Vaccines in 2026: Catch-Up Schedules, New Shots and African Vaccination Week
Quick answer
Childhood vaccines remain one of the most effective ways to protect South African children from serious disease. The EPI-SA schedule was updated in January 2024 with the combined measles and rubella (MR) vaccine replacing measles alone, and a Tdap booster at six years replacing the old Td shot. New shots have arrived in the 2026 private schedule too, including meningococcal B, the maternal RSV vaccine Abrysvo, and nirsevimab for infants. If your child has missed doses, catch-up is available for most vaccines up to age fifteen. African Vaccination Week in late April is a good prompt to pull out the Road to Health Booklet (RtHB) and check what your child still needs.
Key points
- The EPI-SA schedule was revised in January 2024, with measles and rubella combined (MR) and a Tdap booster at six years
- Catch-up vaccination is possible for most vaccines up to age fifteen, but rotavirus has a strict cut-off at 24 weeks
- The HPV catch-up campaign is reaching girls who missed their Grade 5 shot any time since 2014
- Two RSV prevention options are now available in SA private pharmacies: the Abrysvo maternal vaccine (28 to 36 weeks of pregnancy) and nirsevimab (a single injection for the baby)
- Meningococcal B vaccine (Bexsero) is new on the 2026 private schedule at eighteen weeks and twelve to fifteen months
- About one in five South African children under one missed at least one vaccine last year, per NDoH 2023/24 data
What's new in South African vaccines
The National Department of Health revised the EPI-SA schedule in January 2024. The most important changes for parents:
Measles and rubella combined (MR)
The measles-only vaccine given at six and twelve months was replaced by the MR vaccine, which protects against both measles and rubella in one shot. Rubella (German measles) is usually mild in children, but if a pregnant woman catches it in early pregnancy, it can cause serious birth defects including deafness and heart problems in the baby. Including rubella in the childhood schedule helps protect future pregnancies in the community.
Tdap at six years
The old Td booster (tetanus and diphtheria only) was upgraded to Tdap, which adds acellular pertussis protection. Whooping cough has made a comeback in several countries including South Africa, and the booster helps maintain immunity through primary school. The 12-year booster is also Tdap, and pregnant women are offered Tdap between 26 and 34 weeks in each pregnancy to pass antibodies to the newborn.
HPV catch-up campaign
A catch-up campaign is reaching girls who missed their HPV vaccine in Grade 5 any time since the schools programme started in 2014. The vaccine prevents the strains of HPV that cause most cervical cancers. Current NDoH guidance follows WHO SAGE 2022, accepting a single dose as sufficient for girls aged nine to fourteen, though immunocompromised patients still need the full course.
PCV switch
The pneumococcal conjugate vaccine used in the public sector switched from PCV13 to PCV10 in 2024. The two vaccines are considered interchangeable for catch-up purposes, so if your child had PCV13 doses previously, no extra doses are needed.
The 2026 routine schedule
At birth, babies receive BCG (against TB) and oral polio drops. Hepatitis B vaccine at birth is only given if the mother tested positive for HBsAg during pregnancy.
At six, ten, and fourteen weeks, babies receive the hexavalent shot (protecting against diphtheria, tetanus, whooping cough, polio, Haemophilus influenzae type b, and hepatitis B), plus oral rotavirus drops and the pneumococcal conjugate vaccine.
At six months, the first dose of measles and rubella (MR) vaccine is given. A second dose follows at twelve months. At nine months, the third dose of pneumococcal conjugate vaccine is given.
At eighteen months, a fourth hexavalent booster completes the primary course. A Tdap booster follows at six years, another at twelve years.
Girls and boys aged nine and older in Grade 5 receive the HPV vaccine in school-based campaigns.
Catch-up: it's rarely too late
Life happens. Babies get sick at clinic appointments, families move, the RtHB gets misplaced, and during the COVID years many families fell behind. The good news is that South African catch-up schedules are designed for exactly this. You don't restart from scratch. The NDoH catch-up guideline published in 2024 lets health workers pick up where a child left off.
Vaccines with upper age limits
BCG can be given up to twelve months. Beyond that age, the vaccine is no longer recommended because children living in South Africa will have had environmental exposure to tuberculosis, and the protection it offers is limited.
Oral polio drops are given up to six months of age in the routine schedule. Older children who need polio protection get it through the inactivated polio component of the hexavalent vaccine.
Hexavalent (DTaP-IPV-Hib-HepB) can be given for catch-up up to five years. Doses are spaced four weeks apart, and a fourth dose is given at twelve months or later, provided the child is at least eighteen months old.
