Parents may be concern about immunizations causing autism in children. Although there are many benefits from immunization,
some parents question the need for or safety of childhood vaccines. These parents may choose to delay or refrain from
immunizing their children from some or all of the recommended vaccines. Before making immunization decisions parents should
be fully informed, and try to be aware of differing views of vaccine risks and benefits and choose effectively.
Immunization of children has been called one of the most important public health interventions in history, after safe drinking
water. It has saved millions of lives over the years and prevented hundreds of millions of cases of disease. We all know that
getting our children immunized can protect them from some very serious diseases. Some children can’t get certain vaccines for
medical reasons, other children don’t respond well to certain vaccines. For these children, the immunity of people around them is
their only protection.
Immunizations help the child’s immune system function. The child develops protection against future infections, the same as if he
or she had been exposed to the natural disease. Except with vaccines children don’t have to get sick first to get that protection.
The purpose of immunizations is to prevent disease.
Today, children in the United States routinely get immunizations that protect them from diseases. Some childhood vaccines have
been used since the 1940s, others have been around for only a short time. Currently there are 10 routinely used vaccines that
protect children against the 14 diseases. These diseases have, at one time or another, been a serious threat to children in this
country. Most of them are now at their lowest levels in history, thanks to years of immunization.
Immunizations Used on Children
Diphtheria
Diphtheria caused by a bacterium called Corynebacterium diphtheriae. It lives in the mouth, throat and nose of an infected person
and can be spread to others by coughing or sneezing. A child with diphtheria can infect others for 2 to 4 weeks.
Diphtheria can initially cause a sore throat, fever and chills. But if it is not properly diagnosed and treated it produces a toxin
(poison) that can cause serious complications such as heart failure or paralysis. About 1 person out of 10 who get diphtheria dies
from it. Diphtheria used to be a major cause of childhood illness and death. Through the 1920s about 150,000 people a year got
diphtheria in the United States, and about 15,000 of them died.
DTaP Vaccine
DTaP combines vaccines against three diseases, Diphtheria, Tetanus and Pertussis (Whooping Cough) into one shot. (The small
“a” in the name stands for “acellular,” which means that the pertussis component of the vaccine contains only parts of the
pertussis bacterium rather than the whole cell.) The diphtheria and tetanus components of the vaccine are not technically
vaccines, but a substance that is normally toxic but has been treated to destroy its toxic properties. They help the immune system
develop protection against the poisons produced by the diseases rather than against the disease bacteria themselves. All three
components of DTaP are “inactivated” (killed). Tetanus, diphtheria and pertussis (DTP) vaccines have been in common use since
the 1940s. DTaP vaccine (with the acellular pertussis component) was first licensed in 1991.
Children need five DTaP shots for maximum protection. The first three shots are given at 2, 4, and 6 months of age. The fourth
(booster) shot is given between 15 and 18 months, and a fifth shot, another booster, is given when a child enters school, at 4–6
years. When it is given according to this schedule, DTaP protects most children from all three diseases (80%–85% from
pertussis, 95% from diphtheria, nearly 100% from tetanus). Protection can fade with time, so booster doses (using Td or Tdap
vaccine, see below) are recommended every 10 years. These vaccines are also sometimes given when a person gets a serious
wound that could contain tetanus bacteria.
Hepatitis A
Hepatitis A is a liver disease caused by the hepatitis A virus. Until 2004 it was the most frequently reported type of hepatitis in the
United States. Disease rates have been dropping since 1995, when a vaccine was licensed. There are now estimated to be about
20,000 cases a year in the United States. The virus is found mainly in bowel movements and is spread through personal contact
or by eating contaminated food or drinking contaminated water. Children under 6 often don’t show any signs of illness, but for
older children signs include fever, loss of appetite, tiredness, stomach pain, vomiting, dark urine, and yellow skin or eyes
(jaundice). Hepatitis A does not cause long-term illness or permanent liver damage, but about 100 people die each year from liver
failure caused by severe hepatitis A.
Hepatitis A Vaccine
Hepatitis A vaccine is made from inactivated (killed) hepatitis A virus. It is 94%–100% effective in preventing hepatitis A. Because
it has been available only since 1995, it’s yet unknown how long immunity will last, but mathematical research suggests that it
should protect for 20 years or more. The vaccine is not licensed for children younger than 1 year of age.
Until late 2005 hepatitis A vaccine was recommended only for certain children: those who live in states where risk of hepatitis A
is highest and those who live in communities with high levels of hepatitis A, including Alaska Native villages, American Indian
reservations, some Hispanic communities, and some religious communities. Travelers to countries where the disease is common
should also get the vaccine.
As of 2005 hepatitis A vaccine has been routinely recommended for all children from 12 through 23 months of age. Two doses
of hepatitis A vaccine are recommended, the second dose given at least 6 months after the first.
Hepatitis B
Hepatitis B is also a liver disease (the word “hepatitis” comes from the Greek words for “liver” and “inflammation”). It is caused
by the hepatitis B virus. It is spread through contact with the blood, or other body fluids, of an infected person. Adolescents and
adults can be infected through sharing drug needles or through unprotected sex, and health-care and public safety workers are
often exposed to blood in the course of their jobs. People infected with hepatitis B might not feel sick, or might suffer loss of
appetite or tiredness, muscle or stomach pains, diarrhea or vomiting, or yellow skin or eyes (jaundice). People usually recover
from hepatitis B after several weeks, but others become “chronically infected.” They might not feel sick themselves, but they
continue to carry the virus and can infect other people.
Pregnant women can infect their newborn babies. A baby who is born to a chronically infected mother has a 70%–90% chance
of being infected at birth. Many people who are chronically infected will suffer from serious problems such as cirrhosis (scarring
of the liver) or liver cancer. More than a million people in the United States are chronically infected with hepatitis B. In 1996 an
estimated 200,000 people became infected, and 4,000 to 5,000 people die each year from hepatitis B.
Hepatitis B Vaccine
Hepatitis B vaccine is an inactivated (killed) vaccine that is made from a small, non-infectious part of the hepatitis B virus, called
hepatitis B surface antigen (any substance that can stimulate the production of antibodies and combine specifically with them).
The vaccine was licensed in 1986, and 98%–100% of children who get the vaccine develop immunity.
Some parents question why infants and young children should be vaccinated against hepatitis B when they don’t have the risk
factors (drug use, sexual activity, professional risk) that lead to many infections. There are two reasons. One is that babies and
children can become infected too. If a mother infects her baby during birth, for example, and the baby is not immunized
immediately, it will probably become chronically infected too. One out of 4 of these children will eventually die from cirrhosis (a
disease of the liver) or liver cancer. The other reason is that vaccinating only high-risk adolescents and adults has proved not to
be a very effective way to control the disease. It was only after they began routine childhood vaccination that rates of disease
began to drop significantly.
