CATCH-UP

VACCINATION
SCHEDULE

Prepared by:
Adelaide Eleanor Shearley, RITA, JSI

November, 2020
PRESENTATION •
•
Introduction
Definition of Catch-up Vaccination
OUTLINE • Catch-up Vaccination Strategies
• Catch-up Vaccination Policy
• Catch-up Instructions for Health Workers
• Vaccination Schedules- Updated ZEPI RI Schedule
• Proposed Zim Catch-up Vaccination Schedule
• How to use the Catch-up Vaccination Schedule
• Example of Catch-up Vaccination Schedule –
South Africa
• Discussion Points
INTRODUCTION Timely vaccination is key to maintaining population immunity
against vaccine-preventable diseases (VPDs), ensuring
populations are fully protected against life-threatening illnesses
as early as possible, and preventing large outbreaks of VPDs.
However, scheduled vaccinations may be missed for a number
of context-specific reasons (e.g. difficulty accessing health
services and other health system barriers, health worker
practices, stock outs, beliefs held by caregivers and community
members about vaccination, etc.)

No one should miss out on the right to the protection that

vaccines offer, simply because they are unable to access
services in time.
CATCH-UP Refers to the action of vaccinating an individual who, for whatever
reason, is missing/has not received doses of vaccines for which

VACCINATION they are eligible, per the national immunization schedule.

Catch-up vaccination can be conducted through regular routine

immunization service delivery (fixed, outreach, mobile, school-
based), periodic intensification of routine immunization (PIRI)
activities, or through innovative local strategies that ensure
individuals have the opportunity to receive routine immunizations
for which they are overdue and eligible.

A catch-up vaccination strategy (which includes a clearly defined

catch-up vaccination policy and catch-up schedule) is an essential
part of a well-functioning national immunization programme and
should be implemented on a continuous basis.
 CATCH-UP VACCINATION STRATEGIES
Essential and ongoing part of
immunization programme
! Establish catch-up vaccination policy & schedule
! Review vaccination history at every health visit
(immunization and other); refer or provide catch-
up doses (remember MOV?)
! Ensure robust new-born and defaulter tracking
! Conduct periodic intensification of routine
immunization (PIRI) activities that screen for
eligibility and record doses
! Implement school and day-care vaccination
Following extended interruption to
immunization services
! Intensify catch-up vaccination efforts through RI
delivery: e.g. mass call backs, intensified defaulter
tracking, expanded outreach, etc.
! Conduct targeted and selective multi-antigen
vaccination campaigns (PIRI) that screen for
eligibility and record doses
! If large numbers unvaccinated, conduct
supplementary immunization activities (SIAs) for
single or multiple antigens, irrespective of
individual vaccination status
 Engage National Immunization Technical
ESTABLISH A CATCH- Advisory Groups (NITAGs) or
UP VACCINATION other advisory groups to review policies that
create barriers to catch-
POLICY up vaccination, revise if needed
Age restrictions
Multi-dose vial policies (minimum number of
children to open vial)
Limitations on where or when vaccination
takes place and which cadres can vaccinate
Develop catch-up vaccination schedule and
guidance (if not in place)
Plan for rapid dissemination of revised policies
to all levels
Consider interim guidance (e.g. temporary
lifting age-cutoffs) if policy
revision time too lengthy
CATCH-UP At every health contact, review vaccination history (home-based
record or immunization register) to determine whether any
INSTRUCTIONS FOR vaccine doses are missing or due. If there is no evidence or
confirmation of vaccination history, assume the person has not
HEALTH WORKERS been vaccinated.

Do not blame the caregiver or individual if they are missing any

missing doses.

Always respect the minimum age of eligibility for each vaccine in

the schedule.

For most vaccines, it is better to vaccinate late than never. Refer to

the national catch-up vaccination policy and catch-up schedule for
any exceptions to this general principle.

If more than one vaccine is due (or overdue) provide one dose of
each vaccine at that visit. Do not unnecessarily defer giving vaccines
that are due or overdue
 It is safe to give multiple injections at the same time.
CATCH-UP Explain that this will allow protection as soon as possible,
INSTRUCTIONS FOR reduce the number of return visits needed, and minimize the
risk of defaulting.
HEALTH WORKERS If concerns remain, a caregiver or individual should not be
pressured to receive all catch-up doses during one visit.
Work together with the individual to agree when to return
to receive remaining doses at earliest opportunity.