Pneumococcal conjugate vaccine catch-up goes up to six years (72 months). The number of doses needed depends on the child's age at the first dose, with fewer doses required for older children.
Rotavirus has the tightest window. The absolute cut-off is 24 weeks of age. This is for safety: rotavirus vaccine has a very small risk of a bowel problem called intussusception, and this risk increases if the vaccine is given later. If your baby is past 24 weeks without rotavirus vaccine, they stay unprotected, so earlier appointments matter for this one.
Tdap catch-up is allowed up to age fifteen. Because the paediatric formulation contains the higher diphtheria dose, it isn't given beyond that age. Older adolescents and adults use adult Tdap.
Vaccines with no age limit
Measles and rubella has no upper age limit. Anyone, at any age, who is not immune can be vaccinated. This matters during outbreak years.
Hepatitis B can be given at any age. Unvaccinated adolescents and adults at risk should receive the three-dose course.
Measles: why it still matters
South Africa had measles outbreaks in 2023 and 2024, with transmission continuing across the WHO African region. The elimination target is 95% coverage with two doses, and according to NDoH 2023/24 figures, first-dose coverage was at 82.5% nationally. That gap is why measles keeps returning.
If your child missed either dose, a clinic visit and a quick check of the RtHB is worth the trip. MR catch-up is free in the public sector and takes a few minutes to administer.
New shots available in 2026
Four vaccine developments are worth knowing about if you use private healthcare or are pregnant.
Meningococcal B (Bexsero)
Bexsero is now shown on the 2026 Paediatrician Management Group schedule at eighteen weeks and again at twelve to fifteen months. Meningococcal B causes meningitis and bloodstream infection that can become life-threatening within hours. The vaccine is not on EPI-SA but is available privately. The existing meningococcal ACWY vaccine (Menactra) is still recommended from twelve months and protects against the other main strains.
Abrysvo (maternal RSV vaccine)
Abrysvo is registered by SAHPRA for administration to pregnant women between 28 and 36 weeks. The antibodies cross the placenta and protect newborns during their first RSV season, when they are most vulnerable to severe lower respiratory tract infection. For families in private care, this is one of the most important changes in 2026 for preventing infant chest infections.
Nirsevimab (long-acting monoclonal antibody)
Nirsevimab (Beyfortus) became available through SA private pharmacies in the 2025-2026 season. It's a single injection given to the baby that provides around five months of RSV protection. It can be given at birth for babies born during or just before the RSV season, or as a single pre-season dose for older infants still in their first year. Families can choose between Abrysvo during pregnancy or nirsevimab for the baby; both are effective strategies for protecting newborns through their first RSV season. We've written a separate article on RSV and bronchiolitis with more detail on how to choose.
HPV expansion
The HPV vaccine is now recommended for boys as well as girls in private practice. The single-dose schedule (based on WHO SAGE 2022 guidance) is increasingly accepted for ages nine to twenty. Immunocompromised children still need two or three doses.
What's available privately beyond EPI-SA
If you have access to private care, additional vaccines worth discussing with your GP include:
Hepatitis A (Havrix Junior or Avaxim 80) from twelve months, with a second dose at least six months later. Hep A outbreaks happen in South Africa when water or food safety slips, and the vaccine offers long-term protection.
Chickenpox (Varilrix or Onvara) from nine months. Two doses are given, the second usually at five to six years. Chickenpox is usually mild in young children but can be serious in teens, adults, pregnant women, and anyone immunocompromised.
Influenza (Influvac or Vaxigrip Tetra) from six months of age, every year before the winter season starts in May. Particularly important for children in crèche, with chronic lung or heart conditions, or in households with older adults or pregnant women.
MMR in place of MR: The private schedule uses the three-in-one vaccine, adding mumps protection.
Addressing parent concerns
Research from Cape Town found that 59% of vaccinators have encountered vaccine-hesitant parents. Across sub-Saharan Africa, about one in five parents expresses some hesitancy about routine childhood immunisation. The COVID-19 pandemic shifted some parents from default acceptance to active decision-making, which is reasonable, but misinformation has also spread through social media.
The most common concerns I hear in practice:
"Too many vaccines at once will overload her immune system." Babies encounter thousands of antigens every day through ordinary life, including breastfeeding, meals, and normal household contact. The antigens in vaccines are a tiny fraction of this exposure, and studies have consistently shown no adverse effect on the immune system from multiple vaccines at one visit.
"The MMR vaccine causes autism." This claim comes from a 1998 study of twelve children that was retracted, and whose author lost his medical licence. Subsequent studies of millions of children have found no link between MMR and autism.
