This is our recommended schedule for immunizing children. There is room for variation in the exact timing. In general, the interval between doses shouldn't be shortened, but it can be lengthened somewhat without compromising immunity. If your child hasn't followed this exact schedule, any of our nurses or doctors can help you plan how to complete it.
Schedule
| Age | Vaccines |
|---|---|
| Birth | Hepatitis B 1 |
| 1 month | Hepatitis B 2 |
| 2 months | DTaP 1; HIB 1; PCV 1; IPV 1; RV 1 |
| 4 months | DTaP 2; HIB 2; PCV 2; IPV 2; RV 2 |
| 6 months | DTaP 3; HIB 3; PCV 3; IPV 3; Hepatitis B 3 |
| 6 months onwards | Consider annual influenza vaccination |
| 12 months | MMR 1; Varicella 1; Hepatitis A 1 |
| 15 months | DTaP 4; HIB 4; PCV 4; Typhoid conjugate vaccine (TCV) |
| 12–24 months | Hepatitis A 2 (6–12 months after the first dose). Japanese encephalitis vaccine (JEEV or Chengdu) |
| 24 months onwards | TCV if not given earlier; meningococcal vaccine (MCV4 / Menactra). Consider rabies pre-immunization |
| 4–5 years (pre-school) | DTaP 5; IPV 4; MMR 2; Varicella 2 |
| Adolescents (11–12 years) | HPV (2, 4 or 9), as a 2–3 dose series; Tdap, then Td every 10 years |
| 5 years upwards | COVID-19 vaccines (Moderna, Pfizer, Novavax), 2–3 primary doses — currently not available in Nepal |
Abbreviations: DTaP — diphtheria, tetanus and acellular pertussis · HIB — Haemophilus influenzae type B · IPV — inactivated polio vaccine · PCV — pneumococcal conjugate vaccine · RV — rotavirus vaccine · MMR — measles, mumps and rubella · Varicella — chickenpox · Tdap — tetanus, diphtheria and acellular pertussis · TCV — typhoid conjugate vaccine · HPV — human papillomavirus
About each vaccine
DTaP. The three vaccines against diphtheria, tetanus and pertussis (whooping cough), given together, produce a better protective response than each given separately. Acellular pertussis causes fewer reactions than the original DTP. Please tell the nurse if your child has had a bad reaction to this vaccine.
Hepatitis A. An inactivated vaccine given as two injections, with long-lasting immunity. No boosters are recommended after the primary series.
Hepatitis B. Given at birth, one month and six months, but can be started at any time. A combined hepatitis B and DTaP vaccine (Hexaxim, Sanofi) is available, given at 2, 4 and 6 months. Hepatitis B is a potentially serious form of hepatitis that can be passed from mother to child, or through non-sterile needles or sexual activity. We recommend it for all children.
HIB. Haemophilus influenzae is a bacterium that can cause serious infections such as meningitis and epiglottitis in children. Routine immunization has drastically reduced these diseases. If your child didn't receive it on schedule, talk to a nurse about catching up.
Influenza. Recommended every year for everyone over 6 months — particularly children up to 5, who are at high risk of complications. Children from 6 months to 8 years need two doses if they're having the flu vaccine for the first time.
Japanese encephalitis. A viral brain infection found in the Terai and in the Kathmandu valley, with the highest risk from late July to early October. At CIWEC we carry the inactivated Vero cell vaccine (JEEV). The live SA14-14-2 vaccine made by the Chengdu Institute is now available only through the government program, in multi-dose vials.
MMR. Measles, mumps and rubella are viral illnesses, each of which can cause serious complications; rubella in a pregnant woman can cause serious birth defects. The vaccine uses live viruses altered so they produce immunity without causing disease. Two doses give long-lasting immunity.
Meningococcal meningitis. A very safe, highly effective vaccine against the bacteria that cause meningitis or sepsis. A single shot, repeated every three years in children under 7, then every 5 years if the risk continues. We stock the quadrivalent vaccine Menactra (A, C, Y and W135).
Polio. We stock the inactivated polio vaccine for childhood immunization; we don't stock the oral vaccine. Nepal has had no cases of polio since 2011.
Pneumococcal conjugate vaccine (Prevnar 13). Protects infants and children against pneumococcal infections such as pneumonia and meningitis. A few children have mild pain and redness at the injection site, or a low-grade fever. PCV15 and PCV20 aren't available in Nepal.
Rabies. Rabies vaccine can be given before a bite from a possibly rabid animal (pre-exposure immunization), which greatly simplifies treatment afterwards. We feel all children should be pre-immunized against rabies, because they may not always tell you when they've been around stray animals. The series is two injections on days 0 and 7, with a booster between 3 weeks and 3 years later. We recommend starting at around 24–36 months.
Rotavirus. Rotavirus causes severe gastroenteritis in children. The vaccine is a live oral vaccine given at 2 and 4 months (Rotarix), with a third dose at 6 months for RotaTeq, Rotavac or Rotasiil. The first dose can be given as early as 6 weeks; the last must be given by 8 months. Large trials of the newer vaccines have shown no increased risk of intussusception, a kind of bowel blockage seen with earlier rotavirus vaccines.
Typhoid. Typhoid fever, caused by Salmonella Typhi and Paratyphi, is highly endemic in Nepal and caught from contaminated food or water. The typhoid conjugate vaccine (TCV) can be given from 6 months and provides long-term protection. It doesn't protect against paratyphoid.
Varicella (chickenpox). Usually mild and short-lived in small children, but it can be severe in adolescents, adults and pregnant women. The live vaccine is given with MMR: the first dose at 12–15 months and the second at 4–6 years. Side effects are few and mild — redness or pain at the injection site, a low-grade fever or a rash.
HPV (2, 4 or 9). Recommended for girls and boys aged 11–12, as two doses at 0 and 6–12 months. It can be started as early as 9 and given up to age 45; after age 15, three doses are needed (0, 2 and 6–12 months). It protects against the HPV types that can cause cervical, penile, vaginal and oropharyngeal cancers.
About BCG. In Nepal, BCG is given to newborns because TB is common here. It protects against severe forms of TB such as TB meningitis and miliary TB. BCG turns the TB skin test positive, though this fades over the years. TB is very uncommon among expatriates in Nepal despite its prevalence in the country. We don't offer BCG at CIWEC.