THE RECOMMENDED IMMUNIZATION SCHEDULE FOR CHILDREN

According to the Centers for Disease Control and Prevention (CDC), the childhood immunization schedule applies to people aged 18 years old and younger. The following paragraphs enumerate the recommended vaccines for children, along with information on what diseases and conditions can be prevented with the timely and proper use of vaccination.

Hepatitis B

Hepatitis B is a virus that affects the liver. A severe infection due to hepatitis can lead to liver failure, liver cancer, problems with other organ systems, and possibly death.

The hepatitis B vaccine can be given in 3 or 4 doses. Regardless if a mother is hepatitis B positive or negative, all newborns are given one dose of the monovalent hepatitis B vaccine within 24 hours of birth. After hospital discharge, the remaining 3 doses are given at 0 months, 1-2 months and 6-18 months in a combination vaccine. This vaccination series may be completed as early as 6 months old.

A second series may be given to people who are immunocompromised, undergoing hemodialysis, or born to mothers with hepatitis B. These individuals will need to undergo evaluation with a specialist before determining whether a second series is warranted or not.

For newborns born to a hepatitis B positive mother, one dose of hepatitis B immune globulin is given alongside the first dose of hepatitis B vaccine at birth.

Rotavirus

Rotavirus is a virus that can cause acute gastroenteritis. Symptoms include fever, vomiting and diarrhea, leading to severe dehydration if not treated promptly.

The rotavirus vaccine is unique: it is given orally rather than through an injection. The rotavirus vaccine has two different schedules, depending on the type of vaccine given.

The Rotarix vaccine is given in 2 doses, at 2 months old and 4 months old. On the other hand, the RotaTeq vaccine is given in 3 doses, at 2 months, 4 months, and 6 months of age. Infants may be vaccinated as early as 6 weeks old.

The vaccine can no longer be given if the child is 15 weeks old before the first dose is given. The last dose should be given before the infant turns 8 months old.

One very rare side effect of the rotavirus vaccine is intussusception, wherein one part of the intestine telescopes into another segment. This can cause bloody stools, vomiting, irritability, severe crying episodes, and abdominal pain (babies would put up their legs close to their chest). This occurs only in 1 out of 20,000 to 100,000 babies.

Diphtheria, tetanus & acellular pertussis

This combination vaccine comes in two main formulations: DTaP and Tdap. DTaP is used for children less than 7 years old, while Tdap is given to those 7 years of age and above.

Diphtheria is a type of bacteria that creates toxins and can cause serious infections in affected individuals. Diphtheria causes fever, sore throat, swollen lymph nodes, and body weakness. If untreated, it can involve the heart muscle, leading to heart failure, paralysis and possibly death.

Tetanus, also known as lockjaw, is an infection caused by Clostridium tetani, a spore-forming bacteria. This infection leads to headache, fever, difficulty swallowing, muscle spasms, and stiff muscles in the abdomen and neck. Complications include difficulty breathing, fractures, blood clot formation and tightening of the vocal cords. Around 10-20% of tetanus cases lead to death.

Pertussis is well known as whooping cough. It is caused by an infection with bacteria called Bordetella pertussis. Symptoms include cough, colds and difficulty breathing. If left untreated, it could lead to pneumonia and death.

The DTaP vaccine is usually given in 5 doses, at 2 months, 4 months, 6 months, 15-18 months, and 4-6 years old. The fourth dose may be given as early as 12 months old, as long as it is six months apart from the third dose.

The Tdap vaccine is usually given as one dose for children aged 11-12 years old. However, it can also be used for catch-up vaccination in children who are at least 7 years old. The number of doses for catch-up immunization depends on the age of the child and the number of doses that were previously administered.

In children younger than 7 years old with a major or contaminated wound, DTaP may be given if the last tetanus vaccine (on its own or in a combination vaccine) was given more than 5 years ago. Otherwise, Tdap may be used for children 7 years and older. For clean and minor wounds, give one dose of Tdap if the last tetanus vaccine was given more than 10 years ago. For contaminated or major wounds, give one dose if the last tetanus vaccine was given more than 5 years ago.

