Health Care Professionals
Healthcare Professional Vaccine Resources
Providers may use this content to help ensure understanding of vaccines or help answer questions from patients using more clinically-focused information.
No, children are at risk for these vaccine-preventable diseases from the moment they are born. The only way to protect them from these diseases is to help their immune system recognize and fight against them.
Infants and children’s immune systems are really good at recognizing things that don’t belong in the body, like germs. This is important because we are quickly exposed to trillions of bacteria! If 11 vaccines were given at once, it would only use up about 0.1% of the immune system’s ability at that time.
Clear Answers About Your Baby’s Shots
Historical Look at Number of Antigens in Vaccines
Dr. Paul Offit on Number of Vaccines
Diphtheria, Tetanus, and Pertussis
The vaccine is very effective, but its protection decreases over time. It is given at 2, 4, 6, 12-15 months and again at 4-6 years, with booster shots in adolescence. It provides 95% protection from diphtheria and almost 100% protection from tetanus, but booster doses are needed. The protection from pertussis (whooping cough) starts at about 85%, but it fades, and it has been harder to maintain immunity over the past 20 years.
The most common side effects of the DTaP vaccine are pain and swelling at the injection site, which occur in about 1/3 of children and may get worse with later doses. A small percentage of children (3-5%) may have a fever. Severe reactions happen in about 1 in every 10,000 children and can include a fever of 105°F or higher, fever-related seizures, crying that cannot be stopped, or a condition called hypotonic-hyporesponsive syndrome. This condition makes a child feel very tired and weak with poor muscle tone for several hours. There are some precautions and situations where DTaP vaccination may not be recommended. You can find more information on the CDC website, including the CDC Pink Book on pertussis vaccines.
In Japan, when they stopped giving the pertussis vaccine in 1975, the number of pertussis cases rose dramatically, going from 400 to 13,000 per year by 1979. During the same time, the number of deaths from pertussis increased from 10 to 41.
CDC Pink book on pertussis, Pink book chapter on tetanus, Pink book chapter on Diphtheria
Infants have smaller airways, so they have a harder time breathing when they get pertussis. Some babies can have low oxygen levels, which can be life-threatening.
The answer is both! Although DTaP is one vaccine, it helps protect against three diseases: diphtheria, tetanus, and pertussis. DTaP is also included in combination vaccines, like Vaxelis, Pentacel, Pediarix, and others. Quadracel and Kinrix are only used for the booster doses given to 4-6-year-olds.
DTaP vaccine information statement, Pediarix product information, Pentacel product information, Vaxelis product information, Daptacel product information, Infanrix product information
Inactivated poliovirus vaccine
The IPV vaccine is very effective. While people vaccinated with IPV might get polio in their GI tract and pass it on, the vaccine is 99% effective at preventing paralytic polio, which is the most serious form. The graph below shows the huge impact the vaccine had on polio cases in the US.
The vaccine is very safe. The main side effects are fever and pain or swelling at the injection site.
Although wild polio is only found in a few countries, many countries still use the oral polio vaccine, which can be spread and may cause cases of vaccine-derived poliomyelitis. Recently, an unvaccinated person in New York got paralytic polio, likely from this type of exposure. Poliovirus has also been found in wastewater samples in the U.S. Remember, completing the full IPV series prevents paralytic polio. It’s especially important to get vaccinated if you’re traveling internationally.
Polio is spread through the mouth and can be passed in stool. Young infants are more likely to get diseases that spread this way, known as the “fecal-oral” route.
PV is considered a single vaccine (IPOL) because it protects against one virus, but it creates immunity to three different types (serotypes) of that virus. It is also available in combination with other vaccines, such as Kinrix, Quadracel, Pediarix, Pentacel, and Vaxelis. Kinrix and Quadracel are only used for the booster dose for 4-6-year-olds.
CDC Pink book chapter on polio, Pediarix product information, Pentacel product information, Vaxelis product information, IPOL product information
Yes, after the final booster dose given by 15 months of age, about 95% of infants are protected from Hib disease, no matter which vaccine is used, including the combination vaccines. Since the vaccine was introduced, there has been a 99% reduction in clinical disease caused by Haemophilus type b.
Most side effects are local, like pain and swelling at the injection site. Some infants might be fussy. Rarely, there have been reports of allergic reactions to the ingredients
Hib used to be very common, with 1 in 200 children under age 5 getting invasive Hib disease. Before the vaccine, there were 20,000 cases each year. From 2009-2018, only 36 cases were reported in children under 5. However, in 2019, there were 18 cases, all in children who were either not vaccinated or not fully vaccinated. This shows that Hib can return if vaccination rates drop.
Hib mostly affects children under the age of 5, with the highest number of cases happening in infants between 6-11 months old. It’s very important to vaccinate infants to protect those at the greatest risk.
Both! The Hib vaccine can be found as a single vaccine or combined with other vaccines given to infants.
About Hib vaccines, ActHib product information, PedVax Hib product information, Hiberix product information, Vaxelis product information, Pentacel product information
The polysaccharide vaccine has unique sugars from the different pneumococcal serotypes. The conjugate vaccine has serotype polysaccharides attached to a carrier protein. The polysaccharide vaccine elicits an immune response independent of T-cells. The conjugate vaccine covers fewer serotypes (currently) but stimulates T cells and leads to memory B cell production.
Yes, the original 7-valent conjugate vaccine was shown to reduce pneumonia in children by 20%, ear infections (otitis media) by 7%, and the need for ear tubes by 20%. According to the ACIP, the PCV-13 vaccine has helped reduce pneumonia in children by 17-35% and acute ear infections by 11-14%. Both the 7-valent and 13-valent vaccines have also helped lower the spread of the included bacteria types. The CDC reports that, thanks to the childhood PCV-13 vaccine, invasive pneumococcal disease in older adults has dropped by 60%. While there is less data on the newer vaccines, the immune responses they produce for the included bacteria types are just as strong. The polysaccharide vaccine has shown a 60-70% reduction in invasive pneumococcal disease in adults, but it doesn’t reduce how much the bacteria spreads.
