Section 4.4: Disease Prevention, Wellness, and Immunization Schedules

Disease Prevention, Wellness, and Immunization Schedules

National Immunization Schedule (MOH Saudi Arabia)

Vaccination is one of the most effective public health interventions. The Saudi Ministry of Health (MOH) publishes and updates national immunization schedules.

Pediatric Immunization Schedule (Birth through School Age)

Pharmacists must be familiar with the timing and sequence of pediatric vaccines:

• At Birth:
  • BCG (Bacillus Calmette-Guérin): Live vaccine preventing tuberculosis meningitis. Given intradermally.
  • Hepatitis B (HepB): First dose of the monovalent HepB vaccine.
• 2 Months:
  • Hexavalent Vaccine (IPV-DTaP-Hib-HepB): Inactivated Polio (IPV), Diphtheria, Tetanus, acellular Pertussis (DTaP), Haemophilus influenzae type b (Hib), and Hepatitis B.
  • Pneumococcal Conjugate Vaccine (PCV): Protection against Streptococcus pneumoniae.
  • Rotavirus (RV): Live oral vaccine preventing viral gastroenteritis.
• 4 Months:
  • Hexavalent Vaccine (second dose).
  • PCV (second dose).
  • Rotavirus (second dose).
• 6 Months:
  • Hexavalent Vaccine (third dose).
  • PCV (third dose).
  • Oral Polio Vaccine (OPV): Live attenuated polio vaccine (given orally for mucosal immunity).
• 9 Months:
  • Measles: Monovalent vaccine.
  • Meningococcal Conjugate Vaccine (MCV4): Covers serogroups A, C, W, and Y. First dose.
• 12 Months (1 Year):
  • MMR (Measles, Mumps, Rubella): First dose of live vaccine.
  • PCV (fourth/booster dose).
  • MCV4 (second dose).
  • Varicella: Live varicella-zoster vaccine (chickenpox). First dose.
• 18 Months (1.5 Years):
  • DTaP (booster).
  • OPV (booster).
  • MMR (second dose).
  • Varicella (second dose).
  • Hepatitis A (HepA): First dose.
• 24 Months (2 Years):
  • HepA (second dose, given at least 6 months after the first).
• School Age (6 Years / First Grade):
  • Boosters: OPV, DTaP, MMR, and Varicella.

Adult Immunization Schedule

Adult schedules focus on booster doses, travel, and high-risk age-based or comorbidity-based indications:

• Influenza: Annual dose for all individuals $\ge 6$ months of age, particularly pregnant women, healthcare workers, and patients with chronic diseases.
• Tdap: One dose of Tdap should replace a Td booster, then a Td or Tdap booster every 10 years. Pregnancy: A dose of Tdap is recommended during every pregnancy (ideally between 27 and 36 weeks gestation) to pass passive pertussis antibodies to the neonate.
• Pneumococcal Vaccines:
  • Indication $\ge 65$ years: Give PCV20 alone, or PCV15 followed by PPSV23 one year later.
  • Indication 19–64 years with risk factors (e.g., diabetes, chronic heart/lung/liver disease, immunocompromised): Administer PCV20, or PCV15 followed by PPSV23.
• Herpes Zoster (Shingrix): Recombinant, non-live zoster vaccine recommended for adults $\ge 50$ years (2 doses, spaced 2–6 months apart) regardless of prior shingles infection or live zoster vaccination.
• Human Papillomavirus (HPV): Recommended for males and females up to age 26. Administered as a 2-dose series (if started before age 15) or 3-dose series (if started at age 15 or later).

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Travel and Pilgrimage (Hajj & Umrah) Vaccines

The Saudi MOH establishes mandatory health regulations for pilgrims entering the Kingdom for Hajj or Umrah, as well as recommendations for international travelers.

• Mandatory for Hajj & Umrah:
  • Quadrivalent Meningococcal Vaccine (ACYW135): Mandatory for all local and international pilgrims. Must be a conjugate vaccine administered between 10 days and 3–5 years prior to arrival.
  • Yellow Fever Vaccine: Mandatory for travelers arriving from countries endemic for yellow fever. Must be administered at least 10 days before arrival and is valid for life.
  • Polio (OPV or IPV): Mandatory for travelers arriving from polio-endemic or polio-reintroducing countries.
  • COVID-19 and Seasonal Influenza: Recommended or occasionally mandated based on updated MOH annual directives.
• Recommended for Travelers:
  • Hepatitis A & B: Recommended for travel to areas with intermediate-to-high prevalence.
  • Typhoid: Recommended for travelers visiting areas with poor sanitation and risk of contaminated food/water (e.g., Southeast Asia, Africa).

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Chronic Disease Screening Guidelines

Early detection through evidence-based screening reduces morbidity and mortality:

• Hypertension: Screen all adults $\ge 18$ years. Measure blood pressure at every healthcare encounter.
• Dyslipidemia: Lipid profile screening every 5 years for adults aged 20–39 who have cardiovascular risk factors. For average-risk individuals, routine lipid screening is initiated at age 40.
• Diabetes Mellitus: Screen adults aged 35–70 who are overweight or obese (BMI $\ge 25 \text{ kg/m}^2$, or $\ge 23 \text{ kg/m}^2$ for South Asian/Arab populations with risk factors) using fasting plasma glucose (FPG) or HbA1c. Repeat every 3 years if normal.
• Colorectal Cancer: In Saudi Arabia, national guidelines recommend screening average-risk individuals starting at age 45 up to age 75. Methods include an annual fecal immunochemical test (FIT) or a colonoscopy every 10 years.
• Breast Cancer: Mammography screening is recommended for average-risk women starting at age 40, repeated every 1–2 years.
• Osteoporosis: Screen women aged $\ge 65$ years and younger postmenopausal women with elevated risk using Dual-energy X-ray Absorptiometry (DEXA) of the hip and lumbar spine.