Immunizations

Topic Overview

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 a weakened or dead form 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 one time. 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. And they may be needed for employment or for travel to another country.

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 months before you leave, to see if you need any shots.

What immunizations are recommended for children and adolescents?

Ask your doctor what shots your child should get. The immunization schedule includes vaccines for:

  • Bacterial meningitis.
  • Chickenpox.
  • Diphtheria, tetanus, and pertussis (also known as whooping cough).
  • Flu (influenza). This vaccine is not given to children younger than 6 months.
  • Haemophilus influenzae type b disease, or Hib disease.
  • Hepatitis A.
  • Hepatitis B.
  • Human papillomavirus (HPV).
  • Measles, mumps, and rubella.
  • Pneumococcal disease.
  • Polio.
  • Rotavirus.

Immunizations start right after birth, and many are given throughout a baby's first 23 months. Booster shots (the later doses of any vaccines that need to be repeated over time) occur throughout life.

Fewer immunizations are needed after age 6. But older children and teens need shots too (such as those for bacterial meningitis and for tetanus, diphtheria, and whooping cough). Some shots are also given 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. When you enroll your child in day care or school, you may need to show proof of immunizations. Your child may also need the record later in life for college, employment, or travel.

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 meningitis.

What vaccines are recommended for adults?

The vaccines you need as an adult(What is a PDF document?) depend not only on your age, lifestyle, overall health, pregnancy status, and travel plans but also on who you are in close contact with 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.

In some states, pharmacists can give some of these shots.

What are the side effects of vaccines?

Most side effects from vaccines are minor, if they occur at all. Ask your doctor or pharmacist about 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.
  • 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 trouble breathing or a fever of 104.5°F (40.3°C) or higher, 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. 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

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

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

Frequently Asked Questions

Learning about immunizations:

Types of immunizations:

What are the immunization recommendations for:

Common concerns:

Ongoing concerns:

Childhood Immunizations

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) or make a disease less severe if your child does get it. The schedule outlines the immunizations and booster shots needed from birth through age 18, as well as when catch-up immunizations should be given.

The schedule for a premature infant is the same as for a full-term infant, except for hepatitis B vaccine.

Many 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.

The childhood immunization schedule has immunizations for:4

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

This shot (called Varivax) protects against chickenpox.

Who should get it?

  • Two doses are given to all children 12 months of age and older who have not had chickenpox—one at age 12 to 15 months and one at age 4 to 6 years.

The combination MMRV (ProQuad) shot can be given in place of Varivax. 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).

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?

  • Five doses are given to all children—one at age 2 months, one at 4 months, one at 6 months, one at 15 to 18 months, and one at 4 to 6 years.

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

This immunization helps protect against the seasonal 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:5

  • All children 6 months through 18 years of age.
    • Children younger than 9 years of age who are getting the immunization for the first time should get two doses. These doses should be given at least 4 weeks apart.
    • Children younger than 9 years old who got only one dose in their first season should get two doses before or during the next season. After that, one dose yearly is needed.
  • Household contacts and caregivers of children from birth up to 5 years of age and of any child who is at high risk for complications of the flu.
  • Anyone who has a chance of complications from the flu or is more likely to need medical care if infected.

Healthy children ages 2 and older can usually get the nasal spray form (FluMist)(What is a PDF document?) instead of the flu shot(What is a PDF document?) . Protection lasts up to a year for both vaccine types.

For the most current CDC guidelines about seasonal flu, go to www.cdc.gov/flu.

H1N1 influenza (swine flu) (What is a PDF document?)

This shot helps protect against infection caused by the H1N1 flu virus. H1N1 flu may cause symptoms such as fever, cough, body aches, sore throat, and extreme tiredness. Most of the time, the illness is not serious. But severe cases can lead to pneumonia, serious lung problems, and death.

Who should get it?

  • All children starting at age 6 months need this shot.
  • Pregnant women and people who live with or care for children younger than 6 months of age also need this shot.

