Immunizing Your Child

By Jennifer Shapiro, Langan Denhard, and Kate Sackett, BA
Updated February 2013

 

An important step in keeping children safe from many childhood diseases is to make sure they are immunized on time. Below is the recommended childhood immunization schedule for January-December 2013. The schedule is approved by the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC), theAmericanAcademyof Pediatrics (AAP), and theAmericanAcademyof Family Physicians (AAFP).

Vaccines are not 100% risk free, and a small proportion of children may have a bad response to a vaccine.  However, not being vaccinated carries more risks.  That is why all of the major health organizations mentioned above agree that the risk of not having a vaccine, to your child and to the public health for all children, is greater than the risk of the vaccine itself.

The one study that suggested a link between the Mumps, Measles, Rubella (MMR) vaccine and autism was declared a fraud and the study’s author has been barred from medical practice.

Concerns about the safety of the mercury-based preservative thimerosal resulted in thimerosal being removed or reduced to trace amounts from all vaccines for children 6 and under (except for the flu vaccine–see below) since 2001.

 

Vaccine-Preventable Diseases and the Vaccines that Prevent Them

(To read more about each of the diseases listed below, visit this CDC website here)

Hepatitis B
Rotavirus
Diphtheria, Tetanus, Acellular Pertussis (DTaP)
H. influenzae type b (Hib)
Polio
Influenza (seasonal)
Pneumococcal Conjugate (PCV)
Measles, Mumps, Rubella (MMR)
Varicella (Var) (chicken pox)
Hepatitis A (Hep A)

Hepatitis B (Hep B vaccine): Three doses of the hepatitis B vaccine are recommended for children to be protected against hepatitis B infection.

Dose #1: given at birth
Dose #2: given at 1 to 2 months (but at least one month after the first dose)
Dose #3: given at 6 to 18 months (but at least 4 months after the first dose and 2 months after the second dose).

If your child has not previously received 3 doses of the vaccine, he or she should receive 3 doses of the vaccine according to the following schedule: the first dose, the second dose 1-2 months after the first, and the third dose 6 months after the second. Children 11-15 can be given a 2-dose version of the vaccine formulated for adults called Recombivax HB.

Rotavirus Vaccine (RV): Two series of the vaccine are available to choose from: RV-1, with two doses recommended, and RV-5, with three doses recommended.

RV-1:

Dose #1: given at 2 months
Dose #2: given at 4 months

OR

RV-5:

Dose #1: given at 2 months
Dose #2: given at 4 months
Dose #3: given at 6 months

Vaccination with either series should not be started for infants past the age of 15 weeks. The final dose should be given no later than 8 months 0 days.

Diphtheria, Tetanus, Acellular Pertussis (DTaP): Five doses of DTaP are recommended.

Dose #1: given at 2 months
Dose #2: given at 4 months
Dose #3: given at 6 months
Dose #4: given between 15-18 months (may be given as early as 12 months, if at least 6 months have gone by since the third dose)
Dose #5: given between 4-6 years

If your child did not get DTaP according to the above schedule and received his or her fourth dose at 4 years of age or older, a fifth (booster) dose is not necessary.

Starting at age 11, routine diphtheria toxiods (Td) boosters are recommended every 10 years.

H. influenzae type b (Hib): It is recommended that children receive four doses of the Hib vaccine.

Dose #1: given at 2 months
Dose #2: given at 4 months
Dose #3: given at 6 months (unless the first and second doses were PRP-OMP, PedvaxHIB or Comvax, in which case the dose at 6 months should not be administered)
Dose #4: given between 12-15 months

If your child did not get Hib according to the above schedule, read these “catch-up” recommendations:

  • If dose 1 was administered at ages 12-14 months, administer the next and final dose at least 8 weeks after dose 1.
  • If the first 2 doses were PRP-OMP (PedvaxHIB or Comvax) and were administered at age 11 months or younger, the third (and final) dose should be administered at age 12 through 15 months, and at least 8 weeks after the second dose.
  • If your child has not received any doses of the vaccine before age 15 months, only one dose should be administered.

Polio (IPV): Children should receive four doses of IPV (inactivated polio vaccine).

