Vaccines and Vaccinations

Knowing which vaccines you need is an important step toward protecting your health and that of your family and friends. Getting vaccines on time helps prevent illness before you’re exposed.

If you are sick, you may still be able to receive a vaccine, depending on which vaccine you need and the type and severity of your illness. Talk with your health care provider about the vaccines that might be recommended for your age, health status, and lifestyle.

Vaccine schedules are designed with you in mind. They are constructed to be as safe and as convenient as possible, without requiring unnecessary visits to your doctor or health care provider.

Find out which vaccines you may need at different times of life by reading about your age or health condition below.

Infants, Children, & Teens (birth to age 18)

Vaccinating your child is one of the most important steps you can take to protect their health and future. The childhood vaccine schedule designed to be as safe and as convenient as possible, and to protect children when they are at highest risk of complications from disease. Help protect your child’s health by learning about the vaccines they need and being sure to get the pre-teen and teenage vaccines on time. If your child did not get these vaccines at age 11 or 12, schedule an appointment to get them now. Vaccines are an important part of preventive care throughout life.

BCG vaccine

What is Tuberculosis

Tuberculosis is caused by a bacterium called Mycobacterium tuberculosis. The bacteria usually attack the lungs, but tuberculosis bacteria can attack any part of the body such as the kidney, spine, and brain. Not everyone infected with tuberculosis bacteria becomes sick. As a result, two tuberculosis-related conditions exist: latent tuberculosis infection and tuberculosis disease. If not treated properly, tuberculosis disease can be fatal.

BCG Vaccine

Bacille Calmette-Guérin (BCG) is a vaccine for tuberculosis disease. Many foreign-born persons have been BCG-vaccinated. BCG is used in many countries with a high prevalence of tuberculosis to prevent childhood tuberculous meningitis and miliary disease. However, BCG is not generally recommended for use in the United States because of the low risk of infection with Mycobacterium tuberculosis, the variable effectiveness of the vaccine against adult pulmonary tuberculosis, and the vaccine’s potential interference with tuberculin skin test reactivity. If you were vaccinated with BCG, you may have a positive reaction to a tuberculosis skin test. This reaction may be due to the BCG vaccine itself or due to infection with the tuberculosis bacteria. Your positive reaction is more likely to mean you have been infected with tuberculosis bacteria.

The BCG vaccine should be considered only for very select persons who meet specific criteria and in consultation with a tuberculosis expert.

BCG Vaccine Recommendations

In the United States, BCG should be considered for only very select people who meet specific criteria and in consultation with a tuberculosis expert. Health care providers who are considering BCG vaccination for their patients are encouraged to discuss this intervention with the tuberculosis control program in their area.

Children

BCG vaccination should only be considered for children who have a negative tuberculosis test and who are continually exposed, and cannot be separated from adults who:

• Are untreated or ineffectively treated for tuberculosis disease, and the child cannot be given long-term primary preventive treatment for tuberculosis infection; or
• Have tuberculosis disease caused by strains resistant to isoniazid and rifampin.

Health Care Workers

BCG vaccination of health care workers should be considered on an individual basis in settings in which:

• A high percentage of tuberculosis patients are infected with tuberculosis strains resistant to both isoniazid and rifampin;
• There is ongoing transmission of drug-resistant tuberculosis strains to health care workers and subsequent infection is likely; or
• Comprehensive tuberculosis infection-control precautions have been implemented, but have not been successful.

Health care workers considered for BCG vaccination should be counseled regarding the risks and benefits associated with both BCG vaccination and treatment of latent tuberculosis infection.

BCG Vaccine Contraindications

Immunosuppression. BCG vaccination should not be given to persons who are immunosuppressed (e.g., persons who are HIV infected) or who are likely to become immunocompromised (e.g., persons who are candidates for organ transplant).

Pregnancy. BCG vaccination should not be given during pregnancy. Even though no harmful effects of BCG vaccination on the fetus have been observed, further studies are needed to prove its safety.

Testing for tuberculosis in BCG-Vaccinated People

Many people born outside of the United States have been BCG-vaccinated.

People who were previously vaccinated with BCG may receive a tuberculosis skin test to test for tuberculosis infection. Vaccination with BCG may cause a positive reaction to a tuberculosis skin test. A positive reaction to a tuberculosis skin test may be due to the BCG vaccine itself or due to infection with tuberculosis bacteria.

Tuberculosis blood tests (IGRAs), unlike the tuberculosis skin test, are not affected by prior BCG vaccination and are not expected to give a false-positive result in people who have received BCG.

For children under the age of five, the tuberculosis skin test is preferred over tuberculosis blood tests.

A positive tuberculosis skin test or tuberculosis blood test only tells that a person has been infected with tuberculosis bacteria. It does not tell whether the person has latent tuberculosis infection or has progressed to tuberculosis disease. Other tests, such as a chest x-ray and a sample of sputum, are needed to see whether the person has tuberculosis disease.

Chicken pox vaccine

What is Chickenpox

Chickenpox is a very contagious disease caused by the varicella-zoster virus (VZV). It causes a blister-like rash, itching, tiredness, and fever ¹⁾. Chickenpox used to be very common in the United States.

The Centers for Disease Control and Prevention (CDC) recommends two doses of chickenpox vaccine for children, adolescents, and adults. Children should receive two doses of the chicken pox vaccine—the first dose at 12 through 15 months old and a second dose at 4 through 6 years old.

Chicken pox vaccine

Chickenpox vaccine is very effective. Two doses of the vaccine are about 98% effective at preventing chickenpox. Some people who are vaccinated against chickenpox may still get the disease. However, it is usually milder with fewer skin blisters and little or no fever.

Getting chickenpox vaccine is much safer than getting chickenpox disease. Most people who get chickenpox vaccine do not have any problems with it.

Types of Chickenpox Vaccine

There are two chickenpox vaccines that are licensed in the United States—Varivax^® and ProQuad^®.

Varivax^®

• Contains only chickenpox vaccine
• Licensed for use in children 12 months and older, adolescents, and adults
• Can be given to children for their routine two doses of chickenpox vaccine at 12 through 15 months old and 4 through 6 years old

ProQuad^®

• Contains a combination of measles, mumps, rubella, and varicella (chickenpox) vaccines, which is also called MMRV
• Only licensed for use in children 12 months through 12 years old
• Can be given to children for their routine two doses of chickenpox vaccine at 12 through 15 months old and 4 through 6 years old
• Children who get the first dose of this vaccine at 12 to 23 months old may have a higher chance of a seizure caused by fever. This is in comparison to children who get the measles, mumps, and rubella vaccine and the chickenpox vaccine separately during a doctor visit. But, these seizures are not common. They may be scary for parents, but they are not harmful to children. Talk with a doctor if you have questions.

Chickenpox vaccine Schedule

For Infants, Children, and Adults

Children under 13 years old should get two doses of the chickenpox vaccine at these ages:

• 1st dose: 12 through 15 months
• 2nd dose: 4 through 6 years (may be given earlier, if at least three months after the 1st dose)

The second dose may be given at an earlier age if it is given at least three months after the first dose.

People 13 years or older (who have never had chickenpox and never received chickenpox vaccine) should get two doses at least 28 days apart.

ProQuad® (MMRV) is licensed for use in children 12 months to 12 years old. Your child’s doctor can help you decide which vaccine to use.

• However, pregnant women should wait to get the chickenpox vaccine until after they have given birth. Women should not get pregnant for 1 month after getting the chickenpox vaccine.

Who Needs Chicken pox Vaccine

Children under age 13 years should get two doses:

• First dose at age 12 through 15 months
• Second dose at age 4 through 6 years.

The second dose may be given at an earlier age if it is given at least 3 months after the first dose.

People 13 years of age and older who have never had chickenpox or received chickenpox vaccine should get two doses, at least 28 days apart.

Chickenpox vaccination is especially important for—

• Healthcare professionals
• People who care for or are around others with weakened immune systems
• Teachers
• Child care workers
• Residents and staff in nursing homes and residential settings
• College students
• Inmates and staff of correctional institutions
• Military personnel
• Non-pregnant women of child-bearing age
• Adolescents and adults living with children
• International travelers.

Some people with weakened immune systems who do not have immunity against chickenpox may be considered for vaccination after talking with their doctor, including people—

• with HIV-infection
• with cancer, but whose disease is in remission
• on low or high-dose steroids.

Who Should Not Get Chickenpox Vaccine

You do not need to get the chickenpox vaccine if you have evidence of immunity against the disease.

Some people should not get chickenpox vaccine or they should wait.

• People should not get chickenpox vaccine if they have ever had a life-threatening allergic reaction to a previous dose of chickenpox vaccine or any component of the vaccine, including gelatin or the antibiotic neomycin.
• People who are moderately or severely ill at the time the shot is scheduled should usually wait until they recover before getting chickenpox vaccine.
• Pregnant women should not get chickenpox vaccine. They should wait to get chickenpox vaccine until after they have given birth. Women should not get pregnant for 1 month after getting chickenpox vaccine.
• People with the following conditions should check with their doctor about whether they should get chickenpox vaccine, including anyone who:
  • Has HIV/AIDS or another disease that affects the immune system
  • Is being treated with drugs that affect the immune system, such as steroids, for 2 weeks or longer
  • Has any kind of cancer
  • Is getting cancer treatment with radiation or drugs
• People who recently had a transfusion or were given other blood products should ask their doctor when they may get chickenpox vaccine.

Getting Vaccinated After You Are Exposed to Chickenpox

If you do not have immunity against chickenpox and are exposed to someone with this disease or shingles, talk with your doctor about getting chickenpox vaccine.

You should get chickenpox vaccine within 3 to 5 days of being exposed.

You need two doses of vaccine at two different times. For more information, see Who Needs Chickenpox Vaccine.

If you previously got one dose of chickenpox vaccine, you should get a second dose.

Getting vaccinated after you are exposed to someone with chickenpox can—

• prevent the disease or make it less serious
• protect you from chickenpox if you are exposed again in the future

A doctor can prescribe a medicine to make chickenpox less severe. This is especially important for people who are exposed to chickenpox and do not have immunity against the disease and are not eligible for vaccination.

Assessing Immunity to Chicken pox Varicella virus infection

Evidence of immunity to Chickenpox (varicella virus) includes any of the following:

• Documentation of age-appropriate varicella vaccination;
• Preschool-age children (i.e., age 12 months through 3 years): 1 dose
• School-age children, adolescents, adults: 2 doses
• Laboratory evidence of immunity or laboratory confirmation of disease
• Birth in the United States before 1980 (Should not be considered evidence of immunity for health care personnel, pregnant women, and immunocompromised persons)
• Diagnosis or verification of a history of varicella or herpes zoster by a health care provider

To verify a history of varicella, your health care providers should inquire about:

• an epidemiologic link to another typical varicella case or to a laboratory confirmed case, or
• evidence of laboratory confirmation, if testing was performed at the time of acute disease

Persons who have neither an epidemiologic link nor laboratory confirmation of varicella should not be considered as having a valid history of disease. For these persons, a second dose of vaccine is recommended if they previously received only one dose. If a health care provider verifies the diagnosis based on the above criteria, then vaccination is not needed.

Chickenpox vaccine side effects

Varivax^®

Frequently reported (≥10%) adverse reactions in children ages 1 to 12 years include ²⁾:

• fever ≥102.0°F (38.9°C): 14.7%
• injection-site complaints: 19.3%.

Frequently reported (≥10%) adverse reactions in adolescents and adults ages 13 years and older include ³⁾:

• fever ≥100.0°F (37.8°C): 10.2%
• injection-site complaints: 24.4%

Other reported adverse reactions in all age groups include:

• varicella-like rash (injection site)
• varicella-like rash (generalized).

ProQuad^®

The most frequent vaccine-related adverse events reported in ≥5% of subjects vaccinated with ProQuad were ⁴⁾:

• injection-site reactions (pain/tenderness/soreness, erythema, and swelling)
• fever
• irritability.

Systemic vaccine-related adverse events that were reported at a significantly greater rate in recipients of ProQuad than in recipients of the component vaccines administered concomitantly were:

• fever
• measles-like rash.