Hib

Haemophilus influenzae type B is a type of bacteria that can cause severe infection in children less than 5 years of age. It can cause upper airway and lung infections like epiglottitis and pneumonia, leading to difficulty in breathing. It can infect the spinal cord and meninges of the brain, causing meningitis. If left unchecked, it can cause impairments in intellectual development and even death.

The Hib vaccine has two different schedules, depending on the type of vaccine given. Most brands of Hib vaccine offer a 4-dose series, given at 2 months, 4 months, 6 months, and 12-15 months of age. The PedvaxHIB vaccine is given in 3 doses, at 2 months, 4 months and 12-15 months old.

The Hib vaccines may be used for catch-up immunization. The number of doses that are needed depends on the age of the child and the number of doses that were previously administered.

Revaccination may be needed in special groups, such as those undergoing chemotherapy, radiation, hematopoietic stem cell transplant and splenectomy. People living with HIV, asplenia or immunoglobulin deficiency may have a different schedule or number of doses needed.

Pneumococcal

Streptococcus pneumoniae, also known as Pneumococcus, is a bacteria that can infect the lungs, bloodstream, and meninges of the brain. This may lead to pneumonia, sepsis or meningitis, respectively. Severe cases may lead to death.

The pneumococcal conjugate (PCV13) vaccine confers protection against 13 different types of pneumococcus. This is given in 4 doses, at 2 months, 4 months, 6 months, and 12-15 months old. Vaccination can start as early as 6 weeks old.

The second type of vaccine is called pneumococcal polysaccharide (PPSV23) vaccine, which provides protection against 23 different types of pneumococcus. This may be given to children aged 2 years or older, and is usually administered to patients who are immunocompromised, as well as those with certain conditions that make them at higher risk of infection, such as diabetes, kidney failure, liver problems, and heart or lung disease. The number of doses to be given and the timeline of the vaccination series depends on the type of condition they have.

Inactivated poliovirus

Children infected with polio virus may have no symptoms at first, but soon develop fever, sore throat, headache and nausea, progressing to paralysis and even death.

The inactivated poliovirus vaccine (IPV) is given in 4 doses, at 2 months, 4 months, 6-18 months old and 4-6 years old. The first dose can be given at 6 weeks old onwards, but the final dose should be given at a minimum of 4 years old.

A second type is the oral polio vaccine (OPV), which has the same recommended schedule as the IPV.

Influenza

Influenza is a well-known cause of pneumonia. Initial symptoms include fever, cough, sore throat, and muscle pains.

There are three main types of influenza vaccine. The inactivated influenza vaccine (IIV) may be given to children 6 months and older. The live attenuated influenza vaccine (LAIV4) may be given to those 2 years of age and older. The recombinant influenza vaccine (RIV4) is administered to those 18 years of age and older.

• 2 doses, 4 weeks apart for children 6 months to 8 years old who received less than 2 doses before July 1, 2020
• 1 dose for children 6 months to 8 years old who received 2 or more doses before July 1, 2020
• 1 dose per year for all children 9 years and older

Measles, mumps, rubella

A combination vaccine has been formulated for measles, mumps and rubella. This is a recommended vaccine by the CDC.

Measles is a highly infectious virus causing fever, rashes, cough and inflammation of the eyes. This can progress to infect the lungs (pneumonia) and the brain (encephalitis).

Mumps is another virus that causes fever, swollen salivary glands, headache and muscle pains. If untreated, this can lead to deafness and inflammation of other organs, such as the brain, spinal cord, and meninges.

Rubella is a type of virus that can be passed on from a pregnant woman to her unborn child. Miscarriages, birth defects or premature delivery can occur, depending on which trimester of pregnancy the mother acquired the infection. Symptoms in children include fever, rashes, and swelling of lymph nodes. 

