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Clinical Reference Systems: Pediatric Advisor 10.0
Spanish version
Immunizations for Prevention
These immunizations protect your child against several
serious, life-threatening diseases. Your child should have
shots according to the following schedule. If your child's
shots are not up-to-date, call your physician's office for
an appointment.
Routine Immunization Schedule for Infants and Children
Age of Child Immunization
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birth to 2 weeks Hep B
2 months DTaP, Polio, Hib, Hep B, RV
4 months DTaP, Polio, Hib, RV
6 months DTaP, Hib, Hep B, RV
6 to 18 months Polio
12 to 15 months MMR, Hib, Var
18 months DTaP
4 to 6 years DTaP, Polio, MMR
14 to 16 years Td
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Explanation of abbreviations:
DTaP = diphtheria, tetanus, pertussis (whooping cough)
Hib = Haemophilus influenzae type b
Hep B = Hepatitis B
MMR = measles, mumps, rubella
Polio = IPV (inactivated poliovirus) or OPV (oral poliovirus).
Doses 1 and 2 should be IPV, doses 3 and 4 can be either.
Td = adult tetanus and diphtheria (needed every
10 years throughout life)
RV = rotovirus
Var = chickenpox (varicella)
Reference: American Academy of Pediatrics, Committee on
Infectious Diseases, Recommended Childhood
Immunization Schedule, January 1999.
Descriptions of Immunizations
Diphtheria, tetanus, and pertussis (DTaP) vaccine
The pertussis (whooping cough) vaccine scare has made some
parents concerned about getting their child a DTaP vaccine.
Some parents are worried that this vaccine will cause brain
damage, epilepsy, or other neurological damage. Keep in
mind that whooping cough is a very dangerous disease,
especially for infants. The risk of suffering and death
caused by whooping cough is far greater than the possible
side effects of the vaccine. A child who has not been
immunized against pertussis has a chance of 1 in 3000 of
getting whooping cough. In contrast, a child who got the
vaccine has a chance of 1 in 2 million of having
neurological damage with the vaccine. The risk of children
getting pertussis increases if fewer children are immunized.
Measles, mumps, and rubella (MMR) vaccine
Recent outbreaks of measles in high schools and colleges
have made it necessary for children to have two MMR
vaccines. They should have the first shot when they are 12
to 15 months old and the second when they are 4 to 6 years
old. (In some places the second dose is not given to
children until they are 11 or 12 years old.) Mumps is
included in the vaccine because cases of mumps have also
increased in recent years. If your child has been exposed
to measles and has not received two MMR vaccines since the
age 12 months, call your physician's office during office
hours.
Haemophilus influenzae type b (Hib) vaccine
Haemophilus influenzae is a type of bacteria that causes
several life-threatening diseases in young children (such as
meningitis, epiglottitis, and pneumonia). Before the
vaccine was available, over 10,000 children in the U.S.
developed haemophilus meningitis each year. About 500
of them died and 3800 became mentally retarded, blind or
deaf, or got cerebral palsy as a result of the disease.
Because of the vaccine, this haemophilus influenzae is now
uncommon in the U.S.
If your child is over 15 months old, the vaccine can still
be helpful if it is given some time before the age of
6 years. The Hib vaccine does not protect against flu and
meningitis caused by viruses.
Hepatitis B vaccine (Hep B)
Your child needs a total of three hepatitis shots.
Vaccination against hepatitis B prevents this type of
hepatitis and the severe liver damage that can occur 20 or
30 years after a person is first infected. More than 5000
adults die each year in the U.S. from hepatitis-related
liver cancer or cirrhosis. The younger the age when the
infection occurs, the greater the risk of serious problems.
If you have an older child who was not vaccinated against
hepatitis B as an infant, ask your doctor whether he or she
should have the shots.
Polio vaccine
The polio vaccine protects children from this now rare, but
crippling disease. The polio vaccine schedule issued in
1999 recommends inactivated polio vaccine (IPV) for doses
one and two. Doses three and four can be either IPV or oral
polio vaccine (OPV).
Chickenpox (Varicella) vaccine
The chickenpox vaccine is usually given between the ages of
12 and 18 months, but it can be given to older children if
they have not had the vaccine yet. Children age 13 or older
should get 2 doses at least 4 weeks apart.
This vaccine is 70% to 90% effective in preventing
chickenpox. If vaccinated children get chickenpox, they
have a much milder form of the disease. By avoiding
chickenpox, you can avoid missed work and school, possible
skin infections, medical costs, and the chance of getting
shingles later in life.
Rotovirus (RV)
This vaccine has just been added to the schedule. This
vaccine will prevent or reduce one of the most common causes
of infectious diarrhea in young children. You and your
child's doctor may or may not decide to give your child this
vaccine. All doses must be given before your child is 1
year old. Talk to your child's doctor about this vaccine.
Reasons Not To Vaccinate
If any of the following conditions apply to your child, talk
to your doctor before getting your child vaccinated.
- Your child has seizures or serious neurologic disease.
The pertussis vaccine (DTaP) should not be given if a
child has seizures or serious neurologic disease. You
can still give your child the tetanus and diphtheria
(Td) vaccine without the pertussis vaccine.
- Your child has poor immunity.
The live oral polio vaccine (OPV) carries a small risk
that children who have poor immunity, or who are living
with adults who have poor immunity (for example, people
who have AIDS), will get or pass on polio from the
vaccine. These children should be vaccinated with the
inactivated polio vaccine (IPV) for all four doses.
Children with weak immune systems should also not get
other live vaccines (for example, chickenpox or MMR).
- Your child has egg allergies.
Children who are allergic to eggs can receive all the
routine immunizations except measles and mumps. The
measles and mumps vaccines are grown in chick cell
culture. Some children who are allergic to eggs have
allergic reactions to these vaccines.
If your child's reaction to eggs is mild, the vaccines
can still be given. If your child reacts to eggs within
2 hours of eating them or has a severe reaction (such
as, difficulty breathing or swallowing), then an
allergist should skin-test your child to see if the
measles vaccine would be safe.
Unwarranted Reasons Not to Vaccinate
Many children in the U.S. have not received all of the
recommended immunizations. Unnecessary precautions have led
parents to postpone or cancel scheduled immunizations. In
April 1989 the U.S. Public Health Service published the
following list of conditions that are NOT routine reasons
for postponing or canceling immunization. That is, a child
can still be immunized even if one or more of the following
conditions is true:
- The child had soreness, redness, or swelling at the
injection site after a previous DTaP shot.
- The child had a fever of less than 105ƒF (40.5ƒC) after a
previous DTaP shot.
- The child has a mild illness such as a cold, cough, or
diarrhea without a fever.
- The child is recovering from an mild illness such as a
cold, cough, or diarrhea.
- The child has recently been exposed to an infectious
disease.
- The child is taking antibiotics.
- The child was premature.
- The child's mother is pregnant.
- The child is breast-feeding.
- The child has allergies (unless it is an egg allergy).
- The child's family has a history of convulsions or sudden
infant death syndrome (SIDS).
See also Immunization Reactions
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