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Vaccines

Polio

Polio is caused by a virus which is found in the stool and saliva of infected individuals and is easily spread through hands and objects. Polio can cause paralysis, meningitis, lifelong disability and sometimes death. Polio is now a rare disease because of widespread immunisation but it still occurs in outbreaks in some parts of the world. in Malta the disease has been declared as eradicated by the WHO. However, since it is not eradicated from all parts of the world, it is important to vaccinate against polio so that it will not reappear in Malta. Polio vaccination is obligatory by law. 

Polio Vaccine

Polio vaccine is given in combination with other vaccines in one injection as part of the National Immunisation Schedule. First dose may be given from 6 weeks of age, followed by another two doses spaced 4 weeks apart. A booster dose is given at 18 months of age, followed by another booster dose at 14 - 16 years to complete a 5-dose course offering long-term protection. Polio vaccine is offered free of charge through the National Immunisation Service as part of the National Immunisation Schedule.


Diphtheria
 
Diphtheria is caused by a bacteria which is spread by coughing. The disease affects the throat and airways of an infected person. Nowadays, diphtheria has become a very rare disease due to widespread immunisation but it is still seen in some parts of the world. It can lead to very serious complications including multiple organ failure and muscle paralysis. In Malta, vaccination against diphtheria is obligatory by law. 

Diphtheria Vaccine

Diphtheria vaccine is given in combination with other vaccines in one injection. It is a killed vaccine and may be given from 6 weeks of age. The course consists of 3 doses, given 4 weeks apart. A booster is currently given at 18 months and again at 14 - 16 years. Diphtheria vaccine is offered free of charge through the National Immunisation Service as part of the National Immunisation Schedule. 


Tetanus
 
Tetanus is caused by a bacteria which is found in soil and animal manure. The disease is known as “lockjaw” and can occur if the tetanus bacteria enters a deep wound or open cut in the skin. It starts with severe spasms of the jaw muscles but later spreads to the rest of the body and can cause death. In Malta, vaccination against tetanus is obligatory by law. 

Tetanus Vaccine

Tetanus vaccine is given in combination with other vaccines in one injection. It contains the toxin of the bacteria and the course may be started at 6 weeks of age. The primary course consists of 3 doses given 4 weeks apart. A booster dose is given at 18 months and again at 14 - 16 years in order to offer long term protection. Tetanus vaccine is also given to workers in certain high-risk occupations. Tetanus vaccine is offered free of charge through the National Immunisation Service as part of the National Immunisation Schedule. Tetanus vaccine given as part of treatment following an injury, may be found on its own or in combination with diphtheria. 


Pertussis

Pertussis is also known as “whooping cough”. It is caused by a bacteria which is spread by coughing. The disease causes severe bouts of coughing and can lead to pneumonia, chronic lung problems, seizures, brain damage, and sometimes death. The complications are more common in infants and young children. 

Pertussis Vaccine

The pertussis vaccine is given in combination with other vaccines in one injection. It may be given from 6 weeks of age and the course consists of 3 doses given 4 weeks apart. A booster dose is given at 18 months. Pertussis vaccine is offered free of charge through the National Immunisation Service as part of the National Immunisation Schedule. Pertussis vaccine may also be found in combination with diphtheria, tetanus and polio and is licensed for use in persons from 10 years onwards. This preparation is not part of the National Immunisation Schedule. 


Haemophilus influenzae type b (Hib)

Hib is a bacteria which is spread by droplet infection through coughing or sneezing. Many people harbour this bacteria in their throat but are not affected by it. However, they can still transmit the illness to infants and children. Hib can cause meningitis that may lead to hearing loss, brain damage and death, pneumonia, septicaemia, sudden and complete obstruction of the airways leading to death (epiglottitis) and severe middle ear infections.

Hib Vaccine

The Hib vaccine is given in combination with other vaccines in one injection. It may be started at 6 weeks of age and the course consists of 3 doses given 4 weeks apart. A booster dose is given at 18 months. Hib vaccine is offered free of charge through the National Immunisation Service as part of the National Immunisation Schedule. The Hib vaccine is also found as a preparation on its own and is used for specific conditions requiruung repeat doses of Hib vaccine. 


