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Vaccines Overview

Baby getting shot

By the time a baby is 2 years old, she may have had more than 20 vaccine injections. After a few more shots as a preteen, your child will be protected from 16 major diseases. Here's what you need to know about the process.

How vaccines work

When we get a virus, we produce antibodies to fight it and give us immunity from another attack. Vaccines do the same thing, but the antibodies are made from weakened or killed viruses (or bacteria) that stimulate the antibody formation without the illness. Once an entire population is immunized, a disease could be virtually wiped out. (After the polio vaccine was developed in the 1950s, the death and paralyzation rates fell to zero in the U.S. and most of the developed world.)

But it's not a foolproof plan. In 2003, 33 children and six adult caregivers in New York got whooping cough; by February of 2004, another 34 cases were reported. Health officials traced the outbreak's origin to four children in two families whose parents chose not to have them vaccinated.

During an outbreak, even a child who has been inoculated can get sick because in about 5 percent of cases, a vaccine doesn't fully "take." The best protection for all kids, then, is universal immunization whenever possible.

Age-by-age vaccine schedule

Birth: HepB
HepB protects against hepatitis B, a viral illness passed from mother to newborn. Most hospitals give it before discharge, often within hours of birth. In rare circumstances, it can be delayed, but only with a physician's order and a copy of the mother's lab report showing that she's not a carrier. An exception: Preemies under 4.4 pounds should wait until the one-month checkup, unless the mother is a HepB carrier (they should get all their other vaccines on schedule at their actual age, not their gestational age).

1 month: HepB
If your baby got the HepB vaccine (see above for what Hep B protects against) at birth, he'll now get a booster shot; if not, he'll get his first one. In any case, he must get his first shot by 2 months and the second one by 4 months.

2 months: DTaP, Hib, IPV, PCV, RotaTeq
DTaP protects against three bacterial diseases: diphtheria; tetanus, which causes lockjaw; and pertussis (whooping cough). Hib protects against Haemophilus influenzae type b, a cause of bacterial meningitis and pneumonia.
IPV protects against polio, a viral illness that causes paralysis and can be fatal.
PCV protects against pneumococcal bacterial infections, which can cause deafness, pneumonia, and meningitis.
RotaTeq protects against rotavirus, a viral disease that causes severe diarrhea.
Your child can get one vaccine  -- Pediarix  -- in place of HepB, DTaP, and IPV, but there is a higher risk of a mild fever. Pediarix is given at 2, 4, and 6 months.

4 months: Boosters for DTaP, Hib, IPV, PCV, RotaTeq
(See above for explanations of the diseases these vaccines protect against.)

6 months: Boosters for HepB, IPV, and RotaTeq, and often for DTaP, Hib, and PCV
(See above for explanations of the diseases these vaccines protect against.)
Annual flu shots, available in October, aren't mandatory but are recommended for kids 6 months to 5 years old. Ask for a thimerosol-free children's vaccine (regular ones still contain the mercury preservative). Skip the shot entirely if your child is allergic to eggs, which is what's used to make flu vaccines.

12 months: Boosters for Hib and PCV (any time up to 15 months); varicella, MMR (both up to 15 months), and HepA.
(See above for explanations of the diseases that the Hib and PCV vaccines protect against.)
Varicella protects against chicken pox.
MMR protects against three viral illnesses: measles, which can cause pneumonia; mumps, which can lead to deafness; and rubella, a.k.a. German measles, which is especially dangerous if a pregnant woman is exposed to it because it can cause miscarriage or birth defects.
HepA protects against hepatitis A, a viral illness spread by hand-to-mouth contact that affects the liver and can cause jaundice, severe stomach pain, and diarrhea.
You can ask for the ProQuad vaccine, which combines MMR with varicella, so there's one less shot.

15 months: Booster for DTaP (up to 18 months)
(See above for an explanation of the diseases that the DTaP vaccine protects against.)

