Syrian Programme Refugees Advice on assessment of immunisation status and recommendations for additional immunisation

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1 Syrian Programme Refugees Advice on assessment of immunisation status and recommendations for additional immunisation Background Information Immunisation services in Syria Syria had good immunisation services, with reasonable uptake of all childhood vaccines, up to Since 2011 health services, including immunisations have been severely disrupted. The immunisation schedule for Syria is shown in Appendix A. The parents may have immunisation records for their younger children but often do not have them for their older children. The immunisation record cards from Syria are difficult to interpret as they are all in Arabic. Immunisations given in Transit e.g. (Turkey / Greece) Families may have left Syria up to 1-2 years ago and have children born in Greece or Turkey. These children may have received their primary immunisations there. These families should have records of vaccines given in transit. The immunisation record cards from Lebanon are easier to interpret as the vaccines given are listed in English and Arabic. All seem to have records of additional polio vaccines doses in transit countries. Suggested questions to assess immunisation status of children 1. When did the family leave Syria? 2. If the children are preschool were the children born in Syria or in Transit? Where? 3. Do they have vaccination records from Syria or in Transit? (These may be difficult to interpret ask parents if the child was up to date with all their vaccines up to the time they left Syria/Transit). 4. If they have no records ask parents if the child was up to date with all their vaccines up to the time they left Syria/ other country Main differences in Immunisation schedules in Syria, Greece and Ireland 1. PCV not given in Syria. 2. Extra dose of PCV given in Greece : given at 2,4,6 & 13 months 3. MenC not given in Syria. A polysaccharide MenACWY is given in Syria at age 6 years. Unlike the conjugate MenC and MenACWY vaccines used in Ireland this polysaccharide vaccine induces short term (about 5 years) rather than long term immunity. 4. Extra dose of Men C given in Greece: given at 2,4 and 6 7 months 5. Extra dose of DTP/Hib/HepB and Polio given in Syria at 18/ Extra dose of DTP in Greece at months. 7. MMR at 12 and 18 months in Syria. MMR at months and 4-6 years in Greece doses of rotavirus given in Greece. 9. Hep A given to at risk groups in all 3 countries. 10. Varicella given in Greece at months and 4-6 years. HSE Migrant immunization 2017 Page 1 of 6

2 11. Consider Men B catch up if born on or after 01/10/2016 & rotavirus oral vaccine if born since 01/10/2016 and < 7/12 age) and a second dose can be given at or after minimum interval of 1 month. Note If a baby is 8 months and 0 days of age or older then they should NOT receive any dose of rotavirus oral vaccine because of the slightly increased risk of intussusception Recommendations 1. If the immunisation records and/or the parent s history are that the child was fully up to date with immunisations in Syria prior to 2011 it is reasonable to assume child was up to date at that time. 2. Children born in Greece should have immunisation records which along with parent history should indicate vaccination status. 3. If immunisation records and/or parent s history indicate that child is unvaccinated or incompletely vaccinated then proceed with the Irish catch up schedule, see Appendix C. 4. If immunisation records and/or parent s history indicate that the child was up to date with immunisations prior to leaving Syria or Greece additional vaccinations may still be recommended, see Appendix D. 5. Once additional and catch up vaccines have been given, all children should continue with the routine Irish Immunisation Schedule HSE Migrant immunization 2017 Page 2 of 6

3 Appendix A: Immunisation Schedule Syria Country Antigens Description Schedules Entire country Comments Syrian Arab Republic BCG Bacille Calmette-Guérin vaccine birth; Yes (the) DTaPHibIPV Diphtheria and tetanus toxoid with acellular pertussis, Hib and IPV 2, 4, 6, 18 months; Yes DTwPHib DTwPHibHepB vaccine Diphtheria and tetanus toxoid with whole cell pertussis and Hib vaccine Diphtheria and Tetanus and Pertussis and Haemophilus influenzae and Hepatitis B vaccine HepB Hepatitis B vaccine birth; 2, 6 months; Yes IPV Inactivated polio vaccine 2, 4 months; MMR Measles mumps and rubella vaccine 12, 18 months; Yes Measles Measles vaccine 9 months; MenACWY Meningococcal polysaccharide 6 years; Yes ACWY vaccine OPV Oral polio vaccine 6, 12, 18 months; 6 Yes years; TT Tetanus toxoid vaccine 1st contact; +1, +6 months; +1, +1 year; Yes Td Tetanus and diphtheria toxoid for 6, 12 years; Yes older children/adults 2, 4, 6, 18 months; Yes according the availability of vaccines 2, 4, 6, 18 months; Yes according the availability of vaccines CBAW Source: WHO HSE Migrant immunization 2017 Page 3 of 6

4 Appendix B Irish Catch Up Schedule HSE Migrant immunization 2017 Page 4 of 6

5 Appendix C: Additional Immunisations that may be required for children previously immunised according to schedule in Syria or Greece Additional Vaccines Recommended in Irish Primary Schedule Vaccine 4 months to <12 months 12 months to <2 years Men C 1 1 dose (booster at 13 1 dose 1 dose 1 dose (unless received months) MenACWY at age 6 years in Syria 3 ) PCV 2 2 doses 2 months apart 1 dose Only require if in at risk group, see NIAC guidelines 1. Men C not given in Syria or Lebanon. Polysaccharide MenACWY given in Syria at age 6 years. 2. PCV not given in Syria, given in Greece. 3. If there is any doubt re history of MenACWY at age 6 years give MenC. 2 to <4 years 4 to <10 years 10 to <23 years 1 dose (even if received MenACWY previously in Syria) Formatted Table Some children may have missed their 4-6 year or year booster since 2011, see table below Booster Vaccines that may be recommended Vaccine 4 months to <12 months DTaP/IPV (Infanrix IPV) Tdap (Boostrix) 12 months to <2 years 2 to <4 years 4 to <10 years 10 to <23 years 1 dose if has missed Td/DTP and Polio boosters at age 4-6 years 1 dose if has missed Td booster at years or years MMR 1-4 years 1 dose If no MMR 2 doses one month apart Once additional and catch up vaccines have been given, all children should continue with the routine Irish Immunisation Schedule Note: Due to the current unavailability of BCG vaccine no recommendations are given regarding BCG vaccination. HSE Migrant immunization 2017 Page 5 of 6

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