DTaP Vaccine

Diphtheria, tetanus, and pertussis (DTaP) are serious diseases caused by bacteria. Diphtheria and pertussis are spread from person to person. Tetanus enters the body through cuts or wounds.

DIPHTHERIA causes a thick covering in the back of the throat.

It can lead to breathing problems, paralysis, heart failure, and even death.

TETANUS (Lockjaw) causes painful tightening of the muscles, usually all over the body.

It can lead to “locking” of the jaw so the victim cannot open his mouth or swallow. Tetanus leads to death in up to 2 out of 10 cases.

PERTUSSIS (Whooping Cough) causes coughing spells so bad that it is hard for infants to eat, drink, or breathe. These spells can last for weeks.

It can lead to pneumonia, seizures (jerking and staring spells), brain damage, and death.

Diphtheria, tetanus, and pertussis vaccine (DTaP) can help prevent these diseases. Most children who are vaccinated with DTaP will be protected throughout childhood. Many more children would get these diseases if we stopped vaccinating.

DTaP is a safer version of an older vaccine called DTP. DTP is no longer used in the United States.

DTaP Vaccine

Who should get DTaP vaccine and when ?

Children should get 5 doses of DTaP vaccine, one dose at each of the following ages:

• 2 months
• 4 months
• 6 months
• 15-18 months
• 4-6 years

DTaP may be given at the same time as other vaccines.

Some children should not get DTaP vaccine or should wait

• Children with minor illnesses, such as a cold, may be vaccinated. But children who are moderately or severely ill should usually wait until they recover before getting DTaP vaccine.
• Any child who had a life-threatening allergic reaction after a dose of DTaP should not get another dose.
• Any child who suffered a brain or nervous system disease within 7 days after a dose of DTaP should not get another dose.
• Talk with your doctor if your child:
  • had a seizure or collapsed after a dose of DTaP,
  • cried non-stop for 3 hours or more after a dose of DTaP,
  • had a fever over 105°F after a dose of DTaP.

Ask your doctor for more information. Some of these children should not get another dose of pertussis vaccine, but may get a vaccine without pertussis, called DT.

Older children and adults

DTaP is not licensed for adolescents, adults, or children 7 years of age and older.

But older people still need protection. A vaccine called Tdap is similar to DTaP. A single dose of Tdap is recommended for people 11 through 64 years of age. Another vaccine, called Td, protects against tetanus and diphtheria, but not pertussis. It is recommended every 10 years. There are separate Vaccine Information Statements for these vaccines.

DTaP vaccine side-effects

Getting diphtheria, tetanus, or pertussis disease is much riskier than getting DTaP vaccine.

However, a vaccine, like any medicine, is capable of causing serious problems, such as severe allergic reactions. The risk of DTaP vaccine causing serious harm, or death, is extremely small.

Mild Problems (Common)

• Fever (up to about 1 child in 4)
• Redness or swelling where the shot was given (up to about 1 child in 4)
• Soreness or tenderness where the shot was given (up to about 1 child in 4)

These problems occur more often after the 4th and 5th doses of the DTaP series than after earlier doses. Sometimes the 4th or 5th dose of DTaP vaccine is followed by swelling of the entire arm or leg in which the shot was given, lasting 1-7 days (up to about 1 child in 30).

Other mild problems include:

• Fussiness (up to about 1 child in 3)
• Tiredness or poor appetite (up to about 1 child in 10)
• Vomiting (up to about 1 child in 50)

These problems generally occur 1-3 days after the shot.

Moderate Problems (Uncommon)

• Seizure (jerking or staring) (about 1 child out of 14,000)
• Non-stop crying, for 3 hours or more (up to about 1 child out of 1,000)
• High fever, over 105°F (about 1 child out of 16,000)

Severe Problems (Very Rare)

• Serious allergic reaction (less than 1 out of a million doses)
• Several other severe problems have been reported after DTaP vaccine. These include:
• Long-term seizures, coma, or lowered consciousness
• Permanent brain damage.

These are so rare it is hard to tell if they are caused by the vaccine.

Controlling fever is especially important for children who have had seizures, for any reason. It is also important if another family member has had seizures. You can reduce fever and pain by giving your child an aspirin-free pain reliever when the shot is given, and for the next 24 hours, following the package instructions.

Flu vaccine

What is Influenza (flu)

Influenza (flu) is a contagious respiratory illness caused by influenza viruses that infect the nose, throat, and lungs. It can cause mild to severe illness, and can lead to hospitalization and death. Every year in the United States, millions of people are sickened, hundreds of thousands are hospitalized and thousands or tens of thousands of people die from the flu.

Anyone can get the flu (even healthy people) and serious problems related to the flu can happen at any age, but some people are a higher risk of developing serious flu-related complications if they get sick. This includes people 65 years and older, people of any age with certain chronic medical conditions (such as diabetes, asthma, or heart disease), pregnant women, and young children.

The best way and most important step to prevent the flu is by getting a flu vaccine each year. The Centers for Disease Control and Prevention (CDC) recommends that everyone 6 months of age and older get a flu vaccine each year. Flu vaccination can reduce flu illnesses, doctors’ visits, and missed work and school due to flu, as well as prevent flu-related hospitalizations.

Influenza Symptoms

Influenza (also known as the flu) is a contagious respiratory illness caused by flu viruses. It can cause mild to severe illness, and at times can lead to death. The flu is different from a cold. The flu usually comes on suddenly. People who have the flu often feel some or all of these symptoms:

• Fever* or feeling feverish/chills
• Cough
• Sore throat
• Runny or stuffy nose
• Muscle or body aches
• Headaches
• Fatigue (tiredness)
• Some people may have vomiting and diarrhea, though this is more common in children than adults.

* It’s important to note that not everyone with flu will have a fever.

Flu Complications

Most people who get influenza will recover in several days to less than two weeks, but some people will develop complications as a result of the flu. A wide range of complications can be caused by influenza virus infection of the upper respiratory tract (nasal passages, throat) and lower respiratory tract (lungs). While anyone can get sick with flu and become severely ill, some people are more likely to experience severe flu illness. Young children, adults aged 65 years and older, pregnant women, and people with certain chronic medical conditions are among those groups of people who are at high risk of serious flu complications, possibly requiring hospitalization and sometimes resulting in death. For example, people with chronic lung disease are at higher risk of developing severe pneumonia.

Sinus and ear infections are examples of moderate complications from flu, while pneumonia is a serious flu complication that can result from either influenza virus infection alone or from co-infection of flu virus and bacteria. Other possible serious complications triggered by flu can include inflammation of the heart (myocarditis), brain (encephalitis) or muscle (myositis, rhabdomyolysis) tissues, and multi-organ failure (for example, respiratory and kidney failure). Flu virus infection of the respiratory tract can trigger an extreme inflammatory response in the body and can lead to sepsis, the body’s life-threatening response to infection. Flu also can make chronic medical problems worse. For example, people with asthma may experience asthma attacks while they have the flu, and people with chronic heart disease may experience a worsening of this condition triggered by flu.

Flu Vaccine

Everyone 6 months and older is recommended for annual flu vaccination with rare exception. For the 2016-2017 season, the Centers for Disease Control and Prevention (CDC) recommends use of injectable flu vaccines–inactivated influenza vaccine (or IIV) or the recombinant influenza vaccine (RIV). The nasal spray flu vaccine (live attenuated influenza vaccine or LAIV) should not be used during 2016-2017. You should take precautions or talk to your doctor or other health care professional before vaccination. Talk to your doctor or nurse if you have any questions regarding which flu vaccine is best for you and your family.
All persons aged 6 months and older are recommended for annual vaccination, with rare exception.

Vaccination is particularly important for people who are at high risk for serious flu complications from influenza.

Flu Vaccine Effectiveness

Influenza vaccine effectiveness can vary from year to year and among different age and risk groups.

The Centers for Disease Control and Prevention (CDC) conducts studies each year to determine how well the influenza (flu) vaccine protects against flu illness. While vaccine effectiveness can vary, recent studies show that flu vaccination reduces the risk of flu illness by between 40% and 60% among the overall population during seasons when most circulating flu viruses are well-matched to the flu vaccine. In general, current flu vaccines tend to work better against influenza B and influenza A(H1N1) viruses and offer lower protection against influenza A(H3N2) viruses.

What are factors that influence how well the vaccine works ?

How well the flu vaccine works (or its ability to prevent flu illness) can range widely from season to season. The vaccine’s effectiveness also can vary depending on who is being vaccinated. At least two factors play an important role in determining the likelihood that flu vaccine will protect a person from flu illness:

1. characteristics of the person being vaccinated (such as their age and health), and
2. the similarity or “match” between the flu viruses the flu vaccine is designed to protect against and the flu viruses spreading in the community.

During years when the flu vaccine is not well matched to circulating influenza viruses, it is possible that no benefit from flu vaccination may be observed. During years when there is a good match between the flu vaccine and circulating viruses, it is possible to measure substantial benefits from flu vaccination in terms of preventing flu illness. However, even during years when the flu vaccine match is good, the benefits of flu vaccination will vary, depending on various factors like the characteristics of the person being vaccinated, what influenza viruses are circulating that season and even, potentially, which flu vaccine was used.

Each flu season researchers try to determine how well flu vaccines work as a public health intervention. Estimates of how well a flu vaccine works can vary based on study design, outcome(s) measured, population studied and the season in which the flu vaccine was studied. These differences can make it difficult to compare one study’s results with another’s.

While determining how well a flu vaccine works is challenging, in general, recent studies have supported the conclusion that flu vaccination benefits public health, especially when the flu vaccine is well matched to circulating flu viruses.

What are the benefits of flu vaccination ?

While how well the flu vaccine works can vary, there are many reasons to get a flu vaccine each year.

• Flu vaccination can keep you from getting sick with flu.
• Flu vaccination can reduce the risk of flu-associated hospitalization, including among children and older adults.
• Vaccine effectiveness for the prevention of flu-associated hospitalizations was similar to vaccine effectiveness against flu illness resulting in doctor’s visits in a comparative study published in 2016.
• Flu vaccination is an important preventive tool for people with chronic health conditions.
• Flu vaccination has been associated with lower rates of some cardiac (heart) events among people with heart disease, especially among those who experienced a cardiac event in the past year.
• Flu vaccination also has been associated with reduced hospitalizations among people with diabetes (79%) and chronic lung disease (52%).
• Vaccination helps protect women during and after pregnancy. Getting vaccinated can also protect a baby after birth from flu. (Mom passes antibodies onto the developing baby during her pregnancy.)
• A study that looked at flu vaccine effectiveness in pregnant women found that vaccination reduced the risk of flu-associated acute respiratory infection by about one half.
• There are studies that show that flu vaccine in a pregnant woman can reduce the risk of flu illness in her baby by up to half. This protective benefit was observed for several months after birth.
• And a 2017 study was the first of its kind to show that flu vaccination can significantly reduce a child’s risk of dying from influenza.
• Flu vaccination also may make your illness milder if you do get sick. (For example a 2017 study showed that flu vaccination reduced deaths, intensive care unit (ICU) admissions, ICU length of stay, and overall duration of hospitalization among hospitalized flu patients.)
  Getting vaccinated yourself also protects people around you, including those who are more vulnerable to serious flu illness, like babies and young children, older people, and people with certain chronic health conditions.

Is the flu vaccine effective against all types of flu and cold viruses ?

Seasonal flu vaccines are designed to protect against infection and illness caused by the three or four influenza viruses (depending on vaccine) that research indicates will be most common during the flu season. “Trivalent” flu vaccines are formulated to protect against three flu viruses, and “quadrivalent” flu vaccines protect against four flu viruses. Flu vaccines do NOT protect against infection and illness caused by other viruses that can also cause flu-like symptoms. There are many other viruses besides flu viruses that can result in flu-like illness* (also known as influenza-like illness or “ILI”) that spread during the flu season. These non-flu viruses include rhinovirus (one cause of the “common cold”) and respiratory syncytial virus (RSV), which is the most common cause of severe respiratory illness in young children, as well as a leading cause of death from respiratory illness in those aged 65 years and older.

How effective is the flu vaccine in the elderly ?

Older people with weaker immune systems often have a lower protective immune response after flu vaccination compared to younger, healthier people. This can make them more susceptible to the flu. Although immune responses may be lower in the elderly, vaccine effectiveness has been similar in most flu seasons among older adults and those with chronic health conditions compared to younger, healthy adults.

