Category: Immunization Schedules

Which Vaccines Do You Get When You Join the Military?

The oral adenovirus vaccine is approved to prevent adenovirus infections in military populations.

Believe it or not, many vaccines are available that we don’t routinely get.

Some we only get if we travel, like vaccines for yellow fever and typhoid. Others we only get in high risk situations, like if you get exposed to a bat with rabies.

And one, the adenovirus vaccine, you can only get if you join the military.

Which Vaccines Do You Get When You Join the Military?

But don’t folks get a lot of vaccines when they join the military?

It depends…

Whether you join the Army, Navy, Air Force, Marine Corps, or Coast Guard, health personnel will evaluate your immunity status by checking your titers to routine vaccine-preventable diseases. So no, if you were wondering, it doesn’t seem like they just check the vaccine records that you might bring from your pediatrician.

And then once they assess your immunization or immunity status, you will get vaccinated:

  • upon accession – adenovirus, influenza, meningococcal, MMR, Tdap, and chicken pox
  • during the first or second half of collective training – hep A, hep B, and polio (if needed) and other vaccines based on risk

So, in addition to getting caught up on all routine vaccines that they might be missing, there are other “military vaccines” that they might need, including:

  • Adenovirus vaccine – given to enlisted soldiers during basic training
  • Anthrax vaccine – only military personnel with extra risk, although some civilians can get this vaccine too
  • Smallpox vaccine – only military personnel who are high risk and smallpox epidemic response team members, although some civilians can get this vaccine too
Which vaccines you get in the military might be determined by where you are getting deployed to.
Which vaccines you get in the military will likely be determined by where you get deployed.

Like the recommendations for civilians, other vaccines are mainly given to military personal if they have extra risk based on where they are being deployed.

  • Cholera – only military personnel with extra risk based on deployment or travel to endemic areas
  • Japanese encephalitis – only military personnel with extra risk based on deployment or travel to endemic area in Eastern Asia and certain western Pacific Islands
  • Rabies vaccine – pre-exposure vaccination is only for military personnel with animal control duties or with extra risk based on deployment, including special operations personnel
  • Typhoid vaccine – only military personnel with extra risk based on deployment or travel to typhoid-endemic areas and other areas with poor sanitation.
  • Yellow fever vaccine – only military personnel with extra risk based on deployment or travel to yellow-fever-endemic areas in sub-Saharan Africa and tropical South America.

These are the same vaccines that we would get if we traveled to high risk areas.

 

Military Vaccines in Development

It shouldn’t be a surprise that the military does research on infectious diseases and vaccines.

Members of the military are often put at great risk for known and emerging diseases, like Ebola, Zika, and malaria.

That’s why some vaccines might have been given as an investigational new drug in special situations, typically when “individuals who have a high occupational risk – laboratory workers, facilities inspectors, vaccine manufacturers and certain military response teams.”

These vaccines, which were initially developed at US Army labs, are no longer being produced, but have included:

  • Argentine hemorrhagic fever (Junin virus) vaccine
  • Chikungunya fever vaccine
  • Eastern equine encephalitis vaccine
  • Q fever vaccine
  • Rift Valley fever vaccine
  • Tularemia vaccine
  • Venezuelan equine encephalitis vaccine
  • Western equine encephalitis vaccine

Today, the Walter Reed Army Institute of Research (WRAIR) “is a leader in global efforts against the world’s most pervasive and high impact infectious diseases.”

WRAIR is working on vaccines for HIV, Ebola, MERS, and Zika.

What to Know About Military Vaccines

You will need some extra vaccines when you enlist in the military, but how many will depend on if you are up-to-date when you join and your area of responsibility. So there is no one-size-fits-all military immunization schedule.

More on Military Vaccines

 

Vaccines for Kids with Asplenia

Asplenia means lack of a spleen or a spleen that doesn’t work.

Although the spleen is an important organ that helps your body fight infections, in addition to other functions, it is certainly possible to live without a spleen.

Asplenia

There are many reasons a child might have asplenia, including:

  • congenital asplenia (children born without a spleen), sometimes associated with severe cyanotic congenital heart disease, such as transposition of the great arteries
  • surgical removal (splenectomy) secondary to trauma or anatomic defects
  • surgical removal to prevent complications of other conditions, such as ITP, hereditary spherocytosis, pyruvate kinase deficiency, Gaucher disease, and hypersplenism, etc.

