Immunizations

The hepatitis A virus (HAV) causes fever, nausea, vomiting, and jaundice, and can lead to community-wide epidemics. Childcare centers are a common site of outbreaks.

Immunization Schedule

The vaccine is recommended for children 12–23 months old, followed by a second dose 6–18 months later.

The vaccine also is recommended for older kids 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 HAV; people with clotting disorders; and people with chronic liver disease. It also can be given to anyone who wants immunity to the disease.

The HAV vaccine also is useful for staff of childcare facilities or schools where they may be at risk of exposure. If you plan to travel, talk to your doctor in advance so you and your family have time to get any needed immunizations.

Why the Vaccine Is Recommended

Besides protecting the individual child, vaccination against HAV can help prevent epidemics. Some infected kids do not have any symptoms, but can still spread the virus to others. Having many young kids vaccinated against HAV can limit the spread of the disease in a community.

Possible Risks

Side effects are usually mild fever; and tenderness, swelling, and redness at the site of the injection. Allergic reactions to the vaccine are rare.

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
• had a severe allergic reaction to the first dose of hepatitis A vaccine or has a latex allergy

Caring for Your Child After Immunization

Your child may have 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.

When to Call the Doctor

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

Hepatitis B virus affects the liver. Those who are infected can become lifelong carriers of the virus and may develop long-term problems, such as cirrhosis (liver disease) or cancer of the liver.

Immunization Schedule

Hepatitis B vaccine (HepB) usually is given as a series of three injections:

1. shortly after birth
2. at 1–2 months of age
3. at 6–18 months of age

If the mother of a newborn carries the hepatitis B virus in her blood, her baby must receive the vaccine within 12 hours after birth, along with another shot — hepatitis B immune globulin (HBIG) — to immediately provide protection against the virus. If a newborn’s mother shows no evidence of the virus in her blood, the baby can receive the HepB vaccine within 24 hours after birth.

Why the Vaccine Is Recommended

The HepB injection usually creates long-term immunity. Infants who receive the HepB series should be protected from hepatitis B infection not only throughout their childhood but also into their adult years.

Eliminating the risk of infection also decreases risk for cirrhosis of the liver, chronic liver disease, and liver cancer. Young adults and adolescents also should receive the vaccine if they did not as infants.

Possible Risks

There is a very small chance of an allergic reaction with any vaccine. Serious problems associated with receiving the vaccine are rare. Problems that do occur tend to be minor, such as mild fever and soreness or redness at the injection site.

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
• had a severe allergic reaction (anaphylaxis) after a previous dose of the vaccine or is allergic to baker’s yeast

Caring for Your Child After Immunization

The vaccine may cause mild fever and soreness or redness in the area where the shot was given. 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. Very young infants should not be given either of these medicines.

When to Call the Doctor

• Call if you’re not sure of the recommended schedule for the HepB vaccine.
• Call if you have concerns about your own hepatitis B carrier state.
• Call if moderate or serious side effects appear after your child has received a HepB injection.

Haemophilus influenzae type b bacteria (Hib) were the leading cause of meningitis in children younger than 5 years old until the Hib vaccine became available.

Immunization Schedule

The Hib vaccine is given by injection at ages:

• 2 months
• 4 months
• 6 months (however, some of the Hib vaccines do not require a dose at 6 months)
• a booster dose at 12–15 months

Kids ages 15 months or older who are receiving the vaccine for the first time only need one dose.

Children ages 12 months to 59 months (almost 5 years old) may need additional doses if their immune systems are weakened due to things like asplenia (when the spleen is missing or not working properly), HIV infection, chemotherapy or radiation treatment, or a stem cell transplant.

The vaccine is not routinely recommended for kids older than 5, unless they have HIV or asplenia and have never been vaccinated.

Why the Vaccine Is Recommended

The vaccine provides long-term protection from Haemophilus influenzae type b. Those who are immunized have protection against Hib meningitis; pneumonia; pericarditis (an infection of the membrane covering the heart); and infections of the blood, bones, and joints caused by the bacteria.

