Which vaccinations are mandatory in EU member states? Country-by-country analysis

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The countries' vaccination schedules determine when patients should be vaccinated against a given disease and which vaccinations are compulsory for which group. / Foto via flickr (CC BY 2.0) [Marco Verch Professional Photographer]

While almost whole of the vaccination-related discussion focused on the jabs against COVID-19 – the new disease that caused the largest in scale pandemic in decades – we tend to forget that the invention of vaccine as a way of immunisation has helped to eliminate or at least to minimise the extent of emergence of various diseases.

 

 

Countries develop their own vaccination schedules that include the most common and most needed vaccinations. Some EU countries make vaccinations of babies and children mandatory, others do not. In most countries the basic vaccines are funded by national health systems, whereas in some states some vaccines must be paid for.

The vaccine-preventable diseases under EU surveillance include 2009 influenza A (H1N1), cholera, congenital rubella syndrome (CRS), COVID-19, diphtheria, hepatitis B, human papillomavirus infection, haemophilus influenzae type b, invasive pneumococcal disease, Japanese encephalitis, measles, meningococcal disease, mumps, pertussis, poliomyelitis, rabies, rotavirus infection, rubella, seasonal influenza, smallpox, tetanus, tuberculosis, typhoid and paratyphoid fever, varicella, and yellow fever (YF).

What's the difference between COVID-19 vaccines? Pfizer, Moderna, AstraZeneca, Johnson & Johnson

The European Commission has so far approved four vaccines for use throughout the European Union that provide immunity to the disease-causing COVID-19 coronavirus SARS-CoV-2.

Which vaccinations are mandatory in the EU countries and which are free of charge?

Austria

Austria, there are no mandatory vaccinations of children. Until the 5th month it is advised to vaccinate a baby with two doses of vaccines against rotavirus infection, diphtheria, tetanus, pertussis, poliomyelitis, haemophilus influenzae type b, hepatitis B. The vaccinations are repeated around the child’s first birthday, around 7-9 years old, and twice in an adult age. Children are vaccinated against pneumococcal and meningococcal diseases in the 3th to 5th month of their lives, and the consecutive doses are provided when a child is 1 year old. The vaccination against meningococcal disease is then repeated when a patient is 11-13 years old.

From the three last months of a child’s first year it is recommended to provide it with a first dose of a vaccine against measles, mumps and rubella. In the child’s second year of life a vaccine against varicella and influenza should be provided, as well as jabs against hepatitis A and tick-borne encephalitis. From those four, only the jab against influenza is refunded. Around 11-13 years old it is advised to vaccinate a child against human papillomavirus infection. Around 60 years old one may be vaccinated against herpes zoster.

Belgium

Babies born to a mother infected with hepatitis B are offered a dose against hepatitis B at birth simultaneously with HB immunoglobulin. Around the 2nd-4th month of life, babies can be provided with three doses against rotavirus infection, which are not refunded. At the same time, they receive first doses against diphtheria, tetanus, pertussis, poliomyelitis, haemophilus influenzae type b, and hepatitis B. All those vaccinations are repeated in the 15th month of life, the first four, yet another time around 5-6 years old. In the case of the first free it is also advised to provide a patient with two other doses around 14-15 years old and later in life (in this last case, vaccination is not refunded). The three first doses against poliomyelitis are the only mandatory vaccinations in Belgium.

Children receive three doses against pneumococcal disease (2nd, 4th and 12th month) and two doses against meningococcal disease (in the age of 15th month and 14-16 years). The jabs against measles, mumps and rubella are provided in two doses, in the 12th month of life and between 7 and 9 years old. The vaccines against varicella and hepatitis A are only recommended for specific high-risk groups and provided from 12 years old. Only this second one is refunded. Vaccination against influenza is recommended for elderly people (65+), but it is refunded for everyone from 6 years old.

Bulgaria

In Bulgaria, almost all types of vaccinations included in the basic schedule are mandatory, apart from the optional dose of jab against pneumococcal disease, which is provided in elderly age and not refunded, and the vaccines against influenza and human papillomavirus infection. The remaining types of vaccines are not only mandatory, but also refunded.

