Childhood Immunization Schedule

Why Vaccinations Are Important

Vaccinations are some of the most important tools available for preventing disease. Vaccinations not only protect children from developing serious diseases but also protect the community by reducing the spread of infectious disease.

Infectious diseases spread from person to person. If enough people are immunized, the disease may not be transmitted through a population, thus protecting everyone. This concept is called "herd immunity." The concept is that the strongest (those immunized) protect the weakest (those not immunized). Diseases such as smallpox and polio have nearly disappeared because of immunization.

Children get many immunizations during childhood. A community awareness campaign called Every Child by Two urges parents to make sure their children are protected against the diseases of childhood before the child reaches 2 years of age.

Parents should consult their doctors about which vaccines their children should have and when. Keep track of your children's immunizations yourself. You will be asked for these records when the child enrolls in school and throughout the child's school career.

The injection process for childhood vaccinations may sometimes be distressing for parents. Information explaining what parents can do before, during, and after shots is available from the CDC, the American Academy of Pediatrics (AAP), and state health organizations.

Each January, the AAP, the Advisory Committee on Immunization Practices (ACIP) of the CDC, and the American Academy of Family Physicians (AAFP) issue a recommended childhood immunization schedule. Changes may be made during the year if necessary.

The CDC annually publishes the most current childhood immunization schedule. For more information, see the CDC web site (http://www.cdc.gov/). Listed below are the routine vaccinations recommended as of January 2016.

Hepatitis B Vaccine

Hepatitis B is a vaccine-preventable disease that can lead to chronic liver disease and liver cancer. The infection is spread through contact with blood and body fluids of an infected person.

  • Infants should receive the first dose at birth. The immunization schedule encourages the use of hepatitis B vaccine for all infants before hospital discharge. The second and third doses are usually given at 1-4 months and at 6-18 months of age. Specific recommendations exist for infants born to mothers who are infected with hepatitis B. These infants are at high risk for disease unless a different dosage schedule is followed.
  • Unimmunized children younger than 18 years old may begin the series at any age.
  • A combination vaccine that protects infants against five different diseases has been approved by the FDA. That means babies may get six fewer shots during their first few months of life. The combination vaccine (Pediarix) contains hepatitis B vaccine along with DTaP (diphtheria, tetanus, and acellular pertussis vaccine) and inactivated poliovirus vaccine (IPV). Pediarix is recommended to be given as a three-dose primary series to infants at about 2, 4, and 6 months of age. A booster is administered between 15-18 months of age.

Diphtheria, Tetanus, and Pertussis Vaccine

This combination vaccine (DTaP) is composed of vaccines against diphtheria, tetanus (lockjaw), and pertussis (whooping cough). The use of the acellular pertussis (aP) vaccine is now recommended because it is associated with fewer side effects compared to the previous, less refined vaccine.

  • This vaccine is usually given at 2, 4, and 6 months of age. A fourth dose is usually given between 15-18 months of age. A final (fifth) vaccination is administered between 4-6 years of age. A combination DTaP and IPV (see below) vaccine (Kinrix) may be used for the final vaccination.
  • An adolescent preparation of the tetanus, reduced diphtheria, and acellular pertussis (Tdap) vaccine is recommended for children 11-12 years of age.
  • Subsequent booster shots of tetanus and diphtheria (Td) are recommended every 10 years.
  • Some children may have a fever, pain, and swelling at the injection site after this vaccine. To reduce this discomfort, you may give your child an aspirin-free pain reliever.

H Influenzae Type B (Hib) Vaccine

Haemophilus influenzae type b (Hib) is a type of bacteria that can cause devastating illnesses such as meningitis, bone and joint infections, and pneumonia. It usually strikes children younger than 5 years of age. Hib does not cause the flu; the influenza virus is responsible for this seasonal illness (see below).

Hib disease is contagious from person to person via respiratory droplets expelled during sneezing and coughing. Before the vaccine, Hib was the leading cause of bacterial meningitis among children younger than 5 years of age in the United States.

  • This vaccine should be given to children at age 2, 4, and 6 months of age. A fourth dose is commonly given at 12-15 months of age. There are several combination vaccine products that may be used and eliminate the need for the fourth injection.
  • Children older than 5 years of age usually do not need Hib vaccine since the likelihood of disease in older children is very remote. However, some older children and adults with special health conditions (immune compromised) should be vaccinated.

