Parents PACK

Vaccine Schedules

• Immunization scheduler
• Vaccines given at the same time
• Alternative immunization schedules
• Personalized immunization schedule tool
• Immunization record, what if I don't have one?
• Multiple doses of vaccines
• Extra doses of vaccines
• Deciding whether to alter the immunization schedule
• Summer and vaccines

Immunization scheduler

Do you want to know which vaccines your child may be getting at her next check-up? Are you wondering if your child is up to date with his immunizations? The Centers for Disease Control and Prevention (CDC) in Atlanta has designed a schedule that you can customize based on your child’s birth date. You can print it at home as an appointment reminder.

Use the CDC’s scheduler»

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Vaccines given at the same time

Q. Can you tell me if there are any studies that discuss the risks when vaccines are given at the same time?

A. Before licensure, vaccines are always tested with other vaccines that would be given at the same time; these are called concomitant use studies.

More information

"Too Many Vaccines: What you should know":

• English
• Spanish

Our book for parents, Vaccines and Your Child: Separating Fact from Fiction, published in 2011 by Columbia University Press, also addresses questions related to vaccine testing as well as multiple vaccines.

This book is available from:

• Columbia University Press
• Amazon.com
• Barnes and Noble 

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Alternative immunization schedules

Q. I wanted to use an alternative immunization schedule, and my doctor told me to check your website for information regarding the pros and cons. Can you help?

A. Sure; we have addressed this in a few different places:

• Altering the vaccine schedule
• Do vaccines overwhelm the immune system
• "The Problem with Dr. Bob's Alternative Schedule"
• "Too Many Vaccines: What You Should Know"

Several Q&A sheets about different aspects of vaccines and vaccine safety are available on the Educational Materials page of our website.

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Personalized immunization schedule tool

Every Child By Two (ECBT) has a personalized immunization schedule tool that can be used from computers or smart phones. By entering your child’s birth date, you will receive a recommended immunization schedule and have the option to get e-mail reminders when immunizations are due.

Bookmarks and a coloring book are also available to print for your children.

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Immunization record, what if I don't have one?

I recently moved to the U.S., and my son is now starting school. I have been asked to show an immunization record, but I do not have one. How can I get one?

First, you should contact your previous healthcare providers to be sure they do not have a copy that they can send to you. If you are still unable to locate a record, your doctor may consider your son to have had no immunizations and begin the appropriate immunization schedule.

Even if your son had some vaccines previously, the additional doses will not hurt him. Alternatively, the doctor may give your son a blood test to see if he is immune to certain diseases such as measles, mumps, rubella, chickenpox, tetanus, diphtheria, hepatitis A, hepatitis B, and polio. This may reduce the number of vaccines your son needs to get, but he may still require other vaccines depending upon his age and other factors

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Multiple doses of vaccines

Why are some vaccines given as a single dose and others as multiple doses?

Vaccines may be given multiple times for a few reasons:

• Some vaccines are given more than once so that a greater number of people can be protected against the disease. For example, when adults get the chickenpox vaccine, 78 of 100 will be protected after one dose, but that number rises to 99 of 100 after the second dose. Since the additional dose is not harmful and provides extra protection even in first-dose responders, everyone is recommended to get the second dose.
• Some vaccines provide a low level of protection after a single dose, but additional doses provide a greater response, so that individuals are better protected. This is true of the vaccine for Haemophilus infleunzae type b or Hib.
• Another reason for multiple doses is that immune responses last longer after more than one dose of some vaccines. The pertussis vaccine is an example of this.
• Some vaccines protect against agents that change often enough that older versions would not offer protection. The influenza vaccine is an extreme example of this, requiring new versions almost every year.

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My grandson recently got the Hib vaccine, but he had already had it. Can this have any effect on him?

No. An extra dose of any vaccine is similar to being exposed to the virus or bacteria in nature; the difference is that with a dose of vaccine you know that the exposure happened. If your grandson was exposed to Hib in the community, you would not necessarily know about it, but in either case, his immune system will respond in the same way—it will recognize the Hib as “foreign” and make an immune response to prevent disease.

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Deciding whether to alter the immunization schedule

In this age of choices about everything from which songs are on our personal listening devices to which custom drinks we want at the local coffee shop, we are used to deciding what we want and don’t want for ourselves and our families. This notion has also started to pervade healthcare. For example, some parents now feel they should approach the childhood immunization schedule in an a la carte manner, giving their children only those vaccines that they feel are appropriate.

