Immunizations

	Topic Overview
	Health Tools
	Childhood Immunizations
	Adolescent Immunizations
	Adult Immunizations
	Travel Immunizations
	Bioterrorism and Immunizations
	When to Call a Doctor
	Home Treatment
	Other Places To Get Help
	Related Information
	References
	Credits

What are immunizations?

Immunizations help protect you or your child from disease. They also help reduce the spread of disease to others and prevent epidemics. Most are given as shots. They are sometimes called vaccines, or vaccinations.

In many cases when you get a vaccine, you get a tiny amount of the organism that causes the disease. This amount is not enough to give you the actual disease. But it is enough to cause your immune system to make antibodies that can recognize and attack the organism if you are ever exposed to it.

Sometimes a vaccine does not completely prevent the disease, but it will make the disease much less serious if you do get it.

Some immunizations are given only once. Others require several doses over time.

Why should you get immunized?

• Immunizations protect you or your child from dangerous diseases.
• They help reduce the spread of disease to others.
• Getting immunized costs less than getting treated for the diseases that the shots protect you from.
• Vaccines have very few serious side effects.
• They are often needed for entrance into school or day care.

If you are a woman who is planning to get pregnant, talk to your doctor about what immunizations you have had and what you may need to protect your baby. And if you live with a pregnant woman, make sure your vaccines are up-to-date.

Traveling to other countries may be another reason to get immunized. Talk with your doctor 6 months before you leave to see if you need any shots.

What immunizations are recommended for children?

Ask your doctor what shots your child should get. Your doctor may recommend other shots too, if your child is more likely to have certain health problems.

The standard childhood immunization schedule includes vaccines for:

• Diphtheria, tetanus, and pertussis (also known as whooping cough).
• Polio.
• Measles, mumps, and rubella.
• Chickenpox.
• Rotavirus.
• Hepatitis B.
• Hepatitis A.
• Haemophilus influenzae type b disease, or Hib disease. This infection can lead to serious illness in young children, including pneumonia and meningitis.
• Pneumococcal disease. This infection can also cause pneumonia and meningitis, as well as other serious illnesses, in young children.
• Flu (Influenza). This vaccine is not given to children younger than 6 months.

Immunizations start right after birth and are given throughout a baby's first 23 months. Booster shots are usually given between the ages of 4 years and 6 years. Booster shots are the later doses of any vaccines that need to be repeated over time.

Fewer immunizations are needed after age 6. These are mostly just those given every year (such as a flu shot) or on a regular schedule during adulthood (such as a tetanus shot).

It is important to keep a good record (What is a PDF document?), including a list of any reactions to the vaccines. You may need to show proof of immunizations when you enroll your child in day care or school.

Talk to your doctor if you or your child plans to be in a group living situation, like a college dormitory or summer camp. You may want certain shots, like those for the flu or meningitis.

What vaccines are recommended for adults?

The vaccines you need as an adult depend on your gender, age, lifestyle, travel plans, overall health, and what vaccines you had as a child.

Talk to your doctor about which vaccines you need. Depending on your situation, you may need vaccines for:

• Chickenpox.
• Flu.
• Hepatitis A and/or B.
• Human papillomavirus (HPV).
• Measles, mumps, and rubella.
• Pneumococcal disease.
• Polio.
• Shingles.
• Tetanus, diphtheria, and pertussis.

What are the side effects of vaccines?

Most side effects from vaccines are minor, if they occur at all. Your doctor will explain the reactions that could occur. They may include:

• Redness, mild swelling, or soreness where the shot was given.
• A slight fever.
• Drowsiness, crankiness, and poor appetite in some babies.
• A mild rash 7 to 14 days after chickenpox or measles-mumps-rubella shots.
• Temporary joint pain after a measles-mumps-rubella shot.

Serious reactions, such as a fever over 104.5°F (40.3°C) or trouble breathing, are rare. If you or your child has an unusual reaction, call your doctor.

It is much more dangerous for a child to risk getting the diseases than it is to risk having a serious reaction to the vaccine.

Can vaccines cause other problems?

Some parents question whether mercury-containing thimerosal (used as a preservative in vaccines) might cause autism. Studies have not found a link between thimerosal-containing vaccines and autism.¹ Today, all routine childhood vaccines made for the U.S. market contain either no thimerosal or only trace amounts.²

Some people worry that the shot for measles, mumps, and rubella can cause autism in children. This is because symptoms of autism are first noticed around 1 year of age, which is about the same time children get their first shot for measles. But many studies have been done, and no link has been found between this vaccine and autism.³

Should you get immunizations to protect yourself from anthrax or smallpox?

It’s scary to think that someone might use the germs that cause diseases like anthrax and smallpox as weapons. But the U.S. government does not recommend immunizations for these diseases. And the vaccines are not available to the general public.

The Centers for Disease Control and Prevention (CDC) does recommend that certain people be immunized, such as some lab workers, health care workers, and military members.

You can find the latest information about vaccine recommendations for anthrax and smallpox at the CDC’s Web site:

• For smallpox information, go to www.bt.cdc.gov/agent/smallpox.
• For anthrax information, go to www.bt.cdc.gov/agent/anthrax/vaccination/index.asp.

