January 15, 2009
By Claire McCarthy, M.D.
Boston Children's Hospital
As I'm finishing up checkups with children, going over advice and putting on bandaids after shots, I am often asked, "Will I need a shot next time?" And my most honest answer is: "I don't know."
This sounds strange, because doctors are supposed to know what shots are needed when, right? But here's the thing: The schedule changes all the time. New immunizations are being developed continuously, and we are always learning new things about old immunizations. That's why the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention(CDC) jointly update the recommendations usually every January.
There are no new immunizations this year, but there are two changes:
- The influenza vaccine is now routinely recommended every year for children ages 6 months to 18 years. Children younger than 9 years who are getting the flu shot for the first time, should get two doses a month apart. People who have "close contacts" with children younger than 4 years, and with children ages 5 to 18 who have a medical problem that makes influenza particularly risky, such as asthma, also need the vaccine.
- A second oral rotavirus vaccine has been licensed by the U.S. Food and Drug Administration. Both require three doses. The first dose is given between 6 and 14 weeks of age; the last dose must be given before 8 months of age.
Parents should also be aware of changes to the recommendations that occurred within the last two years or so:
- Pneumoccal conjugate vaccine (PCV, Prevnar) – According to the previous recommendation, children who didn't get all four recommended doses by age 2 years were still considered protected. Now, children between 2 and 5 years old who missed any of the doses need one catch-up dose. Live attenuated influenza vaccine. FluMist, a nasal spray, can now be given to children as young as 2 years — but only if they are healthy. Children with asthma or other health problems should continue to get the actual shot.
- Meningococcal vaccine – This change only affects children ages 2 to 10 years old who have a higher than usual risk of meningococcal disease, such as those who are traveling to countries where meningococcal disease is common, or those who have problems with their immune system. It is now recommended that they get the newer meningococcal vaccine (MCV4, marketed as Menactra) instead of the polysaccharide vaccine (MPSV4) given before.
- Catch-up schedules for TdaP – This only applies to kids 7 to 18 years old who got their first dose of diphtheria/pertussis/tetanus before 12 months but then missed remaining doses. They now need four doses, with only four weeks instead of eight between the second and third doses.
- HPV vaccine – This vaccine protects against human papilloma virus (HPV), the most common sexually transmitted disease and the biggest cause of cervical cancer. It’s given in three doses over six months, and is recommended for all women ages 9 to 25 years.
- Varicella vaccine booster – This is an example of how we learn things about vaccines as we use them. Doctors have been seeing cases of varicella (chickenpox) in children who had the vaccine, so a second dose to boost protection is now recommended. Young children can get the booster at ages 4 to 5 when they are getting other boosters. But it can be given anytime, as long as it's been at least 3 months since the first dose. (Older children should get it at their next doctor's visit.)
- Hepatitis A vaccine – This virus, spread between people or through contaminated food, causes a liver infection. While people generally recover fully, they can have stomachaches, nausea, vomiting, fever, and loss of appetite for up to six months. Because of this, the vaccine is recommended for all children 1 year and older. It's given in two doses, six months apart.
- Meningococcal vaccine (Menactra) – This protects against meningoccus, a bacteria that can cause a swift and deadly disease. The illness is most common among people who live together in, for example, dormitories or military barracks. The vaccine is recommended for all children starting at age 11 to 12 years old, but should be considered earlier for those who go to boarding school or an extended sleep-away summer camp.
More detailed information on all vaccine recommendations is available on the CDC webiste. And, as always, if you have any questions you should talk to your doctor.
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Claire McCarthy, M.D. is an assistant professor in pediatrics at Harvard Medical School, an attending physician at Children's Hospital of Boston, and medical director of the Martha Eliot Health Center, a neighborhood health service of Children's Hospital. She is a senior medical editor for Harvard Health Publications.