PPSV-23 effectiveness, Pneumococcal vaccine comparisons, Pneumococcal conjugate vaccine efficacy
The vaccine is generally well tolerated, with most side effects being local, such as pain and tenderness at the injection site. Some people may also experience fatigue, decreased appetite, muscle aches, and fever. Although it is safe to give the PCV vaccine along with the inactivated flu vaccine, there has been a slight increase in febrile seizures when they are given together to children aged 12-15 months.
Before pneumococcal vaccination started in 2000, there were about 17,000 cases of invasive pneumococcal disease (IPD) in children under 5, including 200 deaths. By 2021, that number had dropped to just 770 cases. However, many countries still do not vaccinate with the pneumococcal vaccine. The World Health Organization (WHO) estimates that 300,000 children under the age of 5 die from pneumococcal disease each year in countries without the vaccine.
As mentioned earlier, many cases of invasive pneumococcal disease (IPD) affect young children. Pneumococcal pneumonia still causes about 150,000 hospitalizations every year. It is a known complication following influenza infection and has a mortality rate of 5-7% in adults. Vaccinating at a young age helps build long-lasting immunity that can protect individuals through adulthood and prevent the serious effects of pneumococcal disease.
CDC vaccine preventable diseases chapter on Pneumococcal disease
The pneumococcal vaccine is considered a “single” vaccine, even though it protects against many different serotypes of the bacteria. Currently, it is not available in combination with any other vaccines.
Pneumococcal vaccines, Vaxneuvance product information, Prevnar 20 product information, Pneumovax product information
Yes, studies have shown that the two rotavirus vaccines reduce severe rotavirus gastroenteritis by 85-98% and any rotavirus gastroenteritis by 74-87%. The protection is expected to last for 2-3 years, which covers the period when infants are at the highest risk for the disease.
The rotavirus vaccine can sometimes cause mild vomiting and diarrhea in children, along with occasional fever. Since it’s a live vaccine, it should not be given to children with severe immune system issues, like severe combined immunodeficiency (SCID). If you’re unsure about whether it’s safe, it’s best to talk to a doctor or specialist. Children with mild stomach issues can still receive the vaccine. Rotavirus vaccine should not be given in a hospital setting because there’s a risk of spreading the virus to other patients who may be at higher risk. If a child has a latex allergy, Rotateq is the preferred vaccine since Rotarix contains a latex stopper. Children with conditions like spina bifida or bladder exstrophy are at higher risk of developing a latex allergy. While the current rotavirus vaccines slightly increase the risk of a condition called intussusception, it is about the same risk as getting intussusception from a natural rotavirus infection. Since the vaccine became widely used, there hasn’t been an increase in cases of intussusception across the country.
CDC ” You call the shots” module on Rotavirus
Many adults can carry rotavirus without showing symptoms or only have mild symptoms. These mild or asymptomatic cases help keep the virus spreading, which can put younger children at higher risk for more severe illness. Before the rotavirus vaccine was introduced, the virus caused about 500,000 doctor visits, 55,000-70,000 hospitalizations, and 20-60 deaths each year.
Most children get their first rotavirus infection before they turn 5 years old, and the most severe cases are seen in children between 6 and 24 months old.
Yes, with some restrictions. As mentioned earlier, the rotavirus vaccine should not be given in a hospital setting to avoid infecting other high-risk patients. Additionally, it should be avoided in children with severe immunodeficiencies, such as severe combined immunodeficiency (SCID), and a healthcare professional should be consulted before administering the vaccine to children with unclear immune status.
The rotavirus vaccine is a single vaccine given orally. It helps protect against rotavirus infections, which can cause severe diarrhea and dehydration in young children.
Vaccine information sheet on Rotavirus, Rotateq product information, Rotarix product information
This is a great vaccine! After the first dose, 97% of kids develop immunity, and nearly 100% do after the second dose.
You might have some soreness or redness where the shot was given. Fever, headache, tiredness, or a loss of appetite can also happen but don’t last long. Severe reactions, like an allergic reaction (anaphylaxis), are extremely rare.
Thousands of people in the U.S. still get Hepatitis A each year, and about 75 people die from it annually. In a 2019 outbreak, Tennessee had 2,160 cases. From 1996 to 2011, after the vaccine was introduced, cases dropped by 95%. However, they have gone back up due to widespread outbreaks.
Hepatitis A spreads through the fecal-oral route, which makes it easy to spread in places like daycares. Younger children often don’t show symptoms when they’re infected, which can lead to the disease spreading without anyone realizing it. The antibodies from the vaccine can be detected for 20-25 years, and experts believe they could last up to 40 years based on research models.
The Hepatitis A vaccine is available as a single vaccine or combined with the Hepatitis B vaccine in a single shot called Twinrix.
Hepatitis A vaccine VIS , Vaqta information, Havrix product information, Twinrix product information
Yes! After finishing the primary vaccine series, about 90% of children and adults under 40 years old develop strong protection. For those aged 60 and older, around 75% develop strong immunity. The immune protection lasts for at least 30 years in most people. The Hepatitis B vaccine alone is 75% effective at preventing the transmission of Hepatitis B from positive mothers to their babies if given within the first 12 hours of birth. This increases to 94% when combined with Hepatitis B immunoglobulin.
Most side effects are mild, like soreness or redness at the shot site that lasts 1–2 days. Sometimes, people might have a fever or headache. The vaccine has not been linked to any autoimmune disorders or long-term illnesses.
Between 600,000 and 2.4 million Americans have Hepatitis B, and some may not even know it. The decrease in infections during 2020-2021 is likely because fewer people were seeking medical care during the pandemic. Worldwide, there are about 300 million cases. The biggest concern is chronic infection, which can lead to liver damage or liver cancer. While Hepatitis B is less common in the U.S., it is more common in people who have come from areas where the disease is more widespread.
