Tag: catch-up immunization schedule

How Do You Get Caught up If You Have Never Been Vaccinated?

Why would someone have never gotten any vaccines and need to catch up?

Getting caught up on your vaccines is easy.
Getting caught up on your vaccines is easy.

The usual story is that a child’s vaccines were delayed or skipped for some reason, typically over fears of anti-vaccine propaganda.

You can always get caught up though, right?

Well, not always…

Tragically, kids can get sick and catch these vaccine-preventable diseases before they have time to get vaccinated and protected. You can wait too long to get vaccinated!

How Do You Get Caught up If You Have Never Been Vaccinated?

That’s why it is important to get caught up as soon as possible.

How does that work?

The first step is figuring out which vaccines you need, considering that:

  • rotavirus vaccines are only given up to age 9-months
  • Hib and Prevnar are typically only given up to age 5-years, unless someone has specific conditions that put them at high risk for disease, although Prevnar becomes routine again at age 65-years
  • the polio vaccine is typically only given up to age 18-years
  • the meningococcal vaccines (MenACWY and MenB) are routinely given to teens and young adults through age 16 to 23-years, but older high-risk adults can also be vaccinated if necessary
  • the HPV vaccines are routinely given up to age 26-years, although they are FDA approved to be given through age 45 years
  • hepatitis A vaccines are routinely given to children and teens, but are recommended for high-risk adults, including those who travel out of the country or just want to be protected
  • hepatitis B vaccines are routinely given to children and teens, but are recommended for high-risk adults, including those who travel out of the country or just want to be protected
  • the Pneumovax (PPSV23) and shingles vaccines are given to seniors
  • if you already had a natural case of chicken pox, while you won’t need to be vaccinated, some folks might need a varicella titer to confirm that they are immune

So, depending on your age when you are starting your catch-up, there may be some vaccines that you don’t need anymore.

Still, unless you have a contraindication, you will likely at least need:

  • a yearly flu vaccine
  • 1 to 2 doses (high risk groups) of MMR
  • 2 doses of the chicken pox vaccine (Varivax)
  • 1 dose of Tdap, followed by 2 doses of Td

What’s next?

Once you have an idea of which vaccines you need, you should schedule an appointment with your health care provider and get vaccinated and protected.

A local pharmacy or health department are other places that might offer vaccines to older teens and adults.

More on Getting Caught up on Vaccines

How Long Is a Vaccine Month?

Are you ever concerned that your kids will get their vaccines too early or too late?

Vaccine intervals are typically based on weeks and "months."
Vaccine intervals are typically based on weeks and “months.” But how long is a month?

For example, if your child needs a booster dose of a vaccine in a month, just how long is that?

Does it depend on which month you are in?

For intervals of 3 months or less, you should use 28 days (4 weeks) as a “month.”

Ask the Experts on Scheduling Vaccines

In general, while we often use calendar months, because it is more convenient, you can use a minimum interval of 28 days or 4 weeks as a full month, as long as we are only counting up to three months.

So a second flu shot after a dose on January 1st could be done as early as January 29th. That’s technically one month (28 days, 4 weeks) later. And no, you wouldn’t have to repeat the second dose if you got it on February 1st, as we are typically worried about the minimum intervals or spacing and not about getting the dose a little late.

For intervals of 4 months or longer, you should consider a month a “calendar month”: the interval from one calendar date to the next a month later.

Ask the Experts on Scheduling Vaccines

And just count calendar months if you are counting more than 3 months. So if you got a vaccine on January 1 and needed another 4 months later, you would return on May 1.

Why switch to using “calendar months” for longer intervals? With longer 28 day intervals, scheduling mistakes will likely be made.

More on Spacing and Scheduling Vaccine Doses

Is Surgery a Contraindication to Getting Vaccinated?

There are some situations in which it is very important to think about vaccines before your child has surgery.

“Pneumococcal conjugate vaccine (PCV13, Prevnar 13, Pfizer), Haemophilus influenzae type b vaccine (Hib), meningococcal conjugate vaccine (MenACWY), and meningococcal B vaccine should be given 14 days before splenectomy, if possible.”

Ask the Experts about Scheduling Vaccines

A splenectomy leaves your child at extra risk for many vaccine-preventable diseases, so it is a good idea to get vaccinated and protected well in advance of a planned splenectomy, if possible.