If older people have weaker immune responses to flu vaccination, should they still get vaccinated ?

Despite the fact that older adults (65 years of age and older) have weaker immune responses to vaccine flu vaccines, there are many reasons why people in that age group should be vaccinated each year.

• First, people aged 65 and older are at increased risk of serious illness, hospitalization and death from the flu.
• Second, while the effectiveness of the flu vaccine can be low among older people, there are seasons when significant benefit can be observed. Even if the vaccine provides less protection in older adults than it might in younger people, some protection is better than no protection at all, especially in this high risk group.
• Third, flu vaccine may protect against more serious outcomes like hospitalization and death. For example, one study concluded that one death was prevented for every 4,000 people vaccinated against the flu.
• In frail elderly adults, hospitalizations can mark the beginning of a significant decline in overall health and mobility, potentially resulting in loss of the ability to live independently or to complete basic activities of daily living. While the protection elderly adults obtain from flu vaccination can vary significantly, a yearly flu vaccination is still the best protection currently available against the flu.
• There is some data to suggest that flu vaccination may reduce flu illness severity; so while someone who is vaccinated may still get infected, their illness may be milder.
• Fourth, it’s important to remember that people who are 65 and older are a diverse group and often are different from one another in terms of their overall health, level of activity and mobility, and behavior when it comes to seeking medical care. This group includes people who are healthy and active and have responsive immune systems, as well as those who have underlying medical conditions that may weaken their immune system and their bodies’ ability to respond to vaccination. Therefore, when evaluating the benefits of flu vaccination, it is important to look at a broader picture than what one study’s findings can present.

How effective is the flu vaccine in children ?

Vaccination has consistently been found to provide a similar level of protection against flu illness in children to that seen among healthy adults.

In one study, flu vaccine effectiveness was higher among children who received two doses of flu vaccine the first season that they were vaccinated (as recommended) compared to “partially vaccinated” children who only received a single dose of flu vaccine. However, the partially vaccinated children still received some protection.

Flu vaccine can prevent severe, life-threatening illness in children, for example:

• A 2014 study showed that flu vaccine reduced children’s risk of flu-related pediatric intensive care unit (PICU) admission by 74% during flu seasons from 2010-2012.
• In 2017, a study in the journal Pediatrics was the first of its kind to show that flu vaccination also significantly reduced a child’s risk of dying from the flu.
• The study, which looked at data from four flu seasons between 2010 and 2014, found that flu vaccination reduced the risk of flu-associated death by half (51 percent) among children with underlying high-risk medical conditions and by nearly two-thirds (65 percent) among healthy children.

What kinds of flu vaccines are available ?

The Centers for Disease Control and Prevention (CDC) recommends use of injectable influenza vaccines (including inactivated influenza vaccines and recombinant influenza vaccines) during 2017-2018. The nasal spray flu vaccine (live attenuated influenza vaccine or LAIV) should not be used during 2017-2018 ⁵⁾.

Both trivalent (three-component) and quadrivalent (four-component) flu vaccines will be available.

Trivalent flu vaccines include:

• Standard-dose trivalent shots (IIV3) that are manufactured using virus grown in eggs. Different flu shots are approved for different age groups. Most flu shots are given in the arm (muscle) with a needle. One trivalent vaccine formulation can be given with a jet injector, for persons aged 18 through 64 years.
• A high-dose trivalent shot, approved for people 65 and older.
• A recombinant trivalent shot that is egg-free, approved for people 18 years and older, including pregnant women.
• A trivalent flu shot made with adjuvant (an ingredient of a vaccine that helps create a stronger immune response in the patient’s body), approved for people 65 years of age and older (new this season).

Quadrivalent flu vaccines include:

• Quadrivalent flu shots approved for use in different age groups, including children as young as 6 months.
• An intradermal quadrivalent flu shot, which is injected into the skin instead of the muscle and uses a much smaller needle than the regular flu shot. It is approved for people 18 through 64 years of age.
• A quadrivalent flu shot containing virus grown in cell culture, which is approved for people 4 years of age and older.
• A recombinant quadrivalent flu shot approved for people 18 years of age and older, including pregnant women (new this season).

Who should get vaccinated this season ?

Everyone 6 months of age and older should get a flu vaccine every season. This recommendation has been in place since February 24, 2010 when CDC’s Advisory Committee on Immunization Practices (ACIP) voted for “universal” flu vaccination in the United States to expand protection against the flu to more people.

Vaccination to prevent influenza is particularly important for people who are at high risk of serious complications from influenza. See People at High Risk of Developing Flu-Related Complications for a full list of age and health factors that confer increased risk.

Who Should Not Be Vaccinated ?

CDC recommends use of a flu shot; either an inactivated influenza vaccine or (IIV) or a recombinant influenza vaccine (RIV). The nasal spray flu vaccine (live attenuated influenza vaccine or LAIV) should not be used during 2017-2018. Different flu vaccines are approved for use in different groups of people. Factors that can determine a person’s suitability for vaccination, or vaccination with a particular vaccine, include a person’s age, health (current and past) and any allergies to flu vaccine or its components.

• People who cannot get a flu shot.
• People who should talk to their doctor before getting the flu shot.

When should I get vaccinated ?

You should get a flu vaccine now, if you haven’t gotten one already this season. It’s best to get vaccinated before flu begins spreading in your community. It takes about two weeks after vaccination for antibodies to develop in the body that protect against flu. CDC recommends that people get a flu vaccine by the end of October, if possible. Getting vaccinated later, however, can still be beneficial and vaccination should continue to be offered throughout the flu season, even into January or later.

Children who need two doses of vaccine to be protected should start the vaccination process sooner, because the two doses must be given at least four weeks apart.

Where can I get a flu vaccine ?

Flu vaccines are offered in many locations, including doctor’s offices, clinics, health departments, pharmacies and college health centers, as well as by many employers, and even in some schools.

Even if you don’t have a regular doctor or nurse, you can get a flu vaccine somewhere else, like a health department, pharmacy, urgent care clinic, and often your school, college health center, or workplace.

Why do I need a flu vaccine every year ?

A flu vaccine is needed every season for two reasons. First, the body’s immune response from vaccination declines over time, so an annual vaccine is needed for optimal protection. Second, because flu viruses are constantly changing, the formulation of the flu vaccine is reviewed each year and sometimes updated to keep up with changing flu viruses. For the best protection, everyone 6 months and older should get vaccinated annually.

Does flu vaccine work right away ?

No. It takes about two weeks after vaccination for antibodies to develop in the body and provide protection against influenza virus infection. That’s why it’s better to get vaccinated early in the fall, before the flu season really gets under way.

Can I get seasonal flu even though I got a flu vaccine this year ?

Yes. There is still a possibility you could get the flu even if you got vaccinated. The ability of flu vaccine to protect a person depends on various factors, including the age and health status of the person being vaccinated, and also the similarity or “match” between the viruses used to make the vaccine and those circulating in the community. If the viruses in the vaccine and the influenza viruses circulating in the community are closely matched, vaccine effectiveness is higher. If they are not closely matched, vaccine effectiveness can be reduced. However, it’s important to remember that even when the viruses are not closely matched, the vaccine can still protect many people and prevent flu-related complications. Such protection is possible because antibodies made in response to the vaccine can provide some protection (called cross-protection) against different but related influenza viruses.

Is it true that getting vaccinated repeatedly can reduce vaccine effectiveness ?

Some studies do suggest that flu vaccine effectiveness may be higher in people receiving flu vaccine for the first time compared to people who have been vaccinated more than once; other studies have found no evidence that repeat vaccination results in a person being less-protected against flu.

Immune responses to vaccination may be higher among people who were not vaccinated in a previous season, but repeatedly vaccinated people (i.e., people who receive the flu vaccine each year) may still have increased immune responses after vaccination.

Two reviews of multiple studies have found that for people vaccinated in the prior season, vaccination in the subsequent season provides additional protection against flu.

Information regarding flu vaccination history is particularly important to these types of evaluations, and can be difficult to confirm, as accurate vaccination records are not always readily available. People who choose to get vaccinated every year may have different characteristics and susceptibility to flu compared to those who do not seek vaccination every year. CDC thinks that these findings merit further investigation to understand the immune response to repeat vaccination. CDC supports continued efforts to monitor the effects of repeat vaccination each year. However, based on the substantial burden of flu in the United States, and on the fact that most studies point to vaccination benefits, CDC recommends that yearly flu vaccination remains the first and most important step in protecting against flu and its complications.

Hepatitis A vaccine

What is Hepatitis A

Hepatitis A is a serious liver disease caused by the hepatitis A virus (HAV). Hepatitis A can affect anyone. Hepatitis A virus is spread from person to person through contact with the feces (stool) of people who are infected, which can easily happen if someone does not wash his or her hands properly. You can also get hepatitis A from food, water, or objects contaminated with hepatitis A virus.

Symptoms of hepatitis A can include:

• fever, fatigue, loss of appetite, nausea, vomiting, and/or joint pain
• severe stomach pains and diarrhea (mainly in children), or
• jaundice (yellow skin or eyes, dark urine, clay-colored bowel movements).

These symptoms usually appear 2 to 6 weeks after exposure and usually last less than 2 months, although some people can be ill for as long as 6 months. If you have hepatitis A you may be too ill to work.

Children often do not have symptoms, but most adults do. You can spread HAV without having symptoms.

Hepatitis A can cause liver failure and death, although this is rare and occurs more commonly in persons 50 years of age or older and persons with other liver diseases, such as hepatitis B or C.

Hepatitis A vaccines are available for long-term prevention of hepatitis A virus infection in persons 1 year of age and older. Good personal hygiene and proper sanitation can also help prevent the spread of hepatitis A.

Hepatitis A vaccines were recommended in the United States beginning in 1996. Since then, the number of cases reported each year in the U.S. has dropped from around 31,000 cases to fewer than 1,500 cases.

Hepatitis A vaccine

Hepatitis A vaccine is an inactivated (killed) vaccine. You will need 2 doses for long-lasting protection. These doses should be given at least 6 months apart.

Children are routinely vaccinated between their first and second birthdays (12 through 23 months of age). Older children and adolescents can get the vaccine after 23 months. Adults who have not been vaccinated previously and want to be protected against hepatitis A can also get the vaccine.

You should get hepatitis A vaccine if you:

• are traveling to countries where hepatitis A is common,
• you live in a community with a high rate of hepatitis A,
• are a man who has sex with other men,
• use illegal drugs,
• have a chronic liver disease such as hepatitis B or hepatitis C,
• are being treated with clotting-factor concentrates,
• work with hepatitis A-infected animals or in a hepatitis A research laboratory, or
• expect to have close personal contact with an international adoptee from a country where hepatitis A is common

Ask your healthcare provider if you want more information about any of these groups.

There are no known risks to getting hepatitis A vaccine at the same time as other vaccines.

Who should not get Hepatitis A vaccine

Tell the person who is giving you the vaccine:

• If you have any severe, life-threatening allergies. Signs of a severe allergic reaction can include hives, swelling of the face and throat, difficulty breathing, a fast heartbeat, dizziness, and weakness. These would usually start a few minutes to a few hours after the vaccination. If you ever had a life-threatening allergic reaction after a dose of hepatitis A vaccine, or have a severe allergy to any part of this vaccine, you may be advised not to get vaccinated. Ask your health care provider if you want information about vaccine components.
• If you think it is a severe allergic reaction or other emergency that can’t wait, call your local emergency number and get to the nearest hospital. Otherwise, call your clinic.
• If you are not feeling well. If you have a mild illness, such as a cold, you can probably get the vaccine today. If you are moderately or severely ill, you should probably wait until you recover. Your doctor can advise you.

Risks of a Hepatitis A vaccine reaction

With any medicine, including vaccines, there is a chance of side effects. These are usually mild and go away on their own, but serious reactions are also possible.

Most people who get hepatitis A vaccine do not have any problems with it.

Minor problems following hepatitis A vaccine include:

• soreness or redness where the shot was given
• low-grade fever
• headache
• tiredness

If these problems occur, they usually begin soon after the shot and last 1 or 2 days.

Your doctor can tell you more about these reactions.