Most people need one dose. Only children ages 6 months through 9 years need two doses. The H1N1 shot can be given along with the seasonal flu shot. Healthy children ages 2 and older can usually get the nasal spray form(What is a PDF document?) of the vaccine instead of the shot(What is a PDF document?) .

For more information, see the topic H1N1 Influenza (Swine Flu). For the most current CDC guidelines, go to www.cdc.gov/h1n1flu.

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

This shot protects against bacteria that can cause an infection in the lungs (pneumonia) or the covering of the brain (meningitis), 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.

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

This shot protects against hepatitis A.

Who should get it?

  • All children starting at 1 year of age need two doses, given at least 6 months apart.
  • Anyone who will be in close contact with an adopted child from a country that has high rates of hepatitis A needs two doses. This includes household contacts and babysitters. This recommendation only applies for the first 60 days the child is in the United States.6

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

This shot protects against hepatitis B.

Who should get it?

  • All children need at least three doses. The first dose is given right after birth, before the child leaves the hospital. The remaining doses are given by 6 to 18 months of age. Children who have not been immunized for hepatitis B and are age 18 years or younger can get the shots over a period of about 6 months.

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

This shot (called M-M-R II) protects against measles, mumps, and rubella.

Who should get it?

  • Two doses are given to all children—one at age 12 to 15 months and one at age 4 to 6 years.

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 ages 12 and younger.

Pneumococcal infections (What is a PDF document?)

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

Who should get it?

  • Four doses are given to all children—one at age 2 months, one at 4 months, one at 6 months, and one at 12 to 15 months.
  • One dose is given to healthy children ages 24 to 59 months who did not get all the doses before.
  • Children ages 24 to 59 months who have medical conditions and did not get all the doses before may need one or two doses.

Polio (What is a PDF document?)

This shot protects against polio.

Who should get it?

  • Four doses are given to all children—one at age 2 months, one at 4 months, one at 6 to 18 months, and one at 4 to 6 years.

Rotavirus (What is a PDF document?)

This immunization (called RotaTeq or Rotarix) protects against rotavirus infection, which causes severe diarrhea.

Who should get it?

  • Three doses of RotaTeq are given to all children—one at age 2 months, one at 4 months, and one at 6 months. If your child gets Rotarix, two doses are given—one at age 2 months and one at 4 months.

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

Other immunizations

Your child's doctor may suggest other shots if your child is at higher risk than other children for certain health problems. One example is:

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

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

Who should get it?

  • Some children ages 2 through 10 who have a higher risk than other children for getting and having severe problems from meningitis need one shot.
  • Children who have a damaged or missing spleen, who have certain immune system problems, or who travel or live in areas of the world where the disease is common also need one shot.

Some children need booster shots.7 Check with your child's doctor.

Two forms of the meningococcal vaccine are available: Menactra (MCV4) and Menomune (MPSV4). Menactra may protect your child longer than Menomune.

Combination vaccines

Combination vaccines are usually preferred to separate shots because they reduce the number of needle pricks. Examples include:

  • Comvax (Hepatitis B/Haemophilus influenzae type b)
  • Kinrix (Diphtheria, tetanus, pertussis/Polio)
  • Pediarix (Diphtheria, tetanus, pertussis/Polio/Hepatitis B)
  • Pentacel (Diphtheria, tetanus, pertussis/Polio/Haemophilus influenzae type b)
  • TriHIBit (Diphtheria, tetanus, pertussis/Haemophilus influenzae type b)

Keeping good immunization records

It is important to keep accurate records of immunizations, including any reactions to the vaccines. When you enroll your child in day care or school, you may need to show proof of immunizations. Also, your child may need the record later in life for college, employment, or travel.

  • Know when each immunization should be scheduled, and put reminder notes on your calendar. You also may want to ask your doctor to send you notices when immunizations are due.
  • Have your doctor go 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.