This doesn’t mean that these vaccines won’t work after the surgery, but just that you don’t want your child to be unprotected while he remains unvaccinated.

Is Surgery a Contraindication to Getting Vaccinated?

What about other surgeries?

Some kids are put on an aspirin regimen after cardiac surgery and it should be noted that taking aspirin is a contraindication for getting FluMist, the nasal spray flu vaccine, and is considered a precaution for getting the chicken pox vaccine.

“(j)No adverse events associated with the use of aspirin or aspirin-containing products after varicella vaccination have been reported; however, the vaccine manufacturer recommends that vaccine recipients avoid using aspirin or aspirin-containing products for 6 weeks after receiving varicella vaccines because of the association between aspirin use and Reye syndrome after varicella. Vaccination with subsequent close monitoring should be considered for children who have rheumatoid arthritis or other conditions requiring therapeutic aspirin. The risk for serious complications associated with aspirin is likely to be greater in children in whom natural varicella develops than it is in children who receive the vaccine containing attenuated VZV. No association has been documented between Reye syndrome and analgesics or antipyretics that do not contain aspirin.”

Vaccine Recommendations and Guidelines of the ACIP

In most other situations, not only is surgery not considered a contraindication to getting vaccinated, but “hospitalization should be used as an opportunity to provide recommended vaccinations.”

“Most studies that have explored the effect of surgery or anesthesia on the immune system were observational, included only infants and children, and were small and indirect, in that they did not look at the immune effect on the response to vaccination specifically. They do not provide convincing evidence that recent anesthesia or surgery significantly affect response to vaccines. Current, recent, or upcoming anesthesia/surgery/hospitalization is not a contraindication to vaccination. Efforts should be made to ensure vaccine administration during the hospitalization or at discharge.”

Vaccine Recommendations and Guidelines of the ACIP

The one possible argument that makes sense to delay a vaccine in few days or weeks before a planned surgery is that if your child has a reaction to the vaccine, even if it is a mild reaction, like a fever or irritability, then it might cause them to delay the surgery.

And you could make the same argument about delaying vaccines in the days or weeks after having surgery. Could mild reactions to a vaccine be confused with complications from the surgery?

Otherwise, your anesthesiologist’s preferences aside, a recent or upcoming surgery is not a true contraindication to getting vaccinated, especially if it is a vaccine that your child is already past due for or needs because of a local outbreak, etc.

nless they are giving these kids the oral polio vaccine or plan on them sharing a room with a bone marrow transplant patient, they don't need to worry about shedding. But that's only one of the reasons that this hospital's recommendations don't follow ACIP guidelines.
Unless they are giving these kids the oral polio vaccine or plan on them sharing a room with a bone marrow transplant patient, they don’t need to worry about shedding. But that’s only one of the reasons that this hospital’s recommendations don’t follow ACIP guidelines.

What happens if you delay getting your child vaccinated because of a planned surgery and they get exposed to someone with measles or chicken pox?

Fortunately, this isn’t usually an issue unless your child is already behind on their vaccines and needs to catch up. After all, there is a lot of flexibility built into the immunization schedule, so that your child could get all of their vaccines on time, even with a planned or unexpected surgery.

More on Surgery and Vaccines

How Can I Get Vaccinated If My Parents Are Anti-Vaccine?

What do kids do when their parents are anti-vaccine?

Most teens do know what's in a vaccine and they want to get vaccinated and protected.
Most teens do know what’s in a vaccine and they want to get vaccinated and protected.

Whether or not they know it, they hide in the herd, at least until they understand what’s going on.

And then they often make a choice to either continue with their parents beliefs and remain unprotected or they get caught up.

Can Minors Consent to Getting Vaccinated?

Since getting vaccinated is a medical procedure, in most cases, you are still going to need the consent of a parent, guardian, or other adult family member if you are still a minor, which leaves out simply going out and getting caught up.

“State law is generally the controlling authority for whether parental consent is required or minors may consent for their own health care, including vaccination.”

Abigail English, JD on  the Legal Basis of Consent for Health Care and Vaccination for Adolescents

Are you still a minor?

“In most states, age 18 is the age of majority and thus, before treating a patient under the age of 18, consent must be obtained from the patient’s parent or legal guardian.”

