Immunisation schedule

1. Scheduling of
Diphtheria-Tetanus-Pertussis
Containing Vaccine Booster Doses
A global picture in 2019
April 2021
Prepared by the US Centers for Disease Control and Prevention (CDC) Global Immunization Division in collaboration with
Immunization Vaccines and Biologicals (IVB) Department of the World Health Organization.
Email contact: vpdata@who.int

2. Background
The current rationale for booster doses of diphtheria-tetanus-pertussis
containing vaccine (DTPCV):
• Waning immunity of DTP primary series
• Outbreaks of disease
• Achieve and maintain maternal and neonatal tetanus elimination (MNTE)
• Relative low vaccine cost for 1 DTP/Pentavalent + 2 tetanus-diphtheria (Td)
doses ($0.398-$1.488 per child)
WHO has been recommending booster doses of DTPCV since 1961
• Recommendation revived in 2017
2

3. Definitions of terms used in this presentation
• DTP vaccine: Vaccines containing diphtheria toxoid, tetanus toxoid, and pertussis (acellular or whole cell pertussis – see below)
• DTP-containing vaccines (DTPCV): Refers to the group of vaccines that contain diphtheria toxoid and/or tetanus toxoid and/or pertussis (acellular or whole cell).
• D: Full concentration diphtheria toxoid component of a vaccine which can be given up to 7 years of age.
• d: Reduced diphtheria toxoid component in a vaccine. Use from 4 years of age (children and adults)a.
• aP: Acellular pertussis. Only aP vaccines should be used for vaccination of persons ≥ 7years of age.
• wP: whole-cell pertussis.
• DTPCV primary series
• 3 dose schedule – Three DTP containing vaccines given between 6 weeks and 6 months of age (WHO recommended)
• 2+1 schedule – Due to their epidemiological situation some countries use an alternative schedule for the primary series of DTPCV. This alternative “2 + 1” schedule consists of a two-
doses given between two to five months of age and one booster dose 6months later, around the first birthday. Main “2 + 1” schedules reported are 2,4 and 10-13months or 3,5, 10-
12months. See slide #41 for list of countries with a 2+1 schedule.
• DTPCV booster dose – WHO recommended doses and age ranges (April 2019)b
• Booster 1 – DTP containing vaccine booster dose given between 12 and 23 months of age
• Booster 2 – DT/Td containing vaccine booster dose given between 4 and 7 years of age
• Booster 3 – Td containing vaccine booster dose given between 9 and 15 years of age
• Minimum recommended interval between each dose is 4 years.
• MNTE: Maternal and Neonatal Tetanus Elimination
• HPV: Human papillomavirus
• WHO: World Health Organization
• “Countries”: the 194 WHO member states in 2019
Sources
a. Desai et.al 2020. Use of tetanus-diphtheria (Td) vaccine in children 4–7 years of age: World Health Organization consultation of experts. https://www.sciencedirect.com/science/article/pii/S0264410X20300335
b. WHO Recommended Routine Immunizations for Children – Summary of position papers (updated April 2019). https://www.who.int/immunization/policy/immunization_tables/en
3

4. WHO recommended schedule for DTPCV (2019)
Age Recommended vaccine* Minimum Intervals
Primary series:
- 3 doses (0 – 6months)
3 doses of DTP-containing vaccine
- Full diphtheria toxoid
Minimum 4 weeks apart
12-23 months (Booster 1) 1 dose of DTP-containing vaccine
- Full diphtheria toxoid
Minimum ≥6 months after
primary series
4-7 years
(Booster 2)
1 dose of DTP/DT/Td- containing vaccine
- Full or reduced diphtheria toxoid
- With or without pertussis
Ideally ≥4 years after previous
dose
9-15 years
(Booster 3)
Td or TdaP containing-vaccine
- Reduced diphtheria toxoid
- With or without pertussis
Ideally ≥4 years after previous
dose
* Depending on local epidemiology
Source: WHO Recommended Immunizations for Children – Summary of position papers (updated April 2019) https://www.who.int/immunization/policy/immunization_tables/en/
Countries currently using whole-cell pertussis vaccine (wP) for the primary series should continue to do so
4

