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Vaccines Commonly Given to Children

Today, children are immunized before school age against 11 different diseases. There are other vaccines, such as the influenza vaccine, that are also recommended for some children. Your child’s doctor will tell you when the vaccines are due and if your child needs additional protection in certain circumstances.

Hepatitis B Vaccine

Hepatitis B is a virus that infects the liver; people with the illness can develop serious problems such as cirrhosis (liver disease) or liver cancer. People can also become chronic carriers of the disease, infecting others. The vaccination gives children a long-term immunity to hepatitis B, reducing the increased risk of developing liver cancer and chronic liver disease that follows infection with the hepatitis B virus.

A hepatitis B vaccine (HBV) will probably be your child’s first immunization. The vaccine is given in three rounds. If an infant’s mother is a hepatitis B carrier, the baby must receive the first shot within 12 hours of birth, along with an injection of hepatitis B immune globulin (HBIG) to help fight infection of the infant at birth. Otherwise, the first immunization is usually given either in the hospital before the newborn goes home or delayed until the baby is four to eight weeks old.

The second and third shots are usually given with the other routine childhood immunizations. If the first shot is given shortly after birth, the second is given at one to two months, and the final dose is given at six months. If the first shot is given at four to eight weeks, the second dose is usually given at three to four months, and the final dose is given when the child is six to eighteen months old. Your child may develop fever or redness and soreness at the site of the injection.There are few serious problems associated with the HBV. The vaccination should be delayed if your child is sick with anything other than a minor illness or cold or if he has had a severe allergic reaction to baker’s yeast. If he develops a severe allergic reaction after a dose of HBV, talk to your child’s doctor. Further doses may not be given.

Diphtheria, Tetanus, and Pertussis (DTaP) Vaccine

DTaP vaccine protects against diphtheria, tetanus, and pertussis:

• Diphtheria is a severe throat infection that can block the airway. It can also cause potentially life-threatening complications involving the heart and nervous system.

• Tetanus, which causes lockjaw, affects the nervous system and occurs when tetanus bacteria contaminate an infected wound. Because tetanus can occur at any age, even adults should receive a booster every 10 years.

• Pertussis is a respiratory illness, known as whooping cough because of the sound a child makes breathing following the severe bouts of coughing.Young infants are at greatest risk of developing complications from this disease. In severe cases the disease can cause brain damage or death.

The DTaP vaccination is given in five injections, usually at 2 months, 4 months, 6 months, 15 to 18 months, and 4 to 6 years. Later, at age 11 or 12, a child should be given a Td booster, for tetanus and diphtheria, if at least 5 years have elapsed since the last DTaP dose. This Td booster should then be given every 10 years. Sometimes a child will experience mild side effects after DTaP is given, such as fever, soreness, crankiness, drowsiness, and loss of appetite. The pertussis portion of the vaccine causes most of these reactions. These problems were seen more frequently in the past with the previously used version of the vaccine (DTP). Today, the AAP recommends the use of the newly developed form of the vaccine (DTaP), which contains only certain parts of the pertussis cell instead of the entire killed

cell. The resulting vaccine, the acellular pertussis vaccine, has resulted in fewer problems. The large majority of children tolerate the vaccine without significant problems. But rarely, severe complications occur after DTaP is given. They can include allergic reactions and seizures in 1 out of 2,000 children. Although these are a rare occurrence, you should always call your child’s doctor if your child has a severe reaction. Your child’s doctor will probably advise delaying or not giving the vaccine if any one of the following is true:

• Your child experienced very high fever, prolonged crying (more than three hours), or other worrisome symptoms following a DTaP vaccine in the past.

• Your child is ill with an infection causing more than a cold or mild fever.

• Your child has an uncontrolled seizure disorder or some types of neurological disease.

Hemophilus Influenzae Type B (Hib) Vaccine

Children who receive the Hib vaccine are protected against meningitis, pneumonia, and other infections caused by the Hemophilus influenzae type b bacteria.The vaccine is given at ages 2 months, 4 months, and 6 months. At ages 12 to 15 months, a child receives a booster shot. The possible side effects include fever and soreness at the site of injection. Your child’s doctor will probably advise delaying the vaccine if your child is sick with anything more serious than a cold or if she experienced an allergic reaction after an earlier Hib dose.

