Vaccines for

over 4 years of age

home

All of the following assume your child is at least 4 years old.

Please print out this page
Are my child's vaccines up to date?

Schedule of Check-ups and Immunizations

  Tetanus
Hepatitis B DT / DPT / aDPT
Hib Polio
MMR Chicken Pox
Special Situations Travel

Instructions:

  1. Read the boxes below to see if your child's vaccine are up to date.
  2. If your child's vaccine are not up to date, follow the directions on when to get the next vaccines.
  3. You may get your vaccines at your pediatrician's office or at the local health department.
  4. Please recognize that your pediatrician may not follow this schedule exactly for a very good reason in your particular child's case. At the same time though, please be very resistant to letting your pediatrician defer your child's vaccines unless there is a very good reason. Having a minor illness is NOT a reason to defer any vaccine.
  5. All vaccines should be given at a scheduled check up unless their is a specific reason to give them early. If a vaccine has to be deferred because of an illness (this should be rare), then get the vaccines at the follow up visit for that illness.

Hepatitis B

About the Hepatitis B vaccine
Doses received so far Up to Date? Next dose due from last one
4 Yes having 4 is not harmful
3 Yes *
2 and low risk of exposure Yes if 2nd <12 months ago 6 to 12 months
2 and high risk of exposure Maybe 2 months*
1 and low risk of exposure Yes if 1st <6 months ago 1 to 6 months
1 and high risk of exposure Yes unless 1st >1 months ago 1 month
none and low risk of exposure No Next check up
none and high risk of exposure No As soon as possible

High risk of exposure: Infants born to a mother whom is a carrier for Hepatitis B, health care workers and chronic health care facility patients, hemodialysis patients, patients whom receive blood products, household contacts of those with carriers, international travel, intravenous drug users, prisoners. Low risk is everyone else.

* The 3rd dose may be given as early as 2 months from the 2nd if there is a high risk of exposure, but some may then give a 4th dose a year later. This should be discussed with your pediatrician.


DT / DPT / aDPT

If your child is over 6 years of age then skip this section and go to Tetanus

This schedule applies regardless of which of the above are used. For example, if your child had a DPT and then a DT, then this would count as 2 of this vaccine. Should your child only get the DT and then latter get the Pertussis part, then a special schedule will have to be made by your pediatrician. If you are finished with the primary series, then see then Tetanus section.

About the DT / DPT / aDPT vaccines
Doses received so far Up to Date? Next dose due from last one
5 and 1 dose after 4th birthday Yes Finished with primary series
5 or 4 and none after the 4th birthday No after the 4th birthday, then finished with primary series
4 and 1 dose after 4th birthday Yes Finished with primary series
3 No 6 to 12 months, NOT < 6mo
2, 1 or None No 2 months

Tetanus

This is T part of the DT / Td / DPT / and aDPT vaccines, but has a special situation as follows. A clean wound is basically a wound that should have no risk of contamination or infection, such as a clean knife or clean glass wound, everything else is dirty.

About the Tetanus vaccine
Type of wound Time since last Tetanus Next dose needed
Dirty >5 years Now
Dirty <5 years 10 years from the last
Clean >10 years Now
Clean <10 years 10 years from the last
No wound >10 years Now
No wound <10 years 10 years from the last

Polio

This schedule applies regardless of whether the IPV or OPV was used. For example, if your child had 1 IPV and 1 OPV then they have had 2 vaccines.The OPV is recommended if traveling to an endemic area, but this should be discussed with your pediatrician.

About the Polio vaccine
Doses received so far Up to Date? Next dose due from last one
4 or 3, and 1 after 4th birthday Yes Finished with series*
3 or 2 all before 4th birthday No 2 months, then finished with series*
2 No 2 months*
1 No 2 months
None No As soon as possible

* If the 3rd or 4th dose was given after the 4th birthday, then the series is considered complete.