5. Methods
Data sources
• Review of countries national immunization schedules in 2019 as reported in the 2019
WHO-UNICEF Joint Reporting Form (JRF)
• Includes all WHO member states (n=194)
Data compilation and analysis
• Routine immunization schedule data from 2019 was manually abstracted from the
WHO-UNICEF JRF into a Microsoft Excel database
• Analysis includes vaccination schedules for children and adolescents <16 years old
• When a vaccine was reported with a range of eligible ages (ie. 4 to 7 years) the lower
age was used (ie. 4 years).
• Excludes tetanus-containing vaccine doses scheduled only for women of childbearing
age and DTPCV booster doses given outside WHO-recommended age ranges.
• Data descriptively analyzed to examine
• Prevalence of 0, 1, 2, or 3 DTPCV booster doses in national immunization schedules
• DTPCV presentations used
• Alignment of DPTCV booster schedule with other vaccines and school-based vaccination programs
5

6. Prevalence of DTPCV Booster
Dose Schedules
Results
6

7. DPTCV boosters offered outside of
WHO recommended age schedule in 2019
Booster 1 (12-23 Months) Booster 2 (4-7 years) Booster 3 (9-15 years)
11 months
Netherlands (the)
24 Months
Albania
Bhutan
Estonia
Kyrgyzstan
Republic of Moldova
3.25 Years
United Kingdom of Great Britain
and Norther Ireland (the)
3.6 Years
Kuwait
3.75 Years
Guyana
16 Years
Iran (Islamic Republic of)
Jordan
Saint Kitts and Nevis
Uzbekistan
Ukraine
All WHO member states reported above had other DTPCV boosters schedule at other recommended age schedule points, for which they are included in the analysis.
Official data reported by Member States through the WHO/UNICEF joint reporting Form as at 12/27/2020 .
7
DTPCV boosters scheduled out of WHO recommended age ranges (reported above) are not included in the
subsequent analyses for the respective DTP booster dose listed.

8. 8

9. Proportion of countries (n=194) with DTPCV
booster doses, by dose number, 2019
9
Official data reported by Member States through the WHO/UNICEF joint reporting Form as at 12/27/2020.
One DTPCV
booster dose
Two DTPCV
booster doses
23% 4% 4% 2% 14% 4% 15% 34%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Percent countries
No booster doses Booster 1 (12-23 months) Booster 2 (4-7 years)
Booster 3 (9-15 years) Boosters 1 and 2 Boosters 1 and 3
Boosters 2 and 3 All 3 booster doses

10. No Boosters
(n=44)
All 3 Boosters
(n=64)
Booster 1
12-23 mths
(n=10)
Partial Introductions
Booster 2
4-7 years
(n=8)
Booster 3
9-15 years
(n=4)
Boosters
1&2
(n=28)
Boosters
1&3
(n=7)
Boosters
2&3
(n=29)
DTPCV booster doses among countries (n=194), 2019
ARE
ARG
ARM
ATG
AUS
BEL
BGR
BHR
BHS
BLZ
BRB
CAN
CHE
CHL
CRI
CYP
DEU
ECU
EGY
FSM
GEO
GRC
GRD
GTM
HND
HRV
HUN
IDN
ISR
JAM
KOR
LBN
LBY
LCA
LKA
LTU
LUX
LVA
MDG
MEX
MHL
MKD
NIC
OMN
PER
PLW
POL
PRT
PRY
QAT
RUS
SRB
SWZ
SYR
THA
TKM
TTO
TUN
TUR
UGA*
URY
USA
VCT
ZAF
AFG
AGO
BEN
BFA
BGD
CAF
CIV
CMR
COD
COG
COM
ERI
ETH
GAB
GIN
GNB
GNQ
KEN
KHM
LBR
MLI
MMR
MOZ
MRT
MWI
NER
NGA
NPL
PAK
PRK
PNG
RWA
SDN
SEN
SLB
SLE
SOM
SSD
STP
TCD
TGO
TZA
YEM
ZMB
BDI
CPV
DJI
GMB
GUY
HTI
LSO
SYC
VNM
ZWE
AUT
BRN
CHN
DNK
MCO
NIU
TUV
WSM
GBR
GHA
LAO
KIR
AZE
BLR
BOL
BRA
BWA
COL
CUB
DOM
IND
IRN
IRQ
JOR
KAZ
KNA
MAR
DMA
JPN
KWT
MLT
MNE
SGP
SVN
MUS
MYS
NRU
PAN
SAU
SLV
SUR
TJK
TLS
TON
UKR
UZB
VEN
ALB
AND
BIH
BTN
COK
CZE
ESP
EST
DZA
FJI
FIN
FRA
IRL
ISL
ITA
KGZ
MDA
MDV
MNG
NAM
NLD
NOR
NZL
PHL
ROU
SMR
SWE
SVK
VUT
* Observed practice differs from what is reported in the JRF
Official data reported by Member States through the WHO/UNICEF joint reporting Form as at 12/27/2020. 10

