Vaccine Considerations for Specific Groups


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.

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.


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 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:

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 (chickenpox), 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 be up to date on 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.

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

Pregnant women may have questions about their own vaccine needs, those of their babies, or related to other children in the home. Find out more on Vaccine Considerations for New and Expectant Moms.


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 the website section, "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 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 they get at least one dose prior to traveling. This vaccine is also recommended for adults who wish to avoid hepatitis A infection.
  • The second group consists of yellow fever and Japanese encephalitis virus. Both 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 several countries. Japanese Encephalitis can typically be avoided by not engaging in high-risk activities. Newer Japanese Encephalitis virus vaccines have a much lower rate of side effects than previous versions. Recommendations for use depend on an individual’s age and travel plans.

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. [PDF, (674KB]

Other considerations for travel

Travel notices

Checking travel notices is one way to stay safe and healthy during your trip. Travel notices inform travelers and healthcare professionals about local health issues related to specific destinations. These issues could arise from disease outbreaks (Ebola), special events (the Olympics), natural disasters (earthquakes) or other conditions that may affect travelers’ health, well-being and safety. Be sure to check the CDC’s travel health notices webpage before leaving for any international trip. Travel notices are categorized in three levels:

  • Level 1: Watch — This is a reminder for the traveler to practice usual precautions for the specific destination, such as being up to date on all recommended vaccines, as well as any travel vaccines outlined for your specific destination; and practicing good travel health behaviors, like eating food that is cooked and served hot, drinking sealed, bottled water and beverages and choosing safe modes of transportation. Level 1 notices have limited impact on the traveler as risk caused by the specified event or outbreak is only slightly elevated.
  • Level 2: Alert — Enhanced precautions are recommended under this notice as a result of an increased risk either in defined settings or for those with specific risk factors. Enhanced precautions might include actions like receiving a travel vaccine that isn’t normally recommended for that destination, avoiding the most congested or populated areas of your destination, or adhering to strict hygiene practices.
  • Level 3: Warning — A Level 3 notice means a high risk exists for travelers who may either become ill or experience conditions not suitable for supporting travelers. In these scenarios, travelers are typically recommended to avoid all non-essential travel to this destination.

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

Diseases or conditions

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), rotavirus, varicella (chickenpox), or intranasal version of influenza vaccines.

Find more specific guidance:


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), rotavirus, and intranasal version of influenza. These vaccines can be given about three months after steroids have been stopped, although the rotavirus vaccine has age restrictions, so patients should discuss their situation with their healthcare provider.


People taking biologics, which are medications that target the immune system, may have particular vaccine considerations. See “Vaccines and biologics: What you should know” for more information.

Preterm infants

Any baby born before the 37th week of pregnancy is considered to be preterm. Find answers to vaccine-related questions for preterm babies.

Additional Resources

Reviewed by Paul A. Offit, MD on September 06, 2022

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.