Three doses of hepatitis B vaccine are needed for full protection. The first dose is recommended at birth. This is particularly
important for children whose mothers are chronically infected. The second dose is recommended at 1–4 months and the third at
6–18 months. These three doses should protect children for life. No additional booster doses are needed.
Hib disease (Haemophilus influenzae type b)
Not long ago Hib disease (Haemophilus influenzae type b) was the leading cause of bacterial meningitis in children less than 5
years old. As recently as the mid-1980s it struck one child out of every 200 in that age group. About 1 in 4 of these children
suffered permanent brain damage, and about 1 in 20 died. Hib disease is spread through the air by coughing, sneezing, and even
breathing. If the bacteria stay in a child’s nose and throat, the child will probably not get sick. But if they spread to the lungs or
bloodstream, the child can get meningitis (inflammation of the covering of the brain), pneumonia, epiglottitis (inflammation in the
throat), arthritis, or other problems. A child who is infected can spread the disease to others for as long as the bacteria remain in
the body. Antibiotics can stop spread in 2 to 4 days.
Influenza (Flu)
Influenza (Flu) is a seasonal illness, occurring mainly during the winter. It is caused by influenza virus. Influenza viruses are
continually changing, meaning that immunity (the condition that permits either natural or acquired resistance to disease) you gain
one year will not necessarily protect you in future years. This makes influenza different from most diseases, in that you can get it
more than once. It also means that it is important to be vaccinated every year.
Influenza is spread from person to person through sneezing, coughing or breathing. Signs and symptoms include fever, sore
throat, cough, headache, chills and muscle aches. Young children might also have vomiting and diarrhea. Complications can
include ear and sinus infections, pneumonia, myocarditis (inflammation of the heart), and death. Influenza causes more deaths
(about 36,000 per year) than any other vaccine-preventable disease. Most of these are among the elderly, but some children also
die. Hospitalization rates are high among children, particularly those less than 1 year old.
Influenza Vaccine
There are two types of influenza vaccine. The first is an inactivated (killed) vaccine given as a shot, which has been used for
many years. It can be given to anyone 6 months of age and older. The second is a live, weakened vaccine, which is sprayed into
the nose and was licensed in 2003. It is not licensed for children younger than 2 years old.
Because influenza viruses change from year to year, new vaccines must also be formulated each year, and annual vaccination is
recommended. The inactivated influenza vaccine is 70%–90% effective in healthy children, and the live, intranasal vaccine is
about 87% effective in healthy children 5–7 years of age.
Many other infections have the same symptoms as influenza and are often mistakenly called “flu.” Neither vaccine is effective
against infections that are not actually caused by influenza viruses.
One dose of vaccine (either type, depending on age) is recommended annually, beginning around October or November. For
children younger than 9 who are getting influenza vaccine for the first time, 2 doses are recommended, and should be given at
least a month apart.
Measles
Measles is a viral illness that causes a rash all over the body. It also causes fever, runny nose and cough. About 1 out of 10
children with measles also get an ear infection, and up to 1 out of 20 get pneumonia. About 1 out of 1,000 get encephalitis
(inflammation of the substance of the brain) and 1 or 2 out of 1,000 die. While measles is almost gone from the United States, it
still kills about half a million people a year around the world. Measles can also make a pregnant woman have a miscarriage or give
birth prematurely.
Measles spreads through the air by breathing, coughing or sneezing. It is so contagious that any child who is exposed to it and is
not immune will probably get the disease. Before measles vaccine, nearly all children got measles by the time they were 15. Each
year about 450 people died because of measles, 48,000 were hospitalized, 7,000 had seizures, and about 1,000 suffered
permanent brain damage or deafness. Today there are only about 50 cases a year reported in the United States, and most of these
originate outside the country.
Mumps
Mumps is best known for the swelling of the cheeks and jaw that it causes a result of inflammation of the salivary glands.
Mumps also causes a fever and headache. It is usually a mild disease, but it leads to meningitis in about 1 child in 10 who get the
disease. It can occasionally cause encephalitis, deafness (about 1 in 20,000 cases), or even death (about 1 in 10,000 cases).
Mumps is caused by the mumps virus, which is spread from person to person through the air. Before a vaccine was available
mumps was a very common childhood illness. About 152,000 cases were reported each year. Now mumps is very uncommon,
with only 314 cases reported in 2005.
MMR - Measles, Mumps, and Rubella Vaccine
MMR combines vaccines for Measles, Mumps and Rubella into one shot. MMR has been around since 1971, although its three
components were licensed separately during the 1960s. It is a live vaccine, containing measles, mumps and rubella viruses that
have been weakened, so they won’t cause disease. Most children who get the vaccine develop immunity to all three diseases
(over 99% for measles and 95% for mumps and rubella). Protection is believed to be life-long.
Two doses of vaccine are recommended, with the first dose given at 12–15 months of age. The second dose may be given 4
weeks after the first, but it is usually given at 4–6 years. Measles, mumps and rubella vaccines may be given separately,
although these individual vaccines are not always readily available. Doctors usually prefer not to give the vaccines this way
because it means giving a child 3 shots instead of one.
Pertussis (Whooping Cough)
Pertussis (Whooping Cough) is caused by a bacterium called Bordetella pertussis. If you have ever seen a child with Whooping
Cough you won’t forget it. The child coughs violently and rapidly, over and over, until the air is gone from her lungs and she is
forced to inhale with the loud “whooping” sound that gives the disease its nickname, whooping cough.
Pertussis is a very contagious disease, and one that is fairly common in the United States, even today. In 2005, over 25,000 cases
were reported. While this is down considerably from the approximately 150,000 cases a year before the vaccine, it still makes it
one of the most common vaccine preventable childhood diseases in the country. It is spread from person to person through
personal contact, coughing and sneezing.
At first Whooping Cough is similar to a common cold, with sneezing, runny nose, fever and a mild cough. But after 1 or 2 weeks
the severe coughing spells begin. Pertussis is most severe in infants less than 1 year old. More than half of these infants who get
the disease must be hospitalized. Older children and adults can get pertussis too, but it is usually not as serious. Many infants who
get Whooping Cough catch it from their older brothers and sisters, or from their parents, who might not be aware they have the
disease. About 1 child in 10 who get pertussis also gets pneumonia, and about 1 in 50 will have seizures. The brain is affected in
about 1 person out of 250 (this is called encephalopathy, any of various diseases of the brain). Pertussis causes about 10–20
deaths each year in the United States.
