin.

 

★Vaccination sites and methods of administration
Generally speaking, vaccination for children should be administered to sites away from nerves and veins. As a result, the posterior side of the thigh or upper triceps tends to be the most common sites for vaccination. For infants under the age of two, the recommended vaccination site would be the posterior side of the thigh. Vaccinations for measles, varicella, Japanese Encephalitis and MMR should be given in an intradermal injection while the rest of the inactivated vaccines should be administered intramuscularly.

 

★Potential reactions after vaccination and corresponding treatments
It is possible to develop partial swelling and pain at the vaccination site after the injection and usually the reaction will go away in 2-3 days. Some physicians recommend a cold compress as a way to alleviate the discomfort. If your child develops a fever during the reasonable timeframe when he/she has recently been immunized, you may administer antipyretics that were prescribed by the physician. However, if your child is suffering from a persistent high fever or other unique symptoms, it is possible that he/she might have contracted other diseases. If so, seek medical attention immediately to identify the real cause of the illness. The following table is a list of potential reactions after vaccination and the corresponding treatments:

  • Potential reactions after vaccination and corresponding treatments
Type of vaccination received Reactions and corresponding treatments
B.C.G. ★The site may swell or develop into a hard lump and the child may experience pain. In addition, the child may develop mild-moderate fever within 2 days after the vaccination and experience general discomfort, restlessness and anxiety. These symptoms should subside and the child should recover in 2-3 days.
★If the swelling/hard lump at the site persists or ulcerates or if the child continues to run a high fever after the vaccination, seek medical attention.
Hep B ★There are no known special reactions to the vaccination.
DPT ★The site may swell or develop into a hard lump and the child may experience pain. In addition, the child may develop mild-moderate fever within 2 days after the vaccination and experience general discomfort, restlessness and anxiety. These symptoms should subside and the child should recover in 2-3 days.
★If the swelling/hard lump at the site persists or ulcerates or if the child continues to run a high fever after the vaccination, seek medical attention.
OPV ★There are no known special reactions to the vaccination.
★The child should not ingest water or food 30 minutes prior and after taking the OPV to prevent dilution of the vaccine, which would weaken the results.
Measles ★There are no known special reactions to the vaccination.
★The child should not ingest water or food 30 minutes prior and after taking the OPV to prevent dilution of the vaccine, which would weaken the results.
Chickenpox ★Approximately 5%~10% of the children who received the vaccination would develop slight fever, rash, rhinitis, cough or Koplik Spots 5-12 days after the vaccination. These symptoms may persist for 2-5 days.
MMR ★The child may experience partial swelling and discomfort; the site of vaccination and other areas may develop blisters that resemble chickenpox 5-26 days after the vaccination.
★Similar to the measles vaccination, the child may develop rash, cough, rhinitis or fever within 5-12 days after the vaccination.
Japanese Encephalitis ★There are no known special reactions to the vaccination.

★How can a child receive revaccination if he/she misses the vaccination or if the vaccination has been delayed?

  • The schedule formulated for various vaccines was specifically developed after extensive research to ensure the best results. If the child received two basic dosages of a vaccination longer than the designated interval, the effects of the vaccination would be diminished. If your child misses a vaccination, he/she does not have to revaccinate but you should contact your local health station for catch-up inoculation to make up for the schedule.

★Early vaccination

  • A child can receive early inoculation for the DTP and polio vaccine no more than 6 weeks ahead of the designated schedule.
  • A child can receive early inoculation for the measles, MMR and JE vaccination no more than 1 month ahead of the designated schedule.

★Shortening the intervals for inoculations

  • For Hep B vaccine, the 2nd dose may only be administered 4 weeks (the child may receive the 2nd dose 2-3 days earlier) after the 1st dose. The 3rd dose may be administered no more than 30 days earlier.
  • For polio and DTP vaccine, the intervals between the 1st and subsequent two doses may be no shorter than 1 month. The 4th dose may only be administered no shorter than 6 months after the 3rd dose.
  • For the JE vaccine, the 2-week interval for the first two doses may not be shortened and the interval between the 2nd and 3rd dose may be no shorter than 6 months.

