Immunizations

We’ll be taking a big family vacation in a couple of months. Do my kids need to get any special immunizations before we go?
– Doriana

If you plan to travel abroad or internationally it’s possible that your children — and you — will need additional vaccinations. Different countries have different health risks and may require specific vaccines. For example, your family will need the yellow fever vaccine if you’re traveling to tropical and sub-tropical areas in Africa or South America.

To find out which vaccines your family needs, ask your doctor or visit the Centers for Disease Control and Prevention (CDC) website for a list of recommended or required vaccinations (the site includes a section devoted to travelers’ health that you can search by destination).

Most immunizations should be given at least 1 month before travel, so try to schedule a doctor’s visit 4–6 weeks before your trip. This gives plenty of time for the vaccines to take effect, and allows for vaccines to be given over a period of days or weeks, if necessary. But even if you’re leaving in less than 4 weeks, you should still make an appointment, as kids might still benefit from shots or medications.

Depending on your travel plans, your doctor may recommend that in addition to routine immunizations, you and/or your kids be vaccinated against:

• typhoid
• yellow fever
• Japanese B encephalitis
• meningitis
• rabies

All kids get the measles, mumps and rubella (MMR) vaccine at 12–15 months of age, but any who will travel outside the United States before that can get the vaccine as early as 6 months of age.

Kids of any age can get malaria, so if you’re traveling to a country with a malaria risk, talk to your doctor about antimalarial drugs.

And if you’re traveling internationally, be sure to take your kids’ immunization records with you when you go.

Since the start of widespread vaccinations in the United States, cases of once common childhood illnesses like measles and diphtheria have dropped dramatically. Immunizations have protected millions of kids from dangerous diseases and saved thousands of lives.

In fact, certain diseases crop up so rarely now that parents sometimes ask if vaccines for them are even necessary. But most diseases that can be prevented by vaccines do still exist in the world, even in the United States, although they happen very rarely.

The reality is that vaccinations play a vital role in keeping kids healthy. Unfortunately, misinformation about vaccines could make some parents decide not to immunize their children, putting them and others at a greater risk for illness — or even death.

To better understand the benefits and risks of vaccines, read on.

What do vaccines do?

Vaccines work by preparing the body to fight illness. Each contains either a dead or a weakened germ (or parts of it) that causes a particular disease.

The body practices fighting the disease by making antibodies that recognize specific parts of that germ. This permanent or longstanding response means that if someone is ever exposed to the actual disease, the antibodies are already in place and the body knows how to combat it and the person doesn’t get sick. This is called immunity.

Will my child’s immune system be weaker by relying on a vaccine?

No, the immune system makes antibodies against a germ, like the chickenpox virus, whether it encounters it naturally or is exposed to it through a vaccine. Being vaccinated against one disease does not weaken the immune response to another disease.

Will the vaccine give someone the disease it’s supposed to prevent?

This is one of the most common concerns about vaccines. However, it’s impossible to get the disease from any vaccine made with dead (killed) bacteria or viruses or just part of the bacteria or virus.

Only those immunizations made from weakened (also called attenuated) live viruses — like the chickenpox (varicella) or measles-mumps-rubella (MMR) vaccine — could possibly make a child develop a mild form of the disease. But it’s almost always much less severe than would happen if someone is infected with the disease-causing virus itself. However, for kids with weakened immune systems, such as those being treated for cancer, these vaccines may cause problems.

The risk of disease from vaccination is extremely small. One live virus vaccine that’s no longer used in the United States is the oral polio vaccine (OPV). The success of the polio vaccination program has made it possible to replace the live virus vaccine with a killed virus form known as the inactivated polio vaccine (IPV). This change has completely eliminated the possibility of polio disease being caused by immunization in the United States.

Why should I have my child immunized if all the other kids in school are immunized?

It is true that a single child’s chance of catching a disease is low if everyone else is immunized. But your child is also exposed to people other than just those in school. And if one person thinks about skipping vaccines, chances are that others are thinking the same thing. Each child who isn’t immunized gives highly contagious diseases one more chance to spread.

As more people choose not to vaccinate their kids for one reason or another, outbreaks become more common, especially of diseases that were once wiped out in the U.S. In 2014, 383 cases of measles were reported in Ohio, for instance. That year, 667 cases from 27 states were reported in all. That’s the highest number since measles was declared eliminated from the U.S. in 2000. Most of those cases were among people who did not get vaccinated. Another large, multi-state measles outbreak in 2015 was linked to an amusement park in California. And in 2012, close to 50,000 U.S. cases of whooping cough (pertussis) were reported. That was the first time so many people were affected since the 1950s.