Pneumococcal Disease
Pneumococcal disease caused by Streptococcus pneumoniae bacteria. It is usually thought of as a disease of the elderly, but it
also takes its toll among our children. In 1998, before a vaccine for children was authorized, about 188 of every 100,000 children
younger than 2 years of age developed invasive pneumococcal disease (for instance, meningitis or blood infections). It is the
leading cause of bacterial meningitis in the country, hitting children under 1 year old the hardest. About 200 children died from
persistent pneumococcal disease each year. Pneumococcal disease is also a common cause of ear infections.
Pneumococcal disease is spread through the air. It can be spread by anyone who is infected, even if they don’t have symptoms.
It is most common during the winter and early spring. All children are vulnerable to pneumococcal disease, but some are more
susceptible than others, including African Americans, American Indians, Alaska Natives, and children with certain medical
conditions such as sickle cell disease or HIV infection, or those who don’t have a functioning spleen.
Pneumococcal Vaccine
Pneumococcal conjugate vaccine was licensed in 2000. It is an inactivated (killed) vaccine, which gives immunity against the 7
strains of the pneumococcal bacterium that have caused most of the serious infections in children. It is more than 90% effective
against invasive disease (for example, blood infections and meningitis). Some ear infections are prevented by pneumococcal
vaccine, but many are caused by other organisms, and the vaccine will not prevent these.
Four doses of pneumococcal vaccine are recommended, at 2, 4, 6, and 12–15 months of age. Children who are late starting the
series may need fewer doses. Check with your doctor or clinic for the recommended schedule if your child starts late. This
vaccine is usually not given to children 5 years old and older. But some older children (those with certain chronic diseases or
damaged immune systems) still need pneumococcal vaccine. There is a different vaccine — called pneumococcal polysaccharide
vaccine — that can be given to these children and to adults. Pneumococcal vaccine may be given at the same time as other
childhood vaccines.
Polio
Polio is a disease that has caused paralysis in millions of children worldwide over the years. In the United States, 6,000 people
died and another 27,000 were paralyzed during a major epidemic in 1916. Polio reached a peak in the United States in the 1950s,
when parents were terrified that the disease would leave their children unable to walk or force them to spend the rest of their life
in an iron lung. With the appearance of polio vaccines, the disease began to disappear, and there is no longer any wild polio in the
country.
Polio is caused by a virus that lives in the throat and intestinal tract. It is spread mainly through contact with the feces of an
infected person (for instance, by changing diapers). Some children who get polio don’t feel ill at all. Others have the symptoms of
a common cold, sometimes accompanied by pain and stiffness in the neck, back and legs. But some children get severe muscle
pain, and within a week can be paralyzed (lose the use of their muscles). Usually paralysis affects a child’s legs, but it can also
affect other muscles, including those that control breathing. There is no treatment for polio, and some children die from it. Even
though there is no polio in the United States, it is still common in some parts of the world. We are working towards eliminating it
from the rest of the world within the next few years.
Polio Vaccine
The polio vaccine used in the United States contains 3 types of inactivated (killed) polio virus. It is sometimes called IPV
(Inactivated Polio Vaccine). Once another type of polio vaccine was used, a liquid that was swallowed, called OPV (Oral Polio
Vaccine). This vaccine is no longer available in the United States but is still used in other parts of the world. The first inactivated
polio vaccine (the Salk vaccine) was licensed in 1955, and the vaccine we use today (an improved version) has been in use since
1987. The vaccine protects 99% of children who get at least three doses.
Children should get four doses of polio vaccine, the first three doses at 2, 4, and 6–18 months of age, and a booster dose at 4–6
years.
Rotavirus
Rotavirus is the most common cause of severe gastroenteritis (diarrhea and vomiting) in the world among young children. It kills
about 500,000 children a year worldwide.
Every year in the United States, rotavirus is responsible for:
• 2½ million cases of gastroenteritis
• 400,000 doctor visits
• 200,000 emergency room visits
• 55,000 - 70,000 hospitalizations
• 20-60 deaths
Most children will have been infected at least once by the time they reach 5 years of age. There are several strains of rotavirus
and children can be infected more than once, but the first case is usually the most serious.
In addition to diarrhea and vomiting, rotavirus infections cause a fever of 102°F or higher in about one-third of cases. Severe
dehydration can be a serious complication associated with rotavirus infection. Rotavirus is discarded in the stool. It can be spread
by direct contact with an infected person, or by contact with contaminated objects such as toys, or even food. The disease is
spread within families, hospitals, and child-care facilities. Caregivers and parents can also be infected, but infections in young
children are much more serious. People with weakened immune systems are at higher risk. Rates of rotavirus illness are similar
in modern and less developed countries. This suggests that the disease can’t be eliminated through clean water and good hygiene
alone.
Rotavirus Vaccine
Rotavirus vaccine is a live vaccine, which is given orally rather than by injection. Children should get a total of three doses, one
dose at 2, 4, and 6 months of age. The vaccine protects against five different strains of rotavirus, so even a child who has had a
case of rotavirus disease should get the vaccine. The vaccine has been very effective in preventing rotavirus gastroenteritis (about
74%) and even more effective in preventing severe rotavirus gastroenteritis (about 98%).
Rubella (German Measles)
Rubella is sometime called German Measles or 3-day Measles. It is a generally mild disease caused by the rubella virus. It usually
strikes in the winter and spring, and causes a slight fever, a rash on the face and neck, and (when teenagers or adults get the
disease) swollen glands in the back of the neck and arthritis (inflammation of in the joints) symptoms. It is spread from person to
person through the air, by coughing, sneezing or breathing.
The greatest danger from rubella is to unborn babies. If a woman gets rubella in the early months of her pregnancy, there is an
80% chance that her baby will be born deaf or blind, with a damaged heart or small brain, or mentally retarded. This is called
Congenital Rubella Syndrome, or CRS. Miscarriages are also common among women who get rubella while they are pregnant.
The last major rubella epidemic in the United States was in 1964–1965, when about 12.5 million people got the disease and 20,000
babies were born with CRS. Several years later a vaccine was licensed, and the disease has been disappearing ever since. Today
there are fewer than 20 cases reported each year.
Tetanus (Lockjaw)
Tetanus (lockjaw) differs from other vaccine-preventable diseases in that it is not contagious. It does not spread from person to
person. Clostridium tetani bacteria are usually found in soil, dust, and manure, and they enter the body through breaks in the skin.
Children usually become infected through deep puncture wounds or cuts, like those made by nails or knives. But the bacteria can
enter through even a tiny pinprick or scratch. Children can also get tetanus following severe burns, ear infections, tooth
infections, or animal bites.
