Childhood vaccination in Georgia: the national immunisation calendar

Parents who have moved to Georgia or are raising a child here most often ask three questions: which vaccinations are due and at what age, what to do if some were given in another country, and what to do if the documents are lost. Below is what the Georgian document that establishes the calendar itself says about this — not a retelling from other people's websites.

The national immunisation calendar by age

0–12 hours after birth

Hepatitis B — first dose, in the maternity hospital.

0–5 days

BCG — against tuberculosis, in the maternity hospital.

2 months

Hexavalent vaccine (diphtheria, acellular pertussis, tetanus, hepatitis B, Haemophilus influenzae type b, inactivated polio) — first dose; pneumococcal — first dose; rotavirus (drops by mouth) — first dose.

3 months

Hexavalent vaccine — second dose; rotavirus — second dose.

4 months

Hexavalent vaccine — third dose; pneumococcal — second dose.

12 months

Pneumococcal — third dose; measles-mumps-rubella (MMR) — first dose.

18 months

Booster against diphtheria, (acellular) pertussis, tetanus and (inactivated) polio.

5 years

Measles-mumps-rubella (MMR) — second dose; booster against diphtheria, pertussis, tetanus and polio.

10–11–12 years

Human papillomavirus (HPV) vaccine — for girls and boys, a two-dose course with a minimum interval of 6 months between doses. The minimum age to start the course is 9 years.

14 years and older

Tetanus-diphtheria (Td). After the primary course is completed, a booster is given every 10 years — up to age 55.

Intervals and rules worth knowing in advance

• Hexavalent vaccine: a three-dose course at 2, 3 and 4 months, with a minimum interval of 4 weeks between doses; use of the vaccine is recommended up to 24 months.
• Pneumococcal vaccine: a three-dose course; the minimum interval between the first and second doses is 8 weeks, between the second and third — 6 months.
• Rotavirus vaccine: a two-dose course with a minimum interval of 4 weeks; the first dose is recommended before 16 weeks and the whole course completed by 24 weeks. This is the only vaccination in the calendar with such a firm upper age limit — a missed window cannot be 'caught up'.
• MMR: a two-dose course; unvaccinated children and adolescents are given two doses with a minimum permitted interval of 4 weeks.
• BCG: if the child was not vaccinated in the maternity hospital, the vaccination is given at the first opportunity up to 1 year. For children older than 12 months born in Georgia or another country with high tuberculosis prevalence, BCG is no longer recommended — the vaccine's protective effect at that age decreases. A Mantoux test is not done before BCG.
• The same vaccine: the minimum interval between doses is 4 weeks. Live and non-live vaccines can be given at one visit, with separate syringes and at different sites on the body: the immune system is able to respond to several antigens at once.

If vaccinations were missed or given in another country

The order answers this question directly: every unvaccinated or not fully vaccinated person under the age of 18 must be vaccinated with the vaccine appropriate to their age under the national calendar. In other words, missed dates are not a 'missed train' but a task for catch-up vaccination, and it is solved within the same calendar.

• Diphtheria, tetanus, pertussis, polio: for an unvaccinated child aged 2 to 13 the course is given three times — a minimum interval of 4 weeks between the first and second doses, and a recommended interval of 6 months between the second and third.
• Pneumococcal vaccine in the unvaccinated: at 7–11 months the course is three doses (the first two at least 4 weeks apart, the third in the second year of life, at least 8 weeks after the second); from 12 months to 5 years — a two-dose course with a minimum interval of 8 weeks.
• Measles-mumps-rubella in the unvaccinated: two doses with a minimum interval of 4 weeks, no matter how far past the calendar age the child is.

The situation without documents is dealt with separately. If there is no documentation confirming vaccination status, the child is considered unvaccinated, and on the day of the visit to the medical facility they must be given all the missed vaccinations with vaccines appropriate to their age. That is an important practical consequence for families who moved without a vaccination card: a lack of papers does not leave a child 'between systems'.

What not to do is 'order in' the missing vaccinations yourself from a table on the internet. The schedule depends on what has already been given, at what age and with which products, and an unknown past is a medical task, not arithmetic.

The vaccination card and electronic records

The vaccination card (form № 01) is issued by the medical facility or the village doctor with whom the person is registered — either on paper or as a printout from the electronic immunisation management module. The order expressly provides for the second route as well: a citizen can download the immunisation application themselves, sign in and print an electronic vaccination card to present as needed. Medical staff are required to record in the electronic module not only the vaccinations given but also refusals, contraindications and complications.

