Immunization Schedules for Children in the US

African American nurse giving patient injection
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Immunization schedules vary from country to country, and usually, the recommended schedule depends on the type of vaccine, the disease the vaccine is designed for, and the age of the child at which the vaccine can be most beneficial. Immunizations are designed to protect infants and children when they are most vulnerable (which is early in life) and before they have been exposed to potentially life-threatening diseases.

Vaccination Schedule for Children

The latest immunization schedule recommended for kids by the Centers for Disease Control, American Academy of Pediatrics, and Advisory Committee on Immunization Practices, states that by the time children in the United States start kindergarten, they should get:

  • 3 doses of the hepatitis B vaccine
  • 2 or 3 doses of the oral rotavirus vaccine (Rotarix or RotaTeq)
  • 5 doses of the DTaP vaccine
  • 3 or 4 doses of the Hib vaccine
  • 4 doses of the Prevnar 13 vaccine
  • 4 doses of the polio vaccine
  • 2 doses of the MMR vaccine
  • 2 doses of the chickenpox vaccine (Varivax)
  • 2 doses of the hepatitis A vaccine
  • yearly flu vaccines, available as a nasal spray once kids are at least 2 years old

The number of doses required for the rotavirus and Hib vaccines depends on which brand of vaccine is used. Fewer doses are needed for Rotarix (rotavirus) and PedvaxHIB and Comvax (Hib) vaccines.

Kids can also get fewer shots if combination vaccines are used, such as:

  • Pediarix, a combination of DTaP, IPV, and the hepatitis B vaccine
  • ProQuad, a combination of MMR and Varivax
  • Pentacel, a combination of DTaP, IPV, and Hib
  • Kinrix, a combination of DTaP and IPV

Kids should have booster shots when they are 11 to 12 years old:

  • 1 dose of Tdap
  • 1 dose of Menactra or Menveo, with a booster dose at age 16
  • 3 doses of HPV vaccine

Immunization Statistics

Another way to think about the immunization schedule is that by the time they start kindergarten, most kids will get multiple doses of 10 vaccines to protect them against 14 vaccine-preventable infections.

Why is that better than the immunization schedules from the 1980s when kids only got 10 doses of 3 vaccines (1983) or 11 doses of 4 vaccines (1989)?

Sure, they got fewer shots back then, but the more important statistic is the much higher numbers of many infections that are now preventable with vaccines that people (mainly kids) got each year in the years before a routine vaccine was given for protection, such as:

  • Pneumonia, meningitis, and blood infections from the Streptococcus pneumoniae bacteria – 63,067 cases and 6,500 deaths
  • Meningitis, epiglottitis, and other serious infections from the Haemophilus influenzae type b (Hib) bacteria – 20,000 cases and 1,000 deaths
  • Hepatitis A – 117,333 cases, 6,863 hospitalizations, and 137 deaths
  • Hepatitis B – 66,232 cases, 7,348 hospitalizations, and 237 deaths
  • Rotavirus gastroenteritis – 3 million cases, 70 hospitalizations, and 20 to 60 deaths
  • Chickenpox – just over 4 million cases, 10,000 hospitalizations, and 100 deaths

How Europe Does It

Of course, not everyone in the world follows the CDC immunization schedule. Some people like to point out that other countries have immunization schedules with fewer vaccines, such as Denmark, Sweden, Finland, and Iceland. But are their immunization schedules that different?

According to the National Board of Health and Welfare in Sweden, all children "are offered vaccination against nine serious diseases: diphtheria, tetanus, whooping cough, polio, Hib infection (Haemophilius influenzae type B), pneumococcal infection, measles, mumps, and rubella. From January 1, 2010, all girls born 1999 or later are also offered vaccination against infection with the human papillomavirus (HPV). Children who are at high risk of infection or serious illness are offered vaccination against hepatitis B, tuberculosis, influenza, and pneumococcal infection (if not already vaccinated as infants)."

And according to the Finnish National Vaccination Programme, kids in Finland routinely get the rotavirus vaccine, DTaP, IPV (polio), Hib, MMR, the Pneumococcal conjugate vaccine, and a yearly flu vaccine. Children in high-risk groups are vaccinated against tuberculosis (BCG), hepatitis B, and hepatitis A.

Iceland has added the Streptococcus pneumoniae vaccine to their routine immunization schedule, and others are studying adding it soon.

So the big difference in most European immunization schedules is a lack of a chickenpox vaccine and targeted vaccination against hepatitis A and hepatitis B, while we use universal immunization programs against these vaccine-preventable infections after previous failed attempts at targeted vaccination campaigns.

This makes sense, since:

  • Hepatitis A is not endemic in most countries in Europe
  • Hepatitis B is often found in very well-defined risk groups in many countries in Europe

However, many countries, such as Spain, already give the hepatitis B vaccine, are starting to give the HPV vaccine to teen girls, and even give the chickenpox vaccine to teens if they haven't had chickenpox yet.

Most countries in Europe are still studying the risk versus benefit analysis of routinely using the rotavirus vaccine.

The big takeaway from these other countries is not that they use fewer shots; it is what a good job they do in vaccinating their kids. In Finland, vaccination coverage statistics show that 98 to 99 percent of children are vaccinated.

Also, many countries have immunization schedules that are nearly identical to the CDC immunization schedule. Since 2007, infants in Australia, for example, have gotten five vaccines at two months of age, just like in the United States—hepB, DTaP, Hib, IPV, Prevnar 7, and a rotavirus vaccine.

Alternative Immunization Schedules

Other alternative immunization schedules that some people continue to promote include the:

  • User-Friendly Vaccination Schedule: Beginning at age two years, one at a time, get individual pertussis (acellular pertussis), diphtheria, tetanus, and then IPV (polio) shots every six months, even though individual pertussis, diphtheria, and tetanus shots aren't available anymore
  • Dr. Bob's Alternative Vaccine Schedule: Spaces out vaccines so that infants don't get more than two at a time, but they have to get monthly shots instead, delays hepatitis A and hepatitis B vaccine until kids are older, and recommends individual measles, mumps, and rubella shots instead of the combination MMR vaccine

Parents should understand that whether an alternative schedule can reduce vaccine side effects, or even safely prevent vaccine-preventable infections (the delay in getting shots can leave your child unprotected and risk for getting a vaccine-preventable infection), is untested and unproven.

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Article Sources
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  • Finland National Institute for Health and Welfare. Vaccines in Finland.

  • American Academy of Pediatrics. Immunization Schedule.
  • Australian Government Department of Health and Ageing. National Immunisation Program Schedule.
  • Center for Disease Control and Prevention. The United States 2016 Recommended Immunization Schedules for Persons Aged 0 Through 18 Years.
  • Long: Principles and Practice of Pediatric Infectious Diseases Revised Reprint, 3rd ed. - 2009.
  • MMWR: National, State, and Local Area Vaccination Coverage Among Children Aged 19-35 Months — the United States, 2009. MMWR. September 17, 2010 / 59(36);1171-1177.
  • Sweden National Board of Health and Welfare. Vaccinations in Sweden.