And some children simply have a spleen that doesn’t work (functional asplenia) or doesn’t work very well because of sickle-cell disease and some other conditions.

Vaccines for Children with Asplenia

Because the spleen has such an important function in helping fight infections, without a spleen, a child is at increased risk for infections.

Specifically, there is a risk for severe infections from the Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis bacteria.

Fortunately, there are vaccines that protect against many subtypes of these bacteria, including:

  • Hib – protects against Haemophilus influenzae type B
  • Meningococcal conjugate vaccines – Menactra or Menveo, which protect against 4 common types of the Neisseria meningitidis bacteria – serogroups ACWY
  • Serogroup B Meningococcal vaccines – Bexsero or Trunemba, which protect against Neisseria meningitidis serogroup B
  • Prevnar 13 – protects against 13 subtypes of Streptococcus pneumoniae
  • Pneumovax 23 – protects against 23 subtypes of Streptococcus pneumoniae

Although Prevnar, Hib, and the meningococcal vaccines (Menactra or Menveo and Bexsero or Trunemba) are part of the routine immunization schedule, there are additional recommendations that can change the timing for when kids get them if they have asplenia.

Some kids need extra protection from vaccines.
Some kids need extra protection from vaccines. Photo by Janko Ferlic.

According to the latest recommendations, in addition to all of the  other routine immunizations that they should get according to schedule, children with asplenia should get:

  • one dose of the Hib vaccine if they are older than age 5 years “who are asplenic or who are scheduled for an elective splenectomy” and have not already vaccinated against Hib. Unvaccinated younger kids should get caught up as soon as possible. In general though, Hib is given according to the standard immunization schedule. This recommendation is about kids who are behind on the shot.
  • two doses of a meningococcal conjugate vaccine, either Menactra or Menveo, two months apart once a child with asplenia is at least two years old and a booster dose every five years. Infants with asplenia can instead get a primary series of Menveo at 2, 4, 6, and 12 months, with a first booster dose after three years, and a second booster after another five years. Older infants can get Menactra at 9 and 12 months, again, with a first booster dose after three years, and a second booster after another five years. While these vaccines are recommended for all kids, those with asplenia get them much earlier than the standard age.
  • either a two dose series of Bexsero or a three dose series of Trunemba, once they are at least 10 years old. The Men B vaccines are only formally recommended for high risk kids, others can get it if they want to be protected.
  • between one to four doses of Prevnar, depending on how old they are when they start and complete the series. Keep in mind that unlike healthy children who do not routinely get Prevnar after they are 5 years old, older children with asplenia can get a single dose of Prevnar up to age 65 years if they have never had it before. Like Hib, this recommendation is about kids who are behind on the shot.
  • a dose of Pneumovax 23 once they are at least two years old, with a repeat dose five years later and a maximum of two total doses. Kids who are not high risk typically don’t get this vaccine.

Ideally, children would get these vaccines at least two to three weeks before they were going to get a planned splenectomy. Of course, that isn’t always possible in the case of the emergency removal of a child’s spleen, in which case they should get the vaccines as soon as they can.

More About Asplenia

In addition to these vaccines, preventative antibiotics are typically given once a child’s spleen is removed or is no longer working well. Although there are no definitive guidelines for all children who have had a splenectomy, many experts recommend daily antibiotics (usually penicillin or amoxicillin) until a child is at least 5 years old and for at least 1 year after their splenectomy.

Other less common bacteria that can be a risk for children with asplenia can include Escherichia coli, Staphylococcus aureus, Salmonella species, Klebsiella species, and Pseudomonas aeruginosa. Vaccines aren’t yet available for these bacteria, so you might take other precautions, such as avoiding pet reptiles, which can put kids at risk for Salmonella infections.

Children with asplenia are at increased risk for severe malaria and babesiosis (a tickborne illness) infections. That makes it important to take malaria preventative medications and avoid mosquitoes if traveling to places that have high rates of malaria and to do daily tick checks when camping, etc.

A medical alert type bracelet, indicating that your child has had his spleen removed, can be a good idea in case he ends up in the emergency room with a fever and doctors don’t know his medical history.

Keep in mind that since there are many different causes of asplenia, the specific treatment plan for your child may be a little different than that described here. Talk to your pediatrician and any pediatric specialists that your child sees.