Other problems that could happen after Hepatitis A vaccination:

• People sometimes faint after a medical procedure, including vaccination. Sitting or lying down for about 15 minutes can help prevent fainting, and injuries caused by a fall. Tell your provider if you feel dizzy, or have vision changes or ringing in the ears.
• Some people get shoulder pain that can be more severe and longer lasting than the more routine soreness that can follow injections. This happens very rarely.
• Any medication can cause a severe allergic reaction. Such reactions from a vaccine are very rare, estimated at about 1 in a million doses, and would happen within a few minutes to a few hours after the vaccination.

As with any medicine, there is a very remote chance of a vaccine causing a serious injury or death.

Hepatitis B vaccine

What is Hepatitis B

Hepatitis B is a serious disease caused by a virus that attacks the liver. The virus, which is called hepatitis B virus (HBV), can cause lifelong infection, cirrhosis (scarring) of the liver, liver cancer, liver failure, and death.

• Hepatitis B vaccine is available for all age groups to prevent hepatitis B virus infection and its consequences, including liver cancer, liver failure and cirrhosis.

Hepatitis B virus infection can be either acute or chronic.

Acute hepatitis B virus infection is a short-term illness that occurs within the first 6 months after someone is exposed to the hepatitis B virus. This can lead to:

• fever, fatigue, loss of appetite, nausea, and/or vomiting
• jaundice (yellow skin or eyes, dark urine, clay-colored bowel movements)
• pain in muscles, joints, and stomach

Chronic hepatitis B virus infection is a long-term illness that occurs when the hepatitis B virus remains in a person’s body. Most people who go on to develop chronic hepatitis B do not have symptoms, but it is still very serious and can lead to:

• liver damage (cirrhosis)
• liver cancer
• death

Chronically-infected people can spread hepatitis B virus to others, even if they do not feel or look sick themselves. Up to 1.4 million people in the United States may have chronic hepatitis B infection. About 90% of infants who get hepatitis B become chronically infected and about 1 out of 4 of them dies.

Hepatitis B is spread when blood, semen, or other body fluid infected with the Hepatitis B virus enters the body of a person who is not infected. People can become infected with the virus through:

• Birth (a baby whose mother is infected can be infected at or after birth)
• Sharing items such as razors or toothbrushes with an infected person
• Contact with the blood or open sores of an infected person
• Sex with an infected partner
• Sharing needles, syringes, or other drug-injection equipment
• Exposure to blood from needlesticks or other sharp instruments

Each year about 2,000 people in the United States die from hepatitis B-related liver disease.

Hepatitis B Vaccine

Hepatitis B vaccine is made from parts of the hepatitis B virus. It cannot cause hepatitis B infection. The vaccine is usually given as 3 or 4 shots over a 6-month period.

Who Needs to be Vaccinated against Hepatitis B ?

• Infants should get their first dose of hepatitis B vaccine at birth and will usually complete the series at 6 months of age.
• All children and adolescents younger than 19 years of age should get their first dose of hepatitis B vaccine at birth and should have completed the vaccine series by 6 through 18 months of age.
• Children and adolescents through 18 years of age who did not get the vaccine when they were younger should also be vaccinated.

As an adult, you should get the hepatitis B vaccine if:

• You have sex with or live in the same house as a person with hepatitis B virus infection.
• You have sex with more than one partner.
• You seek care in a clinic for sexually transmitted diseases, HIV testing or treatment, or drug treatment.
• You are a man who has sex with other men.
• You inject drugs.
• You have a job that involves contact with human blood*.
• You are on the staff of, or a client in, an institution for the developmentally disabled*.
• You are a hemodialysis patient or have end-stage renal disease.
• You have HIV infection.
• You are a dialysis patient.
• You have chronic liver disease, kidney disease, HIV infection, or diabetes.
• You have diabetes and are under age 60.
• You live or travel for more than 6 months a year in countries where hepatitis B is common.
• You seek care in a clinic for sexually transmitted diseases, HIV testing, or drug treatment.
• You are a prisoner in a correctional facility.
• You are a victim of sexual assault or abuse.
• You want to be protected from hepatitis B virus infection.

Who should not get hepatitis B vaccine

Tell the person who is giving the vaccine:

• If you have any severe, life-threatening allergies. Signs of a severe allergic reaction can include hives, swelling of the face and throat, difficulty breathing, a fast heartbeat, dizziness, and weakness. These would usually start a few minutes to a few hours after the vaccination. If you ever had a life-threatening allergic reaction after a dose of hepatitis A vaccine, or have a severe allergy to any part of this vaccine, you may be advised not to get vaccinated. Ask your health care provider if you want information about vaccine components.
• If you think it is a severe allergic reaction or other emergency that can’t wait, call your local emergency number and get to the nearest hospital. Otherwise, call your clinic.
• If you are not feeling well. If you have a mild illness, such as a cold, you can probably get the vaccine today. If you are moderately or severely ill, you should probably wait until you recover. Your doctor can advise you.

Hepatitis B vaccine side-effects

With any medicine, including vaccines, there is a chance of side effects. These are usually mild and go away on their own, but serious reactions are also possible.

Most people who get hepatitis B vaccine do not have any problems with it.

Minor problems following hepatitis B vaccine include:

• soreness where the shot was given
• temperature of 99.9°F or higher

If these problems occur, they usually begin soon after the shot and last 1 or 2 days.

Your doctor can tell you more about these reactions.

Other problems that could happen after this vaccine:

• People sometimes faint after a medical procedure, including vaccination. Sitting or lying down for about 15 minutes can help prevent fainting and injuries caused by a fall. Tell your provider if you feel dizzy, or have vision changes or ringing in the ears.
• Some people get shoulder pain that can be more severe and longer-lasting than the more routine soreness that can follow injections. This happens very rarely.
• Any medication can cause a severe allergic reaction. Such reactions from a vaccine are very rare, estimated at about 1 in a million doses, and would happen within a few minutes to a few hours after the vaccination.

As with any medicine, there is a very remote chance of a vaccine causing a serious injury or death.

HIB vaccine

What is Hib (Haemophilus influenzae type b) disease ?

Haemophilus influenzae is a type of bacteria that mainly causes illness in babies and children younger than 5 years old ⁶⁾. These bacteria can cause infections in people of all ages ranging from mild, such as an ear infection, to severe, such as a bloodstream infection. In spite of the name, H. influenzae do not cause influenza (the “flu”).

When the Haemophilus influenzae bacteria invade parts of the body that are normally free from germs, like spinal fluid or blood, this is known as “invasive disease.” Invasive disease is usually severe and can sometimes result in death.

Hib disease was once a leading cause of bacterial meningitis (swelling of the tissue covering the brain and spinal cord) among U.S. children younger than 5 years old. Every year about 20,000 children younger than five years old got invasive Hib disease and about 1,000 children died. More than half of the children who developed invasive Hib disease were younger than one year old. Due to the use of Hib vaccines, by 2014, fewer than 50 cases of Hib disease occurred each year in children younger than five years in the United States. Most cases of Hib disease today are in children who did not get a Hib vaccine or who have not been fully vaccinated.

The most common types of invasive disease caused by H. influenzae are:

• Pneumonia* (lung infection)
• Bacteremia (blood infection)
• Meningitis (infection of the covering of the brain and spinal cord)
• Epiglotittis (swelling of the windpipe that can cause breathing trouble)
• Cellulitis (skin infection)
• Infectious arthritis (inflammation of the joint)

Haemophilus influenzae can also be a common cause of ear infections in children and bronchitis in adults.

• There are six identifiable types of H. influenzae bacteria (a through f) and other non-identifiable types (called nontypeable). The one people are most familiar with is Haemophilus influenzae type b, or Hib, that can be prevented with a vaccine. However, the vaccine does not protect against other types of the bacteria.

Hib vaccines are available that can help prevent Haemophilus influenzae type b or Hib disease. These vaccines do not provide protection against other types of Haemophilus influenzae disease. Haemophilus influenzae disease is any type of infection caused by Haemophilus influenzae bacteria.

Hib (Haemophilus influenzae type b) vaccination is recommended for all children younger than 5 years old in the United States, and the vaccine is usually given to babies starting at 2 months old. In certain situations, people at increased risk for invasive Hib disease who are fully vaccinated need more doses of a Hib vaccine. Unimmunized older children and adults with certain medical conditions should also get a Hib vaccine.

Talk with your or your child’s healthcare professional if you have questions about Hib vaccines.

What Types of Hib Vaccine Are There ?

There are 4 Haemophilus influenzae type b (Hib) vaccines licensed for use in the United States by the Food and Drug Administration (FDA), 1 of which is combined with vaccines for other diseases. Your child will get either 2 or 3 primary doses, depending on which vaccine is used, and a booster dose. The first primary dose can be given as early as 6 weeks. Any of the Hib-only vaccines can also be used for older children and adults that need Hib vaccination.

Hib-only Vaccines

• PedvaxHIB®: It is given in a two-dose primary series plus one booster dose to children who are 2 through 15 months old.
• ActHIB®: It is given in a three-dose primary series plus one booster dose to children who are 2 through 15 months old.
• Hiberix®: It is given in a three-dose primary series plus one booster dose to children who are 2 months through 15 months old.

Combination Vaccines

A combination vaccine is when two or more vaccines are given in a single shot in order to decrease the number of shots given.

• Pentacel®: It is given as a three-dose primary series plus one booster dose to children who are 2 through 18 months old to protect against Hib disease, diphtheria, tetanus, pertussis (whooping cough), and polio.

Who Should Get a Hib Vaccine ?

CDC recommends Haemophilus influenzae type b (Hib) vaccination for all children younger than 5 years old. Older children and adults usually do not need a Hib vaccine. Below is more information about when Hib vaccines are recommended, as well as information on who should not get Hib vaccines.

Talk to your or your child’s healthcare professional about what is best for your specific situation.

Young Children

Children younger than 5 years old need a primary series of two or three doses, depending on the brand used, and a booster dose of a Hib vaccine. Doses are recommended at the following ages:

• 2 months
• 4 months
• 6 months (if needed; depends on brand)
• 12 through 15 months

Older Children and Adults

Older children and adults usually do not need a Hib vaccine. However, some people who are fully vaccinated are at increased risk for invasive Hib disease and need additional doses. Unimmunized older children and adults with certain medical conditions should also get a Hib vaccine. Talk to your or your child’s healthcare professional about what is best for your specific situation.

Who Should Not Get Hib Vaccination ?

Because of age or health conditions, some people should not get certain vaccines or should wait before getting them. Read the guidelines below and ask your or your child’s healthcare professional for more information.

A Hib vaccine should not be given to babies younger than 6 weeks old.

In addition, tell the person who is giving you or your child a Hib vaccine if:

• You or your child have had a life-threatening allergic reaction or have a severe allergy.

Anyone who has ever had a life-threatening allergic reaction after a previous dose of a Hib vaccine, or has a severe allergy to any part of this vaccine, should not get a Hib vaccine. Your or your child’s healthcare professional can tell you about each vaccine’s ingredients.

You or your child are not feeling well.

People who have a mild illness, such as a cold, can probably get the vaccine. People who are moderately or severely ill should probably wait until they recover. Your or your child’s healthcare professional can advise you.

Hib vaccine side-effects

With any medicine, including vaccines, there is a chance of side effects. These are usually mild and go away on their own. Serious reactions are also possible but are rare.

Most people who get Hib vaccine do not have any problems with it.

Mild Problems following Hib vaccine:

• redness, warmth, or swelling where the shot was given
• fever

These problems are uncommon. If they occur, they usually begin soon after the shot and last 2 or 3 days.

Problems that could happen after any vaccine:

Any medication can cause a severe allergic reaction. Such reactions from a vaccine are very rare, estimated at fewer than 1 in a million doses, and would happen within a few minutes to a few hours after the vaccination.

As with any medicine, there is a very remote chance of a vaccine causing a serious injury or death.

Older children, adolescents, and adults might also experience these problems after any vaccine:

• People sometimes faint after a medical procedure, including vaccination. Sitting or lying down for about 15 minutes can help prevent fainting, and injuries caused by a fall. Tell your doctor if you feel dizzy, or have vision changes or ringing in the ears.
• Some people get severe pain in the shoulder and have difficulty moving the arm where a shot was given. This happens very rarely.

