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 Reference childhood immunization schedule each year. Immunizations are recommended, because they protect against diseases (give Reference immunity Opens New Window) 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 Reference schedule for a premature infant is the same as for a full-term infant. But sometimes the hepatitis B vaccine is delayed.

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.

Immunizations recommended for children younger than 11 years of age include:^{Reference 5}

Chickenpox (varicella) (What is a Reference PDF Opens New Window document?)

This shot (called Varivax) protects against Reference chickenpox Opens New Window.

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.

Diphtheria, tetanus, and pertussis (DTaP) (What is a Reference PDF Opens New Window document?)

This shot (immunization) protects against Reference diphtheria Opens New Window, Reference tetanus Opens New Window, and Reference whooping cough Opens New Window (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 Reference PDF Opens New Window document?)

This immunization helps protect against Reference the flu Opens New Window. Flu viruses are always changing, so the flu vaccines are updated every year.

Who should get it?

• All people ages 6 months and older need one dose each year. Children younger than 9 years of age may need two doses depending on when they started getting this yearly immunization.

Healthy children ages 2 and older can usually get the nasal spray form (FluMist) (What is a Reference PDF Opens New Window document?) instead of the flu shot (What is a Reference PDF Opens New Window document?). Protection lasts up to a year for both vaccine types. For the most current CDC guidelines about the flu, go to www.cdc.gov/flu.

Haemophilus influenzae type b (Hib) (What is a Reference PDF Opens New Window document?)

This shot protects against bacteria that can cause an infection in the lungs (Reference pneumonia Opens New Window) or the covering of the brain (Reference meningitis Opens New Window), 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 Reference PDF Opens New Window document?)

This shot protects against Reference hepatitis A Opens New Window disease.

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.^{Reference 6}

Hepatitis B (Hep B) (What is a Reference PDF Opens New Window document?)

This shot protects against Reference hepatitis B Opens New Window disease.

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.

Measles, mumps, and rubella (MMR) (What is a Reference PDF Opens New Window document?)

This shot protects against Reference measles Opens New Window, Reference mumps Opens New Window, and Reference rubella Opens New Window.

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 Reference PDF Opens New Window document?). It can be given to children ages 12 months to 12 years.

Pneumococcal infections (What is a Reference PDF Opens New Window document?)

This shot (called PCV, or Prevnar) protects against a bacteria that causes meningitis, blood infections (Reference sepsis), and ear infections.

Who should get it?

• All children need four doses—one at age 2 months, one at 4 months, one at 6 months, and one at 12 to 15 months.

Polio (What is a Reference PDF Opens New Window document?)

This shot protects against Reference polio Opens New Window.

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 (Rotarix or RotaTeq) (What is a Reference PDF Opens New Window document?)

This immunization protects against Reference rotavirus infection Opens New Window, 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 conjugate (Menactra or Menveo) (What is a Reference PDF Opens New Window document?)

This shot protects against a bacteria that causes Reference meningitis Opens New Window and blood infections (sepsis).

Who should get it?

• Children who have a higher risk than other children for getting and having severe problems from meningitis need at least two shots.
  • Children at high risk who are ages 9 months to 23 months need two doses of Menactra, given 3 months apart. This includes children who have certain immune system problems and children who live in or will travel to areas of the world where the disease is common. This recommendation does not apply to children who have a damaged or missing spleen.
  • Children who are at high risk because they have a damaged or missing spleen need two doses of either Menactra or Menveo, starting at 2 years of age. The doses are given 2 months apart.
  • ACIP has recommended that high-risk infants, starting at age 2 months, get four doses of MenHibrix (a combination vaccine that protects against both meningococcal disease and Hib disease). This includes infants who have certain immune system problems and infants who have a damaged or missing spleen. As of November 2012, the Centers for Disease Control and Prevention (CDC) has not yet made this recommendation official. For the most current information about infant protection against meningococcal disease, see the CDC website www.cdc.gov/vaccines/vpd-vac/mening/who-vaccinate-hcp.htm#infants-children.

Children who remain at high risk need routine booster shots starting a few years after their first doses of meningococcal conjugate shots. Ask your doctor if your child has a high risk of getting infections from bacterial meningitis and whether booster shots are needed.

Pneumococcal polysaccharide (PPSV, or Pneumovax 23) (What is a Reference PDF Opens New Window document?)

This shot does not necessarily reduce the risk of getting Reference pneumonia Opens New Window. 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)
• MenHibrix (Meningococcal/Haemophilus influenzae type b)
• 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 (What is a Reference PDF Opens New Window document?) 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.

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. 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.^{Reference 7} 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 Reference autism Opens New Window. Misleading stories about the Reference 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.^{Reference 1}

For more information about vaccine safety studies and vaccine side effects, see the topic Reference Immunization Safety.

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