If your child age 6 years or younger didn't get all of his or her shots, find out which ones are needed at www.cdc.gov/vaccines/recs/scheduler/catchup.htm.

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

Immunization safety

You may worry that immunizations are dangerous if given when your child has a cold or other minor illness. Talk to your child's doctor 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. Also, getting several vaccines at the same time is as safe as getting one shot at a time.8 There are very few reasons for which doctors suggest that a person postpone or not get an immunization.

Some parents 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. But scientific studies have found no connection between autism and the vaccine.3

Adolescent Immunizations

Recommended immunizations

The importance of continued immunizations in adolescence (ages 11 through about 21 years) 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 and also 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:

Flu shot (What is a PDF document?)

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

Who should get it?

Flu immunization is recommended once a year for:5

  • All children 6 months through 18 years of age.
  • Household contacts and caregivers of anyone who is at high risk for complications of the flu.
  • Anyone who wants to reduce the chance of becoming ill with the flu or spreading it to others.

Healthy people ages 2 years through 49 years can usually get the nasal spray flu vaccine (FluMist)(What is a PDF document?) instead of the flu shot. Pregnant women can get the flu shot but not FluMist.

For the most current CDC guidelines about seasonal flu, go to www.cdc.gov/flu.

H1N1 influenza (swine flu) (What is a PDF document?)

This shot helps protect against infection caused by the H1N1 flu virus. H1N1 flu may cause symptoms such as fever, cough, body aches, sore throat, and extreme tiredness. Most of the time, the illness is not serious. But severe cases can lead to pneumonia, serious lung problems, and death.

Who should get it?

  • All children and young adults from age 6 months to 24 years need this shot.
  • Pregnant females and people who live with or care for children younger than 6 months of age also need this shot.

Most people need one dose. Only children ages 6 months through 9 years need two doses. The H1N1 shot can be given along with the seasonal flu shot. Healthy children ages 2 and older can usually get the nasal spray form(What is a PDF document?) of the vaccine instead of the shot(What is a PDF document?) .

For more information, see the topic H1N1 Influenza (Swine Flu). For the most current CDC guidelines, go to www.cdc.gov/h1n1flu.

Human papillomavirus (HPV) (What is a PDF document?)

The vaccines Cervarix and Gardasil protect against two types of human papillomavirus (HPV) that cause cervical cancer. Gardasil also protects against two types of HPV that cause genital warts. And it protects against some uncommon cancers, such as vaginal cancer.

Who should get it?

  • Girls 11 or 12 years old need three doses of either Cervarix or Gardasil, given over 6 months. (The series of shots can be given to girls as young as 9 or 10 years old.)
  • Females 13 to 26 years old who did not get it when they were younger should get this series of shots.
  • Males ages 9 to 26 can get three Gardasil shots to reduce the chance of getting genital warts.

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

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

Click here to view a Decision Point. HPV: Should my daughter get the vaccine?

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

This shot protects against bacterial 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.

Some people need booster shots.7 Check with your doctor.

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 ages 11 or 12 need one Tdap shot. Teens ages 13 to 18 who haven't had the shot should get it as soon as possible.

Other immunizations

Some adolescents may need or want additional immunizations 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:

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

This is important if your child never had chickenpox or 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.

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.
  • Anyone who will be in close contact with an adopted child from a country that has high rates of hepatitis A needs this shot. This includes household contacts and babysitters. This recommendation only applies for the first 60 days the child is in the United States.6

Two doses are needed over at least 6 months.

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.

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 immunized at age 11 or 12.

College students usually need to have a written record showing proof of immunity, such as having received two doses of MMR.

Pneumococcal polysaccharide (PPSV, or Pneumovax 23) (What is a PDF document?)

This shot does not necessarily reduce the risk of getting pneumonia, but it can prevent some of the serious complications of pneumonia, such as infection in the bloodstream (bacteremia) or throughout the body (septicemia).

Who should get it?