What to Know about Vaccines for Children with Asplenia

Children with asplenia typically need extra vaccines and protection against pneumococcal disease, Hib, and meningococcal disease.

More about Vaccines for Children with Asplenia

Do Your Kids Need a Mumps Booster Shot?

Traditionally, kids get vaccines to protect them against mumps when they are 12 to 15 months old (1st dose of MMR) and again before starting kindergarten (2nd dose of MMR).

Do Your Kids Need a Mumps Booster Shot?

Routine use of the mumps vaccine, which was first licensed in 1967, has helped to greatly reduce the incidence of mumps cases from pre-vaccine era levels.

Outbreaks of mumps the last few years have led to calls for a third dose of MMR in some situations though.

mumps-booster
During an outbreak, universities make sure students are up-to-date with their MMR vaccines.

Does that mean that your kids will need a third dose of the MMR vaccine?

Probably not.

“Persons previously vaccinated with 2 doses of a mumps virus–containing vaccine who are identified by public health authorities as being part of a group or population at increased risk for acquiring mumps because of an outbreak should receive a third dose of a mumps virus–containing vaccine to improve protection against mumps disease and related complications.”

Recommendation of the Advisory Committee on Immunization Practices for Use of a Third Dose of Mumps Virus–Containing Vaccine in Persons at Increased Risk for Mumps During an Outbreak

Is there a mumps outbreak in your area?

While that is the main reason to get a third dose of MMR, simply being near an outbreak still doesn’t mean an extra vaccine is necessary.

“In the setting of an identified mumps outbreak, public health authorities should define target groups at increased risk for mumps during the outbreak, determine whether vaccination of at-risk persons is indicated, and provide recommendations for vaccination to health care providers.”

Recommendation of the Advisory Committee on Immunization Practices for Use of a Third Dose of Mumps Virus–Containing Vaccine in Persons at Increased Risk for Mumps During an Outbreak

Your local or state health department will decide which folks need a third dose of MMR in an outbreak situation.

“Persons at increased risk for acquiring mumps are those who are more likely to have prolonged or intense exposure to droplets or saliva from a person infected with mumps, such as through close contact or sharing of drinks or utensils.”

Recommendation of the Advisory Committee on Immunization Practices for Use of a Third Dose of Mumps Virus–Containing Vaccine in Persons at Increased Risk for Mumps During an Outbreak

Why not just give everyone a third dose of MMR?

The issue with the mumps vaccine is waning immunity, so it isn’t known how long an extra dose would last, and that’s why at this time, the only recommendation is to give an extra dose during outbreaks.

If you are still unsure about needing a third dose of MMR, ask your pediatrician, school health clinic, or local health department, especially if you have heard about local mumps cases.

What to Know About the Mumps Booster Shot

A third dose of MMR is recommended for some people at high risk to get mumps in an outbreak situation.

More on the Mumps Booster Shot

Immunization Schedules from Other Countries

The latest immunization schedule from the CDC and AAP.
The latest immunization schedule from the CDC and AAP.

Why does the United States give so many more vaccines than other countries?

The easy answer might be that we want to protect kids from more vaccine-preventable diseases. Of course, it is much more complicated than that.

But why does it matter?

It still matters because Jenny McCarthy has pushed the idea that we have an ‘autism epidemic‘ in the United States because “other countries give their kids one-third as many shots as we do.”

And some folks still believe her.

They also believe anti-vaccine myths and misinformation linking giving more vaccines to having higher infant mortality rates.

Immunization Schedules from Other Countries

Which vaccines a country routinely gives often depends on the risk a diseases poses to the people that live there. For example, some countries routinely give the BCG and Japanese encephalitis vaccines, but only give the hepatitis B vaccine in high risk situations.

And while many folks still push the myth that the United States gives many more vaccines than other developed countries, you just have to look at their immunization schedules to see that it isn’t true.

Remember that in the United States, children typically get:

  • 36 doses of 10 vaccines before starting kindergarten that protect them against 14 vaccine-preventable diseases
  • at least three or four more vaccines as a preteen and teen, including a Tdap booster and vaccines to protect against HPV and meningococcal disease, plus they continue to get a yearly flu vaccine

So by age 18, that equals about 57 dosages of 14 different vaccines to protect them against 16 different vaccine-preventable diseases. While that sounds like a lot, keep in mind that 33% of those immunizations are just from your child’s yearly flu vaccine.