Observe minimum intervals permissible between doses – for

most vaccines in the primary series, this is 4 weeks (1
month) between doses. For HPV, the minimum interval is 5
months.

Intervals recommended in the national immunization

schedule may be reduced if a previous dose was delayed, as
long as the minimum interval is respected. (Remember
Invalid doses?)
CATCH-UP If previous vaccination history shows that some but
not all doses were given in a series, do not restart
INSTRUCTIONS FOR the series, regardless of the time that has passed
between doses.
HEALTH WORKERS
Continue with the next dose required in the series.

Record dose(s) according to the dose number in the

series they are due and actually receive (regardless of
age).

Schedule subsequent visits, following the appropriate

minimum interval, and communicate this schedule
with the individual so they know when to
return.(record due date on the CHC)

Once the individual is back on track/caught up to

date, revert to using the national immunization
schedule until they are fully vaccinated.
VACCINATION
SCHEDULE
A vaccination schedule is a series of
vaccinations, including the timing of all doses,
which may be either recommended or
compulsory, depending on the country of
residence.
 Zimbabwe Routine Immunisation Schedule
Name of Vaccine Age of administration Route Site Dosage

At birth or first contact before one year Intradermal Insertion of right deltoid muscle 0.05 ml
BCG
bOPV1 6 weeks Oral Oral 2-3 drops
DTP-HepB-Hib1(Pentavalent) 6 weeks Intramuscular Right antero-lateral aspect of mid-thigh 0.5 ml

PCV 13: 1 6 weeks Intramuscular Left antero-lateral aspect of mid-thigh 0.5 ml

Rotavirus 1 6 weeks Oral Oral 1.5 ml

bOPV2 10 weeks Oral Oral 2-3 drops
DTP-HepB-Hib2 (Pentavalent) 10 weeks Intramuscular Right antero lateral aspect of mid-thigh 0.5 ml

PCV 13: 2 10 weeks Intramuscular Left antero lateral aspect of mid-thigh 0.5 ml

Rotavirus 2 10 weeks Oral Oral 1.5 ml

bOPV3 14 weeks Oral Oral 2-3 drops
IPV 1 14 weeks Intramuscular Left antero lateral 2-3cm from site of PCV 0.5 ml

DTP-HepB-Hib3 (Pentavalent3) 14 weeks Intramuscular Right antero lateral aspect of mid-thigh 0.5 ml

PCV 13: 3 14 weeks Intramuscular Left antero lateral aspect of mid-thigh 0.5 ml

Measles Rubella 1 9 months Subcutaneous Left deltoid muscle 0.5 ml

TCV 9 months Intramuscular Left antero lateral aspect of mid-thigh 0.5ml

IPV 2 9 months intramuscular Left antero lateral 2-3 cm from site of PCV 0.5 ml
DTP Booster 18 months Intramuscular Left antero lateral aspect of mid-thigh 0.5 ml

OPV Booster 18 months Oral Oral 2-3 drops

Measles Rubella 2 18 months Subcutaneous Left deltoid muscle 0.5 ml
HPV 1 Girls in Grade 5 and 10 years out of Intramuscular Right deltoid muscle 0.5 ml
school
HPV 2 6 – 15 months after 1st dose Intramuscular Right deltoid muscle 0.5 ml
Td 5 years Intramuscular Left deltoid muscle 0.5ml
Td 10 years Intramuscular Left deltoid muscle 0.5ml
 Proposed Zimbabwe Catch-up Immunisation
Schedule for children who have not started OR are more
than 1 month behind
 Standard Dose 1 Timing of catch-up doses
Vaccine Recommended Age at presentation for catch- (Unless already
Age for dose(s) up immunisation received
as per normal Dose 2 Dose 3 Dose 4
schedule)
BCG Birth <12 months & no Give now A
Bacille Calmette-Guérin contraindications -
>12 months Do not give
bOPV Dose 1: 6 weeks <6 months Give now A minimum of 4 weeks after dose 1 (if A minimum of 4
Oral polio vaccine Dose 2: 10 weeks still <6 months of age) weeks after dose 2 -
Dose 3: 14 weeks (if still <6 months
of age -
>6 months ??Do not give