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

Immunization safety

Most side effects from vaccines are minor, if they occur at all. The doctor may have your child stay in the office for up to 15 minutes after the shots are given, to watch for any reactions.

Many parents worry that immunizations are dangerous if given when their child has a cold or other minor illness. Talk to your child's doctor if you have concerns about the timing of shots. But keep in mind that shots 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 reasons for which doctors suggest that a person postpone or not get an immunization.

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.

Adult Immunizations

Recommended immunizations

Your need for immunizations does not end when you reach adulthood. The specific shots (injections) you need as an adult depend not only on your age, lifestyle, overall health, pregnancy status, and travel plans but also on who you are in close contact with and what vaccines you had as a child. Tetanus and diphtheria shots need to be repeated every 10 years throughout adulthood in order to keep your immunity.

Each year the U.S. Advisory Committee on Immunization Practices (ACIP), the American College of Obstetrics and Gynecologists, the American College of Physicians, and the American Academy of Family Physicians recommend a specific adult immunization schedule(What is a PDF document?) .

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

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

Immunizations given during adulthood may include:9

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.

Flu shot (What is a PDF document?)

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

Who should get it?

Flu immunization is recommended once a year for:5

  • Adults 50 years of age and older.
  • People with a chronic health condition, such as asthma, diabetes, heart or lung disorders, or an impaired immune system (which puts them at high risk for complications of the flu).
  • Women who are or will be pregnant during the flu season.
  • 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.
  • People who live in nursing homes or long-term care centers.
  • Anyone who wants to reduce the chance of becoming ill with the flu or spreading it to others.

Healthy people ages 2 years through 49 years can usually get the nasal spray flu vaccine (FluMist)(What is a PDF document?) instead of the flu shot. Pregnant women can get the flu shot but not FluMist.

For the most current CDC guidelines about seasonal flu, go to www.cdc.gov/flu.

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

Click here to view a Decision Point. Should I get a flu shot?

H1N1 influenza (swine flu) (What is a PDF document?)

This shot helps protect against infection caused by the H1N1 flu virus. H1N1 flu may cause symptoms such as fever, cough, body aches, sore throat, and extreme tiredness. Most of the time, the illness is not serious. But severe cases can lead to pneumonia, serious lung problems, and death.

Who should get it?

Adults who most need the vaccine are:

  • Pregnant women.
  • People who live with or care for children younger than 6 months of age.
  • Health care workers who take care of sick people.
  • People ages 6 months to 24 years.
  • People 25 to 64 years old who have long-term (chronic) health problems (such as asthma or diabetes) or who have a weak immune system.

After these people who most need the vaccine are immunized, then all people ages 25 to 64 should get immunized. Adults need one dose. The H1N1 shot can be given along with the seasonal flu shot. Healthy people ages 2 through 49 can usually get the nasal spray form(What is a PDF document?) of the vaccine instead of the shot(What is a PDF document?) .

For more information, see the topic H1N1 Influenza (Swine Flu). For the most current CDC guidelines, go to www.cdc.gov/h1n1flu.

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 given at least 6 months apart.
  • Adults who have certain risk factors, such as long-term (chronic) liver disease, also need two doses.
  • Anyone who will be in close contact with an adopted child from a country that has high rates of hepatitis A needs two doses. This includes household contacts and babysitters. This recommendation only applies for the first 60 days the child is in the United States.6

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.

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 one or 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.10

Pneumococcal polysaccharide (PPSV, or Pneumovax 23) (What is a PDF document?)

This shot does not necessarily reduce your risk of getting pneumonia, but it can prevent some of the serious complications of pneumonia, such as infection in the bloodstream (bacteremia) or throughout the body (septicemia).

Who should get it?

  • All people 65 years of age or older need this shot.
  • People ages 2 years to 64 years 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.
  • People ages 19 to 64 years who have asthma or who smoke cigarettes need this shot.

This shot is different from the pneumococcal conjugate (PCV) shot that is given to all children. Most adults only need one dose of PPSV for protection. Some people may need a booster shot after 5 years.