How Well Do Hib Vaccines Work ?

Vaccines that help protect against Haemophilus influenzae type b (Hib) disease work well, but cannot prevent all cases.

• Studies show that nearly all (between 93 and 100 out of 100) children are protected against invasive Hib disease after receiving a 2- or 3-dose primary series of Hib vaccine.
• After receiving the primary series, antibody levels decrease and a booster dose is needed for children between 12 and 15 months old to maintain protection during early childhood.

HPV vaccine

What is HPV

Human papillomavirus (HPV) is a very common virus that can lead to cancer. Nearly 80 million people—about one in four—are currently infected with HPV in the United States. About 14 million people, including teens, become infected with HPV each year.

Over 30,000 people in the United States each year are affected by a cancer caused by HPV infection. While there is screening available for cervical cancer for women, there is no screening for the other cancers caused by HPV infection, like cancers of the mouth/throat, anus/rectum, penis, vagina, or vulva.

HPV vaccination provides safe, effective, and lasting protection against the HPV infections that most commonly cause cancer.

HPV Vaccine

What Types of HPV Vaccines Are There ?

Two HPV vaccines have been licensed by the U.S. Food and Drug Administration (FDA).

• Gardasil (Merck) is a quadrivalent HPV vaccine (4vHPV) that protects against HPV types 6, 11, 16, and 18.
• Gardasil-9 (Merck) is a nine-valent HPV vaccine (9vHPV) that protects against HPV types 6, 11, 16, 18, 31, 45, 52, and 58.

All two HPV vaccines protect against the two HPV types, 16 and 18, that cause most HPV cancers.

Who Should Get HPV Vaccine ?

HPV vaccination is recommended for preteen girls and boys at age 11 or 12 years. All preteens need HPV vaccination so they can be protected from HPV infections that cause cancer.

• Teens and young adults who didn’t start or finish the HPV vaccine series also need HPV vaccination.
• Teens and young women can get HPV vaccine until they are 27 years old and young men should get HPV vaccine until they are 22 years old.
• Teens and young men who have sex with other men or who have weakened immune systems should get HPV vaccine until they are 27.
• Transgender individuals should also get HPV vaccine until they are 27.

CDC recommends that 11- to 12-year-olds receive two doses of HPV vaccine at least six months apart to protect against cancers caused by human papillomavirus (HPV) infections.

• The first dose is routinely recommended at 11-12 years old.
• The second dose of the vaccine should be administered 6 to 12 months after the first dose.
• Vaccination with the two-dose series can be started at age 9 and through age 14.

Teens and young adults who start the series later, at ages 15 through 26 years, need three doses of HPV vaccine to protect against cancer-causing HPV infection.

• Adolescents aged 9 through 14 years who have already received two doses of HPV vaccine less than 5 months apart, will require a third dose.
• Three doses are recommended for people with weakened immune systems aged 9-26 years.

Who Should Not Get HPV Vaccine ?

Tell your doctor about any severe allergies. Some people should not get some HPV vaccines, including:

• People who have ever had a life-threatening allergic reaction to any ingredient of an HPV vaccine, or to a previous dose of HPV vaccine.
• People who have an allergy to yeast (Gardasil and Gardasil 9).

HPV vaccines are safe for children who are mildly ill – for example, with a low-grade fever of less than 101 degrees, a cold, runny nose, or cough. People with a moderate or severe illness should wait until they are better.

How Well Do These HPV Vaccines Work ?

HPV vaccination works extremely well. Clinical trials showed the vaccines provided close to 100% protection against precancers and, for Gardasil and Gardasil 9, genital warts.

• Since the vaccine was first recommended in 2006, there has been a significant reduction in HPV infections.
• Research has also shown that fewer teens and young adults are getting genital warts.
• In other countries such as Australia where there is higher HPV vaccination coverage, HPV vaccine has also reduced the number of cases of precancers of the cervix in young women in that country.
• Also, genital warts have decreased dramatically in young adults in Australia since the HPV vaccine was introduced.

HPV vaccine offers long-lasting protection against HPV infection and HPV disease

• 10 years of data show that HPV vaccination provides long-lasting protection.
• There is no evidence to suggest that HPV vaccine loses the ability to provide protection over time.

HPV Vaccine Side Effects

HPV–Gardasil-9 vaccine side-effects

Human Papillomavirus Gardasil-9 vaccine side effects

With any medicine, including vaccines, there is a chance of side effects. These are usually mild and go away on their own, but serious reactions are also possible.

Most people who get HPV vaccine do not have any serious problems with it.

Mild or moderate problems following HPV vaccine:

• Reactions in the arm where the shot was given:
  • Soreness (about 9 people in 10)
  • Redness or swelling (about 1 person in 3)

Fever:

• Mild (100°F) (about 1 person in 10)
• Moderate (102°F) (about 1 person in 65)

Other problems:

• Headache (about 1 person in 3)
• Muscle or joint pain.

Problems that could happen after any injected vaccine:

• People sometimes faint after a medical procedure, including vaccination. Sitting or lying down for about 15 minutes can help prevent fainting and injuries caused by a fall. Tell your doctor if you feel dizzy, or have vision changes or ringing in the ears.
• Some people get severe pain in the shoulder and have difficulty moving the arm where a shot was given. This happens very rarely.
• Any medication can cause a severe allergic reaction. Such reactions from a vaccine are very rare, estimated at about 1 in a million doses, and would happen within a few minutes to a few hours after the vaccination.

As with any medicine, there is a very remote chance of a vaccine causing a serious injury or death.

Meningococcal vaccine

What is Meningococcal Disease

Meningococcal disease can refer to any illness caused by the type of bacteria called Neisseria meningitidis, also known as meningococcus ⁷⁾. These illnesses are often severe and can be deadly. They include infections of the lining of the brain and spinal cord (meningitis) and bloodstream infections (bacteremia or septicemia).

People spread meningococcal bacteria to other people by sharing respiratory and throat secretions (saliva or spit). Generally, it takes close (for example, coughing or kissing) or lengthy contact to spread these bacteria. Fortunately, they are not as contagious as germs that cause the common cold or the flu. People do not catch them through casual contact or by breathing air where someone with meningococcal disease has been.

Sometimes the bacteria spread to people who have had close or lengthy contact with a patient with meningococcal disease. Those at increased risk of getting sick include:

• People who live with the patient
• Anyone with direct contact with the patient’s oral secretions, such as a boyfriend or girlfriend

Close contacts of someone with meningococcal disease should receive antibiotics to help prevent them from getting the disease. This is known as prophylaxis. Health departments investigate each case of meningococcal disease to identify all close contacts and make sure they receive prophylaxis. This does not mean that the contacts have the disease; it is to prevent it. People who are not a close contact of a patient with meningococcal disease do not need prophylaxis.

Doctors treat meningococcal disease with antibiotics, but quick medical attention is extremely important. Keeping up to date with recommended vaccines is the best defense against meningococcal disease.

About 1 in 10 people have Neisseria meningitidis bacteria in the back of their nose and throat with no signs or symptoms of disease; this is called being ‘a carrier’. But sometimes the Neisseria meningitidis bacteria invade the body and cause certain illnesses, which are known as meningococcal disease.

• There are five serogroups (types) of Neisseria meningitidis — A, B, C, W, and Y — that cause most disease worldwide. Three of these serogroups (B, C, and Y) cause most of the illness seen in the United States.

Vaccines are available that can help prevent meningococcal disease, which is any type of illness caused by Neisseria meningitidis bacteria. There are two types of meningococcal vaccines available in the United States:

• Meningococcal conjugate vaccines (Menactra® and Menveo®)
• Serogroup B meningococcal vaccines (Bexsero® and Trumenba®)

All 11 to 12 year olds should be vaccinated with a meningococcal conjugate vaccine. A booster dose is recommended at age 16 years. Teens and young adults (16 through 23 year olds) also may be vaccinated with a serogroup B meningococcal vaccine. In certain situations, other children and adults could be recommended to get meningococcal vaccines.

Talk with your or your child’s healthcare professional if you have questions about meningococcal vaccines.

Meningococcal vaccine

CDC recommends vaccination with a meningococcal conjugate vaccine for all preteens and teens at 11 to 12 years old, with a booster dose at 16 years old. Teens and young adults (16 through 23 year olds) also may be vaccinated with a serogroup B meningococcal vaccine.

What Types of Meningococcal Vaccines Are There ?

There are two types of meningococcal vaccines available in the United States:

• Conjugate vaccines (Menactra® and Menveo®). Conjugate: A type of vaccine that joins a protein to part of the bacteria to improve the protection the vaccine provides.
• Serogroup B (recombinant) vaccines (Bexsero® and Trumenba®). Recombinant: A type of vaccine where proteins from certain bacteria are used to help the body build protection against that germ.

Meningococcal Conjugate Vaccines

• Menactra®: Two doses are given to preteens and teens. It is also given to certain people at increased risk of meningococcal disease. It helps protect against four types of the bacteria that cause meningococcal disease (serogroups A, C, W, and Y).
• Menveo®: Two doses are given to preteens and teens. It is also given to certain people at increased risk of meningococcal disease. It helps protect against four types of the bacteria that cause meningococcal disease (serogroups A, C, W, and Y).

Serogroup B (Recombinant) Meningococcal Vaccines

• Bexsero®: It is given as a two-dose series to people 16 through 23 years old who are not at increased risk of meningococcal disease. It is also given as a two-dose series to people 10 years or older at increased risk of meningococcal disease. It helps protect against one type of the bacteria that causes meningococcal disease (serogroup B).
• Trumenba®: It is given as a two-dose series to people 16 through 23 years old who are not at increased risk of meningococcal disease. It is given as a three-dose series to people 10 years or older at increased risk of meningococcal disease. It helps protect against one type of the bacteria that causes meningococcal disease (serogroup B).

Who Should Get Meningococcal Vaccines ?

CDC recommends vaccination with meningococcal conjugate vaccine for all preteens and teens. In certain situations, other children and adults could be recommended to get meningococcal vaccines. Below is more information about which meningococcal vaccines are recommended for people by age, as well as information on who should not get meningococcal vaccines.

Talk to your or your child’s healthcare professional about what is best for your specific situation.

Preteens and Teens

There are two types of meningococcal vaccines for preteens and teens:

• Meningococcal conjugate vaccines (Menactra® or Menveo®)
• Serogroup B meningococcal vaccines (Bexsero® or Trumenba®)

All 11 to 12 year olds should be vaccinated with a meningococcal conjugate vaccine, with a booster dose given at 16 years old. All teens may also be vaccinated with a serogroup B meningococcal vaccine, preferably at 16 through 18 years old.

In addition to a meningococcal conjugate vaccine, certain preteens and teens should get a serogroup B meningococcal vaccine if they:

• Have a rare type of disorder (complement component deficiency)
• Are taking the medicine called Soliris®
• Have a damaged spleen or their spleen has been removed
• Are part of a population identified to be at increased risk because of a serogroup B meningococcal disease outbreak

Babies and Children

CDC recommends a meningococcal conjugate vaccine (Menactra® or Menveo®) for children who are between 2 months and 10 years old, if they:

• Have a rare type of disorder (complement component deficiency)
• Are taking the medicine called Soliris®
• Have a damaged spleen or their spleen has been removed
• Have HIV
• Are traveling to or residing in countries in which the disease is common
• Are part of a population identified to be at increased risk because of a serogroup A, C, W, or Y meningococcal disease outbreak

Talk to your child’s doctor to find out if, and when, they will need booster shots.

CDC recommends a serogroup B meningococcal vaccine (Bexsero® or Trumenba®) for children 10 years or older if they:

• Have a rare type of disorder (complement component deficiency)
• Are taking a medicine called Soliris®
• Have a damaged spleen or their spleen has been removed
• Are part of a population identified to be at increased risk because of a serogroup B meningococcal disease outbreak

Adults

Meningococcal vaccines are recommended for certain groups of adults at increased risk for meningococcal disease. Each meningococcal vaccine is listed below with which groups of adults are recommended to get it.

