Please read the Disclaimer at the end of this page.
INTRODUCTION — Vaccines are one of the most effective ways to prevent serious illness in children and adults. Vaccine programs in the United States have been quite successful in reducing the number of children affected by many highly contagious diseases, including measles, rubella, mumps, diphtheria, and polio.
In the United States, there are several vaccines that are routinely recommended for infants and children younger than age 7; these are discussed in more detail in this article. The recommended schedule is also available through the Centers for Disease Control and Prevention. More general information about how vaccines work, the risks and benefits of vaccines, and common concerns regarding vaccine safety is available separately. (See "Patient education: Why does my child need vaccines? (Beyond the Basics)".)
Vaccine recommendations for children age 7 to 18 years, as well as for adults, are also discussed separately. (See "Patient education: Vaccines for children age 7 to 18 years (Beyond the Basics)" and "Patient education: Vaccines for adults (Beyond the Basics)".)
VACCINE SAFETY — In most cases, the benefits of vaccinating are much greater than the potential risks. There are a lot of myths about vaccines, and you may have heard rumors about vaccines being dangerous or containing harmful ingredients. In fact, every vaccine must go through a specific process to test it for safety before it can be recommended. More information about vaccine safety is available separately. (See "Patient education: Why does my child need vaccines? (Beyond the Basics)", section on 'Vaccine safety'.)
CONTRAINDICATIONS TO VACCINATION — There are some situations in which an infant or child should not receive a specific vaccine or formulation of vaccine, such as if they have a history of severe allergic reaction. (See "Patient education: Why does my child need vaccines? (Beyond the Basics)", section on 'Contraindications to vaccination'.)
Talk to your child's health care provider if you are concerned about whether a particular vaccine is safe for your child. They will also tell you if there is a situation in which a vaccine should be delayed (for example, in some cases a vaccine might be given later than usual if a child is ill).
RECOMMENDED IMMUNIZATIONS — In the United States, vaccine recommendations for children are based on policies developed by expert groups (table 1). Your child's health care provider can talk to you about when your child should get certain vaccines.
The vaccines recommended for infants and children from birth through 6 years are discussed below.
COVID-19 — Coronavirus 2019 (COVID-19) is an infection caused by a virus called SARS-CoV-2. It can cause a fever, cough, trouble breathing, or other symptoms. Some people get severely ill from COVID-19.
Vaccines for COVID-19 became available in the United States in late 2020. Children age six months and older can get a vaccine; the American Academy of Pediatrics (AAP) recommends COVID-19 vaccination for all eligible children.
Timing and dose — The COVID-19 vaccine comes as a shot. The vaccines available for children are "mRNA" vaccines. They come in a smaller dose than the vaccines teens and adults get:
●For children under age five years, it is given in either two or three doses several weeks apart.
●Children age five years and older get two doses. For those who have a medical condition or take medication that makes their immune system weaker than normal, experts recommend a third dose as part of the regular vaccine series. Children five years and older can also get a "booster" shot at least five months after their original vaccine series.
Side effects — Side effects can include pain at the injection site, fever, fatigue, and headache. Any side effects usually resolve after a day or two.
Serious side effects are rare. A very small number of people have developed inflammation of the heart muscle (myocarditis) after receiving an mRNA vaccine. Most cases have been in teen or young adult males. This side effect is extremely rare and is usually mild and treatable if it does happen. Experts believe that the benefits of getting vaccinated against COVID-19 are much greater than the risks.
Hepatitis B — Hepatitis B virus (HBV) infection can cause inflammation of the liver (hepatitis). Although HBV infection often resolves or causes no symptoms, HBV can cause chronic liver disease that leads to progressive liver scarring (cirrhosis) or liver cancer. HBV is transmitted by contact with an infected person's body fluids and can be transmitted from an infected pregnant person to their baby. HBV can also be transmitted during unprotected sexual intercourse, by sharing contaminated needles, or from contact with contaminated blood or blood products. (See "Patient education: Hepatitis B (Beyond the Basics)".)
Although most infants are not at high risk for becoming infected with HBV, vaccination during infancy is the most effective way to ensure lifetime protection.
Timing and dose — HBV vaccination is recommended for all children beginning at birth. The vaccine requires three doses. The first dose should be given within 24 hours of birth. The second and third doses are given one to two months later and then at 6 to 18 months of age. Children who receive HBV vaccine in a shot combined with other vaccines may receive a fourth dose of HBV vaccine. The fourth dose is considered extra and is not harmful.