Ann McNary, JD on Consent to Treatment of Minors

When it comes to immunizations and health care, in addition to what state you live in, that likely depends on whether or not you are an emancipated minor (court order), married minor, pregnant minor, or minor parent (situational emancipation). It also can depend on the type of health care you are seeking, like if a minor is seeking birth control or treatment for an STD.

“States Parties shall assure to the child who is capable of forming his or her own views the right to express those views freely in all matters affecting the child, the views of the child being given due weight in accordance with the age and maturity of the child.”

Convention on the Rights of the Child

Are you a mature minor? In some states, you can also give consent for medical procedures, including getting vaccinated, if you are a mature minor – someone who is old enough to understand and appreciate the consequences of a medical procedure.

In Washington, for example, minors may get immunizations without their parents consent after their health care provider evaluates the minor’s “age, intelligence, maturity, training, experience, economic independence or lack thereof, general conduct as an adult and freedom from the control of parents.”

Fourteen other states, including Alabama, Alaska, Arkansas, Delaware, Idaho, Illinois, Kansas, Louisiana, Maine, Massachusetts, Montana, Nevada, Oregon, Pennsylvania, South Carolina, Tennessee, and West Virginia have laws that allow mature minors to consent to general medical treatment either in all or a range of restricted circumstances.

How Can I Get Vaccinated If My Parents Are Anti-Vaccine?

Believe it or not, this question comes up a lot more than you can ever imagine.

If you are old enough to consent to getting vaccinated on your own, then you are all set and can start to get caught up on your immunizations.

If not, then your options are more limited, but might include:

  • talking to your parents about your concerns
  • asking someone, like your pediatrician, to be an advocate and talk to your parents with you
  • petitioning the court for emancipation ( you may get a whole lot more than the ability to get consent to get vaccinated though…)
  • waiting until you are old enough to consent to get vaccinated without your parent’s permission

While waiting is likely the easiest option, since that leaves you at risk for getting a vaccine-preventable disease, you should probably think about talking to your parents.

Why don’t they want you to get vaccinated? Do they have specific concerns about side effects? Do they have a religious objection?

Vaccines are safe and necessary. Hopefully you can help your parents understand that and they will allow you to get caught up on all of your vaccines.

More on Getting Vaccinated If Your Parents Are Anti-Vaccine

What Are the Recommended and Minimum Ages and Intervals Between Doses of Vaccines?

Most parents likely don’t think about the minimum age or minimum intervals between vaccines, as they just get their kids vaccinated according to the routine immunization schedule.

Things don’t always go according to schedule though…

Recommended and Minimum Ages for Vaccines

After their birth dose of the hepatitis B vaccine, your baby’s next vaccines are usually at two months.

Can you get them earlier?

When necessary, many vaccines can be given earlier and faster than the standard schedule.
When necessary, many vaccines can be given earlier and faster than the standard schedule.

Yes. The minimum age for the first dose of rotavirus, DTaP, IPV, Hib, Prevnar, is 6 weeks.

Some other vaccines can be given earlier than their recommended age too, including:

  • the first MMR vaccine, which can be given as early as age 6 months in certain high risk situations, like traveling out of the country or in an outbreak situation, although this dose will have to be repeated once the child is 12 months old
  • the 4th dose of DTaP, which can be given as early as age 12 to 15 months, as long as at least 4 to 6 months have passed since the third dose
  • the 2nd dose of Varivax, which may be given as early as 1 to 3 months after the first dose
  • the Tdap vaccine, which can be given as early as age 7 years, instead of the more typical 11 to 12 years
  • the HPV vaccine, which can be given as early as age 9 years, instead of the more typical 11 to 12 years

Why would you get a vaccine early?

What if you are going to be traveling just before you infant is going to be 2 months old? Or your 9 year old stepped on a rusty nail, and it had been just over 5 years since his last tetanus (DTaP) shot?

Recommended and Minimum Intervals for Vaccines

In addition to earlier ages, you can sometimes get vaccines more quickly, on an accelerated schedule.

For example:

  • the minimum interval between the 1st and 2nd dose of rotavirus, DTaP, IPV, Hib, Prevnar is 4 weeks, instead of the standard 2 months
  • the minimum interval between the 2nd and 3rd dose of rotavirus, DTaP, IPV, Hib, Prevnar is 4 weeks, instead of the standard 2 months
  • the minimum interval between the 1st and 2nd dose of HPV is either 4 weeks (3 dose schedule) or 5 months (2 dose schedule)
  • the minimum interval between the 2nd and 3rd dose of HPV is 12 weeks
  • the minimum interval between the 1st and 3rd dose of HPV is 5 months, instead of the standard 6 months

Why give these vaccines more quickly than usual?