About 5% of adult Hepatitis B infections become chronic, but for infants, that number is much higher—90%. Most of these infections happen at birth or during early infancy. Of those who are chronically infected from childhood, about 25% will die early due to liver disease.
The Hepatitis B vaccine is available as a single vaccine or in combination with other vaccines. Be sure to check the dosing instructions, as they can vary depending on the age and the specific product. Vaccines like Twinrix, Hepsilav, and Prehevbrio are approved only for people aged 18 and older.
Pediarix product information, Vaxelis product information, Twinrix product information, Engerix product information, Recombivax product information, Hepsilav product information, Prehevbrio product information
Yes, in fact, 99% of people who receive two doses of the Hepatitis B vaccine have a lasting antibody response. Even after just one dose, 95% of people develop enough immunity. The second dose isn’t exactly a “booster,” but more of a chance to help those who didn’t develop immunity from the first dose. Once vaccinated, the immunity is considered lifelong.
Because MMR (Measles, Mumps, Rubella) is a live vaccine, there are some situations where it should not be given. These include:
• Severe immune problems or a family history of immune deficiencies
• Using high-dose steroids for more than 14 days
• Being pregnant
• Having an allergic reaction to any vaccine ingredients
• HIV-positive status (for the MMRV vaccine only)
• It should also not be given within four weeks of another live vaccine unless they are given on the same day.
Precautions for MMR include:
• Allergy to alpha-gal (a sugar found in red meat)
• Moderate to severe illness
• Recent receipt of blood products or other live vaccines
• Thrombocytopenia (low platelet count)
• Need for TB or interferon gamma testing
• For MMRV (the combination vaccine), precautions include:
• Recent use of aspirin
• Personal or family history of seizures
• Use of certain antivirals in the previous 24 hours
Common side effects include:
• Soreness at the injection site
• Fever and febrile seizures (more common with MMRV)
• Rash
• In older women, joint pain (arthralgias)
• Serious side effects are rare, but they can include:
• Anaphylaxis (severe allergic reaction) in about 2-14 cases per 1 million doses
• Thrombocytopenia (low platelet count), lymphadenopathy (swollen lymph nodes), and parotitis (swelling of the parotid glands)
• Encephalopathy (brain inflammation) in people with immune deficiencies.
CDC Pink book on MMR, “You call the shots” MMR section
Measles still causes outbreaks, especially in communities where people aren’t vaccinated or are only partly vaccinated. In 2024, a 5-year-old child died from measles in Canada, a country where measles was nearly wiped out. Complications from measles are common, and about 2-3 out of every 1,000 people who get it will die. The World Health Organization (WHO) estimates that vaccines have prevented 57 million deaths worldwide. However, between 2000 and 2022, measles still caused 136,000 deaths globally. Before the measles vaccine was created, the United States saw around half a million measles cases each year, with about 500 deaths annually. Measles is very contagious. If 100 people are exposed to it, 90 of them are likely to get it. Also, a room can stay contaminated with the virus for hours after an infected person leave.
The CDC says that children younger than 5 years old are more likely to have serious problems if they get measles.
Even though there are special rules for using live vaccines, they are very safe and help prevent serious and life-threatening diseases. The viruses in these vaccines are grown in different types of cells where they usually infect. Over time, the viruses become less able to cause illness in human cells, so they help the body build immunity without causing significant disease.
The MMR vaccine protects against measles, mumps, and rubella. There is also a version called MMRV, which combines the MMR vaccine with the chickenpox vaccine.
MMR II product information, Priorix product information, Proquad product information (MMRV)
Yes! One dose of the Varicella vaccine is 82% effective at preventing the disease, but it’s nearly 100% effective at preventing severe cases. Two doses are 92-98% effective at preventing any form of the disease and 100% effective against severe cases. We don’t know the exact length of protection, but studies have shown that good immunity lasts for 10-20 years.
- The most common side effects of the varicella vaccine are pain, fever, and a rash. These are usually mild and more common after the first dose. Serious side effects are very rare but may happen if the person has an undiagnosed immune problem. These rare reactions include pneumonia, a severe rash, meningitis (an infection of the brain), and seizures.
- The chance of spreading the chickenpox virus to others after getting the vaccine is rare. It can only happen if a rash is present.
- Varicella (chickenpox) or MMRV (which also protects against measles, mumps, and rubella) should not be given to people with certain cancers, like leukemia or lymphoma, or to those with weakened immune systems, including people with AIDS or severe HIV. It should also not be given to people whose close family members have hereditary immune problems.
- If someone is taking steroids for a long time (more than two weeks) or taking high doses of steroids (more than 2 mg/kg/d), they should not get the vaccine. However, it is okay to vaccinate after stopping steroids for a month or after chemotherapy for 3 months.
- Pregnant women should not get the vaccine, and they should wait at least 4 weeks after getting it before becoming pregnant. People with a personal or family history of seizures should get the varicella vaccine (not MMRV) because MMRV has a higher risk of causing febrile seizures.
- There are also certain rules about when to get the vaccine if you have had blood products or immunoglobulin. You can find more details from the CDC about this.
- If someone is taking antivirals for herpesviruses, like acyclovir or valacyclovir, they should stop taking them 24 hours before getting the vaccine and should avoid them for 14 days after the vaccine. While it is not known to cause harm, it is recommended to avoid taking aspirin for 6 weeks after the vaccine.
CDC “You call the shots” for Varicella
Before the chickenpox vaccine, about 4 million people got chickenpox every year. It caused 10,000 hospitalizations and led to about 100 children dying each year.
CHOP page on Varicella, What if my child in not vaccinated for Chickenpox
Children are more likely to be exposed to chickenpox, and the immunity from the vaccine seems to last for a lifetime. However, the vaccine can’t be given to younger children because the antibodies passed from the mother to the child might interfere with the vaccine’s ability to work.
As mentioned earlier, there are some risks to consider, but for most people, the Varicella vaccine is safe and effective in preventing chickenpox.
Varicella is available as a single vaccine or as a combination vaccine with the MMR vaccine (measles, mumps, and rubella).