Diphtheria, tetanus, pertussis — Diphtheria is a highly contagious disease. It is usually transmitted via droplet particles that are coughed or sneezed into the air. It can cause a thick covering in the back of the throat that can lead to breathing problems or heart failure.
Tetanus is another very serious infection that is caused by a bacterial toxin. The bacteria reside in soil and the intestinal tracts of certain mammals. It enters the body through an open wound, multiplies, and produces a toxin that can affect nerves controlling muscle activity. A common symptom of tetanus infection is stiffness of the jaw muscles ("lockjaw").
Pertussis, or whooping cough, is an upper respiratory illness caused by a bacterium. The organism is highly contagious, spreads easily, and can cause serious illness, especially in infants.
Tetanus and diphtheria disease are rare in the United States because of the high numbers of people who have been immunized. However, pertussis infections continue to occur, especially in infants, despite widespread vaccination. The good news is that infants who are immunized against pertussis disease are typically less ill than those who are not immunized.
Timing and dose — Combined diphtheria, tetanus, and acellular pertussis (DTaP) vaccine is recommended for all children in the United States. The acellular form of pertussis vaccine (DTaP) has replaced the older form of pertussis vaccine (DTP), known as the whole cell vaccine. A total of five separate doses are recommended, at 2, 4, and 6 months of age, with the fourth dose given at 15 to 18 months and the fifth at 4 to 6 years of age. The recommended schedule is available through the Centers for Disease Control and Prevention.
Adolescents should receive a booster dose of tetanus, diphtheria, pertussis vaccine (called "Tdap") at 11 to 12 years of age.
Side effects — Common side effects include injection site pain, redness, and swelling; fever; drowsiness; and loss of appetite. These reactions are more common after the fourth and fifth doses.
Rare side effects include severe allergic reactions (anaphylaxis) or brain swelling. Children who have a severe allergic reaction or brain swelling within seven days of receiving the DTaP or DTP vaccine should not receive future doses of this vaccine.
For children who have a progressive or unstable neurologic disorder (eg, infantile spasms, seizures that are not well controlled), DTaP vaccination should be postponed until the neurologic problem is controlled or stable. For children who have a moderate or severe illness on the day of the scheduled immunization, DTaP vaccination should be postponed until the child is better.
Poliomyelitis — During the first half of the 20th century, poliomyelitis (commonly called "polio") was a major cause of serious illness and death throughout the world. It is still a significant health problem in some resource-limited countries. Before a vaccine was available, more than 20,000 cases of polio were reported in the United States per year. The primary signs of polio include muscle weakness, pain, and fatigue; ultimately, the illness can lead to paralysis and even death.
All children should be vaccinated against polio to avoid new outbreaks. In the United States, the polio vaccine is made from a virus that has been killed and is injected (called IPV). In other countries, where polio disease is still a major problem, oral polio vaccine (OPV) is given.
Timing and dose — The injected polio vaccine series in the United States includes four doses; the first and second doses are given at 2 and 4 months of age. The third dose is usually given at 6 to 18 months of age, and a fourth dose is routinely given at 4 to 6 years, before school entry. Children who miss a dose should be given the remaining doses.
The injected polio vaccine should not be given to children who have a severe allergy to antibiotics contained in the vaccine, including neomycin, streptomycin, or polymyxin B.
Side effects — There is little to no risk of side effects (eg, swelling at injection site). There is no risk of developing polio with the IPV vaccine used in the United States.
Rotavirus — Before a rotavirus vaccine was available, rotavirus was the single most important cause of severe diarrhea and dehydration in infants and young children. A rotavirus vaccine is recommended for all infants in the United States. Two vaccines are available: RotaTeq (RV5) and Rotarix (RV1).
Timing and dose — The vaccine is in a liquid form and is given by mouth (not as a shot). The first dose of the vaccine should be given between 6 and 15 weeks of age, but not after 15 weeks. The number of doses (two or three) depends upon which vaccine is given:
●RV5 – Three doses of RV5 are recommended, given at 2, 4, and 6 months of age. The third dose of the vaccine should be given by 8 months of age.
●RV1 – Two doses of RV1 are recommended, given at 2 and 4 months of age. The second dose should be given by 8 months of age.