Possible Risks

Minor problems — such as redness, swelling, or tenderness where the shot was given — can happen. There is a very small chance of an allergic reaction with any vaccine.

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
• had a severe allergic reaction (anaphylaxis) to a previous Hib vaccine

Caring for Your Child After Immunization

The vaccine may cause mild soreness 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.

When to Call the Doctor

• Call if you aren’t sure whether the vaccine should be postponed or avoided.
• Call if moderate or serious adverse reactions appear after the Hib injection.

Human papillomavirus (HPV) is a sexually transmitted disease (STD). It can cause genital warts and changes in the cervix that can result in cervical cancer. It can also lead to cancer in other areas, such as the penis, anus, and throat. Recent research suggests it may even be linked to cardiovascular disease in women.

Immunization Schedule

The vaccine is recommended for girls and boys 11 or 12 years old, as well as for older kids who are unvaccinated. If needed, kids can get the vaccine starting at age 9.

The vaccine is given as a series of shots:

• For children ages 9-14, it is given in two shots over a 6- to 12-month period.
• For teens and young adults ages 15-26, it is given in three shots over a 6-month period.

Why the Vaccine Is Recommended

Because HPV can cause serious problems such as genital warts and some types of cancer, a vaccine is an important step in preventing infection and protecting against the spread of HPV. It works best when given before someone becomes sexually active.

Possible Risks

The most common side effects are mild fever and tenderness, swelling, and redness at the injection site. Dizziness, fainting, nausea, and vomiting also can follow a shot. Allergic reactions to the vaccine are rare.

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 had a severe allergic reaction (anaphylaxis) to the first dose of HPV vaccine or has a yeast allergy
• your daughter is pregnant

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 follow the directions carefully.

When to Call the Doctor

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

Influenza — what most of us call “the flu” — is a highly contagious viral infection of the respiratory tract.

Immunization Schedule

Flu season runs from October to May. It’s best to get a flu vaccine 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 flu vaccine later in the season is still better than not getting the vaccine at all.

The Centers for Disease Control and Prevention (CDC) now recommends a flu vaccine for everyone 6 months of age and older (instead of just certain groups, as was recommended before).

But it’s especially important that those in higher-risk groups get vaccinated to avoid health problems as a result of the flu. They include:

• all kids 6 months through 4 years old
• 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
• any adult or child with chronic medical conditions, 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

Babies younger than 6 months 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.

• Kids younger than 9 years old will receive two doses of flu vaccine this flu season if they have received fewer than two doses 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 need only one dose of the vaccine.

Talk to your doctor about how many doses your child needs.

Types of Vaccines

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 currently recommended to be given to kids by injection with a needle (the flu shot). It is safe and effective.

Although the flu vaccine also came in a nasal spray (or mist) form in the past, the nasal spray is not currently recommended.

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.

Why the Vaccine Is Recommended

While the flu vaccine isn’t 100% effective, it still greatly reduces a person’s chances of catching the flu, which can be very serious. It also can make symptoms less severe if someone does still get the flu after immunization.

Even if you or your kids got the flu vaccine last year, that won’t protect you this year, because flu viruses constantly change. That’s why the vaccine is updated each year to include the most current strains of the virus.

Sometimes the same strains are included in the vaccine one year after the next. In this case, it’s still important to get a seasonal flu shot because the body’s immunity against the influenza virus declines over time.

Possible Side Effects

Usually given as an injection in the upper arm, the flu shot contains killed flu viruses that will not cause someone to get the flu, but can cause mild side effects like soreness, redness, or swelling at the injection site. A low-grade fever and aches are also possible.

Very rarely, the flu vaccine can cause a severe allergic reaction.

When to Delay or Avoid Immunization

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)

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.

Caring for Your Child After Immunization

Check with your doctor to see if you can give either acetaminophen or ibuprofen for pain and fever 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 if the vaccine should be postponed or avoided
• there are problems after the immunization, such as an allergic reaction or high fever, or if you have other concerns

The MMR vaccine protects against measles, mumps, and rubella (German measles).