Seasonal Flu (Influenza) Vaccine

This vaccine is indicated to prevent seasonal influenza in healthy children, adolescents, and adults. Flu vaccine contents often change each year, and the contents of the vaccine are decided by the U.S. Public Health Service. Typically, four virus strains are included in the formulation each year. These strains are chosen to represent the influenza virus strains likely to circulate during the upcoming flu season.

The flu vaccine is recommended annually for all individuals 6 months of age and older. Infants, elderly individuals, and those of any age with certain chronic conditions (for example, asthma, COPD, diabetes) are at high risk for severe illness should they contract influenza.

Children younger than 9 years of age who are given the influenza vaccine for the first time require a second vaccination one month after the first.

Polio Vaccine

Polio is a disease caused by a virus causing primary symptoms of vomiting and diarrhea. It enters a child's body through the mouth. About 1%-3% of individuals who contract polio may experience permanent paralysis of the extremities and, in some individuals, paralysis of the muscles necessary for breathing. Prior to the development of ventilators (breathing machines), those with such paralysis either spent their life in an iron lung or suffocated.

Polio used to be very common in the United States. It paralyzed and killed thousands of people a year in epidemics before we had a vaccine to prevent it.

  • All children should receive four doses of the inactivated polio vaccine (IPV) injection.
  • Immunizations are given at age 2, 4, 6-18 months, and between 4-6 years of age. The previous oral polio vaccine (OPV) is no long available in the United States due to the very rare risk of vaccine-caused polio disease.

Measles, Mumps, and Rubella (MMR) Vaccine

This combination vaccine is given to protect against measles, mumps, and rubella (also known as German measles).

You or your child could catch these diseases by being around someone who has them. The virus is spread from person to person through the air due to coughing or sneezing by an infected individual.

  • The first vaccine dose is given at 12-15 months of age. The second dose is usually given to children at 4-6 years of age but can be given at any time, provided that it has been at least four weeks since the first dose (and that both doses were given after the child's first birthday).
  • Separate vaccines for each component of measles and mumps only are not available in the United States. A (German) measles-only vaccine is generally administered to women in the childbearing years who do not have evidence of immunity. Intrauterine fetal infection with measles virus can lead to catastrophic consequences.

Chickenpox Vaccine

Chickenpox (also called varicella) is a common childhood disease. It is usually mild, but it can be serious, especially in young infants and adults.

Chickenpox can be spread from person to person through the air or by contact with fluid from chickenpox blisters.

  • This vaccine is recommended for children who have not had chickenpox, in order to minimize their chances of getting the disease and its complications. Three percent of children who receive the vaccine may still get the disease, but it is usually milder (fewer skin lesions, a quicker recovery time, and lower chance for complications).
  • The vaccine is administered at 12 months of age with a booster dose between 4-6 years of age. Children 4 years of age and older may receive a combination MMR and varicella vaccination (MMRV).

Pneumococcal-13 Vaccine

This vaccine will help prevent diseases caused by the bacterium Streptococcus pneumoniae, also called Pneumococcus. This vaccine differs from the pneumococcal-23 vaccine that is typically given to adults.

Meningitis, blood infections, and pneumonia are some serious examples of the diseases caused by Pneumococcus. Likewise, these diseases are some of the most invasive (aggressive and may rapidly spread throughout the body) infections in children.

  • The pneumococcal-13 vaccine is recommended for all children 2 months to 5 years of age. High-risk older children and adults may need further vaccination. The vaccine is to be given together with the other routine shots at ages 2, 4, 6, and 12-15 months. The number of doses depends upon the age at which the first dose is given.

Hepatitis A Vaccine

Hepatitis A is a serious liver disease caused by a virus, which is found in the stool of people with the disease. It is usually spread by close personal contact and sometimes by eating food or drinking water containing the virus.

  • All children aged 12-23 months of age should receive two doses given at least six months apart.
  • Anyone who lives in communities that have prolonged outbreaks of hepatitis A or is traveling to a high-risk geographic location should receive two doses of the vaccine at least six months apart.
  • Specific information regarding high-risk geographic locations is available from local and state health departments and the CDC's web site.