Immunization Schedules from Europe

How do immunization schedules from European countries differ from the United States?

Austria's immunization schedule for 2017 includes all of the same vaccines as the US schedule.
Austria’s immunization schedule for 2017 includes all of the same vaccines as the US schedule, plus the vaccine for Japanese encephalitis (if high risk).

Surprisingly, they don’t differ by that much, despite what you may have heard or read.

And in many European countries, even if you don’t get more vaccines overall, you do get more dosages at an earlier age, often with two dosages of MMR and the chicken pox vaccine by the time your child is 15 to 24 months old.

The latest immunization schedule from Germany.
The latest immunization schedule from Germany.

Some vaccines, like hepatitis A and chicken pox aren’t routine in every European country, like Iceland and Sweden, but many countries give vaccines that we don’t, like BCG and MenC. And even Iceland and Sweden have recently added the HPV vaccine to their schedule and Sweden may soon add the rotavirus vaccine too.

Immunization Schedules from Other Countries

Many countries, in addition to those in Europe, have vaccine schedules that are very similar to the one that is used in the United States.

The 2017 Immunization Schedule for South Korea includes all of the US vaccines, plus BCG and Japanese encephalitis vaccines.
The 2017 Immunization Schedule for South Korea includes all of the US vaccines, plus BCG and   Japanese encephalitis vaccines.

Just look at the immunization schedules for Australia, Canada, Israel, South Korea, or Taiwan, etc.

What about Japan? They must give fewer vaccines than we do in the United States, right? After all, aren’t they the country that banned the use of the HPV vaccine?

Although that myth is still pushed by many anti-vaccine websites, the HPV vaccine is not banned in Japan. It was removed as a vaccine that is actively recommended in 2013, but it still available and is still on the Japanese immunization schedule.

The 2016 routine and voluntary immunization schedule in Japan.
The 2016 routine and voluntary immunization schedule in Japan.

All of our other vaccines are also on the Japanese immunization schedule. In addition, they give infants the BCG and Japanese encephalitis vaccines.

What to Know About Immunization Schedules from Other Countries

Many countries use a similar immunization schedule and give the same types of vaccines as we do in the United States.

More On Immunization Schedules from Other Countries

Catch-Up Immunization Schedules

It is surprisingly easy to get behind on your child’s immunizations, even if you are trying to stay on schedule.

How do you miss a shot?

Your child could have been sick when they were supposed to get their vaccines, your pediatrician might have been out of one or more vaccines, or you might have simply missed one of your child’s well checkups.

Catching Up On Vaccines

A catch-up immunization schedule
A catch-up vaccination schedule program can help you figure out when to get the vaccines your child has missed.

If your child gets behind and misses one or more vaccines, be sure to get caught up as soon as possible.

If your child needs to get caught up quickly, like to start daycare or school, to travel out of the country, or because of a disease outbreak in your area, you can even use an accelerated immunization schedule, using minimum intervals between doses.

Depending on your child’s age, you might even be able to skip a few doses or vaccines.

For example, with rotavirus vaccines, vaccination should not be started if an infant is already 15 weeks old and the final dose must be given by 8 months of age.

And if your child gets their first dose of Hib after they are 15 months old, they don’t need any more doses. And they wouldn’t need any doses at all if they are already 5 years old.

Prevnar, IPV, and DTaP might also need to given on an alternative schedule when given on a catch-up schedule.

Specifically, your child might be able to skip:

  • the fifth dose of the DTaP vaccine, if the fourth dose was given at age 4 years or older.
  • the fourth dose of the IPV vaccine, if the third dose was given at age 4 years or older.
  • one or more doses of Prevnar, depending on when the other doses were given

Is this a good way to get out of getting some doses or vaccines?

Of course not. In addition to missing out on those vaccines, your child is missing out on the protection from those vaccines.

“Combination vaccines can be used for children who have fallen behind. Combination vaccines may be used when any of the components are indicated and none are contraindicated. The minimum interval between doses is the greatest interval between any of the individual antigens.”

Immunization Action Coalition on Combination Vaccines

Using combination vaccines, like Pediarix, Pentacel, Kinrix, Quadracel, and ProQuad, etc., can make getting caught up easier too.

