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Hong Kong Childhood Immunisation Programme (2007)
1. What is the Hong Kong Childhood Immunisation Programme (2007)?
In Hong Kong, childhood immunisation programme has been established for many years. It includes vaccines for the prevention of tuberculosis, hepatitis B, poliomyelitis, diphtheria, tetanus, pertussis, measles, mumps and rubella. In 2006, the Scientific Committee on Vaccine Preventable Diseases of the Centre for Health Protection, Department of Health, updated the recommendations on the local childhood immunisation programme which was launched in February 2007.

The following table summarizes the original and the updated childhood immunisation schedule recommended:

Original Immunisation Recommended Updated Immunisation Recommended

Age
Immunisation
Age
Immunisation
Newborn B.C.G. Vaccine
Hepatitis B Vaccine - First Dose
Polio Type I Vaccine		 Newborn B.C.G. Vaccine
Hepatitis B Vaccine - First Dose
1 month Hepatitis B Vaccine - Second Dose 1 month Hepatitis B Vaccine - Second Dose
2-4 months DTwP Vaccine - First Dose
Polio Trivalent Vaccine - First Dose		 2 months DTaP-IPV Vaccine - First Dose
3-5 months DTwP Vaccine - Second Dose 4 months DTaP-IPV Vaccine - Second Dose
4-6 months DTwP Vaccine - Third Dose
Polio Trivalent Vaccine - Second Dose		 6 months DTaP-IPV Vaccine - Third Dose
Hepatitis B Vaccine - Third Dose
6 months Hepatitis B Vaccine - Third Dose
1 year MMR Vaccine - First Dose 1 year MMR Vaccine - First Dose
1 years DTwP Vaccine - Booster Dose
Polio Trivalent Vaccine - Booster Dose		 1 years DTaP-IPV Vaccine - Booster Dose
Primary 1 MMR Vaccine - Second Dose
DT Vaccine - Booster Dose
Polio Trivalent Vaccine - Booster Dose		 Primary 1 MMR Vaccine - Second Dose
DTaP-IPV Vaccine - Booster Dose
Primary 6 dT Vaccine - Booster Dose
Polio Trivalent Vaccine - Booster Dose		 Primary 6 dTap-IPV Vaccine - Booster Dose

Remarks:
DTwP Vaccine: Diphtheria, Tetanus & whole cell Pertussis Vaccine
DTaP-IPV Vaccine: Diphtheria, Tetanus, acellular Pertussis & Inactivated Poliovirus Vaccine
dTap-IPV Vaccine: Diphtheria, Tetanus, acellular Pertussis (reduced dose) & Inactivated Poliovirus Vaccine
DT Vaccine: Diphtheria & Tetanus Vaccine
dT Vaccine: Diphtheria & Tetanus Vaccine (reduced dose)
MMR Vaccine: Measles, Mumps & Rubella Vaccine

2. What are DTaP-IPV and dTap-IPV vaccines?
The DTaP-IPV and dTap-IPV vaccines are the 2 formulations of a combination 4-in-1 vaccine containing diphtheria and tetanus toxoids, purified proteins of Bordetella pertussis (acellular) as well as inactivated polioviruses (types I, II & III). It is used for prevention of four infectious diseases, namely, diphtheria, tetanus, pertussis (also called whooping cough) and acute poliomyelitis. DTaP-IPV vaccine should be used for children under 10 years of age. For older children aged 10 or older, dTap-IPV with a smaller dose of diphtheria and pertussis should be used.

3. What is special about DTaP-IPV?
The vaccine DTaP-IPV was introduced in 2007 in the Hong Kong Childhood Immunisation Programme to replace the combined 3-in-1 DTwP vaccine and the oral poliovirus vaccine. The vaccines have similar components for diphtheria and tetanus.

For pertussis, the vaccine contains an acellular preparation (abbreviated as aP, acellular pertussis) and, as compared with the traditional whole-cell pertussis (abbreviated wP), causes fewer side effects.

Moreover, the new vaccine contains killed poliovirus component, the IPV (stands for inactivated poliovirus vaccine). IPV is usually used in areas where acute poliomyelitis has been eliminated. The traditional OPV (oral poliovirus vaccine) contains live attenuated viruses which is effective for eliminating the acute poliomyelitis but may cause a rare but debilitating adverse effect called Vaccine Associated Paralytic Poliomyelitis (VAPP). OPV is also contraindicated among individuals, or those whose household close contacts are or have conditions such as cancer, HIV carriers or AIDS patients, immunodeficiency as well as those on long term corticosteroids.

4. Is DTaP-IPV safe? What are the side effects of DTaP-IPV?
DTaP-IPV has been introduced from 1981 onwards in various countries such as Japan, US, Canada, Australia and New Zealand. It has been found to be a safe vaccine. Severe systemic adverse effects, such as immediate anaphylaxis or anaphylactoid reactions have very rarely been reported. Some recipients may suffer from high fever (40.5oC, or 105oF, or higher), persistent crying lasting for 3 hours or longer, febrile seizures as well as hypotonic-hyporesponsive episodes (collapse or shock-like state) but these are not common. Other potential adverse effects include neurological complications such as encephalitis/encephalopathy which was reported in about 1 out of 10 million vaccine recipients.

Minor side effects, such as local pain, redness or swelling, have been reported at a frequency of 20-40% of children after the first 3 doses. Infrequently, transient benign swelling of the entire upper arm or thigh after the 4th and 5th doses of DTaP vaccines have been reported in up to 2.7% of vaccine recipients. Mild and self-limited systemic reactions such as drowsiness, fussiness and low-grade fever may also occur. Fever (38.3oC, or 101oF, or higher) is reported in 3-5% of recipients.

