Immunizations

Childhood 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:⁴

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. 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:⁵

• All children 6 months through 18 years of age.
  • Children younger than 9 years of age who are getting the immunization for the first time should get 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 should get two doses before or during the next season. After that, one dose yearly is needed.
• 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 the most current CDC guidelines about seasonal flu, go to www.cdc.gov/flu.

H1N1 influenza (swine flu) (What is a PDF document?)

This shot helps protect against infection caused by the H1N1 flu virus. H1N1 flu may cause symptoms such as fever, cough, body aches, sore throat, and extreme tiredness. Most of the time, the illness is not serious. But severe cases can lead to pneumonia, serious lung problems, and death.

Who should get it?

• All children starting at age 6 months need this shot.
• Pregnant women and people who live with or care for children younger than 6 months of age also need this shot.

Most people need one dose. Only children ages 6 months through 9 years need two doses. The H1N1 shot can be given along with the seasonal flu shot. Healthy children ages 2 and older can usually get the nasal spray form (What is a PDF document?) of the vaccine instead of the shot (What is a PDF document?) .

For more information, see the topic H1N1 Influenza (Swine Flu). For the most current CDC guidelines, 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.⁶

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). It can be substituted for either or both doses of MMR in 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.

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 59 months who have medical conditions and did not get all the doses before may need one or two doses.

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. One example is:

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.
• Children who have a damaged or missing spleen, who have certain immune system problems, or who travel or live in areas of the world where the disease is common also need one shot.

Some children need booster shots.⁷ Check with your child's doctor.

Two forms of the meningococcal vaccine are available: Menactra (MCV4) and Menomune (MPSV4). Menactra may protect your child longer than Menomune.

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 Web site 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 Web sites, the media, and word of mouth. But scientific studies have found no connection between autism and the vaccine.³

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Author:	Debby Golonka, MPH	Last Updated: February 26, 2010
Medical Review:	John Pope, MD - Pediatrics William Atkinson, MD, MPH - Public Health and Preventive Medicine
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