Vaccination Information

All three potentially fatal diseases are caused by toxin-producing bacteria.

All three vaccines are recommended to be given as primary immunization during early childhood, as well as booster shots during adolescence and adulthood.

DTaP: For infants and children below 7 years of age – total 5 shots; included in the “5-in-1” vaccine (DTaP+IPV+HiB)

Tdap: Booster shots from 7 years of age onwards – one shot every 10 years (currently not available in Shanghai)

Td: Pertussis-free alternative for Tdap ( currently not available in Shanghai)

Hepatitis A is a food and water borne viral illness that can cause reversible liver infection. It commonly affects travelers worldwide.

Hep A: For children over 1 year old and adults

Schedule: 2 shots – 6 to 12 months apart

Hepatitis B is a blood borne viral infection that occasionally leads to chronic infection of the liver which can cause liver cancer and cirrhosis. Hepatitis B is endemic in many parts of Asia.

Hep B: For children beginning at birth and adults

Schedule: 3 shots: day 0, 1 month, and 6 months

Hib is a potentially serious bacterial infection that can lead to pneumonia, meningitis, and epiglottitis. It usually affects children less than 5 years old. It spreads person to person via respiratory droplets.

Hib: For children 2 months to 5 years old (as single shot or included in the 5-in-1 vaccine)

Schedule: 4 shots

Influenza is a contagious respiratory virus that is spread person to person. The peak season is during the winter months. It is usually a self-limiting infection that lasts about 7 days but may lead to pneumonia and even death in those at high risk.

Influenza: For children aged 6 months to 18 years old, persons 50 years and older, pregnant women, people of any age with chronic medical conditions, healthcare workers, household contacts or caregivers of children less than 6 months of age and of those persons at high risk for complications from the flu.

Schedule: Annually

*For those children less than 9 years old who are receiving the flu vaccine for the first time, 2 flu shots spaced at least 4 weeks apart is necessary.

Japanese Encephalitis is a mosquito-borne viral illness which can cause encephalitis or inflammation of the brain leading to brain dysfunction or death. The peak season in Shanghai is from May to September. The season for the rest of China and Southeast Asia varies according to each region.

JE (inactivated vaccine): For children 6 months of age and above as well as adults.

Children: total 4 shots: from 8 months of age

Adults: total 3 shots

A group of viral illnesses associated with significant morbidity and mortality. Complications include pneumonia, meningitis, deafness, and miscarriage for pregnant women. These diseases are spread person to person via respiratory droplets.

Measles vaccine (single ingredient) and MMR (Measles-Mumps-Rubella) vaccines are recommended from 8 months of age onwards.

Both Measles and MMR vaccines are currently available from local vaccination clinics only.

Meningococcal disease is caused by bacteria and can lead to pneumonia, meningitis, sepsis, and death. It is spread via direct close contact via respiratory droplets.

Meningococcal: For children 6 months and older

Schedule: for children:  4 doses from 6 months onwards;  for adults: one dose.

Polio is a viral illness which can lead to paralysis of the limbs. Polio is still endemic in parts of the world , that’s why immunization is still recommended in children and adults. It is spread via oral-fecal contact.

Some countries might provide an oral live vaccine (OPV).

Most countries recommend injected inactivated vaccine (IPV).

IPV: For children 6 weeks of age onwards and adults (included in the 5-in-1 vaccine)

Total 4-5 doses for primary immunization; booster every 10 years for high-risk areas

Pneumococci are bacteria that can cause meningitis and pneumonia. They are spread person to person contact via respiratory droplets or oral contact and are a major cause of mortality worldwide.

Pneumococcal vaccine (PCV):

PCV-7 or PCV-13: Primary immunization for children: 3-4 doses, booster every 5 years for special population (currently not available in Shanghai)

PCV-23: For special population as well as adults age 65 years and up: 1 dose of Pneumococcal vaccine, to be repeated every 3-5 years.

TB, caused by mycobacteria, is primarily an illness of the respiratory system. It is spread person to person via respiratory droplets (via coughing or sneezing). One third of all new cases in the world are from China and India.

BCG vaccine: For children beginning at birth (PPD skin test required before BCG vaccine if living in China > 3 months)

Rabies is a viral illness which is transmitted by infected saliva from animals such as dogs, cats, bats, and monkeys through bites or scratches. If contracted and no previous or immediate vaccination is given, rabies is usually fatal. Effective treatment within a few days after exposure to rabies can prevent the onset of symptoms and death. Rabies is endemic in China.

Pre-exposure: Rabies vaccine for prevention of infection before exposure
Schedule: 3 doses: day 0, day 7, and between day 21 to 28.
Booster: Consider a booster in 3 years if at high risk; usually not recommended for international travelers.
Post-exposure: If exposed and not previously vaccinated, 4-5 doses of rabies vaccine and rabies immunoglobulin are advised to be given.