How refusal of a vaccination works in Georgia

Here the Georgian rules differ from what parents from many countries are used to, so the wording is given as it stands. Under the text of the order, apart from cases of deferral or non-administration of a vaccination on medical grounds (immunodeficiency and immunosuppressive therapy, contraindications and precautions), the patient, parent or legal representative does not have the right to refuse a preventive vaccination.

• Before a vaccination, medical staff are required to give full information: why the recommended vaccine is needed, what being unvaccinated risks, and what adverse events are possible after immunisation.
• On a categorical refusal by the parent or legal representative, staff complete the established refusal-of-preventive-vaccination form, enter a record in the refusals log and register the refusal in the electronic immunisation management module.
• The reasons for non-administration or deferral of a vaccination are entered in the vaccination card (form № 01) and registered in parallel in the electronic module.

Contraindications: real and 'false'

The question of whether to vaccinate, postpone or not vaccinate at all is decided by the doctor — with reference to the table of contraindications and precautions in the order. For all vaccines, a contraindication is a severe allergic reaction or complication to a previous dose or to a vaccine component: anaphylaxis, shock, collapse, encephalopathy or encephalitis, convulsions without fever. A precaution — that is, a reason to postpone rather than cancel — is an acute illness of moderate severity or a severe one with marked clinical signs, with or without fever: the vaccination is carried out after recovery. Live vaccines have their own contraindications listed separately, including immunosuppressive therapy and states involving immunodeficiency.

A separate article of the order is the list of 'false contraindications': states that are NOT a reason to withhold or postpone a vaccination. It is because of these that children most often lose their calendar dates without medical grounds. The list includes, among others:

• a mild upper respiratory illness — with or without a temperature;
• a mild or moderate local reaction to a previous dose of the vaccine, as well as a mild or moderate general reaction to it;
• perinatal encephalopathy and stable neurological states — including cerebral palsy, developmental delay, controlled convulsions and controlled epilepsy;
• anaemia, underweight, dysbacteriosis, enzymopathy, developmental defects;
• chronic tonsillitis, otitis, an enlarged thymus shadow;
• allergy, asthma, hay fever, eczema, diathesis — the only exception is a severe allergic reaction to a previous dose or a vaccine component;
• local steroids and antimicrobial therapy;
• diarrhoea without intoxication;
• contact with an infected person or a recently passed infection, as well as the recovery phase after an acute illness;
• prematurity and low birth weight — at a weight over 2000 g;
• a history of sepsis, haemolytic disease of the newborn;
• autoimmune diseases — systemic lupus erythematosus, rheumatoid arthritis;
• pregnancy in the mother or another close contact; breastfeeding or formula feeding.

Why every country has its own calendar

A national calendar is not a universal list but a decision by a particular country. It rests on international recommendations, but takes into account which infections are common on its territory, which vaccines are available and how the healthcare system is organised. That is why the dates and the set of vaccinations in two neighbouring countries can differ, and that is not a mistake on either side.

Something important for parents follows from this: the calendar of the country you came from is neither cancelled nor 'reset', but nor is it carried over automatically. Matching what has been done against what is practised here is a doctor's job — by dates, vaccine names and numbers of doses. The infections the calendar protects against remain real: measles, for example, continues to cause outbreaks precisely where vaccination coverage falls.

Vaccination during an illness

The order's logic here is simple: a mild upper respiratory illness — a runny nose, a leftover cough, even with a low temperature — is expressly classed among the false contraindications, while an acute illness of moderate severity or a severe one with a marked clinical picture is a reason to move the vaccination until recovery. The line between those two situations is drawn by the doctor at the examination on the day of vaccination: they also take into account chronic illnesses, medicines being taken and reactions to previous doses. There is no universal home rule here.

What can happen after a vaccination

Expected reactions are soreness and redness at the injection site, a raised temperature, sleepiness or fussiness in the first day or two. That is not a complication but the body's response. Adverse events following immunisation in Georgia are subject to registration: medical staff have a duty to record them, so any unusual reaction is worth reporting to the doctor even if it has already passed. The signs in the list below should put you on alert: they call for seeing a doctor, not watching at home.

When a separate consultation is needed

• The child arrived from another country, and what has been done needs to be matched against what is practised here.
• The vaccination documents are lost or incomplete.
• There is a chronic illness, immunosuppression or regular medication.
• There was a marked reaction to a previous dose.
• The dates were missed by a long way and it is unclear where to resume.
• The child is close to the upper age limit for a particular vaccine — for example the rotavirus one, where the course must be completed by 24 weeks.
• You have doubts and want to discuss the decision calmly rather than in the corridor before the procedure.

This page is for general information only and is not a substitute for a consultation with a doctor. A child's diagnosis and treatment are determined by a doctor during an examination.