The vaccination schedule is the best schedule for every child in the Netherlands. Therefore, there is no medical reason for a healthy child to deviate from the schedule.

Starting vaccination later

There is no medical reason to deviate from the vaccination schedule of the National Immunisation Programme. Vaccinating later is risky, because a child will be unprotected for longer. Since 2020, most children receive the first DTaP-IPV-Hib-HBV vaccination after 3 months of age if the mother was vaccinated against whooping cough during pregnancy. After the first vaccination, additional vaccinations at 5 months and 11 months are still needed to ensure effective, long-lasting protection. If the mother was not vaccinated against whooping cough during pregnancy, the child will get a first vaccination at 2 months. This is because many young infants can become seriously ill from whooping cough. Subsequent vaccinations are then given at 3 months, 5 months and 11 months. A child can easily tolerate vaccinations with multiple components at a young age, and vaccinating earlier ensures that children are protected at a younger age. In some other European countries, the vaccination programme for all babies starts at 3 months. That means that those children receive one less DTaP-IPV-Hib-HBV vaccination before the age of 12 months. This alternative schedule is listed in the vaccine information leaflet and results in similar protection after completing the entire series of vaccinations.

Rescheduling a vaccination time

It may be necessary to reschedule vaccination times. There may be medical or practical reasons for this. A child may be ill or need surgery. Or a child may temporarily be taking medication that is not advisable to combine with vaccination, or the scheduled time may not be convenient due to travelling abroad. Discuss the options with the paediatrician at the well-baby clinic. The doctor can check what is best for you and your child. If necessary, a vaccination can also be given in a different country, or the vaccination can be given at an earlier time, just before departure. If you opt to vaccinate your child in a different country, you will have to arrange that yourself.

Consequences of deviating from the schedule

The consequences of deviating from the vaccination schedule are listed below:

  • Starting vaccination later: Starting later also means delaying build-up of protection, resulting in a higher risk of illness in an infant’s most vulnerable months. Sometimes that means one less vaccination. That may seem better, but it means that the child is unprotected for longer.

  • Spreading out vaccinations: In the National Immunisation Programme, the vaccination schedule is designed to build immunity and ensure that protection remains optimal, even in the period between vaccinations. If vaccinations are given later, it can lead to a period of insufficient protection between vaccinations. During that period, the child has a higher risk of illness. In some cases, leaving a longer interval between vaccinations can have a slightly positive effect on long-term vaccine-induced protection, since it gives the immune system more time to respond well. A vaccination series does not need to be restarted if vaccinations are given later than planned. Similarly, additional vaccinations are not needed if there is a longer interval between vaccinations.

  • Giving vaccinations in a faster sequence: It may be necessary to give a subsequent vaccination earlier because of travel plans. Sometimes it may be possible, but giving multiple vaccinations too close together is not a good idea. The immune system needs time to respond properly and build up enough antibodies. When a series of vaccinations is given in a faster sequence, it may be less effective. In that case, effective long-lasting protection may not be guaranteed. If vaccinations are given too close together, it may sometimes be necessary to give additional vaccine doses to guarantee optimal protection.

  • Skipping vaccinations: To build up effective immunity against some infectious diseases, multiple vaccinations may be required. If a vaccination is skipped, then the child does not have optimal immunity against that infectious disease.

  • Separate vaccines instead of combined vaccines:  Some vaccines are available separately or in combinations that contain fewer components. However, these vaccines are often fundamentally different, and not suitable for children. As a result, vaccination with these vaccines may lead to insufficient protection, leaving the child at risk of getting an infectious disease. This risk is especially relevant for alternatives to DTaP and DT-IPV vaccination in young infants (vaccinations against diphtheria, tetanus and polio). If vaccinations are given separately on multiple occasions, there are also more times when side effects can occur. The side effects of combined vaccines are not more severe than those of separate vaccines or vaccines containing fewer components.

Alternative vaccines

There is no medical reason for a healthy child to deviate from the vaccines used in the National Immunisation Programme.

The vaccines given in the National Vaccination Programme do not have many alternatives that are equally effective. The DTaP-IPV-Hib-HBV vaccine is composed to offer effective protection against the targeted diseases in babies. The DT-IPV and DTaP vaccines available through pharmacies in the Netherlands do not have these properties, and are therefore not suitable for this age group. These vaccines have a lower dose of the immune-boosting substances. The immune system of young children does not respond sufficiently to these vaccinations. However, they can be used as subsequent vaccinations at 4 years and 9 years, and for vaccinations later in life. These repeat vaccinations (boosters) only work optimally in children who have previously been vaccinated with a complete series of DTaP-IPV-Hib-HBV. Vaccinating young infants with these DT-IPV or DTaP vaccines leads to insufficient and unpredictable protection. That means they are still at risk of becoming ill. An example of such a disease is tetanus. A person can get tetanus from contact with street refuse that gets into a wound, or from the bite of a dog or other animal. Children who were vaccinated with the DT-IPV and/or DTaP vaccine as infants will always need the correct vaccine if they are injured, since they may not be sufficiently protected. Tetanus antibodies should also be administered. Tetanus can be fatal.

In the National Immunisation Programme, girls and boys in the Netherlands are vaccinated with Cervarix® to protect against human papillomavirus (HPV) infections. There are also vaccines against HPV that also offer protection against genital warts: Gardasil® and Gardasil9®. These are good alternatives, but are only available through GPs. These vaccinations are not covered by basic health insurance in the Netherlands.

Other vaccinations

Apart from the National Immunisation Programme, other vaccinations are also available that can protect children of various ages against infectious diseases. Here is a summary:

These vaccinations can be arranged through the GP or a travellers clinic. You will need to pay for these vaccines yourself. In some cases, travel vaccinations are reimbursed from supplementary health insurance policies.