Pediatrician Answers Common Questions About Vaccines

From the recommended immunization schedule for children 18 and younger, to booster shots, to what to do if you miss a shot, Dr. Misty Woodard, M.D., has some answers.

Parents often have questions about vaccines for their children. We often assume that vaccinations are only given to infants and toddlers, but there are schedules for shots that go through adolescence. We asked Dr. Misty Woodard, M.D., a pediatrician at Warren Clinic Tulsa Hills, to answer some common questions about vaccines and boosters.

Q: What is the current recommended immunization schedule for children aged 18 and younger?

Dr. Woodard: According guidelines established by the Centers for Disease Control and Prevention (CDC), newborns are scheduled to receive their first Hepatitis B vaccine at birth.  Infants then receive routine immunizations at 2, 4, and 6 months of age.  These include DTaP (diphtheria, tetanus, and pertussis), Haemophilus influenzae B (HiB), which is a bacteria that can cause meningitis in infants and toddlers, Polio, Pneumococcal vaccine (PCV13), which is a bacteria that can cause pneumonia and some ear infections in children, the remaining Hepatitis B series, and an oral vaccine again rotavirus, which can cause severe vomiting and diarrhea in infants and young children.  Physicians are frequently able to combine several of these vaccines to reduce the number of shots given at each visit.

Recommendations say at 6 months, the first influenza vaccine can be administered between the months of October and April. An infant’s very first flu vaccine does require a booster one month later, but then is only once yearly for future seasons.

Starting at 12 months, children can receive MMR (measles, mumps, and rubella), varicella (chickenpox), and their first Hepatitis A immunizations.  They may also receive the remainder of their HiB and PCV13 immunizations, as well as the next DTaP booster.  Your physician may choose to delay some until the 15 month visit, but as long as a minimum amount of time has passed between the 6 month and 12 month shots, this isn’t mandatory and is at the parents’ discretion.

Children receive the last Hepatitis A vaccine at 18 months or at 2 years, depending on when they received their initial vaccination.

At the 4- or 5-year visit, children receive their final doses of MMR, varicella, and Polio, along with the next shot in their DTaP series. These can also frequently be combined.

At the 11-year visit, children receive the Tdap, which is the adult version of DTaP, and will continue with booster tetanus shots every 10 years for the rest of their lives. They may also receive the meningococcal vaccine as well as the HPV (human papilloma virus) vaccine, commonly called Gardasil. The HPV vaccine, if obtained at this age, requires a booster in six months.  The meningococcal vaccine requires a booster at age 16 years, and is required by some colleges.  This vaccinates against several variants of bacteria that cause meningitis. There is a new vaccine that covers for an additional meningococcal variant, but is not yet widely available and can be obtained through the health department by parents who desire this for their teenagers.

These are routine immunization guidelines for healthy children under the age of 18 years. Parents of children with special health considerations, such as sickle cell disease, prematurity, or certain cancers, should speak with their child’s physician about special immunization requirements for them.

Q: Is there anything new that parents or caregivers need to know?

Dr. Woodard: There is a new vaccine that covers for an additional meningococcal variant, but is not yet widely available and can be obtained through the health department by parents who desire this for their teenagers.

The intranasal flu vaccine has been removed from the market due to poor efficacy, so for now, a flu shot is the only way to protect your child against the flu.

Q: Is the HPV vaccine recommended for both boys and girls? Why? How many shots are involved in this vaccine?

Dr. Woodard: It is recommended for all children, boys and girls, starting at age 9 years, though the first dose is routinely given at the 11-year visit. They may receive the vaccine until the age of 26 years.

Certain strains of HPV (human papilloma virus) have been shown to cause genital warts and cervical cancer in women, and genital warts and oral cancers in both men and women. The vaccine covers nine of the most severe strains. HPV is one of the most common STDs in the U.S. today, and it is presumed that any currently or previously sexually active adult has been exposed to HPV at some point. HPV can continue to exist in your system for several years before causing problems. Therefore, we recommend vaccinating children before they are sexually active and thus exposed.

If the HPV series is started prior to age 15, the series includes two doses separated by at least six months. If a child receives his or her first dose after age 15, it is a three-dose series, with the second dose follow-up two months later, and the final one given six months after the first dose.

Q: What should you do if you miss a shot on this schedule?

Dr. Woodard: First, don’t panic. Talk to your doctor or healthcare professional. There are specialized catch-up schedules designed to catch children up on missed vaccines as soon as possible. It’s important to remember that your child does not need to restart the series if he or she misses a dose.