Hepatitis B

Hepatitis B is caused by a virus which is spread through contact with infected blood or other body fluids. A mother who has the hepatitis B virus can pass it on to her baby during pregnancy and childbirth. The hepatitis B virus affects the liver, and may lead to liver failure and death. Sometimes, people infected with the virus show no symptoms of disease, but they are still at risk of developing serious liver problems and liver cancer.

Hepatitis B Vaccine 

The vaccine contains the inactivated form of the hepatitis B virus which is grown artificially on yeast cells. On the National Immunisation Schedule it is started at 12 months, with a second dose 1 month later and a third dose given 6 months from the first dose.
Some combination vaccines given to infants also contain the Hepatitis B antigen (6 in 1 vaccine). In this case the course would start at 6 weeks of age and consist of 3 doses given one month apart with a booster dose at 18 months.
The Hepatitis B vaccine is offered free of charge to those born after 1987 through the National Immunisation Service as part of the National Immunisation Schedule. The Hepatitis B vaccine may also be found in combination with the Hepatitis A vaccine and the schedule for this vaccine is the same as for Hepatitis B vaccine.

 Hepatitis A

 Hepatitis A is a highly contagious liver infection caused by the hepatitis A virus. It is transmitted from contaminated food or water or from close contact with a person or object that is infected. Mild cases of hepatitis A do not require treatment and most people who are infected recover completely with no permanent liver damage. Practicing good hygiene, including washing hands frequently, is one of the best ways to protect against hepatitis A. Vaccines are available for people most at risk.

Hepatitis A Vaccine

The Hepatitis A vaccine may be used from 1 year onwards and is given as a single dose with a booster dose given after 6 months to a year. Two dosage forms are available, the junior dose is used up to 18 years of age and the adult dose is for persons over 18 years. Hepatitis A vaccine is also found iin combination with the Hepatitis B antigen. In this case the schedule used is the same as that for Hepatitis B vaccine.

Measles
 
Measles is caused by a virus and is spread by sneezing and coughing. It is very infectious and unprotected persons are very likely to become ill if exposed to the illness. Measles starts with symptoms of a cold, which then progresses to a high fever, cough, watery eyes and a red rash on the face and body. Measles infection can lead to severe complications and death through pneumonia, encephalitis (inflammation of the brain) and a rare disabling brain illness that can occur even after recovery from the measles infection. 

Measles Vaccine

The measles vaccine is found in combination with the mumps and rubella vaccines. The vaccine is known as the MMR vaccine. The course consists of 2 doses given at least 4 weeks apart. On the National Immunisation Schedule the first dose is given at 13 months and the second when the child is over 3 years old. If the vaccine is given to a previously unvaccinated adult, the schedule is 2 doses, at least 8 weeks apart. Pregnancy should be avoided for at least 4 weeks following the last dose. The vaccine is offered free of charge to those born after 1982 through the National Immunisation Service as part of the National Immunisation Schedule. 

Mumps
 
Mumps is caused by a virus and is spread by sneezing and coughing. It causes fever, headaches and a painful swelling of the parotid glands which are found just below the ears. Mumps can lead to serious complications including hearing loss, meningitis (inflammation of the lining of the brain), cardiomyopathy (inflammation of the heart muscle), kidney failure, joint inflammation, and inflammation of the testes or ovaries that can lead to infertility. 

Mumps Vaccine

The mumps vaccine is found in combination with the measles and rubella vaccines. The vaccine is known as the MMR vaccine. The course consists of 2 doses given at least 4 weeks apart. On the National Immunisation Schedule the first dose is given at 13 months and the second when the child is over 3 years old.. If the vaccine is given to a previously unvaccinated adult, the schedule is 2 doses, at least 8 weeks apart. Pregnancy should be avoided for at least 4 weeks following the last dose. The vaccine is offered free of charge to those born after 1982 through the National Immunisation Service as part of the National Immunisation Schedule.

Rubella

 
Rubella is caused by a virus and is commonly known as “German Measles”. It is spread by sneezing and coughing and causes a rash, sore throat and swollen glands in the neck. Although rubella is a mild disease in children and rarely causes complications, it can be very dangerous in adults and can lead to very serious consequences to the foetus of a pregnant mother. If the mother catches German measles during pregnancy, the child can be born with hearing loss, blindness, brain damage and heart problems. 