18 months: Possible boosters for HepB, DTaP, IPV; booster for HepA
(See above for explanations of the diseases these vaccines protect against.)
If your child hasn't had her HepB, DTaP, or IPV boosters yet, she'll get them now. After a booster of HepA, your baby is home free until kindergarten.

4-6 years: Boosters for DTaP and IPV (even if your child got Pediarix), MMR (even if your child got ProQuad), and varicella
(See above for explanations of the diseases these vaccines protect against.)

11-12 years: MCV4, Tdap; girls will be offered a three-dose series of HPV
MCV4 protects against meningitis, a rare infection that can be fatal.
Tdap is the booster for adolescents (and adults) against diphtheria; tetanus, which causes lockjaw; and pertussis (whooping cough).
HPV protects against human papilloma-virus later in life, a sexually transmitted disease and the main cause of cervical cancer.
Note: The Centers for Disease Control and Prevention updates vaccine recommendations based on new data. For the most recent information on recommended vaccines, go to the CDC's website

Who shouldn't be vaccinated

* Children with moderate or severe illness  -- a high fever, vomiting  -- should wait until they're well before getting shots. If it's just a cold, cough, mild fever, or even mild diarrhea, though, go ahead and get the immunizations.

* Kids who've ever had a severe reaction  -- hives, low blood pressure, difficulty breathing, or shock  -- to a shot should not be given that particular vaccine again. But stay on schedule with other shots.

* Children with a weakened immune system due to cancer or AIDS should not be given MMR or varicella, which are made from live viruses. Talk to your doctor.

* Any child on long-term, high-dose steroids should not receive the live vaccines. But they're fine if your child takes inhaled steroids or uses oral steroids on a short-term basis.

"I nurse my babies right after their shots while we're still in the doctor's office. It comforts them every time."
 -- Ann Dominick, Homewood, AL

* Children allergic to gelatin or to the antibiotics neomycin, polymixin B, and streptomycin should receive alternative vaccines. Talk to your doctor.

The vaccine debate

The odds of your child becoming ill from not being vaccinated are much higher than the odds of her having a serious reaction to a shot. Over the years, concerns have been raised linking vaccines to SIDS, autism, and other problems, but no links have been substantiated. The details:

Autism: Until 1999, several vaccines contained tiny amounts of the mercury derivative thimerosol as a preservative. Some researchers hypothesize that thimerosol may contribute to autism rates by damaging the developing brain, and, as part of a campaign to reduce all mercury exposure, vaccine makers voluntarily stopped using it. (It's still in some flu vaccines, but thimerosol-free versions are available.) Since then, repeated studies have failed to find a link between the preservative and any form of neurological damage, including autism.

SIDS: The suspicion that there's a link between sudden infant death syndrome (SIDS) and the hepatitis B vaccine has never been proven. In fact, SIDS rates have actually plummeted since the vaccine was first recommended for newborns in 1991 (though experts argue that may have more to do with babies being put on their backs to sleep).

Allergic reactions: Most vaccines produce no side effects, or very minor ones, like soreness at the injection site or a low-grade fever. But some do contain ingredients that kids could be allergic to, such as gelatin. Still, the risks are very small. The MMR vaccine, for example, has been linked to one death per 2 million doses.

How to take the ouch out of shots

An appropriate dose of acetaminophen or ibuprofen about an hour before the appointment can help lessen the pain. But there are effective ways to soothe your child without medication:

Blow soap bubbles. Your child's eyes will follow them instead of the syringe. Even better: Let her blow them herself (kids can do it as early as age 3). She'll have to breathe deeply to do so, which automatically relaxes the body.

Work your magic. Simple stuff like "Peekaboo!"; "Which hand has the red ball?"; and "Look how I can stretch my thumb!" can be great distractors.

Sing or read together. Humming along to a favorite tune or soothing lullaby can go a long way toward taking her mind off the shot. Or read a book with interesting pictures  -- preferably something upbeat that never fails to garner giggles.


Making sure your child is up to date on vaccines is one of the most important things you can do to keep her healthy. Shots aren't the most fun part of a checkup, but with the right distractions and soothers your child will get through them just fine.

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