Baby and Childhood Vaccinations in Malta

Vaccination is getting a vaccine – having the injection or taking an oral dose of the vaccine.

Immunisation is the process of both getting the vaccine and becoming immune after vaccination.

Vaccines need time to work, because the immune system needs a while to produce an immune response to the vaccine.

Some vaccines work after one dose, but others need more doses to be effective, and for some you will need a “booster” later to restore immunity to diseases that may weaken over time.

Polio is caused by a virus found in infected people’s stool and saliva, which is easily transmitted through hands and objects. Polio can cause paralysis, meningitis, permanent disability, and even death. Polio is now a rare disease thanks to widespread immunisation, yet outbreaks continue to occur in some parts of the world. The World Health Organisation has declared the sickness eradicated in Malta. However, because it has not been eradicated in other parts of the world, vaccination against polio is vital to preventing its reemergence in Malta.

Polio vaccination is mandated by law.
The polio vaccination is provided for free as part of the National Immunisation Schedule.

•  The first dose may be administered at 6 weeks of age, followed by two doses spaced 4 weeks apart.
•  A booster dose is administered at 18 months of age, followed by another booster dose between the ages of 14 and 16 to complete a 5-dose course that provides long-term protection.

Diphtheria is caused by a bacterium that is spread by coughing. The condition affects the throat and airways of an infected person. Diphtheria is no longer a common disease due to extensive immunisation, although it can still be found in select regions of the world. It can cause severe problems, such as multiple organ failure and muscular paralysis.

In Malta, diphtheria vaccination is required by law. 
Diphtheria vaccination is provided for free as part of the National Immunisation Schedule. 

Diphtheria vaccine is given in combination with other vaccines in one injection. It is a dead vaccine.

• The first dose: from 6 weeks of age.
• The course consists of 3 doses, given 4 weeks apart.
• A booster is currently administered at 18 months and again at 14-16 years.

Tetanus is caused by a bacteria which is found in soil and animal manure. The disease is known as “lockjaw” and can occur if the tetanus bacteria enters a deep wound or open cut in the skin.

In Malta, vaccination against tetanus is obligatory by law.
Tetanus vaccine is provided for free as part of the National Immunisation Schedule.

Tetanus vaccine is given in combination with other vaccines in one injection.

• The first dose: from 6 weeks of age.
• The primary course consists of 3 doses given 4 weeks apart.
• A booster dose is given at 18 months and again at 14 – 16 years in order to offer long term protection.

Pertussis is caused by a bacteria that is spread through coughing. The disease produces intense coughing, which can progress to pneumonia, chronic lung issues, convulsions, brain damage, and even death. Complications are more prevalent in newborns and young children.

Pertussis vaccine is provided for free as part of the National Immunisation Schedule.

The pertussis vaccine is given in combination with other vaccines in one injection.

• The first dose: from 6 weeks of age.
• The course consists of 3 doses given 4 weeks apart.
• A booster dose is given at 18 months.

Hib is a pathogen that spreads via droplet infection through coughing or sneezing. Many people have this bacteria in their throat but are unaffected by it. However, they can still pass the disease on to newborns and toddlers. Hib can cause meningitis, which can result in hearing loss, brain damage, and death.

The Hib vaccine is provided for free as part of the National Immunisation Schedule.

The Hib vaccine is given in combination with other vaccines in one injection.

• The first dose: from 6 weeks of age.
• The course consists of 3 doses given 4 weeks apart.
• A booster dose is given at 18 months.

Hepatitis B is caused by a virus that spreads through contact with infected blood or body fluids. A mother who carries the hepatitis B virus can pass it on to her child during pregnancy and childbirth. The hepatitis B virus affects the liver and can cause liver failure and death. People infected with the virus may not have any symptoms, but they are nonetheless at risk of developing major liver issues and liver cancer.

The vaccine contains an inactivated type of the hepatitis B virus, which grows artificially on yeast cells.