Frequently Asked Questions

Health tools help you make wise health decisions or take action to improve your health.

	Decision Points focus on key medical care decisions that are important to many health problems.
	Should I get a flu shot?
	Should my daughter get the HPV vaccine?

Recommended immunizations

The U.S. Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics, and the American Academy of Family Physicians recommend a specific childhood immunization schedule each year. Immunizations are recommended because they protect against diseases (give immunity) and make a disease less severe if your child does get it. The schedule outlines the immunizations and booster shots needed from birth through age 6 and ages 7 to 18, as well as when catch-up immunizations should be given.

Some immunizations require more than one dose given at varying intervals. Although your child does not need to restart the series if a scheduled dose is missed, the immunization should be given as soon as possible. Consult your doctor or public health department if your child missed an immunization or to find out whether your child needs a specific immunization. For more information about each vaccine, see the topic Vaccine Information Statements.

The childhood immunization schedule has immunizations for:⁴

Diphtheria, tetanus, and pertussis (DTaP) (What is a PDF document?)

This shot (immunization) protects against diphtheria, tetanus, and whooping cough (pertussis).

Who should get it?

• A total of five doses are given to all children at ages 2 months, 4 months, 6 months, 15 to 18 months, and 4 to 6 years.

Polio (What is a PDF document?)

This shot protects against polio.

Who should get it?

• A total of four doses are given to all children at ages 2 months, 4 months, between 6 and 18 months, and between 4 and 6 years.

Measles, mumps, and rubella (MMR) (What is a PDF document?)

This shot protects against measles, mumps, and rubella.

Who should get it?

• All children need one dose at 12 to 15 months of age and a second dose at 4 to 6 years of age.

Research has shown no link between the MMR shot and autism.³ There is a measles, mumps, rubella, and varicella (MMRV, or ProQuad) shot that also protects against chickenpox (varicella). It can be substituted for either or both doses of MMR in children age 12 and younger.⁵

Chickenpox (varicella) (What is a PDF document?)

This shot, called Varivax, protects against chickenpox.

Who should get it?

• All children 12 months of age and older who have not had chickenpox should get one dose at 12 to 15 months and a second dose at 4 to 6 years old.
  • The second dose may be given earlier if it's been at least 3 months since the first dose.

The combination MMRV (ProQuad) shot can be given to children age 12 and younger in place of Varivax.⁵ The vaccines for chickenpox, measles, mumps, and rubella are all in this one shot. Many states require that children entering day care or school get immunized against chickenpox unless they can show proof of immunity (through blood test results or having had chickenpox).

Hepatitis B (Hep B) (What is a PDF document?)

This shot protects against hepatitis B.

Who should get it?

• All children who weigh at least 2000 g (4.4 lb) need three doses. The first dose is given right after birth, before leaving the hospital. The remaining two doses are given by about 6 months of age. Children who have not been immunized for hepatitis B and are age 18 or younger can be given the three shots separately over a period of about 6 months.

Hepatitis A (Hep A) (What is a PDF document?)

This shot protects against hepatitis A.

Who should get it?

• All children beginning at 1 year of age need two doses, given at least 6 months apart.

Haemophilus influenzae type b (Hib) (What is a PDF document?)

This shot protects against bacteria that can cause an infection in the covering of the brain (meningitis) or lungs (pneumonia), skin and bone infections, and other serious illnesses in young children. It does not protect against viral influenza (flu).

Who should get it?

• All children need three or four doses, starting at 2 months of age and ending by 15 months of age.
• Children who are older than 5 years and have certain health conditions may also need this shot.

Pneumococcal infections (What is a PDF document?)

This shot (called PCV, or Prevnar) protects against meningitis, blood infections (sepsis), ear infections, and pneumonia.

Who should get it?

• A total of four doses are given to all children at ages 2, 4, 6, and 12 to 15 months.

Rotavirus (What is a PDF document?)

This immunization (called RotaTeq) protects against rotavirus infection.

Who should get it?

• Three doses are given to all children at ages 2, 4, and 6 months.

This immunization is swallowed rather than given as a shot. Without the vaccine, most children will get infected by the time they are about 5 years old. Rotavirus infection causes severe diarrhea.

Flu (Influenza) (What is a PDF document?)

This immunization helps protect against the flu. Flu viruses are always changing, so the flu vaccines are updated every year.

Who should get it?

Flu immunization is recommended once a year for:⁶

• All children from 6 months up to 5 years of age.
  • Children younger than 9 years of age who are getting the immunization for the first time should get 2 doses. These doses should be given at least 4 weeks apart for the flu shot. (What is a PDF document?) The doses should be given 6 to 10 weeks apart for the nasal spray flu vaccine. (What is a PDF document?)
  • Children younger than 9 years old who got only one dose in their first season should get two doses in their second season. After that, one dose yearly is needed.
• Children with certain medical conditions (such as asthma, chronic heart or lung disorders, or an impaired immune system).
• Household contacts and caregivers of children from birth up to 5 years of age and of any child that is at high risk for complications of the flu.

Instead of the flu shot, people between 5 and 49 years of age usually can be immunized with the nasal spray flu vaccine. Protection lasts up to a year for both vaccine types.