Dose #1: given at 2 months
Dose #2: given at 4 months
Dose #3: given between 6-18 months
Dose #4: given between 4-6 years (and at least 6 months after the third dose)

If your child did not get the polio vaccines according to the above schedule, read these recommendations:

  • In the first 6 months of life, when and how far apart doses are given is only important and recommended if the baby or people caring for the baby are likely to come into contact with the poliovirus—because there is an outbreak or because they are traveling or living in an area where polio is endemic.
  • If 4 or more doses are administered before age 4 year, an additional dose should be administered between 4 and 6 years.
  • A fourth dose is not necessary if the third dose was administered at age 4 years or older and at least 6 months after the previous dose.
  • If both OPV (oral polio vaccine) and IPV were administered as part of a series, a total of 4 doses should be administered, regardless of the child’s current age.
  • IPV is not routinely recommended forU.S.residents aged 18 years or older.

Influenza (seasonal): The inactivated flu vaccine should not be administered before 6 months, and the live flu vaccine should only be given to healthy children aged 2 years and older (i.e., those who do not have underlying medical conditions).

If 2012-2013 is the first time a child 6 months to 8 years is receiving a flu vaccine, administer 2 doses at least 4 weeks apart.

For children ages 9 years and older, administer 1 dose (as is done with adults).

Pneumococcal Conjugate (PCV): PCV is recommended for all children younger than 5 years. The schedule recommends that PCV be given along with other childhood vaccines.

Dose #1: given at 2 months
Dose #2: given at 4 months
Dose #3: given at 6 months
Dose #4: given between 12-15 months

One dose of PCV is recommended for children aged 24 to 59 months who are not completely vaccinated for their age.  The CDC also recommends a single supplementary dose of PCV13 for children of 14-59 months who have been completely vaccinated.

For children with certain diseases or medical conditions, recommendations vary. To see what doses should be given and how often, click here.

Measles, Mumps, Rubella (MMR): Two doses of MMR vaccine are recommended.

Dose #1: given between 12-15 months
Dose #2: given between 4- 6 years (If 4 weeks have passed since the first dose, the second dose may be given before age 4 year during any visit to a doctor)

All school-aged children who have not completed the vaccination series should receive two doses of the MMR vaccine with at least 4 weeks between doses.

Children aged 6-11 months should receive one dose of MMR vaccine if traveling internationally, according to the updated 2013 schedule.  Two more doses of the vaccine should be administered to this same group at age 12-15 months, and again at least 4 weeks later.

Children aged 12 months and older should receive two doses of the vaccine if traveling internationally. The first dose should be administered on or after age 12 months and the second dose at least 4 weeks later.

Varicella (Var) (chicken pox): Two doses of the chicken pox vaccine are recommended.

Dose #1: given between 12-15 months
Dose #2: given between ages 4-6 (may be received before age 4 years if at least 3 months have passed since the first dose)

Children aged 7 through 12 years who have not previously received the vaccine should receive both doses of the vaccine 3 months apart.

Children aged 13 years or older who have not previously received the vaccine should receive both doses of the vaccine 4 weeks apart.

Hepatitis A (Hep A): Two doses of the Hep A vaccine are recommended.

Dose #1 and dose #2: given between ages 12 to 23 months, with at least 6 to 18 months between the two.

Children who have received the first dose of the vaccine before age 24 months should receive the second dose 6 to 18 months after the first administration.

It can also be administered from 4 to 6 years or from 11 to 12 years for high risk groups. Children aged 2 years and older who have not received the vaccine series can complete the two doses of HepA vaccine with 6-18 months between doses.

Please note that this vaccine is only recommended in selected states and/or regions. To check if it is recommended in your area, contact your local public health authorities.

 

Older Children

Tetanus and diphtheria toxoids and acellular pertussis vaccine (Tdap): Tdap is recommended as a booster immunization for adolescents.

Dose #1: given between 11-12 years, regardless of the number of years that have gone by since the last dose of DTP, DTaP, or DT.

One dose should be administered to pregnant adolescents, regardless of the number of years that have elapsed since their last dose of Td or Tdap. The dose should be administered during each pregnancy, ideally during weeks 27 through 36.

Children ages 7 to 10 years who did not complete immunization with the childhood DTaP vaccine series should receive one dose of Tdap as the first dose in the catch-up series. Additional catch up doses should use Td vaccine.

Later routine Td boosters are recommended every 10 years.

Human papillomavirus (HPV): Human papillomavirus is commonly spread through sexual activity. Certain strains of the virus can cause cancers, including cervical, vulvar, vaginal, penile, anal, and oropharyngeal (part of the throat); other types cause genital warts in both men and women.

