One of the greatest health achievements in the twentieth century has been the near elimination of the common childhood infectious illnesses by 95 to 100 percent. However, these "bad bugs" are still in our environment, and our children need their immune systems to be ready to protect against them.
Through immunizations, your baby is protected from serious diseases like polio, whooping cough, and all the others listed on the chart below. Young infants are at the greatest risk, so babies need all of these immunizations before their second birthday. Because vaccines are always being improved and because different brands of shots may be slightly different, your own health care provider may have a slightly different schedule of shots for your baby. In any case, keep a chart like the one below handy so you can keep track of your baby's shots yourself. Double-check with your health care provider at each visit to make sure your baby is up to date. New vaccines are on the horizon, so don't be surprised by changes in this schedule.
At ages 4 to 6 and 11 to 12, your child will need to have "boosters," additional shots, as well as other recommended immunizations for older children and teens. Be sure to keep your child's immunization record all through childhood and bring it to each health visit. Children with special health concerns may need additional shots or will need the schedule varied to suit their situation. Preemies will need their shots at the correct ages, not at times adjusted for their prematurity. Should your child miss an immunization and need to catch up, there are guidelines to get your child up to date.
All good health plans cover the cost of the full recommended schedule of immunizations described below. However, if you have no health insurance for your child, free vaccines are available through your local public health department and through state and county funded programs at your medical office. Don't let money issues get in the way of your child's health.
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1. Varies by situation, but three shots are needed to complete the series. Boosters may be needed later. If Mom tested positive for the hepatitis B virus during pregnancy, other management of this series of shots will be required. If this series of three shots was missed in the first year, it can be administered any time into adulthood. For children who did not receive the recommended birth dose, the minimum age for administration of the 3rd dose of the series has been added to the catch-up schedule, noting that the final dose in the hepatitis B series is given no earlier than 24 weeks of age.
2. The new form of the vaccine, DTaP, contains an acellular form of the pertussis vaccine. It is becoming the preferred form as it produces less fever. DTP is still used in some cases and provides good protection as it has for the past 30 years.
3. The Hib vaccine may be combined with other vaccines or given as a separate shot. Because this immunization comes in slightly different forms, it's important to stay with the same clinic or provider for the series. If this isn't possible, make sure to bring in your immunization card on which the exact vaccine information is recorded so your provider can match your previous dose. In some cases, the 6-month dose may not be needed. For children 5 years and older who have not received the Hib vaccine, one dose of Hib vaccine should be considered for those children who have sickle cell disease, leukemia, HIV infection, or who have had a splenectomy.
4. The polio injection using the inactivated (IPV) polio virus is now preferred because we have lowered the overall incidence of polio and the oral vaccine contains the live, attenuated (modified) virus. The last dose in the inactivated poliovirus vaccine series is now recommended to be given on or after the 4th birthday and at least 6 months after the previous dose. If 4 doses are administered before age 4 years, an additional 5th dose should be given between 4 and 6 years of age. If you or your child is going to a foreign country, is in an epidemic, or crosses the United States' southern border frequently, the OPV (oral polio vaccine) may be better, particularly for the later immunizations in the series. Most children in military families will need the oral form.
5. This shot is recommended for all children ages 2 months to 23 months and for some children several times between 2 and 18 years. The original vaccine, which is still being used, is 7-valent pneumococcal conjugate vaccine (PCV 7). It has been replaced by the 13-valent pneumococcal conjugate vaccine (PCV 13). A PCV series begun with PCV 7 should be completed with PCV 13. A single supplemental dose of PCV 13 is recommended for all children 14 through 59 months of age who have received an age-appropriate series of PCV 7. The supplemental dose of PCV 13 should be administered at least 8 weeks after the previous dose of PCV 7.
6. Two doses of varicella vaccine are now recommended. Children 12 months through 12 years old should receive two 0.5ml doses, separated by at least three months.
7. Hepatitis A vaccine (Hep-A), protecting against a certain type of liver infection, is now recommended for all children at 1 year of age (12 to 23 months) as a two-dose regimen. The doses should be given at least six months apart. Children not fully vaccinated by age 2 years can be vaccinated at subsequent visits. Hepatitis A vaccine is also recommended for older children who live in areas where vaccination programs target older children, those who are at increased risk for infection, or those for whom immunity against Hepatitis A is desired.
8. Children age 6 months to 18 years should get a flu vaccine every year. For children who have not been vaccinated before, two doses at least 28 days apart must be administered. Children previously vaccinated need only one dose. Children aged 2 years and older who do not have underlying medical conditions may now get either the intranasal vaccine (live, attenuated influenza vaccine) or the injectable form (trivalent inactivated influenza vaccine
9. The Rotavirus vaccine is an oral vaccine that helps protect against a common type of viral gastroenteritis, the vomiting and diarrhea illness that affects infants and toddlers especially in the winter and early spring. There are two approved vaccines: RotaTeq, which requires three doses; and Rotarix, which requires two doses. Talk to your child’s health care provider about the dosage schedule for these vaccines.