This includes vaccines against tuberculosis (given to newborns, in the first two days of life), diphtheria, tetanus (both: 2, 3, 4, 16 months, 6, 12, 17 y.o. and later) , pertussis (2, 3, 4, 16 months, 6, 12 y.o.), poliomyelitis (2, 3, 4, 16 months, 6 y.o.), Haemophilus influenzae type b (2, 3, 4, 16 months old), hepatitis B (at birth and through six first months of life), pneumococcal disease (2, 4, 12 months old), and measles, mumps and rubella (13 months, 12 y.o.).

Croatia

All types of vaccinations included in the national basic vaccine schedule are mandatory but those against tuberculosis (newborns), human papillomavirus infection (14 y.o.) and influenza (from 6 months old, strongly recommended for elderly people). All mentioned vaccinations are funded by the national health body.

Cyprus

Vaccinations are voluntary. Most types of vaccines are state-funded. Among the paid ones are another dose of jab against meningococcal disease (for patients from 2 y.o.), jab against hepatitis A, and, in the case of most groups, the vaccine against influenza, which is provided to patients from 6 mths old, but is funded only for those over 65.

Czech Republic

Among the mandatory vaccinations are those against tuberculosis (at birth, but for at-risk groups only), rotavirus infection (6 weeks, 2, 3 m.o.), diphtheria (3, 5, 11-13 mths, 5-6, 10-11 years), tetanus (3, 5, 11-13 mths, 5-6, 10-11, 25-26 years, next doses every 10-15 years), pertussis (3, 5, 11-13 mths, 5-6, 10-11 years), poliomyelitis (3, 5, 11-13 mths, 10-11 years), haemophilus influenzae type b (3, 5, 11-13 mths), hepatitis B (at birth for babies from HBsAg-positive mothers, 3, 5, 11-13 mths), measles, mumps and rubella (13-18 mths, 5-6 y.o.), and hepatitis A (from 60 y.o.).

Most of non-mandatory vaccines are paid, including the subsequent doses of jabs against pertussis (recommended in pregnancy and for elderly people), herpes zoster (recommended “as soon as possible”, but strongly advised for all people over 50) and tick-borne encephalitis (from 12 mths old, 3 doses, re-vaccination every 5 years), as well as those indended for at-risk groups only.

Denmark

No vaccinations are mandatory, but all are state-funded. The vaccinations recommended for all citizens include those against diphtheria, tetanus, pertussis and poliomyelitis (all four: 3, 5, 12 mths, 5 y.o.), haemophilus influenzae type b (3, 5, 12 m.o.), pneumococcal disease (3, 5, 12 m.o.), measles, mumps and rubella (15 m., 4 y.o.), and human papillomavirus infection (12 y.o.). Vaccines against influenza are particularly recommended (and state-funded) for people from 65 years old.

Estonia

There are no mandatory vaccinations. Most vaccines are free in all age groups they are recommended, excluding the pneumococcal disease, influenza, and herpes zoster vaccines. Only girls are vaccinated against human papillomavirus infection, administered at the age of 12. When it comes to vaccination of adults, they can be vaccinated against diphtheria and tetanus free of charge.

Finland

Similarly to Estonia, Finland does not impose on its citizens the duty to vaccinate themselves against any disease, yet it provides funding for most of the vaccines. Those payable include only the jabs against pneumococcal disease for senior people belonging to at-risk groups, at tick-borne encephalitis. Vaccines against influenza are also free.

France

All vaccines are free of charge. Babies up to 18 m.o. must be vaccinated obligatorily against diphtheria, tetanus, pertussis, poliomyelitis, haemophilus influenzae type b, hepatitis B, and pneumococcal disease (all: 2, 4, 11 m.o.), meningococcal disease (5, 12 m.o.) and measles, mumps and rubella (12, 16-18 m.o.). Vaccinations against diphtheria, tetanus, pertussis and poliomyelitis should be repeated around 6 y.o., between 11 and 13 y.o., around 25 y.o., 45 y.o. and every 10 years from 65 y.o., although it is not compulsory.

Girls between 11 and 14 y.o. are vaccinated with two doses against human papillomavirus infection. Influenza vaccines are especially recommended for people over 65 y.o., as well as jabs against herpes zoster.