Although vaccination rates are fairly high in the United States, there’s no reliable way to know if everyone your child comes into contact with has been vaccinated, particularly now that so many people travel to and from other countries. So the best way to protect your kids is through immunization.

Can getting so many vaccines at once harm my baby?

Babies have stronger immune systems than you might think, and they can handle far more germs than what they receive from vaccines. In fact, the amount of germs in vaccines is just a small percentage of the germs babies’ immune systems deal with every day.

Sometimes, kids can have a reaction to a vaccine like a mild fever or rash. But the risk of serious reactions is small compared with the health risks associated with the often-serious diseases they prevent, and do not happen because the baby got several vaccines at once.

A lot of consideration and research went into creating the immunization schedule most doctors use, and it has been proven safe time and time again. Still, some parents choose to use alternative schedules (spreading or “spacing out” vaccines) because they’re concerned about the number of shots their babies get at each checkup. This is actually more likely to make a baby sick. Studies show that many babies on alternative immunization schedules never get all the vaccines they need.

Plus, alternative schedules can be a real hassle. Spacing out vaccines over more doctor visits means that you’ll have to take your child to the doctor — and your child will have to get a shot — more often.

Why should my child get a painful shot if vaccines aren’t 100% effective?

Few things in medicine work 100% of the time, but vaccines are one of the most effective weapons we have against disease — they work in 85% to 99% of cases. They greatly reduce your child’s risk of serious illness (particularly when more and more people are vaccinated) and give diseases fewer chances to take hold in a population.

It can be hard to watch kids get a shot, but the short-term pain is nothing compared with suffering through a potentially deadly bout of diphtheria, whooping cough, or measles.

Why do kids who are healthy, active, and eating well need to be immunized?

Vaccinations are intended to help keep healthy kids healthy. Because vaccines work by protecting the body before disease strikes, if you wait until your child gets sick, it will be too late for the vaccine to work. The best time to immunize kids is when they’re healthy.

Can immunizations cause a bad reaction in my child?

The most common reactions to vaccines are minor and include:

• redness and swelling where the shot was given
• fever
• soreness at the site where the shot was given

In rare cases, immunizations can trigger more serious problems, such as seizures or severe allergic reactions. If your child has a history of allergies to food or medicine, or has had a problem with a vaccine before, let the doctor know before any vaccines are given. Every year, millions of kids are safely vaccinated and very few experience serious side effects.

Research continually improves the safety of immunizations. The American Academy of Pediatrics (AAP) now advises doctors to use a diphtheria, tetanus, and pertussis vaccine that includes only specific parts of the pertussis cell instead of the entire killed cell. This vaccine, called DTaP, has been associated with even fewer side effects.

Do immunizations or thimerosal cause autism?

No. Numerous studies have found no link between vaccines and autism (a developmental disorder that’s characterized by mild to severe impairment of communication and social interaction skills). Likewise, a groundbreaking 2004 report from the Institute of Medicine (IOM) found that thimerosal (an organic mercury compound that’s been used as a preservative in vaccines since the 1930s) does not cause autism.

Still, some parents have opted not to have their children immunized, putting them at great risk of contracting deadly diseases.

The MMR vaccine, especially, has come under fire even though many scientific reports have found no evidence linking the vaccine to autism. In fact, a long-disputed 1998 study that suggested a possible link between autism and the MMR vaccine was retracted in 2004 and the doctor who published it lost his medical license. Even before it was discredited and declared fraudulent, the study was rejected by all major health organizations, including the AAP, the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), and the World Health Organization (WHO).

There’s also no reason to believe that thimerosal is linked to autism, according to the 2004 IOM report. Still, in an effort to reduce childhood exposure to mercury and other heavy metals, thimerosal began being removed from kids’ vaccines in 1999. Now, vaccines for infants and young children contain no or very little thimerosal. And recent studies have not shown any cognitive and behavioral problems in babies who might have received these thimerosal-containing vaccines.

So what could explain the increased rates of autism in recent years? For one thing, there’s a broader definition of autism that can be applied to more kids who show varying degrees of symptoms. A greater awareness of the condition among health professionals also has led to more diagnoses.

And although the number of children diagnosed with autism may be increasing, the rates of MMR vaccination are not. In London, diagnoses of autistic disorders have been on the rise since 1979, but rates of MMR vaccination haven’t increased since routine MMR vaccination began in 1988.