Here's a list of descriptions of the diseases the vaccines prevent.
POLIO (IPV, the injectable polio vaccine, administered as a shot, or in some cases, OPV, the oral polio vaccine, administered in the mouth)
DIPHTHERIA (the "D" in the DTaP vaccine). Diphtheria is a serious respiratory illness that causes a thick coating or film in the nose, throat, and air passages, which can lead to breathing problems, heart failure, paralysis, and even death. Up to 20 percent of people who get the disease die from it. Very young infants are at the greatest risk, although unprotected adults can get and transmit the disease, too.
HEMOPHILUS INFLUENZA/ TYPE B (Hib vaccine). Hemophilus influenza is a bacterial infection that can cause pneumonia, meningitis, severe swelling in the throat, and other serious infections. It is not influenza (aka "the flu"). It's a regular cause of bacterial otitis, middle ear infections. Before the vaccine, hemophilus influenza killed or seriously disabled thousands of children. It is most common in children under 5.
HEPATITIS A (the Hep-A shot). Hepatitis A is a viral infection of the liver, causing fever, tiredness, jaundice, and loss of appetite. Although most children have few or no symptoms, infected adults can be sick for months or even years. Hepatitis A is transmitted most often from person to person through fecal contamination and commonly occurs in certain communities in outbreaks. Very young children in developing countries tend to get this disease, Kenya included. In addition to the Hep-A vaccine, immunoglobulin shots are often administered to provide additional protection to children over 2 who are at risk because of household or community exposure.
HEPATITIS B. Serum hepatitis (HBV) is a viral disease of the liver that can be very serious, even leading to liver failure or chronic liver disease. More than a million people carry this virus in the United States. Three doses of hepatitis B vaccine are needed for full protection. Adolescents and adults may also get this series for protection. Those who have had the disease may have an increased chance of getting liver cancer later in life, so early protection has long- and short-term effects. Transmission from mum to baby may occur during birth, while others get the disease through contact with infected blood. People who share a household with someone who has Hep-B can get it, and it's also spread through sexual intercourse. Although this series is best given at birth, children, adolescents, or adults who haven't gotten the shots should get the series as soon as possible.
MEASLES (the first "M" of the MMR vaccine). Measles (also called "red" or "hard" measles) is a viral illness causing a rash, cough, and fever that can lead to diarrhea, ear infections, pneumonia, brain damage, or death. Children at greatest risk are those who are malnourished or have chronic illnesses. Measles outbreaks occur every year in the United States, and it is a common illness around the globe.
MUMPS (the second "M" of the MMR vaccine). Mumps causes fever, headache, and swelling of the parotid gland in front of the ear. In some cases it leads to meningitis, an infection of the brain and spinal cord, or encephalitis, a swelling of the brain. It can also lead to hearing loss, and, in boys and men, can cause swollen testicles and possibly infertility. Mumps can be very serious and very painful in adults, so it's best to get immunized early in life.
PERTUSSIS (the "P" in the DTaP vaccine). Pertussis, or whooping cough, causes coughing and choking that lasts for weeks. The coughing spell is followed by the characteristic "whoop" of the child trying to catch her breath. Vomiting afterwards is common. Pertussis can lead to pneumonia, seizures, brain damage, or death. Very young unimmunized children are at the greatest risk and often need to be hospitalized if they become ill. Adults who catch pertussis may become very sick, but they usually recover after weeks or months. Unfortunately, they may pass the disease along to infants and young children.
PNEUMOCOCCAL DISEASES. The pneumococcus bacterium can cause pneumonia and meningitis and is the most common bacterial cause of ear infections. There are several subtypes of pneumococcus, and vaccines protect against some — but not all — of them. Young infants are at greatest risk for these infections. Children over 7 months and under 5 years who missed the shot as infants will benefit from one or more of these shots.
POLIO (IPV, the injectable polio vaccine, administered as a shot, or in a few cases, OPV, the oral polio vaccine, administered in the mouth). Polio is a common virus that causes fever, sore throat, nausea, headaches, diarrhea, stomachaches, and stiffness and weakness in the neck, back, and legs. It's considered an old-fashioned disease that caused paralysis. However, it's only old-fashioned because so many of us received the vaccine. The injectable form is now preferred, as the oral vaccine -- which has never caused any cases of polio -- allows the altered virus to get into the environment through bowel movements. However, for those going to a foreign country where polio is common, or if there is an epidemic, the oral form gives the best protection for the individual, as the virus enters the body through the gastrointestinal tract.
ROTAVIRAL GASTROENTERITIS. Rotaviral gastroenteritis is an intestinal viral infection that occurs primarily in infants and toddlers. It occurs most commonly in the winter and early spring, and usually starts with lots of vomiting that then progresses on to watery diarrhea that can last five to seven days. The most common serious complication with the illness is dehydration, which can be so severe that it can require hospitalization and cause death in malnourished children. Infants and toddlers with the illness should be carefully watched for signs of dehydration such as decreased urination, dry mouth, reduced tears, and lethargy. Children who have received the Rotavirus vaccination usually do not get the illness or have a milder form of illness that does not lead to severe dehydration.