Other immunizations

There is a combination vaccine for diphtheria, tetanus, pertussis, polio, and hepatitis B (DTaP/IPV/HepB). It is called Pediarix and can be given in place of some of the other separate vaccines listed above. It is given at 2, 4, and 6 months.

Your child's doctor may recommend other immunizations depending on whether your child is at higher risk than other children for certain health problems. One example is:

Meningococcal vaccine (MPSV4, or Menomune) (What is a PDF document?)

This shot protects against meningitis and blood infections (sepsis).

Who should get it?

• Some children between ages 2 and 10 who have a higher risk than other children for getting and having severe problems from meningitis need this shot.
• Children who have a damaged or missing spleen or who have certain immune system problems also need this shot.

Children age 11 and older will usually receive another form of the vaccine, the meningococcal conjugate vaccine (MCV4). This vaccine, licensed in the United States in 2005, is known as Menactra.⁷

Keeping good immunization records

It is important to keep accurate records of immunizations, including any reactions to the vaccines. You may need to show proof of immunizations when you enroll your child in day care or school.

• Know when each immunization should be scheduled and put reminder notes on your calendar. You also may want to ask your health professional to send you notices when immunizations are due.
• Make sure your health professional goes over your child's immunization record with you during each office visit.
• Keep the record in a safe place, and never throw it away. It is an important part of your child's lifelong medical records.

To print a list of recommended immunizations based on your child's birth date, go to the U.S. Centers for Disease Control and Prevention (CDC) interactive Web site at www2a.cdc.gov/nip/kidstuff/newscheduler_le.

For a form you can use to track your child's immunizations, see the childhood immunization record (What is a PDF document?).

Immunization safety

Many parents worry that immunizations are dangerous if given when their child has a cold or other minor illness. Talk to your health professional if you have concerns about the timing of immunizations. But keep in mind that immunizations can usually still be given during a mild illness, while medicines are being taken, and in other situations where a child may not be in perfect health. There are very few valid reasons for not getting your child immunized.

Some parents also fear that the measles-mumps-rubella (MMR) vaccine may cause their child to develop autism. Misleading stories about the MMR shot and autism have circulated through Web sites, the media, and word of mouth. However, scientific studies investigating these claims have found no connection between autism and the vaccine.³

Recommended immunizations

The importance of continued immunizations between ages 11 and about 21 years (adolescence) is not always recognized. Adolescents need to continue their immunization series and receive booster shots for ongoing protection (immunity) against diseases. Many adolescents were born after the current recommendations for certain immunizations, such as for hepatitis B, were established. So they did not receive all their needed shots (injections) in early childhood.

The U.S. Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics, and the American Academy of Family Physicians recommend a specific immunization schedule for children and adolescents each year.⁴ This schedule outlines the immunizations and booster shots needed during adolescence as well as when catch-up immunizations should be given.

To print a list of what shots are needed, go to the U.S. Centers for Disease Control and Prevention (CDC) interactive Web site at www2.cdc.gov/nip/adultImmSched.

Immunizations given during adolescence usually include:

Human papillomavirus (HPV), for girls (What is a PDF document?)

This shot, called Gardasil, protects against four types of HPV that together cause most cases of cervical cancer and genital warts.⁸

Who should get it?

• Girls 11 to 12 years old need three doses, given over 6 months. (The shot can be given to girls as young as 9.)
• The CDC also recommends this shot for females 13 to 26 years old who did not get it when they were younger. However, the American Cancer Society states that there is not enough evidence to recommend for or against the shot for women 19 to 26 years old.⁹

If your daughter already has HPV infection, talk with her doctor about whether to get immunized. The shot has not been shown to help existing HPV infection, but it may protect her from other HPV infections.⁸

For help deciding if the HPV vaccine is right for your daughter, see:

Should my daughter get the HPV vaccine?

Meningococcal (MCV4, or Menactra) (What is a PDF document?)

This shot protects against meningitis and blood infections (sepsis).

Who should get it?

• All adolescents should get this shot at age 11 or 12. Teens ages 13 to 18 who haven’t had the shot should get it as soon as possible.
• All college freshmen who live in dormitories and have not had this shot should get it.

If MCV4 (Menactra) is not available, the other form of the vaccine (meningococcal polysaccharide vaccine, or MPSV4) can be given.

The MPSV4 vaccine, called Menomune, is made for children ages 2 to 10.

Tetanus, diphtheria, and pertussis (Tdap) (What is a PDF document?)

This booster shot protects against tetanus, diphtheria, and whooping cough (pertussis).

Who should get it?

• All adolescents between 11 and 12 years of age need this shot.

In 2005, combination booster shots that include a pertussis vaccine became available. Before 2005, combination booster shots given after age 6 included only the vaccines for tetanus and diphtheria.

Other immunizations

Some adolescents may need or want additional immunizations. Some immunizations may be required for situations that increase a person's risk for exposure to disease, such as being in group living situations (when attending college or summer camp) or traveling to foreign countries. These immunizations may include:

Hepatitis A (Hep A) (What is a PDF document?)

This shot protects against hepatitis A.

Who should get it?

