Anticipatory Guidance



Click HERE for the CDC Immunization Schedule


Commonly Asked Questions About Immunizaions

  1. How much time can elapse between immunizations before you need to start over?
    1. You never have to start schedule over. You should continue schedule where it was interrupted.
  2. What should you do if a parent cannot find the child's shot record?
    1. Every effort should be made to find the old records from previous doctors or clinics and from schools the child has attended. If unsuccessful, start immunizations from scratch. Extra doses of live or inactivated immunizations are not dangerous to the child.
    2. Documented overseas vaccines are usually acceptable
  3. Which vaccines can be given together?
    1. All routine vaccines can be given simultaneously.
  4. What are the true contraindications to giving vaccines?
    1. An anaphylaxis reaction to a previous immunization
    2. The development of encephalopathy within 7 days of the DTP.
    3. All vaccines should be held if child has a moderate to severe acute febrile illness.
    4. HIV patients:
      1. Varicella can be given to Class I HIV+ with a CD4 count that is >15% for age 
      2. MMR may be given to patients with HIV
    5. Children receiving steroids in the dose of 2mg/kg/day or greater or 20 mg per day for more than 14 days, should not receive live vaccines until 1 month after stopping drug.  If steroids are given topically, intranasally or by inhaler, vaccines should proceed on the normal schedule. 
    6. If a patient received IVIG, wait ~1 year before proceeding with vaccinations
    7. T cell deficits:  no live vaccines
    8. Solid organ transplantation- try to immunize prior to transplant.  Resuming immunizations after transplant varies.  Most may resume MMR and Varaicella 6 months following procedure. 
    9. None of the below are contraindications or reasons to delay the immunization schedule:
      1. The child has a minor illness, otitis, gastroenteritis, URI
      2. The child's mother is pregnant
      3. The child is premature. Should get immunizations on the same schedule as full-term individuals( use age from time of birth, not corrected age).
  5. My child is allergic to eggs. Can they receive the MMR?
    1. Yes. Allergy to eggs is not a contraindication to giving the MMR. After administering the shot, the child should wait in the office for about 30 minutes to make sure there is no reaction.
  6. If there are contraindications to giving the DTwP, can I give the DTaP?
    1. No. If there are contraindications to the DTwP, you shouldn't give the DTaP.
  7. My patient has epilepsy, can he receive the DaPT?
    1. Patients with stable neurologic conditions may receive the DPT.  However, patients with progressive neurologic disorders characterized by developmental delay, should have their DPT deferred.
  8. Should I give the Hib vaccine after 5 years of age? Can I interchange different manufactures' Hib vaccines?
    1. Hib doesn't need to be given after 5 years of age and all approved Hib vaccines approved for children can be interchanged

Approaching parents who DO NOT want to immunize their children

CDC Handouts on Immunizations for Parents - Click Here 

CDC Handout with Answers to Parents Frequently Asked Questions - Click Here and Select Part 4


  1. Agha R and Adam HM. Complications of Immunizations. Pediatrics in Review. 1997; 18:66-67.
  2. Barlow W.E. et al. The Risk of Seizures after Receipt of Whole-Cell Pertussis or Measles, Mumps, and Rubella Vaccine.  NEJM Vol. 345 No. 9 pg 656 August 30, 2001
  3.   2007 Immunization Schedule 
  4. Levitsky, Lynne. Childhood Immunizations and Chronic Illness.  NEJM April1, 2004 pg 1380
  6. Sugarman S. Cases in Vaccine Court-Legal Battles over Vaccines and Autism. NEJM Sept 27, 2007
  7. DTaP recommendations for older children and adults.
  8. Omer et. al. Vaccine Refusal and the Risk of Vaccine Preventable Disease.  
  9. NEJM 2009;360:1981
  10. Kahn J.A. HPV Vaccination for the Prevention of Cervical Intraepithelial Neoplasia.  NEJM July 16, 2009
  11. MMWR ACIP Update on Use of Tdap Jan 14, 2011
  12. 2012 Immunization Update AAP
  13. AAP Meningococcal Conjugate Vaccones Policy Update: Booster Dose Recommendations.  December 2011