If your child is starting kindergarten, middle school or college this year, your back-to-school checklist includes not only pencils and notebooks, but those dreaded vaccinations. Here's a primer to make things a bit easier.
"Immunization is one of the best things you can do to protect your child," said Dr. Mary Anne Jackson, chief of the Section of Pediatric Infectious Diseases at Children's Mercy Hospitals and Clinics in Kansas City, Mo. "It's like putting your child in a car seat or a bike helmet."
First, check your state's vaccination requirements, and the American Academy of Pediatrics' childhood and catch-up immunization schedules. If your child is behind on any shots, an online catch-up scheduler can help.
Schedule a back-to-school physical as soon as you can. It's safe for children to get all the vaccinations for their age group in one appointment.
Children on Medicaid or without insurance coverage for vaccines can get them free of charge, except for an administrative fee under $20, through the Vaccines for Children Program. "Finance should never be a reason not to immunize your child," said Jackson.
Kindergarten and grade school:
Most kids starting kindergarten need four shots, if they have had all their early childhood immunizations. Children 4 to 6 should get the fifth shot of the DTaP vaccine against diphtheria, tetanus, and pertussis, or whooping cough. They also need the second shot of the MMR vaccine against measles, mumps and rubella, and the final shots of the vaccines for polio and varicella, or chicken pox.
Make sure your child has had the three-shot series for hepatitis B, which is required in most states. The AAP also recommends the hepatitis A series if your child has not had it yet.
Students starting middle school should get the Tdap vaccine against tetanus, diphtheria, and pertussis, or whooping cough. Current whooping cough outbreaks make this shot preferred over the Td booster, which covers only tetanus and diphtheria. Most states require either the Tdap or Td.
The AAP recommends that kids 11 to 12 receive the vaccine against bacterial meningitis, MCV4, but it is required in only a few states. Teens who haven't had this shot or the Tdap yet should also get them.
To prevent cervical cancer, middle school girls should receive three doses of the human papillomavirus, or HPV, vaccine, according to the AAP. Two versions of the vaccine are available: HPV2 protects only against cervical cancer, while HPV4 also prevents other genital cancers and genital warts. Either is recommended for girls, although Jackson said the second provides more benefits.
Girls can receive the first dose as early as age 9. The AAP also recently advised doctors to make the HPV4 vaccine available to boys 9 to 18, because it protects against genital warts. No state requires HPV vaccination.
Check that your child has been vaccinated for hepatitis A and B, as well as chicken pox, which teens are at high risk to develop complications for, Jackson said. Most states require the hepatitis B series, and kids 11 to 15 can get the two-dose formulation, Recombivax HB.
For college, most states require a record of MMR vaccination, as well as Tdap or Td. The AAP also recommends that teens have the vaccines against bacterial meningitis, hepatitis B and chicken pox, which are required in some states. Those 18 or older who have not yet been vaccinated against hepatitis A or B can get a shot that protects against both, called Twinrix.
Girls not yet vaccinated for HPV are recommended to get the three-shot series, and boys can get the HPV4 series against genital warts.
The danger of contracting a disease preventable by a vaccine far outweighs any health risk of the shot, Jackson said. "Based on improvements [in vaccines], we are giving kids fewer antigens, and certainly less than you get when you eat," she said. Parents who refuse to vaccinate their children put their own kids at risk as well as those in the community, she said.
Recent outbreaks of whooping cough attest to this, said Dr. Paul Offit, director of the Vaccine Education Center at the Children's Hospital of Philadelphia. In California, children under 6 months old, who are too young to be vaccinated against whooping cough and rely on the community to protect them, have died this year from the disease.