Adolescent Might Need Immunizations

Most parents realize that immunizations are an important part of infant and early childhood medical visits and that vaccines are necessary to keep our children healthy. Often parents (and teens!), however, don’t recognize that adolescence is an important time for immunizations as well. As the end of summer approaches and many adolescents head to their doctor’s office for school physicals, it is a great time to think about the shots that teens might need.

The Centers for Disease Control and Prevention (CDC) recommends the following four vaccines for administration at your child’s 11-12 year-old checkup (or as soon as possible if your child is older and has not received the vaccines).

Tdap protects teens against three serious illnesses: tetanus, diphtheria and pertussis. Tetanus causes painful tightening of the muscles, usually all over the body, and leads to death in 20 percent of cases. Diptheria causes a thick covering over the back of the throat and may lead to breathing problems, paralysis, heart failure and even death. Pertussis, which is also known as whooping cough, causes severe coughing spells, and can lead to pneumonia, hospitalization and death in young infants. Adolescents 11-18 should receive one dose of Tdap.

MCV4 protects teens against meningococcal disease, which is a very serious bacterial illness. It is a leading cause of bacterial meningitis in children and teens in the U.S. Meningococcal disease can also cause blood infections. One out of every 10 people who get meningococcal disease die, and many more experience life-long complications, such as mental retardation, seizures, deafness and loss of limbs. Adolescents should receive one dose of MCV4 at 11-12 years of age or at high-school entry. Students who are about to start college (and who may live in a dorm) and military recruits should also receive MCV4, as they are at increased risk.

HPV protects teens against infection with genital human papillomavirus, which is the most common sexually transmitted infection in the U.S. HPV infection is important because it causes cervical cancer, which kills approximately 4,000 women in the U.S. each year. HPV also is associated with other types of cancer in men and women and causes warts in the respiratory and genital tracts. HPV vaccination can prevent most cases of warts and most cases of cervical cancer. HPV is recommended for girls 11-12 years of age, but may be given as young as 9 years. It is recommended for this age group because it is important to receive the vaccine before sexual contact, as this is how HPV is spread. Girls and women who are up to age 26 years should receive HPV if they did not when they were younger, and HPV is recommended even if a young woman has had sexual contact. HPV is a three-dose series, with the second dose given two months after the first, and the third dose six months after the first.

Hepatitis A
Hepatitis A protects teens against Hepatitis A illness, which may cause diarrhea, vomiting, jaundice and serious liver disease. Up to 20 percent of people with Hepatitis A infection require hospitalization. All adolescents should receive Hepatitis A vaccination, which requires two doses for lasting protection, given six months apart.
In addition, the CDC recommends teens receive the following vaccines if they didn’t get all of the recommended doses when they were younger: Hepatitis B, MMR and Varicella.

Hepatitis B
Hepatitis B protects teens against Hepatitis B, which is a serious disease that affects the liver and may give rise to symptoms of diarrhea and vomiting, jaundice and loss of appetite. Hepatitis B may also give rise to chronic liver disease, liver cancer and death. Adolescents and young adults are the age group most commonly infected with Hepatitis B. Everyone who is 18 years and younger should receive hepatitis B vaccination, which is a three-dose series. Similarly to HPV, the second dose should be given two months after the first, and the third dose six months after the first.

MMR protects against measles, mumps and rubella. Measles virus causes rash, cough, eye irritation, runny nose and fever. Serious cases may lead to pneumonia, seizures and death. Mumps virus causes fever and swollen lymph nodes, and can cause deafness, meningitis, and, rarely, death. Rubella is also known as German measles, and can cause rash, fever and arthritis. Rubella in pregnant women can cause miscarriage or serious birth defects. Children require two doses of MMR, and typically get the first at around 1 year and the second at 4-6 years. Some adolescents may not have received the second dose, and it is important to give this dose if that is the case.

Varicella is also known as chickenpox. Varicella is a very common childhood disease, which is usually mild and causes fever and rash. It can be very serious in young infants and adults, and can cause pneumonia, brain damage and death. Teens 13 years and older who have never received varicella immunization or have never had the illness should get two doses at least 28 days apart.

The most common side effects of all these immunizations in teens are redness, swelling or pain where the shot was given or-low grade fever. The benefits of vaccination clearly outweigh the risks. Please discuss these immunizations with your teen’s health-care provider at his or her next visit (or schedule a visit if you know your teen is not up to date). For more information, go to

Dr. Kristin M. Rager is the medical director of the Teen Health Connection and also the director of adolescent medicine at Levine Children’s Hospital.