Rotavirus vaccine should not be given to infants with a known immunodeficiency (eg, a medical condition that weakens the immune system) or history of intussusception (a condition in which part of the intestine slides into another part). RV1 should not be given to infants with a history of latex allergy.
Side effects — In all infants, there is a small risk of diarrhea and vomiting in the week after the vaccine is given. Healthy infants with normal immunity can be given the rotavirus vaccine even if there is a sibling or other family member who does not have normal immunity as long as the family practices good hand washing and proper hygiene, especially after changing the infant's diapers.
If an infant develops abdominal pain, vomiting, diarrhea, blood in the stool, or has a change in bowel movements after receiving the rotavirus vaccine, contact a health care provider immediately.
Haemophilus influenzae type b (Hib) — Until the mid-1990s, Haemophilus influenzae serotype b (Hib) was the most common cause of bacterial meningitis (inflammation of the covering of the brain) in children. It was also responsible for other serious bacterial infections, including skin, throat, and joint infections. The widespread use of Hib vaccines in infancy has led to a dramatic decline in the incidence of invasive Hib disease in children. However, the disease remains common in countries that do not use the vaccine. Despite its name, Hib is not related to the influenza virus.
Timing and dose — There are several types of Hib vaccines available in the United States; one is given in three doses at 2, 4, and 6 months of age and as a booster dose at 12 to 15 months. The second type is given in two doses, at 2 and 4 months, and as a booster dose at 12 to 15 months of age. There are vaccines that combine the Hib vaccine with another vaccine or vaccines, including Hib/diphtheria, tetanus, and acellular pertussis (DTaP)/inactivated poliovirus vaccine (IPV), and Hib/DTaP/IPV/hepatitis B vaccine.
There are no medical conditions that require a child to avoid receiving Hib vaccine, other than a severe allergic reaction to one of the vaccine components.
Side effects — Reactions (eg, fever, irritability) are uncommon after Hib vaccine. Local reactions, consisting of pain, redness, and/or swelling at the injection site occur in approximately 25 percent of children. Such local reactions usually are mild and resolve within 24 hours.
Pneumococcus — Streptococcus pneumoniae (pneumococcus) can cause serious infections, including meningitis and pneumonia, which can be fatal in young children. This also is true in older children with a chronic medical condition or a weakened immune system.
Before infants were routinely immunized against pneumococcus in the United States, there were approximately 17,000 cases of invasive disease each year among children younger than 5 years of age, including 700 cases of meningitis and 200 deaths.
Timing and dose — Children should receive a total of four doses of pneumococcal vaccine. Doses should be given at 2, 4, and 6 months of age and 12 to 15 months of age. The first dose can be given as early as 6 weeks of age.
Side effects — The most common side effect of the vaccine is an injection site reaction (redness, pain) and fever. (See "Patient education: Fever in children (Beyond the Basics)".)
Influenza — Influenza (flu) is a highly contagious viral infection that occurs in outbreaks worldwide, usually during the winter in the United States. Young children, older adults, and people with certain underlying medical conditions are at increased risk for severe illness if they are infected with the influenza virus. Vaccinating everyone older than six months can help decrease this risk. The influenza vaccine does not prevent other illnesses such as the common cold or strep throat. (See "Patient education: Influenza prevention (Beyond the Basics)".)
Immunization against influenza is recommended for everyone older than six months.
Timing and dose — There are two ways for children to receive the flu vaccine: as a shot into muscle (intramuscular injection, also known as simply the "flu shot") or as a nasal spray. Your child's health care provider can talk to you about the options, and you can decide together which one is best for your child.
The flu shot can be given to adults and children 6 months of age and older, while the nasal spray is approved only for those 2 through 49 years of age.
The influenza vaccine must be given every year (ideally in the fall or early winter in the northern hemisphere). The main reason for this is that protection from influenza vaccine decreases over time. Yearly vaccination also allows the vaccine to be reformulated if the influenza viruses change from year to year. In the first year that a child younger than nine years receives the vaccine, two doses are recommended; the second dose is given at least one month after the first. In subsequent years, most children will need only one dose.
Children who have a fever (higher than 100.4°F [38°C]) should wait to get the vaccine until the fever resolves. However, children with mild illnesses that do not cause a fever can get the vaccine.
Side effects — The most common side effect of the shot is redness and soreness at the injection site. Some children develop a low-grade fever or a runny or congested nose after vaccination, particularly in children younger than 2 years. (See "Patient education: Fever in children (Beyond the Basics)".)