Also, the average age of diagnosis of autism has been found to be the same both in children who have and who have not received the MMR vaccine. What many researchers are discovering is that subtle symptoms of autism are often present before a child’s first birthday — sometimes even in early infancy — but often go unnoticed until the symptoms are more obvious to parents.

Wasn’t there a problem with the rotavirus vaccine?

Rotavirus is one of the most common causes of diarrhea in young children. In 1999, a rotavirus vaccine was taken off the market because it was linked to an increased risk for intussusception, a type of bowel obstruction, in babies.

However, two different rotavirus vaccines (RotaTeq and Rotarix) are now available and are very safe. Some studies suggest that they have a very small increased risk for intussusception, but that problem is rare. These vaccines have been shown to prevent most cases of rotavirus infection and almost all of the severe cases.

The vaccine is now on the regular immunization schedule to be given orally to infants as a liquid during standard vaccination visits — RotaTeq at ages 2 months, 4 months, and 6 months, and Rotarix at ages 2 months and 4 months. Your doctor will have the most current information.

Do vaccines cause SIDS, multiple sclerosis, or other problems?

There are concerns, many of which circulate on the Internet, linking some vaccines to multiple sclerosis, sudden infant death syndrome (SIDS), and other problems. To date, studies have failed to show any connection between immunizations and these conditions. The number of SIDS cases has actually fallen by more than 50% in recent years, whereas the number of vaccines given yearly has continued to rise.

Why do kids need to be immunized if a disease has been eliminated?

Diseases that are rare or nonexistent in the United States, like measles and polio, still exist in other parts of the world. Doctors continue to vaccinate against them because it’s easy to come into contact with illnesses through travel — either when Americans travel abroad or when people who aren’t properly immunized come to the United States.

If immunization rates fell, a disease introduced by someone visiting from another country or returning home from a foreign country could cause serious damage in an unprotected population. In 2008, a measles outbreak sickened many in San Diego, California, after a family who had taken a European vacation returned home with their unvaccinated child, who had contracted measles. In 2011, low immunization rates contributed to the largest whooping cough epidemic California had seen in 50 years — more than 9,000 people contracted the illness and 10 babies died.

It’s only safe to stop vaccinations for a particular disease when that disease has been eradicated worldwide, as in the case of smallpox.

How long does immunity last after getting a vaccine?

A few vaccines, like the two for measles or the series for hepatitis B, may make you immune for your entire life. Others, like tetanus, last for many years but require periodic shots (boosters) for continued protection against the disease.

The whooping cough (pertussis) vaccine also does not give lifelong immunity, and that may be one reason why outbreaks still happen. Whooping cough isn’t a serious problem for older kids and adults, but it can be for infants and young children. Because of this, teens and adults now receive a pertussis booster along with the tetanus and diphtheria booster (Tdap) — an important step in controlling this infection.

It’s important to keep a record of vaccinations so the doctor knows when your kids are due for a booster. Also make sure your kids get the flu vaccine each year. Having been immunized last year won’t protect someone from getting the flu this year because flu viruses constantly change. The vaccine is updated each year to include the most current strains of the virus.

The flu vaccine reduces the average person’s chances of catching the flu by up to 80%. It can’t prevent infection by all viruses that can cause flu-like symptoms, though, so being immunized isn’t a guarantee that someone won’t get sick during flu season. Still, even if someone who’s gotten the vaccine has the flu, symptoms usually will be fewer and milder.

Are vaccines continuously studied and improved because they’re unsafe?

The FDA’s Center for Biologics Evaluation and Research is the government agency responsible for regulating vaccines in the United States. Working with the CDC and the NIH, they continuously research and monitor vaccine safety and effectiveness.

New vaccines are licensed only after thorough laboratory studies and clinical trials, and safety monitoring continues even after a vaccine has been approved. There have been — and will continue to be — improvements (such as those that have already been made to the DTaP and polio vaccines, for example) that will minimize potential side effects and ensure the best possible safety standards.

Where can I get affordable immunizations for my child?

Clearly, vaccines are one of the best tools we have to keep kids healthy, but the effectiveness of immunization programs depends on availability. You can receive inexpensive or free vaccines through many local public health clinics and community health centers, and campaigns to vaccinate kids often hold free vaccination days.

