First-Year Vaccines in the Pink Book: Which Are Free, Which Are Optional, and Do You Restart If You Miss One?

You made it through the 2-month visit and thought you were done. Then you open the vaccine page of the Pink Book and there are still 4-month, 6-month, 9-month and 1-year appointments ahead, plus this year’s news about free PCV, and now you’re not sure what your baby is supposed to get.

Let’s go through it one appointment at a time: what’s free at each visit, which ones are optional, and what to do if your baby is sick and you have to postpone. One thing first: the schedule gets updated from time to time, so go by the appointments in your Pink Book and the advice of your baby’s doctor. For birth to 2 months, read Your baby’s first vaccines in the Pink Book.

1. Overview of free routine vaccines in the first year

Quick Answer: The main first-year visits are at 2, 4, 6 and 9 months and 1 year. Each visit includes free routine vaccines as shown below.

Age	Routine vaccines	Protects against
2 months	DTP-HB-Hib 1, IPV 1, Rota 1, PCV 1	Diphtheria, tetanus, pertussis, hepatitis B, Hib, polio, rotavirus, pneumococcus
4 months	DTP-HB-Hib 2, IPV 2, Rota 2, PCV 2	Same as 2 months
6 months	DTP-HB-Hib 3, OPV (oral), Rota 3 (3-dose type only)	Completes the first combined series
9 months	MMR 1	Measles, mumps, rubella
1 year	LAJE 1, PCV 3	Japanese encephalitis, pneumococcus

After that come the 18-month visit (diphtheria, tetanus, pertussis booster, oral polio and MMR dose 2) and the 2.5-year visit (LAJE dose 2).

2. Why is polio injected at 4 months but given by mouth at 6 months?

Quick Answer: Because since mid-2023 Thailand has used a “2 injected, 3 oral” polio schedule: IPV at 2 and 4 months, then OPV at 6 months, 18 months and 4 years.

The Ministry of Public Health’s 2 IPV + 3 OPV guideline took effect on 1 July 2023. If a relative or friend with an older child says, “Mine had oral polio at 2 months,” that was right for the old schedule. Some older Pink Books may still print the old table. Don’t worry that your baby has missed anything. Just follow what the hospital records.

3. What happens at 6 months, and why do some babies skip rotavirus?

Quick Answer: At 6 months your baby gets DTP-HB-Hib dose 3 and oral polio. The third rotavirus dose is only for babies on the 3-dose oral type. If the hospital uses the 2-dose type, your baby finished at 4 months.

This visit completes the first series of the 5-in-1 combined vaccine, including the hepatitis B series. If you’re not sure which rotavirus type your baby had, check the Pink Book or ask the nurse.

Rotavirus vaccine has age limits, so a long delay may mean it can’t be continued. Details are in the rotavirus section of Vaccines from birth to 2 months.

4. Why do the 9-month and 1-year visits matter?

Quick Answer: At 9 months comes the first dose of measles, mumps and rubella (MMR), and at 1 year the first Japanese encephalitis (LAJE) dose. Both are free routine vaccines.

• MMR dose 1 at 9 months. Measles spreads very easily and still has periodic outbreaks in Thailand. The immunity your baby got from you at birth fades during this period.
• LAJE dose 1 at 1 year. Protects against mosquito-borne Japanese encephalitis.
• PCV dose 3 at 1 year, for babies who started the PCV series.

The 9-month visit also lines up with the Ministry of Public Health’s developmental screening round. The doctor or nurse will often ask about sitting, crawling and picking things up. Get ready with the 6-month milestones checklist.

5. Is PCV really free now? What if my baby is already past 2 months?

Quick Answer: An announcement by Thailand’s National Health Security Board makes PCV a benefit for children aged 2 to 12 months, effective 1 October 2026, with 3 doses at 2, 4 and 12 months.

According to Hfocus, the announcement was published in the Royal Gazette on 20 July 2026. In practice, vaccine supply and scheduling may not roll out at the same pace at every hospital. If your baby is over 2 months and hasn’t had PCV yet, ask directly at the next visit: “Is my baby still eligible, and how many doses do they need?” or call the NHSO hotline 1330.

If you’ve already paid for some doses at a private hospital, bring the Pink Book. The doctor will work out how many more are needed. No need to start over.

6. Which optional vaccines are your call?

Quick Answer: The common ones in the first year are the flu vaccine (free for ages 6 months to 5 years during the campaign), the acellular-pertussis 5-in-1 or 6-in-1 combined vaccines (paid), and vaccines that start around age 1, like chickenpox or hepatitis A.

• Flu: the NHSO offers it free to children aged 6 months to 5 years during the annual campaign, usually around May to September. Young children usually need 2 doses 4 weeks apart the first year.
• Acellular combined vaccines: less fever and soreness than the routine version, but you pay. Both protect well. The free one isn’t so inferior that you need to pay extra.
• Chickenpox and hepatitis A: optional vaccines that usually start after age 1. Ask the doctor about the right timing for your baby.

Whatever extra you choose, ask the nurse to record it in the Pink Book every time, so you don’t double up if you change hospitals.

7. We postponed or missed an appointment. Do we start counting again?

Quick Answer: No need to restart. CDC guidance says longer gaps don’t reduce immunity once the series is completed. Just get the missed dose at the next visit.

The CDC Pink Book says clearly that “it is not necessary to restart a series or add doses,” because a longer interval doesn’t lower immunity after the series is done. The catch is that until the series is complete, your baby isn’t fully protected, so don’t leave it too long, and rotavirus has age limits.

If your baby is sick on the day, a mild cold without fever is usually fine, but with a high fever or acute illness the doctor will usually postpone. Always tell the nurse and let the doctor decide.

After the shot, go to the hospital now if…

• Trouble breathing, a swollen mouth or face, or a rash all over within minutes to hours of the shot (call 1669)
• Seizures, a floppy body, drowsiness, or being hard to wake
• Crying nonstop for hours that nothing soothes
• Fever lasting more than 2 days, or fever with refusing milk
• Episodes of screaming with legs pulled up to the tummy, repeated vomiting or blood in the stool in the week after rotavirus drops

Common reactions that usually pass in 1 to 2 days are low fever, fussiness, and redness or swelling at the injection site. MMR can cause a mild fever or rash around 1 to 2 weeks after the shot. If you’re unsure, you can always call the hospital that gave the vaccine.

The big picture of the whole first year is in Your baby’s first year guide, and if you’re in Chiang Mai, see the list of Pediatric hospitals and clinics in Chiang Mai.

Getting your baby to every appointment in the first year sounds ordinary, but it’s one of the biggest gifts you can give them.