Vaccination Information
At 18 & Under MD, we believe in following the AAP and ACIP guidelines for shot schedules. However,
there are many parents who prefer an alternate shot schedule. Vaccines are always up to you as a
parent. If you prefer an alternate shot schedule, talk with your provider—we are happy to
accommodate your wishes provided you understand the risks of delaying vaccines. There are certainly
some vaccines that are more important than others. Below you will find information about the
recommended vaccines and the schedule we usually follow.
Schedule:
0-6yrs immuniz sch.pdf
7-18yrs-immuniz sch.pdf
Hepatitis B: Hepatitis B is a virus which causes chronic liver disease. There is no known cure for
Hepatitis B infection. If a mother is positive for Hepatitis B, she could potentially infect the baby. It is
spread by infected blood and body fluids—provided mom was not infected at delivery, your child should
not be at risk for Hepatitis B until they are sexually active, a health care worker, or an IV drug user.
There is a very tiny risk of getting it from a blood transfusion. Hepatitis B is a life-long infection that
causes liver cancer and cirrhosis. The Hepatitis B vaccine is generally given some time during the 1st
month of life, at 2 months, and at 6 months of age.
DTaP (Diphtheria, Tetanus, and Pertussis): Diphtheria is caused by a bacteria and is spread through
coughing and sneezing. It causes fever, sore throat, nasal congestion, fatigue, and a thick gray
membrane that coats the throat. It can spread a toxin throughout the body causing difficulty
swallowing, paralysis, heart failure, and death. It is exceptionally rare in the U.S. Tetanus is a serious
and potentially fatal infection caused by a bacteria that is present everywhere, in the dirt, all the time. If
you step on a rusty nail or cut your foot walking in the garden you may develop tetanus. Tetanus causes
lockjaw; it also can cause muscle tightening, pain, and spasms throughout all the body’s muscles which
can be fatal. Pertussis (or Whooping Cough) is on the RISE in the U.S. If an older child or an adult gets
pertussis, it looks like a bad cold and then develops into a chronic cough that lasts about 3 months (it’s
nicknamed the 100-day cough). If an infant gets pertussis they may show symptoms of the classic
“whooping” cough and some infants may get apneic and not breathe—it is frequently fatal in children
younger than 1 year. It is transmitted through respiratory secretions and commonly spreads throughout
the teenage population as these children have often not been vaccinated in 10 years. If you are
susceptible and are exposed, the transmission rate is nearly 100%. Pertussis is caused by a bacteria and
can be treated with antibiotics if it is diagnosed within the first 5 days of illness. All close contacts of a
person with pertussis must be treated with antibiotics to prevent them from contracting the infection.
DTAP is typically given at 2, 4, 6, and 15 months of age, at age 4 and a booster (TDaP) every 5-10 years
after that. Parents of new babies should also receive a TDaP vaccine.
Polio (IPV): Polio is caused by a virus and was once one of the most feared infectious diseases. It is
spread through close person-to-person contact and can produce muscle paralysis. Some people who
had polio became permanently disabled, many others died. Polio is still relatively common in some
areas of the world but thanks to the vaccine, it has been eradicated in many developed countries. It is
recommended that children continue to receive the polio vaccine in order to prevent polio from making
a comeback. The vaccine is typically given at 2, 4, 6, and 15 months and at age 4 yrs.
Hemophilus Influenza type B (HiB): This vaccine prevents a serious bacterial infection that is spread by
sneezing and coughing. In severe cases it can cause meningitis, an infection of the tissues that surround
the brain and spinal cord. Meningitis can lead to seizures, brain damage and even death. Before the
advent of the vaccine, HiB was the most common cause of bacterial meningitis here in the U.S. This
bacteria can also cause epiglottitis, a condition that causes swelling in the upper airway (similar to
croup) and is capable of causing severe airway obstruction necessitating an emergency tracheostomy in
order to re-establish an airway. This disorder can progress extremely rapidly. Thanks to this vaccine,
HiB was virtually unheard of in the U.S. for many years. However it is recently making a comeback, as
more people decline or postpone vaccinations. Side benefits of this vaccine are that it also prevents
some ear infections and pneumonias. This vaccine is typically given at the 2, 4, 6, and 15 month visits.
Pneumoccal vaccine (Prevnar, PCV13): Streptococcus pneumonia or pneumococcus as it is commonly
known is a bacteria that can cause severe invasive disease including pneumonia, sepsis (blood infection),
ear infections, etc. In its worst form it causes pneumococcal meningitis—a disease we still see
commonly in the U.S. Pneumococcal meningitis can cause seizures, deafness, blindness, and profound
mental retardation (it makes your brain look like Swiss cheese). These infections are spread through
sneezing, coughing, and touching hands. This vaccine not only prevents this type of meningitis, but it
also protects against some forms of ear infections and pneumonia. This vaccine is typically given at the
2, 4, 6, and 12-15 month visits.
Rotavirus vaccine: This virus is extremely common in the U.S. and causes severe vomiting and diarrhea.