11. Countries (n=194) with DTPCV booster doses, by
number of doses (none, 1, 2 or 3), 2019
11
Official data reported by Member States through the WHO/UNICEF joint reporting Form as at 12/27/2020.
44
10
8
4
28
7
29
64
0
20
40
60
80
100
120
140
160
180
No booster doses One booster dose Two booster doses All 3 booster doses
Number
of
countries
(n=194)
No booster doses Booster 1 (12-23 months) Booster 2 (4-7 years) Booster 3 (9-15 years)
Boosters 1 and 2 Boosters 1 and 3 Boosters 2 and 3 All 3 booster doses

12. Proportion of countries (n=194) delivering DTPCV booster
doses by age and booster number, 2019
Some DTPCV boosters offered over a range of years. Indicated at age at first reported offering (Scheduled 18-23 months recorded as 18 months)
Boosters offered outside of the WHO recommended schedule not included
Official data reported by Member States through the WHO/UNICEF joint reporting Form as at 12/27/2020. 12
8%
1%
14%
5%
72%
35%
24%
32%
9% 9%
13%
17% 16%
8%
18% 19%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
12
months
13
months
15
months
16
months
18
months
4
years
5
years
6
years
7
years
9
years
10
years
11
years
12
years
13
years
14
years
15
years
Percent
of
Countries
with
booster
dose
(n=194)
Booster 1 Booster 2 Booster 3
Countries offering Booster 1 (n=109) Countries offering Booster 2
(n=129)
Countries offering Booster 3 (n=106)

13. DTPCV booster doses among 68 Gavi-eligible countries, 2019
Official data reported by Member States through the WHO/UNICEF joint reporting Form as at 12/27/2020.
13
61 12 5 10 3 9
0 10 20 30 40 50 60 70 80 90 100
% Gavi-eligible countries
No booster doses Booster 1 (12-23 months) Booster 2 (4-7 years) Booster 3 (9-15 years)
Boosters 1 and 2 Boosters 1 and 3 Boosters 2 and 3 All 3 booster doses
Two DTPCV
booster doses
One DTPCV
booster dose

14. No Boosters
(n=42)
All 3
Boosters
(n=6)
Booster 1
12-24 mths
(n=8)
Partial Introductions
Booster 2
4-7 years
(n=0)
Booster 3
9-15 years
(n=2)
Boosters
1&2
(n=7)
Boosters
1&3
(n=0)
Boosters
2&3
(n=3)
Mali
Mauritania
Mozambique
Myanmar
Nepal
Niger (the)
Nigeria
Pakistan
Papua New Guinea
Rwanda
Sao Tome and
Principle
Senegal
Sierra Leone
Solomon Islands
Somalia
South Sudan
Sudan (the)
Togo
United Republic of
Tanzania
Yemen
Zambia
Burundi
Djibouti
Gambia
Guyana
Haiti
Lesotho
Viet Nam
Zimbabwe
Ghana
Lao People's
Democratic
Republic (the)
Azerbaijan
Bolivia (Plurinational
State of)
Cuba
India
Tajikistan
Timor-Leste
Uzbekistan
Kyrgyzstan
Republic of
Moldova (the)
Kiribati
Afghanistan
Angola
Bangladesh
Benin
Burkina Faso
Cambodia
Cameroon
Central African
Republic (the)
Chad
Comoros
Congo (the)
Côte d'Ivoire
Democratic Peoples
Republic of Korea
(the)
Democratic Republic
of the Congo (the)
Eritrea
Ethiopia
Guinea
Guinea-Bissau
Kenya
Liberia
Malawi
Armenia
Georgia
Indonesia
Madagascar
Nicaragua
Uganda*
DTPCV booster doses among Gavi-eligible 68 countries, 2019
* Observed practice differs from what is reported in the JRF
Official data reported by Member States through the WHO/UNICEF joint reporting Form as at 12/27/2020.
14