When tetanus gets into the body it can take up to 3 weeks for the first symptoms to appear. These are usually a headache,
crankiness, and spasms of the jaw muscles. The bacteria produce a toxin (poison), which spreads throughout the body, causing
painful muscle spasms in the neck, arms, legs, and stomach. These can be strong enough to break a child’s bones. Children with
tetanus might have to spend several weeks in the hospital under intensive care. The number of tetanus cases in the United States
has fallen from about 500 a year in the 1940s to only about 50 cases a year today. But 2 out of every 10 people who get tetanus
die from it.
Varicella (Chickenpox)
Varicella (Chickenpox) was, until recently, one of the most common of childhood diseases. Before there was a vaccine, almost
everyone got it — there were about 4 million cases a year in the United States.
Chickenpox is caused by the varicella herpes virus. Its most recognizable feature is an itchy rash all over the body. It also causes
fever and drowsiness. It is spread from person to person through the air, by coughing, sneezing or breathing, and can also be
spread by contact with fluid from the blisters. It usually takes 2–3 weeks from the time of exposure for a person to become ill,
and an infected person is contagious from 1 or 2 days before the rash appears until all the blisters are dried up, usually 4 to 5 days
after.
Chickenpox is usually mild, but it occasionally causes serious problems. The blisters can become infected, and some children get
encephalitis. Among infants less than 1 year old who get the disease, about 1 in 250,000 die. For older children, about 1 in
100,000 die. If a woman gets chickenpox just before or after giving birth, her baby can get very sick, and about 1 in 3 of these
babies will die if not treated quickly. About 1 child in 500 who gets chickenpox is hospitalized (about 1 in 50 adults). After a
person has chickenpox the virus stays in the body. Years later it can cause a painful disease called herpes zoster, or shingles.
Varicella Vaccine
Varicella vaccine is made with live, weakened varicella virus. It was licensed in the United States in 1995. It prevents chickenpox
in 70%–90% of people who get it, and it prevents severe chickenpox in more than 95%. It is expected to provide life-long
immunity. Individuals vaccinated during testing, before the vaccine was licensed, are still immune.
Two doses of varicella vaccine are recommended for children. The first dose is recommended at 12–15 months of age. It is
usually given at the same time as MMR vaccine. The second dose is recommended at 4-6 years, before entering kindergarten or
first grade. It may be given sooner, as long as it is separated from the first dose by at least 3 months. Anyone who has had
chickenpox does not need the vaccine.
Each year, about 1% of people who have gotten varicella vaccine develop chickenpox in spite of having responded to the vaccine.
This is called “breakthrough” infection. Breakthrough infections are much milder than normal chickenpox. Patients generally have
fewer than 50 lesions, which do not form blisters. They also do not get a fever and have no complications. It’s unknown why
breakthrough infections occur.
Immunizations and Side Effects
Immunizations are very safe, like any medicine they do sometimes cause reactions. Mostly, these are mild “local” reactions
(soreness or redness where the shot is given) or a low-grade fever. They last a day or two and then go away. Sometimes more
serious reactions are associated with vaccines. These are much less common. Some of them are clearly caused by the vaccine;
some have been reported after vaccination but are so rare that it is impossible to tell if they were caused by the vaccine or would
have happened anyway.
In the immunization process some children will have allergies, and occasionally a child will have a severe allergy to a substance
that is part of a vaccine. There is a very small risk (estimated at around one in a million) that a vaccine could trigger a severe
reaction in a child who has such an allergy. Should one of these allergic reactions occur, it would usually happen within several
minutes to several hours after the vaccination, and would be characterized by hives, difficulty breathing, paleness, weakness, a
hoarse throat or wheezing, a rapid heart beat, and dizziness. Doctors’ offices are equipped to deal with these reactions. Always
tell your provider if your child has any allergies that you know of. . If your child shows these symptoms after getting
vaccinations, or if he/she shows other unusual symptoms, such as a high fever or behavior changes don’t hesitate to:
- Call a doctor or get the child to a doctor right away.
- Tell your doctor what happened, the date and time it happened, and when the vaccination was given.
Immunization and Vaccine Precautions
A child who has had a severe (life-threatening) allergic reaction to a previous dose of any vaccine should not get another dose of
that vaccine. A child with a known severe (life-threatening) allergy to any vaccine ingredient should not get a vaccine containing
that component. If a child has any moderate or severe illness on the day any vaccine is scheduled, it should probably be delayed
until the child has recovered. A mild illness or fever is usually not a reason to delay an immunization.
Two live vaccines (for example, varicella and MMR) may be given on the same day or separated by at least 4 weeks. But they
should not be given less than 4 weeks apart, because they might interfere with each other. Varicella and inactivated (killed)
vaccines may be given together, or at any time in relation to each other.
There is a very small risk that a child who has gotten varicella vaccine could infect a susceptible family member — particularly
one with a suppressed immune system. This appears to happen very rarely, and only when the vaccinated child develops a rash.
To be safe, anyone with a suppressed immune system should consider avoiding contact with a child who develops a varicella
vaccine-related rash.
Combination Vaccines
Several vaccines are sometimes combined into a single shot. These are called combination vaccines. Some combination vaccines
are used routinely DTaP is a combination; so is MMR. There are currently four other combination vaccines available for children.
One combines DTaP and Hib vaccines; the second Hib and hepatitis B; the third combines DTaP, hepatitis B, and polio, and the
fourth combines measles, mumps, rubella and varicella. The advantage of combination vaccines is, of course, that children get
the protection of all the component vaccines while getting fewer injections. Each of these vaccines has certain restrictions, and
not all providers carry them. But ask your provider about them if you are interested in reducing the number of shots your child
needs.
Childhood Immunization Schedule
Vaccines work best when they are given at certain ages. For example, measles vaccine is not usually given to children until they
are at least a year old. If it is given earlier it might not work as well. For vaccines requiring multiple doses, the doses should not
be given too close together. Your health-care provider can advise you about use of these vaccines.
Reporting Adverse Reactions from Immunizations
In the event your child has a immunization associated injury or even if you think a medical problem your child has might have
been caused by a vaccine you should report the problem.
VAERS (the Vaccine Adverse Event Reporting System) collects reports of suspected vaccine injuries. Generally, the doctor fills
out a VAERS report and sends it to the program. But a parent or individual can also file a VAERS report. You can get more
information about VAERS from their toll-free information line at 800-822-7967.
If your child were to suffer a serious injury that proves to have been caused by immunizations, a program called the National
Vaccine Injury Compensation Program will provide compensation to help with their care. You can learn more about the National
Vaccine Injury Compensation Program by calling the program tool-free at 800-338-2382.
