Category: Immunization Schedules

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.

For More Information on Catch-Up Immunization Schedules

Vaccines in Special Situations

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Children with a cochlear implant need the Pneumovax 23 vaccine.

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

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 – MenHibrix or Menveo (infants), 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 – MenHibrix or Menveo (infants), 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?

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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.

For more information:

Immunization Schedules

Each year, since 1995, the Advisory Committee on Immunization Practices (ACIP) of the CDC has reviewed the recommended immunization schedule, and it has then been approved by ACIP, the American Academy of Pediatrics, the American Academy of Family Physicians, and the American College of Obstetricians and Gynecologists.

Before 1995, in 1994, 1989, and 1983, an immunization was simply published as part of the ACIP’s general recommendations.

Looking for an alternative to the ACIP immunization schedule?

According to the American Academy of Pediatrics:

No alternative vaccine schedules have been evaluated and found to provide better safety or efficacy than the recommended schedule, supported by the Advisory Committee on Immunization Practices of the CDC and the Committee on Infectious Diseases of the AAP (the committee that produces the Red Book).

Pediatricians who routinely recommend limiting the numbers of vaccines administered at a single visit such that vaccines are administered late are providing care that deviates from the standard evidence-based schedule recommended by these bodies.

Again, there are no alternative immunization schedules.

For more information:

Vaccines for Adults

Adults need to get vaccines, just like kids. Of course, they don’t get as many vaccines as kids, since many adults are either already immune or are no longer at risk to many vaccine-preventable diseases.

Adults do get:

They can also get most other vaccines, except Rotavirus and DTaP (they get Tdap instead), that they need because they lack immunity. Although it is not on the immunization schedule, adults can get the polio vaccine if necessary.

Another question that comes up concerning adult vaccines is why so adults and children get the same vaccines. In other words, are vaccines calibrated taking into account a child’s weight and age?

Donald Trump often says that he is against vaccines because we give “one massive dose for a child,” going on to say that they should get smaller dosages in a more spread out schedule. Some others agree, claiming that infants shouldn’t get the same dose of vaccine as an adult.

But do they?

Not always. There are pediatric versions of the influenza, hepatitis A, hepatitis B, and DTaP (vs Tdap) vaccines.

It doesn’t necessarily matter though. Unlike medications you take, like Tylenol or an antibiotic, vaccines don’t go through your whole body to work, so your size doesn’t matter.

For more information on why this isn’t a real issue:

Vaccines in Pregnancy

Can children get vaccinated when their mother is pregnant?

Yes.

The CDC states that “pregnancy of recipient’s mother or other close or household contact” is not a contraindication to getting vaccinated, even for live vaccines like MMR or Varivax.

What about pregnant women? Are vaccines safe or necessary for them?

While they shouldn’t get live vaccines, like MMR, Varivax, Flumist, or the yellow fever vaccine, or the HPV vaccine, it is safe and necessary for pregnant women to get most other vaccines.

In fact, all pregnant women should get:

Getting vaccinated during pregnancy helps protect newborn babies and infants against the flu and pertussis (whooping cough).

For more information:

Vaccines for Premature Babies

Do premature babies get different vaccines or vaccines on a different immunization schedule than full term babies?

Not usually. Being a preemie is not a contraindication to getting vaccinated.

Vaccines work and are safe for preemies. They should not usually be delayed.

In fact, the CDC states that:

In the majority of cases, infants born prematurely, regardless of birth weight, should be vaccinated at the same chronological age and according to the same schedule and precautions as full-term infants and children.

The only exception is for the hepatitis B vaccine, which may not work as well in premature infants with low birth weight. They should still get it if their mother is has hepatitis B, but it will need to repeated when they are one month of age.

If the premature baby’s mother is HBsAg-negative, and they weigh less than 2000g (4.4 pounds), then they can wait to be get their first hepatitis B vaccine when they are one month old or when they are discharged from the hospital.

So except for the hepatitis B vaccine in low birth weight infants, premature babies should be vaccinated according to the same immunization schedule that we use for other children.

For more information: