Children's Health Issues - Staying Healthy:
Vaccinations – Keeping up to date with the U.S. System
By Karen L., MD, AWC of Amsterdam
Parents of children who may be returning to the U.S. should try to keep their children’s vaccinations up to date for the U.S. system. The country you are living in will have its own system of immunizing children; you will want to double check the immunizations they provide as well as the timing of them against the ones currently given to children in the US. As these are constantly being updated, you should look at least twice a year for the most up-to-date schedule for children in the US, available at www.cdc.gov/nip. This website provides excellent fact sheets about each vaccine, including their risks – I have not included this information in this article, given space restrictions, but it is well worth reading. In addition, it is essential to keep track of all the immunizations your child has received in one place, and the CDC website also provides a convenient scheduler, which may be helpful for this purpose.
With the exception of the flu shot, the vaccinations listed below are part of the routine schedule in the U.S., and most are required for entry to schools there. In other countries, some of the illnesses protected against by these vaccines may be considered either too benign or too uncommon to justify the cost and risk of vaccinating the entire population. For those interested in receiving these vaccines while living abroad, some may be available. However, especially if you also have U.S. insurance, it may be simpler and cheaper to schedule visits to receive them on trips to the U.S. Typically, there is no problem with longer time lapses between doses of the vaccination than recommended.
Following are the recommended vaccines, in the order listed on the scheduler found at www.cdc.gov/nip.
- Hepatitis B: This vaccine protects against Hepatitis B, a severe liver disease transmitted through blood and body fluids. In the U.S., it is routinely given at birth-2 months, 1-4 months (at least 4 weeks after the first dose) and 6-18 months of age (at least 2 months after the second dose and 4 months after the first). In other countries, it may be routinely given only to immigrants from countries with high prevalence of the disease, which does not include the U.S. For those who do not fall into this category but wish to receive it in their country of residence, it may be available in clinics where travel vaccinations are also administered.
- DTP: This vaccine protects against Diphtheria, Tetanus and Pertussis. In the U.S., this combination vaccine is given at 2, 4, 6 and 15-18 months of age.
- The formulation of the Pertussis component of this vaccine (called “acellular”) which is currently used in the U.S. may or may not yet be in use in your country. This formulation is equally effective as the “cellular” form still in use in some countries, but has fewer side effects. If you notice your child has a significant reaction to the vaccine the first or second time, it may be worth asking your doctor about this point, as the “acellular” form may be available for an extra fee.
- Any potential difference in timing of the first three doses is not an issue as long as they are given at least 4 weeks apart, beginning after 6 weeks of age. In the U.S., the fourth dose may be given as early as 12 months of age, but not before. To avoid confusion (and potentially extra shots) on enrolling children in school in the U.S., it is best to wait until after the child’s first birthday for the fourth dose, even if it is routinely given earlier in your country of residence.
- A booster of Diphtheria, Tetanus, Pertussis and Polio is given at 4-6 years of age (again, make sure that it is given after your child’s fourth birthday). Following this series, a tetanus booster is recommended at 11-12 years of age and subsequently every 10 years thereafter.
- Hib: This vaccine protects against Haemophilus influenzae, and is given at 2, 4, 6, and 12-15 months of age. While protective against a disease that can cause serious meningitis in infants, Hib vaccine is not usually recommended in children over 5 years old. However, some older children or adults with special health conditions should get it. These conditions include sickle cell disease, HIV/AIDS, removal of the spleen, bone marrow transplant, or cancer treatment with drugs.
- Polio: This vaccine is given at 2, 4, 6 – 18 months of age, and again at 4-6 years.
There are two kinds of polio vaccine: IPV, which is the shot recommended in the U.S. today, and a live oral polio vaccine, OPV, which is drops that are swallowed. Until recently, OPV was recommended for most children in the US. OPV helped us rid the country of polio, and it is still used in many parts of the world. Both vaccines give immunity to polio, but OPV is better at keeping the disease from spreading to other people. However, for a few people (about one in 2.4 million), OPV actually causes polio. Since the risk of getting polio in the U.S. is now extremely low, experts believe that using oral polio vaccine is no longer worth the slight risk, but this may not be true in the country where you are living.
- MMR: This vaccine protects against Measles, Mumps and Rubella. It is given twice, at 12-15 months and at 4-6 years of age in the U.S.
- Varicella: This vaccine protects against the Varicella virus, which causes chicken pox and shingles. It is routinely given at 12-18 months of age in the U.S. Those who have not received the vaccine or had the disease by 13 years of age should get 2 doses, 4 to 8 weeks apart.
- Pneumococcal (PCV): This vaccine, also called Prevnar, protects against seven strains of Streptococcus pneumoniae, a prevalent bacterium which can cause serious infections of the blood, lungs (pneumonia) and covering of the brain (meningitis), as well as more minor ear infections. It should not be confused with the PPV, which is more comprehensive but only necessary for those over age 2 with chronic illnesses. PCV vaccine is routinely given at 2, 4, 6, and 12-15 months of age in the U.S. I recommend obtaining it for infants when possible, but catch-up vaccination is generally not necessary for children over age 2 as they develop immunity by exposure to the disease.
- Influenza: As influenza viruses change quickly, this vaccine is updated every year. It is best to receive it in October or November, but it may still be helpful later in the season. In the U.S., it is highly recommended for children 6 to 23 months of age, household contacts of infants 0 to 23 months of age, people with chronic illnesses and the elderly. Children under 9 years of age who have not previously been vaccinated should receive two doses, one month apart. Note that the dose for children 23 months or younger is half the adult dose.
Some vaccinations may be given in your country but not in the U.S. Typically if a vaccine is recommended in a country where you are living, it is advisable to receive it, as the incidence of the disease protected against there is considered high enough to warrant the cost and risk of giving the vaccine. However, you will want to ask for more information about such vaccines, to make sure that you are aware of any potential risks.
Staying Healthy is a monthly column focused on AWC of Amsterdam members’ health concerns – if you have comments or questions about this article or other health-related topics you would like to read more about, please let me know at . This article is also available in a form specific to life in the Netherlands. Feel free to email me for a copy of this version if you are interested.
Take care of yourselves and each other!
Karen L., M.D.
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