Varicella product information, Proquad product information (MMRV)
(Starting with 2024-25 season, flu vaccines will be trivalent. The Yamagata B flu strain has been removed from the vaccine as it is no longer circulating. Most resources mentioned still reference the quadrivalent vaccine)
The flu vaccine is effective in preventing influenza infection, with effectiveness ranging from 20% to 60%, depending on factors like how well the vaccine matches the virus circulating that year. While that number might seem low, the vaccine still helps reduce hospitalizations and deaths, especially in children. For example, one study showed a 74% reduction in ICU admissions for children with the flu. Another study showed a 51% reduction in flu-related deaths for children with high-risk conditions, and a 65% reduction for healthy children. The flu vaccine also helps make flu cases less severe.
The flu shot can cause some pain, redness, or swelling where the needle went in. This happens in about 15-20% of people. Less than 1% of people might get a fever, chills, or sore muscles. If you get the flu vaccine as a spray in your nose, some children might get a stuffy nose, runny nose, or fever. Adults might feel more tired, have sore muscles, a sore throat, headache, or cough. There’s a very small chance (about 1 in a million) of getting a serious condition called Guillain-Barré syndrome (GBS) after getting the flu vaccine. However, if someone has had GBS within 6 weeks of a previous flu vaccine, they should not get the vaccine unless they are at higher risk of flu complications.
Some people should not get the flu vaccine as a nasal spray:
- Pregnant women
- Children ages 2-4 who have had asthma or wheezing in the last 12 months
- People who take aspirin all the time
- People with weak immune systems
- People who live with someone who has a weak immune system
- People who have taken medicine for the flu recently (make sure to check when it’s safe to get the vaccine)
- People who have had ear implants or leaks in the fluid around the brain
- People who have had a bad allergic reaction to the flu vaccine before
- There is no longer a need to avoid the flu vaccine if you are allergic to eggs. But people with asthma over 5 years old should avoid the nasal spray version of the vaccine.
- If you are very sick, you should wait to get the flu vaccine until you feel better. If you have a bad cold and your nose is stuffy, the nasal spray might not work well.
CDC “You call the shots” module on influenza vaccine, Can I get a flu vaccine?
Infection rates are higher among children, and children under 2 years old are at a higher risk for being hospitalized or dying from the flu. On average, about 120-130 children die from the flu each year. It is recommended that everyone over the age of 6 months get a flu vaccine. If a child is under 9 years old and has not had more than one flu vaccine in the past, they should get two doses for that flu season. The best time to get the vaccine is in September or October in the Northern Hemisphere.
Flyer on benefits of influenza vaccination, Guide for determining how many doses of flu vaccine to give a patient, How serious is influenza?
Yes, if the precautions mentioned in Concern 2 are followed. Even though it’s a “live” vaccine, the intranasal flu vaccine is “cold-adapted.” This means it works well in the cooler upper part of the nose (nasopharynx) where it helps trigger the immune system. It doesn’t grow well in the warmer parts of the lower respiratory tract, so it doesn’t cause a full-blown flu infection.
Researchers are still working on finding better vaccines to prevent influenza. However, the current vaccines are still very effective at reducing serious flu complications and saving lives. You can check the resource below for more information and helpful ways to share this message with patients and the public.
Influenza vaccine comes in different forms. The live intranasal vaccine (FluMist) is for people ages 2 to 49. There are also vaccines made without eggs, including the recombinant vaccine (FluBlok) and the mammalian cell-based vaccine (FluCelvax). Egg-based vaccines include standard-dose vaccines like Afluria, Fluarix, Flulaval, and Fluzone. There is also a high-dose version of Fluzone and a standard-dose adjuvanted vaccine called Fluad.
Injectable flu vaccine VIS, Intranasal flu vaccine VIS, Clinical information on influenza including product information on available vaccines
mRNA vaccines, which are being used more now, have been researched and tested for many years. A big breakthrough was the development of lipid nanoparticles, which protect the mRNA from breaking down too quickly so it can trigger an immune response. These vaccines have gone through the same safety tests as other vaccines. The COVID-19 pandemic sparked a lot of public interest in vaccine trials and provided extra funding, which allowed for faster testing and monitoring. Even now, after millions of doses, the vaccine is being closely watched for any safety issues. So far, it appears to be just as safe as other vaccines we regularly use. For people aged 12 and up, there’s also a protein subunit vaccine called Novavax. This technology is like what has been used in the Hepatitis B and HPV vaccines. Side effects are like the mRNA vaccines but are usually less common and milder.
Yes, the COVID-19 vaccines have been proven safe for children. Younger children are more likely to have no prior immunity and are less likely to have had previous COVID-19 infections. Ongoing monitoring has not found any major safety concerns in young children. The one exception is a slight increase in myocarditis (inflammation of the heart) seen in adolescent males. This happens in about 1 in 50,000 boys after the second dose of the vaccine. However, the rate of myocarditis is lower than what is seen after a natural COVID-19 infection, and the vaccine-related myocarditis is usually temporary and less severe.
Q/A about COVID vaccines, COVID disease vs vaccine, CHOP vaccine center on COVID vaccines, Kelly Moore on the safety of mRNA vaccines in children
No, mRNA doesn’t affect your DNA. It goes into the cell and helps make a protein in the part of the cell called the cytoplasm. The mRNA doesn’t go into the nucleus where your DNA is, so it can’t change your DNA.
Most side effects are short-lived and include pain and swelling at the injection site. Some people may also experience fever, tiredness, headaches, and muscle aches in the first few days after getting the vaccine. Sometimes, a rash may form around the injection site. Anaphylaxis, a severe allergic reaction, happens in about 5 out of every 1 million doses. Myocarditis (inflammation of the heart) and pericarditis (inflammation of the lining around the heart) have been seen in about 1 in 50,000 doses, mostly in males in their teens and twenties, usually a few days after the second dose. However, these cases are mild and go away on their own. Since the risk of myocarditis from a COVID infection is higher, this side effect has not changed any vaccine recommendations.