Measles-mumps-rubella (MMR) — Measles, mumps, and rubella are illnesses that may be transmitted by airborne droplets released during coughing or sneezing.
●Measles (also known as rubeola) is a highly contagious viral illness of the respiratory tract that primarily affects children; it causes a distinctive rash, fever, and cough, and may result in complications, including infection of the middle ear, lungs, and brain.
●Mumps is an acute, usually mild viral infection of childhood that causes painful swelling of the salivary glands. Mumps complications can develop, including inflammation of the brain (encephalitis), the protective membranes of the brain (meningitis) and, in males after puberty, swelling and tenderness of one or both testes (orchitis).
●Rubella, also known as German measles, is a mild viral infection that causes fever, swelling of the lymph nodes in the neck, and a distinctive rash; however, it can cause severe birth defects (congenital rubella syndrome) if it occurs during early pregnancy.
The number of people affected by these diseases has fallen dramatically in the United States since vaccines were developed. Despite the rarity of these diseases in the United States, vaccination is still recommended for a number of reasons:
●Individuals who visit or emigrate from countries that do not vaccinate against measles can spread the virus to those who are not immune.
●Measles that develops during pregnancy can cause early labor and miscarriage.
●The most serious complications of mumps occur more frequently in adults than children, including orchitis (leading to sterility), neurologic complications, and a risk of fetal death if the infection is acquired in early pregnancy.
●Well-vaccinated groups of children help to protect almost everyone, including adults as well as other children.
Timing and dose — The first dose of MMR is given at 12 to 15 months of age. A second dose is recommended routinely before school entry (between 4 and 6 years of age). The recommended schedule is available through the Centers for Disease Control and Prevention.
Children living in or traveling to areas where there is a measles outbreak (defined as ≥3 cases linked in time and space) and children traveling outside the United States should receive MMR vaccine earlier than it is routinely recommended.
Side effects — Common side effects of the MMR vaccine include a mild rash or fever; these may be seen one to two weeks after the vaccine is given and usually last one to three days. (See "Patient education: Fever in children (Beyond the Basics)".)
For the first dose, the risk of febrile seizures is twice as high in children 12 to 23 months of age who receive MMR vaccine combined with varicella vaccine as in children who receive MMR vaccine and varicella vaccine separately. For this reason, separate MMR and varicella vaccines are generally preferred for the first dose if the child is younger than 48 months (4 years). The risk of febrile seizures decreases as children get older, so the combination MMR-varicella vaccine can be used for the second dose.
Concern has been raised about a possible link between the MMR vaccine and autism. After doing many careful studies, scientists have not found any link between vaccines and autism. Many years ago, one very small study said there was a link between autism and vaccines, but that study turned out to be false. (See "Patient education: Why does my child need vaccines? (Beyond the Basics)", section on 'Vaccine safety'.)
Varicella (chickenpox) — Varicella is a highly contagious viral illness caused by infection with the varicella zoster virus (VZV). The disease causes fever, sore throat, and a distinctive, itchy rash with fluid-filled blisters that later forms scabs. The virus is transmitted by the spread of airborne droplets or direct contact with skin lesions. Complications of chickenpox may include bacterial infections of the skin, pneumonia, or, less commonly, inflammation of the brain. (See "Patient education: Chickenpox prevention and treatment (Beyond the Basics)".)
Before the vaccine was available, an estimated 3.7 million cases of chickenpox occurred in the United States every year, resulting in nearly 9000 hospitalizations and approximately 100 deaths.
Timing and dose — In the United States, VZV vaccine is recommended for all children at 12 to 18 months of age. A second dose is recommended at 4 to 6 years of age. The recommended schedule is available through the Centers for Disease Control and Prevention.
The varicella vaccine contains a live weakened form of VZV; thus, it is not recommended for children with a weakened immune system or in someone experiencing moderate to severe illness. The vaccine should be delayed in a child who has recently received an injection of immunoglobulin, a blood transfusion, or other blood product.
Side effects — The most common side effects of the VZV vaccine are redness or soreness at the injection site and a mild rash (approximately five spots).
For the first dose, risk of febrile seizures is twice as high in children 12 to 23 months of age who receive VZV vaccine combined with measles-mumps-rubella (MMR) vaccine as in children who receive VZV vaccine and MMR vaccine separately. For this reason, separate VZV and MMR vaccines are generally preferred for the first dose if the child is younger than 48 months. The risk of febrile seizures decreases as children get older, so the measles, mumps, rubella, and varicella combination vaccine (MMRV) vaccine can be used for the second dose.