Meningococcal Conjugate Vaccine Recommendations

Adults should get a meningococcal conjugate vaccine (Menactra® or Menveo®) if they:

• Have a rare type of disorder (complement component deficiency)
• Are taking a medicine called Soliris®
• Have a damaged spleen or their spleen has been removed
• Have HIV
• Are a microbiologist who is routinely exposed to Neisseria meningitidis
• Are traveling to or residing in countries in which the disease is common
• Are part of a population identified to be at increased risk because of a serogroup A, C, W, or Y meningococcal disease outbreak
• Are not up to date with this vaccine and are a first-year college student living in a residence hall
• Are a military recruit

Talk to your doctor to find out if, and when, you will need booster shots.

Serogroup B Meningococcal Vaccine Recommendations

Adults should get a serogroup B meningococcal vaccine (Bexsero® or Trumenba®) if they:

• Have a rare type of disorder (complement component deficiency)
• Are taking a medicine called Soliris®
• Have a damaged spleen or their spleen has been removed
• Are a microbiologist who is routinely exposed to Neisseria meningitidis
• Are part of a population identified to be at increased risk because of a serogroup B meningococcal disease outbreak

Who Should Not Get Meningococcal Vaccines ?

Because of age or health conditions, some people should not get certain vaccines or should wait before getting them. Read the guidelines below and ask your or your child’s healthcare professional for more information.

Tell the person who is giving you or your child a meningococcal vaccine if:

• You or your child have had a life-threatening allergic reaction or have a severe allergy.

Anyone who has ever had a life-threatening allergic reaction after a previous dose of a meningococcal vaccine should not get another dose of that vaccine.
Anyone who has a severe allergy to any part of these vaccines should not get another dose of that vaccine. Your child’s healthcare professional can tell you about the vaccine’s ingredients.

You are pregnant or breastfeeding.

• Meningococcal conjugate vaccines may be given to pregnant women who are at increased risk for serogroup A, C, W, or Y meningococcal disease.
• Serogroup B meningococcal vaccines should only be given to pregnant or breastfeeding women who are at increased risk for serogroup B meningococcal disease who decide, after talking with a doctor, that the benefits of getting the vaccine outweigh the risk.

You or your child are not feeling well.

• People who have a mild illness, such as a cold, can probably get the vaccine. People who are moderately or severely ill should probably wait until they recover. Your or your child’s healthcare professional can advise you.

How Well Do These Meningococcal Vaccines Work ?

Vaccines that help protect against meningococcal disease work well, but cannot prevent all cases.

In studies demonstrating the efficacy of meningococcal conjugate vaccines:

• Menactra® in preteens and teens: Between 8 and 9 people out of every 10 vaccinated had a protective immune response one month after completing the series
• Menactra® in adults: Between 7 and 9 people out of every 10 vaccinated had a protective immune response one month after completing the series
• Menveo® in preteens and teens: Between 7 and 9 people out of every 10 vaccinated had a protective immune response one month after completing the series
• Menveo® in adults: Between 7 and 9 people out of every 10 vaccinated had a protective immune response one month after completing the series

In studies demonstrating the efficacy of serogroup B meningococcal vaccines:

• Besexero® in preteens, teens, and young adults: Between 6 and 9 people out of every 10 vaccinated had a protective immune response one month after completing the series
• Trumenba® in preteens, teens, and young adults: 8 people out of every 10 vaccinated had a protective immune response one month after completing the series.

Meningococcal ACWY vaccine side-effects

With any medicine, including vaccines, there is a chance of side effects. These are usually mild and go away on their own within a few days, but serious reactions are also possible.

As many as half of the people who get meningococcal ACWY vaccine have mild problems following vaccination, such as redness or soreness where the shot was given. If these problems occur, they usually last for 1 or 2 days. They are more common after MenACWY than after MPSV4.

• A small percentage of people who receive the vaccine develop a mild fever.

Mild Problems

Meningococcal Conjugate Vaccines

Mild problems following meningococcal conjugate vaccination can include:

• Reactions where the shot was given
  • Redness
  • Pain
• Fever

If these problems occur, they usually last for 1 or 2 days.

Serogroup B Meningococcal Vaccines

Mild problems following a serogroup B meningococcal vaccination can include:

• Reactions where the shot was given
  • Soreness
  • Redness
  • Swelling
• Feeling tired
• Headache
• Muscle or joint pain
• Fever or chills
• Nausea or diarrhea

If these problems occur, they can last up to 3 to 7 days.

Problems that could happen after any injected vaccine:

• People sometimes faint after a medical procedure, including vaccination. Sitting or lying down for about 15 minutes can help prevent fainting, and injuries caused by a fall. Tell your doctor if you feel dizzy, or have vision changes or ringing in the ears.
• Some people get severe pain in the shoulder and have difficulty moving the arm where a shot was given. This happens very rarely.
• Any medication can cause a severe allergic reaction. Such reactions from a vaccine are very rare, estimated at about 1 in a million doses, and would happen within a few minutes to a few hours after the vaccination.

As with any medicine, there is a very remote chance of a vaccine causing a serious injury or death.

MMR Vaccine

What is MMR (measles, mumps and rubella) disease ?

Measles is a very contagious disease caused by a virus. It spreads through the air when an infected person coughs or sneezes. Measles starts with fever. Soon after, it causes a cough, runny nose, and red eyes. Then a rash of tiny, red spots breaks out. It starts at the head and spreads to the rest of the body.

Measles can be prevented with MMR vaccine. The vaccine protects against three diseases: measles, mumps, and rubella. CDC recommends children get two doses of MMR vaccine, starting with the first dose at 12 through 15 months of age, and the second dose at 4 through 6 years of age. Teens and adults should also be up to date on their MMR vaccination.

The MMR vaccine is very safe and effective. Two doses of MMR vaccine are about 97% effective at preventing measles; one dose is about 93% effective.

Children may also get MMRV vaccine, which protects against measles, mumps, rubella, and varicella (chickenpox). This vaccine is only licensed for use in children who are 12 months through 12 years of age.

Before the measles vaccination program started in 1963, an estimated 3 to 4 million people got measles each year in the United States. Of these, approximately 500,000 cases were reported each year to CDC; of these, 400 to 500 died, 48,000 were hospitalized, and 1,000 developed encephalitis (brain swelling) from measles. Since then, widespread use of measles vaccine has led to a greater than 99% reduction in measles cases compared with the pre-vaccine era. However, measles is still common in other countries. Unvaccinated people continue to get measles while abroad and bring the disease into the United States and spread it to others.

CDC recommends that people get MMR vaccine to protect against measles, mumps, and rubella. Children should get two doses of MMR vaccine, starting with the first dose at 12 to 15 months of age, and the second dose at 4 through 6 years of age. Teens and adults also should also be up to date on their MMR vaccination.

Children may also get MMRV (Measles, Mumps, Rubella & Varicellavaccine, which protects against measles, mumps, rubella, and varicella (chickenpox). This vaccine is only licensed for use in children who are 12 months through 12 years of age.

MMR Vaccine

MMRV vaccine protects against four diseases: measles, mumps, rubella, and varicella (chickenpox). This vaccine is only licensed for use in children 12 months through 12 years of age.

CDC recommends that children get one dose of MMRV (Measles, Mumps, Rubella & Varicella) vaccine at 12 through 15 months of age, and the second dose at 4 through 6 years of age. A doctor can help parents decide whether to use this vaccine or MMR vaccine.

MMRV is given by shot and may be given at the same time as other vaccines.

Who Should Get MMR Vaccine ?

Children

CDC recommends all children get two doses of MMR (measles-mumps-rubella) vaccine, starting with the first dose at 12 through 15 months of age, and the second dose at 4 through 6 years of age. Children can receive the second dose earlier as long as it is at least 28 days after the first dose.

MMR vaccine is given later than some other childhood vaccines because antibodies transferred from the mother to the baby can provide some protection from disease and make the MMR vaccine less effective until about 1 year of age.

MMRV (Measles, Mumps, Rubella & Varicella) vaccine, which protects against measles, mumps, rubella, and varicella (chickenpox), is only licensed for use in children who are 12 months through 12 years of age.

Students at post-high school educational institutions

Students at post-high school educational institutions who do not have evidence of immunity need two doses of MMR vaccine, separated by at least 28 days.

Adults

Adults who do not have evidence of immunity should get at least one dose of MMR vaccine.

International travelers

People 6 months of age and older who will be traveling internationally should be protected against measles. Before any international travel—

• Infants 6 through 11 months of age should receive one dose of MMR vaccine. Infants who get one dose of MMR vaccine before their first birthday should get two more doses (one dose at 12 through 15 months of age and another dose separated by at least 28 days).
• Children 12 months of age and older should receive two doses of MMR vaccine, separated by at least 28 days.
• Teenagers and adults who do not have evidence of immunity against measles should get two doses of MMR vaccine separated by at least 28 days.

Healthcare personnel

Healthcare personnel should have documented evidence of immunity, according to the recommendations of the Advisory Committee on Immunization Practices. Healthcare personnel without evidence of immunity should get two doses of MMR vaccine, separated by at least 28 days.

Women of Childbearing Age

Women of childbearing age should check with their doctor to make sure they are vaccinated before they get pregnant. Women of childbearing age who do not have evidence of immunity should get at least one dose of MMR vaccine.

It is safe for breastfeeding women to receive MMR vaccination. Breastfeeding does not interfere with the response to MMR vaccine, and the baby will not be affected by the vaccine through breast milk.

Who Should Not Get MMR Vaccine ?

Some people should not get MMR vaccine or should wait.

• Anyone who has ever had a life-threatening allergic reaction to the antibiotic neomycin, or any other component of MMR vaccine, should not get the vaccine. Tell your doctor if you have any severe allergies.
• Anyone who had a life-threatening allergic reaction to a previous dose of MMR or MMRV vaccine should not get another dose.
• Some people who are sick at the time the shot is scheduled may be advised to wait until they recover before getting MMR vaccine.
• Pregnant women should not get MMR vaccine. Pregnant women who need the vaccine should wait until after giving birth. Women should avoid getting pregnant for 4 weeks after vaccination with MMR vaccine.
• Tell your doctor if the person getting the vaccine:
  • Has HIV/AIDS, or another disease that affects the immune system
  • Is being treated with drugs that affect the immune system, such as steroids
  • Has any kind of cancer
  • Is being treated for cancer with radiation or drugs
  • Has ever had a low platelet count (a blood disorder)
  • Has gotten another vaccine within the past 4 weeks
  • Has recently had a transfusion or received other blood products
  • Any of these might be a reason to not get the vaccine, or delay vaccination until later.

A minor illness, such as a cold or chickenpox, should not delay anyone from receiving the benefits of MMR or any other vaccine. In addition, it is safe for people around a pregnant woman to be vaccinated. Measles, mumps, and rubella vaccine viruses are not transmitted from the vaccinated person, so a recently vaccinated person would not pose a risk to a pregnant woman.

Who Does Not Need MMR Vaccine ?

You do not need measles, mumps, and rubella (MMR) vaccine if you meet any of these criteria for evidence of immunity:

• You have written documentation of adequate vaccination:
  • at least one dose of a measles-, mumps-, and rubella-containing vaccine administered on or after the first birthday for preschool-age children and adults not at high risk for exposure and transmission
  • two doses of measles- and mumps-containing vaccine for school-age children and adults at high risk for exposure and transmission, including college students, healthcare personnel, and international travelers
• You had blood tests that show you are immune to measles, mumps, and rubella.
• You have laboratory confirmation of past measles, mumps, or rubella infection.
• You were born before 1957.*

If you do not have evidence of immunity against measles, mumps, and rubella, talk with your doctor about getting vaccinated. If you’re unsure whether you’ve been vaccinated, you should first try to find your vaccination records. If you do not have written documentation of MMR vaccine, you should get vaccinated. The MMR vaccine is safe, and there is no harm in getting another dose if you may already be immune to measles, mumps, or rubella.

If you received a measles vaccine in the 1960s, you may not need to be revaccinated. People who have documentation of receiving LIVE measles vaccine in the 1960s do not need to be revaccinated. People who were vaccinated prior to 1968 with either inactivated (killed) measles vaccine or measles vaccine of unknown type should be revaccinated with at least one dose of live attenuated measles vaccine. This recommendation is intended to protect those who may have received killed measles vaccine, which was available in 1963-1967 and was not effective.

