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INTRODUCTION — Vaccines are one of the most effective ways to prevent serious illness in children and adults. Vaccine programs in the United States have been quite successful in reducing the number of children affected by many highly contagious diseases, including measles, rubella, mumps, diphtheria, and polio.
In the United States, there are several vaccines that are routinely recommended for children and adolescents between the ages of 7 and 18 years; these are discussed in more detail in this article. The recommended schedule is also available through the Centers for Disease Control and Prevention. More general information about how vaccines work, the risks and benefits of vaccines, and common concerns regarding vaccine safety is available separately. (See "Patient education: Why does my child need vaccines? (Beyond the Basics)".)
Vaccine recommendations for infants and children age 0 to 6 years, as well as for adults, are also discussed separately. (See "Patient education: Vaccines for infants and children age 0 to 6 years (Beyond the Basics)" and "Patient education: Vaccines for adults (Beyond the Basics)".)
VACCINE SAFETY — In most cases, the benefits of vaccinating are much greater than the potential risks. There are a lot of myths about vaccines, and you may have heard rumors about vaccines being dangerous or containing harmful ingredients. In fact, every vaccine must go through a specific process to test it for safety before it can be recommended. More information about vaccine safety is available separately. (See "Patient education: Why does my child need vaccines? (Beyond the Basics)", section on 'Vaccine safety'.)
CONTRAINDICATIONS TO VACCINATION — There are some situations in which a child should not receive a specific vaccine or formulation of vaccine, such as if they have a history of severe allergic reaction. (See "Patient education: Why does my child need vaccines? (Beyond the Basics)", section on 'Contraindications to vaccination'.)
RECOMMENDED IMMUNIZATIONS — In the United States, vaccine recommendations for children are based on policies developed by expert groups (table 1). Your child's health care provider can talk to you about when your child should get certain vaccines.
The vaccines recommended for children age 7 to 18 years are discussed below; some children may need other vaccines as well.
COVID-19 — Coronavirus 2019 (COVID-19) is an infection caused by a virus called SARS-CoV-2. It can cause a fever, cough, trouble breathing, or other symptoms. Some people get severely ill from COVID-19.
Children age six months and older can get a COVID-19 vaccine; the American Academy of Pediatrics (AAP) recommends COVID-19 vaccination for all eligible children.
Timing and dose — The COVID-19 vaccine comes as a shot. In the United States, experts recommend that children age six months and older get an "mRNA" vaccine. In the fall of 2023, both available mRNA vaccines were updated for the 2023 to 2024 season and protect well against the common variants of the virus.
For children who have a medical condition or take medication that makes their immune system weaker than normal, their doctor might recommend additional vaccine doses. The exact schedule will depend on your child's age, health, and which vaccine(s) they have had previously.
Side effects — Side effects can include pain at the injection site, fever, fatigue, and headache. Any side effects usually resolve after a day or two.
Serious side effects are rare. A very small number of people have developed inflammation of the heart muscle (myocarditis) after receiving a COVID-19 vaccine. Most cases have been in teen or young adult males. This side effect is extremely rare and is usually mild and treatable if it does happen. Experts believe that the benefits of getting vaccinated against COVID-19 are much greater than the risks.
Influenza — Influenza (flu) is a highly contagious viral infection that occurs in outbreaks worldwide, usually during the winter in the United States. Young children, older adults, and people with certain underlying medical conditions are at increased risk for severe illness if they are infected with the influenza virus. Vaccinating everyone older than six months can help decrease this risk. The influenza vaccine does not prevent other illnesses such as the common cold or strep throat. (See "Patient education: Influenza symptoms and treatment (Beyond the Basics)".)
Timing and dose — There are two ways for children to receive the flu vaccine: as a shot into muscle (intramuscular injection, also known as simply the "flu shot") or as a nasal spray. Your child's health care provider can talk to you about the options, and you can decide together which one is best for your child.
The flu shot can be given to adults and children 6 months and older, and the nasal spray can only be given to people 2 through 49 years of age. People who have a weakened immune system, are pregnant, or who have chronic heart, lung, kidney, or metabolic disease should not use the nasal spray since it contains live virus that has been weakened. In very rare situations, household contacts of those who have severely weakened immune systems should also not receive the nasal spray.
