After the flurry of shots during the first two years of your child's life, he finally gets a break. Usually there is no routine scheduled immunization between the ages of two and four. However, if your child goes to daycare, the daycare may require your child to get tested for tuberculosis through a skin test. This is also called the PPD skin test (PPD stands for purified protein derivative), the tuberculin test, or the Mantoux test (named after the French physician who helped invent this test). This test is not technically a vaccine but a screening test to see who may have been exposed to tuberculosis. This book will not discuss the TB test because it is beyond the topic of vaccine. Talk to your doctor for more information about this test.

Four to Six Years

When your child is ready to enter preschool, the school usually requires a form to be filled out. This form includes a copy of your child's immunization record or a statement that you have declined immunization because it is against your religious or ethical principles.

The four-year vaccination includes the second MMR vaccine, the second chickenpox vaccine, the fifth dose of the DTaP vaccine, and the fourth IPV (killed polio) vaccine. If your child has not gotten the hepatitis A vaccine, this is the time to get that, too.


Even though the second MMR vaccine is usually scheduled at the four-to six-year visit, it can be given as early as four weeks after the initial MMR vaccine. If your child has already received two doses of the MMR vaccine (assuming the first dose is given after the first birthday), a third dose would be unnecessary.

Adolescent Years

Many adolescents are not getting the vaccines they need because they are busy with school, and there is no frequent, regularly scheduled visit to the doctor's around this time. Unless they are sick and come to the doctor's office often, they can slip through the cracks and get behind on their immunization needs.

The most common missed vaccine for adolescents is the tetanus booster. The booster given to adolescents is different from the DTaP vaccine designed for younger children. For children older than eleven, the Tdap booster vaccine is recommended instead. The difference between the childhood DTaP vaccine and the adolescent Tdap vaccine is that the Tdap vaccine contains smaller amounts of the diphtheria and pertussis components.

The capitalization scheme for the DTaP vaccine and the Tdap vaccine actually confers some meaning. The capitalized letter in the name means the vaccine contains a full dose of that particular component. The small letter in the name means that the vaccine contains only a partial dose of a component.

For example, the DTaP means this vaccine has the full dose for the diphtheria, tetanus, and pertussis component. The small a stands for acellular, indicating that this vaccine does not have whole pertussis germ in the vaccine. The Tdap vaccine only contains the full dose of the tetanus vaccine. The letters d and p are not capitalized because the Tdap vaccine contains only partial doses for these two components. The older Td booster had a full dose of the tetanus component but only a partial diphtheria component. The Td booster did not have any pertussis component in the vaccine.

In addition to the Tdap booster, adolescents may have fallen behind on their hepatitis A vaccine and chickenpox booster. The hepatitis A vaccine was not universally recommended when some adolescents were still in their childhood, so they may have never gotten this vaccine. Only one dose of the chickenpox vaccine was given prior to 2006, but the new recommendation suggests two doses for everyone. Therefore, many teens may have only received one dose.

Starting in 2005, a new vaccine for adolescents that prevents meningitis became available. A single dose of the meningococcal vaccine (trade name Menactra) is recommended for all children age eleven to eighteen. Please refer to Chapter 16 for a detailed discussion about this new vaccine.

Finally, the HPV (human papilloma virus) vaccine was introduced in 2006. This vaccine is recommended only for girls between age eleven and twenty-six. Please consult Chapter 17 of this book for a comprehensive description for the HPV vaccine.

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  3. Current Immunization Schedule
  4. Childhood
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