15. Proportion of countries (n=194) scheduling DTPCV booster
doses (3, 2, 1, or none) by WHO Region, 2019
Official data reported by Member States through the WHO/UNICEF joint reporting Form as at 12/27/2020. 15
68%
11%
36%
24%
15%
30%
8%
5%
3%
4%
41%
36%
53%
24%
34%
13%
19%
27%
40%
48%
63%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
AFR (n=47)
WPR (n=27)
SEAR (n=11)
EUR (n=53)
EMR (n=21)
AMR (n=35)
No Boosters 1 Booster 2 Boosters All 3 Boosters

16. Proportion of countries (n=192) scheduling DTPCV booster doses
(3, 2, 1, or none) by World Bank Income Classification*, 2019
*Niue (1 booster) and Cook Islands (2 boosters) not classified according to WB
Official data reported by Member States through the WHO/UNICEF joint reporting Form as at 12/27/2020.
16
76%
36%
4%
12%
16%
7%
12%
3%
29%
47%
38%
9%
20%
42%
50%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
LIC (n=34)
LMIC (n=45)
UMIC (n=55)
HIC (n=58)
Percent of WHO member states
No Boosters 1 Booster 2 Boosters All 3 Boosters

17. Proportion of World Population under 15 years of age* with
schedule of DTPCV booster doses, by dose number, 2019
(n = 183 countries**)
*n= 1,958,502,835
** In 2019, 12 countries did not have data available for population under 15years of age: Andorra, Cook Islands, Dominica, Marshall Islands, Monaco, Nauru, Niue, Palau, Panama, Saint Kitts and Nevis, San
Marino, Tuvalu; n is therefore 183
Official data reported by Member States through the WHO/UNICEF joint reporting Form as at 12/27/2020 and UN 2019 population estimates.
29% 2% 13% 1% 27% 1% 5% 22%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Percent of global population under 15 years of age
No Boosters Booster 1 (12-23 months) Booster 2 (4-7 years) Booster 3 (9-15 years)
Boosters 1 and 2 Boosters 1 and 3 Boosters 2 and 3 All 3 Boosters
One DTPCV booster dose Two DTPCV booster doses

18. Vaccine Presentations used for
DTPCV Booster Doses
Results
18

19. Pertussis vaccine presentation by DTPCV booster dose number, 2019
• Pertussis-containing booster doses are more commonly reported in high- and middle-income countries
o Booster 1 contains pertussis in 37(34)% HICs, 61(55%) MICs and 6(5%) LICs delivering this dose
o Booster 2 contains pertussis in 47(37%) HICs, 37(28%) MICs and (0%) LICs delivering this dose
o Booster 3 contains pertussis in 34(32%) HICs, 5 (5%) MICs and 0% LICs delivering this dose
Official data reported by Member States through the WHO/UNICEF joint reporting Form as at 12/27/2020.
19
44
59
6
0
20
40
60
80
100
120
Number
of
Countries
(n=109)
Countries scheduling Booster 1
(12-23 months) (n=109)
Acellular Whole cell Vaccines Without Pertusis
53
32
44
0
20
40
60
80
100
120
Number
of
countries
(n=129)
Countries scheduling Booster 2
(4-7 years) (n=129)
Acellular Whole cell Vaccines Without Pertusis
40
64
0
20
40
60
80
100
120
Number
of
countries
(n=104)
Countries scheduling Booster 3
(9-15 years) (n=104)
Acellular Whole cell Vaccines Without Pertusis

