Key Takeaways
- Hepatitis B vaccine is given at birth, with a 3-dose series completed by 6-18 months; this is often the first vaccine a newborn receives
- DTaP (Diphtheria, Tetanus, Pertussis) requires a 5-dose series at 2, 4, 6, 15-18 months, and 4-6 years; adults receive Tdap booster then Td every 10 years
- MMR (Measles, Mumps, Rubella) and Varicella vaccines are live vaccines given at 12-15 months and 4-6 years; contraindicated in pregnancy and severe immunocompromise
- Annual influenza vaccination is recommended for everyone 6 months and older; high-dose or adjuvanted formulations available for adults 65+
- Shingles vaccine (Shingrix) is recommended for adults 50+ as a 2-dose series; pneumococcal vaccines (PCV15/PCV20 and PPSV23) recommended at 65+
Last updated: January 2026
Immunization Fundamentals
Vaccines prevent serious diseases by stimulating the immune system to develop protection without causing the disease itself. Nurses play a crucial role in administering vaccines, educating patients, and addressing vaccine hesitancy.
Types of Vaccines
| Type | Description | Examples |
|---|---|---|
| Live attenuated | Weakened live organism | MMR, Varicella, Rotavirus, Nasal flu |
| Inactivated | Killed organism | Injectable flu, Hepatitis A |
| Subunit/conjugate | Parts of organism | Hep B, HPV, Pertussis component |
| Toxoid | Inactivated toxin | Diphtheria, Tetanus |
| mRNA | Genetic instructions | COVID-19 (Pfizer, Moderna) |
Live Vaccine Considerations
Live vaccines are contraindicated in:
- Pregnancy
- Severe immunocompromise
- Recent blood product transfusion (varies by vaccine)
Key Point: Live vaccines can be given on the same day; if not given simultaneously, wait 4 weeks between live vaccines.
Childhood Immunization Schedule (Birth to 6 Years)
Birth
- Hepatitis B (first dose) - Given before hospital discharge
2 Months
| Vaccine | Disease Protected |
|---|---|
| DTaP | Diphtheria, Tetanus, Pertussis |
| IPV | Polio |
| Hib | Haemophilus influenzae type b |
| PCV15/PCV20 | Pneumococcal disease |
| Rotavirus | Rotavirus gastroenteritis |
| Hepatitis B | Hepatitis B (if not given earlier) |
4 Months
- DTaP, IPV, Hib, PCV, Rotavirus
6 Months
- DTaP, Hib, PCV, Rotavirus (final dose)
- Hepatitis B (if 3rd dose due)
- Influenza (begin annual vaccination; 2 doses first season if <9 years)
12-15 Months
| Vaccine | Notes |
|---|---|
| MMR | Live vaccine |
| Varicella | Live vaccine |
| Hepatitis A | 2-dose series starts |
| Hib | Final dose |
| PCV | Final dose |
| DTaP | 4th dose (15-18 months) |
4-6 Years
- DTaP (5th dose)
- IPV (4th dose)
- MMR (2nd dose)
- Varicella (2nd dose)
Childhood Schedule Summary Table
| Vaccine | Birth | 2 mo | 4 mo | 6 mo | 12-15 mo | 4-6 yr |
|---|---|---|---|---|---|---|
| Hep B | 1st | 2nd-3rd | ||||
| DTaP | 1st | 2nd | 3rd | 4th | 5th | |
| IPV | 1st | 2nd | 3rd | 4th | ||
| Hib | 1st | 2nd | 3rd | 4th | ||
| PCV | 1st | 2nd | 3rd | 4th | ||
| Rotavirus | 1st | 2nd | 3rd | |||
| MMR | 1st | 2nd | ||||
| Varicella | 1st | 2nd | ||||
| Hep A | 1st-2nd | |||||
| Influenza | Annual (begins at 6 mo) |
Adolescent Immunizations (11-18 Years)
11-12 Years
| Vaccine | Schedule |
|---|---|
| Tdap | Single dose (replaces Td booster) |
| HPV | 2-dose series (if starting before age 15) |
| Meningococcal ACWY | First dose |
| Annual Influenza | Every year |
16 Years
- Meningococcal ACWY (booster)
- Meningococcal B (based on risk/shared decision)
HPV Vaccine Details
- Protects against cervical, anal, oropharyngeal, and other HPV-related cancers
- Ages 9-14: 2-dose series (0 and 6-12 months)
- Ages 15-26: 3-dose series (0, 1-2, and 6 months)
- Catch-up available through age 45 (shared decision)
Adult Immunization Schedule