A program called Vaccines for Children covers Medicaid-eligible, uninsured, Alaskan and Native American populations, and some underinsured kids for routine immunizations up to 18 years of age. The vaccines are provided by the government and administered in a doctor’s office. However, the doctor’s visit itself is not covered (unless the child has insurance, including Medicaid). But some public health clinics may cover both the visit and the immunizations.

Where can I find out more about immunizations?

Read Your Child’s Immunizations for details about each recommended immunization. You also can visit the CDC’s National Immunization Program website for more information about vaccinations.

And talk with your doctor about which immunizations your kids need — working together, you can help keep your family healthy.

If your daughter is a newborn or under 5 months old, try a method called the “5 S’s” immediately after she gets a vaccine. These are:

1. swaddling immediately after the shot. You also can swaddle (wrapping a baby tightly in a blanket like a “burrito”) before the shot, but leave your baby’s legs exposed for the vaccination.
2. placing her on her side or stomach
3. making shushing sounds in her ear
4. swinging her in your arms or an infant swing
5. giving her the opportunity to suck (whether through breastfeeding, a bottle, or a pacifier)

Research has shown that doing at least 4 of the 5 S’s greatly reduces the amount of time infants cry after getting a shot. If you’re OK with breastfeeding your daughter at the doctor’s office (to fulfill the sucking recommendation), this alone can be an effective method of distracting your baby and calming her down. You might even be able to do it while your child gets the vaccine.

In some situations, a sugar water solution may be available. Dipping a pacifier into this solution, then giving it to a fussy baby may help soothe the child.

Before and after the shot is given, try applying gentle pressure and rubbing the skin around the injection site. This massage may prevent the area from feeling so painful.

For an older baby or a toddler, swaddling or shushing might not work. Try letting your child sit on your lap during the shot and distract her with a toy, book, or song. Try not to look upset or concerned. Children can pick up on a parent’s anxiety, and it can make them anxious as well.

If your child has pain at the site where the shot was given or develops a fever and feels sick, speak to your child’s doctor about giving medicine such as acetaminophen or ibuprofen to relieve symptoms.

Also, don’t forget to praise your child afterward. A little positive reinforcement can make the next trip to the doctor easier. When possible, try to do something fun after the appointment. A trip to the park or playground can make the overall immunization experience less stressful.

This schedule of recommended immunizations may vary depending upon where you live, your child’s health, the type of vaccine, and the vaccines available.

Some of the vaccines may be given as part of a combination vaccine so that a child gets fewer shots. Talk with your doctor about which vaccines your kids should receive.

Birth

• HepB: Hepatitis B vaccine; ideally, the first dose is given at birth, but kids not previously immunized can get it at any age.

1–2 months

• HepB: Second dose should be administered 1 to 2 months after the first dose.

2 months

• DTaP: Diphtheria, tetanus, and acellular pertussis vaccine
• Hib: Haemophilus influenzae type b vaccine
• IPV: Inactivated poliovirus vaccine
• PCV: Pneumococcal conjugate vaccine
• RV: Rotavirus vaccine

4 months

• DTaP
• Hib
• IPV
• PCV
• RV

6 months

• DTaP
• Hib: This third dose may be needed, depending on the brand of vaccine used in previous Hib immunizations.
• PCV
• RV: This third dose may be needed, depending on the brand of vaccine used in previous RV immunizations.

6 months and annually

• Influenza (Flu): The flu vaccine is recommended every year for children 6 months and older:
  • Kids younger than 9 who get the flu vaccine for the first time (or who have only had one dose before July 2016) will get it in two separate doses at least a month apart.
  • Those younger than 9 who have had at least two doses of flu vaccine previously (in the same or different seasons) will only need one dose.
  • Kids older than 9 only need one dose.
• The vaccine is given by injection with a needle (the flu shot). The nasal spray form that was available in the past is not currently recommended because it was not found to be effective enough in recent years.

6–18 months

• HepB
• IPV

12–15 months

• Hib
• MMR: Measles, mumps, and rubella (German measles) vaccine
• PCV
• Chickenpox (varicella)

12–23 months

• HepA: Hepatitis A vaccine; given as two shots at least 6 months apart

15–18 months

• DTaP

4–6 years

• DTaP
• MMR
• IPV
• Varicella

11–12 years

• HPV: Human papillomavirus vaccine, given in two shots over a 6- to 12-month period. It can be given as early as age 9. For teens and young adults ages 15–26, it is given in three shots over 6 months. It’s recommended for both girls and boys to prevent genital warts and certain types of cancer.
• Tdap: Tetanus, diphtheria, and pertussis booster. Also recommended during each pregnancy a woman has.
• Meningococcal conjugate vaccine: And a booster dose is recommended at age 16.