Hib

This vaccine is only given after 5 years of age in those whose initial series was not complete and have an altered immune system.

This applies regardless of what brand of vaccine was used. If it appears that your child does not have enough of this vaccine, then check which DPT shot was given. The Hib vaccine may have been combined with the DPT in a product called Tetramune or Acel-immune. Most nurses whom fill in your shot record will write down the brand name Tetramune or Acel-immune in the DPT vaccine space AND write down that a Hib vaccine was given also, but some may not. There are no DT / aDPT and Hib vaccines available in this country commercially yet. The currently available brands are: PedvaxHIB (PRP-OMP), HIBTITER (HbOC), ActHIB (PRP-T), OmniHIB(PRP-T) and ProHIBit (PRP-D). Any brand may be given after the 1st birthday.

About the Hib vaccine
Doses received so far Up to Date? Next dose due from last one
2 and both after 1st birthday Yes Finished with series
2 and none after 1st birthday No Now, then finished
1 after 1st birthday, but <15 mo No Now, then finished
1 before 1st birthday and child now >15 months old No Now, then finished
none No Now, then finished

MMR

About the MMR vaccine
Doses received so far Up to Date? Next dose due from last one
3 or 2, and last 2 given after 1st birthday and >1 month apart Yes Finished with series
2 and 1 dose after1st birthday Yes 1 month, then finished
1 before 1st birthday No Now
1 after 1st birthday No 1 month, then finished
None No As soon as possible

Chicken Pox

This vaccine is currently not required for school entrance, but probably will be within the next few years. Most pediatricians, including myself, do recommend this vaccine. I personally gave my daughter this vaccine just after her 1st birthday. The vaccine can be given with all other vaccine but in a separate syringe except the DPT because the Chicken Pox vaccine may not work as well (the DPT will work fine). If the Chicken Pox vaccine is not given at the same time as the MMR, then they should not be given within 1 month of each other. There is currently a MMR and Chicken Pox combined vaccine in trials and will be released "soon".

About the Chicken Pox vaccine
Doses received so far Up to Date? Next dose due from last one
2 doses Yes Finished with series
1 dose after 12 years of age No 1 month, then finished
1 before 13 years of age Yes Finished with series
None No If >12 years of age, then test to see if immune, and if not, then as soon as possible and 1 month later

SPECIAL SITUATIONS

My child or a close family member has heart disease, asthma or other lung disease, some immune deficiencies or suppressions, sickle cell disease or other hemoglobinopathies, diabetes, chronic kidney disease, or is on long term aspirin therapy.

You child should then receive the Influenza vaccine every year. If a close family member has one of the above, then your child needs the vaccine to protect the family member not your child. Since the vaccine is not 100% effective, all close contacts should have the vaccine for the best protection. The flu vaccine may be given as early as 6 months of age. Should the child be less than 9 years of age and this is the 1st dose of vaccine given, then a 2nd dose is required 1 month later (every year thereafter only one dose is needed). The vaccine is changed every year as different strains become more common and is generally available each year in September.

My child is over 2 years of age and has frequent ear infections, no spleen, has heart or lung disease.

Your child should have the Pneumovax vaccine. Only one vaccine should be required, but occasionally a 2nd dose is given a few years later.


TRAVEL

If your child has not completed the series of vaccines outlined above, then your child will need a special schedule to update them before travel. Certain countries also require special vaccines. See the other section on travel. This definitely requires consultation with your physician.


DISCLAIMER

This web site is designed to provide accurate and authoritative information in regard to the subject matter covered. In providing this site, the author is not engaged in rendering medical or any other professional service. Individual conditions may vary and the information contained herein should not be relied upon for the diagnosis and/or treatment of any particular individual. If medical advice or other expert assistance is required, the services of a competent professional should be sought.

 Copyright 2005 Joe Matusic, MD. This document may be freely copied and distributed, providing there is no charge for duplication or the material and this copyright notice remains affixed.