20. Use of DT (full diphtheria toxoid) vs Td (reduced diphtheria
toxoid) by DTPCV booster dose, 2019
Booster 1 (n=109)
(12-23 months)
Booster 2 (n=129)
(4-7 years)
Booster 3 (n=104)
(9-15 years)
DT-containing vaccine 107 (98%) 96 (74%)b 8 (8%)
High Income Countries 38 (35%) 39 (41%) 7 (88%)
Middle Income Countries 63 (59%) 54 (56%) 1 (13%)
Low Income Countries 6 (6%) 2 (2%) 0 (0%)
Gavi-eligible Countries 19 (18%) 11 (11%) 0 (0%)
Non Gavi-eligible Countries 88 (82%) 83 (86%) 8 (100%)
Td-containing vaccine 2 (2%)a 33 (26%)b 96 (92%)
High Income Countries 0 (0%) 12 (36%) 43 (44%)
Middle Income Countries 0 (0%) 18 (55%) 50 (52%)
Low Income Countries 2 (100%) 2 (6%) 3 (3%)
Gavi-eligible Countries 2 (100%) 4 (12%) 11 (11%)
Non Gavi-eligible Countries 0 (0%) 29 (88%) 85 (89%)
a. Madagascar and Uganda reported scheduling of Td for booster 1 which is outside WHO recommendation for use of vaccines containing reduced diphtheria toxoid
b. Nuie (TdaPIPV) and the Cook islands (DTaP) offer booster 2 but do not have an income classified by the World Bank.
Official data reported by Member States through the WHO/UNICEF joint reporting Form as at 12/27/2020.
20

21. Vaccine presentations by DTPCV booster dose, 2019
n (%) Countries with booster 1
(12-23 months)
(n=112)
n (%) Countries with booster 2
(4-7 years)
(n=135)
n (%) Countries with booster 3
(9-15 years)
(n=107)
DTaP 9 (8%) 12 (9%) 2 (2%)
DTaPHib 3 (3%) 0 (0%) 0 (0%)
DTaPHepBIPV 1 (1%) 1 (1%) 0 (0%)
DTaPHibHepB 2 (2%) 0 (0%) 0 (0%)
DTaPHibHepBIPV 8 (7%) 1 (1%) 0 (0%)
DTaPIPV 2 (2%) 24 (18%) 3 (3%)
DTaPHibIPV 20 (18%) 0 (0%) 0 (0%)
DTwP(DTP) 47 (42%) 30 (22%) 0 (0%)
DTwPHib 2 (2%) 0 (0%) 0 (0%)
DTwPHibHepB 11 (10%) 2 (1%) 0 (0%)
DT 4 (4%) 28 (20%) 2 (2%)
DTIPV 0 (0%) 1 (1%) 1 (1%)
TdaPIPV 0 (0%) 12 (9%) 5 (5%)
Tdap 0 (0%) 6 (4%) 31 (29%)
TdIPV 0 (0%) 0 (0%) 3 (3%)
Td 2 (2%)* 17 (13%) 60 (56%)
A country may schedule more than one different vaccine presentation at the same age-based schedule point leading to increased n for each booster dose
* Madagascar and Uganda reported scheduling of Td for Booster 1 which is outside WHO recommendation for use of vaccines containing reduced diphtheria toxoid
Official data reported by Member States through the WHO/UNICEF joint reporting Form as at 12/27/2020.
21

22. Alignment of DTPCV Booster Doses
with Disease Elimination Initiatives
and other Routinely Recommended
Vaccines
Results
22

23. MTNE not
eliminated
(n=12)
MTNE eliminated
(n=47)
1 Booster Dose
(n=11)
2 Booster Doses
(n=7)
3 Booster Doses
(n=4)
DTPCV booster doses in countries (n=59a) by Maternal Neonatal
Tetanus Elimination (MTNE) Status, 2019
All 3 Boosters 2 Boosters 1 Booster No Boosters
Eliminated MNT 6 (13%) 5 (11%) 7 (15%) 29 (62%)
(n=47) Egypt
Indonesia
Madagascar
South Africa
Turkey
Ugandab
India
Iraq
Namibia
Philippines (the)
Timor-Leste
Burundi
China
Ghana
Haiti
Lao People's Democratic
Republic (the)
Viet Nam
Zimbabwe
Bangladesh
Benin
Burkina Faso
Cambodia
Cameroon
Chad
Comoros
Congo (the)
Côte d'Ivoire
Democratic Republic of the
Congo (the)
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Guinea-Bissau
Kenya
Liberia
Malawi
Mauritania
Mozambique
Myanmar
Nepal
Niger (the)
Rwanda
Senegal
Sierra Leone
Togo
United Republic of
Tanzania
Zambia
MNT partly or not eliminated 0 (0%) 0 (0%) 0 (0%) 12 (100%)
(n=12) Afghanistan
Angola
Central African Republic
(the)
Guinea
Mali
Nigeria
Pakistan
Papua New Guinea
Somalia
South Sudan
Sudan (the)
Yemen
a. WHO member states that are part of the original WHO/UNICEF/UNFPA Maternal and Neonatal Tetanus Elimination Initiative (https://www.who.int/immunization/diseases/MNTE_initiative/en/index1.html)
b. Observed practice differs from what is reported in the JRF
Official data reported by Member States through the WHO/UNICEF joint reporting Form as at 12/27/2020. 23

