Vaccine Schedule: Schedule Considerations for Specific Groups

  • Adoptees

    For children who have received vaccines outside of the United States, you should be aware that doses are often missed and records may or may not be accurate, even when written. Therefore, your child's doctor might suggest beginning all immunizations again or testing for immunity if a blood test is available. Even if your child received some vaccines before arriving in the U.S., repeat doses are not dangerous.

    The American Academy of Pediatrics offers a helpful brochure, A Healthy Beginning: Important Information for Parents of Internationally Adopted Children.

    The Immunization Action Coalition provides a list of multiple resources for families who have or are considering international adoption.

    Families of adoptees

    Adopting a child is an exciting time for a family; however, amid all of the preparations, one aspect of preparation should not be overlooked.

    Prospective parents should talk with their healthcare provider before it is time to get the child because anyone traveling to pick up the child is likely to need certain vaccines, and some family members at home may also need vaccines, such as the hepatitis A vaccine.

    Watch as one family prepares to bring home their adopted children.

  • Adults

    Some adults incorrectly assume that the vaccines they received as children will protect them for the rest of their lives. Generally this is true, except that:

    • Some adults were never vaccinated as children.
    • Scientific discoveries are always being made, bringing vaccines into our lives that were not around during our childhood.
    • The immunity provided by some of the vaccines received in childhood begins to fade over time.
    • Adults become more susceptible to serious diseases caused by common infections as they age (for example, influenza and pneumococcus).

    Vaccines all adults need

    Additional vaccines needed

    Some adults are at higher risk of contracting vaccine-preventable diseases or suffering complications due to their short- or long-term health status (examples include pregnancy, cancer treatment, lack of a spleen, asthma), type of employment (working in healthcare or childcare) or activities (smoking, international travel). This list is not an exhaustive list, so you should talk with your healthcare provider about whether there are vaccines that you need.

    Vaccines and Adults: A Lifetime of Health is a 46-page booklet developed by the Vaccine Education Center that can help you and other adults in your life stay informed of your vaccine needs. Download a copy today:

  • Breastfeeding

    Baby

    Infants who are being breastfed may receive all 14 vaccines routinely recommended for infants. Antibodies in breast milk do not interfere with any of the currently recommended vaccines.

    Sometimes parents wonder whether they can forego immunizations for their baby because the baby is being breastfed; however, this is not the best decision because antibodies in human breast milk bathe the intestinal surface but are not absorbed. Therefore, breast milk antibodies never enter the bloodstream where they would be needed to protect against certain diseases. Examples of these types of diseases include diphtheria, tetanus, pertussis, measles, mumps, rubella, varicella (chickenpox), pneumococcusHaemophilus influenzae type b, polio, hepatitis A and hepatitis B.

    Mom

    Women who are breastfeeding can receive any vaccines they need during this time. Although some live viral vaccines may replicate and cause viruses to be excreted in breast milk, the viruses are weakened sufficiently that they will not harm the baby.

    In most cases, women are recommended to have received the live viral vaccines (specifically, MMR and chickenpox) prior to becoming pregnant because the diseases they prevent may be harmful to a developing fetus if the woman is infected during pregnancy.

  • Childcare workers

    Anyone who works with children, especially in childcare centers, is at high risk of coming into contact with a number of bacteria or viruses. Therefore, childcare workers should be up to date on vaccines including measles-mumps-rubella (MMR), tetanus-diphtheria (Td) or tetanus-diphtheria-pertussis (Tdap), varicella, influenza and hepatitis B. Because infants are at increased risk of suffering complications and death from pertussis infections (whooping cough), adults and teens who will be around them, including childcare providers, should have a single dose of the Tdap vaccine.

    Young children in childcare centers are commonly infected with hepatitis A virus. Whereas young children infected with hepatitis A virus often do not develop any symptoms of infection, the same cannot be said for adults who get infected. Childcare workers who have not previously had the hepatitis A vaccine may be recommended to get the vaccine or treatment if hepatitis A cases are diagnosed in their center. Hepatitis A virus can occasionally cause severe and rarely fatal infection of the liver.