CDC-INFO: Talk with a trained operator who can answer individual questions about immunizations, vaccines and vaccine-
preventable diseases. Call (800) 232-4636 (CDC-INFO) 24 hours a day.
some parents question the need for or safety of childhood vaccines. These parents may choose to delay or refrain from
immunizing their children from some or all of the recommended vaccines. Before making immunization decisions parents should
be fully informed, and try to be aware of differing views of vaccine risks and benefits and choose effectively.
Immunization of children has been called one of the most important public health interventions in history, after safe drinking
water. It has saved millions of lives over the years and prevented hundreds of millions of cases of disease. We all know that
getting our children immunized can protect them from some very serious diseases. Some children can’t get certain vaccines for
medical reasons, other children don’t respond well to certain vaccines. For these children, the immunity of people around them is
their only protection.
Immunizations help the child’s immune system function. The child develops protection against future infections, the same as if he
or she had been exposed to the natural disease. Except with vaccines children don’t have to get sick first to get that protection.
The purpose of immunizations is to prevent disease.
Today, children in the United States routinely get immunizations that protect them from diseases. Some childhood vaccines have
been used since the 1940s, others have been around for only a short time. Currently there are 10 routinely used vaccines that
protect children against the 14 diseases. These diseases have, at one time or another, been a serious threat to children in this
country. Most of them are now at their lowest levels in history, thanks to years of immunization.
Immunizations Used on Children
Diphtheria
Diphtheria caused by a bacterium called Corynebacterium diphtheriae. It lives in the mouth, throat and nose of an infected person
and can be spread to others by coughing or sneezing. A child with diphtheria can infect others for 2 to 4 weeks.
Diphtheria can initially cause a sore throat, fever and chills. But if it is not properly diagnosed and treated it produces a toxin
(poison) that can cause serious complications such as heart failure or paralysis. About 1 person out of 10 who get diphtheria dies
from it. Diphtheria used to be a major cause of childhood illness and death. Through the 1920s about 150,000 people a year got
diphtheria in the United States, and about 15,000 of them died.
DTaP Vaccine
DTaP combines vaccines against three diseases, Diphtheria, Tetanus and Pertussis (Whooping Cough) into one shot. (The small
“a” in the name stands for “acellular,” which means that the pertussis component of the vaccine contains only parts of the
pertussis bacterium rather than the whole cell.) The diphtheria and tetanus components of the vaccine are not technically
vaccines, but a substance that is normally toxic but has been treated to destroy its toxic properties. They help the immune system
develop protection against the poisons produced by the diseases rather than against the disease bacteria themselves. All three
components of DTaP are “inactivated” (killed). Tetanus, diphtheria and pertussis (DTP) vaccines have been in common use since
the 1940s. DTaP vaccine (with the acellular pertussis component) was first licensed in 1991.
Children need five DTaP shots for maximum protection. The first three shots are given at 2, 4, and 6 months of age. The fourth
(booster) shot is given between 15 and 18 months, and a fifth shot, another booster, is given when a child enters school, at 4–6
years. When it is given according to this schedule, DTaP protects most children from all three diseases (80%–85% from
pertussis, 95% from diphtheria, nearly 100% from tetanus). Protection can fade with time, so booster doses (using Td or Tdap
vaccine, see below) are recommended every 10 years. These vaccines are also sometimes given when a person gets a serious
wound that could contain tetanus bacteria.
Hepatitis A
Hepatitis A is a liver disease caused by the hepatitis A virus. Until 2004 it was the most frequently reported type of hepatitis in the
United States. Disease rates have been dropping since 1995, when a vaccine was licensed. There are now estimated to be about
20,000 cases a year in the United States. The virus is found mainly in bowel movements and is spread through personal contact
or by eating contaminated food or drinking contaminated water. Children under 6 often don’t show any signs of illness, but for
older children signs include fever, loss of appetite, tiredness, stomach pain, vomiting, dark urine, and yellow skin or eyes
(jaundice). Hepatitis A does not cause long-term illness or permanent liver damage, but about 100 people die each year from liver
failure caused by severe hepatitis A.
Hepatitis A Vaccine
Hepatitis A vaccine is made from inactivated (killed) hepatitis A virus. It is 94%–100% effective in preventing hepatitis A. Because
it has been available only since 1995, it’s yet unknown how long immunity will last, but mathematical research suggests that it
should protect for 20 years or more. The vaccine is not licensed for children younger than 1 year of age.
Until late 2005 hepatitis A vaccine was recommended only for certain children: those who live in states where risk of hepatitis A
is highest and those who live in communities with high levels of hepatitis A, including Alaska Native villages, American Indian
reservations, some Hispanic communities, and some religious communities. Travelers to countries where the disease is common
should also get the vaccine.
As of 2005 hepatitis A vaccine has been routinely recommended for all children from 12 through 23 months of age. Two doses
of hepatitis A vaccine are recommended, the second dose given at least 6 months after the first.
Hepatitis B
Hepatitis B is also a liver disease (the word “hepatitis” comes from the Greek words for “liver” and “inflammation”). It is caused
by the hepatitis B virus. It is spread through contact with the blood, or other body fluids, of an infected person. Adolescents and
adults can be infected through sharing drug needles or through unprotected sex, and health-care and public safety workers are
often exposed to blood in the course of their jobs. People infected with hepatitis B might not feel sick, or might suffer loss of
appetite or tiredness, muscle or stomach pains, diarrhea or vomiting, or yellow skin or eyes (jaundice). People usually recover
from hepatitis B after several weeks, but others become “chronically infected.” They might not feel sick themselves, but they
continue to carry the virus and can infect other people.
Pregnant women can infect their newborn babies. A baby who is born to a chronically infected mother has a 70%–90% chance
of being infected at birth. Many people who are chronically infected will suffer from serious problems such as cirrhosis (scarring
of the liver) or liver cancer. More than a million people in the United States are chronically infected with hepatitis B. In 1996 an
estimated 200,000 people became infected, and 4,000 to 5,000 people die each year from hepatitis B.
Hepatitis B Vaccine
Hepatitis B vaccine is an inactivated (killed) vaccine that is made from a small, non-infectious part of the hepatitis B virus, called
hepatitis B surface antigen (any substance that can stimulate the production of antibodies and combine specifically with them).
The vaccine was licensed in 1986, and 98%–100% of children who get the vaccine develop immunity.
Some parents question why infants and young children should be vaccinated against hepatitis B when they don’t have the risk
factors (drug use, sexual activity, professional risk) that lead to many infections. There are two reasons. One is that babies and
children can become infected too. If a mother infects her baby during birth, for example, and the baby is not immunized
immediately, it will probably become chronically infected too. One out of 4 of these children will eventually die from cirrhosis (a
disease of the liver) or liver cancer. The other reason is that vaccinating only high-risk adolescents and adults has proved not to
be a very effective way to control the disease. It was only after they began routine childhood vaccination that rates of disease
began to drop significantly.