The usual reason is that a child is a little behind and is working to get caught up.

Absolute Minimum Ages for Vaccines

It is important to remember that in some cases, there are some hard and fast rules about minimum ages. That means that if you get these vaccines any earlier, they won’t count and you will likely have to repeat them, including getting :

  • the 3rd dose of hepatitis B before 6 months (24 weeks) or sooner than 8 weeks after 2nd dose and  16 weeks after 1st dose
  • the first dose of MMR, Varivax or hepatitis A before 12 months
  • the 4th dose of Hib before 12 months
  • the 4th dose of Prevnar before 12 months
  • the 4th dose of DTaP before 12 months
  • the 5th dose of DTaP before 4 years
  • the 4th dose of IPV before 4 years

Sticking to the routine schedule helps to avoid vaccine errors, like giving a vaccine too early. In some situations, the 4 day grace period helps if a vaccine is given a little early.

More on Recommended and Minimum Ages and Intervals Between Doses of Vaccines

Catching up on 17 Years Worth of Vaccinations to Attend College

With the passage of California’s new vaccination law, it is not just kids in daycare, kindergarten, and high school who have to be up-to-date on their immunizations.

“If I chose to attend Berkeley, I would have to catch up on 17 years worth of vaccinations.”

Madeline Scott

Many California universities strengthened their immunization requirements at about the same time as SB 277 passed.

Does that really mean that an unvaccinated, incoming freshman would have to get 17 years worth of vaccinations?

How To Catch Up On Missing Immunizations

Of course not. Teens don’t really need to get 17 years worth of vaccinations to get caught up, even if they had never had a single vaccine before.

Why not?

They are too old for some vaccines, like those for rotavirus, Haemophilus influenzae type b (Hib), and Streptococcus pneumoniae (Prevnar).

And because they are starting so late, they would get fewer doses of a few vaccines, so most older teens could get fully caught up after getting just:

  • 1 dose of MCV4 (a meningococcal vaccine)
  • 2 or 3 doses of MenB (a meningococcal vaccine)
  • 2 doses of MMR
  • 2 doses of the chicken pox vaccine
  • 1 dose of Tdap, followed by 2 doses of Td (instead of the standard 5 doses of DTaP vaccine that younger children get, which is followed by a Tdap booster at age 12 years)
  • 2 doses of HepA
  • 3 doses of HepB
  • 3 doses of IPV (instead of the standard 4 doses of polio vaccine that younger children get)
  • 3 doses of HPV vaccine
  • a flu shot

How quickly could they get caught up?

Probably in about 8 months – the minimal interval between all of the Tdap/Td doses. Most of the rest of the vaccines can be given over a 6 month interval or even quicker.

Catching up on 17 Years Worth of Vaccinations to Attend College

Surprisingly, the University of California at Berkeley actually requires very few of these immunizations for new students though.

Students at Berkeley are much more likely to march for science than against it.
Students at Berkeley are much more likely to march for science than against it.

The only vaccines that are required include:

  • two doses of MMR
  • two doses of the chicken pox vaccine
  • one dose of the MCV4 meningococcal vaccine
  • one dose of Tdap

Using the combination vaccine ProQuad (MMR and chicken pox together), that could mean as few as 4 shots instead of “17 years worth of vaccinations.”

Of course, that leaves the student unprotected against a lot of vaccine-preventable diseases.

Other vaccines that are recommended, but not required, include those that can protect students against flu, hepatitis B, MenB, HPV, hepatitis A, polio, and pneumococcal bacteria (if high risk).

More On College Vaccine Requirements

Updated November 25, 2018

The Latest Vaccine Scandal in China

There is a vaccine scandal in China.

What does that mean for you and your kids?

Not much unless they were vaccinated in China. Remember, none of the vaccines used in the United States are made in China.

And our vaccines are tested for safe, pure, and potent before they are released for distribution.

The Latest Vaccine Scandal in China

Changchun Changsheng Life Sciences Ltd. is no longer making vaccines
Changchun Changsheng Life Sciences Ltd. is no longer making vaccines.

