Childhood Immunization (Vaccination) Schedule

  • Medical Author:
    David Perlstein, MD, MBA, FAAP

    Dr. Perlstein received his Medical Degree from the University of Cincinnati and then completed his internship and residency in pediatrics at The New York Hospital, Cornell medical Center in New York City. After serving an additional year as Chief Pediatric Resident, he worked as a private practitioner and then was appointed Director of Ambulatory Pediatrics at St. Barnabas Hospital in the Bronx.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Why do we need vaccines?

None of us wants to see our children get sick. If we could, we would protect them from any illness, no matter how small, even the sniffles.

Now suppose you could make your child safe from some of the most deadly diseases in history...And suppose that at the same time you could also help protect your neighbors' children and other children around the country from the same diseases, and finally, you could actually help to rid the world of some of these diseases that have been crippling and killing children for centuries.

You can do all of these things with one of the easiest and yet most powerful health tools ever developed. You can make sure you immunize your children.

How do vaccines work?

When you receive a vaccine, it helps your body to create antibodies. Antibodies are the body's defenses that fight off any foreign substances (germs). Although your body can create antibodies on its own, many of the vaccine-preventable diseases cause severe illness and even death before enough antibodies are produced.

Immunization (vaccination) schedule

Vaccines work best when they are given at certain ages. For example, measles vaccine is not usually given until a child is at least 1 year old. If it is given earlier than that, it may not work as well. On the other hand, the DTaP vaccine should be given over a period of time in a series of properly spaced doses. More information about the specific diseases your child is vaccinated against is listed later in this article.

Following is a description of the routine childhood immunization schedule. It is published each year by the U.S. Centers for Disease Control and Prevention (CDC).

Quick GuideChildhood Diseases: Measles, Mumps, & More

Childhood Diseases: Measles, Mumps, & More

Chickenpox Vaccine for My Child?

Even if chickenpox doesn't cause lasting problems in most people, the condition is far from harmless for some. It can lead to serious illness in adults, very young infants, and those whose immune systems are suppressed. According to the U.S. Centers for Disease Control and Prevention (CDC), before the advent of the chickenpox vaccine, about 11,000 people were hospitalized each year and about 100 deaths occurred each year in the U.S. as a result of infection with the chickenpox virus (varicella-zoster virus, or VZV).

What childhood vaccines are recommended, and at what ages they should be given?

Hepatitis B vaccine:

  1. First dose at birth before discharge
  2. Second dose at 1 to 2 months
  3. Third dose at 6 to 18 months

Hib vaccine:

  1. First dose at 2 months
  2. Second dose at 4 months
  3. Third dose at 6 months (depending upon type of Hib vaccine given)
  4. Fourth dose at 12 to 15 months

Inactivated polio vaccine:

  1. First dose at 2 months
  2. Second dose at 4 months
  3. Third dose at 6 to 18 months
  4. Fourth dose at 4 to 6 years

DTaP vaccine:

  1. First dose at 2 months
  2. Second dose at 4 months
  3. Third dose at 6 months
  4. Fourth dose at 15 to 18 months
  5. Fifth dose at 4 to 6 years
  6. Tdap is recommended at 11 years

Pneumococcal vaccine:

  1. First dose at 2 months
  2. Second dose at 4 months
  3. Third dose at 6 months
  4. Fourth dose at 12 to 18 months

Rotavirus vaccine:

  1. First dose at 2 months
  2. Second dose at 4 months
  3. Third dose at 6 months (depending upon type of rotavirus vaccine given)

Hepatitis A vaccine:

  1. First dose at 12 to 23 months
  2. Second dose at 6 to 18 months after the first dose

Influenza vaccine:

  1. First dose at 6 months (requires a booster one month after initial vaccine)
  2. Annually after that

MMR (measles, mumps, and rubella) vaccine:

  1. First dose at 12 to 15 months
  2. Second dose at 4 to 6 years

Varicella vaccine:

  1. First dose at 12 to 15 months
  2. Second dose at 4 to 6 years

Meningococcal vaccine:

  1. First dose at 11 years
  2. Second dose at 16 years

Human papillomavirus vaccine:

  1. First dose at 11 years
  2. Second dose two months after first dose
  3. Third dose six months after first dose

What if your child misses a shot?

For most vaccines, it is never too late to catch up on missed shots. Children who missed their first shots at 2 months of age can start later. Children who have gotten some of their shots and then fallen behind schedule can catch up without having to start over. If you have children who were not immunized when they were infants, or who have gotten behind schedule, contact your doctor or the health department clinic. They will help you get your children up to date on their immunizations.

(NOTE: Don't postpone your child's immunizations just because you know he or she can catch up later. Every month a child goes without scheduled immunizations is a month that the child is not fully protected from vaccine-preventable diseases.)

Combination vaccines

A combination vaccine is more than one vaccine contained in a single shot. Doctors and parents both like them because they allow a child to get several vaccines at once without having to get as many injections. Several combination vaccines are already in use (for example, MMR, DTaP, Hib/HepB, DTaP/IPV/HepB), and more are under development.

Vaccination checklist

Rarely, a child should wait before getting certain vaccines or should not get them at all. Tell your doctor or nurse if any of these apply to your child on a day when an immunization visit is scheduled.

  1. Is your child very sick today? (He or she has more than a common cold, earache, etc.)
  2. Does your child have any severe (life-threatening) allergies?
  3. Has your child ever had a severe reaction after a vaccination?
  4. Does your child have a weakened immune system (because of diseases such as cancer or medications such as steroids)?
  5. Has your child received a transfusion or any other blood product recently?
  6. Has your child ever had convulsions or any kind of nervous system problem?