Three doses of hepatitis B vaccine are needed for full protection. The first dose is recommended at birth. This is particularly
important for children whose mothers are chronically infected. The second dose is recommended at 1–4 months and the third at
6–18 months. These three doses should protect children for life. No additional booster doses are needed.
Hib disease (Haemophilus influenzae type b)
Not long ago Hib disease (Haemophilus influenzae type b) was the leading cause of bacterial meningitis in children less than 5
years old. As recently as the mid-1980s it struck one child out of every 200 in that age group. About 1 in 4 of these children
suffered permanent brain damage, and about 1 in 20 died. Hib disease is spread through the air by coughing, sneezing, and even
breathing. If the bacteria stay in a child’s nose and throat, the child will probably not get sick. But if they spread to the lungs or
bloodstream, the child can get meningitis (inflammation of the covering of the brain), pneumonia, epiglottitis (inflammation in the
throat), arthritis, or other problems. A child who is infected can spread the disease to others for as long as the bacteria remain in
the body. Antibiotics can stop spread in 2 to 4 days.
Influenza (Flu)
Influenza (Flu) is a seasonal illness, occurring mainly during the winter. It is caused by influenza virus. Influenza viruses are
continually changing, meaning that immunity (the condition that permits either natural or acquired resistance to disease) you gain
one year will not necessarily protect you in future years. This makes influenza different from most diseases, in that you can get it
more than once. It also means that it is important to be vaccinated every year.
Influenza is spread from person to person through sneezing, coughing or breathing. Signs and symptoms include fever, sore
throat, cough, headache, chills and muscle aches. Young children might also have vomiting and diarrhea. Complications can
include ear and sinus infections, pneumonia, myocarditis (inflammation of the heart), and death. Influenza causes more deaths
(about 36,000 per year) than any other vaccine-preventable disease. Most of these are among the elderly, but some children also
die. Hospitalization rates are high among children, particularly those less than 1 year old.
Influenza Vaccine
There are two types of influenza vaccine. The first is an inactivated (killed) vaccine given as a shot, which has been used for
many years. It can be given to anyone 6 months of age and older. The second is a live, weakened vaccine, which is sprayed into
the nose and was licensed in 2003. It is not licensed for children younger than 2 years old.
Because influenza viruses change from year to year, new vaccines must also be formulated each year, and annual vaccination is
recommended. The inactivated influenza vaccine is 70%–90% effective in healthy children, and the live, intranasal vaccine is
about 87% effective in healthy children 5–7 years of age.
Many other infections have the same symptoms as influenza and are often mistakenly called “flu.” Neither vaccine is effective
against infections that are not actually caused by influenza viruses.
One dose of vaccine (either type, depending on age) is recommended annually, beginning around October or November. For
children younger than 9 who are getting influenza vaccine for the first time, 2 doses are recommended, and should be given at
least a month apart.
Measles
Measles is a viral illness that causes a rash all over the body. It also causes fever, runny nose and cough. About 1 out of 10
children with measles also get an ear infection, and up to 1 out of 20 get pneumonia. About 1 out of 1,000 get encephalitis
(inflammation of the substance of the brain) and 1 or 2 out of 1,000 die. While measles is almost gone from the United States, it
still kills about half a million people a year around the world. Measles can also make a pregnant woman have a miscarriage or give
birth prematurely.
Measles spreads through the air by breathing, coughing or sneezing. It is so contagious that any child who is exposed to it and is
not immune will probably get the disease. Before measles vaccine, nearly all children got measles by the time they were 15. Each
year about 450 people died because of measles, 48,000 were hospitalized, 7,000 had seizures, and about 1,000 suffered
permanent brain damage or deafness. Today there are only about 50 cases a year reported in the United States, and most of these
originate outside the country.
Mumps
Mumps is best known for the swelling of the cheeks and jaw that it causes a result of inflammation of the salivary glands.
Mumps also causes a fever and headache. It is usually a mild disease, but it leads to meningitis in about 1 child in 10 who get the
disease. It can occasionally cause encephalitis, deafness (about 1 in 20,000 cases), or even death (about 1 in 10,000 cases).
Mumps is caused by the mumps virus, which is spread from person to person through the air. Before a vaccine was available
mumps was a very common childhood illness. About 152,000 cases were reported each year. Now mumps is very uncommon,
with only 314 cases reported in 2005.
MMR - Measles, Mumps, and Rubella Vaccine
MMR combines vaccines for Measles, Mumps and Rubella into one shot. MMR has been around since 1971, although its three
components were licensed separately during the 1960s. It is a live vaccine, containing measles, mumps and rubella viruses that
have been weakened, so they won’t cause disease. Most children who get the vaccine develop immunity to all three diseases
(over 99% for measles and 95% for mumps and rubella). Protection is believed to be life-long.
Two doses of vaccine are recommended, with the first dose given at 12–15 months of age. The second dose may be given 4
weeks after the first, but it is usually given at 4–6 years. Measles, mumps and rubella vaccines may be given separately,
although these individual vaccines are not always readily available. Doctors usually prefer not to give the vaccines this way
because it means giving a child 3 shots instead of one.
Pertussis (Whooping Cough)
Pertussis (Whooping Cough) is caused by a bacterium called Bordetella pertussis. If you have ever seen a child with Whooping
Cough you won’t forget it. The child coughs violently and rapidly, over and over, until the air is gone from her lungs and she is
forced to inhale with the loud “whooping” sound that gives the disease its nickname, whooping cough.
Pertussis is a very contagious disease, and one that is fairly common in the United States, even today. In 2005, over 25,000 cases
were reported. While this is down considerably from the approximately 150,000 cases a year before the vaccine, it still makes it
one of the most common vaccine preventable childhood diseases in the country. It is spread from person to person through
personal contact, coughing and sneezing.
At first Whooping Cough is similar to a common cold, with sneezing, runny nose, fever and a mild cough. But after 1 or 2 weeks
the severe coughing spells begin. Pertussis is most severe in infants less than 1 year old. More than half of these infants who get
the disease must be hospitalized. Older children and adults can get pertussis too, but it is usually not as serious. Many infants who
get Whooping Cough catch it from their older brothers and sisters, or from their parents, who might not be aware they have the
disease. About 1 child in 10 who get pertussis also gets pneumonia, and about 1 in 50 will have seizures. The brain is affected in
about 1 person out of 250 (this is called encephalopathy, any of various diseases of the brain). Pertussis causes about 10–20
deaths each year in the United States.
