Systematic Vaccination Schedule (Catalonia)
| Age | Vaccines to Administer | Key Notes |
|---|---|---|
| 2 Months | Hexavalent VNC15 MenB Rotavirus* | Separate MenB from others if there is a risk of high fever. *Rotavirus funded according to updates. |
| 4 Months | Hexavalent VNC15 MenB Rotavirus* | Dosing of MenC at 4 months is no longer routine except for risk groups. |
| 11 Months | Hexavalent VNC15 | Reminder dose (booster). |
| 12 Months | MMR (TV) MenACWY MenB | First dose of live attenuated virus (TV). |
| 15 Months | Chickenpox Hepatitis A | First dose of Chickenpox and Hepatitis A. |
| 3-4 Years | TV Chickenpox | Second dose (can be administered as a tetraviral). |
| 6 Years | DTPa-VPI Hepatitis A | I remember polio and diphtheria/tetanus/whooping cough. Second dose of Hepatitis A. |
| 11-12 Years | HPV MenACWY | HPV in boys and girls (2 doses if <15a, 6m apart). |
Adjuvants
What are they and what are they for? They are chemical or biological substances that are added to vaccines (especially inactivated or purified subunit vaccines) to enhance, direct and prolong the immune response. They allow a smaller amount of antigen to be used, reduce the number of doses necessary and achieve much longer-lasting immunity.
Main Adjuvants in Vaccines from Spain
Aluminum Salts
Aluminum phosphate, Aluminum hydroxide
The most classic adjuvant. It acts by forming a local "depot" in the muscle that slowly releases the antigen, attracting macrophages and dendritic cells.
Present in: Hexavalent, DTPa, Pneumococcus, MenB (Bexsero), HPV (Gardasil 9), HAV/HBV.
AS04
Aluminum + MPL (Monophosphoryl Lipid A)
MPL is a purified derivative of the bacterial wall (Salmonella). Tremendously enhances cellular and humoral immunity by stimulating Toll-like receptor 4 (TLR4).
Present in: HPV (Cervarix).
MF59/AS03
Lipid-based emulsions (Squalene)
Squalene is a natural organic lipid. It creates an "oil-in-water" emulsion that generates transient local inflammation that is very effective in recruiting presenting cells.
Present in: Flu vaccines (Chiromas), pandemic.
Virosomes
Lipid vesicles that mimic viruses
They are empty viral envelopes (without DNA/RNA). By simulating the exact three-dimensional shape of a virus, the immune system recognizes and attacks them in a very natural way.
Present in: Epaxal (Hepatitis A) and some flu.
Clinical Impact in Emergencies
Intense erythema, local pain and the formation of a painless palpable subcutaneous nodule (granuloma) on the child's thigh/arm are common and expected reactions to aluminum. It is usually self-limiting (although it can last weeks) and NOT contraindicated the administration of future doses of that same vaccine.
Absolute Contraindications
General (All vaccines)
Severe anaphylactic reaction to a previous dose of the same vaccine or to any of its components (e.g. neomycin, gelatin, egg proteins in yellow fever).
Live Vaccines (TV, Chickenpox, Rotavirus)
- Severe primary or secondary immunodeficiency.
- Pregnancy (theoretical risk for the fetus).
- Current immunosuppressive treatment.
Specific
Rotavirus: History of intestinal intussusception or uncorrected gastrointestinal malformation.
Whooping cough (DTPa): Encephalopathy of unknown etiology within 7 days of a previous dose.
FALSE Contraindications
Important for Emergencies! These situations DO NOT contraindicate vaccination and we should not miss opportunities to vaccinate:
Precautions (Assess Risk/Benefit)
• Moderate/severe acute illness: Postpone until resolution so as not to mask adverse symptoms.
• Live vaccines: If the patient has recently received blood products or immunoglobulins, live vaccination (TV, chickenpox) should be delayed for between 3 and 11 months depending on the product.
• History of Guillain-Barré Syndrome within 6 weeks of a previous vaccination.
Argument Against Myths and Anti-Vaccines
Evidence-based answers, with empathy and science, to convince doubtful parents.