"Natural infection gives better immunity than vaccines." Natural infection does produce strong immunity for some diseases, but at the cost of getting the disease, which for measles, whooping cough, meningitis, or polio can mean hospitalisation, permanent disability, or death. Vaccines give protection without the risk of serious illness.
"She's had a cold, we should skip today's vaccines." Mild illness with or without a low fever is not a reason to defer. Significantly unwell children with a high fever or clearly more serious illness should defer, but a runny nose is not a reason to delay.
If you have a question not listed here, please ask at your next visit. Good questions deserve clear answers, and I'd rather discuss a concern than leave it unresolved.
In this guide
African Vaccination Week and the Big Catch-Up
African Vaccination Week is held every year in the last week of April, coordinated by WHO AFRO and UNICEF. The 2026 focus continues the Big Catch-Up initiative launched by WHO, UNICEF, and Gavi in 2023. The goal is to identify children who missed vaccines during the COVID years, restore immunisation coverage to pre-pandemic levels, and reach the zero-dose children who have never received any vaccine.
South Africa has work to do. NDoH 2023/24 figures show 233,247 children (26% of the target population) missed their first hexavalent dose. Zero-dose proportions are highest in OR Tambo, Alfred Nzo, Ugu, Bojanala, and Harry Gwala districts. In the Western Cape, including the Garden Route, about 16% of eligible children missed a first hexavalent dose last year.
You can help by checking your children's RtHBs this month, booking a catch-up appointment if anything has been missed, and mentioning to family or friends with young children that a quick clinic visit can bring their schedule up to date.
Where to get catch-up vaccines
Public sector clinics provide all EPI-SA vaccines free of charge, including catch-up doses within the age limits above. Staff are trained on the 2024 catch-up schedule, and the RtHB is all you need to bring.
For vaccines outside EPI-SA (hepatitis A, chickenpox, meningococcal B, Abrysvo in pregnancy, nirsevimab for the baby, annual flu shots), you'll need private care. At NeoHealth George we stock the common private vaccines and can advise on catch-up for children who've missed public schedule doses too.
Always bring the Road to Health Booklet (RtHB) to every clinic or GP visit. It is South Africa's official patient-held record of your child's immunisations, growth, and developmental milestones from birth, used across both public and private health sectors. Clinicians need the RtHB to plan catch-up doses safely, track growth over time, and maintain a continuous health record across different providers. If the RtHB has been lost or never issued, any GP or clinic can start a new record and rebuild the immunisation history from available sources.
Important: This article provides general medical information and is not a substitute for personalised medical advice. If you have specific concerns about your child's vaccination schedule, please book a consultation with your GP. In medical emergencies, call 10177 or visit your nearest emergency facility.
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Frequently Asked Questions
My child is three and only had BCG and the six-week shots, is it too late?
No. Hexavalent catch-up is available up to age five, PCV up to age six, MR at any age, and Tdap up to fifteen. You can start catching up at your next clinic visit. Bring the Road to Health Booklet (RtHB) if you have it.
Does my baby need the rotavirus vaccine if we missed the 6-week dose?
Rotavirus vaccine can still be given up to 24 weeks of age. After that, the vaccine isn't given because of a small safety concern. If your baby is under 24 weeks, book a visit soon.
Should I get my son vaccinated against HPV?
Yes. The HPV vaccine is recommended for boys as well as girls in private practice. It protects against cancers of the throat, anus, and penis, as well as genital warts. Boys also protect their future partners from cervical cancer risk by being vaccinated.
Abrysvo in pregnancy or nirsevimab for the baby, which should we choose?
Either protects the newborn through their first RSV season. Abrysvo is given to the mother between 28 and 36 weeks of pregnancy, and antibodies cross the placenta. Nirsevimab is given to the baby as a single injection, either at birth or before the RSV season starts. Cost, timing of pregnancy relative to the RSV season, and personal preference usually decide it. Speak to your GP or obstetrician about the right option for you.
Can I split up the vaccines instead of having several on the same day?
Splitting vaccines means more clinic visits, more stress for your child, and a longer window of being unprotected. The evidence shows no benefit to splitting and some harm in terms of delayed immunity. The recommended schedule is the best balance.
My child missed HPV in Grade 5, can she still get it?
Yes. The NDoH catch-up campaign was specifically designed to reach all eligible girls missed since 2014. Any girl of Grade 5 age or older who did not receive the school-based dose can still get HPV vaccination. Private practice also offers catch-up for boys.
Where can I check what my child still needs?
Your best first step is to bring the Road to Health Booklet (RtHB) to a clinic visit. If you've lost it, any GP or clinic can review vaccine records or start a new record and catch up from there.