Here’s a question that my patients ask all the time: which vaccines do I need for myself and my children?

First, it’s important to realize that each country has their own vaccine schedule.  Even while in China, it’s best to follow your home country schedule, as well as whatever your child’s school requires. So, when you see your expat doctor, you need to bring your child’s immunization book, as they usually detail the schedule. (Here are the schedules for US children and adolescents; Canada; the UK; and other European countries. If you’re interested, here are China’s requirements). Travel vaccines are a separate story and will be discussed in a future post, but you can start by checking out the CDC Travel site.

Routine vaccines: Most countries cover the basics of measles, mumps, rubella, polio, diptheria, pertussis, tetanus and hepatitis B. I assume you’re up to date on these, as well as the adult boosters. If you’re not sure, check your country’s vaccine websites. The main expat issues are the optional vaccines, including hepatitis A, rabies and japanese encephalitis.

Hepatitis A: I think this one should be required, as it now is in the US. Hepatitis A is the food-borne virus, and you often hear about restaurant outbreaks affecting hundreds of people. This virus causes hepatitis, the liver inflammation which can make you feel tired for months, but it doesn’t cause chronic liver disease or cancers like hepatitis B or C.  It is very common in China, as is hepatitis B. If you never got this vaccine, consider it for children and adults! It’s a two shot series, 6 months apart, with no boosters needed.

Rabies: This is the tough scenarioI see all the time: a parent comes in and their unvaccinated child was nipped on the heel by a trusted neighbor’s healthy dog while playing around. What to do? Unfortunately, we usually have to advise that the child needs the entire 5 shot rabies series, plus a painful and very expensive rabies immunoglobulin shot. Why? Because we just can’t guarantee that the dog doesn’t have rabies without killing the dog and performing a brain autopsy. Chinese rabies vaccines for pets do not have the highest reputation for efficacy, so even that isn’t 100% reassuring. It’s an agonizing and painful decision for parents, who of course usually decide on the full treatment because the disease risk, while usually very small, would be 100% fatal.

Rabies is the deadly virus transmitted by mammals, usually dogs, cats and bats. It is not common but is found all over China, especially rural areas, and a few thousand persons die annually. The scary thing about rabies is that it may take over a year to develop symptoms — and it is 100% fatal. And yes, expats have died of rabies. The vaccine is a 3 shot series, given initially and day 7 and day 21-28. If the child was already vaccinated to rabies and is bitten later on, they would only need two rabies vaccine boosters, a much less painful and cheaper treatment than if never vaccinated.

You should definitely consider the rabies vaccine for your children, who are the most vulnerable as they often play with stray dogs and cats, and you may not even be aware that they were bitten.

Japanese Encephalitis: This is a mosquito-born virus which can cause a serious brain infection, sometimes death. It’s more an issue in southern China and islands but Beijing also has cases, and it’s a required vaccine for Beijing infants. I think this vaccine series is good to get if you plan to live here for a few years, and it will also protect you during your travels to southern China and Asia. The vaccine is usually a 3-shot series.

HPV vaccine: This vaccine isn’t Beijing-specific but is newer and may not be well known by Beijingers. It’s important because it will save tens of thousands of women from cervical cancer. HPV is a sexually transmitted virus that causes genital warts, and also is the main contributor to cervical cancer in women. Now, a new vaccine can prevent that virus, and thus the cancer (as well as genital warts, not deadly but not fun). It’s a 3 shot series over 6 months. It’s approved for females age 9-26, and is best given in preteens before becoming sexually active. Call your expat clinic first to see if they have it, as import issues make supply tricky.

For more vaccine information, including safety issues, you can review the American Academy of Pediatrics and the Centers for Disease Control vaccine websites.