On the National Immunisation Schedule it is incorporated in the 6 in 1 vaccine.

• The first dose: from 6 weeks of age.
• The course consists of 3 doses given one month apart.
• A booster dose at 18 months.

Hepatitis A is an extremely contagious liver infection caused by the hepatitis A virus. It spreads by contaminated food or water, as well as close touch with an infected person or object.

• The first dose: from 1 year .
• A booster dose given after 6 months to a year.

Measles is caused by a virus and spreads by sneezing and coughing. It is extremely contagious, and unprotected individuals are highly likely to become ill if exposed to the illness. Measles begins with cold-like symptoms, which escalate to a high fever, cough, watery eyes, and a red rash on the face and body. Measles infection can result in serious consequences and mortality, including pneumonia, encephalitis, and a rare crippling brain condition that can continue long after recovery from the infection.

The measles vaccine is found in combination with the mumps and rubella vaccines. The vaccine is known as the MMR vaccine.

The vaccine is offered free of charge to those born after 1982 as part of the National Immunisation Schedule.

• The course consists of 2 doses given at least 4 weeks apart.
• The first dose: at 13 months and the second when the child is over 3 years old.

Mumps is caused by a virus and spreads by sneezing and coughing. It produces fever, headaches, and a painful swelling of the parotid glands, located directly behind the ears. Mumps can cause major problems such as hearing loss, meningitis, cardiomyopathy, renal failure, joint inflammation, and testicular or ovarian inflammation, which can lead to infertility.

The vaccine is offered free of charge to those born after 1982 as part of the National Immunisation Schedule.

The mumps vaccine is found in combination with the measles and rubella vaccines. The vaccine is known as the MMR vaccine.

• The course consists of 2 doses given at least 4 weeks apart.
• The first dose: at 13 months and the second when the child is over 3 years old.

Rubella is spread by sneezing and coughing. Rubella symptoms include a rash, sore throat, and swollen glands in the neck. Rubella is a benign condition in infants and seldom causes difficulties, but it may be quite deadly in adults and have significant repercussions for a pregnant woman’s foetus. If the mother has German measles while pregnant, the child may be born with hearing loss, blindness, brain damage, or cardiac difficulties.

The vaccine is offered free of charge to those born after 1982 as part of the National Immunisation Schedule.

The rubella vaccine is found in combination with the mumps and measles vaccines. The vaccine is known as the MMR vaccine.

• The course consists of 2 doses given at least 4 weeks apart.
• The first dose: at 13 months and the second when the child is over 3 years old.

Pneumococcal disease is caused by a bacteria that lives in healthy people’s noses and throats. This bacteria spreads by sneezing or coughing and can cause severe sickness in certain people, particularly newborns and young children under the age of five.

There are currently two brands of conjugate pneumococcal vaccines on the market which can be used in infants and children (Synflorix​  and Prevenar13 )​.

• The first dose: from 6 weeks of age.
• A second dose at 4 months.
• A booster dose during the second year of life.

If the course is started later, children under 1 year of age should still receive 2 doses before 1 year and a third dose during the second year of life. If started after the child is 1 year old, the course consists of 1 dose followed by another dose at least 2 months later. Children starting the vaccine between 2 and 5 years of age may receive just 1 dose of Prevenar but still require 2 doses of Synflorix at least 8 weeks apart.

The 10-valent vaccine (SynflorixTM) was introduced on the National Immunisation Schedule in May 2020. It is given as part of the National Immunisation Schedule at 2 months, 4 months and 12 months.

Chickenpox is caused by a highly contagious virus. It creates extensive itching blisters throughout the body. The majority of chicken pox episodes are moderate, although blisters can leave unpleasant skin scars. Complications of the sickness may include pneumonia and encephalitis. If a pregnant woman contracts chicken pox, her baby may be born with skin scars and/or limb malformations.

The chicken pox (Varicella) vaccine is a live vaccine.