16–18 years

• Meningococcal B vaccine (MenB): The MenB vaccine may be given to kids and teens in two or three doses, depending on the brand. Unlike the meningococcal conjugate vaccine, which is recommended, the MenB vaccine is given at the discretion of the doctor.

Special circumstances

• HepA is also recommended for kids 2 years and older and adults who are at high risk for the disease. This includes people who live in, travel to, or adopt children from locations with high rates of hepatitis A; people with clotting disorders; and people with chronic liver disease. The vaccine also can be given to anyone who desires immunity to the disease, and is useful for staff at childcare facilities or schools where they may be at risk of exposure.
• The MMR vaccine can be given to babies as young as 6 months old if they will be traveling internationally. These children should still be given the recommended routine doses at 12–15 months and 4–6 years of age.
• The flu vaccine is especially important for kids who are at risk for health problems from the flu. High-risk groups include, but aren’t limited to, kids younger than 5 years old and those with chronic medical conditions, such as asthma, heart problems, sickle cell disease, diabetes, or HIV.
• The meningococcal vaccines can be given to kids as young as 6 weeks old (depending on the type of vaccine) who are at risk of getting a meningococcal infection, such as meningitis. This includes children with certain immune disorders. Kids who live in (or will be traveling to) countries where meningitis is common, or where there is an outbreak, should also receive a vaccine.
• Pneumococcal vaccines also can be given to older kids (age 2 and up) who have conditions that affect their immune systems, such as asplenia or HIV infection, or other conditions, like a cochlear implant, chronic heart disease or chronic lung disease.

The flu vaccine is a good idea for all families. It does not cause the flu and it helps keep kids and parents from getting sick. Getting the flu is worse than having a cold and can make a person sick for a week or more.

Babies younger than 6 months old can’t get the vaccine, but if their parents, other caregivers, and older kids in the household get it, that will help protect the baby. This is important because infants are more at risk for serious complications from the flu.

Who Should Be Immunized?

The Centers for Disease Control and Prevention (CDC) recommends a flu vaccine for everyone 6 months of age and older.

But it’s especially important for those who are at greater risk of developing health problems from the flu, including:

• all kids 6 months through 4 years old (babies younger than 6 months are also considered high risk, but they cannot receive the flu vaccine)
• anyone 65 years and older
• all women who are pregnant, are considering pregnancy, have recently given birth, or are breastfeeding during flu season
• anyone whose immune system is weakened from medications or illnesses (like HIV infection)
• residents of long-term care facilities, such as nursing homes
• anyone (adults, teens, and kids) with a chronic medical condition, such as asthma
• kids or teens who take aspirin regularly and are at risk for developing Reye syndrome if they get the flu
• caregivers or household contacts of anyone in a high-risk group (like children younger than 5 years old, especially those younger than 6 months, and those with high-risk conditions)
• Native Americans and Alaskan Natives

Certain things might prevent a person from getting the flu vaccine. Talk to your doctor to see if the vaccine is still recommended if your child:

• has ever had a severe reaction to a flu vaccination
• has Guillain-Barré syndrome (a rare condition that affects the immune system and nerves)

Types of Flu Vaccine

Different types of vaccines are available. One type (called trivalent) protects against three strains of the flu virus (usually, two types of influenza A viruses and one influenza B virus). Another type (called quadrivalent) protects against four strains.

The vaccine is given to kids by injection with a needle (the flu shot). This vaccine is safe and effective.

Some vaccines are approved only for adults at this time, such as egg-free vaccines and intradermal shots, which are injected into the skin (instead of muscle) with a smaller needle.

Vaccine shortages and delays sometimes happen, so check with your doctor about availability and to see which vaccine is right for your kids.

The nasal spray version of the flu vaccine is no longer recommended by the US Centers for Disease Control (CDC), for kids or adults. The nasal vaccine did not prevent people from getting the flu between 2013 and 2016. Researchers aren’t sure why recent versions of the vaccine no longer work well, but at this time, doctors can no longer recommend the nasal spray version.

Egg Allergy and Flu Vaccine

In the past, it was recommended that anyone with an egg allergy talk to a doctor about whether receiving the flu vaccine was safe because it is grown inside eggs. But health experts now say that the amount of egg allergen in the vaccine is so tiny that it is safe even for kids with a severe egg allergy. This is especially important during a severe flu season.