• Adolescents may need this shot if they did not get it as a child. Talk to your child's doctor if your child never got this shot.
• Some states and communities have set up routine immunization because hepatitis A occurs there more often than in other areas. Adolescents living in these areas need this shot.
• Adolescents in communities where outbreaks of hepatitis A are happening may need this shot.
• Anyone 1 year of age and older who is traveling to certain foreign countries, such as those in Central or South America, also needs this shot.

Hepatitis B (Hep B) (What is a PDF document?)

This is important if your child never got this shot.

This shot protects against hepatitis B.

Who should get it?

• Anyone 18 years of age or younger who has not had this shot should get three doses over a period of about 6 months.
• If your child hasn't had this shot before entering college, it may be needed.

Chickenpox (varicella) (What is a PDF document?)

This is important if your child never got this shot.

This shot, called Varivax, protects against chickenpox.

Who should get it?

• Adolescents and adults who are not already immune to the chickenpox virus need this shot. Anyone who gets this shot at age 13 or older should get two doses at least 4 weeks apart.

Chickenpox infection can be very serious when it occurs after childhood.

Measles, mumps, and rubella (MMR) (What is a PDF document?)

This is important if your child never got this shot.

This shot protects against measles, mumps, and rubella.

Who should get it?

• If your child did not get either or both doses, he or she should try to get it at age 11 or 12.

College students and international travelers may need written documentation that shows evidence of immunity, such as having received two doses of MMR.

Pneumococcal polysaccharide (PPV) (What is a PDF document?)

This shot protects against meningitis, pneumonia, and blood infections (sepsis).

Who should get it?

• Adolescents with certain chronic diseases, such as diabetes or heart disease, need this shot.

Inactivated influenza (flu) shot (What is a PDF document?) or nasal spray flu vaccine (FluMist) (What is a PDF document?)

This immunization helps protect against the flu. Flu viruses are always changing, so the flu vaccines are updated every year. Protection lasts up to a year for both vaccine types.

Who should get it?

• Adolescents with certain health conditions, such as asthma, chronic heart or lung disorders, or an impaired immune system, need this immunization once a year.
• Siblings or close contacts of all children younger than 5 years old and of anyone who is at high-risk for complications of the flu should be immunized each year.
• Anyone who wants to reduce the chance of becoming ill with the flu or spreading it to others should get immunized.⁶

Consult your doctor or public health department if your child missed an immunization or to find out whether your child needs a specific immunization. For more information about each vaccine, see the topic Vaccine Information Statements.

Recommended immunizations

Your need for immunizations does not end when you reach adulthood. The specific shots (injections) you need as an adult are determined by factors such as your age, lifestyle, type and locations of travel, overall health, and previous immunizations. Tetanus and diphtheria immunizations need to be repeated (booster shots) every 10 years throughout adulthood in order to maintain immunity. The U.S. Advisory Committee on Immunization Practices (ACIP), the American College of Obstetrics and Gynecologists, and the American Academy of Family Physicians recommend a specific immunization schedule each year for:

• General adult population .¹⁰
• Adults with medical conditions (including pregnancy) .¹⁰

Your doctor will consider your medical and immunization history (and documentation) when deciding which shots you need.

To print a list of what shots you may need, go to the U.S. Centers for Disease Control and Prevention interactive Web site at www2.cdc.gov/nip/adultImmSched.

Immunizations given during adulthood may include:

Chickenpox (varicella) (What is a PDF document?)

This shot, called Varivax, protects against chickenpox. Chickenpox infection can be very serious when it occurs after childhood.

Who should get it?

• Adults who are not already immune to the chickenpox virus need two doses, given at least 4 weeks apart.
• Women who don't have evidence of immunity and recently gave birth should get this shot.

Pregnant women and people with immune system problems should not get this shot.

Hepatitis A (Hep A) (What is a PDF document?)

This shot protects against hepatitis A.

Who should get it?

• Adults who will be traveling to certain foreign countries, such as those in Central or South America, need two doses.
• Adults who have certain risk factors, such as long-term (chronic) liver disease, also need this shot.

Hepatitis B (Hep B) (What is a PDF document?)

This shot protects against hepatitis B.

Who should get it?

• Adults who have not received the vaccine series for hepatitis B need this shot when occupation, travel, health condition, or lifestyle increases their risk of exposure.

Three doses are needed over at least 4 months.

A hepatitis combination vaccine (Twinrix) is recommended for those who are at risk for both hepatitis A and hepatitis B. This vaccine is approved in the United States only for those 18 years of age or older.

Inactivated influenza (flu) shot (What is a PDF document?) or nasal spray flu vaccine (FluMist) (What is a PDF document?)

This immunization helps protect against the flu. Flu viruses are always changing, so the flu vaccines are updated every year. Protection lasts up to a year for both vaccine types.

Who should get it?

• Women who are or will be pregnant during the flu season, adults 50 years of age and older, and those with a chronic health condition, such as asthma, chronic heart or lung disorders, or an impaired immune system (which puts them at high risk for complications of the flu) need this immunization.
• Household contacts and caregivers of all children younger than 5 years old and close contacts of others who are at high risk for complications of the flu also need this immunization each year.
• Residents of nursing homes and other chronic-care facilities need this immunization each year.
• Anyone who wants to reduce the chance of becoming ill with the flu or spreading it to others should get immunized.⁶

Except for pregnant women, people between the ages of 5 and 49 can get either the shot or the nasal spray form of the vaccine.

