If my child missed vaccines, do we need to restart from the beginning?

No. No vaccine series needs to be restarted due to delays. The body retains immunological memory from previous doses. Simply resume the schedule where you left off, following the minimum intervals between doses. Your pediatrician will create an appropriate catch-up plan.

How many catch-up vaccines can be given on the same day?

According to the Brazilian Pediatric Society (SBP) and Ministry of Health, there is no limit to the number of injectable vaccines that can be given on the same day, as long as they are administered at different anatomical sites. The exception is live virus vaccines (such as MMR and varicella), which should be given on the same day or 30 days apart.

Do delayed vaccines provide less protection than those given on time?

The final protection is the same once the complete series is finished. The risk of delay is that the child remains unprotected during the period when they should have been vaccinated. The sooner you catch up, the better.

Can I update my child's vaccines at a public clinic (SUS) even if previous doses were given abroad?

Yes. The Brazilian public health system (SUS) accepts vaccination records from any source — private clinics, other states, or other countries. Bring the previous vaccination card and healthcare professionals will assess which doses are pending and administer them for free.

Catch-Up Vaccination Schedule: How to Get Your Child Back on Track

Are your child's vaccines behind schedule? Don't worry — and don't blame yourself. Delays happen for many reasons: illness on the scheduled date, moving to a new country, lack of information, or simply the rush of daily life. The most important thing is to resume the schedule. In this guide, I explain how to catch up on vaccines in Brazil, which ones can be given together, and what to prioritize. For the full schedule, see our 2026 baby vaccination guide.

What Happens When Vaccines Are Delayed?

The main risk of delayed vaccination is that your child remains unprotected against diseases that can be severe. Babies and young children are especially vulnerable because their immune systems are still developing. The sooner you catch up, the better.

Diseases That Have Resurged Due to Declining Vaccination Rates

• Measles: Outbreaks in Brazil between 2018 and 2022 after MMR coverage declined

• Pertussis (whooping cough): Increase in cases among infants under 6 months who were not fully vaccinated

• Polio: Risk of reintroduction flagged by the Ministry of Health and WHO

Catch-Up Vaccination Principles

The catch-up schedule follows guidelines from the Brazilian Society of Pediatrics (SBP) and the National Immunization Program (PNI). These principles are consistent with CDC and WHO recommendations:

1. Never Restart from Zero

Every dose counts. If your child received the 1st and 2nd doses and missed the 3rd, simply give the 3rd dose. The immune system retains memory from previous doses for years. This is the same principle used by the CDC and NHS.

2. Respect Minimum Intervals

Between doses of the same vaccine, there is a minimum interval that ensures an adequate immune response. Your pediatrician calculates these intervals and creates the optimal timeline.

3. Maximize Vaccines per Visit

There is no limit to the number of injectable vaccines that can be given on the same day. Each vaccine is administered at a different site (left arm, right arm, left thigh, right thigh). Learn about expected vaccine reactions.

4. Live Virus Vaccine Rule

Live attenuated virus vaccines (MMR, varicella, yellow fever) should be given on the same day or with a minimum 30-day interval between them. This is important when catching up on multiple live vaccines.

Catch-Up Schedule by Age Group

The catch-up strategy depends on the child's age and how many doses are missing. Below is a general guide based on Brazilian Ministry of Health and SBP recommendations:

Babies 0 to 12 Months

Highest priority: Pentavalent or hexavalent, pneumococcal, rotavirus (has an age limit of 8 months), and meningococcal.

Special attention: Rotavirus has a strict window — the 1st dose must be given by 3 months and 15 days, and the last dose by 7 months and 29 days. After these ages, it can no longer be administered.

Track progress closely during well-child checkups.

Children 1 to 4 Years

Important vaccines: DTaP boosters (pertussis, diphtheria, tetanus), MMR (measles, mumps, rubella), varicella, hepatitis A, and meningococcal.

Typical plan: In most cases, it is possible to catch up in 2 to 3 visits spaced 30 to 60 days apart.

The annual flu vaccine should also be considered.

Children 5 to 12 Years

Commonly missed vaccines: DTaP booster (4-6 years), 2nd dose of varicella (4-6 years), 2nd dose of hepatitis A, HPV (9-14 years), and meningococcal ACWY (11-12 years).

Pre-teens: The meningococcal ACWY booster is especially important in this age group, as adolescents are at risk for meningococcal disease.

Where to Get Vaccinated in Brazil

Public (SUS) — Free

• Any UBS (public health unit) in any neighborhood
• No doctor referral needed
• Accepts vaccination records from other countries
• Periodic multi-vaccination campaigns
• Available to everyone, including foreigners

Private Clinics

• Shorter waits and flexible scheduling
• Combination vaccines (fewer injections)
• Additional vaccines (meningococcal B, hexavalent)
• More comfortable environment
• Popular options: Delboni, Lavoisier, Einstein, Fleury

Special Situations for Expat Families

Coming from Another Country

Brazil's vaccination schedule differs from the US (CDC), UK (NHS), and European schedules. Bring your child's previous vaccination card (in any language) to the first consultation. I will assess which vaccines are equivalent and which need to be added — especially BCG, yellow fever, and dengue, which are specific to Brazil and other tropical countries.

Lost Vaccination Records

If you cannot locate your child's vaccination card, your pediatrician can assess the situation. For older children, blood tests (serology) can help determine existing immunity. In some cases, it is safe to repeat certain vaccines rather than risk leaving the child unprotected.

Children with Chronic Conditions

Children with special conditions (prematurity, HIV, immunosuppression, heart conditions) may require modified schedules. The pediatrician evaluates each case individually, potentially recommending additional vaccines or avoiding live virus vaccines in specific situations.

School Requirements in Brazil

Most schools in Brazil require an up-to-date vaccination card (carteirinha de vacinação) for enrollment. International schools may accept records from abroad, but public and many private schools expect the Brazilian schedule to be followed. Dr. Paula provides the documentation you need.

My Recommendation as a Pediatrician

I know parents feel guilty when they realize vaccines are behind schedule. But what matters most is not the delay — it is the decision to catch up. The good news is that in most cases, it is possible to get everything back on track in just a few weeks.

During routine checkups, I always review the vaccination card and create a personalized catch-up plan. I also explain the expected reactions for each vaccine, so you know exactly what to expect.