Still, a child with an egg allergy should get the flu shot in a doctor’s office, not at a supermarket, drugstore, or other venue. And if the allergy is severe, it might need to be given in an allergist’s office.

If your child is sick and has a fever, talk to your doctor about rescheduling the flu shot.

When Should Kids Get Vaccinated?

Flu season runs from October to May. It’s best to get a flu shot as early in the season as possible, as it gives the body a chance to build up immunity to (protection from) the flu. But getting a shot later in the season is still better than not getting the vaccine at all.

Flu season runs from October to May, with most cases happening from late December to early March. But the flu vaccine is usually offered from September until mid-November. Getting vaccinated before the flu season is in full force gives the body a chance to build up immunity to (protection from) the virus.

Even though it’s best to get vaccinated as soon as the flu vaccine is available, getting the vaccine later can still be helpful. Even as late as January, there are still a few months left in the flu season, so it’s still a good idea to get protected.

Who Should Get the Flu Vaccine?

The flu vaccine is recommended for everyone age 6 months and older. It’s especially important for people who are at greater risk of developing health problems from the flu to get vaccinated. They include:

• all kids 6 months through 4 years old (babies younger than 6 months are also considered high risk, but they cannot receive the flu vaccine)
• anyone 65 years and older
• all women who are pregnant, are considering pregnancy, have recently given birth, or are breastfeeding during flu season
• anyone whose immune system is weakened from medications or illnesses (like HIV infection)
• residents of long-term care facilities, such as nursing homes
• anyone (adults, teens, and kids) with a chronic medical condition, such as asthma
• kids or teens who take aspirin regularly and are at risk for developing Reye syndrome if they get the flu
• caregivers or household contacts of anyone in a high-risk group (like children younger than 5 years old, especially those younger than 6 months, and those with high-risk conditions)
• Native Americans and Alaskan Natives

Kids under 9 years old will receive two doses this flu season if they have received fewer than two doses of flu vaccine before July 2016. This includes kids who are getting the flu vaccine for the first time. Those under 9 who have received at least two doses of flu vaccine previously (in the same or different seasons) will only need one dose. Kids older than 9 only need one dose of the vaccine.

It can take 1 to 2 weeks for the flu vaccine to become effective, so it’s best to get vaccinated as soon as possible.

Types of Flu Vaccine

Different types of vaccines are available. One type (called trivalent) protects against three strains of the flu virus (usually, two types of influenza A viruses and one influenza B virus). Another (called quadrivalent) protects against four strains.

The vaccine is given to kids by injection with a needle (the flu shot). This vaccine is safe and effective.

Some vaccines are approved only for adults at this time, such as egg-free vaccines and intradermal shots, which are injected into the skin (instead of muscle) with a smaller needle.

Although the flu vaccine also came in a nasal spray (or mist) form in the past, the nasal spray is not currently recommended. The Centers for Disease Control and Prevention (CDC) found that it didn’t prevent cases of the flu between 2013 and 2016.

Those Who Should Not Get the Vaccine

Certain things might prevent a person from getting the vaccine. Talk to your doctor to see if the vaccine is still recommended if your child:

• has ever had a severe reaction to a flu vaccination
• has Guillain-Barré syndrome (a rare condition that affects the immune system and nerves)

In the past, it was recommended that anyone with an egg allergy talk to a doctor about whether receiving the flu vaccine was safe because it is grown inside eggs. But health experts now say that the amount of egg allergen in the vaccine is so tiny that it is safe even for kids with a severe egg allergy. This is especially important during a severe flu season.

Still, a child with an egg allergy should get the flu shot in a doctor’s office, not at a supermarket, drugstore, or other venue. And if the allergy is severe, it might need to be given in an allergist’s office.

If your child is sick and has a fever, talk to your doctor about rescheduling the flu vaccine.

Are There Side Effects?

Most people do not have any side effects from the flu shot. Some have soreness or swelling at the site of the shot or mild side effects, such as headache or low-grade fever.

Where Can My Family Get the Vaccine?

The flu vaccine is available at:

• many health care settings, including doctors’ offices and public, employee, and university health clinics
• some pharmacies
• some supermarkets
• some community groups or centers
• some schools

If you have an HMO insurance plan, be sure to check with your primary care doctor before having your kids vaccinated outside the office, since most HMOs will pay for shots only if they’re given through their plan.

