Immunizations

Recommended immunizations

The U.S. Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics, and the American Academy of Family Physicians recommend a specific childhood immunization schedule each year. Immunizations are recommended because they protect against diseases (give immunity) or make a disease less severe if your child does get it. The schedule outlines the immunizations and booster shots needed from birth through age 18, as well as when catch-up immunizations should be given.

The schedule for a premature infant is the same as for a full-term infant, except for hepatitis B vaccine.

Many immunizations require more than one dose, given at varying intervals. Although your child does not need to restart the series if a scheduled dose is missed, the immunization should be given as soon as possible.

The childhood immunization schedule has immunizations for:⁵

Chickenpox (varicella)(What is a PDF document?)

This shot (called Varivax) protects against chickenpox.

Who should get it?

Two doses are given to all children 12 months of age and older who have not had chickenpox—one at age 12 to 15 months and one at age 4 to 6 years.

The combination MMRV (ProQuad) shot can be given in place of Varivax. The vaccines for chickenpox, measles, mumps, and rubella are all in this one shot. Many states require that children entering day care or school get immunized against chickenpox unless they can show proof of immunity (through blood test results or having had chickenpox).

Diphtheria, tetanus, and pertussis (DTaP)(What is a PDF document?)

This shot (immunization) protects against diphtheria, tetanus, and whooping cough (pertussis).

Who should get it?

Five doses are given to all children—one at age 2 months, one at 4 months, one at 6 months, one at 15 to 18 months, and one at 4 to 6 years.

Flu (influenza)(What is a PDF document?)

This immunization helps protect against the seasonal flu and the H1N1 (swine) flu. Flu viruses are always changing, so the flu vaccines are updated every year.

Who should get it?

Flu immunization is recommended once a year for:⁶

All children ages 6 months and older.
- Children younger than 9 years of age who are getting the immunization for the first time need two doses. These doses should be given at least 4 weeks apart.
- Children younger than 9 years old who got only one dose in their first season need two doses before or during the next season. After that, one dose yearly is needed.
- Children younger than 9 years old who did not get the H1N1 flu vaccine in the 2009–2010 flu season need two doses of flu vaccine in the 2010–2011 flu season.
Household contacts and caregivers of children from birth up to 5 years of age and of any child who is at high risk for complications of the flu.
Anyone who has a chance of complications from the flu or is more likely to need medical care if infected.

Healthy children ages 2 and older can usually get the nasal spray form (FluMist) (What is a PDF document?) instead of the flu shot (What is a PDF document?). Protection lasts up to a year for both vaccine types.

For more information about the flu, see the topics Influenza (Seasonal Flu) and H1N1 Influenza (Swine Flu). For the most current CDC guidelines about seasonal flu, go to www.cdc.gov/flu. For the most current CDC guidelines about H1N1 flu, go to www.cdc.gov/h1n1flu.

Haemophilus influenzae type b (Hib)(What is a PDF document?)

This shot protects against bacteria that can cause an infection in the lungs (pneumonia) or the covering of the brain (meningitis), skin and bone infections, and other serious illnesses in young children. It does not protect against viral influenza (flu).

Who should get it?

All children need three or four doses, starting at 2 months of age and ending by 15 months of age.
Children who are older than 5 years and have certain health conditions may also need this shot.

Hepatitis A (Hep A)(What is a PDF document?)

This shot protects against hepatitis A.

Who should get it?

All children starting at 1 year of age need two doses, given at least 6 months apart.
Anyone who will be in close contact with an adopted child from a country that has high rates of hepatitis A needs two doses. This includes household contacts and babysitters. This recommendation only applies for the first 60 days the child is in the United States.⁷

Hepatitis B (Hep B)(What is a PDF document?)

This shot protects against hepatitis B.

Who should get it?

All children need at least three doses. The first dose is given right after birth, before the child leaves the hospital. The remaining doses are given by 6 to 18 months of age. Children who have not been immunized for hepatitis B and are age 18 years or younger can get the shots over a period of about 6 months.

Measles, mumps, and rubella (MMR)(What is a PDF document?)

This shot (called M-M-R II) protects against measles, mumps, and rubella.

Who should get it?

Two doses are given to all children—one at age 12 to 15 months and one at age 4 to 6 years.

There is a measles, mumps, rubella, and varicella (MMRV, or ProQuad) shot that also protects against chickenpox (varicella). Talk to your child's doctor about the pros and cons of the MMRV shot (What is a PDF document?). It can be given to children ages 12 and younger.

Pneumococcal infections(What is a PDF document?)

This shot (called PCV, or Prevnar) protects against meningitis, blood infections (sepsis), and ear infections. In March 2010, the CDC recommended that the new vaccine PCV13 be used instead of PCV7 vaccine. PCV13 protects against more types of pneumococcal disease than PCV7 did.