Germany

No vaccinations are mandatory, but most vaccines are funded by the state. There are recommendations to vaccinate babies against rotavirus infection (6 weeks, 2, 3, 4 m.o.), diphtheria, tetanus, pertussis, poliomyelitis, haemophilus influenzae type b, hepatitis B (all: 2, 3, 4, 11-14 m.o.), pneumococcal disease (2, 4, 11-14 m.o.), meningococcal disease (12-23 m.o.), measles, mumps and rubella. and varicella (both: two doses from 11 to 23 m.o.).

Subsequent doses against diphtheria, tetanus and pertussis are administered around 5-6 y.o., between 9 and 17 y.o. and then every 10 years.

Greece

Vaccination is not mandatory and the vaccines included in the basic vaccine schedule are state-funded. It is recommended to vaccinate babies and with three doses against rotavirus infection in their 2nd, 4th and 6th months, four doses against diphtheria, tetanus, pertussis  (2, 4, 6, 15-18 m.o.). three against poliomyelitis and hepatitis B (2, 4, 6-18 m.o.), and three against pneumococcal disease (2, 4, 12 m.o.). Babies are also inoculated against meningococcal disease (12 m.o.), measles, mumps, rubella and varicella (12-15 m.o.).

Among the vaccinations repeated later in life are those against measles, mumps and rubella and varicella (2-3 y.o.), diphtheria, tetanus and pertussis (4-6, 11-12 y.o., the subsequent doses every 10 years), pneumococcal disease (65+ y.o.) and meningococcal disease (11-12 y.o.). Children’s vaccinations also include those against hepatitis A (recommended for 2-5 y.o. children, but a catch-up jab may be provided later in life) and human papillomavirus infection (11-12 y.o.). People over 65 y.o. are recommended to get vaccinated with free-of-charge jabs against influenza and herpes zoster.

Hungary

Mandatory are vaccinations against tuberculosis (at birth), diphtheria, tetanus and pertussis (2, 3, 4, 18 m.o., 6, 11-12 y.o.), poliomyelitis (2, 3, 4, 18 m.o., 6 y.o.), haemophilus influenzae type b (2, 3, 4, 18 m.o.), hepatitis B (12-13 y.o.), pneumococcal disease (2, 4, 12 m.o.), measles, mumps and rubella (15 m.o., 11-12 y.o.) and varicella (13, 16 m.o. – mandatory for the children born after 31 July 2018). The last doses of jabs against diphtheria, tetanus, pertussis, hepatitis B and measles, mumps and rubella are provided in schools to 6- and 7-graders.

Vaccination against human papillomavirus infection (12-13 y.o.) is non-mandatory. The same concerns influenza vaccines. They are however recommended for elderly people. Seniors are also advised to get the last dose of the jab against pneumococcal disease – the only vaccination of those mentioned, which is not funded by the national health bodies.

Ireland

All vaccinations in the basic vaccination schedule are voluntary. They are also state-funded. This includes vaccines against tuberculosis (provided to newborns), rotavirus infection (2, 4 m.o.), diphtheria, tetanus and pertussis (2, 4, 6 m.o., 4-5, 12-13 y.o.), poliomyelitis ((2, 4, 6 m.o., 4-5, 12-13 y.o.), haemophilus influenzae type b (2, 6, 13 m.o.), hepatitis B (2, 4, 6 m.o.), pneumococcal disease (2, 6, 13 m.o.), meningococcal disease (2, 4, 6, 12, 13 m.o., 12-13 y.o.), measles, mumps and rubella (12 m.o., 4-5 y.o.), and human papillomavirus infection (12-13 y.o., gender-neutral and provided in schools in the first year of second level of education). Vaccines against influenza are also free.

Italy

The mandatory vaccinations include those against diphtheria, tetanus, pertussis, poliomyelitis (all administered to 3, 5, 11 m.o., 6, 12-18 y.o. children and adolescents), haemophilus influenzae type b and hepatitis B (both: 3, 5, 11 m.o.), as well as jabs against measles, mumps and rubella (13-15 m.o., 6 y.o.). Vaccinations against rotavirus infection (2-3 doses from the 3rd to the 7th months of life), pneumococcal disease (3, 5, 11 m.o., after 65 y.o.), meningococcal disease (3, 4, 6, 13, 14-15 m.o., 12-18 y.o.) and human papillomavirus (from 12 y.o.) are optional, but strongly recommended.