24. Countries co-administering measles-containing vaccine
(MCV) with DPTCV booster doses in 2019
Booster 1 (12-23 months) with MCV
n=52
Booster 2 (4-7 yrs) with MCV
n=33
Booster 1 & 2 with
MCV n=9
Booster 3 (9-15 yrs)
with MCV n=1
Antigua
and Barbuda
Australia
Bahrain
Barbados
Belize
Bhutan*
Bolivia (Plurinational
State of)
Botswana
Brazil
Burundi
Canada
Costa Rica
Djibouti
Dominica
Dominican
Republic (the)
Ecuador
Egypt
Eswatini
Gambia
Germany
Grenada
Guatemala
Guyana
Honduras
India
Iran (Islamic
Republic of)
Jamaica
Jordan
Lebanon
Lesotho
Libya
Marshall Islands
Micronesia
(Federated
States of)
Morocco
Nauru
Nicaragua
Oman
Palau
Panama
Peru
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the
Grenadines
Singapore
Suriname
Switzerland
Syrian Arab Republic
(the)
Timor-Leste
Tonga
Tunisia
Venezuela (Bolivian
Republic of)
Zimbabwe
*MCV and DPTCV offered at 24 months in Bhutan and 3.25years in United Kingdom, slightly outside of WHO recommended window
Official data reported by Member States through the WHO/UNICEF joint reporting Form as at 12/27/2020.
El Salvador
Greece
Indonesia
Latvia
Republic of Korea (the)
Saudi Arabia
Serbia
United Arab Emirates (the)
United States of America (the)
Algeria
Argentina
Armenia
Azerbaijan
Bahamas (the)
Belarus
Chile
Colombia
Cook Islands
Cuba
Cyprus
Czech Republic
Georgia
United Kingdom of
Great Britain and
Norther Ireland
(the)*
Ireland
Israel
Italy
Kazakhstan
Kyrgyzstan
Lithuania
Malaysia
Montenegro
Niue
Paraguay
Portugal
Republic of Moldova
(the)
Russian Federation
(the)
Tajikistan
Turkey
Turkmenistan
Ukraine
Uruguay
New Zealand
Netherlands (the)
24

25. Limitations (1 of 2)
• JRF data are self-reported; however, these data are currently the only available source
from which the global prevalence of scheduling of DTPCV booster doses can be derived.
• Consistent with previous analyses, the JRF data used in these analyses were not
systematically verified against other data sources or implementation status, although
countries' national immunization schedules (obtained online) were used to clarify any
uncertainties in reported JRF data.
• Where age of vaccination was reported as a range in the JRF the first reported age of
delivery was used, thus may not be reflective of complete range of age cohorts
receiving each vaccine.
• When reporting pertussis vaccine in JRF, if a country did not specify acellular pertussis
vaccine the response defaulted to whole cell pertussis vaccine. This may have led to an
underreporting of acellular pertussis vaccine.
25

26. Limitations (2 of 2)
• Where WHO member states reported multiple vaccine presentations at one
scheduled visit with no commentary, all were included in the reporting of
presentations used. This increased the breadth of vaccine presentations reported.
• In these analyses, the third dose of DTPCV in the 2+1 primary vaccination
schedule (+1) was considered part of the primary DTPCV vaccination schedule.
This reduced the number of WHO member states counted as having a booster
dose of DTPCV in the second year of life (booster 1), per WHO recommendation.
Use of the 2+1 DTPCV primary schedule in 17 WHO member states is considered
immunologically equivalent to 3-dose primary schedule with a DTPCV booster
dose in the second year of lifea.
• In 2019, administrative vaccination coverage for DTPCV booster doses was not
collected in the JRF, thus there are no global coverage estimates available.
26