For help deciding if the flu shot is right for you, see:

Should I get a flu shot?

Measles, mumps, and rubella (MMR) (What is a PDF document?)

This shot protects against measles, mumps, and rubella.

Who should get it?

• Adults born during or after 1957 may need two doses if they do not have evidence of immunity.

Women should avoid becoming pregnant for 28 days after getting the MMR shot. Women who are known or suspected to be pregnant and people who have impaired immune systems should not get this shot.¹¹

Pneumococcal polysaccharide (PPV) (What is a PDF document?)

This shot protects against meningitis, pneumonia, and blood infections (sepsis).

Who should get it?

• All people 65 years of age and older need this shot.
• People ages 2 to 64 who have a chronic disease (such as heart or lung disease), do not have a spleen, or have a damaged spleen also need this shot.

This shot is different from the pneumococcal conjugate (PCV) shot that is recommended for children. Most adults only need one dose of PPV for protection. Some people might need to get a booster shot after 5 years.

Polio (IPV) (What is a PDF document?)

This shot protects against polio.

Who should get it?

• Adults whose travel puts them at increased risk for exposure to polio need this shot.

Routine polio immunization is not recommended for adults (age 18 and older) who live in the United States.

Shingles (herpes zoster) (What is a PDF document?)

This shot, called Zostavax, protects against shingles.

Who should get it?

• Adults 60 years of age and older need one dose.

Zostavax is not a substitute for the chickenpox shot (Varivax). Zostavax has not been studied in people who have already had shingles. It’s not known if the shot will prevent shingles from occurring again. The U.S. Food and Drug Administration (FDA) does not recommend this shot for people who have already had shingles.

Tetanus, diphtheria, and pertussis (Tdap) (What is a PDF document?) and Tetanus and diphtheria (Td) (What is a PDF document?)

The Tdap shot protects against tetanus, diphtheria, and whooping cough (pertussis). The Td shot does not protect against pertussis.

Who should get it?

• All adults need Td booster shots every 10 years throughout life.
• All adults 19 to 64 years of age should have one shot of Tdap in place of a Td shot.

Tdap is usually only given if it has been at least 10 years since a person's last Td booster. The CDC recommends getting Tdap 2 years or less from the last dose of Td for:

• People with greater risk for pertussis.
• Child care providers and other adults having close contact with infants less than 12 months old. (Women would ideally get this dose before pregnancy.)
• Health care workers with direct patient contact.

The more immunizations you get in a short time frame, the more likely you are to react with arm swelling and redness at the site of the shot. But it may be worth a mild reaction to protect a young infant who is at risk for pertussis.

Other immunizations

Some adults may need or want additional immunizations for situations that increase a person's chance for exposure to disease. These immunizations may include:

Meningococcal (MCV4 or MPSV4, depending on your age) (What is a PDF document?)

This shot protects against meningitis and blood infections (sepsis).

Who should get it?

• Anyone 2 years of age and older needs this shot if he or she:
  • Has a greater chance of becoming infected during an outbreak of bacterial meningitis.
  • Has a damaged spleen or has had the spleen removed.
  • Travels to or lives in areas of the world where meningitis is common, such as to certain parts of Africa or to Saudi Arabia during the Hajj.
  • Lives in a college dorm.

The meningococcal conjugate (MCV4) vaccine, called Menactra, is given to people 11 to 55 years of age who need this immunization. Children ages 2 to 10 and adults older than age 55 are immunized with the meningococcal polysaccharide (MPSV4) vaccine, called Menomune.

Human papillomavirus (HPV), for women (What is a PDF document?)

This shot, called Gardasil, protects against four types of HPV that together cause most cases of cervical cancer and genital warts.⁸

Who should get it?

• The CDC recommends this shot for females 13 to 26 years old who did not get it when they were younger. (Three doses are given over 6 months.) However, the American Cancer Society states that there is not enough evidence to recommend for or against the shot for women 19 to 26 years old.⁹

If you already have HPV infection, talk with your doctor about whether to get immunized. The shot has not been shown to help existing HPV infection, but it may protect you from other HPV infections.⁸

Consult your doctor or public health department if you missed an immunization or to find out whether you need a specific immunization. For more information about each vaccine, see the topic Vaccine Information Statements.

Immunizations and pregnancy

Before you become pregnant, it is best to discuss your immunization history with your health professional. If you need the chickenpox or measles, mumps, and rubella (MMR) shots, wait at least 4 weeks after the immunization before becoming pregnant.

The Centers for Disease Control and Prevention (CDC) recommends the inactivated influenza vaccine (flu shot) for all women who are or who plan to be pregnant during the flu season. Pregnant women should not receive the nasal spray flu vaccine.¹¹ Pregnant women who are due for their tetanus booster can get immunized with Td vaccine. The CDC recommends that women who have not previously had Tdap should get a dose of Tdap before or right after their baby is born. This is to protect the newborn baby from whooping cough (pertussis). In some cases, Tdap may be given during pregnancy.