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

This shot (called Zostavax) protects against shingles.

Who should get it?

  • Adults ages 60 and older need one dose, whether or not they've had shingles before.

Zostavax is not a substitute for the chickenpox shot (Varivax).

Tetanus and diphtheria (Td) or Tetanus, diphtheria, and pertussis (Tdap) (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.
  • Health care workers who have direct contact with patients.
  • People who live with or care for infants younger than 12 months old. (Ideally, women would get this dose before pregnancy.)

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

You may need or want additional immunizations if certain situations raise your chance for exposure to disease. Or you may have missed shots when you were younger. Or a vaccine may not have been offered when you were younger. These immunizations may include:

Human papillomavirus (HPV) (What is a PDF document?)

The vaccines Cervarix and Gardasil protect against two types of human papillomavirus (HPV) that cause cervical cancer. Gardasil also protects against two types of HPV that cause genital warts. And it protects against some uncommon cancers, such as vaginal cancer.

Who should get it?

  • Females 13 to 26 years old need three doses of either Cervarix or Gardasil, given over 6 months.
  • Males ages 9 to 26 can get three Gardasil shots to reduce the chance of getting genital warts.

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.

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

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

Who should get it?

  • An adult 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 ages 2 years to 55 years who need this immunization. Adults older than age 55 are immunized with the meningococcal polysaccharide (MPSV4) vaccine, called Menomune. Some people may need booster shots after 5 years.7

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

This shot protects against polio.

Who should get it?

  • Adults whose travel or job puts them at increased risk for exposure to polio need three doses of this shot.
  • Adults who never had the full series of oral polio vaccine (OPV) or inactivated polio vaccine (IPV) and who have an increased risk of being exposed to polio need the shots they missed.

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

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 pregnancy10

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

The CDC recommends the inactivated flu shots (seasonal and H1N1) for all women who are or who plan to be pregnant during the flu season. Pregnant women should not receive the nasal spray flu vaccines.

Also, pregnant women should not receive the HPV vaccine.

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 getting pregnant or right after their baby is born. This is to protect the newborn baby from whooping cough (pertussis).

If you are pregnant, your children should still get their immunizations on schedule. You do not need to speed up or delay your other children'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.11

Immunization safety

You may worry that immunizations are dangerous if given when you have a cold or other minor illness. Talk to your doctor if you have concerns about the timing of shots. But keep in mind that shots can usually still be given during a mild illness, while medicines are being taken, and in other situations where you may not be in perfect health. There are very few reasons for which doctors suggest that a person postpone or not get an immunization.

Talk with 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.

Travel Immunizations

Recommended immunizations

Talk with your doctor months in advance of a trip to find out 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 your 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. Also, 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 of 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). For example:

The need for travel immunizations 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:

  • Exploring rural areas or those off the usual tourist route.
  • Taking backpacking trips.
  • Visiting people in 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 wwwn.cdc.gov/travel.

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

Bioterrorism and Immunizations

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.12

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.

Five shots are given over 18 months. And booster shots are needed every year 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.

The United States has enough smallpox vaccine to vaccinate Americans in an emergency.13

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.

When to Call a Doctor

Call 911 or other emergency services if you or your child develops any of the following symptoms:

  • An allergic reaction, such as difficulty breathing, wheezing, hives, hoarseness, paleness, weakness, a fast heart rate, or dizziness.
  • Behavior changes, such as passing out (losing consciousness), acting confused, being very sleepy or hard to wake up, or not responding to being touched or talked to.
  • A seizure.

Call your doctor if:

  • Redness and swelling at the site of the shot (injection) last longer than 48 hours.
  • A fever lasts longer than 48 hours after receiving a shot.
  • Any unusual reaction occurs.

If a fever develops after an immunization, see one of the following topics to find out if you need to call your doctor:

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

  • Are in close contact with people who have an infectious disease.
  • Have planned international travel, especially to developing countries.
  • Live with or visit a pregnant woman or baby.
  • Live with someone who has an impaired immune system.