* Birth before 1957 provides only presumptive evidence for measles, mumps, and rubella. Before vaccines were available, nearly everyone was infected with measles, mumps, and rubella viruses during childhood. The majority of people born before 1957 are likely to have been infected naturally and therefore are presumed to be protected against measles, mumps, and rubella.

MMR vaccine side-effects

A vaccine, like any medicine, is capable of causing serious problems, such as severe allergic reactions.

The risk of MMR vaccine causing serious harm, or death, is extremely small.

Getting MMR vaccine is much safer than getting measles, mumps or rubella.

Most people who get MMR vaccine do not have any serious problems with it.

Mild problems

• Fever (up to 1 person out of 6)
• Mild rash (about 1 person out of 20)
• Swelling of glands in the cheeks or neck (about 1 person out of 75)

If these problems occur, it is usually within 6-14 days after the shot. They occur less often after the second dose.

Moderate problems

• Seizure (jerking or staring) caused by fever (about 1 out of 3,000 doses)
• Temporary pain and stiffness in the joints, mostly in teenage or adult women (up to 1 out of 4)
• Temporary low platelet count, which can cause a bleeding disorder (about 1 out of 30,000 doses)

Severe problems (very rare)

• Serious allergic reaction (less than 1 out of a million doses)
• Several other severe problems have been reported after a child gets MMR vaccine, including:
• Deafness
• Long-term seizures, coma, or lowered consciousness
• Permanent brain damage

These are so rare that it is hard to tell whether they are caused by the vaccine.

MMRV (Measles, Mumps, Rubella, and Varicella) vaccine side-effects

A vaccine, like any medicine, is capable of causing serious problems, such as severe allergic reactions. The risk of MMRV vaccine causing serious harm, or death, is extremely small.

Getting MMRV vaccine is much safer than getting measles, mumps, rubella, or chickenpox.

Most children who get MMRV vaccine do not have any problems with it.

Mild problems

• Fever (about 1 child out of 5).
• Mild rash (about 1 child out of 20).
• Swelling of glands in the cheeks or neck (rare).

If these problems happen, it is usually within 5-12 days after the first dose. They happen less often after the second dose.

Moderate problems

• Seizure caused by fever (about 1 child in 1,250 who get MMRV), usually 5-12 days after the first dose. They happen less often when MMR and varicella vaccines are given at the same visit as separate shots (about 1 child in 2,500 who get these two vaccines), and rarely after a 2nd dose of MMRV.
• Temporary low platelet count, which can cause a bleeding disorder (about 1 child out of 40,000).

Severe problems (very rare)

Several severe problems have been reported following MMR vaccine, and might also happen after MMRV. These include severe allergic reactions (fewer than 4 per million), and problems such as:

• Deafness.
• Long-term seizures, coma, lowered consciousness.
• Permanent brain damage.

Because these problems occur so rarely, we can’t be sure whether they are caused by the vaccine or not.

Pneumococcal Vaccine

What is Pneumococcal disease

Pneumococcal disease is an infection caused by Streptococcus pneumoniae bacteria, sometimes referred to as pneumococcus. Pneumococcus is the most common cause of bloodstream infections, pneumonia, meningitis, and middle ear infections in young children.

Doctors consider some of these infections “invasive.” Invasive disease means that germs invade parts of the body that are normally free from germs. For example, pneumococcal bacteria can invade the bloodstream, causing bacteremia, and the tissues and fluids covering the brain and spinal cord, causing meningitis. When this happens, disease is usually very severe, requiring treatment in a hospital and even causing death in some cases.

Children younger than 2 years old and adults 65 years or older are among those most at risk for disease. There are vaccines to prevent pneumococcal disease in children and adults.

There are two kinds of pneumococcal vaccines available in the United States:

• Pneumococcal conjugate vaccine (PCV13 or Prevnar 13®) protects against 13 types of pneumococcal bacteria.
• Pneumococcal polysaccharide vaccine (PPSV23 or Pneumovax®) protects against 23 types of pneumococcal bacteria.

Pneumococcal conjugate vaccine is recommended for all babies and children younger than 2 years old, all adults 65 years or older, and people 2 through 64 years old with certain medical conditions. Pneumococcal polysaccharide vaccine is recommended for all adults 65 years or older, people 2 through 64 years old who are at increased risk for disease due to certain medical conditions, and adults 19 through 64 years old who smoke cigarettes.

Talk with your or your child’s healthcare professional if you have questions about pneumococcal vaccines.

Pneumococcal Vaccine

What Types of Pneumococcal Vaccines Are There ?

There are two pneumococcal vaccines that are licensed for use in the United States by the Food and Drug Administration (FDA):

• Pneumococcal conjugate vaccine (PCV13 or Prevnar 13®). Conjugate: A type of vaccine that joins a protein to part of the bacteria to improve the protection the vaccine provides.
• Pneumococcal polysaccharide vaccine (PPSV23 or Pneumovax23®). Polysaccharide: A type of vaccine that is made to look like the surface of certain bacteria in order to help the body build protection against that germ.

Pneumococcal Conjugate Vaccine

Prevnar 13®: This vaccine is given in a three-dose primary series starting at 2 months of age plus one booster dose at 12 through 15 months of age. Children who begin vaccination after 6 months of age will receive fewer doses. Adults who are recommended to receive it only need a single dose. The vaccine helps protect against the 13 types of pneumococcal bacteria that are the most common causes of serious infections in children and adults. It can also help prevent some ear infections.

Pneumococcal Polysaccharide Vaccine

Pneumovax23®: This vaccine is given as a single dose to people who are recommended to receive it. One or two booster doses are recommended for some people. This vaccine helps protect against 23 types of pneumococcal bacteria.

Who Should Get Pneumococcal Vaccines ?

CDC recommends pneumococcal vaccination for all babies and children younger than 2 years old and all adults 65 years or older. In certain situations, other children and adults should also get pneumococcal vaccines. Below is more information about who should and should not get each type of pneumococcal vaccine.

Talk to your or your child’s healthcare professional about what is best for your specific situation.

PCV13 for Infants, Children, and Adults

The pneumococcal conjugate vaccine (PCV13 or Prevnar 13®) protects against 13 types of pneumococcal bacteria.

Before the vaccine, there were about 700 cases of meningitis, 13,000 bloodstream infections, and 200 deaths from pneumococcal disease each year among children younger than 5 years old. After children started getting this vaccine, these numbers dropped quickly.
doctor vaccinating patient

CDC recommends vaccination with the pneumococcal conjugate vaccine (PCV13 or Prevnar 13®) for

• All babies and children younger than 2 years old
• All adults 65 years or older
• People 2 through 64 years old who are at increased risk for disease due to certain medical conditions

PPSV23 for Children and Adults

CDC recommends vaccination with the pneumococcal polysaccharide vaccine (PPSV23 or Pneumovax23®) for:

• All adults 65 years or older
• People 2 through 64 years old who are at increased risk for disease due to certain medical conditions
• Adults 19 through 64 years old who smoke cigarettes.

Who Should Not Get These Vaccines ?

Because of age or health conditions, some people should not get certain vaccines or should wait before getting them. Read the guidelines below and ask your or your child’s healthcare professional for more information.

Pneumococcal Conjugate Vaccine

Tell the person who is giving you or your child a pneumococcal conjugate vaccine if:

You or your child have had a life-threatening allergic reaction or have a severe allergy.

• Anyone who has had a life-threatening allergic reaction to a dose of this vaccine, to an earlier pneumococcal conjugate vaccine called PCV7 (or Prevnar®), or to any vaccine containing diphtheria toxoid (for example, DTaP) should not get PCV13.
• Anyone with a severe allergy to any component of PCV13 should not get the vaccine. Your or your child’s healthcare professional can tell you about each vaccine’s ingredients.

You or your child are not feeling well.

• People who have a mild illness, such as a cold, can probably get the vaccine. People who are moderately or severely ill should probably wait until they recover. Your or your child’s healthcare professional can advise you.

You are pregnant.

There is no evidence on the safety of PCV13 use during pregnancy. As a precaution, women who need the vaccine should be vaccinated before becoming pregnant, if possible.

Pneumococcal Polysaccharide Vaccine

Children younger than 2 years old should not get this vaccine. In addition, tell the person who is giving you or your child a pneumococcal polysaccharide vaccine if:
You or your child have had a life-threatening allergic reaction or have a severe allergy.

• Anyone who has had a life-threatening allergic reaction to PPSV23 should not get another dose.
• Anyone who has a severe allergy to any component of PPSV23 should not get it. Your or your child’s healthcare professional can tell you about each vaccine’s ingredients.

You or your child are not feeling well.

People who have a mild illness, such as a cold, can probably get the vaccine. People who are moderately or severely ill should probably wait until they recover. Your or your child’s healthcare professional can advise you.

You are pregnant.

There is no evidence that PPSV23 is harmful to either a pregnant woman or to her baby. However, as a precaution, women who need the vaccine should be vaccinated before becoming pregnant, if possible.

What Are the Possible Side Effects-Pneumococcal Vaccines ?

Most people who get a pneumococcal vaccine do not have any serious problems with it. With any medicine, including vaccines, there is a chance of side effects. These are usually mild and go away on their own within a few days, but serious reactions are also possible.

Mild Problems

Pneumococcal Conjugate Vaccine

Mild problems following pneumococcal conjugate vaccination can include:

• Reactions where the shot was given
• Redness
• Swelling
• Pain or tenderness
• Fever
• Loss of appetite
• Fussiness (irritability)
• Feeling tired
• Headache
• Chills

Young children who get pneumococcal conjugate vaccination along with inactivated flu vaccine at the same time may be at increased risk for seizures caused by fever. Ask your doctor for more information.

Pneumococcal Polysaccharide Vaccine

Mild problems following pneumococcal polysaccharide vaccination can include:

• Reactions where the shot was given
• Redness
• Pain
• Fever
• Muscle aches

If these problems occur, they usually go away within about two days.

Polio Vaccine

What is Polio

Polio is an infectious disease caused by a virus that lives in the throat and intestinal tract. It is most often spread through person-to-person contact with the stool of an infected person and may also be spread through oral/nasal secretions. Polio used to be very common in the United States and caused severe illness in thousands of people each year before polio vaccine was introduced in 1955. Most people infected with the polio virus have no symptoms; however, for the less than 1% who develop paralysis it may result in permanent disability and even death.

There are two types of vaccine that protect against polio: inactivated poliovirus vaccine (IPV) and oral poliovirus vaccine (OPV). IPV is given as an injection in the leg or arm, depending on the patient’s age. Polio vaccine may be given at the same time as other vaccines. Most people should get polio vaccine when they are children. Children get 4 doses of IPV at these ages: 2 months, 4 months, 6-18 months, and a booster dose at 4-6 years. OPV has not been used in the United States since 2000 but is still used in many parts of the world.

CDC recommends that children get polio vaccine to protect against polio, or poliomyelitis. Inactivated polio vaccine (IPV) is the only polio vaccine that has been given in the United States since 2000. IPV is given by shot in the leg or arm, depending on the patient’s age. Oral polio vaccine (OPV) is used in other countries.

CDC recommends that children get four doses of polio vaccine. They should get one dose at each of the following ages: 2 months old, 4 months old, 6 through 18 months old, and 4 through 6 years old.

Polio Vaccine

What are the Types of Polio Vaccine ?

Two types of vaccine that protect against polio, or poliomyelitis.

Inactivated poliovirus vaccine (IPV)

• IPV is the only polio vaccine that has been used in the United States since 2000.
• It is given by shot in the leg or arm, depending on the patient’s age.
• Children should get four doses total, with one dose at each of the following ages:
  • 2 months old,
  • 4 months old,
  • 6 through 18 months old, and
  • 4 through 6 years old.

Oral poliovirus vaccine (OPV)

• OPV was used in the United States before IPV was available in this country.
• This vaccine is no longer licensed or available in the United States.
• It is still used in many parts of the world.
• Children receive doses of the vaccine by drops in the mouth.

Who Should Get Polio Vaccine ?