  • Healthcare workers

    People who work in hospitals are at higher risk of catching certain infections than those who don't work in hospitals. Specifically, hospital workers are at high risk of catching influenza and hepatitis B infections. Therefore, in addition to the vaccines recommended for all adults (measles-mumps-rubella (MMR) vaccine, influenza, tetanus-diphtheria (Td) or tetanus-diphtheria-pertussis (Tdap) vaccine, and varicella vaccine), all healthcare workers are recommended to have the hepatitis B vaccine.

    In addition, healthcare workers who are ill can unintentionally infect their patients, including those who are at risk of suffering severe complications and death because of weakened immunity. Therefore, medical institutions might require their employees to be immunized. In the case of the annual influenza vaccine, these practices have generated debate about the individual rights of the employee versus the safety of patients.

    Read more about this issue in an article about the ethics of mandating influenza vaccine for healthcare workers.

  • Pregnant women

    Important vaccines during pregnancy

    • Influenza. Women who will be pregnant during the influenza season should receive the inactivated flu vaccine (flu shot). Pregnant women are at increased risk for influenza-related complications that require hospitalization.
    • Hepatitis B. Because many people do not know that they are infected with hepatitis B virus, and because an infant can get the disease at birth from an infected mother, your obstetrician will perform a blood test to determine whether you are infected with hepatitis B. If you are, your baby will be given a vaccine and an antibody preparation shortly after birth to prevent him or her from getting the disease.
    • Tdap. During each pregnancy, women should receive a dose of Tdap vaccine between 27 and 36 weeks’ gestation. Women who did not receive the vaccine during pregnancy should get it immediately after giving birth. Dads, grandparents, and other teens and adults who will be around the baby should also get a dose if they have not had the booster.
    • Pneumococcal. If a woman is considered high risk for pneumococcal disease, she should get this vaccine. High-risk conditions include chronic disorders of the pulmonary system (but not asthma), cardiovascular disease, diabetes mellitus, chronic liver diseases, chronic renal failure, asplenia (including sickle cell disease), immunosuppressive conditions (e.g., HIV, leukemia, lymphoma, multiple myeloma, Hodgkin's disease, generalized malignancy, or organ or bone marrow transplantation), treatment with certain medications, or cochlear implants.

    Vaccines to avoid during pregnancy

    • Live, attenuated influenza vaccine. Even though a woman is recommended to receive the influenza vaccine while pregnant, she should not receive the live version of the vaccine.
    • MMR. Women who are pregnant should not receive live, weakened viral vaccines, including the ones for measles, mumps, and rubella (MMR). A woman should avoid becoming pregnant for four weeks after receipt of the MMR vaccine.
    • Varicella or shingles. As with MMR, these vaccines contain a live, weakened virus and should not be given to pregnant women. Additionally, women should avoid becoming pregnant for at least one month after receipt of either of these vaccines.
    • HPV. Women who have started the three-dose series before becoming pregnant should wait until after delivery to get the remaining doses.

    If you have inadvertently received any of these vaccines during pregnancy, you should be aware that none has been proven to be harmful to your unborn baby. The recommendation to avoid these vaccines is theoretical. In some cases, databases are maintained by the manufacturers to track these occurrences, so if you receive one of these vaccines, you or your doctor should report it to the manufacturer:

    • Varicella-containing vaccines (varicella, MMRV, or shingles): Call 800-986-8999.
    • HPV vaccines: For Gardasil® call 800-986-8999; for Cervarix® call 888-452-9622.

    Children in the home of someone who is pregnant

    Children living in the home of a pregnant woman can receive all recommended vaccines.

  • Travelers

    In 1996 a man from Tennessee came back from a trip to South America and died of yellow fever. Although he was advised to receive the yellow fever vaccine, he chose not to get it. The decision cost him his life.