For More Information on Catch-Up Immunization Schedules

Vaccines in Special Situations

In addition to getting routine vaccines, there are some special situations in which kids need extra vaccines or extra dosages of vaccines.

800px-infant_with_cochlear_implant
Children with a cochlear implant need the Pneumovax 23 vaccine.

Traveling out of the country and being pregnant are almost certainly the most common special situation when it comes to vaccines.

Vaccines for High Risk Conditions

Other special situations include children with high risk conditions, such as:

  • complement component deficiencies – Menveo or Menactra, MenB
  • chronic heart disease – PPSV23
  • chronic lung disease (not including asthma) – PPSV23
  • diabetes mellitus – PPSV23
  • CSF leaks – PPSV23
  • cochlear implants – PPSV23
  • chronic liver disease – PPSV23
  • cigarette smoking – PPSV23
  • sickle cell disease – PPSV23
  • congenital or acquired asplenia – Menveo or Menactra, PPSV23, MenB
  • congenital or acquired immunodeficiencies – PPSV23
  • HIV infection – PPSV23
  • chronic renal failure – PPSV23
  • nephrotic syndrome – PPSV23
  • leukemia – PPSV23
  • lymphoma – PPSV23
  • hodgkin disease – PPSV23
  • iatrogenic immunosuppression – PPSV23
  • solid organ transplant – PPSV23
  • multiple myeloma – PPSV23

In general,  the 23-valent pneumococcal polysaccharide vaccine, PPSV23 or Pneumovax 23, should be given when a high risk child is at least 2 years old and at least 4 weeks after their last dose of Prevnar 13. Some will need an additional booster dose of Pneumovax 23 after five years.

Remember, most children routinely get 4 doses of Prevnar 13 when they are 2, 4, 6, and 12-15 months old.

And while most kids just get one dose of PPSV23, others, especially those with any type of immunosuppression, get a repeat dose every five years.

Getting Revaccinated

Are there ever situations when kids need to get revaccinated?

While it might be hard to believe, there are more than a few reasons that kids get revaccinated.

The most obvious is when kids lose their vaccine records, although checking vaccine titers might help avoid repeating some or all of your child’s vaccines.

Children who have had a hematopoietic cell transplant (HCT) should routinely get revaccinated:

  • starting with inactivated vaccines six months after the transplant, including a 3-dose regiment of Prevnar 13, followed by PPSV23, a 3-dose regiment of Hib, and a yearly flu shot and other inactivated vaccines
  • continuing with a dose of MMR 24 months after the transplant if they are immunocompetent and possibly the chicken pox vaccine

Children who are adopted in a foreign country also often need to repeat all or most of their vaccines. Again, titers can often be done to avoid repeating doses.

Other Special Situations

Other special situations in which your child might need to get vaccinated off the standard immunization schedule might include:

  • missing one or more vaccines and needing to catch-up
  • getting exposed to rabies (cats, dogs, raccoons, skunks, bats, foxes, and coyotes)
  • having a wound that is not considered clean and minor (usually “wounds contaminated with dirt, feces, soil, and saliva; puncture wounds; avulsions; and wounds resulting from missiles, crushing, burns, and frostbite”) if it has been more than five years since their last dose of tetanus vaccine (or a clean and minor wound and it has been more than 10 years)
  • getting exposed to chicken pox (or shingles) or measles and not being fully vaccinated (two doses of the chicken pox and two doses of the MMR vaccines) or naturally immune, as a vaccine within 72 hours may decrease their risk of getting sick

Do your kids have a medical condition that might put them at high risk for a vaccine-preventable disease?

Do they need a vaccine that other kids don’t routinely get?

For More Information on Vaccines in Special Situations

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Translating Foreign Language Immunization Schedules

It can be hard to enough to read an immunization schedule if you don’t have a medical degree, what with all of the acronyms and all.

DTaP, MMR, and lot numbers, etc.

But what if the immunization schedule is in a foreign language?

foreign-language-immunization-schedules
A Chinese to English immunization record to help make translating records easier.

How much luck will you have reading it then?

Fortunately, there is help for English speakers who get an immunization schedule in Spanish, French, Chinese, or Arabic, etc. And you don’t need your own translator.

Check out the resources below.

More on Translating Foreign Immunization Records:

Updated September 13, 2017