Rubella Vaccine

The rubella vaccine is found in combination with the mumps and measles vaccines. The vaccine is known as the MMR vaccine. The course consists of 2 doses given at least 4 weeks apart. On the National Immunisation Schedule the first dose is given at 13 months and the second when the child is over 3 years old.If the vaccine is given to a previously unvaccinated adult, the schedule is 2 doses, at least 8 weeks apart. Pregnancy should be avoided for at least 4 weeks following the last dose. The vaccine is offered free of charge to those born after 1982 through the National Immunisation Service as part of the National Immunisation Schedule. 


Pneumococcal Disease
 
Pneumococcal disease is caused by a bacterium which is commonly found in the nose and throat of healthy individuals. This bacterium spreads by sneezing or coughing and can cause serious illness in some, especially infants and young children under 5 years. Pneumococcal disease can cause meningitis leading to hearing loss, brain damage or death, septicaemia (blood infection), pneumonia (lung infection) and middle ear infections. 

Pneumococcal Vaccine

There are currently two brands of conjugate pneumococcal vaccine on the market which can be used in infants and children (Synflorix​TM  and Prevenar 13TM )​. The vaccine may be given to children from 6 weeks of age, with a second dose at 4 months and a booster dose during the second year of life. If the course is started later, children under 1 year of age should still receive 2 doses before 1 year and a third dose during the second year of life. If started after the child is 1 year old, the course consists of 1 dose followed by another dose at least 2 months later. Children starting the vaccine between 2 and 5 years of age may receive just 1 dose. This vaccine is not on the National Immunisation Schedule.

Varicella (Chicken Pox)
 
Chicken pox is caused by a virus which is highly contagious. It causes widespread itchy blisters all over the body. The illness is spread very easily by sneezing, coughing or contact with the chicken pox blisters. Most cases of chicken pox are mild but blisters may lead to ugly skin scars. Sometimes the illness may lead to complications such as pneumonia (lung infection) and encephalitis (brain infection). If a pregnant mother gets chicken pox, the baby may be born with skin scarring and/or limb deformities. 

Varicella Vaccine

The chicken pox (Varicella) vaccine is a live vaccine. It is available on its own as a single component vaccine or in combination with measles, mumps and rubella (MMRV). Vaccination may be started in children over the age of one and a 2-dose schedule is recommended at least 8 weeks apart. The varicella vaccine is also recommended in adults and adolescents who have not had chicken-pox before. The same dose schedule applies. Pregnancy should be avoided for at least 1 month following the second dose of vaccine. Varicella vaccine is not on the National Immunisation Schedule. 

Rotavirus
 
Rotavirus is a virus that can cause severe diarrhoea and vomiting in infants. This may lead to dehydration and hospitalisation. It is spread from the stool of infected children, from hand to mouth and by touching contaminated surfaces or objects. 

Rotavirus Vaccine

The rotavirus vaccine is live and is found in the form of drops given by mouth. The course consists of 2 or 3 doses (depending on the brand) given at 6 weeks,  10 weeks and 14 weeks (if applicable) of age. The rotavirus vaccine is not on the National Immunisation Schedule. 

Human Papilloma Virus (HPV)
 
Human Papilloma Virus (HPV) is the most common sexually transmitted infection. Most people who have HPV, do not know that they are infected. Some types of HPV can cause genital warts and other types can cause cervical cancer. HPV is spread through sex and genital contact even when the infected partner has no signs or symptoms. Very rarely a woman with genital HPV can pass the virus to her baby during childbirth and this can cause the formation of warts in the baby’s respiratory tract. 

HPV Vaccine 

Two vaccine brands are available to protect females against the types of HPV that cause most cervical cancers. One of these vaccines also protects against most genital warts and is also licensed for use in boys. Both vaccines are recommended from the age of 9 years and for older females who did not get any or all of the shots when they were younger. The vaccine has been shown to work better when given at a young age and before becoming sexually active, compared to when it is given in adults. It is recommended that the same vaccine brand is used for all the schedule, whenever possible.
 
It is important to note that the HPV vaccine does not completely protect against all HPV infection and it is not a treatment for HPV. Smear tests should still be carried out even in sexually active vaccinated women.
 