DTP-HepB-Hib <2 years Give now A minimum of 4 A minimum of 4 weeks after dose 2 At or after 18
Diphtheria, Tetanus, pertussis, Dose 1:6 weeks weeks after dose 1 months of age.
Hepatitis B, Haemophilus Dose 2: 10 weeks (4 weeks after dose
influenzae type b vaccine Dose 3: 14 weeks 3)
Dose 4: 18 2- <10 years Give Td A minimum of 4 A minimum of 4 weeks after dose 2. (If A minimum of 12
months weeks after dose 1. still <6 years of age) months after dose
(If still <6 years of 3. (If still <6 years
age) of age)

RV Dose 1:6 weeks 20 weeks Give now A minimum of 4 - -

Rotavirus vaccine Dose 2: 10 weeks weeks after dose 1.

20-24 weeks Give now A minimum of 4 weeks after dose 1.-

>24 weeks Give now -
PCV Dose 1:6 weeks <6 months Give now A minimum of 4 At 14 weeks of age -
Pneumococcal conjugate Dose 2: 10 weeks weeks after dose 1.
vaccine Dose 3: 14 weeks
6-11 months Give now A minimum of 4 After 1 year of age (8 weeks after dose 2) -
weeks after dose 1.

12 months- <6 months Give now No further doses unless specific long-term health condition is present , in which
case dose 2 (at least 4 weeks after dose 1) and dose 3 (8 weeks after dose 2)
 Dose 1: 14 <6 months Give now A minimum of 4
weeks weeks after dose
IPV Dose 2: 9 1.
months
6-11 months Give now A minimum of 4
weeks after dose
1.

Measles Dose 1:9 <11 months Give now At 18 months of - -

months age
Dose 2: 18 >11 months Give now A minimum of 4 - -
months weeks after dose
1
TCV Dose 1: 9 <11 months Give now
months
>11 months Give now
Td Dose 1: 5-6 >6 years Give now A minimum of - -
Tetanus, Reduced strength years 5years after
Dose 2: 10 dose 1.
years >10-15 years Give now A minimum of 5 -
years after dose
1.
HPV Dose 1: Girls in >10 years Give now 6-15 months
Grade 5 and 10 after dose 1
years girls out
of school 11 -15 years Give now 6-15 months
Dose 2: Grade 6 after dose 1
and 11 years
girls out of
school
How to Use the First check if child has received any
Proposed Catch-up vaccines documented in the Child Health
Card
Schedule If not documented assume that vaccine
has not been given.
Always continue from the last dose the
child has received.
Child may be too old to receive some
vaccines.
Use the standard intervals and ages
recommended in the National
Immunisation Programme schedule once
the child is up to date.
 ! If child presents after 6 months of age and has not received any
Discussion Points vaccination, it is recommended to give all vaccines according to the
schedule.
! Contraindications to BCG vaccination include confirmed HIV infection,
neonates or infants who are receiving tuberculosis prevention therapy
(TPT) or anti-tuberculosis (TB) treatment, primary immunodeficiency
diseases or immunosuppressive therapy. Administer BCG vaccine 2 weeks
after completing TPT or anti-TB treatment if no other contraindications.
! PCV over 12 months but below 6 months dose 1 only is given and No
further doses unless specific long-term health condition is present , in
which case dose 2 (at least 4 weeks after dose 1) and dose 3 (8 weeks
after dose 2) Specific long-term health conditions including: - chronic lung
diseases, chronic heart disease, diabetes mellitus, cerebrospinal fluid leak,
cochlear implant, haemoglobinopathy, asplenia, congenital or acquired
immunodeficiency, chronic renal failure, nephrotic syndrome, chronic liver
NOTE disease. Obtain expert advice for specific recommendations for different
Sites for administration : -
conditions
Left Arm MR, TCV (FOR OLDER CHILDREN) & Td ! South Africa Policy says: - Do not administer measles vaccine (MeasBio*)
Left thigh TCV, IPV& PCV (2-3 cm from each other)
at the same time as other vaccines- if missed, give first on its own and
allow an interval of 4 weeks before next dose of any vaccine. Zimbabwe
Right Arm BCG & HPV(girls) Policy says it is safe to give measles at the same time with other antigens
Right Thigh PENTA
THANK YOU FOR YOUR ATTENTION