Vaccine immunity can decrease over time. However, protection against severe disease and death seems to last longer. People in higher-risk groups still need regular immunizations to reduce the serious health effects of COVID. All children ages 6 months to 23 months are at higher risk for hospitalizations and would benefit from getting vaccinated. Vaccination also helps protect against “long COVID,” with about 40% effectiveness in preventing persistent symptoms. SARS-CoV-2 is likely to stay around for a long time, and vaccination will remain our best way to prevent serious health problems, especially in those who are at higher risk.
COVID-19 vaccines currently come as a single dose and include a monovalent strain formulation. The mRNA vaccines use the KP.2 strain, while the Novavax vaccine uses the JN.1 strain. These strains are closely related and have been dominant at different times in 2024. They are expected to provide strong immunity, even as the virus continues to evolve. It’s expected that, like the flu vaccine, the COVID vaccine may adjust to new strains annually. However, there is no combination vaccine for COVID-19 and influenza currently.
Comirnaty product information, Spikevax product information, Novavax product information
RSV (Respiratory Syncytial Virus) vaccine and monoclonal antibody
- The RSV vaccine is approved for people aged 60 and older, with shared decision-making based on their risk for severe RSV disease. The vaccine is 83-89% effective at preventing RSV-caused pneumonia in the first year. After the second year, protection drops to 56% against RSV pneumonia.
- Another RSV vaccine, Abrysvo, is recommended for pregnant women between 32 and 36 weeks of pregnancy, ideally from September 1 to January 31. However, some areas may have different schedules based on local RSV seasonality.
- Nirsevimab, a monoclonal antibody for RSV, is recommended for infants under 8 months old born between October 1 and March 31, or those entering their first RSV season. Nirsevimab should not be given if the baby’s mother received Abrysvo vaccine unless specific conditions apply, like Abrysvo not being given to the mother, given less than 14 days before delivery, or given more than 14 days before delivery but with a potential for a weak response (e.g., if the mom is immunocompromised or the baby has certain medical conditions).
- The RSV vaccine given to pregnant women showed 51-57% effectiveness in preventing all medically attended RSV infections and 69-82% effectiveness against severe RSV infections, lasting up to 180 days after vaccination.
- Nirsevimab can also be given to infants aged 8-19 months during their second RSV season if they are at higher risk for severe RSV, such as American Indian and Alaskan Native children, severely immunocompromised children, those with chronic lung disease of prematurity, or severe cystic fibrosis.
- In 2023-2024, Nirsevimab was shown to reduce RSV-related hospitalizations, with late-phase testing predicting an 80% reduction in RSV-related hospitalizations and a 90% reduction in ICU admissions.
Standing orders for RSV immunization, Nirsevimab recommendations MMWR 2023
Soreness, redness, and rash are common side effects that have been reported after receiving any of the RSV vaccines.
RSV is very common and causes about 10,000 deaths each year in the United States, including 100-300 children. The CDC estimates that 1-2% of all children in the US will be hospitalized with RSV in their first six months of life. By the time they are two years old, almost all children will have been infected with RSV. RSV leads to about 2 million outpatient visits every year for children under the age of five.
Nirsevimab is a monoclonal antibody, meaning it contains just one type of antibody specifically targeted against RSV. Both the RSV vaccines and Nirsevimab are only for RSV and are not combined with any other vaccines.
Abrysvo product information, Arexvy product information, Nirsevimab product information, RSV vaccine VIS, Nirsevimab immunization information statement
Free Adult/Adol/Peds
MOST BUT NOT ALL INSURANCE MANDATED TO COVER.
Patients under the age of 19 are allowed to receive VFC vaccines in eligible. Eligibility includes uninsured patients or those having Medicaid (TennCare) even if secondary. CHIP program enrollees do NOT qualify for VFC. Alaska Native or American Indian patients are also VFC eligible even in privately insured.
Underinsured patients may receive VFC vaccines, but only at a Rural Health Clinic or a Federally Qualified Health Center. See this link for more details on definition of uninsured. CDC page on VFC eligibility.
Most privately insured patients will have coverage for vaccination, but some self- funded plans have limits on coverage. Cost sharing plans (ie. MediShare) are not traditional insurance plans and therefore those patients should be VFC eligible. Check with your state vaccine program for confirmation.
CDC guide on how to pay for vaccines
DTaP is used for children up to age 7. For children 7 and up, Tdap should be used.
- The DTaP vaccine is very effective but its protection decreases over time. It’s given at 2, 4, 6, and 12-15 months, and again at 4-6 years, with boosters during adolescence. The vaccine provides 95% protection from diphtheria and almost 100% protection from tetanus, but booster doses are needed. Immunity to pertussis (whooping cough) starts at about 85%, but this protection wears off over time, and maintaining immunity has become harder over the past 20 years.
- The Tdap vaccine, given to children over age 7, is estimated to have 73% effectiveness one year after vaccination, but this drops to 34% by four years after vaccination.
DTaP vaccine information from CHOP, CDC “You call the shots” module on Tdap
The most common side effects of the DTaP vaccine are pain and swelling at the injection site, which occur in about 1 in 3 children and can get worse with later doses. A small percentage of children may have a fever (3-5%). More severe reactions happen in about 1 in 10,000 children and can include a high fever of 105°F or more, seizures caused by the fever, inconsolable crying, or hypotonic-hyporesponsive syndrome. This syndrome makes a child become very tired, weak, and have poor muscle tone for several hours. Local reactions, like pain and swelling, are usually more common with the booster doses.
In 1975, Japan stopped giving the pertussis vaccine, and as a result, the number of pertussis cases increased from 400 to 13,000 per year by 1979. Deaths also rose from 10 to 41 during the same time. This shows how important it is to give booster shots to school-age children, as they can often have mild cases of the disease but still spread it to more vulnerable people, like babies and the elderly.