Between the ages of 9 and 14, the vaccine is given in 2 doses spaced 6 months apart. After the age of 14, the course is of 3 doses, with the first 2 doses given 1 month apart and the third dose given 5 months after the second dose. It is not yet known whether the vaccine gives lifelong protection.

HPV vaccine is part of the National Immunisation Schedule and is given free of charge to girls born from 2000 onwards on reaching their 12th birthday.

Meningitis

 
Meningococcal  disease is a serious bacterial illness and is caused by meningococcus bacteria. Meningitis is an infection of the fluid surrounding the brain and spinal cord. Meningococcal disease also causes blood infections. Anyone can get meningococcal disease. But it is most common in infants less than one year of age and in teenagers. Meningococcal infections can be treated with drugs such as penicillin. Still, about 1 out of every ten people who get the disease dies from it, and many others are affected for life. A number of vaccines are currently available that offer protection against serotypes A, B, C, W and Y.  

Meningitis C Vaccine

This vaccine protects only against the Group C meningococcus and offers no protection against the other Group types. The vaccine is given to infants in 3 doses at 2 and 4 months of age with a booster dose at 12 months. Adults and children over 1 year of age only need one injection. This vaccine is most commonly used in infants. 

Meningitis ACWY Vaccine

This is a conjugate polysaccharide combination vaccine which offers protection against meningococcal serotypes A, C, W and Y. It can be given to children and adults from 6 weeks onwards. In infants, the schedule is at 6 weeks, 4 and 12 months.  Over 1 year of age a single dose is sufficient. 

Meningitis B Vaccine

There are currrently rwo types of vaccine which prevent meningococcal disease due to meningococcus type B. One (Bexsero​TM) can be used from 2 months onwards using the following schedule:

Age at first dose

Primary Immunisation

Intervals between Primary Doses

Booster

Infants, 2 months to 5 months 

Three doses each of 0.5 ml

Not less than 1 month

Yes, one dose between 12 and 15 months of age with an interval of at least 6 months between the primary series and booster dose 

Infants, 3 months to 5 months

Two doses each of 0.5 ml

Not less than 2 months

Infants, 6 months to 11 months

Two doses each of 0.5 ml

Not less than 2 months

Yes, one dose in the second year of life with an interval of at least 2 months between the primary series and booster dose 

Children, 12 months to 23 months

Two doses each of 0.5 ml

Not less than 2 months

Yes, one dose with an interval of 12 months to 23 months between the primary series and booster dose 

Children, 2 years to 10 years

Two doses each of 0.5 ml

Not less than 1 month

Not necessary in normal cases.

 
 The other preparation (TrumenbaTM) is used from 10 years onwards and is given in 2 doses administered at a 6-month interval. A booster dose is not necessary in normal cases.

Seasonal Influenza
Influenza is caused by a virus which tends to change every season. That is the reason why influenza vaccine needs to be taken every year, a few weeks before the expected influenza season. Influenza is a very contagious illness which is spread by sneezing, coughing and by touching infected surfaces and transferring the hands to the eyes, nose and mouth.
 
Although influenza is a self-limiting illness and most people recover within a week, it can cause serious complications in the elderly, the very young and in
people suffering from other chronic illnesses. It must be distinguished from the common cold by the symptoms. Influenza typically presents with high fever, muscle pains, headaches, sore throat, a dry cough, loss of appetite and extreme tiredness. Young children may present with fever, vomiting and diarrhoea.
 
Influenza Vaccine
 
Influenza vaccine gives excellent protection against seasonal flu. The vaccine is made from a mixture of strains of influenza viruses that are expected in the coming winter. Each year, the expected virus strains are slightly different so a new vaccine has to be made every year. Vaccination is recommended in October or November and the vaccine can be given to children over 6 months of age.
 
The vaccine is offered free of charge through the National Immunisation Service where priority is given to the following persons:
 
  • All persons over 55 years of age
  • Persons suffering from diabetes
  • Persons with chronic disease of the lungs, liver, kidneys
  • Persons who are on long-term systemic steroid medication
  • Persons who are having chemotherapy or radiotherapy
  • Persons with HIV/AIDS​
 
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