    Because unusual infectious diseases such as typhoid, yellow fever or cholera rarely or never occur in the United States, we don't often think about them. However, in some parts of the world, these diseases are common and often fatal.

    When traveling, protect yourself and your family by considering the following four-step plan:

    Step 1: Consult resources on disease risks and vaccines available for international travel

    Resources available include travel clinics, doctors, travel agencies, airlines, cruise lines, missionary organizations, and academic institutions. The following is a list of organizations that provide up-to-date information on disease risks (and the necessity of vaccines) based on where you are traveling:

    Step 2: Prepare for the possibility of vaccines at least eight weeks before leaving

    In most developed countries such as Japan, Canada, Australia, New Zealand and Western Europe, the risk of various infectious diseases is the same as that in the United States. However, when traveling to developing countries or regions such as Africa, South America, Asia, the Mediterranean Basin, Mexico, the Caribbean, Central America or Oceania, various vaccines, as well as preventive measures against diseases such as malaria, must be considered.

    Prepare for the health risks that you may encounter on your trip at least eight weeks before you leave. Some vaccines require more than one dose to be effective, and all vaccines require several weeks before they are fully effective.

    Step 3: Know the five vaccines recommended before traveling to developing countries

    Five vaccines are often recommended for travel to developing countries: hepatitis A, cholera, typhoid, yellow fever and Japanese Encephalitis. For more information on specific vaccines see A Look at Each Vaccine.

    The five vaccines can be divided into two groups.

    The first group consists of hepatitis A virus, cholera and typhoid. All of these infections are transmitted by contaminated food or contaminated water. Two of these diseases, cholera and typhoid, can be avoided by staying in standard tourist accommodations and drinking only bottled or boiled water and avoiding uncooked meat, unpeeled fruits, shellfish, beverages with ice, salads and food from street vendors. However, hepatitis A virus is so prevalent and so easily transmitted that even standard tourist accommodations and careful avoidance of various foods and beverages may not protect against infection. The hepatitis A vaccine is recommended for all children in the U.S. beginning at 1 year of age. If your child did not receive this vaccine yet, be sure to get at least one dose prior to traveling.

    The second group consists of yellow fever and Japanese encephalitis virus. Both of these diseases are transmitted by the bite of a mosquito. The yellow fever vaccine has a very low rate of side effects and is required or recommended for entry into a number of countries. On the other hand, the Japanese Encephalitis virus vaccine has a fairly high rate of severe side effects, and the disease can be avoided by not engaging in high-risk activities. The new Japanese Encephalitis virus vaccine, made in a different cell substrate, has a much lower rate of side effects. This newer vaccine is not yet available for young children.

    Step 4: Consider other vaccines

    You should also consider the meningococcal vaccine and, depending on where and when you are traveling, the rabies vaccine.

    All routinely recommended vaccines including DTaP, MMR, varicella, Hib, polio, hepatitis B, hepatitis A, rotavirus, influenza and pneumococcus should be up to date. Preferably at least two doses of vaccines that require more than one dose should be given prior to travel.

    Download Infectious diseases and travel Q&A for more information.

    Other considerations for travel

    Prescription medicines

    If you take prescription medicines on a regular basis, it’s important to make sure you have an adequate supply for the duration of your trip. These medications should be packed in carry-on luggage to prevent them from being lost. Travelers who have severe allergies are also recommended to pack their epinephrine auto-injector in case of emergency. If any of the medications are injectable or considered to be controlled substances, travelers should consider having their doctor write a letter identifying their need to use these medicines.

    Other ways to stay healthy

    We all know it’s important to pack the right clothes for your travel destination, both according to the weather and any special activities you might be doing while there, such as hiking or swimming. But travelers should also pack a travel health kit that includes basic first-aid supplies, insect repellant and sunscreen. It is also a good idea to carry your health insurance card as well as the names and phone numbers for your family members’ healthcare providers.