If you are pregnant, your children should still get their immunizations on schedule. You do not need to speed up or delay your child's immunizations.

Immunizations and new health threats

In 2007, the FDA approved the first vaccine for humans against bird flu (avian influenza). Immunization is not currently recommended for the public. The vaccine will be kept in the U.S. government stockpile.¹²

Recommended immunizations

Talk with your health professional months in advance of a trip to determine whether any immunizations are recommended. Certain factors, such as your age and health, where you are going, and the length of your stay, affect your risk of disease and need for immunization.

Your age and health

People with certain medical conditions, such as immune system problems, may have different immunization recommendations than healthy people. In addition, young children who are traveling may need to receive their routine immunizations sooner than normally scheduled.

Where you travel

In most developed countries (including Canada, Australia, New Zealand, Japan, and western and northern European countries), the risk of exposure to serious diseases is generally no greater than it is in the United States.

The risk for exposure to serious disease may be much higher in developing countries (such as those in most parts of Africa and Asia and many parts of South and Central America) than it is in most developed countries. This is especially true for areas with poor sanitation (for example, poor water and food handling).

• If you are going to travel to South America and Africa, your doctor may suggest that you get the yellow fever vaccine. (What is a PDF document?)
• Travelers to developing countries should take precautions to prevent hepatitis A infection, which may include getting immunizations. Additional immunizations, such as typhoid vaccine (What is a PDF document?), may be recommended. The need for these shots depends on your immunization history, the specific area you plan to visit, the time of year, and whether any outbreaks of disease have recently occurred.

How you travel and types of activities

Certain activities or modes of travel increase your risk of exposure to disease. These include:¹³

• Exploring rural areas or those off the usual tourist route.
• Backpacking trips.
• Visiting another country.

Length of stay

The longer you stay in a country, the more exposure you have to local pathogens that could cause harm.

Other immunizations

You can get information about travel immunizations by:

• Contacting your local health department or doctor.
• Visiting the Web site of the Centers for Disease Control and Prevention (CDC) at www.cdc.gov/travel.

For more information on immunizations and health related to travel, see the topic Travel Health.

The United States government has developed plans on how to respond to possible bioterrorism threats.

A 2007 law called the Pandemic and All-Hazards Preparedness Act ("Bioshield II") will help companies make more vaccines and drugs that protect against bioterror agents.¹⁴ This law also makes it clear that the U.S. Department of Health and Human Services, not the Department of Homeland Security, is the lead agency for public health responses to emergency events.

Certain diseases have been identified that pose the greatest threat to the U.S. public. At this time, there is a supply of anthrax and smallpox vaccines only. These immunizations are not currently available to or recommended for the general public. But the government has advised immunization for people at high risk of exposure to anthrax or smallpox, such as health care workers specifically designated to respond to a bioterrorism emergency. Some of these recommendations are listed below.

Anthrax vaccine (What is a PDF document?)

This shot protects against anthrax.

Who should get it?

• This shot is for people at high risk of exposure, such as certain lab workers, people who work with imported animals where preventive standards are lacking (such as veterinarians who travel to work in other countries), and certain military members.

Six shots are given over 18 months. And booster shots are needed each year thereafter for continued protection (immunity).

Smallpox vaccine (What is a PDF document?)

This shot protects against smallpox.

Who should get it?

• This shot is for certain health care and public health workers, infection-control specialists, and certain military members.

This shot is given once as several quick punctures on the upper arm, using a special prong device. Immunity after a first-time immunization is likely to be 3 to 5 years. If you have been immunized in the past, successful revaccination may extend your immunity for 10 to 20 years or more.¹⁵

The United States has enough smallpox vaccine to vaccinate Americans in an emergency.¹⁶

More information about these immunization recommendations can be found on the Centers for Disease Control and Prevention (CDC) Web site at www.bt.cdc.gov/bioterrorism. For general information about bioterrorism issues, see the topic Terrorism and Other Public Health Threats.

Call 911 or other emergency services if you or your child has a severe reaction to any immunization as indicated by:

• A major allergic reaction, such as a severe asthma episode, severe problems breathing or swallowing, or hives.
• Significant changes in alertness within 7 days of getting immunized.
• A seizure.
• Collapsing.

Call your doctor immediately if:

• Your child has signs of a severe reaction within 2 to 3 days after an immunization. For example, call your doctor if your child cries for more than 3 hours and cannot be consoled or has a fever of 104.5°F (40.3°C) or higher. For more information about a fever, see the topics:
  • Fever, Age 3 and Younger.
  • Fever, Age 4 and Older.
• You or your child has any unusual reaction after receiving an immunization.

Call your doctor if:

• Redness and swelling at the site of the shot (injection) persists for more than 48 hours after being immunized.
• A fever lasts for more than 48 hours after receiving a shot.

Talk with your doctor about whether you need special immunizations because of:

• Close contact with people who have an infectious disease.
• Planned international travel, especially to developing countries.

Help your child handle immunizations

Many immunizations are given as shots (injections). Your child may experience brief pain as the needle penetrates the skin or muscle, and some vaccines cause more discomfort than others. In general, you can help decrease your child's discomfort by making sure he or she is physically comfortable and well rested before getting immunized. You can use home treatment measures to help relieve some of the common minor reactions to immunizations.