Immunization Schedule

MMR vaccinations are given by injection in two doses:

1. at age 12–15 months
2. at age 4–6 years

Children traveling outside the United States can get the vaccine as early as 6 months of age. These children should still get the recommended routine doses at 12–15 months and 4–6 years of age (if they are staying in an area where disease risk is high, they should get the first dose at 12 months and the second at least 4 weeks later).

Why the Vaccine Is Recommended

Measles, mumps, and rubella are infections that can lead to significant illness. More than 95% of children receiving MMR will be protected from the three diseases throughout their lives.

Possible Risks

Serious problems such as allergic reactions are rare. Potential mild to moderate reactions include rash, fever, swollen cheeks, febrile seizures, and mild joint pain.

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 had a severe allergic reaction to a previous dose of MMR vaccine, to gelatin, or to the antibiotic neomycin

Talk to your doctor about whether it’s a good idea for your child to be vaccinated if he or she:

• recently received gamma globulin or a blood transfusion
• has a medical problem that affects the immune system, such as cancer
• is taking prednisone, steroids, or other immunosuppressive drugs
• is undergoing chemotherapy or radiation therapy
• has ever had a low platelet count

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

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

Caring for Your Child After Immunization

If your child develops a rash without other symptoms, no treatment is needed. The rash should go away in several days. 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 if you aren’t sure if the vaccine should be postponed or avoided.
• Call if there are problems after the immunization.

The meningococcal vaccines protect against meningococcal disease, a serious infection that can lead to bacterial meningitis and other serious infections.

Two kinds of meningococcal vaccines are currently given to kids in the United States:

1. The meningococcal conjugate vaccine protects against four types of meningococcal bacteria (called types A, C, W, and Y). It is recommended for all kids.
2. The meningococcal B vaccine (MenB) protects against a fifth type of meningococcal bacterium (called type B). It is fairly new and not yet recommended as a routine vaccination for healthy people, but might be given to some kids and teens (ages 16 through 23) who are at increased risk for meningococcal disease.

Immunization Schedule

Vaccination with meningococcal conjugate vaccine is recommended:

• when kids are 11 or 12 years old, with a booster given at age 16
• for teens 13–18 years old who haven’t been previously vaccinated

Those who have their first dose between the ages of 13–15 should get a booster dose between the ages of 16–18. Teens who get their first dose after age 16 (for example, previously unvaccinated college freshmen who will be living in dorms or those entering the military) won’t need a booster dose.

A full series of the meningococcal conjugate vaccines should be given to kids and teens who are at higher risk for meningococcal disease, including those who:

• live in or travel to countries where the disease is common
• are present during an outbreak of the disease
• have certain immune disorders. If the immune disorders are chronic, these kids also need a booster dose a few years later, depending on the age at which the first dose is given.

The sequence and dosage will depend on the child’s age.

Kids 10 years and older with these risk factors should get a full series of the MenB vaccine. The preferred age range for getting the vaccine is 16–18 years. Two or three doses are needed depending on the brand. The decision to get this vaccine should be made together by the teen, his or her parents, and the doctor.

Why the Vaccines Are Recommended

Meningococcal disease is caused by a type of bacteria. It can lead to an infection of the bloodstream or meningitis, or both, and can be life-threatening if not quickly treated. The meningococcal conjugate vaccine is very effective at protecting against four strains of the bacteria, while the MenB vaccine protects against a fifth strain.

Possible Risks

Some of the most common side effects are swelling, redness, and pain at the site of the injection, along with headache, fever, or tiredness. Severe problems, such as allergic reactions, are rare.

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 a severe allergic reaction to a previous dose of meningococcal vaccine, to the DTaP vaccine, or to latex

If your child has a history of Guillain-Barré syndrome (a disease of the nervous system that causes progressive weakness), talk to your doctor about whether the vaccines are a good idea.