CDC Pink book on pertussis, Pink book chapter on tetanus, Pink book chapter on Diphtheria
Booster doses at school age help keep our immunoglobulin levels high, which helps prevent infection. This is especially important because, as mentioned earlier, immunity can weaken over time, making booster shots necessary to maintain protection.
The answer is both! DTaP is a single vaccine that protects against three diseases: diphtheria, tetanus, and pertussis. It can also be combined with other vaccines in combination shots like Vaxelis, Pentacel, and Pediarix.
However, there are some important rules about these combinations:
- Vaxelis should not be used for the 4th or 5th dose of DTaP.
- Pediarix and Pentacel should not be used for the 5th dose or for children aged 5 or older.
DTaP vaccine information statement, Kinrix product information, Pediarix product information, Pentacel product information, Quadracel product information, Vaxelis product information, Daptacel product information, Infanrix product information
Inactivated Polio Virus
The IPV (inactivated polio vaccine) is a very effective vaccine. Even though people who receive the IPV vaccine might still get polio in their stomach or intestines and spread it to others, the vaccine is 99% effective at preventing the severe and dangerous form of polio called paralytic polio. The graph below shows how dramatically the number of polio cases in the U.S. dropped after the vaccine was introduced.
The IPV vaccine is very safe. The most common side effects are fever and pain or swelling at the injection site. These side effects are usually mild and go away on their own.
While wild polio is limited to just a few countries, some places still use the oral polio vaccine, which can sometimes spread and cause cases of vaccine-derived poliomyelitis. Recently, an unvaccinated person in New York got paralytic polio, likely from this type of exposure. Poliovirus has also been found in U.S. wastewater samples. It’s important to remember that getting the full IPV vaccine series protects against paralytic polio. Being vaccinated is even more crucial if you’re traveling internationally.
Polio is spread through the mouth and can be found in stool. Young infants are more at risk for diseases spread this way, called the “fecal-oral” route. A booster shot at age 4-6 years helps make sure people stay protected and have good immunity throughout their life.
PV is a vaccine that helps protect against polio. It helps the body fight off three different types of the polio virus. Sometimes, this vaccine is combined with other vaccines, but there are rules for when it can be used:
- PENTACEL is not for children who are 5 years old or older.
- PEDIARIX can be given to children up to age 6, but it is not used for the 4th dose of the polio vaccine.
- VAXELIS should not be used for the 4th dose of the polio vaccine, and it’s not for children who are 5 or older.
- Quadracel and Kinrix are only used for the booster doses when children are 4 to 6 years old.
CDC Pink book chapter on polio, Quadracel product information, Kinrix product information, Pediarix product information, Pentacel product information, Vaxelis product information, IPOL product information
After babies get their last booster shot by 15 months of age, about 95% of them are protected from Hib disease. This is true no matter which vaccine is used, even the combination ones. Since the Hib vaccine was introduced, cases of the disease caused by Haemophilus type b have dropped by 99%.
Most side effects are mild and happen at the injection site, such as pain and swelling. Some babies might be a little fussy. In very rare cases, there are reports of allergic reactions to the ingredients in the vaccine.
Before the vaccine, Hib disease was very common, with 1 in 200 children under 5 getting sick from it. There were about 20,000 cases each year. But from 2009 to 2018, only 36 cases were reported in children under 5. However, in 2019, 18 cases were seen, and all of them were in children who hadn’t received the vaccine or didn’t get all their doses. This shows that without vaccination, the disease can come back.
Hib disease mostly affects children under the age of 5, with the highest number of cases in babies 6 to 11 months old. It’s important to vaccinate infants to protect them from this disease. The Hib vaccine is not usually given to children over 59 months old if they haven’t been vaccinated before, but some children with special health needs may still get the vaccine. These children include:
- Kids who have had a bone marrow or stem cell transplant
- Children with HIV
- Kids with no spleen, low immune system, or those receiving chemotherapy or radiation.
Both! The Hib vaccine can be given as a single vaccine or as part of a combination with other infant vaccines. However, combination vaccines are not commonly used for this age group due to certain restrictions. Pentacel should not be used for children age 5 and older. Vaxelis is not recommended for a booster dose.
About Hib vaccines, ActHib product information, PedVax Hib product information, Hiberix product information, Pentacel product information,
The polysaccharide vaccine has unique sugars from the different pneumococcal serotypes. The conjugate vaccine has serotype polysaccharides attached to a carrier protein. The polysaccharide vaccine elicits an immune response independent of T-cells. The conjugate vaccine covers fewer serotypes (currently) but stimulates T cells and leads to memory B cell production.
The original 7-valent conjugate vaccine helped reduce pneumonia in children by 20%, ear infections (otitis media) by 7%, and the need for ear tubes (tympanostomy tubes) by 20%. The PCV-13 vaccine has helped reduce pneumonia in children by 17-35% and ear infections by 11-14%. Both the 7-valent and 13-valent vaccines have also reduced the number of people carrying the bacteria that causes these illnesses. According to the CDC, giving PCV-13 to children has helped lower invasive pneumococcal disease (a severe type of infection) by 60% in older adults. Although the newer vaccines don’t have as much clinical data, the immune responses to the included bacteria types are just as strong. The polysaccharide vaccine, which is used for adults, has been shown to reduce invasive pneumococcal disease in adults by 60-70%, but it doesn’t reduce the number of people carrying the bacteria.
PPSV-23 effectiveness, Pneumococcal vaccine comparisons, Pneumococcal conjugate vaccine efficacy
The vaccine is generally well tolerated, with most side effects being local, like pain and tenderness at the injection site. Some people may also feel tired, have a decreased appetite, or experience muscle aches. Occasionally, fever can occur. Although it is safe to give the PCV and inactivated flu vaccines together, there has been a small increase in febrile seizures (seizures caused by fever) when they are given at the same time to children aged 12-15 months.
Pneumococci are bacteria that often live in the upper respiratory tract without causing illness. The percentage of people who carry pneumococci can range from 5% to 90%, depending on the group being studied. While carrying these bacteria doesn’t always lead to disease, it’s important to remember that pneumococci can cause serious infections when the body’s immune system is weakened. Vaccination is a keyway to help prevent these types of infections.