Even if your child had been vaccinated in China, there is likely nothing to be concerned about at this point.

The vaccines were not contaminated.

There is a concern that they were “substandard,” or that they might not work as well as they should.

That’s not good either though.

Getting a substandard vaccine might mean that you could get a disease that you thought you were vaccinated and protected against.

Still, since the scandal seems limited to a few companies (well, really just one company) and a few vaccines (just rabies and DTaP), it is very unlikely that many people in other countries have been affected.

“WHO assessed the national regulatory authorities in 2010 and 2014, and found that they met WHO criteria as a functional regulator for vaccines with a clear commitment to continual improvement. WHO welcomes the fact that China’s NDA continues to work with WHO’s Regulatory Systems Strengthening program, as it has been doing for nearly 20 years. While the current incident is clearly regrettable, the detection of this event by an unannounced inspection shows that the regulatory authority’s system of checks and balances to protect population health is working.”

WHO Statement on Rabies Incident in China

It is also important to realize that:

  • affected vaccines include 650,000 doses of DTaP vaccine, which were only sent to Chongqing and the provinces, of Shandong and Hebei. And while they initially passed testing for safety and efficacy before being released for distribution, later, routine testing found low titer testing in vaccines from two companies, Changchun Changsheng Life Sciences Ltd. and Wuhan Institute of Biological Products, who’s vaccines were recalled. Batch numbers have been published, so parents should be able to figure out if they got one of these vaccines.
  • problems with rabies vaccines from Changchun Changsheng Life Sciences Ltd. were discovered on a routine inspection and before the vaccine had been released for distribution. Unfortunately, the problem is that they made up production and inspection records, which is why at least 15 people from the company have been arrested. This is the scandal.

While some folks are concerned of more widespread problems, it is important to keep in mind that vaccines have been working in China. Despite these recent problems, China is polio-free and has “significantly reduced vaccine-preventable diseases such as measles, mumps, rubella, and hepatitis A and B among children.”

If there were a big problem with the effectiveness of their vaccines, they should be seeing more disease. And they aren’t.

And in places that are seeing more disease, like Europe, with their measles outbreaks and deaths, it is clearly unvaccinated folks that are getting sick.

“If you are unsure as to whether or not your child was vaccinated, the doctor can have their blood tested for antibodies to determine their immunity to certain diseases. However, these tests may not always be accurate, so the doctor may not be sure your child is truly protected. In some cases, doctors may prefer to revaccinate your child anyway for best protection. It is safe for your child to be revaccinated, even if your child received that vaccine in their birth country.”

CDC on Adoption and Vaccines

If you are still concerned about vaccines that your child may have gotten in China, either because you were living in China when your child was vaccinated or your child was adopted from China, remember that you can always have those vaccines repeated.

Titer testing is another option for most vaccines.

Until and if we get further guidance on this issue from the WHO, CDC, or AAP, neither seems to be necessary for what seems to be an isolated problem right now.

Update on the Vaccine Scandal in China

There have been a few updates since the initial news of the vaccine scandal in China, including that:

  • at least 10 officials with the State Food and Drug Administration and the State Drug Administration have been fired and 35 non-centrally-administered officials will be held accountable
  • an additional 247,200 DTaP vaccines from Changchun Changsheng Life Sciences Ltd. have been found to be substandard

And there are reports of some parents going to Hong Kong to get their kids vaccinated.

Vaccine Scandals in China

Tragically, these aren’t the first vaccine scandals in China.

  • there were reports of kids getting sick in 2016 in Shandong providence after getting vaccines that had not been stored properly
  • there were reports of kids getting sick in 2015 after getting expired vaccines in Henan province
  • in 2013, several infant deaths were blamed on hepatitis B vaccines, but they were later determined to be coincidental

And before that, in 2010, at least four children reportedly died in Shanxi province after getting what were said to be improperly stored vaccines.

While improperly stored vaccines could become contaminated, getting kids sick, it is unlikely that they would get sick from expired vaccines, which might just be less effective than newer vaccines.

What to Know About Vaccine Scandals in China

While it is horrible that anyone put profits before safety when it comes to keeping kids safe from vaccine-preventable disease, it would also be terrible to further use the China vaccine scandals to scare parents away from vaccinating and protecting their kids.

More on the Vaccine Scandals in China

Updated August 18, 2018