• The first dose: from 1 year.
• The course consists of 2 doses given at least 8 weeks apart.

Varicella vaccine is not on the National Immunisation Schedule. 

Rotavirus is a virus that can cause severe diarrhoea and vomiting in newborns. This may result in dehydration and hospitalisation. It spreads through sick children’s stools, hand-to-mouth contact, and contact with contaminated surfaces or items.

The rotavirus vaccine is live and is found in the form of drops given by mouth.

• The course consists of 2 or 3 doses (depending on the brand) given at 6 weeks, 10 weeks and 14 weeks (if applicable) of age.

The rotavirus vaccine is not on the National Immunisation Schedule. 

Human papillomavirus (HPV) is the most prevalent sexually transmitted infection. Most people who have HPV are unaware that they are infected.
The HPV vaccination has been shown to be more effective when administered at a young age, before the individual becomes sexually active, than when given to adults.

The 9-valent HPV vaccine is part of the National Immunisation Schedule and is given free of charge to children  on reaching their 12th birthday.

• HPV vaccine is recommended for children under the age of 9 years. Between the ages of 9 and 14, the vaccine is given in 2 doses spaced 6 months apart.
• After the age of 14, the course is in 3 doses, with the first 2 doses given 1-2 months apart and the third dose given 5 months after the second dose.

Meningococcal disease is a dangerous bacterial infection caused by meningococcus bacteria. Meningitis is an infection of the fluid that surrounds the brain and spinal cord. Anyone can contract meningococcal disease. However, it is more frequent in newborns under one year of age and teens.

A number of vaccines are currently available that offer protection against serotypes A, B, C, W and Y.

This vaccine protects only against the Group C meningococcus and offers no protection against the other Group types.

• The vaccine is given to infants in 3 doses at 2 and 4 months of age with a booster dose at 12 months.
• Children over 1 year of age only need one injection.
• This vaccine is most commonly used in infants.

This is a conjugate polysaccharide combination vaccine which offers protection against meningococcal serotypes A, C, W and Y.

• Depending on the brand It can be given to children and adults from 6 weeks onwards or from 2 years onwards.
• In infants, the schedule is at 3 months and 12 months.
• Over 1 year of age a single dose is sufficient.
• The same applies if started after 2 years.

This vaccine has been introduced on the National Immunisation Schedule in June 2020 and is given at 3 months, 13 months and 14 years. This last dose at 14 years should be given irrespective of previous vaccinations against the meningococcus types ACW and Y. This is because teenagers are more prone to meningococcal infection, so boosting the immune response is beneficial at this age.

There are currrently two types of Meningitis B Vaccine:
1. BEXSERO Meningitis B Vaccine:

• The first dose: from from 2 months onwards using the following schedule:

This vaccine has been introduced on the National Immunisation Schedule in June 2020. It is given at 2 months, 4 months and 12 months.

2. TRUMENBA Meningitis B Vaccine:

• The first dose: from 10 years onwards and is given in 2 doses administered at a 6-month interval.
• A booster dose is not necessary in normal cases.

Influenza is caused by a virus that changes seasonally. That is why the influenza vaccination should be taken every year.

Influenza is a highly infectious disease that spreads by sneezing, coughing, and touching infected surfaces before moving the hands to the eyes, nose, and mouth. The symptoms separate it from the typical cold. Influenza is characterised by high temperature, muscular pains, headaches, sore throat, dry cough, lack of appetite, and excessive weariness. Young children may appear with fever, vomiting, and diarrhoea.

Influenza vaccination protects against the seasonal flu. The vaccine is made up of a variety of influenza virus types that are likely to appear this winter. Because the predicted virus strains fluctuate from year to year, a new vaccination should be developed each time.

• The vaccine can be given to children over 6 months of age.
• For children over 2 years the live attenuated vaccine (LAIV) is now available. This is given in the form of a nasal spray thus avoiding injection. This form of the vaccine may be given up to the age of 17 years.