Meningococcal Vaccines

Meningococcal infections are most common in close living conditions (such as college dormitories, military barracks, or child-care centers). The infection may invade the bloodstream and then rapidly spread to the rest of the body and/or to the brain (meningitis). Symptoms progress very rapidly and can be severe (leading to shock, coma, or death). Meningitis caused by meningococcal bacteria is difficult to distinguish from that of other bacteria that causes meningitis, making the disease more difficult to recognize and treat. There are two types of meningococcal vaccine:

  • Meningococcal conjugate ACWY vaccine (Menactra/Menveo) -- generally administered at 11-12 years of age with a booster at 16 years of age
  • Meningococcal B vaccine (Trumenba/Bexsero) -- generally administered as a three-dose series between 16-18 years of age

Since the two vaccine formulations are protective against different strains of Meningococcus, they should not be substituted one for each other.

  • Who should receive the vaccine:
    • Children 2 years of age or older in high-risk groups (those who have had their spleen removed, those with a suppressed immune system)
    • Adolescents 11-12 years of age and unvaccinated adolescents entering high school, college students, military recruits, and those travelling to epidemic areas should receive meningococcal conjugate ACWY vaccine.
    • Current recommendations for receipt of meningococcal B vaccine include those in a community with active disease or an area of high likelihood of exposure. Routine vaccination to the general age appropriate population is not currently recommended.
  • Side effects: Pain, swelling, and redness at site of injection may occur one to two days following immunization.

Rotavirus Vaccine

The U.S. Food and Drug Administration (FDA) has approved two oral vaccines to help prevent rotavirus infection. Rotavirus is the most frequent cause of infectious diarrhea throughout the world and also in the United States. RotaTeq and Rotarix are both oral vaccines that have been shown to be effective and safe. Rotarix is administered at 2 and 4 months of age. RotaTeq is administered at 2, 4, and 6 months of age.

Clinical trials have found that both vaccines prevent approximately 75% of all rotavirus gastroenteritis cases, nearly all severe rotavirus gastroenteritis cases, and nearly all hospitalizations. A previously marketed rotavirus vaccine (RotaShield) was associated with intussusception (blockage of the intestine) and was removed from the market. Neither RotaTeq nor Rotarix have not shown an increased risk of intussusception when compared with placebo in clinical trials.

Human Papillomavirus (HPV) Vaccines

HPV infection is considered to be the most common sexually transmitted infection (sexually transmitted disease [STD]) in the U.S. There are about 79 million people currently infected with HPV, and there are about 14 million people newly infected each year.

Although HPV infection often does not cause symptoms or signs, it is known that certain members of the HPV family of viruses cause precancerous changes of the cervix as well as cervical, vaginal, vulvar, and penile cancer. HPV is also associated with oral and anal cancer. HPV also causes genital warts.

Two vaccines are available to protect against HPV infection: (1) Gardasil 9 is indicated for both males and females; (2) Cervarix is licensed only for females.

  • Both human papillomavirus vaccines are recommended in a three-dose schedule with the second and third doses administered two and six months after the first dose. Routine vaccination with HPV is recommended to be initiated for individuals 11-12 years of age.

For More Information on Childhood Immunizations

Centers for Disease Control and Prevention
1600 Clifton Rd
Atlanta, GA 30333
800-311-3435

American Academy of Pediatrics
141 Northwest Point Blvd
Elk Grove Village, IL 60007
847-434-4000

CDC, National Immunization Program, January 2016, Vaccines for Children

American Academy of Pediatrics, Immunization Initiatives

MedlinePlus, Childhood Immunizations

Childhood Immunization Schedule

2016 Recommended childhood immunization schedule. Courtesy of the U.S. Department of Health and Human Services, Centers for Disease Control and Prevention
2016 Recommended childhood immunization schedule. Courtesy of the U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Click to view larger image.

Catch-up immunizations schedules for children ages 4 months to 6 years and 7 through 18 years. Courtesy of the U.S. Department of Health and Human Services, Centers for Disease Control and Prevention.
"Catch-up" immunizations schedules for children ages 4 months to 6 years and 7 through 18 years. Courtesy of the U.S. Department of Health and Human Services, Centers for Disease Control and Prevention.

Reviewed on 1/8/2018
Sources: References

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