The influenza vaccine must be given every year (ideally in the fall or early winter). The main reason for this is that protection from influenza vaccine decreases over time. Yearly vaccination also allows the vaccine to be reformulated if the influenza viruses change from year to year. In the first year that a child younger than nine years receives the vaccine, two doses are recommended; the second dose is given at least one month after the first. In subsequent years, most children will need only one dose.
A yearly flu vaccine is recommended for all children six months and older, particularly those who:
●Have chronic medical conditions (eg, lung or heart disease, diabetes, kidney disease, weakened immune conditions, nervous system disorders)
●Live with a person who is at high risk for complications of influenza
Side effects — The most common side effect of the flu shot is redness and soreness at the injection site. A temporary low-grade fever may develop after vaccination. Serious side effects are rare. (See "Patient education: Fever in children (Beyond the Basics)".)
Side effects after the nasal spray vaccine may include nasal congestion or low-grade fever.
Meningococcus — Neisseria meningitidis (meningococcus) is a bacterium that can cause meningitis and meningococcemia. Meningitis is an inflammation of the tissues surrounding the brain and spinal cord that causes symptoms of a stiff and painful neck. Meningococcus is the most common cause of bacterial meningitis among children and adolescents in the United States. Meningococcemia is a serious infection of the bloodstream that can begin with dramatic rash and fever and lead to shock and death. Meningitis and meningococcemia may occur separately or together.
Meningococcus first infects the lining of the nose and pharynx (wind pipe) and is transmitted from person to person by respiratory secretions (eg, from coughing, sneezing). Meningococcal infection is contagious and can spread quickly to close contacts of a person who is infected. This includes household members; the infection can also spread through kissing or sharing cups or utensils.
If caught early, meningococcal disease can be treated in most people. However, the illness is frequently mistaken for a common viral illness (eg, the common cold) during the early stages, which can delay diagnosis. Meningococcal disease often progresses quickly to serious illness or death. Serious long-term complications can occur, even in people who are treated promptly. Up to 15 percent of people who become infected die as a result of their infection. In survivors, 10 to 20 percent of patients have long-term complications, including hearing loss, nerve or brain injury, finger/toe/limb amputation, or skin scarring.
Meningococcal vaccines are available to protect against the five common subtypes of meningococcus affecting humans (subtypes A, C, W135, Y, and B). There is a vaccine that helps prevent meningococcal types A, C, W135, and Y; there is a different vaccine that prevents meningococcal type B. It is possible to become infected with meningococcus despite having received one of these vaccines, although the risk is significantly lower than in someone who is unvaccinated. (See "Patient education: Meningitis in children (Beyond the Basics)".)
Timing and dose
●Children not at increased risk of meningococcal disease – Expert groups recommend the meningococcal vaccine that protects against types A, C, W135, and Y meningococcal disease for all children age 11 or 12 years and a booster dose at age 16 years. Adolescents who receive the first dose of this vaccine between 13 and 15 years should receive a booster dose between 16 and 18 years of age. Those who receive the first dose after age 16 years do not need a booster dose.
The vaccine that protects against type B meningococcal disease is not routinely recommended for children and adolescents who are not at increased risk for meningococcal disease. However, it may be administered to adolescents and young adults 16 through 23 years of age wishing to prevent disease, preferably between 16 and 18 years of age, after they discuss the vaccine with their doctor or nurse.
●Children at increased risk of meningococcal disease – The meningococcal vaccine that protects against types A, C, W135, and Y meningococcal disease is recommended for children aged greater than 2 months who are at increased risk for meningococcal disease. In addition, the meningococcal vaccine that protects against type B meningococcal disease is recommended for people 10 years and older who are at increased risk of meningococcal disease, including those in an outbreak area. The vaccination schedule for children at increased risk for meningococcal disease depends upon the underlying medical condition and whether they remain at increased risk for disease. Booster doses of both vaccines are recommended at varying intervals for those who continue to be at high risk of getting meningococcal disease.
Side effects — Approximately 70 percent of people have a local reaction (eg, tenderness, redness) at the injection site.