The MMR vaccine is usually given in 2 doses, at 12-15 months old and 4-6 years old. The minimum interval between the two doses is 4 weeks, so the second dose may be given earlier.

Varicella

Varicella, also known as chickenpox, can cause fever, rashes, body weakness and headache. Like other viruses, progression of the illness can lead to pneumonia and encephalitis. Other cases report the development of bleeding disorders.

The varicella vaccine is given in 2 doses, at 12-15 months and 4-6 years of age. The minimum interval between the two doses is 3 months, so the second dose may be given earlier as well.

A specially formulated vaccine, called the MMRV, combines MMR and varicella. This may be given in children 12 years and younger.

Hepatitis A

Hepatitis A, like hepatitis B, affects the liver. Some infected individuals may not have symptoms. Commonly, this virus causes fever, body weakness, jaundice, dark urine, abdominal pain, vomiting and loss of appetite. Complications include kidney, pancreatic, joint and blood disorders.

The hepatitis A vaccine is given in 2 doses, and may be started at 12 months old. The minimum interval between the two doses is 6 months.

Human papillomavirus

Human papillomavirus (HPV) is one of the most common sexually transmitted viruses, but is preventable. While some HPV infections can spontaneously resolve, a persistent infection with certain HPV types can lead to cancer. The tongue, tonsils, back of the throat, cervix, vagina, vulva and penis are areas where cancer can develop.

HPV vaccine can be given as early as 9 years old, but may also be started at around 15 years old. If the child is 9-14 years old during the first dose, the vaccine is given as a 2-dose series with the two doses at least 5 months apart. If the child is 15 years of age or older, a 3-dose series is given, with the next doses at 1-2 months and 6 months from the first one.

A different vaccination schedule may be required for children who are immunocompromised or who have experienced sexual abuse.

Meningococcal

Neisseria meningitis is a bacteria that can cause meningococcal disease. It is a serious and potentially fatal infection that can cause inflammation of the brain and the spinal cord. Children who recover from the illness may even lose a limb or develop brain and kidney problems.

The meningococcal vaccine has different brands, but commonly target the A,C, W and Y serogroups of the infection (ACWY vaccine). It is given in 2 doses, at 11-12 years and 16 years of age.

What about the COVID-19 vaccine?

As of writing, the COVID-19 vaccine has not been included in the CDC-recommended vaccination schedule as studies are still underway to determine the appropriate vaccine and schedule for children. To date, only the Pfizer-BioNTech COVID-19 vaccine may be given to children 12 years of age and older.

Summary

Scientific advancements such as vaccines help keep children safe as they grow and explore the world around them. While vaccinations directly protect a child, when administered to most of the population, it helps protect other vulnerable members of the community. Let’s do our part to keep each other safe.

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Source

• Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger, United States, 2021. Centers for Disease Control and Prevention. Taken from: https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html
• Recommended Adult Immunization Schedule for ages 19 years or older, United States, 2021. Centers for Disease Control and Prevention. Taken from: https://www.cdc.gov/vaccines/schedules/downloads/adult/adult-combined-schedule.pdf
• 2021 Recommended Vaccinations for Infants and Children (birth through 6 years) Parent-Friendly Version. Centers for Disease Control and Prevention. Taken from: https://www.cdc.gov/vaccines/schedules/easy-to-read/child-easyread.html
• Questions & Answers about Intussusception and Rotavirus Vaccine. Centers for Disease Control and Prevention. Taken from: https://www.cdc.gov/vaccines/vpd/rotavirus/about-intussusception.html
• Tetanus. Centers for Disease Control and Prevention. Taken from: https://www.cdc.gov/tetanus/index.html
• Your Child’s Immunizations: Pneumococcal Vaccines (PCV, PPSV). Rady Children’s Hospital San Diego. Taken from: https://www.rchsd.org/health-articles/your-childs-immunizations-pneumococcal-vaccines-pcv-ppsv/
• About HPV. Centers for Disease Control and Prevention. Taken from: https://www.cdc.gov/hpv/parents/about-hpv.html

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