27. Summary (1 of 2)
• 64/194 (33%) countries had introduced all 3 WHO-recommended DTPCV
booster doses as of 2019
• 44/194 (23%) countries had not introduced any DTPCV booster doses as of
2019
• Among countries that reported offering any DTPCV booster dose in 2019,
14 (9%) scheduled them outside of the WHO recommended age ranges.
• 6 (9%) of the 68 Gavi-eligible countries had introduced all 3 WHO-
recommended DTPCV booster doses by 2019 and 42 (62%) had not
introduced any DTPCV booster doses by 2019.
• DTPCV booster doses containing pertussis decreased with age. As of 2019,
no countries used whole-cell pertussis-containing vaccine at booster 3 (9 –
15 years of age).
27

28. Summary (2 of 2)
• Acellular pertussis vaccine was used more often in DTPCV booster doses in
HICs. In MICs and LICs, combination vaccines containing whole cell pertussis
were more often used for DTPCV boosters.
• WHO recommends countries using whole-cell pertussis in the primary DTPCV series to
continue using this vaccine presentation.
• In line with WHO recommendations, DT-containing vaccine was more often
used for booster 1 (98%) and booster 2 (74%) while Td-containing vaccine
was more commonly scheduled as booster 3 (92%).
• No DTPCV booster doses were introduced in the 12 countries that did not (or
partially) achieved MNTE status in 2019; nor in 29 (62%) countries that
achieved achieved MNTE status.
• A school-based vaccination platform was reported in less than half (39%) of
countries offering DTPCV booster 2 and less than two thirds (60%) of countries
offering DTPCV booster 3.
• 95 (49%) countries had at least one DTPCV booster scheduled at the same time
as measles-containing vaccine (MCV).
28

29. Additional slides
29

30. Scheduling of DTPCV booster doses among 17
countries with 2+1 primary DTP schedule in 2019
30
Country name WHO
REGION
Primary schedule
2, 4, 10 - 12months
Primary schedule
3, 5, 10 – 12months
Booster 1
(12 – 23 months)
Booster 2
(4 – 7years)
Booster 3
(9 – 15years)
Algeria EMR Y (2, 4, 11) Y (6yr) Y (11 – 13yr)
Andorra EUR Y (2, 4, 12) Y (5yr) Y (15yr)
Austria EUR Y (2, 4, 11) Y (6yr) N
Bosnia and
Herzegovina
EUR Y (2, 4, 10) Y (5yr) Y (14yr)
Czech Republic EUR Y (3, 5, 11) Y (5yr) Y (10yr)
Denmark EUR Y (3, 5, 12) Y (5yr) N
Finland EUR Y (3, 5, 12) Y (4yr) Y (14 – 15yr)
France EUR Y (2, 4, 11) Y (6yr) Y (13yr)
Iceland EUR Y (3, 5, 12) Y (4yr) Y (14yr)
Italy EUR Y (2, 4, 11) Y (5 - 6yr) Y (11 – 18yr)
Monaco EUR Y (2, 4, 11) Y (6yr) N
Norway EUR Y (3, 5, 12) Y (7yr) Y (15yr)
Romania EUR Y (2, 4, 11) Y (6yr) Y (14yr)
San Marino EUR Y (3, 5, 11) Y (5yr) Y (15yr)
Slovakia EUR Y (2, 4, 10) Y (5yr) Y (12yr)
Spain EUR Y (2, 4, 11) Y (6yr) Y (14yr)
Sweden EUR Y (3, 5, 12) Y (5yr) Y (14 – 16yr)

31. DTPCV booster doses among 47 countries in AFR
Region, by dose number in 2019
Official data reported by Member States through the WHO/UNICEF joint reporting Form as at 12/27/2020.
31
32 6 1 2 2 4
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Percent of Region
No booster doses Booster 1 (12-23 months) Booster 2 (4-7 years) Booster 3 (9-15 years)
Boosters 1 and 2 Boosters 1 and 3 Boosters 2 and 3 All 3 booster doses
One DTPCV
booster dose
Two DTPCV
booster doses