Relieve mild reactions to immunizations

You can help relieve some of the common, temporary, mild reactions to immunizations with basic home care.

• Fever. A child may develop a slight fever after getting immunized. Give your child acetaminophen (such as Tylenol) or ibuprofen (such as Advil) to help lower a fever, especially at a temperature of 102°F (38.89°C) or higher. Talk to your doctor before giving ibuprofen to a baby 3 months of age or younger. You can give acetaminophen to your baby who is 3 months of age or younger, but use caution. Check with your doctor first if you are not sure your young baby's fever is related to getting immunizations. Do not give aspirin to anyone younger than age 20 because of the risk of Reye's syndrome. For more information on fevers, see the topic Fever, Age 3 and Younger or Fever, Age 4 and Older.
• Swelling or redness. The area around the injection site may become red and swollen. Apply a wrapped ice pack or cool compress to the area for about 10 to 20 minutes. If this does not reduce the symptoms, give your child a dose of acetaminophen or ibuprofen to help relieve the discomfort.
• Fretfulness and poor appetite. For a few hours after getting immunized, a baby may be fretful and drowsy and may refuse to eat. Plan quiet activities at home for the evening after your child receives an immunization. Hold and cuddle your child when needed. Keep your home at a comfortable temperature, because your child is more likely to be fretful if he or she gets too warm.
• Skin rash. A mild skin rash may arise 7 to 14 days after your child gets the chickenpox or measles, mumps, and rubella (MMR) shot. These types of rashes can last several days and go away without treatment.

Call 911 or other emergency services if your child has a severe reaction to immunizations, which is indicated by:

• A major allergic reaction, such as a severe asthma episode, severe problems breathing or swallowing, or hives.
• Significant changes in alertness within 7 days of getting immunized.
• A seizure.
• Collapsing.

For more information about reactions to immunizations, see the When to Call a Doctor section of this topic.

Online Resources

Organizations

• Anthrax
• Avian Influenza (Bird Flu)
• Cervical Cancer
• Chickenpox (Varicella)
• Fever, Age 3 and Younger
• Fever, Age 4 and Older
• Genital Warts (Human Papillomavirus)
• Hepatitis A
• Hepatitis B
• Home Medical Records
• Influenza
• Measles (Rubeola)
• Meningitis
• Mumps
• Pneumonia
• Rotavirus
• Rubella (German Measles)
• Shingles
• Smallpox
• Tetanus
• Travel Health
• Tuberculosis (TB)
• Vaccine Information Statements
• Whooping Cough (Pertussis)

Citations

1. Parker SK, et al. (2004). Thimerosal-containing vaccines and autistic spectrum disorder: A critical review of published original data. Pediatrics 114(3): 793–804.

2. U.S. Food and Drug Administration (2006). Thimerosal content in some currently manufactured U.S. licensed vaccines. Available online: http://www.fda.gov/cber/vaccine/thimerosal.htm#t3.

3. Demicheli V, et al. (2007). Vaccines for measles, mumps and rubella in children. Cochrane Database of Systematic Reviews (1). Oxford: Update Software.

4. Centers for Disease Control and Prevention (2007). Recommended immunization schedules for persons aged 0–18 years—United States, 2007. MMWR, 55(51 and 52): Q1–Q4. Also available online: http://www.cdc.gov/mmwr/pdf/wk/mm5551-Immunization.pdf. [Erratum in MMWR, 56(02): 32. Also available online: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5602a6.htm?s_cid=mm5602a6_e.]

5. Centers for Disease Control and Prevention (2005). Notice to readers: Licensure of a combined live attenuated measles, mumps, rubella, and varicella vaccine. MMWR, 54(47): 1212–1214. Also available online: http://www.cdc.gov/mmwr/PDF/wk/mm5447.pdf. [Erratum in MMWR, 54(48): 1237. Also available online: http://www.cdc.gov/mmwr/pdf/wk/mm5448.pdf.]

6. Centers for Disease Control and Prevention (2007). Prevention and control of influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR, 56(RR-6): 1–60. Also available online: http://www.cdc.gov/mmwr/PDF/rr/rr5606.pdf.

7. Centers for Disease Control and Prevention (2005). Prevention and control of meningococcal disease: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR, 54(RR-7): 1–21.

8. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (2007). Quadrivalent human papillomavirus vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR, 56(RR–2): 1–24. Also available online: http://www.cdc.gov/mmwr/PDF/rr/rr5602.pdf.

9. Saslow D, et al. (2007). American Cancer Society guideline for human papillomavirus (HPV) vaccine use to prevent cervical cancer and its precursors. CA: A Cancer Journal for Clinicians, 57(1): 7–28.

10. Centers for Disease Control and Prevention (2006). Recommended adult immunization schedule—United States, October 2006–September 2007. MMWR, 55(40): Q1–Q4.

11. Centers for Disease Control and Prevention (1998, updated 2007). Guidelines for Vaccinating Pregnant Women From Recommendations of the Advisory Committee on Immunization Practices (ACIP). Available online: http://www.cdc.gov/vaccines/pubs/preg-guide.htm.