Who should get it?

Four doses are given to all children—one at age 2 months, one at 4 months, one at 6 months, and one at 12 to 15 months.
One dose is given to healthy children ages 24 to 59 months who did not get all the doses before.
Children ages 24 to 71 months who have medical conditions and did not get all the doses before may need one or two doses.
All children ages 14 to 59 months who finished the full series of PCV7 shots need one dose of PCV13. Children who have medical conditions and are younger than 6 years of age need one dose of PCV13, even if they finished the full series of PCV7 shots or had the PPSV shot.

Polio(What is a PDF document?)

This shot protects against polio.

Who should get it?

Four doses are given to all children—one at age 2 months, one at 4 months, one at 6 to 18 months, and one at 4 to 6 years.

Rotavirus(What is a PDF document?)

This immunization (called RotaTeq or Rotarix) protects against rotavirus infection, which causes severe diarrhea.

Who should get it?

Three doses of RotaTeq are given to all children—one at age 2 months, one at 4 months, and one at 6 months. If your child gets Rotarix, two doses are given—one at age 2 months and one at 4 months.

This immunization is swallowed rather than given as a shot. Without this vaccine, most children will get infected by the time they are about 5 years old.

Other immunizations

Your child's doctor may suggest other shots if your child is at higher risk than other children for certain health problems. These may include:

Meningococcal (MCV4, or Menactra)(What is a PDF document?)

This shot protects against bacterial meningitis and blood infections (sepsis).

Who should get it?

Some children ages 2 through 10 who have a higher risk than other children for getting and having severe problems from meningitis need one shot. This includes children who will travel or live in areas of the world where the disease is common.
Children ages 2 and older who have a damaged or missing spleen or who have certain immune system problems need two shots, given 2 months apart. A booster dose is also needed every 5 years.

Your child may be able to get this shot as early as age 9 months. Talk to your doctor about it.

Pneumococcal polysaccharide (PPSV, or Pneumovax 23)(What is a PDF document?)

This shot does not necessarily reduce the risk of getting pneumonia. But it can prevent some of the serious complications of pneumonia, such as blood infections (sepsis).

Who should get it?

Children ages 2 years and older who have certain chronic diseases, such as diabetes or heart disease, need this shot at age 2 or as soon as possible after it is known that they have a chronic illness. This shot is usually given after the PCV series is finished.

Combination vaccines

Combination vaccines are usually preferred to separate shots because they reduce the number of needle pricks. Examples include:

Comvax (Hepatitis B/Haemophilus influenzae type b)
Kinrix (Diphtheria, tetanus, pertussis/Polio)
Pediarix (Diphtheria, tetanus, pertussis/Polio/Hepatitis B)
Pentacel (Diphtheria, tetanus, pertussis/Polio/Haemophilus influenzae type b)
TriHIBit (Diphtheria, tetanus, pertussis/Haemophilus influenzae type b)

Keeping good immunization records

It is important to keep accurate records of immunizations, including any reactions to the vaccines. When you enroll your child in day care or school, you may need to show proof of immunizations. Also, your child may need the record later in life for college, employment, or travel.

Know when each immunization should be scheduled, and put reminder notes on your calendar. You also may want to ask your doctor to send you notices when immunizations are due.
Have your doctor go over your child's immunization record with you during each office visit.
Keep the record in a safe place, and never throw it away. It is an important part of your child's lifelong medical records.

To print a list of recommended immunizations based on your child's birth date, go to the U.S. Centers for Disease Control and Prevention (CDC) interactive website at www2a.cdc.gov/nip/kidstuff/newscheduler_le.

If your child age 6 years or younger didn't get all of his or her shots, find out which ones are needed at www.cdc.gov/vaccines/recs/scheduler/catchup.htm.

For a form you can use to track your child's immunizations, see the childhood immunization record (What is a PDF document?).

Immunization safety

You may worry that immunizations are dangerous if given when your child has a cold or other minor illness. Talk to your child's doctor if you have concerns about the timing of immunizations. But keep in mind that immunizations can usually still be given during a mild illness, while medicines are being taken, and in other situations where a child may not be in perfect health. Also, getting several vaccines at the same time is as safe as getting one shot at a time.⁸ There are very few reasons for which doctors suggest that a person postpone or not get an immunization.

Some parents fear that the measles-mumps-rubella (MMR) vaccine may cause their child to develop autism. Misleading stories about the MMR shot and autism have circulated through websites, the media, and word of mouth. But scientific studies have found no connection between autism and the vaccine.³

Adolescent Immunizations

By:	Healthwise Staff	Last Revised: May 27, 2011
Medical Review:	John Pope, MD - Pediatrics

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