Tetanus and diphtheria, with or without acellular pertussis — Diphtheria is a highly contagious disease. It is usually transmitted via droplet particles that are coughed or sneezed into the air. It can cause a thick covering in the back of the throat that can lead to breathing problems or heart failure.
Tetanus is another very serious infection that is caused by the bacterial toxin of Clostridium tetani bacterium. The bacteria reside in soil and the intestinal tracts of certain mammals. The bacteria can enter the body through an open wound, multiply, and produce a toxin that can affect nerves controlling muscle activity. A common symptom of tetanus infection is stiffness of the jaw muscles ("lockjaw").
Tetanus and diphtheria disease are rare in the United States because so many people have been vaccinated. However, the consequences of untreated tetanus or diphtheria can be very serious.
Pertussis, or whooping cough, is an upper respiratory illness caused by the toxin of Bordetella pertussis bacteria. The organism is highly contagious, spreads easily, and can cause serious illness, especially in infants.
Pertussis was added to the traditional tetanus and diphtheria ("Td") booster for teenagers and adults because the vaccine's protection decreases after 5 to 8 years and cases in adolescents were increasing. The vaccine is recommended even for people who have had pertussis, as natural immunity decreases over time after being infected.
There are several forms of combined diphtheria, tetanus, and pertussis vaccines:
●The DTaP (diphtheria-tetanus-acellular pertussis) vaccine is used for routine immunization of children younger than 7 years of age.
●The Tdap (tetanus, reduced diphtheria, acellular pertussis vaccine) is recommended routinely for children at 11 to 12 years, for adolescents 13 to 18 years who were not previously immunized with Tdap, and for pregnant people during each pregnancy.
Tdap is also recommended for:
•At least one of the series of catch-up doses of tetanus and diphtheria toxoid-containing vaccines for children between 7 and 10 years of age who are incompletely vaccinated against tetanus, diphtheria, or pertussis.
•Adults requiring the Td (tetanus and reduced diphtheria vaccine without pertussis) booster who have not previously received a Tdap vaccine. (See "Patient education: Vaccines for adults (Beyond the Basics)".)
●Either Td or Tdap is recommended for adolescents and adults who require tetanus vaccine and have already received one dose of Tdap.
Timing and dose — The Tdap vaccine is recommended for children and adolescents at age 11 to 12 years unless there is an allergy to one of the vaccine components.
For adolescents who are pregnant, Tdap is recommended during each pregnancy to protect the infant.
If an adolescent has an injury that requires a tetanus shot, Tdap may be given instead of Td.
Subsequent booster doses of either Tdap or Td are recommended every 10 years throughout life. Repeated doses of Tdap have been shown to be safe. (See "Patient education: Vaccines for adults (Beyond the Basics)".)
Side effects — The most common side effect of the Tdap vaccine is pain at the injection site.
Human papillomavirus — Human papillomavirus (HPV) is a virus that can cause genital warts and cancer of the cervix, vagina, penis, anus, and oropharynx (mouth and throat). It is spread by skin-to-skin contact, including sexual contact. This includes sexual intercourse (vaginal sex), oral sex, anal sex, or any other contact involving the genital area (eg, hand to genital contact). While condoms are an important way to prevent most sexually transmitted infections, they do not provide complete protection from HPV infection, because they do not cover all exposed genital skin.
The risk of HPV exposure increases with the number of sexual partners a person has. Having sex with a partner who has had many other partners in the past also increases risk. It has been estimated that 75 to 80 percent of sexually active adults will acquire at least one genital HPV infection before the age of 50. A majority of people become infected for the first time with one or more HPV types in the anogenital region between ages 15 and 25 years.
Over 100 different types of HPV have been identified, approximately 40 of which are known to infect the anogenital region and 15 of which are known to cause cancer. The HPV vaccine available in the United States protects against HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58. Types 16 and 18 cause most cases of cervical and other types of cancer (vaginal, vulvar, penile, anal, oropharyngeal). Types 31, 33, 45, 52, and 58 are also high-risk for cervical cancer. Types 6 and 11 can cause warts but rarely cause cancer.