Varicella is a highly contagious viral illness that is otherwise known as chicken pox. It is spread person to person via respiratory droplets or via contact of the fluid from the blisters.

Varicella: 2 doses for children beginning at 1 year of age
Schedule: 2 shots

Why do we have to switch brands?

In 2011, the Chinese government changed the pharmaceutical standard of all vaccines marketed in China. The remaining antibiotic content allowed in vaccines has been lowered. As a result, a lot of foreign brands (e.g. GSK’s) have been affected and will no longer be available unless they change their purification process.

Why does SHU choose Shanghai Institute of Biological Products?

Shanghai Institute was established in 1949, as a subsidiary of the China National Biotech Group. Its manufacturing plant was established in 1999 using the European GMP standard with advanced technological equipment from China. Shanghai Institute is the only Chinese brand that uses the original patented Varicella Oka strain (same as GSK’s). The company’s website is www.siobp.com.

How long have these vaccines been on the market?

Varicella vaccine has been marketed in China since 2000, with yearly vaccinations of more than 3.5 million doses. In Beijing and Shanghai, it is a self-paying vaccine, and is not subsidized by the government.

What are the differences/similarities between the two brands?

Varicella: The Oka strain (cultured in the MRC-5 Human diploid cell) is the same as in the GSK branded product. The antibiotic content of the GSK vaccine is neomycin and Shanghai’s is gentamicin.

Studies have shown that the Shanghai Institute brands of Varicella and MMR vaccines are as safe and effective as the GSK branded vaccines.

Pharmacy Department
Shanghai United Family Hospital
2016–8–22

What are these vaccines Td and Tdap (Boostrix) for?

Td vaccine protects against tetanus and diphtheria

Tdap vaccine protects against tetanus, diphtheria, and pertussis.

Tetanus is a neuromuscular illness caused by toxin-producing bacteria which can be fatal. Open wounds such as from accidents, lacerations, animal bites, and even small puncture wounds such as stepping on a nail are susceptible to tetanus spores.

Diphtheria is a respiratory disease caused by toxin-producing bacteria which can cause fatal airway obstruction if not treated. It is transmitted by person-to-person contact.

Pertussis is a respiratory illness also known as whooping cough, caused by toxin-producing bacteria which can be fatal. Because of a higher incidence of whooping cough in adolescents and adults, a booster is now recommended for this group.

When did the shortage of these vaccines start?

In Shanghai, the Tetanus-diphtheria (Td) vaccine was backordered since January, 2013; Tdap (Boostrix) was backordered since February, 2013.

What is the reason for the Td vaccine shortage?

Most local manufacturers of Tetanus-diphtheria vaccine (Td) do not plan to continue producing this vaccine due to low usage demand in China. This low demand is mainly because the China immunization schedule does not include the once every 10 year booster for all adults.

In addition, the vaccine manufacturer in Shanghai is undergoing major plant reconstruction, causing further prolonged shortage of the Td vaccine.

What is the reason for the Tdap (Boostrix) vaccine shortage?

Boostrix is manufactured by GSK Belgium. This imported vaccine has been discontinued in the China market, but still available elsewhere globally.

Who will be most affected by the Td vaccine shortage?

Adolescents (> 12 years old) or adults with an unknown or incomplete tetanus vaccination history, or who have had tetanus vaccine more than 10 years ago.

What can be done if I am in the above group, and had an accident resulting in open and dirty wounds?

SHU has the tetanus immunoglobulin that our doctor can administer intramuscularly to prevent possible tetanus infection, but without the Td vaccine, we are unable to offer you complete wound management.

Who will be most affected by the Tdap (Boostrix) shortage?

Adolescents ages 11 and up and adults (i.e. parents, siblings, grandparents, childcare providers, and healthcare personnel) who have, or anticipate having, close contact with infants younger than 12 months of age and pregnant women who previously have not received Tdap.

US Advisory Committee on Immunization Practices (ACIP) recommends this group of people to be vaccinated against pertussis (also known as whooping cough) with Tdap vaccine (Boostrix), because pertussis causes a high risk of pneumonia and death in young infants, especially those less than 3 months-old if infected.

Is the Tetanus vaccine for infants and children affected?

No. For Infants and children, the recommended dosage of Tetanus-diphtheria vaccine is still in the China immunization schedule. It is offered as DTaP and DT for different ages of children.

Can adolescents or adults use the DtaP or DT vaccines?

Children tetanus booster has a higher content of diphtheria toxoid. It is not suitable for adolescent and adult use. It will cause a higher incidence of adverse effect in adolescents and adults if used.

What should I do if I need this vaccine?

If you require a Tdap or Td booster, you should proactively plan to get immunized in your home country or anywhere where this vaccine is available.

Pharmacy Department
Shanghai United Family Hospital & Clinics
August 22, 2016