The flu vaccine is covered by Medicare for senior citizens and is generally covered by insurance for people in other high-risk groups. Otherwise, the vaccine may cost anywhere from $10 to $50.

I’ve heard that children who are taking antibiotics for an illness — like an ear infection — should not get a vaccine at the same time. Is this true?
– Ishani

Not usually. For the vast majority of kids, taking antibiotics for a mild illness (like an ear infection) shouldn’t keep them from getting their vaccinations on schedule. Antibiotics do not interfere with the ingredients in vaccines or cause a bad reaction in a child who has just been vaccinated.

Kids taking antibiotics for a moderate or severe illness should not get vaccinated until they recover from the illness — but this applies to all children who are sick, not just those who are taking antibiotics. That’s because it can be hard to figure out whether symptoms like a fever following a vaccination are a side effect of the vaccine or due to the illness itself. As soon as a child is feeling better, even if he or she is on antibiotics, the vaccine can and should be given.

If you’re concerned about your child’s health and the safety of getting vaccinated, talk to your doctor or the person administering the vaccine.

Babies are born with protection against certain diseases because antibodies from their mothers were passed to them through the placenta. After birth, breastfed babies get the continued benefits of additional antibodies in breast milk. But in both cases, the protection is temporary.

Immunization (vaccination) is a way of creating immunity to certain diseases by using small amounts of a killed or weakened microorganism that causes the particular disease.

Microorganisms can be viruses (such as the measles virus) or they can be bacteria (such as pneumococcus). Vaccines stimulate the immune system to react as if there were a real infection — it fends off the “infection” and remembers the organism so that it can fight it quickly should it enter the body later.

Types of Vaccines

There are a few different types of vaccines. They include:

• Attenuated (weakened) live viruses are used in some vaccines such as in the measles, mumps, and rubella (MMR) vaccine.
• Killed (inactivated) viruses or bacteria are used in some vaccines, such as in IPV.
• Toxoid vaccines contain an inactivated toxin produced by the bacterium. For example, the diphtheria and tetanus vaccines are toxoid vaccines.
• Conjugate vaccines (such as Hib) contain parts of bacteria combined with proteins.

The American Academy of Pediatrics (AAP) recommends that kids get combination vaccines (rather than single vaccines) whenever possible. Many vaccines are offered in combination to help reduce the number of shots a child receives.

The Vaccines Your Child Needs

The following vaccinations and schedules are recommended by the AAP. Please note that some variations are acceptable and that changes in recommendations often occur as new vaccines are developed. Your doctor will determine the best vaccinations and schedule for your child.

Recommended vaccinations:

• Chickenpox (varicella) vaccine
• Diphtheria, tetanus, and pertussis vaccine (DTaP)
• Hepatitis A vaccine (HepA)
• Hepatitis B vaccine (HepB)
• Hib vaccine
• Human papillomavirus (HPV) vaccine
• Influenza vaccine
• Measles, mumps, and rubella vaccine (MMR)
• Meningococcal vaccines
• Pneumococcal vaccine (PCV)
• Polio vaccine (IPV)
• Rotavirus vaccine

Vaccine Concerns

Some parents may hesitate to have their kids vaccinated because they’re worried that the children will have serious reactions or may get the illness the vaccine is supposed to prevent. But because the components of vaccines are weakened or killed — and in some cases, only parts of the microorganism are used — they’re unlikely to cause any serious illness.

Some vaccines may cause mild reactions, such as soreness where the shot was given or fever, but serious reactions are rare. The risks of vaccinations are small compared with the health risks associated with the diseases they’re intended to prevent.

Immunizations are one of the best means of protection against contagious diseases.

The varicella vaccine protects against chickenpox (varicella), a common and very contagious childhood viral illness.

Immunization Schedule

The varicella vaccine is given by injection when kids are between 12 and 15 months old. They receive a booster shot for further protection at 4 to 6 years of age.

Kids who are older than 6 but younger than 13 who have not had chickenpox also may receive the vaccine, with the two doses given at least 3 months apart.

Kids 13 years or older who have not had either chickenpox or the vaccine need two vaccine doses at least 1 month apart.

Why the Vaccine Is Recommended

The varicella vaccine prevents severe illness in almost all kids who are immunized. It’s up to 85% effective in preventing mild illness. Vaccinated kids who do get chickenpox generally have a mild case.

Possible Risks

Possible mild effects are tenderness and redness where the shot was given, fever, tiredness, and a varicella-like illness. There is a very small chance of an allergic reaction with any vaccine.

