Back-to-School Vaccine Checklist

6 Sep

By Mary Beth Koslap-Petraco, DNP, CPNP

The lazy summer days are quickly coming to an end and it is time for all parents to start thinking of getting their children prepared to return to school.  Of course we want our children to be healthy and one of the most important things we can do to keep them healthy is to immunize them.  No matter what age our children are when they are either beginning or returning to school, we as parents need to ensure that our children are fully immunized.

Since different vaccines are indicated for different age groups, let’s review what is needed for school for each age group of children.  Let’s start with nursery school.  Nursery school children need the following:

Age 3-4 years old for children who will be starting or returning to nursery school:
4 doses Diphtheria-Tetanus-Acellular Pertussis (whooping cough) vaccine (DTaP)
3 doses Inactivated Polio vaccine (IPV)
3-4 doses Haemophilus Influenzae type b vaccine (Hib)
4 doses Pneumococcal Conjugate vaccine (PCV13)
3 doses Hepatitis B vaccine (Hep B)
2 doses of Hepatitis A vaccine (Hep A)
1 dose Measles-Mumps-Rubella vaccine (MMR)
1 dose Varicella (chickenpox) vaccine (VAR)

These vaccines are very important for young children.  It takes the full series of each vaccine to offer optimal protection.  The United States has experienced a resurgence of whooping cough, most likely due to children who have not completed the vaccine series and older children and adults who were vaccinated as young children, but whose immunity has worn off.

Now let’s talk about children who will be entering kindergarten.

Age 4-5 year old children who will be starting kindergarten need the following:
5 doses Tetanus-Diphtheria-Acellular Pertussis (whooping cough) vaccine (DTaP)
4 doses Inactivated Polio vaccine (IPV)
3-4 doses Haemophilus Influenzae type b vaccine (Hib)
2 doses Hepatitis A vaccine (Hep A)
4 doses Pneumococcal Conjugate vaccine (PCV7 or PCV13 or a combination of both)

–          A single supplemental dose of PCV13 is recommended for all children 14 -59 months who received an age appropriate series of PCV7
–          A single supplemental dose of PCV13 is recommended for all children 60-71 months with underlying medical conditions who received age appropriate series of PCV7

3 doses Hepatitis B vaccine (Hep B)
2 doses Measles-Mumps-Rubella vaccine (MMR)
2 doses Varicella (chickenpox) vaccine (VAR)

Children entering kindergarten will have received most of the vaccines listed above under nursery school vaccines, but as you can see with the vaccines listed for the 4-5 year old children booster or additional doses of some of the vaccines have been added.  Specifically for kindergarten children need DTaP and IPV boosters and the second doses of MMR and Varicella vaccines.

Unimmunized individuals have contributed to a resurgence of measles.  The US has experienced 156 cases of measles since January 2011.  These cases are occurring in unimmunized US residents who have traveled abroad to countries where measles are widespread.  When these individuals return to the US with measles, both the immunized and unimmunized are put at risk.  No vaccine is one hundred percent effective and once the disease is reintroduced into the community, the chances of anyone contracting measles increases.  This scenario is just what the US is experiencing right now.  Please make sure your 4-5 year old receives the recommended DTaP and IPV boosters, and second doses of MMR and Varicella vaccines to keep themselves and the community healthy.

Many think that once children receive vaccines to start kindergarten they no longer need any more vaccines.  This could not be farther from the truth.  The next group of school aged individuals who need immunizations are adolescents aged 11-12 years old.  If children received all of the vaccines they should have in infancy and for kindergarten, then the following immunizations are indicated.  If adolescents did not finish their vaccine series as very young children, then they might also need additional vaccines in addition to those listed below.

Age 11-12 years old adolescents who will be starting middle school:
1 dose Tdap (a version of the DTaP vaccine for adolescents and adults)
1 dose of meningococcal vaccine (MCV4)
2 doses of Hepatitis A vaccine (Hep A if they have not previously received it)
3 doses of Human Papillomavirus vaccine (HPV)

You might ask why we need to give meningococcal vaccine to adolescents when you probably have never heard of anyone who has had meningitis.  Meningitis is a devastating disease and is often fatal.  Those who do survive are usually changed forever.  They may lose their arms, legs, or both or maybe fingers or toes.  Survivors may be deaf following meningitis.  While the disease is rare, do you want to take the chance that your child may develop it?  And what about HPV vaccine which protects against the most common forms of cervical cancer?  Currently there are two HPV vaccines licensed in the US.  One protects against two of the most common forms of cervical cancer and the other protects against the two most common forms of cervical cancer and genital warts.  Boys can also receive the HPV vaccine that prevents genital warts.

As you prepare your child to head off to college you will want to review that immunization record also.  Your college bound child should have received all of the vaccines we have discussed already, but a review by your child’s health care provider is in order to make sure.  Listed below are the vaccines that we want to make sure your college freshman has received.

1 dose MCV4 (if your child received the first dose before age 16 or has never had a dose)
1 dose VAR (if your child did not receive 2 doses previously)
1-2 doses of Hep A vaccine (if your child did not receive 2 doses previously)
1-3 doses of HPV vaccine (if your child did not receive 3 doses previously)
1 dose Tdap (if our child did not receive a dose previously)

Intervals from one to six months between doses are necessary if your child requires a vaccine that has more than one dose in the series.  Please ask your health care provider about any intervals between doses of vaccine.

If you as the parent will be in contact with children less than 2 years of age you should consider Tdap vaccine for yourself.  Very young babies cannot start the DTaP vaccine series until they are about 2 months old and it takes 4 doses to offer the best protection.  Everyone who comes in contact with infants should get a dose of Tdap vaccine not only to protect themselves against pertussis but especially the babies.  This is called cocooning.  We immunize everyone who comes in contact with the baby to provide a protective cocoon.

There is one final vaccine that everyone 6 months through the entire life span should receive and that is influenza vaccine.  Influenza season begins every year in early fall.  Please make sure everyone in your family receives this vaccine every year.  Influenza is a serious disease that can cause pneumonia and even death and we want to make sure everyone is protected.  If you child is 6 months old through 8 years old your child will need 2 doses of influenza vaccine separated by 4 weeks if this is the first year that the child receives influenza vaccine.

Remember that those school bells are not only signaling the start of a new school year, but a reminder that it is time to check to make sure our children and we as parents are up to date on our vaccines.

Mary Beth is the Coordinator of Child Health for the Suffolk County Department of Health Services. She is a clinical Assistant Professor at SUNY Stony Brook School of Nursing.


One Response to “Back-to-School Vaccine Checklist”


  1. Back In School, But Are They Protected? « Shot of Prevention - September 7, 2011

    […] Meningitis Association or Meningitis Angels.  You may even want to check this recent post on Parents Who Protect which provides a detailed back-to-school vaccine checklist for all […]

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