The pneumococcal vaccine for children should follow the catch-up schedule listed below. The CDC has created a PneumoRecs app to help with vaccine decisions, especially for those at high risk. You can find links to the app below. As mentioned earlier, many cases of invasive pneumococcal disease (IPD) affect younger children. Pneumococcal pneumonia still causes around 150,000 hospitalizations each year. It is also a common complication after influenza infection and has a death rate of 5-7% in adults. Giving the vaccine at this age helps build strong immunity that lasts into adulthood and can prevent serious health issues caused by pneumococcal disease.
Catch up schedule for pneumococcal conjugate vaccine, PneumoRecs App from CDC
The pneumococcal vaccine is a single vaccine, but it covers different types (serotypes) of the bacteria, depending on which version of the vaccine is used.
PPSV 23 VIS, Pneumococcal conjungate VIS, Pneumococcal vaccines, Vaxneuvance product information, Prevnar 20 product information, Pneumovax product information
Vaccine recommended universally for all children under age 18. Catch-up is recommended at this age if not given previously.
The pneumococcal vaccine is very effective. About 97% of children developed immunity after the first dose, and nearly 100% developed immunity after the second dose.
Some children may experience soreness or redness at the injection site. Other mild side effects can include fever, headache, loss of appetite, and tiredness, but these usually go away quickly. Severe reactions, like anaphylaxis, are very rare.
Even though the Hepatitis A vaccine has been around for a while, thousands of people still get Hepatitis A in the U.S. each year, with about 75 deaths linked to the disease. For example, in 2019, there were 2,160 cases of Hepatitis A in Tennessee alone. From 1996 to 2011, after the vaccine was introduced, cases of Hepatitis A went down by 95%. However, outbreaks have started to increase again in recent years.
If someone hasn’t already been vaccinated, they should get the Hepatitis A vaccine to protect themselves. The risk of getting Hepatitis A increases with age and certain risk factors. Since Hepatitis A is common in many parts of the world, anyone who plans to travel internationally should also get this vaccine.
The Hepatitis A vaccine is available as a single vaccine or as a combination vaccine with Hepatitis B, called Twinrix.
Hepatitis A vaccine VIS , Vaqta information, Havrix product information
Follow catch-up schedule at this age if not previously vaccinated
Yes, after completing the primary series, 90% of children and adults under 40 develop a strong antibody response. About 75% of those aged 60 and older also have a strong antibody response. Most people who receive the vaccine have immune protection that lasts at least 30 years. The Hepatitis B vaccine alone is 75% effective in preventing transmission from Hepatitis B positive mothers to their infants if given within the first 12 hours of birth. The protection increases to 94% when given with Hepatitis B immunoglobulin.
Most side effects of the Hepatitis B vaccine are mild and local, such as soreness or redness at the injection site, which typically lasts 1-2 days. Occasionally, people may experience fever or a headache. There has been no evidence linking the vaccine to any autoimmune disorders or chronic diseases.
Between 600,000 and 2.4 million Americans live with Hepatitis B, and some may not even know they have it. The decrease in infections seen during 2020-2021 is likely due to the pandemic, as fewer people were seeking medical care at that time. Worldwide, there are about 300 million cases of Hepatitis B. Chronic Hepatitis B is the most concerning, as it can lead to cirrhosis or liver cancer. While the prevalence in the U.S. is low, the rates are higher among people who have come from regions where Hepatitis B is more common.
About 5% of Hepatitis B infections in adults become chronic, but for infants, 90% of infections turn chronic. Most of these infections are acquired at birth or in early infancy. Of those who become chronically infected as children, around 25% will die prematurely from liver disease.
Hepatitis B vaccine is available as a single vaccine or in combination with other vaccines. Be sure to check the dosing instructions carefully, as they can vary by age for some products. Twinrix, Hepsilav, and Prehevbrio are approved only for individuals aged 18 and older.
Pediarix product information, Vaxelis product information, Twinrix product information, Engerix product information, Recombivax product information, Hepsilav product information, Prehevbrio product information
Give 2 doses one month apart at this age if not previously vaccinated.
Yes, in fact, 99% of people who receive two doses of the vaccine have a lasting antibody response. Even after just one dose, 95% of people develop adequate immunity. The second dose is not a “booster” but an opportunity to help those who didn’t respond to the first dose. Immunity is considered lifelong after vaccination.
Since the MMR vaccine is a live vaccine, there are some situations where it shouldn’t be given. These include severe immune system problems, a family history of inherited immune issues, using high-dose steroids for more than 14 days, and being pregnant. If you have an allergic reaction to any component of the vaccine, it should also be avoided. HIV positive status is a contraindication only for the MMRV vaccine. The vaccine should not be given within four weeks of another live vaccine unless they are given on the same day. Some precautions for the MMR vaccine include having an allergy to alpha-gal (a sugar found in meat), being acutely ill, recently receiving blood products or other live vaccines, having low platelet count (thrombocytopenia), or needing TB or interferon gamma tests. For the MMRV vaccine, additional precautions include using aspirin products recently, having a personal or family history of seizures, or taking some antivirals within 24 hours. Common side effects include pain at the injection site, fever, and febrile seizures (more common with MMRV), rash, and joint pain, especially in adult women. Anaphylaxis is very rare, estimated at 2-14 cases per 1 million doses. Other rare side effects include low platelet count (thrombocytopenia), swollen lymph nodes, and mumps-like symptoms (parotitis). Encephalopathy (brain inflammation) has been rarely reported in people with immune deficiencies.
Measles continues to cause outbreaks, especially in communities with low vaccination rates. In 2024, a 5-year-old child died of measles in Canada following an outbreak, despite measles having been nearly eliminated in that country. Complications from measles are common, and the mortality rate is about 2-3 deaths per 1,000 cases. Vaccination has prevented an estimated 57 million deaths worldwide, but from 2000 to 2022, 136,000 people still died from measles globally. Before the measles vaccine was introduced, the United States had about half a million measles cases each year, leading to around 500 deaths annually. Measles is highly contagious, with 90% of people exposed to the virus getting infected. A room where an infected person has been can remain contaminated for hours after they leave.
