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Vaccinations

Vaccinations are generally confusing; in China even more so, because every one you meet seems to be following a different schedule for their child. Add to that the additional vaccinations that are recommended specifically for China, and it's a total minefield!

If you are not planning on staying in China for a long time, most doctors recommend you follow your own country's vaccination schedule and, depending on your situation, add special vaccinations recommended for China.

Every time you go home, make sure you are up-to-date with your child's vaccinations and booster shots, as you might not be able to get all of them here in China.

Below are the vaccinations you will need to consider for your child, in accordance with your doctor's advice:

I. Standard Vaccinations

The standard vaccinations recommended by the American Academy of Pediatrics (AAP) for children 0 to 6 years include:

5-in-1 vaccine: Diptheria, Tetanus, Perbussis (DTaP), Polio and Haemophlus (Hib)
Pneumococcal vaccines
Rotavirus vaccines
Varicella (Chicken Pox) vaccine
Measles, mumps, and rubella (MMR) vaccine
Hepatitis A (Hep A) vaccine
Hepatitis B (Hep B) vaccine
Meningococcal Conjugate vaccines, quadrivalent (MCV4)

The CDC Vaccination Schedule can be downloaded here.

Optional vaccination:

Influenza (Flu Shot): The flu vaccine is recommended for infants and children starting at 6 months old, especially if they have conditions like asthma. The inactivated (TIV) should be used and the vaccine is contraindicated in those with severe egg allergies or previous severe reactions to the flu vaccine.

II. Additional Vaccinations Recommended for China

For residents in China, these are some of the vaccinations that are additionally recommended. As these are not standard vaccinations it is best to discuss the risks and benefits with your pediatrician:

BCG vaccine: This is a vaccine that is given to newborns. The vaccine comprises basically live organisms, which protect against tuberculosis. BCG is not used in developed countries because it is not highly effective and it confuses testing for exposure to actual TB. In China, they've correctly decided to give it to all infants since the disease has not been eradicated and thus cut down on early childhood deaths from TB, especially TB meningitis. The effect would be most noted in rural areas where access and affordability of healthcare is poor, not in Shanghai among expats, who get good healthcare. It is important for parents to ensure that their children's care-givers (ayis and drivers) get a proper health check (chest x-ray) to ensure that they do not have active TB. For parents who do not expect to be in Shanghai long term and/or send their children to local schools where the vaccine is mandatory, they can skip the BCG. Its origin is local and most doctors consider it safe. It leaves a scar, so many parents choose to inject in the ankle or in the baby's arm.

Japanese Encephalitis vaccine (JEV): This vaccine is given in 3 doses and recommended for travelers who will spend more than 30 days in rural areas in China. It is a widespread disease in Asia, especially in China. Viral infection is spread by infected Culex mosquitoes. Mosquitoes pick up the virus from pigs and ducks. City portions of Shanghai are very low risk. Countryside/farming areas higher risk, in particular rice paddy areas, generally remote from Shanghai. The illness can be horrible, equally for adults and children, and may leave one with permanent brain disease from the brain infection, "encephalitis." Therapy, once you have the illness, is not too helpful. The vaccine is local in origin and inexpensive. It is only recommended for those who will tour China or other Asian countries' rural areas where they might encounter such mosquitoes.

Rabies vaccine: Rabies has not been eradicated from Shanghai, let alone China. Many stray dogs and cats may carry the virus and accidental exposure to their bites carries the risk. In addition, some families keep those animals as pets at home yet they do not follow the standard recommended vaccinations for the animals i.e. exposing themselves, their families and people close by to the risk of rabies. Depending on the area where you live (pretty isolated compound vs. lane houses with lot of pets around), your child's character (curious explorer vs. shy observer) and your own perception of risk, the rabies vaccine may be recommended to your family. If you or someone in your family is bitten by an infested animal the difference between having been previously vaccinated or not is essential: the person with previous vaccinations needs two boosters of the vaccine at days 1 and 3, in order to booster immunity, whereas the person with no vaccination, needs immunoglobulin against rabies within the first 24 hours, plus five booster shoots of the rabies vaccine. Side effects of the vaccine are usually minor and local - only up to 6 % of people experience sore muscle, fever or pain.

Meningococcal A+C: Recommended for children over 2 years old living or traveling in areas where there is risk of disease exposure.

Typhoid: Recommended for children over 2 years old living or traveling in areas where there is risk of disease exposure.

Meningitis ACWY: Bacterial infection spread by close contact. Given Shanghai's population density this is probably a good vaccine to have but not an officially recommended vaccination.

III. Vaccination Schedule for Chinese Children

For longer-term foreign expats, in particular those intending to send their kids to local schools, it will be mandatory to follow the Chinese vaccination schedule. China's current vaccines system is divided into two categories: Type 1 Vaccines, which are mandatory and given by the government for Chinese nationals; and Type 2 Vaccines, which are optional vaccinations for children and are not free for Chinese nationals.

Type 1 Vaccines

BCG: At birth
Hepatitis B vaccine: At birth 1st shot, 2nd within 30 days of birth, 3rd is 6 months from birth
Polio (oral vaccine): 1st is given second month from birth, 2nd third month from birth, 3rd is four month from birth, 4rd is at four years
DTP: 1st is third month from birth, 2nd is four month after birth, 3rd is fifth month, 4th shot is 1.5 to 2 -year-old, and a booster shot at 6 years old
Epidemic Cerebrospinal Meningitis vaccine: 1st is sixth month from birth (basic), 2nd shot is 3 years old (booster), 4th shot at 6 years old
Measles Vaccine: 1st is eighth months from birth, 2nd shot is ninth month from birth, 3rd is 1.5 to 2 -year-old
Japanese Encephalitis Vaccine (JEV): 1st is eighth month from birth, 2nd shot is at 1.5 to 2 years old, 3rd shot at 6 years old

Type 2 Vaccines

Group A + C meningitis vaccine: 1st time at the age of three, 2nd time at the age of six, and 3rd time at the age of nine. (Injection)
DTaP: This is the alternative to whole-cell DTP vaccine, vaccination schedule the same with whole-cell DTP vaccine in Type 1 Vaccine.
MMR vaccine: 1st injection at the age of 1.5 – 2, and 2nd time four years after the first one.
Live attenuated hepatitis A vaccine: 1st shot at the age of two, and second one after 4 years old.
Inactivated hepatitis A vaccine: Two injections between the age of one and 16; the injections should be at least 6 months apart.
Chickenpox (Varicella) vaccine: One injection between the age of one and 12.
Haemophilus influenza type B bacteria vaccine: for babies under 12 months old: injections at 2nd month, 4th month and 6th month. For babies over 12 months old: one injection.
Common influenza vaccine: for babies between the age 1 and 3: two shots every year with intervals of more than one month in between.