Q: Some parents talk about spacing out immunizations. Is there any advantage or disadvantage to spreading out the timing of immunizations?

Dr. Woodard: Immunization schedules have been put through rigorous testing to determine the most effective times to vaccinate children, weighing the risks of giving several vaccines at once against the benefits of early protection. What researchers have found is that there is little risk associated with following the current immunization schedule and giving multiple vaccinations at once.

The immunization schedule is set up to minimize the amount of time an infant or a child loses optimal immunity to certain diseases. Therefore, the risk with “spacing” immunizations is that there will be increased periods of time when an infant or a child could become dangerously sick from the diseases you’re wanting to protect them against.  The only advantage that comes with “spacing” vaccines is that it will make parents a little less nervous, but this isn’t ideal for the child’s health.

Q: Have you seen an upsurge in any childhood diseases that are preventable through immunizations? If yes, what accounts for the upsurge?

Dr. Woodard: There has been a significant increase in deadly diseases, such as measles and pertussis (whooping cough), as well as ones that are viewed as not being as serious but in fact can be life-threatening, such as Hepatitis A and chickenpox. The upsurge has many causes, such as waning immunity in adults, but the primary driving force has been linked directly to children who are unimmunized or under immunized (those who do not complete the schedules or who are on delayed schedules).

Q: Is there any reason that a child or an adult should not get a recommended immunization?

Dr. Woodard: There are several special health considerations that may require delaying or avoiding certain vaccines. If you have previously had a severe allergic reaction to any vaccine, in general you should not receive that vaccine again. If you are immunocompromised, on immune suppressants, or pregnant, you should not receive live vaccines such as MMR or varicella, or these may be delayed until you are able to receive them.

The vast majority of people, however, should be safely able to receive their vaccines on time.  Foremost, if you are concerned that your health condition may prevent you from receiving a vaccine, or if you have had any reactions to vaccines in the past, speak to your healthcare professional. They can determine the appropriate immunizations for you.

Q: What are booster shots and who needs them?

Dr. Woodard: Booster shots are additional doses of the same immunization. They are designed to “boost” your immunity. The immune system is sometimes imperfect and can “forget” certain diseases it has not been exposed to in a while. The booster shot reminds your immune system not to “forget” those diseases and maintains your immunity for longer. Anyone who has not had a severe reaction to previous vaccines or special health conditions should receive all recommended boosters per the immunization schedule.

Q: Do you recommend the Meningococcal immunization for teens? Why or why not?

Dr. Woodard: Meningococcal disease frequently leads to a severe bacterial meningitis that is highly contagious and life-threatening. It spreads rapidly in places where a large number of people are in close proximity, and thus high school students as well as college students living in dorms are at high risk of contracting the disease if exposed. Therefore, we recommend routine immunization of all teenagers and young adults against meningococcal disease. There are two kinds of meningococcal vaccine on the market: one that covers for four types and another that covers an additional type (serogroup B).  The 4-serogroup vaccine is widely available, but the serogroup-B vaccine may be harder to find. Both are recommended where available. If you would like for your teenager to have both vaccines, ask your healthcare provider if the serogroup-B vaccine is available through their office, or you may also go to your local health department.

Q: What immunizations are recommended for adults?

Dr. Woodard: All adults are recommended to have a tetanus booster every 10 years.  This can either be in the form of Tdap (if not given previously), or as a Tetanus-diphtheria booster alone (Td). You may require this vaccine sooner than 10 years if you suffer an injury or have surgery. Everyone should have at least one Tdap in their lifetime, especially if you’ll be around infants. If you have had the Tdap previously, it is not necessary to have it again unless you are pregnant.

The zoster (shingles) vaccine is recommended for all adults age 60 years and older. The pneumococcal vaccine (PPSV23) is recommended for all adults aged 65 years and older.  Both can be given at younger ages depending on certain risk factors.

The varicella (chicken pox) vaccine is recommended for anyone with no documented history of previous vaccination and no evidence of previous infection (usually a blood test).

And of course, the flu shot is recommended yearly for everyone.

Q: What other information should parents/caregivers know about immunizations for their children and for themselves?

Dr. Woodard: If parents have questions about vaccines, always ask. Healthcare professionals overwhelmingly recommend routine immunizations, and we follow the schedules for our own families. We want to keep you and your child just as safe and healthy as we would keep our own. Therefore, if parents have any reservations about vaccines, your child’s healthcare provider will be happy to discuss those concerns.