★How to keep up with the designated vaccination schedule if your child has to travel frequently
If you reside with your child/children abroad periodically or travel frequently with your children, you should be aware of the differences in vaccinations and schedules in different countries. Chances are these details would vary due to different local epidemic trends and other factors. This is why you should make the effort to find out about the immunizations and schedules enforced in the country you are visiting in order to ensure your child/children could keep up with their inoculation schedules as required after returning to Taiwan. You can bring the original Immunization Record Forms for your children and bring it to your local health station and designated contract hospitals offering inoculations so that your child/children may receive their catch-up vaccinations. 
★Keeping your child’s Immunization Record Form and re-issuance
Information such as the dates of various vaccinations and institutions that administered the vaccinations should be duly recorded on the “Immunization Schedule and Record Form” handbook and properly stored for the reference of other medical staff administrating other vaccinations in the future. When your child attends kindergarten, nursery and elementary school, you will be required to submit a photocopy of the form to the school and competent health agencies for inspection. If you child is missing any vaccination, arrangements will be made for him/her to receive the catch-up vaccination. It is important to remember that the Immunization Record Form is a vital piece of documentation that will be required by foreign authorities when your child leaves the country for studies, work or immigration.
If you have misplaced your child’s Immunization Record Form, you may contact the original immunization agency for a new one to be issued. If your child has received his/her vaccinations at different locations, you should contact your local health station first; if all the previous vaccination information for your children were stored electronically, (generally speaking, if your child received a vaccination at any health station or contracted medical institutions, relevant information will be transferred to your local health station), it is possible for your local health center to provide all previous records of vaccinations that your child has received.
★Immunization Record Form inspection for new students and principles for catch-up vaccinations at elementary school for foreign students (including the American School)
In light of the fact that children of Taiwan nationals and overseas Chinese residents are enrolled in elementary schools for foreign students/American School and most reside in the country for substantially long periods of time, the Public Health Bureau has advocated implementation of full vaccination for grade 1 students at these schools along with inspection of immunization record forms and catch-up vaccination through appropriate negotiations considering that the nature of school operations. Those who have yet to receive their designated vaccinations may receive their catch-up vaccination at their schools or local health stations/contract medical institutions. Because students from different countries may have received different vaccinations with different vaccination schedules, you should refer to the following guidelines of inspection for various vaccinations and your children may receive their catch-up vaccination with your consent:

  • OPV/IPV


In recent years, many European countries and the US have given up on IPV and instead opted to mix IPV with other combined vaccinations (i.e. DTaP-IPV-Hib, DTaP-IPV-HepB or DTaP-IPV-Hib-HepB). Regardless of OPV or IPV, the officially adopted number of doses has been accepted in Taiwan. Currently, the government provides OPV in Taiwan and IPV vaccines are only kept in reserve at various local public health bureaus to cater to infant and children suffering from immunodeficiency disorders and are therefore not suited for OPV or healthy infant/children from families with members suffering from the aforementioned illness. (Pure IPVs not covered in the National Health Insurance are not available in the domestic market; IPVs only come in combined vaccinations). If parents consent to have their children receive the catch-up OPV, it would be administered according to the schedule and intervals for elementary school children. 

  • DTP/DTaP/dTpa/Td


Some countries have adopted the DTaP vaccine or combined vaccines with DTaP for the children. In the schedules adopted by some countries, apart from the three basic dosages and the additional dosage after 18 months, children between the age of 4-6 would receive one extra dosage of DTaP or dTpa (already available in the domestic market). In addition, some domestic medical institutions are also providing dTpa vaccinations for children over the age of four (not covered by the National Health Insurance). In order to prevent children (aged 4-6 whom have received their 5th dose of DTP, DTaP or dTpa) from receiving their Td vaccination after such a short interval at grade one (which might caused adverse reactions and complicate the vaccination operations), the full vaccination for grade one students aforementioned in the previous paragraph should exclude Td vaccination. For children who have yet to receive their 4th dose, they would receive their catch-up vaccination along with the rest of the grade one students and their schedule.

  • Measles/MMR


Some countries administer the 1st dose of MMR or MV to newborns when they are 12-15 month old and 2nd dose of MMR or MV when they are between the ages of 
3-6. The relevant guidelines for the assessment for catch-up vaccinations are as follows:

  • For children who have already received two doses of MMR before their enrollment in elementary schools (with an interval of more than 28 days between the two doses), they would be exempted from the inoculation during the full vaccination for grade one students.
  • For children who have already received two doses of MV (or one dose of MV and one dose MMR), they would receive one dose of MMR during the full vaccination for grade one students.
  • For children who received only one dose of MV at 9 months old or one dose of MV or MMR between 12-15 months of age, they would receive one dose of MMR during the full vaccination for grade one students.
  • For children who have never received a single dose of MV or MMR, they would receive one dose of MMR during the full vaccination for grade one students and the 2nd dose of MMR after an interval of two months.

*The guidelines for the assessment of catch-up vaccinations also apply for ordinary grade one students

  • The administration of JE vaccine and Hep B vaccine shall be implemented in accordance to the guidelines applicable for elementary school students.
     

Vaccination Schedule in Taiwan           Revised on May 19, 2009

  • The varicella vaccine is administered to children over 12 months old born after Jan 2003 (due to global shortage of the varicella vaccine, effective from January 1 2008, the schedule has been temporarily changed so that children have to be over 15 months old to receive the vaccination)
  • The 1st dose of JE vaccination would be administered to children over 15 months old and the 2nd dose would be administered after a two-week interval.
  • Presently, the free Hep A vaccination is implemented to children with household registration across the 30 mountain indigenous townships, 9 neighboring plain townships and those from Kinmen and Lienchiang Counties. The schedule requires the 1st dose to be administered when children reach the age of two and the 2nd dose administered after a 6-month interval.
  • Effective from April 2009, the schedule for the MMR vaccination has been changed so that children have to be over 12 months old to receive the first MMR dose.
  • For grade one students enrolled during the academic year of 2008, the Tdap vaccination would replace the former Td vaccination (standard) in the existing full vaccination implementation.

 


2017-09-23
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