Influenza vaccines, although it is administered from 6 y.o., is especially recommended to people over 65 y.o. For elderly persons, it is also advised to get vaccinated against herpes zoster. Moreover, it is recommended to repeat vaccination against diphtheria, tetanus and pertussis every 10 years. All the mentioned types of vaccines are funded by the national system.

Latvia

Almost all vaccinations in the elementary vaccination system are mandatory. This includes vaccines against tuberculosis (given to newborns), rotavirus (2, 4 and in case of some vaccines 6 m.o.), diphtheria and tetanus (2, 4, 6, 12-15 m.o., 7, 14 y.o.), two doses against pertussis (12-15 m.o., 7 y.o.), four doses against poliomyelitis (2, 4, 6 m.o. and 7 y.o.), haemophilus influenzae type b and hepatitis B (2, 4, 6, 12-15 m.o.), pneumococcal disease (2, 4, 12-15 m.o.), measles, mumps and rubella (12-15 m.o., 7 y.o.), varicella (12-15 m.o., 7 y.o.), and human papillomavirus (12 y.o., girls only). Also, children from 6 m.o. to 2 y.o. must be vaccinated against influenza.

It is recommended to repeat the vaccination against diphtheria and tetanus every 10 years. Elderly people are also advised to get vaccinated against influenza. All the mentioned vaccines are free of charge.

Lithuania

No vaccination in the basic schedule is mandatory. It is recommended to vaccinate newborns against tuberculosis, and babies and children against rotavirus (2, 4, 6 m.o.), diphtheria, tetanus and pertussis (2, 4, 6, 18 m.o., 6-7 y.o., 15-16 y.o., subsequent doses every 5-10 years), poliomyelitis (2, 4, 6, 18 m.o., 6-7 y.o.), haemophilus influenzae type b (2, 4, 6, 18 m.o.), pneumococcal disease (2, 4, 12-15 m.o.), meningococcal disease (3, 5, 12-15 m.o.), measles, mumps and rubella (15-16 m.o., 6-7 y.o.) and human papillomavirus (11 y.o., girls only, two doses with a 6-month interval). All these vaccinations are free.

Luxembourg

All the vaccines in the basic vaccination schedule are non-mandatory and free-of-charge. The recommended vaccination include those against rotavirus (2, 3 m.o.) diphtheria, tetanus and pertussis (2, 3, 4, 13 m.o., 5-6, 15-16 y.o., subsequent doses every 10 years), haemophilus influenzae type b (2, 3, 4, 13 m.o.), hepatitis B (2, 3, 13 m.o., babies born to mothers infected receive their first dose after birth), pneumococcal disease (2, 4, 12 m.o. plus elderly population), meningococcal disease (13 m.o.), measles, mumps and rubella (12, 15-23 m.o.) and varicella (12, 15-23 m.o.), human papillomavirus infection (9-13 y.o., gender-neutral vaccine, 2 doses with 6-month interval) and influenza.

Malta

Vaccinations against diphtheria and tetanus and and poliomyelitis (both: 2, 3, 4, 18 m.o., 14-16 m.o.) are mandatory. Recommended, but non-mandatory are vaccines against pertussis, haemophilus influenzae type b (2, 3, 4, 18 m.o.), hepatitis B (12, 13, 18 m.o.), pneumococcal disease (2, 4, 12 m.o.), meningococcal disease (2, 3, 4, 12, 13 m.o., 14-16 y.o.), measles, mumps and rubella (13 m.o., 3-4 y.o.), human papillomavirus (12 y.o., girls only, 2 doses with a 6-month interval).

The influenza vaccines are particularly recommended for 55+ people, as well as persons suffering from diabetes, with chronic disease of the lungs, liver, or kidneys, persons who are on long-term systemic steroid medication, who are having chemotherapy or radiotherapy, and persons with HIV/AIDS.

