| Vaccines | Adult dose | Pediatric age/dose | Standard primary schedule | Duration of protection |
| Hepatitis A | ||||
| Havrix | 1 mL IM (1440 EU) | 1 to 18 years: 0.5 mL IM (720 EU). | 0 and 6 to 12 months. | Probably lifelong after completion of primary series.* |
| Vaqta | 1 mL IM (50 units) | 1 to 18 years: 0.5 mL IM (25 units). | 0 and 6 to 18 months. | |
| Hepatitis B | ||||
| Engerix-B | 1 mL IM (20 mcg) | Birth to 19 years: 0.5 mL IM (10 mcg). | 0, 1, and 6 months.¶Δ | Probably lifelong after completion of primary series. |
| Recombivax-HB | 1 mL IM (10 mcg) | Birth to 19 years: 0.5 mL IM (5 mcg). | 0, 1, and 6 months.Δ◊ | |
| Heplisav-B | 0.5 mL IM (20 mcg) | Not approved for <18 years. | 0, 28 days. | |
| Hepatitis A/B | ||||
| Twinrix | 1 mL IM (720 EU/20 mcg) | Not approved for <18 years. | 0, 1, and 6 months (alternative: 0, 7, and 21 to 30 days). | Booster recommended at 12 months with accelerated schedule; otherwise, probably lifelong after completion of primary series. |
| Japanese encephalitis | ||||
| Ixiaro (JE-VC) | Age 18 to 65: 0.5 mL IM/dose; two doses (first dose on day 0; second dose any time between day 7 and day 28) Age >65: 0.5 mL IM/dose; two doses given on days 0 and 28 | Age 2 months to <3 years: 0.25 mL IM/dose; two doses given on days 0 and 28. Age ≥3 years: Same as for adults >65. | Schedule varies with age (see preceding columns). | A single booster >1 year after completion of primary series if ongoing risk.§ |
| Meningococcus | ||||
| Menveo | 0.5 mL IM (10 mcg serogroup A, 5 mcg serogroup C, Y, W135) | ≥2 years: 0.5 mL IM (10 mcg serogroup A, 5 mcg serogroup C, Y, W135). | ≥2 to 55 years: Single dose.¥ | Repeat every 5 years‡ if ongoing risk. |
| Menactra | 0.5 mL IM (4 mcg of each antigen) | ≥9 months: 0.5 mL IM 4 mcg of each antigen. | 9 to 23 months: 0, 3 months. ≥2 to 55 years: Single dose. | Repeat every 5 years‡ if ongoing risk. |
| Rabies | ||||
| Imovax (HDCV) | 1 mL IM (≥2.5 international units of rabies antigen) | All ages: 1 mL IM (≥2.5 international units of rabies antigen). | 0 and 7 days. Empiric third dose between day 21 and 3 years.†,** | Third dose unnecessary if titer check at 1 to 3 years shows protective levels.** |
| RabAvert (PCECV) | 1 mL IM (≥2.5 international units of rabies antigen) | All ages: 1 mL IM (≥2.5 international units of rabies antigen). | 0 and 7 days. Empiric third dose between day 21 and 3 years.†,** | |
| Typhoid | ||||
| Vivotif | 1 cap PO (contains 2 to 6 × 10† viable colony-forming units of S. Typhi Ty21a) | ≥6 years: 1 cap PO (contains 2 to 6 × 10† viable colony-forming units of S. Typhi Ty21a). | 1 cap every other day × 4 doses. | Repeat every 5 years if ongoing risk. |
| Typhim Vi | 0.5 mL IM (25 mcg) | ≥2 years: 0.5 mL IM (25 mcg). | Single dose. | Repeat every 2 years (3 years in Canada) if ongoing risk. |
| Yellow fever | ||||
| YF-Vax | 0.5 mL SC (4.74 log¶¶ plaque forming units of 17D204 attenuated YF virus) | ≥9 months: 0.5 mL SC (4.74 log¶¶ plaque forming units of 17D204 attenuated YF virus). | Single dose. | Booster dose every 10 years if ongoing risk. |
| Cholera | ||||
| Vaxchora | Aged 18 to 64: 100 mL PO (lyophilized Vibrio cholerae CVD 103-HgR) | Age 2 to <6: 50 mL by mouth (lyophilized V. cholerae CVD 103-HgR). Age ≥6 years: Same as for adults. | Single dose. | No specific recommendation; consider booster every 6 months if at continued risk. |
| Tick-borne encephalitis vaccine | ||||
| Ticovac (known as FSME/IMMUN in some European countries) | Age 16 years and older: 0.5 mL IM/dose; three doses (first dose on day 0, second dose 14 daysΔΔ to 3 months after the first dose, third dose 5 to 12 months after the second dose) | Age 1 to 15 years: 0.25 mL IM/dose; three doses (first dose on day 0, second dose 1 to 3 months after the first dose, third dose 5 to 12 months after the second vaccination). | Schedule varies with age (see preceding columns). | A booster dose (fourth dose) may be given at least 3 years after completion of the primary series if ongoing exposure or re-exposure to tickborne encephalitis virus is expected. |
IM: intramuscular; SC: subcutaneous; PO: by mouth; JE-VC: Vero cell culture-derived Japanese encephalitis; HDCV: human diploid cell vaccine; PCECV: purified chick embryo cell vaccine; PrEP: pre-exposure prophylaxis; ACIP: Advisory Committee on Immunization Practices; MMWR: Morbidity and Mortality Weekly Report.
* Protection likely lasts at least 12 months after a single dose.
¶ An alternate schedule is three doses given at 0, 1, and 2 months, followed by a fourth dose at 12 months.
Δ An accelerated schedule of 0, 7, and 14 days followed by a booster dose at 6 months has been used but is not US Food and Drug Administration-approved.
◊ An alternate schedule for adolescents 11 to 15 years old is 0 and 4 to 6 months.
§ Adults previously vaccinated with JE Vax should receive a primary series of Ixiaro.[1]
¥ For children 2 to 5 years old at continued high risk, a second dose may be administered two months after the first.
‡ Repeat after 3 years for children vaccinated at <7 years of age. Considerable published data indicates that protection significantly wanes after 3 years; travelers to the meningitis belt should consider a booster after 3 years due to the high risk of infection compared to risk at home.[2]
† Regimen for PrEP. If a previously vaccinated traveler is exposed to a potentially rabid animal, postexposure prophylaxis with 2 additional vaccine doses separated by 3 days should be initiated as soon as possible.
** For immunocompetent individuals with short-term risk for rabies (such as travelers), the World Health Organization and the United States Centers for Disease Control and Prevention endorse a 2-dose PrEP regimen.[3,4] For those at ongoing risk, such as long-stay or frequent travelers, an empiric booster (third) dose may be given between day 21 and 3 years; alternatively, such individuals may have antibody levels checked at 1 to 3 years postvaccination, with booster (third) dose if antibody titer is <0.5 international units/mL. Thereafter, no further titers are needed, and no further vaccine doses are needed unless postexposure prophylaxis is warranted following an exposure.
¶¶ Minimal acceptable antibody level is complete virus neutralization at a 1:5 serum dilution by the rapid fluorescent focus inhibition test.
ΔΔ Short-stay travelers are protected a week after a second dose given at day 14 but should receive either the third dose or a titer check at 1 to 3 years is further exposure is expected.Adapted with special permission from: Treatment Guidelines from The Medical Letter, June 2012; Vol. 10 (118):45. www.medicalletter.org.