Pneumococcal Vaccine

Pneumococcus (Streptococcus pneumoniae) is the most common cause of severe bacterial diseases such as meningitis, bloodstream infection, and otitis media (middle ear infection). Until recently, the only available pneumococcal vaccine worked only for those over age two, leaving many of the children at highest risk for these infections without an effective vaccine to protect them. However, a newly developed biosynthetic pneumococcal vaccine, trade name Prevnar, was recently released and has been recommended by the AAP for routine immunization of infants and children. The recommended schedule includes four doses given at 2 months, 4 months, 6 months, and 12 to 15 months. If your child is over two years old and has a chronic illness (such as a lung condition or sickle-cell anemia), consult your child’s doctor to see if your child might benefit from this vaccine.

Inactivated Poliovirus Vaccine

The inactivated poliovirus vaccine (IPV) is given as protection against polio—a gastrointestinal viral infection that can affect the nervous system and cause permanent paralysis. IPV is given by injection at 2 months, 4 months, 6 to 18 months, and four to six years. The possible side effects include fever, soreness at the site of injection, and rash. However, the vaccine should not be given to people who are allergic to the antibiotics neomycin, streptomycin, or polymyxin B because these are used in the preparation of the vaccine.

Measles, Mumps, and Rubella (MMR) Vaccine

Measles, mumps, and rubella were common childhood illnesses until the development of vaccines (now usually given in combined form) effective against these viral infections:

• Measles (rubeola) causes runny nose, cough, high fever, and conjunctivitis (pinkeye). After three to four days, a rash develops on the forehead and spreads downward over the body. Complications can include ear infection, pneumonia, and encephalitis (infection of the central nervous system).

• Mumps causes swelling, pain, and tenderness of one or both parotid glands (salivary glands located between the ear and the bottom of the jaw). Pain with swallowing, mild fever, headache, and loss of appetite are other typical symptoms. Complications can include encephalitis, inflammation of the pancreas causing abdominal pain, and inflammation of the testicle that can permanently damage its ability to make sperm.

• Rubella (German measles) causes swollen lymph nodes (glands) in the neck and behind the ears, rash, and mild fever. The major health impacts of rubella are the severe effects (miscarriage, stillbirth, mental retardation, major birth defects) on the fetus if a pregnant woman becomes infected with the virus.

The MMR vaccine is given by injection in two doses: one at 12 to 15 months and the second at four to six years. It gives 90 percent of children protection against these childhood illnesses. Some children develop a rash and occasionally a slight fever about a week after vaccination; it usually goes away in a few days. Your child’s doctor may recommend delaying or not giving the MMR vaccine if your child has more than a minor illness; has a serious allergy (more than just a mild rash) to neomycin; has received gamma globulin in the past three months; has immune system problems related to cancer, leukemia, or lymphoma; or is taking steroids (such as prednisone). In the past, doctors sometimes worried about giving measles vaccine to individuals who were allergic to eggs. Experts now believe, however, that the risk of a serious allergic reaction to MMR vaccine is low in this group.

Varicella Vaccine

The varicella vaccine protects children against chicken pox—a common viral illness that almost all children came down with in the past. Varicella causes the characteristic itchy, blistering rash and fever. Complications of the infection can include secondary bacterial skin and bloodstream infections, pneumonia, and encephalitis. Prior to the introduction of the vaccine, chicken pox was a major cause of missed school for children and missed workdays for their parents. The vaccine is given between ages 12 and 18 months.

It prevents chicken pox in 70 to 90 percent of children, and if a child still does get the disease after receiving the vaccine, it’s usually a mild case. Serious reactions are rare, although a child may experience soreness, fever, fatigue, and a rash, which may occur up to a month after vaccination and will go away on its own. Immunization should be delayed if your child has more than a mild illness, has a serious allergy (more than a slight rash) to neomycin or gelatin, has received gamma globulin or a blood or plasma transfusion in the past three months, or has immune system problems.

Special-Case Vaccines

Other childhood vaccines may be recommended by your child’s doctor. Some children with asthma, cystic fibrosis, sickle-cell anemia, diabetes, or other chronic conditions may receive influenza vaccine to protect against the complications that could result if a child with one of these conditions gets the flu. Rabies vaccine may be necessary if your child is bitten by an animal that is rabid or might possibly have rabies, or if the animal’s rabies vaccination record is unknown. Dogs, skunks, raccoons, foxes, coyotes, and bats are most commonly infected. If your child is bitten by an animal, call your child’s doctor or the health department for advice about rabies vaccine. Hepatitis A vaccine is recommended for children who are traveling to or living in areas in which infection with the hepatitis A virus is common. There is a modified schedule for immunizing HIV-infected children and those who have other disorders of the immune system.