Caring for Your Child After Immunization

Your child might have a fever, soreness, and some swelling and redness in the area where the shot was given. 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.

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 if the vaccine should be postponed or avoided.
• Call if there are problems after the immunization.

The pneumococcal conjugate vaccine (PCV13) and the pneumococcal polysaccharide vaccine (PPSV23) protect against pneumococcal infections, which are caused by bacteria.

The bactera spread through person-to-person contact and can cause such serious infections as pneumonia, blood infections, and bacterial meningitis.

PCV13 protects against 13 types of pneumococcal bacteria (the types that cause the most common pneumococcal infections in kids). PPSV23 protects against 23 types. These vaccines not only prevent infections in children who are immunized, but also help stop the infections from spreading.

Immunization Schedule

PCV13 immunizations are given to all infants as a series of four injections:

• the first at 2 months of age
• then at 4 months, 6 months, and 12–15 months

Some kids older than age 2 also might need a shot of PCV13; for example, if they have missed one or more shots or if they have a chronic health condition (such as heart or lung disease) or one that weakens the immune system (like asplenia, HIV infection, etc.). A doctor can decide when and how often a child will need to receive PCV13.

PPSV23 immunizations are recommended as added protection against pneumococcal disease in kids 2–18 years old who have certain chronic health conditions, including heart, lung, or liver disease; diabetes; kidney failure; a weakened immune system (such as from cancer or HIV infection); or cochlear implants.

Why the Vaccines Are Recommended

Children younger than 2 years old, adults over 65, and people with certain medical conditions are at high risk of developing serious pneumococcal infections. These vaccines are very effective at preventing severe disease, hospitalization, and even death.

Possible Risks

Kids may have redness, tenderness, or swelling where the shot was given. A child also might have a fever after getting the shot. There is a very small chance of an allergic reaction with any vaccine.

When to Delay or Avoid Immunization

These vaccines are not recommended if your child:

• is currently sick, although simple colds or other minor illnesses should not prevent immunization
• has had a severe allergic reaction to a previous dose of a pneumococcal vaccine or to the DTaP vaccine

Caring for Your Child After Immunization

These vaccines may cause mild fever and soreness or redness in the area where the shot was given. 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 if your child missed a dose in the series.
• Call if a severe allergic reaction or high fever happens after immunization.

Rotavirus is a common virus that causes vomiting and diarrhea, especially in infants and young children. Childcare centers are a common site of outbreaks.

Immunization Schedule

The vaccine, which is a liquid given by mouth, is recommended at ages 2 and 4 months, and again at 6 months, depending on the brand of vaccine used.

Why the Vaccine Is Recommended

Rotavirus can cause severe diarrhea, which can lead to dehydration and, for some kids, hospitalization. Besides protecting the individual child, vaccination against rotavirus can help stop spread in the community.

Possible Risks

Side effects can include diarrhea and vomiting, and a fever.

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
• had a severe allergic reaction to a previous dose of the vaccine
• has severe combined immune deficiency (SCID), a genetic disorder
• had intussusception, a type of bowel blockage, in the past

Let the doctor know if your child has an allergy to latex, since one of the rotavirus vaccine brands has a latex applicator.

Talk to your doctor about whether it’s a good idea for your child to be vaccinated if he or she:

• has an abnormality of the digestive system or a gastrointestinal disease
• had intussusception in the past
• has recently received a blood transfusion
• has immune system problems from a disease such as cancer; is taking steroids, or other drugs that weaken the immune system; or is undergoing chemotherapy or radiation therapy

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

Caring for Your Child After Immunization

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.

If vomiting or diarrhea happen, give your child small amounts of fluid often and watch for signs of dehydration, such as less urine (pee) than usual.

When to Call the Doctor

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

Rarely, some kids will develop intussusception within a week of getting the first dose of the vaccine. So after the first dose, watch for symptoms such as periods of intense abdominal pain with uncontrollable crying; vomiting; blood or mucus in the poop; and seeming weak, drowsy, or fussy.