Netherlands

No vaccination in the basic vaccination schedule is mandatory. The health authorities recommend to vaccinate babies and children against diphtheria and tetanus (3, 5, 11 m.o., 4, 9 y.o.), pertussis (3, 5, 11 m.o., 4 y.o., poliomyelitis (3, 5, 11 m.o., 4, 9 y.o.), haemophilus influenzae type b and hepatitis B (3, 5, 11 m.o.), pneumococcal disease (3, 5, 11 m.o.), meningococcal disease (14 m.o., 14 y.o.), measles, mumps and rubella (14 m.o., 9 y.o.), and human papillomavirus (12-13 y.o., gender-neutral vaccines offered from 2021, 2 doses with a 6-month interval).

In specific circumstances, (e.g. infants born to a mother not vaccinated against pertussis during pregnancy or infants born to a mother infected with Hepatitis B) babies are given one more dose of vaccines against diphtheria and tetanus, pertussis, poliomyelitis, haemophilus influenzae type b and hepatitis B in their 2nd month. Yet another dose of vaccines against diphtheria and tetanus and pertussis is recommended for pregnant women from 22 weeks gestation.

Tuberculosis vaccines are only given at birth to newborns on specific indications. The jab against rotavirus is offered from June 2020 for high-risk groups. Infants born to a mother infected with hepatitis B should receive their first dose against this disease after birth.

Starting from autumn 2020, healthy adults aged 60 to 75 years are recommended to get another dose against pneumococcal disease. First dose at 60 years is followed by booster doses every 5 years with a last dose at 75 years. Influenza vaccines are particularly recommended for citizens aged 60+.

Poland

Most of the basic vaccines administered to babies and children are mandatory. This includes vaccines against tuberculosis (in the first 24 hours after birth), diphtheria, tetanus and pertussis (2, 4, 5-6, 16 m.o., 6, 14 y.o.), poliomyelitis (4, 5-6, 16 m.o., 6 y.o.), haemophilus influenzae type b (2, 4, 5-6, 16 m.o.), hepatitis B (at birth, 2, 7 m.o.), pneumococcal disease (2, 4, 13 m.o.) and measles, mumps and rubella (13 m.o., 10 y.o.).

The vaccines against rotavirus (6 w.o.-6 m.o.), meningococcal disease (2-6 m.o., 7 m.o.-19 y.o.) and human papillomavirus (11-12 y.o., girls only) are non-mandatory, but recommended. However, they are not state-funded. People over 50 y.o. are also advised to get a booster jab against pneumococcal disease, which is not free either.

The influenza vaccines are not funded by the National Health Fund. They cost about 8-10 euro. The groups that are particularly advised to get vaccinated are children and adolescents (6-19 y.o.) and people over 55 y.o. For people over 75 y.o. and health care workers the vaccine is free.

Portugal

The vaccines in the basic vaccination schedule are non-mandatory and free of charge, including those against diphtheria and tetanus (2, 4, 6, 18 m.o., 5, 10, 25, 45, 65 y.o., subsequent doses every 10 years), pertussis (2, 4, 6, 18 m.o., 5 y.o., also during pregnancy in all ages between 20 to 36 weeks of gestation), haemophilus influenzae type b (2, 4, 6, 18 m.o.), hepatitis B (after birth, 2, 6 m.o.), pneumococcal disease (2, 4, 12 m.o.), meningococcal disease (12 m.o.), measles, mumps and rubella (12 m.o., 5 y.o.), and human papillomavirus infection (10 y.o., girls only, 2 doses with 6-month interval). The vaccines against influenza are particularly recommended for persons from 65 y.o.

Romania

The basic vaccines are non-mandatory and most of them are state-funded. This includes jabs against tuberculosis (after birth), diphtheria and tetanus (2, 4, 11 m.o., 6 y.o., 14 y.o.), pertussis (2, 4, 11 m.o., 6 y.o.), poliomyelitis (2, 4, 11 m.o., 6 y.o.), haemophilus influenzae type b (2, 4, 11 m.o.), hepatitis B (within 24 h after birth, 2, 4, 11 m.o.), pneumococcal disease (2, 4, 11 m.o., included in the calendar depending on the available funds) and measles, mumps and rubella (12 m.o., 5 y.o.).

Also recommended is vaccination against human papillomavirus for girls between 11 and 14 y.o., yet it is not funded by the state. Influenza jabs are not free either, but they are recommended for patients over 65 y.o.