Pneumococcal Disease
Pneumococcal disease caused by Streptococcus pneumoniae bacteria. It is usually thought of as a disease of the elderly, but it
also takes its toll among our children. In 1998, before a vaccine for children was authorized, about 188 of every 100,000 children
younger than 2 years of age developed invasive pneumococcal disease (for instance, meningitis or blood infections). It is the
leading cause of bacterial meningitis in the country, hitting children under 1 year old the hardest. About 200 children died from
persistent pneumococcal disease each year. Pneumococcal disease is also a common cause of ear infections.
Pneumococcal disease is spread through the air. It can be spread by anyone who is infected, even if they don’t have symptoms.
It is most common during the winter and early spring. All children are vulnerable to pneumococcal disease, but some are more
susceptible than others, including African Americans, American Indians, Alaska Natives, and children with certain medical
conditions such as sickle cell disease or HIV infection, or those who don’t have a functioning spleen.
Pneumococcal Vaccine
Pneumococcal conjugate vaccine was licensed in 2000. It is an inactivated (killed) vaccine, which gives immunity against the 7
strains of the pneumococcal bacterium that have caused most of the serious infections in children. It is more than 90% effective
against invasive disease (for example, blood infections and meningitis). Some ear infections are prevented by pneumococcal
vaccine, but many are caused by other organisms, and the vaccine will not prevent these.
Four doses of pneumococcal vaccine are recommended, at 2, 4, 6, and 12–15 months of age. Children who are late starting the
series may need fewer doses. Check with your doctor or clinic for the recommended schedule if your child starts late. This
vaccine is usually not given to children 5 years old and older. But some older children (those with certain chronic diseases or
damaged immune systems) still need pneumococcal vaccine. There is a different vaccine — called pneumococcal polysaccharide
vaccine — that can be given to these children and to adults. Pneumococcal vaccine may be given at the same time as other
childhood vaccines.
Polio
Polio is a disease that has caused paralysis in millions of children worldwide over the years. In the United States, 6,000 people
died and another 27,000 were paralyzed during a major epidemic in 1916. Polio reached a peak in the United States in the 1950s,
when parents were terrified that the disease would leave their children unable to walk or force them to spend the rest of their life
in an iron lung. With the appearance of polio vaccines, the disease began to disappear, and there is no longer any wild polio in the
country.
Polio is caused by a virus that lives in the throat and intestinal tract. It is spread mainly through contact with the feces of an
infected person (for instance, by changing diapers). Some children who get polio don’t feel ill at all. Others have the symptoms of
a common cold, sometimes accompanied by pain and stiffness in the neck, back and legs. But some children get severe muscle
pain, and within a week can be paralyzed (lose the use of their muscles). Usually paralysis affects a child’s legs, but it can also
affect other muscles, including those that control breathing. There is no treatment for polio, and some children die from it. Even
though there is no polio in the United States, it is still common in some parts of the world. We are working towards eliminating it
from the rest of the world within the next few years.
Polio Vaccine
The polio vaccine used in the United States contains 3 types of inactivated (killed) polio virus. It is sometimes called IPV
(Inactivated Polio Vaccine). Once another type of polio vaccine was used, a liquid that was swallowed, called OPV (Oral Polio
Vaccine). This vaccine is no longer available in the United States but is still used in other parts of the world. The first inactivated
polio vaccine (the Salk vaccine) was licensed in 1955, and the vaccine we use today (an improved version) has been in use since
1987. The vaccine protects 99% of children who get at least three doses.
Children should get four doses of polio vaccine, the first three doses at 2, 4, and 6–18 months of age, and a booster dose at 4–6
years.
Rotavirus
Rotavirus is the most common cause of severe gastroenteritis (diarrhea and vomiting) in the world among young children. It kills
about 500,000 children a year worldwide.
Every year in the United States, rotavirus is responsible for:
• 2½ million cases of gastroenteritis
• 400,000 doctor visits
• 200,000 emergency room visits
• 55,000 - 70,000 hospitalizations
• 20-60 deaths
Most children will have been infected at least once by the time they reach 5 years of age. There are several strains of rotavirus
and children can be infected more than once, but the first case is usually the most serious.
In addition to diarrhea and vomiting, rotavirus infections cause a fever of 102°F or higher in about one-third of cases. Severe
dehydration can be a serious complication associated with rotavirus infection. Rotavirus is discarded in the stool. It can be spread
by direct contact with an infected person, or by contact with contaminated objects such as toys, or even food. The disease is
spread within families, hospitals, and child-care facilities. Caregivers and parents can also be infected, but infections in young
children are much more serious. People with weakened immune systems are at higher risk. Rates of rotavirus illness are similar
in modern and less developed countries. This suggests that the disease can’t be eliminated through clean water and good hygiene
alone.
Rotavirus Vaccine
Rotavirus vaccine is a live vaccine, which is given orally rather than by injection. Children should get a total of three doses, one
dose at 2, 4, and 6 months of age. The vaccine protects against five different strains of rotavirus, so even a child who has had a
case of rotavirus disease should get the vaccine. The vaccine has been very effective in preventing rotavirus gastroenteritis (about
74%) and even more effective in preventing severe rotavirus gastroenteritis (about 98%).
Rubella (German Measles)
Rubella is sometime called German Measles or 3-day Measles. It is a generally mild disease caused by the rubella virus. It usually
strikes in the winter and spring, and causes a slight fever, a rash on the face and neck, and (when teenagers or adults get the
disease) swollen glands in the back of the neck and arthritis (inflammation of in the joints) symptoms. It is spread from person to
person through the air, by coughing, sneezing or breathing.
The greatest danger from rubella is to unborn babies. If a woman gets rubella in the early months of her pregnancy, there is an
80% chance that her baby will be born deaf or blind, with a damaged heart or small brain, or mentally retarded. This is called
Congenital Rubella Syndrome, or CRS. Miscarriages are also common among women who get rubella while they are pregnant.
The last major rubella epidemic in the United States was in 1964–1965, when about 12.5 million people got the disease and 20,000
babies were born with CRS. Several years later a vaccine was licensed, and the disease has been disappearing ever since. Today
there are fewer than 20 cases reported each year.
Tetanus (Lockjaw)
Tetanus (lockjaw) differs from other vaccine-preventable diseases in that it is not contagious. It does not spread from person to
person. Clostridium tetani bacteria are usually found in soil, dust, and manure, and they enter the body through breaks in the skin.
Children usually become infected through deep puncture wounds or cuts, like those made by nails or knives. But the bacteria can
enter through even a tiny pinprick or scratch. Children can also get tetanus following severe burns, ear infections, tooth
infections, or animal bites.