A rash can happen up to 1 month after the injection. It may last for several days but will disappear on its own without treatment. There is a very small risk of febrile seizures after vaccination.

When to Delay or Avoid Immunization

The vaccine is not recommended if:

• your child is currently sick, although simple colds or other minor illnesses should not prevent immunization
• your child has had an allergic reaction to gelatin or to the antibiotic neomycin that required medical treatment

Talk to your doctor about whether being vaccinated is a good idea if your child:

• had a severe allergic reaction to a previous dose of varicella vaccine
• has recently received gamma globulin or a blood transfusion
• has a disorder that affects the immune system (such as cancer); is taking prednisone, steroids, or other immunosuppressive drugs; or is undergoing chemotherapy or radiation therapy

Your doctor may decide that the benefits of vaccinating your child outweigh the potential risks.

Pregnant women should not receive the chickenpox vaccine until after childbirth.

Caring for Your Child After Immunization

Check with your doctor to see if you can give either acetaminophen or ibuprofen for pain or fever and to find out the appropriate dose.

When to Call the Doctor

Call your doctor if:

• you aren’t sure if the vaccine should be postponed or avoided
• there are problems after the immunization

The diphtheria, tetanus, and pertussis (DTaP) vaccine protects against:

• Diphtheria: a serious infection of the throat that can block the airway and cause severe breathing problems
• Tetanus (lockjaw): a nerve disease that can happen at any age, caused by toxin-producing bacteria contaminating a wound
• Pertussis (whooping cough): a respiratory illness with cold-like symptoms that lead to severe coughing (the “whooping” sound happens when a child breathes in deeply after a severe coughing fit). Serious complications can affect children under 1 year old, and those younger than 6 months old are especially at risk. Teens and adults with a lasting cough might have pertussis and not realize it, and could pass it to vulnerable infants.

Immunization Schedule

DTaP immunizations are given as a series of five injections, usually administered at ages:

• 2 months
• 4 months
• 6 months
• 15–18 months
• 4–6 years

A vaccine called Tdap (the booster shot) should be given at ages 11 to 12, and to older teens and adults who haven’t yet had a booster with pertussis coverage. Then, Td (tetanus and diphtheria) boosters are recommended every 10 years.

Pregnant women should get the Tdap vaccine in the second half of each pregnancy, even if they’ve been vaccinated in the past. Tdap also can be given after a deep cut or severe burn to prevent tetanus infection.

Why the Vaccine Is Recommended

Use of the DTaP vaccine has virtually eliminated diphtheria and tetanus in childhood and has greatly reduced the number of pertussis cases.

Possible Risks

The vaccine frequently causes mild side effects: fever; mild crankiness; tiredness; loss of appetite; and tenderness, redness, or swelling in the area where the shot was given.

Rarely, a child may have a seizure or cry uncontrollably after getting the vaccine. But these sorts of side effects are so rare that researchers question whether they’re even caused by the vaccine. Most kids have a few minor or no side effects.

When to Delay or Avoid Immunization

• The vaccine is not recommended if your child is currently sick, although simple colds or other minor illnesses should not prevent immunization.
• Talk to your doctor about whether getting the vaccine is a good idea if your child had any of the following after an earlier DTaP shot:
  • a brain or nervous-system problem, like a seizure
  • the worsening of a seizure disorder
  • an allergic reaction, like mouth, throat, or facial swelling
  • fever of 105°F (40.5°C) or higher during the first 2 days after injection
  • collapse or a “shock”-like state during the first 2 days after injection
  • uncontrolled crying that lasts for more than 3 hours during the first 2 days after injection

Your doctor might decide to just give a partial vaccine or no vaccine, or may determine that the benefits of vaccinating your child outweigh the potential risks.

Caring for Your Child After Immunization

Your child may have a fever, soreness, and some swelling and redness in the area where the shot was given. For pain and fever, check with your doctor to see if you can give either acetaminophen or ibuprofen, and to find out the appropriate dose.

A warm, damp cloth or a heating pad on the injection site may help reduce soreness, as can moving or using the arm.

When to Call the Doctor

• Call if you aren’t sure whether the vaccine should be postponed or avoided. Children who have had certain problems with the DTaP vaccine usually can safely receive the Td (tetanus and diphtheria) vaccine.
• Call if complications or severe symptoms begin after immunization, including seizures, fever above 105°F (40.5°C), difficulty breathing, signs of an allergic reaction, shock or collapse, or uncontrolled crying for more than 3 hours.