Immunisation schedule for infants and small children

This page gives an overview of the vaccinations of pregnancy and the first years of life according to the current Austrian immunisation schedule. It is meant as preparation: anyone who knows the appointments before the child is there does not have to work them out later between breastfeeding and lack of sleep.

It begins before the birth

Two vaccinations are recommended in Austria in every pregnancy, and both are less for the mother than for the child.

dTpa against whooping cough, diphtheria and tetanus, preferably between weeks 27 and 36 of pregnancy. The antibodies formed cross the placenta to the child in the last third and bridge the time until its own basic course. It is given afresh in every pregnancy, regardless of when the last booster was. More under whooping cough.

Influenza, in every trimester and throughout the flu season. Pregnant women fall more severely ill than other adults, and infants under six months cannot yet be vaccinated themselves.

Both are inactivated vaccines. They can be given on the same day into different arms without effectiveness suffering.

Before the pregnancy, by contrast, the live vaccines should be dealt with: measles, mumps and rubella as the MMR vaccination, and chickenpox. Two doses at least four weeks apart, then a month's interval before a pregnancy. Anyone who does not know their vaccination status is best clarifying it in preconception advice – the screening planner lists what else belongs to it.

The sequence in the first year of life

This overview is for orientation. The exact sequence follows the immunisation schedule in force and is determined by the paediatrician; for premature babies and for children with pre-existing conditions different schedules apply.

What is striking is how few appointments there are: by far the greater part is contained in combination vaccines. Six illnesses in one injection, plus pneumococci in a second – that makes three main appointments in the first year of life instead of eighteen. If the components had to be given separately, not only would the effort be greater; in practice immunisation programmes fail not on effectiveness but on missed appointments, and every additional appointment is an opportunity to miss one.

The vaccinations one by one

Rotavirus – an oral vaccine from the sixth week of life, two or three doses depending on the preparation. It is the only vaccination with a hard age limit: if the start is missed, it cannot be caught up. Which is why the decision belongs before the birth. See rotavirus.

Meningococci B – from the second month of life, because the peak of the illness lies in the first year. This vaccine causes fever more often than others; here paracetamol is exceptionally recommended in advance. See Bexsero.

The six-in-one vaccination against diphtheria, tetanus, whooping cough, polio, Haemophilus influenzae b and hepatitis B – three doses following the 2+1 schedule. See Hexyon.

Pneumococci – a conjugate vaccine, at the same appointments as the six-in-one vaccination, into the other thigh. See pneumococcal disease.

Measles-mumps-rubella – from the completed ninth month of life, the second dose at the earliest four weeks later. A live vaccine, and the only one a child receives in the first year of life.

What protection from the mother achieves – and what it does not

The mother's antibodies cross the placenta to the child in the last third of pregnancy. How much arrives differs considerably between organisms, and that explains the order in the schedule.

It works well with organisms against which antibodies are directed at proteins: whooping cough, tetanus, diphtheria, measles, influenza. That is exactly why vaccination against whooping cough and influenza is given in pregnancy.

It works poorly with encapsulated bacteria – pneumococci, meningococci, Haemophilus influenzae b. Antibodies against sugar capsules are low in unvaccinated adults, and what is transferred does not go far. This is why the child's vaccination against meningococci B begins so early and why there is no vaccination for pregnant women here that would change it.

The transferred protection also fades over the first months of life – and it can weaken the response to early vaccinations of the child. That is the reason why the measles vaccination is only given from the ninth month of life: before that, maternal antibodies would still be in the way.

What comes in addition in the second year of life

After the third dose of the six-in-one vaccination and the second MMR dose, the greater part is dealt with. What follows is manageable.

Tick-borne encephalitis – the vaccination against the tick-borne form of meningoencephalitis is possible from the completed first year of life and is of considerable importance in Austria because of how widespread it is. Three doses for the basic course, then boosters.

Meningococci ACWY follows later, at school age – see the page immunisation schedule for school children.

Hepatitis A is recommended for travel to countries where it is widespread and in certain situations, but is not part of the general programme.

Influenza is possible from the sixth month of life and is included in the free programme for children in Austria.

When something gets in the way

Hardly any schedule runs without a postponement, and most are unproblematic. What actually applies can be summed up in three sentences.

An interrupted series is continued, not begun again. Even after months or years every dose already given counts. With the vaccinations of the first year of life there is no deadline after which everything would have to be repeated – with the known exception of rotavirus, where the opportunity ends rather than being postponed.

It is postponed with an acute febrile illness. The reason is not a risk but distinguishability: the reaction to the vaccination and the signs of the illness could otherwise not be told apart.

Not reasons to postpone are: a cold without fever, a slight cough, a course of antibiotics under way, a chronic illness in a stable state, atopic eczema, asthma, an allergy to foods or pollen, low weight, a forthcoming operation, ill siblings or teething. This list is here because in practice it regularly leads to unnecessary postponements – and every postponement lengthens the time during which a child is unprotected.

Common worries – answered briefly

“That is too much at once.” A six-in-one vaccine contains fewer than forty protein components in total. The gut of a newborn is colonised in the first days of life by billions of bacteria, each with numerous surface structures. The orders of magnitude are not comparable.

“We want to give the vaccinations separately.” Single vaccines for these components are no longer on the market in Europe. The question therefore does not arise as a choice.