32. DTPCV booster doses among 35 countries
in AMR Region, by dose number in 2019
Official data reported by Member States through the WHO/UNICEF joint reporting Form as at 12/27/2020.
32
2 10 1 22
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Percent of Region
No booster doses Booster 1 (12-23 months) Booster 2 (4-7 years) Booster 3 (9-15 years)
Boosters 1 and 2 Boosters 1 and 3 Boosters 2 and 3 All 3 booster doses
One DTPCV
booster dose
Two DTPCV
booster doses

33. DTPCV booster doses among 21 countries
in EMR Region, by dose number in 2019
One country in the WHO EMR Region has a 2+1 primary pertussis vaccination schedule.
Official data reported by Member States through the WHO/UNICEF joint reporting Form as at 12/27/2020.
33
5 1 5 1 9
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Percent of Region
No booster doses Booster 1 (12-23 months) Booster 2 (4-7 years) Booster 3 (9-15 years)
Boosters 1 and 2 Boosters 1 and 3 Boosters 2 and 3 All 3 booster doses
One DTPCV
booster dose
Two DTPCV
booster doses

34. DTPCV booster doses among 53 countries in EUR
Region, by dose number in 2019
34
16 countries in the WHO European Region have a 2+1 primary pertussis vaccination schedule thus booster dose 1 is not offered in these countries.
Official data reported by Member States through the WHO/UNICEF joint reporting Form as at 12/27/2020.
3 1 6 3 19 21
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Percent of Region
Booster 1 (12-23 months) Booster 2 (4-7 years) Booster 3 (9-15 years)
Boosters 1 and 2 Boosters 1 and 3 Boosters 2 and 3
All 3 booster doses
One DTPCV booster dose Two DTPCV booster doses

35. DTPCV booster doses by primary DTPCV vaccination schedule
among 53 countries in EUR Region, by dose number in 2019
35
Official data reported by Member States through the WHO/UNICEF joint reporting Form as at 12/27/2020.
3
1 6 3
13
6 21
0 5 10 15 20 25 30 35 40 45 50
2+1 primary schedule (n=16)
3 dose primary schedule (n=37)
n WHO member states in the WHO European Region (n=53)
No booster doses Booster 1 (12-23 months) Booster 2 (4-7 years) Booster 3 (9-15 years)
Boosters 1 and 2 Boosters 1 and 3 Boosters 2 and 3 All 3 booster doses

36. DTPCV booster doses among 11 countries
in SEAR Region, by dose number in 2019
Official data reported by Member States through the WHO/UNICEF joint reporting Form as at 12/27/2020.
36
4 2 2 3
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Percent of Region
No booster doses Booster 1 (12-23 months) Booster 2 (4-7 years) Booster 3 (9-15 years)
Boosters 1 and 2 Boosters 1 and 3 Boosters 2 and 3 All 3 booster doses
Two DTPCV booster doses

37. DTPCV booster doses among 27 countries in
WPR Region, by dose number in 2019
Official data reported by Member States through the WHO/UNICEF joint reporting Form as at 12/27/2020.
37
3 1 4 2 3 2 7 5
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Percent of Region
No booster doses Booster 1 (12-23 months) Booster 2 (4-7 years) Booster 3 (9-15 years)
Boosters 1 and 2 Boosters 1 and 3 Boosters 2 and 3 All 3 booster doses
One DTPCV booster dose Two DTPCV booster doses

38. Number of countries (n=192*) with pertussis vaccine by type of
pertussis vaccine, income level and booster dose number, 2019
*Niue (1 Booster) and Cook Islands (2 Boosters) do not have an income classification from the World Bank
Official data reported by Member States through the WHO/UNICEF joint reporting Form as at 12/27/2020. Income classification from World Bank, July 2020
38
2 2
15
25
1
9
41
1 4
34
4
16
27
12
6
20
6
2
2
1
1
4
15
21
4
3
18
28
16
0
10
20
30
40
50
60
LIC LMIC UMIC HIC LIC LMIC UMIC HIC LIC LMIC UMIC HIC
Booster 1 (12-23mnths) n=106 Booster 2 (4-7yrs) n=127* Booster 3 (9-15yrs) n=104
n
WHO
member
states
Acellular Whole Cell Vaccines Without Pertussis