12. U.S. Food and Drug Administration (2007). FDA approves first U.S. vaccine for humans against the avian influenza virus H5N1. FDA News. Available online: http://www.fda.gov/bbs/topics/NEWS/2007/NEW01611.html.

13. Ryan ET, Kain KC (2000). Health advice and immunizations for travelers. New England Journal of Medicine, 342(23): 1716–1725.

14. Mitka M (2007). Bioterror vaccine production: Take 2. JAMA, 297(6): 575–576.

15. Breman JG, Henderson DA (2002). Diagnosis and management of smallpox. New England Journal of Medicine, 346(17): 1300–1308.

16. Centers for Disease Control and Prevention (2006). Smallpox fact sheet: Vaccine overview. Available online: http://www.bt.cdc.gov/agent/smallpox/vaccination/facts.asp.

Other Works Consulted

• American Academy of Family Physicians, American Academy of Pediatrics, Advisory Committee on Immunization Practices, and U.S. Public Health Service (2000). Joint Statement Concerning Removal of Thimerosal From Vaccines. Available online: http://www.cdc.gov/od/science/iso/concerns/thimerosal.htm.

• American Academy of Pediatrics (2007). Hepatitis A vaccine recommendations. Pediatrics, 120(1): 189–199. Also available online: http://aappolicy.aappublications.org/cgi/reprint/pediatrics;120/1/189.pdf.

• Atkinson W, et al., eds. (2007). Epidemiology and Prevention of Vaccine-Preventable Diseases, 10th ed. (The Pink Book). Washington, DC: Public Health Foundation. Also available online: http://www.cdc.gov/vaccines/pubs/pinkbook/default.htm. [Errata and updates available online: http://www.cdc.gov/vaccines/pubs/pinkbook/pink-errata.htm.]

• Centers for Disease Control and Prevention (1998). Measles, mumps, and rubella — vaccine use and strategies for elimination of measles, rubella, and congenital rubella syndrome and control of mumps: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR, 47(RR-8): 1–59. Also available online: http://www.cdc.gov/mmwr/PDF/rr/rr4708.pdf.

• Centers for Disease Control and Prevention (2005). A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States. MMWR, 54(RR-16): 1–23. Also available online: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5416a1.htm.

• Centers for Disease Control and Prevention (2006). Preventing tetanus, diphtheria, and pertussis among adolescents: Use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR, 55(RR-3): 1–44. Also available online: http://www.cdc.gov/mmwr/PDF/RR/RR5503.pdf.

• Centers for Disease Control and Prevention (2006). Preventing tetanus, diphtheria, and pertussis among adults: Use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP) and Recommendation of ACIP, supported by the Healthcare Infection Control Practices Advisory Committee, for Use of Tdap Among Health-Care Personnel. MMWR, 55(RR-17): 1–37. Also available online: http://www.cdc.gov/mmwr/PDF/rr/rr5517.pdf.

• Centers for Disease Control and Prevention (2006). Shingles vaccine: What you need to know. Vaccine Information Statement. Department of Health and Human Services, National Immunization Program (9/11/06). Available online: http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-shingles.pdf.

• Centers for Disease Control and Prevention (2007). Prevention of varicella: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR, 56(RR-4): 1–48. Also available online: http://www.cdc.gov/mmwr/PDF/rr/rr5604.pdf.

• Centers for Disease Control and Prevention (2007). Revised recommendations of the Advisory Committee on Immunization Practices to vaccinate all persons aged 11-18 years with meningococcal conjugate vaccine. MMWR, 56(31): 794–795. Also available online: http://www.cdc.gov/mmwr/PDF/wk/mm5631.pdf.

• Committee on Infectious Disease, American Academy of Pediatrics (1999). Prevention of poliomyelitis: Recommendations for use of only inactivated poliovirus vaccine for routine immunization. Pediatrics, 104(6): 1404–1406.

• Committee on Infectious Diseases, American Academy of Pediatrics (2000). Policy statement: Recommendations for the prevention of pneumococcal infections, including the use of pneumococcal conjugate vaccine (Prevnar), pneumococcal polysaccharide vaccine, and antibiotic prophylaxis. Pediatrics, 106(2): 362–366.

• Dear KB G, et al. (2006). Vaccines for preventing pneumococcal infection in adults. Cochrane Database of Systematic Reviews (1). Oxford: Update Software.

• Pneumococcal vaccine (Prevnar) for otitis media (2003). Medical Letter on Drugs and Therapeutics, 45 (W1153B): 27–28.

• Reis EC, et al. (1998). Taking the sting out of shots: Control of vaccination-associated pain and adverse reactions. Pediatric Annals, 27(6): 375–386.

• U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (2006). General recommendations on immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR, 55(RR-15): 1–48. Also available online: http://www.cdc.gov/mmwr/PDF/rr/rr5515.pdf. [Erratum in MMWR, 56(11): 256. Also available online: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5611a6.htm?s_cid=mm5611a6_e.]

• Weller PF (2005). Health advice for international travelers. In DC Dale, DD Federman, eds., ACP Medicine, Clinical Essentials, chap. 7. New York: WebMD.