A vaccine against HPV is available for males and females. The vaccine is discussed in greater detail separately. (See "Patient education: Human papillomavirus (HPV) vaccine (Beyond the Basics)".)
Timing and dose — With any HPV vaccine, a person will have the greatest protection from HPV if they are vaccinated before becoming sexually active. The vaccine does not help to get rid of HPV infection or any cervical abnormality after it has occurred.
The HPV vaccination series is recommended for all youth at 11 to 12 years of age, and it can be given as young as age 9 years. "Catch-up" vaccination is recommended for all people up to 26 years of age who have not yet received it. Older adults may also choose to receive the vaccine after talking with their health care provider.
The vaccination series consists of two or three shots, depending upon the age at the time of the first dose.
●Healthy children who get the first shot before their 15th birthday need two shots. The second shot is ideally given 6 to 12 months after the first.
●Those who get the first shot at or after the age of 15, or those with a weakened immune system, need three shots. The second shot is ideally given 1 to 2 months after the first, and the third shot is given at least 6 months after the first and at least 3 months after the second shot.
If the second and/or third shots are delayed for any reason, it is not necessary to restart the vaccination series.
Side effects — There are no serious adverse events associated with the HPV vaccine. The most common side effect is pain at the injection site.
Other vaccines — Children who are 7 to 18 years may need vaccines other than those mentioned above if they have missed any of the recommended vaccines for children age 0 to 6 years. This may include hepatitis A, hepatitis B, varicella, polio, or measles, mumps, and rubella vaccines. The recommended schedule is available through the Centers for Disease Control and Prevention. Detailed information about these vaccines is available separately. (See "Patient education: Vaccines for infants and children age 0 to 6 years (Beyond the Basics)".)
Children who are age 7 to 18 years may need additional vaccines if they are at high risk for certain infections, such as pneumococcal infection (eg, if they have sickle cell disease) or mumps infection during an outbreak.
WHERE TO GET MORE INFORMATION — Your child's health care provider is the best source of information for questions and concerns related to your child's medical problem.
This article will be updated as needed on our website (www.uptodate.com/patients). Related topics for patients and caregivers, as well as selected articles written for health care professionals, are also available. Some of the most relevant are listed below.
Patient level information — UpToDate offers two types of patient education materials.
The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.
Patient education: Vaccines for children age 7 to 18 years (The Basics)
Patient education: What you should know about vaccines (The Basics)
Patient education: Meningitis in children (The Basics)
Patient education: Vaccines for babies and children age 0 to 6 years (The Basics)
Patient education: Vaccines for travel (The Basics)
Patient education: Vaccines for adults (The Basics)
Patient education: Whooping cough (The Basics)
Patient education: Sickle cell disease (The Basics)
Patient education: Tdap vaccine (The Basics)
Patient education: When your child has sickle cell disease (The Basics)
Patient education: COVID-19 vaccines (The Basics)
Patient education: COVID-19 and children (The Basics)
Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.
Patient education: Human papillomavirus (HPV) vaccine (Beyond the Basics)
Patient education: Why does my child need vaccines? (Beyond the Basics)
Patient education: Vaccines for infants and children age 0 to 6 years (Beyond the Basics)
Patient education: Vaccines for adults (Beyond the Basics)
Patient education: Influenza symptoms and treatment (Beyond the Basics)
Patient education: Fever in children (Beyond the Basics)
Patient education: Meningitis in children (Beyond the Basics)
Patient education: Chickenpox prevention and treatment (Beyond the Basics)
Patient education: Influenza prevention (Beyond the Basics)
Patient education: Vaccines for travel (The Basics)
Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.
Allergic reactions to vaccines
Meningococcal vaccination in children and adults
Human papillomavirus vaccination
Standard immunizations for children and adolescents: Overview
The following organizations also provide reliable health information.
●Centers for Disease Control and Prevention
Toll-free: (800) 232-4636
●National Library of Medicine
(www.nlm.nih.gov/medlineplus/healthtopics.html)
●National Institute of Allergy and Infectious Diseases
●National Foundation for Infectious Diseases
Tel: (301) 656-0003
●The Children's Hospital of Philadelphia Vaccine Education Center
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