All Adults
| Vaccine | Recommendation |
|---|---|
| Influenza | Annual |
| Td/Tdap | Tdap once if not given in adolescence; Td every 10 years |
| COVID-19 | Per current recommendations |
Based on Age
| Age | Vaccine |
|---|---|
| 50+ | Shingrix (2-dose series) |
| 65+ | Pneumococcal (PCV15/PCV20, may add PPSV23) |
| 65+ | RSV vaccine (single dose) |
Based on Risk Factors
| Condition | Vaccines |
|---|---|
| Asplenia | Pneumococcal, Meningococcal, Hib |
| Immunocompromise | Inactivated vaccines (avoid live) |
| Chronic liver disease | Hepatitis A, Hepatitis B |
| Healthcare workers | Hepatitis B, annual flu |
Special Populations
Pregnancy
Recommended during pregnancy:
- Tdap (each pregnancy, preferably 27-36 weeks)
- Influenza (inactivated)
- COVID-19
- RSV (32-36 weeks, during RSV season)
Contraindicated during pregnancy:
- Live vaccines (MMR, Varicella, Live attenuated influenza)
Immunocompromised
- Avoid live vaccines
- May need higher doses or additional doses
- Household contacts should receive indicated vaccines
- Consider timing relative to immunosuppressive therapy
Common Vaccine Reactions
Expected Reactions
- Injection site pain, redness, swelling
- Low-grade fever
- Fussiness (infants)
- Fatigue, headache
Management: Acetaminophen or ibuprofen as appropriate; cold compress to site.
Concerning Reactions
| Reaction | Action |
|---|---|
| High fever (>104°F/40°C) | Notify provider |
| Severe local reaction | Document; may affect future doses |
| Anaphylaxis | Emergency treatment; document contraindication |
| Encephalopathy within 7 days (DTaP) | Contraindication to pertussis component |
Contraindications and Precautions
True Contraindications
- Severe allergic reaction (anaphylaxis) to previous dose or vaccine component
- Encephalopathy within 7 days of pertussis vaccine (for DTaP/Tdap)
- Severe immunodeficiency (for live vaccines)
- Pregnancy (for live vaccines)
NOT Contraindications
These are NOT reasons to delay vaccination:
- Mild illness without fever
- Current antibiotic therapy
- Premature birth (vaccinate per chronological age)
- Breastfeeding
- Family history of vaccine reactions
- Allergies to products not in the vaccine
Addressing Vaccine Hesitancy
Communication Strategies
- Listen to concerns without judgment
- Acknowledge emotions and provide empathy
- Provide information in clear, simple terms
- Use trusted sources (CDC, AAP, WHO)
- Give strong recommendation - provider recommendation is most influential
Common Concerns and Responses
| Concern | Response |
|---|---|
| "Too many vaccines" | Immune system handles thousands of antigens daily; vaccines add minimal burden |
| "Vaccines cause autism" | Thoroughly disproven; original study was fraudulent |
| "Natural immunity is better" | Disease risks far outweigh vaccine risks |
| "Ingredients are harmful" | Components are in safe amounts; strictly tested |
Exam Tips
- Know the childhood schedule - especially timing of first doses
- Hep B is given at birth (before hospital discharge)
- Live vaccines: MMR, Varicella, Rotavirus - avoid in pregnancy/immunocompromise
- Tdap in every pregnancy (27-36 weeks)
- Annual influenza for everyone 6 months and older
- Shingrix at age 50+ (not the old Zostavax)
- True contraindications are RARE - mild illness is not a reason to delay
Test Your Knowledge
A mother asks the nurse if her 6-month-old infant with a mild upper respiratory infection can receive vaccines today. The nurse should respond:
A
B
C
D
Test Your Knowledge
A pregnant woman at 30 weeks gestation asks about recommended vaccines. Which vaccines should the nurse recommend?
A
B
C
D
Test Your Knowledge
Which statement about the HPV vaccine is correct?
A
B
C
D