Cervarix and Gardasil are the 2 approved HPV vaccines. Both protect against HPV 16 and 18, the strains known to lead to most cervical cancers; they also provide more limited protection against certain other HPV-associated cancers such as vulvar, vaginal, penile, anal, and oropharyngeal.  Cervarix is approved only for females; Gardasil is approved for use with both males and females. Gardasil also protects against HPV types 6 and 11, which can cause genital warts.

The 2012 vaccine schedule recommends a 3-dose series of Gardasil (also called HPV4 because it protects against 4 strains of the virus) or Cervarix (also called HPV2 because it protects against 2 strains) for girls between the ages 11 and 12, and a 3-dose series of Gardasil for boys between the ages of 11 and 12. There should be 4-8 weeks between the first 2 doses; the third dose should be administered 6 months after the 2nd dose. The minimum age for the vaccine is 9 years, and the CDC recommends that it be given before the age of 26. If boys and girls between the ages of 13 and 18 have not previously received the vaccination, boys should receive the 3-dose series of Gardasil and girls the 3-dose series of Gardasil or Cervarix. You can read more about the HPV vaccine here.

Experts at the NationalResearchCenterfor Women and Families are concerned that while the HPV vaccine may be quite safe, data proving its long-term efficacy is still lacking. Gardasil and Cervarix are very expensive vaccines—the most expensive on the schedule—and yet we still do not know if and when a booster shot will be required. Cost-effectiveness and safety can not be fully evaluated without knowing how long the vaccine’s protection lasts. One worry is that children who get the vaccine when they are 11 or 12 may end up having inadequate protection against HPV when they become sexually active teenagers. For this reason, some parents may decide to delay their children’s vaccination against HPV until they are a little older and more information on the vaccines’ duration and safety are available. Whatever parents decide—to vaccinate or not to vaccinate—starting at age 21, young women must get regular Pap smears, a test used to screen for cervical cancer (to find out more, read Cervical Cancer Screening: The Key to Prevention).

Meningococcal Conjugate Vaccine (MCV): The meningitis vaccine can be administered after the age of 2. It is recommended for previously unvaccinated college entrants who will live in dormitories. One dose will suffice for healthy college students whose only risk factor is dormitory living.

For routine vaccination, children should receive one dose of the vaccine at age 11-12 years and a second booster dose at age 16 years.

Adolescents between 13 and 18 years old who have not received the vaccine should be given the vaccine according to the following recommendations:

  • Adolescents between 13 and 15 years should receive one dose of the vaccine followed by a second booster dose at age 16 through 18 years. Wait at least 8 weeks between the two doses.
  • Adolescents ages 16 years and older should receive only one dose of the vaccine. A booster dose is not needed.

For children with certain diseases or medical conditions, recommendations vary. To see what doses should be given and how often, click here.

 

What should you do if your child is having a serious reaction to a vaccine?

If you think your child is having a persistent or severe reaction to a vaccine, you should call your doctor or take your child to a doctor immediately. It is important to write down what happened and the date and time it happened. You should also contact the Vaccine Adverse Event Reporting System (VAERS) or ask your doctor, nurse, or health department to do so.

 

What is VAERS?

The Vaccine Adverse Event Reporting System, which is sponsored by the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA), collects and analyzes information from reports of possible adverse events that occur following vaccination. VAERS encourages reporting of any clinically significant adverse event that occurs after the administration of any vaccine licensed in the U.S., even if it is not certain that the reaction was caused by the vaccine.

There are many different types of events that can occur after vaccination. About 85% of VAERS reports describe mild reactions such as fever, local reactions, episodes of crying or mild irritability, and other less serious events. Approximately 15% of the reports describe serious adverse events involving life-threatening conditions, hospitalization, permanent disability, or death.

In 1986, Congress asked theInstituteofMedicineto conduct a scientific review of the possible adverse events following commonly used childhood vaccines. The Institute published two reports based on its findings; both concluded that adverse events caused by vaccines are rare.

For more information about VAERS, you can:

1.                   send email inquiries to info@vaers.org
2.                   visit the VAERS website at vaers.hhs.gov.
3.                   call the toll-free VAERS information line at 800-822-7967
4.                   fax inquiries to the toll-free information fax line at 877-721-0366

To find out if a certain vaccine adverse event has ever been reported to VAERS, send a written information request to:
Food and Drug Administration
Division of Freedom of Information (HFI-35)
Office of Shared Services
Office of Public Information and Library Services
5600 Fishers Lane
Rockville, MD 20857
Phone: 301-443-2414
You can also fax requests to: 301-443-1726