While this may seem reasonable, sometimes these individual decisions are not based on complete information or follow false logic. If you are considering picking and choosing which vaccines to give your child, please consider the following:

• Evaluate each disease fairly – Of course all diseases are not created equal. Some are very scary, some are more deadly, and some are more easily spread. Unfortunately, the ones that are deemed less scary, less deadly, or less infectious may seem like good candidates to forego when choosing vaccines. This kind of logic is like deciding only to treat one’s cancer if it is more deadly or affecting a certain part of the body. The fact of the matter is that every type of cancer—and every vaccine-preventable disease—can kill. Whether the death rate is 1 in 100 or 1 in 10,000, we can’t predict who will be spared and who will not.
• Consider whether vaccine immunity is “good enough” – When the disease is considered to be mundane, some parents would rather their children experience the infection rather than the vaccine, especially since diseases often create stronger immunity than vaccines. In addition to the fact that the disease is not mundane for everyone, the fact is that vaccine-induced immunity is typically good enough without paying the price for natural infection. You might think of it like filing taxes; if you can file the 1040EZ and get the same refund, why use the 1040A?
• Realize the full scope of the “wait and see” approach - When a new vaccine is developed, some people prefer to delay using it in order to make sure that it works well and is safe. However, each vaccine must be extensively tested before being added to the schedule and millions of vaccines are given by the approved schedule each year. On the other hand, when people arbitrarily make a schedule based on personal preferences, they are essentially subjecting their children to a vaccine without the benefit of data. In one case, the vaccines are delayed to “wait and see” if they are safe despite the existence of data from tens of thousands of people and years of studies. In the other case, the vaccines are given without the benefit of previous experience or data creating a potentially dangerous “wait and see” situation.
• Understand the importance of timing – Many parents focus on the number of vaccines given at a single visit and understandably feel that there are too many given at once, particularly for younger infants. However, three issues should be considered:
  • Vaccines are added to the schedule based on when an infant is likely to be most susceptible to the disease - During the first few months of life, babies are somewhat protected from infectious diseases by maternal antibodies present in their bloodstream at birth or in their mother’s milk; however, protection afforded by maternal antibodies wanes during the first year of life and is somewhat variable. For example, studies have shown that maternal antibody levels in infant blood increase right before delivery, so babies who are born prematurely tend to have lower levels than their full-term counterparts.
    
    Because the length of protection and robustness of the maternal response cannot be predicted, maturing the infant’s own immune response before the maternal response wanes is the most conservative approach. You might think of it like replacing the 15-year-old water heater before the water is flooding your house.
  • Because most vaccines require more than one dose, limiting the number given at one appointment makes getting all of the doses in a timely manner a tremendous feat – A small percentage of parents have willingly scheduled monthly visits to the doctor’s office in order to give only one or two vaccines to their child at a time. This is similar to the difference between going to the grocery store every day to get the ingredients for dinner and getting a single order on the weekend; in the long run, you have accomplished the same thing, but you’ve probably spent less time and money if you used the latter plan. Unfortunately, when it comes to childhood vaccines, the decision goes beyond time and money because children who are given vaccines one or two at a time are vulnerable to some diseases longer and, may experience more stress. Specifically, in a study completed a few years ago, children given multiple vaccines at once did not experience more pain than children given only a single shot, so multiple visits to the doctor would cause more pain over the long term.
  • If a baby is not too young to get the disease, she is not too young to get the vaccine – All vaccines expose recipients to a smaller number of antigens, parts that generate an immune response, than the actual pathogen. Even when multiple vaccines are given together, the number of antigens is limited compared with the number of pathogens to which infants are exposed during a normal day. The difference is we know when our children were exposed to antigens through a vaccine, but we aren’t always aware of their exposures to diseases.
• Consider ingredients in the appropriate context – Many vaccine-related concerns center on the ingredients that are in vaccines. Contemplating giving our children aluminum, mercury, formaldehyde or any of the other oft-mentioned chemicals in vaccines can be scary; however, thinking about what is in a vaccine should be kept in perspective. For example, consider how we have all become adept at reading nutrient labels; ingredients like unsaturated, polyunsaturated, and trans fats are all in many foods; however, we evaluate the foods based on the quantities of these items. The same should be true for vaccines; the quantities of ingredients in vaccines are not sufficient to cause harm even when multiple vaccines are given at the same time.

Vaccines are arguably the safest, best-tested products we put into our bodies, so the choice not to get them is a choice to take a different and much more potentially serious risk.

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Summer and vaccines: What you should know

With the end of school and the start of summer, we want to relax and vaccines tend to be the furthest thing from our minds. However, during the summer we are at increased risk of coming into contact with certain infections both because we tend to travel more and because we tend to be outside where we are more likely to suffer from bug or animal bites, and be exposed to organisms in the soil.

Which pathogens are spread by animal or insect bites or found in soil?

Some diseases are spread by the bites of bugs, particularly mosquitoes. Most of these are not common in the U.S., but are in other places.

