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Updated August 11, 2015.

As you get educated about vaccines, understand that none of these vaccines are optional. Skipping or delaying a vaccine simply puts your child at risk for getting a dangerous vaccine-preventable disease.

Vaccines for Infants and Toddlers

By age two years, infants and toddlers will get protected against 13 vaccine-preventable diseases by getting:

• 3 doses of hepatitis B vaccine
• 2 or 3 doses of rotavirus vaccine

• 4 doses of DTaP
• 3 or 4 doses of Hib vaccine
• 4 doses of Prevnar (pneumococcal vaccine)
• 3 doses of polio vaccine
• 1 dose of MMR
• 1 dose of Varivax (chicken pox vaccine)
• 2 doses of hepatitis A vaccine

Those vaccines can be given in as few as 15 individual shots if combination vaccines, such as Pediarix or Pentacel, are used.

Infants should also begin to get a yearly flu vaccine beginning when they are six months old. Most without medical problems can switch from a flu shot to the nasal spray flu vaccine when they are at least two years old.

Vaccines for School

Kids typically get more vaccines before starting kindergarten, before entering the 7th grade, and before going to college, including:

• boosters before starting kindergarten - DTaP, IPV, Varivax, and MMR (just two shots if given as the Kinrix and ProQuad combination vaccines)
• HPV vaccine series for preteen boys and girls at age 11 to 12 years
• Tdap booster at age 11 to 12 years
• meningococcal vaccine - 1st dose at age 11 to 12 years and a booster at age 16 to 18 years

These older kids should also get a yearly flu vaccine and any vaccines that they missed when they were younger.

Vaccines for Adults

The most common vaccines that adults should get include:

• a yearly flu vaccine
• at least one dose of Tdap and then a Td booster every 10 years
• a dose of Tdap during each pregnancy during 27 to 36 weeks' gestation
• two doses of Varivax if they have never had chicken pox
• the HPV vaccine series (adults through age 26 years)
• the Zoster vaccine once they are 60 years old to prevent shingles
• Prevnar if they are at least 65 years old
• Pneumovax if they are at least 65 years old

Other vaccines, including MMR, hepatitis A, hepatitis B, meningococcal vaccine, and Hib vaccine might be given to adults with certain risk factors.

Vaccines for Travel

There are actually many licensed vaccines that children and adults do not routinely get in some countries. You may need them if you travel to an area of the world where a disease is more common though.

Some commonly needed vaccines for travel include:

• measles - although children are routinely vaccinated against measles, they may need their MMR vaccines early if they are traveling out of the country before they are 1 to 4 years old. In this situation, the first dose may be given as early as age six months (although it will have to be repeated when they are 12 months old), and older children may get their second dose at least 4 weeks after their previous dose. Unvaccinated or partially vaccinated older children and adults should also get one or two MMR vaccines before traveling out of the United States.
• typhoid vaccine - often needed when traveling to areas at high risk for typhoid fever, especially South Asia, Southeast Asia, Africa, Central America, and South America.
• yellow fever - typically only needed when traveling to areas of South America (Argentina, Brazil, Peru, etc.) and Africa (Ethiopia, Kenya, Nigeria, etc.) where there is a high risk of getting yellow fever from mosquito bites.
• Japanese encephalitis - typically only needed when traveling to high-risk areas of Asia and the western Pacific for extended periods of time.
• meningococcal vaccine - typically only needed when traveling to the meningitis belt of sub-Saharan Africa.

Although there are two cholera vaccines licensed in other countries, they are not available in the United States.

Vaccines for Special Situations

There are also vaccines that are only given to children in special situations, typically when they have specific health problems that put them at higher risk for infections, such as:

• Prevnar 13 and Pneumovax for unvaccinated school aged children and teens "who have cerebrospinal fluid leak; cochlear implant; sickle cell disease and other hemoglobinopathies; anatomic or functional asplenia; congenital or acquired immunodeficiencies; HIV infection; chronic renal failure; nephrotic syndrome; diseases associated with treatment with immunosuppressive drugs or radiation therapy, including malignant neoplasms, leukemias, lymphomas, and Hodgkin’s disease; generalized malignancy; solid organ transplantation; or multiple myeloma."
• Pneumovax for unvaccinated school aged children and teen "with chronic heart disease (particularly cyanotic congenital heart disease and cardiac failure), chronic lung disease (including asthma if treated with high-dose oral corticosteroid therapy), diabetes mellitus, alcoholism, or chronic liver disease."
• Meningococcal vaccines, including Menveo, MenHibrix, and Menactra, should be given to infants with anatomic or functional asplenia and persistent complement component deficiency.

The first dose of Pneumovax is typically given when children are at least two years old. Some high risk children, including those with sickle cell disease, get a second dose five years later.

Premature babies are another special situation, in that the hepatitis B vaccine may be delayed if their mothers are hepatitis B negative until they are at least one month old or are discharged from the hospital. The rotavirus vaccine is also sometimes delayed for premature babies until they are discharged, as long as they aren't more than 15 weeks old.

Vaccines for Post-Exposure Prophylaxis

Although we often think of vaccines as something to be given to children to prevent them from getting sick long before they are ever exposed to an illness (preexposure prophylaxis), there are some that can help keep your kids healthy after they are exposed.

The rabies vaccine likely comes to mind when you think of a post-exposure vaccine. When exposed to animal with rabies, we get rabies immune globulin and four doses of the rabies vaccine to keep us from getting rabies.

It might surprise some people that other vaccines can be used for post-exposure prevention too, including:

• Varivax - if not immune to chicken pox, the Varivax vaccine can be given within 3 to 5 days of exposure to chicken pox or shingles to prevent chicken pox or at least make it less severe.
• hepatitis A vaccine - can be given to unvaccinated exposed persons instead of immune globulin
• hepatitis B vaccine - can be given to unvaccinated exposed persons within 24 hours of exposure to a source with unknown HBsAg status to prevent infection. When exposure is to a known HBsAg positive source, exposed persons should get both the hepatitis B vaccine and hepatitis B immune globulin.
• MMR - may prevent measles if given within 3 days of exposure to someone with measles. Getting the MMR vaccine does not prevent mumps or rubella after exposure though.

Unfortunately, you might not know that you were exposed to someone with measles or chicken pox in time to get vaccinated.

In addition to vaccines, certain medications can be given as post-exposure prevention. For example, antibiotics are typically given if you are exposed to someone with whooping cough and certain types of meningitis. Similarly, Tamiflu and Relenza are antiviral medications that can help prevent influenza.

 

<sub>Sources:

 

CDC. Update: Prevention of Hepatitis A After Exposure to Hepatitis A Virus and in International Travelers. Updated Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. October 19, 2007 / 56(41);1080-1084.

CDC. Advisory Committee on Immunization Practices Recommended Immunization Schedules for Persons Aged 0 Through 18 Years — United States, 2015. MMWR. February 6, 2015 / 64(04);93-94.</sub>