Hepatitis A vaccine — Hepatitis due to infection with the hepatitis A virus (HAV) is one of the most common viral infections in children and adolescents in the United States. HAV infection often causes few or no symptoms in younger children. By contrast, infection in adults can vary in severity from a mild flu-like illness to rapidly progressive, severe liver disease. Vaccinating children can help to protect adult caregivers from a potentially serious illness. (See "Patient education: Hepatitis A (Beyond the Basics)".)
HAV is found in the stool of infected individuals. A person can become infected with HAV by consuming contaminated food or water or by touching the mouth, nose, or eyes after touching a contaminated surface (eg, in the bathroom or during a diaper change). Washing the hands can help to prevent infection.
Timing and dose — The hepatitis A (HepA) vaccine is recommended for all children between 12 and 23 months of age. Catch-up immunization is recommended for children between 2 and 18 years of age. In all age groups, two doses are required, given at least six months apart.
The vaccine also is recommended for certain high-risk adults, such as international travelers, people with blood clotting disorders or chronic liver disease, homeless individuals, and those who live in communities with a high hepatitis A infection rate.
For babies 6 to 11 months who are traveling internationally, vaccination should be administered; the travel-related dose should not be counted toward the routine two-dose series.
Side effects — The most common side effect of the HepA vaccine is brief redness or discomfort at the injection site.
WHERE TO GET MORE INFORMATION — Your child's health care provider is the best source of information for questions and concerns related to your child's medical problem.
This article will be updated as needed on our website (www.uptodate.com/patients). Related topics for patients and caregivers, as well as selected articles written for health care professionals, are also available. Some of the most relevant are listed below.
Patient level information — UpToDate offers two types of patient education materials.
The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.
Patient education: Vaccines for babies and children age 0 to 6 years (The Basics)
Patient education: What you should know about vaccines (The Basics)
Patient education: Meningitis in children (The Basics)
Patient education: Vaccines for children age 7 to 18 years (The Basics)
Patient education: Vaccines for travel (The Basics)
Patient education: Vaccines for adults (The Basics)
Patient education: Whooping cough (The Basics)
Patient education: Sickle cell disease (The Basics)
Patient education: Parotitis (The Basics)
Patient education: Mumps (The Basics)
Patient education: Hemophilia (The Basics)
Patient education: Poliomyelitis (The Basics)
Patient education: Measles (The Basics)
Patient education: Tdap vaccine (The Basics)
Patient education: When your child has sickle cell disease (The Basics)
Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.
Patient education: Why does my child need vaccines? (Beyond the Basics)
Patient education: Vaccines for children age 7 to 18 years (Beyond the Basics)
Patient education: Vaccines for adults (Beyond the Basics)
Patient education: Hepatitis B (Beyond the Basics)
Patient education: Fever in children (Beyond the Basics)
Patient education: Influenza prevention (Beyond the Basics)
Patient education: Chickenpox prevention and treatment (Beyond the Basics)
Patient education: Hepatitis A (Beyond the Basics)
Patient education: Vaccines for travel (The Basics)
Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.
Allergic reactions to vaccines
Mumps
Hepatitis A virus infection: Treatment and prevention
Hepatitis B virus immunization in adults
Meningococcal vaccination in children and adults
Pneumococcal vaccination in children
Poliovirus vaccination
Vaccination for the prevention of chickenpox (primary varicella infection)
Human papillomavirus vaccination
Rubella
Seasonal influenza in children: Prevention with vaccines
Standard immunizations for children and adolescents: Overview
Treatment of varicella (chickenpox) infection
Vaccines to prevent smallpox, mpox (monkeypox), and other orthopoxviruses
The following organizations also provide reliable health information.
●National Library of Medicine
(www.nlm.nih.gov/medlineplus/healthtopics.html)
●National Institute of Allergy and Infectious Diseases
●Centers for Disease Control and Prevention (CDC) National Immunization Program
Toll-free: (800) 232-4636
●National Foundation for Infectious Diseases
Tel: (301) 656-0003
●The Children's Hospital of Philadelphia Vaccine Education Center
(www.chop.edu/service/vaccine-education-center/home.html)
[1-5]