Home Treatment

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 that 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 slight fever may occur after you or your child gets a shot. Acetaminophen (such as Tylenol) or ibuprofen (such as Advil) may help lower a fever. Follow the package instructions carefully. If you give medicine to your baby, follow your doctor’s advice about what amount to give. 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 syndrome. For more information on fevers, see the topic Fever, Age 11 and Younger or Fever, Age 12 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, acetaminophen or ibuprofen may help relieve the discomfort. Follow the package instructions carefully.
  • 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.

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

Other Places To Get Help

Organizations

American Academy of Pediatrics: Immunization Information
E-mail: cispimmunize@aap.org
Web Address: www.aap.org/immunization
 

Through the Childhood Immunization Support Program, the AAP strives to deliver current pediatrician-recommended information about the importance of immunizations. This Web site has information about vaccine safety, immunization schedules, vaccine-preventable diseases, personal stories, and more.


Centers for Disease Control and Prevention (CDC): Vaccines and Immunizations
1600 Clifton Road
Atlanta, GA  30333
Phone: 1-800-CDC-INFO (1-800-232-4636)
TDD: 1-888-232-6348
E-mail: cdcinfo@cdc.gov
Web Address: www.cdc.gov/vaccines
 

This CDC Web site has information about vaccines and the diseases that can be prevented by immunization. The Web site includes the recommended immunization schedules for children, teens, and adults. There is also information about vaccine side effects and safety, school and state requirements, and immunization records. Interactive schedules are also available.


Centers for Disease Control and Prevention, Travelers' Health
1600 Clifton Road
Atlanta, GA  30333
Phone: 1-800-CDC-INFO (1-800-232-4636)
TDD: 1-888-232-6348
E-mail: cdcinfo@cdc.gov
Web Address: wwwn.cdc.gov/travel
 

The CDC's Travelers' Health Web site provides health information for the traveler. The Web site provides information on immunizations that are needed for travel to various areas of the world. It also provides information for safe travel, including traveling with children and with people who have special needs. Information about current outbreaks of disease in the world is also provided. The CDC is the leading federal agency for protecting U.S. citizens' health and safety by providing credible health information and health promotion.


Immunization Action Coalition
1573 Selby Avenue
Suite 234
St. Paul, MN  55104
Phone: (651) 647-9009
Fax: (651) 647-9131
E-mail: admin@vaccineinformation.org
Web Address: www.vaccineinformation.org
 

The Immunization Action Coalition (IAC) works to increase awareness of the need for immunization and to boost immunization rates. This IAC Web site has videos and photos about vaccine-preventable diseases. The site also offers information about common concerns and myths about vaccines.


National Network for Immunization Information
301 University Boulevard
Galveston, TX  77555
Phone: (409) 772-0199
Fax: (409) 772-5208
E-mail: nnii@i4ph.org
Web Address: www.immunizationinfo.org
 

The National Network for Immunization Information provides information on immunizations, including each of the recommended childhood vaccines, the recommended childhood immunization schedule, tips on using the World Wide Web as a source of immunization and health information, and links to other helpful sites. You can also search for the vaccines that each state requires before entry into school or day care.


References

Citations

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  10. 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.
  11. 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.
  12. Mitka M (2007). Bioterror vaccine production: Take 2. JAMA, 297(6): 575–576.
  13. Centers for Disease Control and Prevention (2007). Smallpox fact sheet: Vaccine overview. Available online: http://emergency.cdc.gov/agent/smallpox/vaccination/facts.asp.

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Credits

Author Debby Golonka, MPH
Editor Susan Van Houten, RN, BSN, MBA
Associate Editor Pat Truman, MATC
Primary Medical Reviewer John Pope, MD - Pediatrics
Specialist Medical Reviewer William Atkinson, MD, MPH - Public Health and Preventive Medicine
Last Updated February 26, 2010

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