RUBELLA (the "R" of the MMR vaccine). Also known as "German measles," rubella is a mild viral illness that causes a rash on the face and neck, mild fever, and swollen glands. It can cause arthritis, especially in women and girls. If pregnant women become infected, their babies can have birth defects or die. Immunization in childhood protects the next generation, as well as pregnant women in the environment.
TETANUS (the "T" in the DTaP vaccine). Tetanus causes serious and painful muscle tightening and is often deadly. It's sometimes called "lockjaw" because it causes the muscles in the jaw to "lock," making it difficult or impossible to eat. Breathing failure causes death. The bacteria live in dirt and thrive when they get into deep cuts or puncture wounds.
VARICELLA ZOSTER (the VZV shot). Commonly called chicken pox (or shingles), this is a highly contagious infection with a blistering rash on the scalp and body developing over the course of three to four days, as well as respiratory symptoms. In most cases, it's not seriously harmful to healthy children, but it can be very serious for small infants, older children and adults who haven't had the disease (or the vaccine), people with immune deficiencies, and for some children who have eczema or are taking certain medications (for example, salicylates). Each year almost 10,000 people are hospitalized for chicken pox, and about 100 die. The disease lasts seven to 21 days, and its long incubation period means that children harboring the disease will pass it on to hundreds of people before anyone knows they are ill. Children must stay out of daycare or school until they are no longer infectious. Pneumonia, serious skin infection, brain damage, and other problems can complicate the disease. Non-immune women may give birth to infants who are at serious risk if they're exposed to chicken pox during infancy. Most people who get the shot will be protected, but some immunized people who get the shot will get a mild case of the disease.
Immunization Myths
• "These diseases aren't around anymore, so what's the point?"
Wrong: All of the bacteria and viruses against which we immunize are still in the environment in the United States and abroad. Every year there are outbreaks and deaths among unimmunized children.
Wrong: These small, fragile babies are at the greatest risk if they acquire any of the diseases we immunize against. They need their shots right on time, not adjusted for their prematurity.
Yes and No: Your breast milk does contain powerful infection-fighting proteins and cells. However, the level of specific protection is not high enough to keep your infant completely safe. He needs to build specific antibodies to those diseases he'll come up against.
• "The vaccines don't work anyway — you can still get the diseases."
No and Yes: The vaccines work very well — 90 to 99 percent of the time. There's a small chance your baby will be among the few who aren't protected, but it's very tiny, particularly if he gets the whole series of a vaccine. For those who get the disease after being immunized, the illness is usually mild.
• "These shots cause autism — I heard it on TV."
Wrong: Autism appearance and some shots come at the same time. But after years and years of investigation, there is no scientific evidence that immunizations cause this disorder. Autism is caused by irregularities in very early (pre-birth) brain development.
What's the Downside?
Immunizations are one of the great triumphs of modern medicine. Although there are risks of side effects, these risks are very low, the incidence of problems is very rare, and all are far less serious than the risks associated with the diseases. Many of today's parents grew up without seeing the illnesses against which we immunize children, so it's sometimes hard for them to understand why we do it, particularly if their child develops a fever or a sore leg. As someone who has seen children in the United States put on respirators for whooping cough, babies gagging with diphtheria, and children disabled by bacterial meningitis, I know immunizations are worth it. But you should be informed of the risks of all medical procedures. Here are a few to think about with immunizations.
• Fever. We expect some fever with most of the shots — it's a sign that the body is responding as we wish to the injection, building up immunity. In general, the fever increases with each subsequent dose of a particular shot. When fever occurs after a shot, have your thermometer and the correct dose of acetaminophen ready. Call your health care provider if the fever gets high or lasts more than a day or two.
• Local redness, bumps. The place where your child gets the shot will be a little tender and may develop a small bump. This is another sign that the shot is working to spark the body's response. Acetaminophen or ibuprofen and a warm washcloth on the spot will ease any discomfort. Call your health care provider if the red area is bigger than a dime, produces any pus, or is still red after two to three days. Sometimes a little area of fat damage at the injection site can leave a small hard lump that lasts a month or two but will go away. It shouldn't be red or tender, however.
• A rash. Sometimes the shot creates a mini-illness of the type we are immunizing against. The symptoms, which can develop up to two weeks after the shot, are very mild and usually cause little concern.
• An allergic reaction. This is extremely rare but very serious. Sometimes kids are allergic to the components used in the vaccine and develop an allergic reaction. For example, children with egg allergies will have trouble with vaccines made from viruses originally grown on eggs. Symptoms of this allergic response may include a blotchy, red rash (hives), shortness of breath, wheezing, breathing difficulties, paleness, dizziness, or a fast heartbeat. These symptoms develop within minutes to hours after the shot. For that reason, most health care facilities have you wait a bit after the shot before leaving, and you should certainly return right away if these symptoms develop after you leave. If your family tends to have allergies, or if anyone in the family has had a reaction to shots, be sure to tell your health care provider before the shot is given.
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