Before the advent of the vaccine, 80% of 2 year olds had had rotavirus before their 2nd birthday. Many
of these patients required hospitalization and IV fluids to treat dehydration. This virus is a live vaccine
and is not a shot, but is given by mouth, generally at the 2, 4, and 6 month visits.
MMR (Measles, Mumps, Rubella): Measles is a viral infection characterized by fever, cough, runny
nose, pink eye, a rash, and Koplik spots (white spots inside the mouth). It can also cause ear infections,
croup, pneumonia, and a brain infection called encephalitis. Encephalitis can result in permanent brain
damage. Measles can also lead to subacute sclerosing panencephalitis (SSPE), a rare degenerative
disease causing brain deterioration 7-10 years after the infection. Widespread immunization nearly
eliminated cases of SSPE in the U.S., but as fewer people are vaccinating, measles is making a comeback
and SSPE can be expected to make a resurgence as well. Measles is spread through close contact and
occasionally respiratory droplets. There has recently been an outbreak here in North Texas. Mumps is
also caused by a virus and is characterized by swelling of the salivary glands on one or both cheeks. It is
usually spread via coughing. Over half of the people with mumps will have some signs of infection in the
fluid surrounding their spine and some may have meningitis. Other complications include orchiitis (an
infection of the testicles often resulting in sterility), inflammation of the thyroid, kidneys, heart, and
pancreas. It also can cause deafness. There have been outbreaks of mumps in the U.S. in recent years—
these seem to be increasing as fewer people are vaccinating. Rubella (or German Measles) is also a viral
infection that can be spread through close contact or airborne droplets. There has not been any
documented rubella in the U.S. since the advent of the vaccine in the 1960’s. It causes fever, a rash, and
tender glands around the neck and ears. Rubella is generally a very mild disease unless it infects a
pregnant woman and her fetus. Maternal rubella during pregnancy can result in birth defects such as
hearing loss, mental retardation, growth retardation, a “blueberry muffin” rash, heart defects and other
problems. The MMR is currently only manufactured in the U.S. as a combination vaccine (the individual
components are currently not available in the U.S.) and is generally given at 1 and 4 years of age.
Chickenpox vaccine (VZV): Chickenpox is caused by a Herpes virus and is still relatively common.
Infection results in the classic itchy, blister-like rash, but can result in complications such as necrotizing
fasciitis (some children have required limb amputations because of this), pneumonia, encephalitis (a
brain infection), hepatitis (liver infection), glomerulonephritis (chronic kidney inflammation), and
hemorrhage. If a pregnant woman gets chickenpox, it can cause severe birth defects and even death for
the unborn child. The vaccine is generally given at 1 and 4 years of age.
Hepatitis A: This is a viral infection that is fecal-to-oral spread. So if someone doesn’t wash their hands
after using the bathroom (or changing a diaper) and makes food, they may infect anyone who eats that
food. It commonly goes around day-care settings, is occasionally linked to certain restaurants, and is
more common in third-world countries with untreated water sources. Hepatitis A causes severe
vomiting and diarrhea, liver inflammation leading to jaundice, and dehydration. Adults tend to get a
much worse case than young children. The vaccine is a two-dose series given six months apart at 12-24
months.
Meningococcal Meningitis vaccine (MCV): This is a type of meningitis caused by the bacteria Neisseria
meningitidis—a bacteria that many people harbor in their noses and mouths—most people never get
sick but occasionally someone develops symptoms including fever, rash, and vomiting. This is a severe,
rapidly progressing infection—most people with it spend some time on a ventilator in the ICU, many die
from this infection, and those who survive often lose limbs. Outbreaks are more common in college
dorm rooms or military barracks. The vaccine is generally given at ages 11-14, and again at college age.
Human Papillomavirus vaccine (HPV): This is a sexually transmitted infection that causes genital warts
and, in girls, cervical cancer. Statistically, 70% of young women ages 19-26 have had HPV at some point.
Those with the infection may develop cervical dysplasia (an early form of cervical cancer) and require
surgical intervention to remove the cancerous areas. In males, HPV can cause genital warts and anal
cancer. The vaccine is a 3-dose series given over a 6 month period and can be given as early as age 11
years. It is ideal to complete the series before initiating sexual activity.
Influenza vaccine (Flu): Influenza is a highly contagious viral illness spread via respiratory droplets. It
can cause 7-10 days of fever, muscle aches, headache, cough, and fatigue. Respiratory symptoms like
sort throat or nasal congestion are common, as are nausea and vomiting. The “flu” is famous for
causing secondary bacterial infections such as pneumonia, ear infections, sinus infections, and
bronchiolitis. The flu season tends to peak during the winter months. Influenza causes approximately
15,000 deaths in the U.S. every year. It is now recommended that all children greater than 6 months
receive a flu vaccine yearly. Flu vaccines are available as injections (shots) or as a nasal spray. Talk with
your provider about which your child should receive. If your child is diagnosed with influenza, there are
antiviral drugs available that will limit the course of the illness, however these must be given within the
first 48 hours of the illness.
For more information, check out the CDC’s website:
www.cdc.gov/vaccines/