Infants and Children

Children in the United States should get inactivated polio vaccine (IPV) to protect against polio, or poliomyelitis. They should get four doses total, with one dose at each of the following ages:

• 2 months old
• 4 months old
• 6 through 18 months old
• 4 through 6 years old

Children who will be traveling to a country where the risk of getting polio is greater should complete the series before leaving for their trip. If a child cannot complete the routine series before leaving, an accelerated schedule is recommended as follows:

• 1 dose at age 6 weeks or older
• a second dose 4 or more weeks after the first dose
• a third dose 4 or more weeks after the second dose
• a fourth dose 6 or more months after the third dose

If the accelerated schedule cannot be completed before leaving, the remaining doses should be given in the affected country, or upon returning home, at the intervals recommended in the accelerated schedule. In addition, children completing the accelerated schedule should still receive a dose of IPV at 4 years old or older, as long as it has been at least 6 months after the last dose.

Adults

Most adults do not need polio vaccine because they were already vaccinated as children. But three groups of adults are at higher risk and should consider polio vaccination in the following situations:

• You are traveling to a country where the risk of getting polio is greater. Ask your healthcare provider for specific information on whether you need to be vaccinated.
• You are working in a laboratory and handling specimens that might contain polioviruses.
• You are a healthcare worker treating patients who could have polio or have close contact with a person who could be infected with poliovirus.

Adults in these three groups who have never been vaccinated against polio should get 3 doses of IPV:

• The first dose at any time,
• The second dose 1 to 2 months later,
• The third dose 6 to 12 months after the second.

Adults in these three groups who have had 1 or 2 doses of polio vaccine in the past should get the remaining 1 or 2 doses. It doesn’t matter how long it has been since the earlier dose(s).

Adults who are at increased risk of exposure to poliovirus and who have previously completed a routine series of polio vaccine (IPV or OPV) can receive one lifetime booster dose of IPV.

Who Should Not Get Polio Vaccine ?

Tell the person who is giving the vaccine:

• If the person getting the vaccine has any severe, life-threatening allergies.
• If you ever had a life-threatening allergic reaction after a dose of IPV, or have a severe allergy to any part of this vaccine, you may be advised not to get vaccinated. Ask your health care provider if you want information about vaccine components.
• If the person getting the vaccine is not feeling well.
• If you have a mild illness, such as a cold, you can probably get the vaccine today. If you are moderately or severely ill, you should probably wait until you recover. Your doctor can advise you.

Polio vaccine side-effects

With any medicine, including vaccines, there is a chance of side effects. These are usually mild and go away on their own, but serious reactions are also possible.

Some people who get IPV get a sore spot where the shot was given. IPV has not been known to cause serious problems, and most people do not have any problems with it.

Other problems that could happen after this vaccine:

• People sometimes faint after a medical procedure, including vaccination. Sitting or lying down for about 15 minutes can help prevent fainting and injuries caused by a fall. Tell your provider if you feel dizzy, or have vision changes or ringing in the ears.
• Some people get shoulder pain that can be more severe and longer-lasting than the more routine soreness that can follow injections. This happens very rarely.
• Any medication can cause a severe allergic reaction. Such reactions from a vaccine are very rare, estimated at about 1 in a million doses, and would happen within a few minutes to a few hours after the vaccination.

As with any medicine, there is a very remote chance of a vaccine causing a serious injury or death.

Rabies Vaccine

Rabies is a preventable viral disease of mammals most often transmitted through the bite of a rabid animal. The vast majority of rabies cases reported to the Centers for Disease Control and Prevention (CDC) each year occur in wild animals like raccoons, skunks, bats, and foxes.

Wash any wounds immediately. One of the most effective ways to decrease the chance for infection is to wash the wound thoroughly with soap and water.

See your doctor for attention for any trauma due to an animal attack before considering the need for rabies vaccination.

Your doctor, possibly in consultation with your state or local health department, will decide if you need a rabies vaccination. Decisions to start vaccination, known as postexposure prophylaxis (PEP), will be based on your type of exposure and the animal you were exposed to, as well as laboratory and surveillance information for the geographic area where the exposure occurred.

Rabies vaccine is given to people at increased risk of rabies to protect them if they are exposed. It can also prevent the disease if it is given to a person after they have been exposed.

Rabies vaccine is made from killed rabies virus. It cannot cause rabies.

Preexposure vaccination is recommended for persons in high-risk groups, such as veterinarians, animal handlers, and certain laboratory workers. Although preexposure vaccination does not eliminate the need for additional medical attention after a rabies exposure, it can decrease the number of vaccine doses needed, and it minimizes adverse reactions to multiple doses of vaccine.

Rabies vaccine side-effects

A vaccine, like any medicine, is capable of causing serious problems, such as severe allergic reactions. The risk of a vaccine causing serious harm, or death, is extremely small. Serious problems from rabies vaccine are very rare.

Mild problems

• soreness, redness, swelling, or itching where the shot was given (30% – 74%)
• headache, nausea, abdominal pain, muscle aches, dizziness (5% – 40%)

Moderate problems

• hives, pain in the joints, fever (about 6% of booster doses)

Other nervous system disorders, such as Guillain Barré syndrome (GBS), have been reported after rabies vaccine, but this happens so rarely that it is not known whether they are related to the vaccine.

NOTE: Several brands of rabies vaccine are available in the United States, and reactions may vary between brands. Your provider can give you more information about a particular brand.

Smallpox Vaccine

After smallpox was eliminated from the world, routine vaccination against smallpox among the general public was stopped because it was no longer needed. However, because of concern that variola virus might be used as an agent of bioterrorism, the U.S. government has stockpiled enough smallpox vaccine to vaccinate everyone who would need it if a smallpox outbreak were to occur.

When there is NO smallpox outbreak, you should get the smallpox vaccine if you are a lab worker who works with virus that causes smallpox or other viruses that are similar to it.

If you need long-term protection, you may need to get booster vaccinations regularly. To stay protected from smallpox, you should get booster vaccinations every 3 years.

When there IS a smallpox outbreak, you should get the smallpox vaccine if you are directly exposed to smallpox virus. For example, if you had a prolonged face-to-face contact with someone who has smallpox.

If there is a smallpox outbreak, public health officials will say who else should get the vaccine. CDC works with federal, state, and local officials to prepare for a smallpox outbreak.

You can get additional information on smallpox vaccine here: ⁸⁾

Typhoid Vaccine

What is Typhoid Fever ?

Typhoid fever is a life-threatening illness caused by the bacterium Salmonella Typhi. An estimated 5,700 cases occur each year in the United States. Most cases (up to 75%) are acquired while traveling internationally. Typhoid fever is still common in the developing world, where it affects about 21.5 million people each year.

If you are traveling to a country where typhoid (Salmonella serotype Typhi) is common, you should consider being vaccinated against typhoid. Visit a doctor or travel clinic to discuss your vaccination options.

Remember that you will need to complete your vaccination at least 1 week before you travel so that the vaccine has time to take effect. Typhoid vaccines lose effectiveness after several years; if you were vaccinated in the past, check with your doctor to see if it is time for a booster vaccination.

Typhoid Vaccine

Typhoid vaccination is not usually needed in the U.S. It is usually recommended only for international travelers going to developing countries where exposure to contaminated food or water is likely. If needed, there are currently two vaccines available in the United States. Please consult your doctor or travel clinic to determine which vaccine is right for you.

Typhoid vaccine side-effects

Like any medicine, a vaccine could cause a serious problem, such as a severe allergic reaction. The risk of typhoid vaccine causing serious harm, or death, is extremely small. Serious problems from either typhoid vaccine are very rare.

Inactivated typhoid vaccine (Shot)

Mild reactions

• Fever (up to about 1 person in 100)
• Headache (up to about 1 person in 30)
• Redness or swelling at the site of the injection (up to about 1 person in 15)

Live typhoid vaccine (Oral)

Mild reactions

• Fever or headache (up to about 1 person in 20)
• Stomach pain, nausea, vomiting, rash (rare).

Varicella Vaccine

See Chickenpox vaccine above.

Yellow Fever Vaccine

What is Yellow Fever

Yellow fever is a serious disease caused by the yellow fever virus.  Yellow fever virus is found in tropical and subtropical areas in South America and Africa. The virus is transmitted to people by the bite of an infected mosquito and cannot be spread directly from person-to-person. Yellow fever is a very rare cause of illness in U.S. travelers. Illness ranges in severity from a self-limited febrile illness to severe liver disease with bleeding.

Yellow fever disease is diagnosed based on symptoms, physical findings, laboratory testing, and travel history, including the possibility of exposure to infected mosquitoes. There is no specific treatment for yellow fever; care is based on symptoms. Steps to prevent yellow fever virus infection include using insect repellent, wearing protective clothing, and getting vaccinated.

Yellow fever vaccine can prevent yellow fever.

Yellow fever can cause:

• Fever and flu-like illness
• Jaundice (yellow skin or eyes)
• Liver, kidney, respiratory, and other organ system failure
• Vomiting blood
• Death (20% – 50% of serious cases)

People with yellow fever disease usually have to be hospitalized.

Yellow fever vaccine is given only at approved vaccination centers. After receiving the vaccine, you should receive an International Certificate of Vaccination (yellow card) that has been validated by the vaccination center. The certificate becomes valid 10 days after vaccination and lasts for ten years. You will need this card as proof of vaccination to enter certain countries.

Another way to prevent yellow fever is to avoid mosquito bites by:

• staying in well-screened or air-conditioned areas,
• wearing clothes that cover most of your body,
• using an effective insect repellent, such as those containing DEET.

Yellow Fever Vaccine

Yellow Fever Vaccine is Recommended for:

• Persons nine months or older traveling to or living in a country that requires yellow fever vaccination for certain travelers. Check with your health care provider.
• Persons nine months or older traveling to a country that does not require yellow fever vaccination, but is located in an area where the risk of yellow fever is known to exist. Check with your health care provider.
• Information about known or probable infected areas is available from the World Health Organization, the Pan American Health Organization, and CDC.
• If you continue to live or travel in yellow fever-endemic areas, you should receive a booster dose of yellow fever vaccine after 10 years. Yellow fever vaccine may be given at the same time as most other vaccines.

Consult your health department or visit CDC’s travel information website ⁹⁾ to learn the travel requirements for different countries or to find the nearest approved vaccination center. Please make sure you discuss your travel itinerary with your doctor or nurse before you receive your yellow fever vaccination.

Who should not get yellow fever vaccine ?

• Anyone with a severe (life-threatening) allergy to any component of the vaccine, including eggs, chicken proteins, or gelatin, or who has had a severe allergic reaction to a previous dose of yellow fever vaccine should not get yellow fever vaccine. Tell your doctor if you have any severe allergies.
• Infants younger than 6 months of age should not get the vaccine.
• Tell your doctor if:
  • You have HIV/AIDS or another disease that affects the immune system.
  • Your immune system is weakened as a result of cancer or other medical conditions, a transplant, or radiation or drug treatment (such as steroids, cancer chemotherapy, or other drugs that affect immune cell function).
  • Your thymus has been removed or you have a thymus disorder, such as myasthenia gravis, DiGeorge syndrome, or thymoma.
  • Your doctor will help you decide whether you can receive the vaccine.
• Adults 60 years of age and older who cannot avoid travel to a yellow fever area should discuss vaccination with their doctor. They might be at increased risk for severe problems following vaccination.
• Infants 6 through 8 months of age, pregnant women, and nursing mothers should avoid or postpone travel to an area where there is risk of yellow fever. If travel cannot be avoided, discuss vaccination with your doctor.

If you cannot get the vaccine for medical reasons, but require proof of yellow fever vaccination for travel, your doctor can give you a waiver letter if he considers the risk acceptably low. If you plan to use a waiver, you should also contact the embassy of the countries you plan to visit for more information.

Yellow Fever vaccine side-effects

A vaccine, like any medicine, could cause a serious reaction. But the risk of a vaccine causing serious harm, or death, is extremely low.

Mild problems

Yellow fever vaccine has been associated with fever, and with aches, soreness, redness or swelling where the shot was given.

These problems occur in up to 1 person out of 4. They usually begin soon after the shot, and can last up to a week.

Severe problems

• Severe allergic reaction to a vaccine component (about 1 person in 55,000).
• Severe nervous system reaction (about 1 person in 125,000).
• Life-threatening severe illness with organ failure (about 1 person in 250,000). More than half the people who suffer this side effect die.

These last two problems have never been reported after a booster dose.