“We want to start later.” That lengthens the time during which the child grows unprotected into the age at which the illnesses are dangerous. With rotavirus it ends the opportunity altogether.

“Aluminium.” One dose of vaccine contains less than one milligram. Through food an infant takes in a multiple of that in the first six months of life.

“A connection with autism, sudden infant death, allergies.” These questions have been examined in studies involving millions of children; no connection could be found.

How the programme has changed over the years

Anyone comparing the schedule with the one under which their own parents were vaccinated will find more vaccinations and considerably fewer components. The two belong together and are worth explaining.

More illnesses covered: Haemophilus influenzae b was added in the 1990s, pneumococci and meningococci in the 2000s, rotavirus in 2007 in Austria, meningococci B in the 2010s. Each of these vaccinations became possible after a technical problem had been solved – with the encapsulated bacteria through conjugation to a carrier protein, with meningococcus B through a completely new route of development.

Fewer components: the old whooping cough vaccine contained whole killed bacteria with more than three thousand proteins and was correspondingly reactive. Today's acellular vaccine contains a handful of purified components. The smallpox vaccine with which whole generations were vaccinated contained around two hundred on its own.

In sum, a child today deals with fewer vaccine components than a child forty years ago – with more than twice as many illnesses covered. That is the answer to the objection that it has “become more and more”: the number of illnesses has risen, the load has not.

The whooping cough vaccine, however, also has a downside to this development. The acellular vaccine is considerably better tolerated, but its protection lasts a shorter time than that of the old one – one of the reasons why whooping cough does not disappear despite good coverage and why vaccination is given afresh in every pregnancy.

What helps at an appointment

Breastfeeding or a bottle during or immediately after the injection measurably reduces the pain response – better than anything else parents can do.

Hold the child upright rather than laying it down. An infant in its mother's arms cries for a shorter time than one on the examination couch.

Several vaccinations at one appointment are overall less of a burden for the child than ones spread over several appointments. The stress arises from the situation, not from the number of injections.

Keep the evening free. Fever and a tender leg are normal and last one to two days.

Stay a quarter of an hour after every vaccination. Very rare immediate reactions occur during this time, and practically not afterwards.

What is normal after the vaccination

The commonest reactions appear in the first one to two days and are an expression of the immune system doing its work: redness, swelling and tenderness on the thigh; fever; restlessness, more crying, loss of appetite, increased sleeping.

Cooling the injection site helps, as does an antipyretic in a dose appropriate to the age if the child is suffering from the fever. Lowering fever preventively is not recommended, because it damps down the response to the vaccination slightly – with one exception: the meningococcal B vaccination, where three doses of paracetamol are expressly recommended. Ask about it at the appointment when that vaccination is due.

The vaccinated leg should be moved normally and not rested – that disperses the swelling faster. Bathing and the usual daily routine are unproblematic.

What belongs with a doctor: fever above 39.5 degrees, fever lasting more than 48 hours, a seizure, unusually shrill crying over hours, swelling involving the whole leg, or striking listlessness. In infants under three months any temperature above 38 degrees is a reason for assessment – regardless of whether a vaccination has been given.

In an infant, incidentally, behaviour counts for more than the height of the fever. A child with 39 degrees that feeds, makes eye contact and can be settled is in a different situation from one with 38 degrees that seems listless and no longer feeds.

The vaccination record

Every vaccination is entered with the date, the trade name and the batch number – in the yellow vaccination record, in the parent-child pass or in the electronic vaccination record. Photograph the record after every appointment; it takes ten seconds and, if it is lost, replaces the entire search.

A missing vaccination record is the commonest reason why people are later vaccinated unnecessarily or have to research laboriously – on starting school, before travelling, after an injury and especially in a pregnancy. Any adult who has looked for her own vaccination record knows what this is about.

What all this costs in Austria

By far the greater part of the vaccinations named here is included in the free childhood immunisation programme and is financed jointly by the federal government, the provinces and social insurance. That covers the six-in-one vaccination, pneumococci, rotavirus, measles-mumps-rubella and the influenza vaccination for children.

For individual vaccinations the arrangement was and is different. The meningococcal B vaccination was for a long time paid for privately; how it is classified has changed several times. The vaccination against tick-borne encephalitis is not fully covered either, though there are discounted campaigns. And the dTpa vaccination for pregnant women is not free of charge everywhere; the handling differs by province and health insurance fund.

These details change faster than a website can follow, which is why no amounts are given here. Ask at the vaccination appointment or at the public vaccination centre about the current position – and do not let a question of cost put you off before you have clarified it. The amounts are in the range of a few vaccine prices; the harm prevented is not.

What happens next

The child's vaccinations are given by the paediatrician. In this practice it is the part before that which matters: the dTpa and influenza vaccinations in pregnancy, the hepatitis B test, rubella protection and the question of what is due in the first year of life. Arranging an appointment. The examination appointments of the parent-child pass are worked out from your due date by the parent-child pass planner.

Two things are worth doing before the birth: find a paediatrician and pencil in a first appointment – in Vienna places within the public system are taken early, and the first examination is due in the first week of life – and go through the vaccination questions of the first six months once in peace. Both are unspectacular, take less than an hour together and make a considerable difference to the first weeks.