What are the vaccine-preventable diseases?

Hib vaccine

  • This vaccine protects against infection with the Haemophilus influenzae type b bacteria.
  • These bacteria cause meningitis (an inflammation of the covering membranes that surround the brain) and may cause brain damage. Also these bacteria can infect the blood, joints, bones, muscles, throat, and the cover surrounding the heart. This is especially dangerous for babies. Before the vaccine era, this was an extremely common cause of acquired brain injury in children and infants.

DTaP vaccine

The D in DTaP stands for diphtheria.

  • Corynebacterium diphtheriae is a bacterium that attacks the throat, mouth, and nose. This is a very contagious disease (easy to get), but occurrences have been rare since the vaccine was created.
  • Diphtheria can form a gray web that may completely cover the windpipe and cause someone to stop breathing.
  • Also, if this disease is not treated right away, it could cause pneumonia, heart failure, or paralysis.

The T in DTaP stands for tetanus.

  • Tetanus is an infection caused by a type of bacteria found in dirt, gravel, and rusty metal. It usually enters the body through a cut.
  • Infection with tetanus bacteria causes the muscles to spasm (move suddenly). If tetanus attacks the jaw muscles, it causes lockjaw, which is the inability to open and close your mouth.
  • Tetanus can also cause the breathing muscles to spasm, with potentially fatal consequences.

The P in DTaP stands for pertussis.

  • Bordetella pertussis is the type of bacteria which causes whooping cough. It infects the airways and destroys the cells responsible for clearing mucus and other debris. This results in an infection associated with a severe prolonged cough and typical "whoop." The cough can last for more than two months and typically causes severe illness in the very young and very old. Recently recommendations were added to administer boosters to adolescents.

Polio vaccine

  • Polio is caused by a virus. It can cause paralysis of the legs and chest, making walking and breathing difficult or impossible.
  • The first symptoms of polio are fever, sore throat, headache, and a stiff neck. Polio is very rare in the United States since the vaccine became available; however, it is still somewhat common in other countries.

MMR vaccine

The first M in MMR stands for measles.

  • Measles is a highly contagious (easy to get) virus that causes a high fever, cough, and a spotty rash all over the body. It may also cause ear infections and pneumonia.

The second M in MMR stands for mumps.

  • Mumps is a virus which causes painful, swollen salivary glands, which are under the jaw, as well as a fever and a headache.
  • Mumps also may cause serious problems, including meningitis or hearing loss. It can cause inflammation of the testicles (orchitis) in males.

The R in MMR stands for rubella.

Hepatitis B vaccine

  • Hepatitis B is a virus which causes inflammation of the liver. Signs and symptoms are extreme tiredness and jaundice (all the white parts on your body, like your eyes, teeth and nails, turn yellow). It may cause the liver to stop working and has been associated with lifelong infection, liver failure, liver cancer, and even death.

Varicella vaccine

  • Varicella is a virus which causes chickenpox. It causes an itchy rash and a fever. You can catch it from someone who already has it if you touch an open blister on that person's skin or if that person sneezes or coughs around you. Varicella infection, though usually believed to be mild, also causes pneumonia (lung infections) and encephalitis (brain infections).

Pneumococcal vaccine

  • Streptococcus pneumoniae is a bacterium which causes ear infections, pneumonia (lung infection), sepsis (blood infection), and meningitis. It is very dangerous to the very young and very old.

Hepatitis A vaccine

  • Hepatitis A is a virus similar to hepatitis B. Transmission occurs by coming in contact with contaminated food or drink. Early symptoms of the disease are nonspecific and may include fever, diarrhea, and abdominal pain. It causes acute liver disease. It can affect anyone at any age, and in the United States, it can occur as isolated cases or even in epidemics.

Meningococcal vaccine

  • Neisseria meningitidis is a bacterium which causes meningitis (brain infection), sepsis (blood infection), and other infections. It is very dangerous infection and can cause seizures and death. Often outbreaks occur in epidemics.

Rotavirus vaccine

  • Rotavirus is a virus which causes severe diarrhea in very young infants. It causes over 55,000 hospitalizations each year in the United States and over 400,000 deaths worldwide. Children with this virus develop vomiting and watery diarrhea, which causes them to become dehydrated.

Human papillomavirus vaccine

Influenza vaccine

  • Influenza is a virus which causes severe respiratory illness. There are two major types, A and B. Each year, a new influenza vaccine is required because of the virus' tendency to mutate (change). The flu, as the disease is commonly called, causes the most severe illness in the very young and the very old.

For more information about vaccinations, please visit the MedicineNet Immunizations (Vaccinations) Center and http://www.cdc.gov/vaccines.

Portions of the above information have been provided with the kind permission of the Food and Drug Administration (www.fda.gov) and the Centers for Disease Control and Prevention (www.cdc.gov).

Medically reviewed by Margaret Walsh, MD; American Board of Pediatrics

REFERENCE:

United States. Centers for Disease Control and Prevention. "Recommended Immunization Schedule for Persons Aged 0 Through 18 Years -- United States, 2014." <http://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-trifold-schedule.pdf>.

Last Editorial Review: 3/21/2016

Reviewed on 3/21/2016
References
Medically reviewed by Margaret Walsh, MD; American Board of Pediatrics

REFERENCE:

United States. Centers for Disease Control and Prevention. "Recommended Immunization Schedule for Persons Aged 0 Through 18 Years -- United States, 2014." <http://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-trifold-schedule.pdf>.

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