5. What are the side effects of the reduced dose dTap-IPV vaccines?
The most common side effects include local reactions such as pain of any intensity (75-78%) with severe pain in less than 5%, redness (21-23%) or swelling (21%) at the site of injection. Fever of 38oC (100.4oF) or higher was reported in 5% of recipients. Other nonspecific systemic events such as headache, fatigue and gastrointestinal symptoms have also been reported. Allergic reactions including anaphylactoid reactions may very rarely occur.

6. Who should not be given DTaP-IPV/dTap-IPV?
DTaP-IPV or dTap-IPV should not be given to children with history of the following:

(i) Immediate anaphylactic reaction to any of the vaccine components (e.g. neomycin, streptomycin, polymyxin B) or following previous dose of DTwP, DTaP or DTaP-IPV; or

(ii) Encephalopathy not due to another identifiable cause within 7 days following previous dose of DTaP-IPV or a pertussis-containing vaccine.

7. Is there any vaccine precaution?
It is generally advisable to consult your family doctor before vaccinating your child. In general, vaccination could be given if the child is having a mild cold on the day of vaccination but if there is a moderate or severe illness (e.g. fever) at the time the shot is scheduled, vaccination should be delayed until he/she has recovered.

Inform your doctor if your child has the following: - History of the following conditions after a previous dose of DTaP-IPV or a pertussis-containing vaccine which are precautions to the further use of DTaP-IPV:
  1. Temperature of 40.5oC ( 105oF) within 48 hours, not attributable to another identifiable cause.
  2. Collapse or shock-like state (hypotonic hyporesponsive episode) within 48 hours.
  3. Persistent crying lasting 3 hours, occurring within 48 hours.
  4. Convulsions with or without fever, occurring within 3 days.
- Known or suspected neurologic condition (e.g. progressive encephalopathy, uncontrolled epilepsy) or history of Guillain-Barre syndrome within 6 weeks following a tetanus toxoid-containing vaccine

Additional precautions to the use of dTap-IPV include history of a severe local reaction (Arthus reaction) following a prior dose of a tetanus and/or diphtheria toxoid-containing vaccine.

8. Can one previously rejected for injecting the traditional DTwP be given the DTaP-IPV vaccine?
If the child was rejected previously for DTwP, it is important to find out the reasons behind this. A thorough assessment by a medical doctor is needed before a decision on whether DTaP-IPV should be provided could be made.

9. Is it alright if my child turns up beyond the recommended vaccination dates as we will not be in Hong Kong during that period?
It is strongly advisable to follow the recommended schedule for vaccination in order to provide the best protection for children. However, if your child cannot receive the vaccine on the recommended dates, he/ she should turn up as soon as possible and receive vaccination as advised by our professional staff.

10. My child has been started on the conventional DTwP vaccine and OPV previously. Does my child need to be started on a full regimen of DTaP-IPV ?
Children who have been given DTwP and OPV can have their vaccination schedule continued with DTaP-IPV. This transition is both safe and effective.

11. My family has just immigrated to Hong Kong and I noticed the childhood immunisation programme here is different from where I am from. What should I do for my child?
In principle, one should comply with the immunisation programme of the place where one lives in order to gain optimum protection. Please take your child and all of his/her previous immunisation records for an assessment at our vaccination sites and our professional staff will arrange for catch-up vaccination as appropriate. Generally speaking, children aged below 6 years may visit any one of the Maternal and Child Health Centres of the Family Health Service (you may visit http://www.fhs.gov.hk or call the 24-hour Information Hotline at 2112 9900) and children in primary schools may contact the School Immunisation Teams (you may call 2615 8566 or 2615 8567). Students in secondary schools are advised to enrol in the Student Health Service and attend the annual appointment at Student Health Service Centres. They should bring along all previous immunisation records so that our professional staff could check the completeness of vaccination and provide catch-up as appropriate (you may visit http://www.studenthealth.gov.hk or call 23494212).

12. My 6-month-old baby will be getting the third dose of DTaP-IPV and hepatitis B vaccines soon. Can these vaccines be given together in the same doctor visit?
The two vaccines can be given at the same time provided they are administered in different sites, such as one on each thigh. If you wish, you may request to have the vaccines be given in two different visits. It is, however, undesirable to delay any one of these vaccines which would delay protection from the respective diseases for your child.

13. I was previously told that a child aged 7 years or older should not be given pertussis vaccine. However, your new schedule is recommending to provide the 4-in-1 DTaP-IPV vaccine which contains the pertussis element. Will it be harmful?
The previous whole-cell pertussis vaccine is not suitable for children 7 years or older for the possible increased side effects such as local reactions. The new preparation of pertussis vaccine, the acellular type, is much safer and can be administered in older children. For children aged 10 years or older, a preparation with reduced dose diphtheria and pertussis components can be used. These new preparations have been demonstrated to be safe in older children and provide extra protection to them by boosting the immune response to pertussis.

14. Where can I obtain further information about the childhood immunisation programme?
For any further question, parents of children from birth to 5 years old, please call the Family Health Service 24-hour Information Hotline at 2112 9900. For parents of primary school students, please contact the School Immunisation Teams of the Department of Health at Tel: 2615 8566 or 2615 8567.
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Last revison date: 2009/09/14