• Japanese encephalitis (JE) virus is spread by the bites of infected mosquitoes and is most common in southeastern Asia. Immunization has decreased the prevalence of disease in developed Asian countries such as Japan, Taiwan and Korea.
• Plague is caused by bites from infected fleas. The fleas become infected when they bite infected rodents (such as rats). In the U.S. vaccination is not routinely recommended and, in fact, the vaccine is not available. Preventive measures should include maintaining conditions that decrease or prevent rodent access to homes, treating pets with appropriate insecticides, using DEET-containing insect repellents on clothing, and avoiding direct contact with or handling of sick or dead animals.
• Tick-borne encephalitis or TBE is most common in parts of Europe and Asia. As its name implies, the virus is transmitted to humans through ticks. TBE vaccine is commonly administered in central Europe, and people considered to be at high risk can consider the vaccine. In addition to people living in areas where the disease is common, people at high risk because of their jobs or outside activities, should also consider vaccination. Travelers to infected areas who will be camping, hunting, or hiking should consider getting the vaccine.
• Tetanus bacteria live in the soil and infect people through cuts or wounds. Because this disease is not transmitted from person to person, people cannot be protected simply because everyone around them is protected. That is to say, the concept of herd immunity does not apply to this infection.
• Rabies virus is spread by the bite of an infected animal. Animals that may be infected include dogs, wolves, foxes, coyotes, jackals, raccoons, mongooses, skunks, cats, or bats. Immunization of domesticated animals has helped to reduce the risk of disease in humans. Most people are not commonly recommended to get a rabies vaccine because the course of disease can be modified by vaccine following exposure. People in high-risk groups, such as veterinarians, animal handlers, researchers, some laboratory workers, some travelers, and people whose activities bring them into frequent contact with potentially rabid animals should consider being immunized.
• Yellow fever is transmitted to humans most commonly by infected mosquitoes and in some cases, monkeys. The disease is common in South America and sub-Saharan Africa. Some countries require proof of immunization against this disease prior to entry. Only certified centers throughout the U.S. can give this vaccine.
• Dengue is caused by the bite of an infected mosquito and is most common in tropical countries. Although there are vaccines in development, currently there is no vaccine available.
• Lyme disease is transmitted through the bite of a tick. In the U.S. there are three areas that have the highest incidence of disease including the Northeast from Maine to Virginia, the Midwest in Wisconsin and Minnesota, and the West, mostly in northern California. The disease is also commonly found in Germany, Austria, Slovenia, Sweden, Russia, China and Japan. Although there was a vaccine available in the U.S. between 1998 and 2002, it was removed from the market due to limited public acceptance. Current prevention methods rely upon use of protective clothing and tick repellants as well as personal inspection for ticks after potential exposure.
• Malaria is spread through the bite of mosquitoes that are infected. Most cases occur in Africa; however, transmission also occurs in parts of Central and South America, Haiti, the Dominican Republic, Asia, Eastern Europe and the South Pacific. Many countries have instituted environmental control strategies such as insecticides and bed nets; however, there is not currently a vaccine.
• Parasitic infections can be caused by hookworms, snails, or sandflies that are infected with the parasites. Similarly, ingestion of parasites through contaminated food or water can lead to these uncommon infections that tend to occur in developing countries.

What should I consider before traveling?

Travelers to other countries should consult a travel clinic at least four to six weeks prior to leaving for their trip. The professionals in these clinics can help determine whether vaccines or medications are needed based on travel destination, time of year, and activities during the trip.

Learn more about travel clinics near you»

The Centers for Disease Control and Prevention (CDC) has a travel Web site that is a great source of information.

In addition to being up to date on recommended vaccines for this country, there are some other diseases that can be encountered on trips to other countries:

• Cholera is spread through contaminated food and water. People in developing countries of Asia, Africa, and Central and South America are at particular risk. Travelers to these countries are also at risk.
• Hepatitis A is spread through feces from infected individuals. Often this occurs in lower socioeconomic settings or overcrowded areas; however, spread can also occur by means of contaminated food or water.
• JE virus, described above.
• Typhoid fever is spread through contaminated food and water and is still present in several countries in Africa, Asia and Latin America.
• Some countries require proof of immunization against yellow fever before allowing entrance into the country; see above.
• Several diarrheal diseases are spread through contaminated food and water, particularly in developing countries. Many of these can be avoided by following certain rules of food consumption on trips. These include eating foods that are freshly cooked and served hot; avoiding ice, reconstituted juices and milks, and foods washed with water but not cooked (e.g., salads); avoiding raw or undercooked foods; and consuming beverages that are bottled and sealed or which have been boiled or treated with iodine or chlorine. Learn more» 
• Travelers who may be at risk for malaria during their trip can take antimalarial drugs prior to travel and can learn more about ways to protect themselves on their trip. Learn more» 

In the same way that people plan ahead regarding where to stay, best methods of transportation and which activities to do and sights to see, they should also plan ahead for health-related considerations.

What do I need to consider before my child goes to sleep-away camp?

Make sure your child:

• Is up to date on recommended vaccines
• Understands good hygiene - hand washing, not sharing drinks or other items that come into contact with saliva or body fluids, etc.
• Knows not to share medications and how to take any prescribed medications (although camp staff should be aware of and involved in the latter)
• Is aware of health maintenance - eating healthy foods and getting enough sleep and exercise
• Knows what to do in the event of illness or injury

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Updated: January 2012