  • People with weakened Immunity

    If a child or adult has leukemia, lymphoma, other types of cancers or AIDS, they should not receive vaccines made with what is known as the "live, weakened" viruses — that is, they should not receive the measles, mumps, rubella (MMR), intranasal influenza (FluMist®), rotavirus or varicella vaccines.

    Steroids

    Steroids, which can weaken the immune system, are often given to people with diseases such as asthma, rheumatologic diseases and poison ivy. If people are taking steroids for any reason, they should discuss with their doctor whether it is safe to proceed with the vaccination schedule. In general, the following rules apply:

    Steroid creams or sprays (aerosols)

    It is safe to be vaccinated. The use of topical or inhaled steroids does not prevent the administration of vaccines.

    Steroids taken by mouth for less than two weeks

    It is safe to be vaccinated.

    High doses of steroids taken by mouth for more than two weeks

    People should not receive live, "weakened" vaccines if they have been taking high doses of steroids by mouth for more than two weeks. (A high dose is considered to be that greater than 2 milligrams (mg) per kilogram [2.2 pounds] of prednisone per day). The live viral vaccines include measles, mumps, rubella, varicella (chickenpox), shingles, rotavirus and the intranasal version of influenza. These vaccines can be given about three months after steroids have been stopped, although the rotavirus vaccine has age restrictions and the influenza vaccine is seasonal, so patients should discuss their situation with their healthcare provider.

  • Preterm infants

    Any baby born before the 37th week of pregnancy is considered to be preterm. About 12 percent of births in the United States are preterm.

    Maternal antibodies

    Preterm babies acquire lesser quantities of antibodies through the placenta than full-term babies. Since these antibodies are present at lower levels, they do not last as long as those of full-term babies. Because preterm infants rely on their own immune systems for protection sooner than full-term babies, it is important that they receive needed vaccinations so they can protect themselves against disease.

    Chronologic age

    Vaccines should be given according to a baby's chronologic age — the time since delivery.

    Hepatitis B vaccine

    Preterm infants of mothers infected with hepatitis B should receive the hepatitis B vaccine at or shortly after birth. If the baby weighs less than 2,000 grams, the dose should not be counted as part of the hepatitis B series, and the baby should start the three-dose series one month after birth.

    Preterm infants of mothers who are not infected with hepatitis B should get the vaccine one month after birth.

    Preterm babies discharged before 1 month of age may get the vaccine at discharge as long as they are considered medically stable and have been consistently gaining weight.

    In both cases, later doses should be given at least 4 weeks after the dose at 1 month. The third dose should be given at least 16 weeks after the first dose and at least 8 weeks after the last dose, but not before 6 months of age.

    Vaccines typically administered at 2 months

    In addition to hepatitis B, 2-month-old babies require vaccination against diphtheria, tetanus, pertussis, polio, Haemophilus influenzae type b, pneumococcus and rotavirus. Preterm infants should receive these vaccines at the chronologic age of 2 months, even if they are still hospitalized.

    These vaccines should continue to be given at the appropriate chronologic ages according to the Centers for Disease Control and Prevention's vaccine schedule until each series is completed.

    Other vaccines

    Other vaccines should also be given according to the recommended schedule; these include vaccines for measles, mumps, rubella, varicella and hepatitis A.

    Influenza vaccine is not recommended until 6 months of age. At 6 months of age, the baby may get the inactivated version of the vaccine. Healthcare workers and family members in contact with a baby less than 6 months old should be immunized to lessen the baby's chance of being infected with influenza.

  • Additional Resources

Reviewed by Paul A. Offit, MD on November 06, 2014

Materials in this section are updated as new information and vaccines become available. The Vaccine Education Center staff regularly reviews materials for accuracy.

You should not consider the information in this site to be specific, professional medical advice for your personal health or for your family's personal health. You should not use it to replace any relationship with a physician or other qualified healthcare professional. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult your physician or, in serious cases, seek immediate assistance from emergency personnel.