Slovakia

Most of the basic vaccinations for babies and children are mandatory, including those against diphtheria and tetanus (2, 4, 10 m.o., 5, 12 y.o.), pertussis (2, 4, 10 m.o., 5, 12 y.o.), poliomyelitis (2, 4, 10 m.o., 5, 12 y.o.), haemophilus influenzae type b, hepatitis B and pneumococcal disease (2, 4, 10 m.o.), and measles, mumps and rubella (14-17 m.o., 4 y.o.).

Also recommended, but non-mandatory are vaccinations against human papillomavirus (12 y.o., gender-neutral), subsequent booster against diphtheria and tetanus (every 15 years in adults), and booster jabs against pneumococcal disease for 60+ persons (recommended for all, but mandatory only to persons residing in social care facilities).

Flu vaccine is mandatory for at-risk groups based on national legislation. For the rest of the society it is non-mandatory, but strongly recommended for children between 6 and 12 y.o. and people over 60 y.o.

Slovenia

Among the mandatory vaccinations are those against tuberculosis (only to newborn infants of immigrant families who moved to Slovenia from countries with a high incidence of tuberculosis in the last 5 years), diphtheria, tetanus and pertussis (3, 5, 11-18 m.o., 8 y.o., tetanus also 16-18 y.o.), poliomyelitis and haemophilus influenzae type b (3, 5, 11-18 m.o.), hepatitis B (3, 5, 11-18 m.o. – introduced in 2020 for babies born from October 2019, 5-6 y.o. – three doses of monovalent vaccine for children born before October 2019 (first and second dose at 5-6 years of age, before school; third dose in the first school year), and measles, mumps, rubella (11-18 m.o., 5-6 y.o.).

Non-mandatory, but recommended are vaccinations against pneumococcal disease (3, 5, 11-18 m.o.), human papillomavirus (11, 12 y.o., girls only, 2 doses), subsequent booster doses of jab against diphtheria and tetanus (every 10 years) and pertussis for pregnant women (1 dose Tdap vaccine recommended from the 24th week of pregnancy). All the mentioned vaccines are state-funded.

The jabs against influenza are especially recommended for children between 6 and 23 m.o., pregnant women and persons over 65 y.o. The vaccines against tick-borne encephalitis are free-of-charge for children aged 3 y.o. (3 doses) and individuals aged 49 y.o. (3 doses). In both cases additional doses are self-paid.

Spain

None of the vaccinations included in the basic vaccination schedule is mandatory. The recommended vaccinations include those against diphtheria and tetanus (2, 4, 11 m.o., 6, 14, 65 y.o.), pertussis (2, 4, 11 m.o., 6 y.o.), poliomyelitis, haemophilus influenzae type b and hepatitis B (2, 4, 11 m.o.), pneumococcal disease (2, 4, 11 m.o. plus high-risk groups among adolescents and adults), meningococcal disease (4, 12 m.o., 12 y.o. to individuals who have not received any doses of MCV4 since 10 years of age), measles, mumps and rubella (12 m.o., 3-4 y.o.), varicella (15 m.o., 3-4 y.o.), human papillomavirus (12 y.o., girls only, 2 doses).

All the mentioned vaccines are free-of-charge. Influenza vaccinations, which are also free, are recommended for adults and adolescents from 15 y.o., especially for pregnant women. People from 65 y.o. are advised to get a jab every year.

Sweden

No vaccination in the basic schedule is mandatory. Among the recommended vaccinations are those against rotavirus (6 w.o., 3 m.o., 5 m.o. in the case of a pentavalent rotavirus vaccine), diphtheria and tetanus (3, 5, 12 m.o., 5, 14-16 y.o., subsequent booster jabs every 20 years), pertussis (3, 5, 12 m.o., 5, 14-16 y.o. – given to 8-graders), poliomyelitis (3, 5, 12 m.o., 5 y.o.), haemophilus influenzae type b and hepatitis B (3, 5, 12 m.o.), pneumococcal disease (3, 5, 12 m.o., over 65 y.o.), measles, mumps and rubella (18 m.o., 6-8 y.o.) and human papillomavirus infection (gender-neutral, given to students in fifth grade). Most of the mentioned vaccines are free of charge. In the case of the pneumococcal vaccine for elderly population and flu vaccine funding varies by region.

 

All data comes from the European Center for Disease Prevention and Control