When tetanus gets into the body it can take up to 3 weeks for the first symptoms to appear. These are usually a headache,
crankiness, and spasms of the jaw muscles. The bacteria produce a toxin (poison), which spreads throughout the body, causing
painful muscle spasms in the neck, arms, legs, and stomach. These can be strong enough to break a child’s bones. Children with
tetanus might have to spend several weeks in the hospital under intensive care. The number of tetanus cases in the United States
has fallen from about 500 a year in the 1940s to only about 50 cases a year today. But 2 out of every 10 people who get tetanus
die from it.
Varicella (Chickenpox)
Varicella (Chickenpox) was, until recently, one of the most common of childhood diseases. Before there was a vaccine, almost
everyone got it — there were about 4 million cases a year in the United States.
Chickenpox is caused by the varicella herpes virus. Its most recognizable feature is an itchy rash all over the body. It also causes
fever and drowsiness. It is spread from person to person through the air, by coughing, sneezing or breathing, and can also be
spread by contact with fluid from the blisters. It usually takes 2–3 weeks from the time of exposure for a person to become ill,
and an infected person is contagious from 1 or 2 days before the rash appears until all the blisters are dried up, usually 4 to 5 days
after.
Chickenpox is usually mild, but it occasionally causes serious problems. The blisters can become infected, and some children get
encephalitis. Among infants less than 1 year old who get the disease, about 1 in 250,000 die. For older children, about 1 in
100,000 die. If a woman gets chickenpox just before or after giving birth, her baby can get very sick, and about 1 in 3 of these
babies will die if not treated quickly. About 1 child in 500 who gets chickenpox is hospitalized (about 1 in 50 adults). After a
person has chickenpox the virus stays in the body. Years later it can cause a painful disease called herpes zoster, or shingles.
Varicella Vaccine
Varicella vaccine is made with live, weakened varicella virus. It was licensed in the United States in 1995. It prevents chickenpox
in 70%–90% of people who get it, and it prevents severe chickenpox in more than 95%. It is expected to provide life-long
immunity. Individuals vaccinated during testing, before the vaccine was licensed, are still immune.
Two doses of varicella vaccine are recommended for children. The first dose is recommended at 12–15 months of age. It is
usually given at the same time as MMR vaccine. The second dose is recommended at 4-6 years, before entering kindergarten or
first grade. It may be given sooner, as long as it is separated from the first dose by at least 3 months. Anyone who has had
chickenpox does not need the vaccine.
Each year, about 1% of people who have gotten varicella vaccine develop chickenpox in spite of having responded to the vaccine.
This is called “breakthrough” infection. Breakthrough infections are much milder than normal chickenpox. Patients generally have
fewer than 50 lesions, which do not form blisters. They also do not get a fever and have no complications. It’s unknown why
breakthrough infections occur.
Immunizations and Side Effects
Immunizations are very safe, like any medicine they do sometimes cause reactions. Mostly, these are mild “local” reactions
(soreness or redness where the shot is given) or a low-grade fever. They last a day or two and then go away. Sometimes more
serious reactions are associated with vaccines. These are much less common. Some of them are clearly caused by the vaccine;
some have been reported after vaccination but are so rare that it is impossible to tell if they were caused by the vaccine or would
have happened anyway.
In the immunization process some children will have allergies, and occasionally a child will have a severe allergy to a substance
that is part of a vaccine. There is a very small risk (estimated at around one in a million) that a vaccine could trigger a severe
reaction in a child who has such an allergy. Should one of these allergic reactions occur, it would usually happen within several
minutes to several hours after the vaccination, and would be characterized by hives, difficulty breathing, paleness, weakness, a
hoarse throat or wheezing, a rapid heart beat, and dizziness. Doctors’ offices are equipped to deal with these reactions. Always
tell your provider if your child has any allergies that you know of. . If your child shows these symptoms after getting
vaccinations, or if he/she shows other unusual symptoms, such as a high fever or behavior changes don’t hesitate to:
- Call a doctor or get the child to a doctor right away.
- Tell your doctor what happened, the date and time it happened, and when the vaccination was given.
Immunization and Vaccine Precautions
A child who has had a severe (life-threatening) allergic reaction to a previous dose of any vaccine should not get another dose of
that vaccine. A child with a known severe (life-threatening) allergy to any vaccine ingredient should not get a vaccine containing
that component. If a child has any moderate or severe illness on the day any vaccine is scheduled, it should probably be delayed
until the child has recovered. A mild illness or fever is usually not a reason to delay an immunization.
Two live vaccines (for example, varicella and MMR) may be given on the same day or separated by at least 4 weeks. But they
should not be given less than 4 weeks apart, because they might interfere with each other. Varicella and inactivated (killed)
vaccines may be given together, or at any time in relation to each other.
There is a very small risk that a child who has gotten varicella vaccine could infect a susceptible family member — particularly
one with a suppressed immune system. This appears to happen very rarely, and only when the vaccinated child develops a rash.
To be safe, anyone with a suppressed immune system should consider avoiding contact with a child who develops a varicella
vaccine-related rash.
Combination Vaccines
Several vaccines are sometimes combined into a single shot. These are called combination vaccines. Some combination vaccines
are used routinely DTaP is a combination; so is MMR. There are currently four other combination vaccines available for children.
One combines DTaP and Hib vaccines; the second Hib and hepatitis B; the third combines DTaP, hepatitis B, and polio, and the
fourth combines measles, mumps, rubella and varicella. The advantage of combination vaccines is, of course, that children get
the protection of all the component vaccines while getting fewer injections. Each of these vaccines has certain restrictions, and
not all providers carry them. But ask your provider about them if you are interested in reducing the number of shots your child
needs.
Childhood Immunization Schedule
Vaccines work best when they are given at certain ages. For example, measles vaccine is not usually given to children until they
are at least a year old. If it is given earlier it might not work as well. For vaccines requiring multiple doses, the doses should not
be given too close together. Your health-care provider can advise you about use of these vaccines.
Reporting Adverse Reactions from Immunizations
In the event your child has a immunization associated injury or even if you think a medical problem your child has might have
been caused by a vaccine you should report the problem.
VAERS (the Vaccine Adverse Event Reporting System) collects reports of suspected vaccine injuries. Generally, the doctor fills
out a VAERS report and sends it to the program. But a parent or individual can also file a VAERS report. You can get more
information about VAERS from their toll-free information line at 800-822-7967.
If your child were to suffer a serious injury that proves to have been caused by immunizations, a program called the National
Vaccine Injury Compensation Program will provide compensation to help with their care. You can learn more about the National
Vaccine Injury Compensation Program by calling the program tool-free at 800-338-2382.
CDC-INFO: Talk with a trained operator who can answer individual questions about immunizations, vaccines and vaccine-
preventable diseases. Call (800) 232-4636 (CDC-INFO) 24 hours a day.
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