Measles is one of the most contagious viruses we know. Keeping vaccination rates high is key to reducing the number of cases and preventing the serious health problems and deaths that can come from infections.
Even though there are precautions for using live vaccines, they are very safe and help prevent serious, potentially deadly diseases. The viruses used in these vaccines are grown in different types of cells, which makes them less likely to cause illness in humans. This helps the body build immunity without causing significant disease.
The MMR vaccine is a combination vaccine that protects against three diseases: measles, mumps, and rubella. There is also a version called MMRV, which combines the MMR vaccine with the chickenpox vaccine.
MMR II product information, Priorix product information, Proquad product information (MMRV)
Follow catch-up schedule. At this age, give 2 doses 3 months apart if not already immunized.
Yes! One dose of the Varicella (chickenpox) vaccine is about 82% effective at preventing the disease, but it’s almost 100% effective at preventing severe disease. When two doses are given, the vaccine is 92-98% effective at preventing any form of the disease and 100% effective at preventing severe disease. While the exact length of protection is still unknown, studies have shown that good immunity lasts for 10 to 20 years.
The most common side effects of the Varicella (chickenpox) vaccine are pain, fever, and a mild rash, which are more common with the first dose. Serious side effects are very rare but may occur in individuals with undiagnosed immune deficiencies. These rare side effects include pneumonia, severe rashes, meningitis, and seizures. It’s also very rare for the vaccine to spread the virus to others, and this can only happen if a rash is present
Varicella or MMRV vaccines should not be given to people with certain types of cancer, such as leukemia and lymphoma, or to those with immune deficiencies, either congenital or acquired (like AIDS or advanced HIV). It’s also not recommended for individuals with a first-degree relative who has hereditary immunodeficiency. People on prolonged immunosuppressive therapy (more than 2 weeks) or those taking high-dose steroids (greater than 2 mg/kg/d of prednisone equivalent) should not receive the vaccine. However, vaccination is acceptable once steroids are stopped for at least a month or 3 months for chemotherapy. Pregnant women should not receive the Varicella or MMRV vaccine, and pregnancy should be avoided for 4 weeks after getting the vaccine. It’s also advised that anyone with a personal or family history of seizures should receive Varicella instead of MMRV, as MMRV has a slightly higher risk of febrile seizures. There are also specific guidelines about spacing the vaccine with immunoglobulin or blood products. For more details, check the CDC’s guidelines on live vaccines and blood products. If you are taking antiviral medications for herpes viruses (like acyclovir or valacyclovir), these should be stopped 24 hours before vaccination and avoided for 14 days after vaccination. While there’s no evidence of harm, it’s also recommended to avoid aspirin for 6 weeks after vaccination.
Before the chickenpox vaccine was introduced, the disease infected around 4 million people each year in the U.S. It caused about 10,000 hospitalizations annually and resulted in the deaths of approximately 100 children each year
CHOP page on Varicella, What if my child in not vaccinated for Chickenpox
Children are more likely to be exposed to chickenpox, and the immunity from the vaccine seems to last a lifetime. However, the vaccine cannot be given to children before their first birthday because the maternal antibodies passed to the baby might interfere with the effectiveness of the vaccine. Before the vaccine, adults were about 10 times more likely than children to be hospitalized due to chickenpox or its complications
As discussed above under risks, for the public, the Varicella vaccine is safe and effective. It helps prevent chickenpox and its complications, providing long-lasting protection for most people.
Varicella is available as a single vaccine or in combination with the MMR vaccine (measles, mumps, and rubella) as the MMRV vaccine.
Varicella product information, Proquad product information (MMRV)
Starting with 2024-25 season, flu vaccines will be trivalent. The Yamagata B flu strain has been removed from the vaccine as it is no longer circulating. Most resources mentioned still reference the quadrivalent vaccine
The effectiveness of the flu vaccine in preventing influenza infection can range from 20% to 60%, depending on how well the vaccine matches the circulating virus strain. While this might seem low, the vaccine still provides important benefits. It reduces hospitalizations and pediatric deaths from influenza and lowers the severity of illness. For example, one study showed a 74% reduction in pediatric ICU admissions due to flu, and another study showed a 51% reduction in flu deaths for children with high-risk conditions, and a 65% reduction in deaths for healthy children.
The side effects of the flu vaccine depend on how it’s given. If it’s an injection, about 15-20% of people might feel pain, redness, or swelling where the shot was given. Fewer than 1% may also have fever, chills, or muscle aches. If the flu vaccine is given as a nasal spray, kids might get a stuffy nose, runny nose, or fever. Adults might feel muscle aches, sore throat, headache, tiredness, or cough, but they don’t usually get a fever. Guillain-Barré syndrome is a very rare side effect. It happens in about 1 person per million doses. People who have had Guillain-Barré syndrome within 6 weeks of a flu shot should avoid getting the vaccine, unless they are at high risk of serious illness.
The nasal spray flu vaccine shouldn’t be given to:
- Pregnant women
- Kids ages 2-4 who have had wheezing or asthma in the past year
- People taking aspirin regularly
- People with weakened immune systems
- People who live with or are around people with weakened immune systems
- People who have had certain types of antiviral medicine recently
- People with cochlear implants or who have had surgery that affects the brain or spinal fluid
- People who’ve had a severe allergic reaction to the flu vaccine before
- It’s okay for people with egg allergies to get the flu vaccine now. But kids with asthma over 5 years old should be careful when getting the nasal spray flu vaccine.
- If you are very sick, you should wait to get the flu vaccine until you feel better. You should also avoid the nasal spray flu vaccine if you have a stuffy nose that will stop the medicine from working properly.
CDC “You call the shots” module on influenza vaccine, Can I get a flu vaccine?
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