Updating a child's immunizations is an annual back-to-school rite of passage for all parents. The American Academy of Pediatrics traditionally recommends that children receive nine vaccines for 13 primary childhood diseases.

The nine traditional vaccines are:

  • DTaP: Combines vaccines against three diseases — diphtheria, tetanus and pertussis — into one shot. Children need five DTaP shots for maximum protection. The first three shots are given at 2, 4 and 6 months of age. The fourth booster shot is given between 15 and 18 months, and a fifth shot, another booster, is given when a child enters school at 4 to 6 years old.
  • Hepatitis A: The vaccine is 94 percent to 100 percent effective in preventing hepatitis A. Children between 12 and 23 months of age should receive the two-time vaccine, administered at least six months apart.
  • Hepatitis B: Three doses are needed for full protection from the disease. The first dose is usually given at birth. This is particularly important for children whose mothers are chronically infected. For other babies, the first dose can be given between birth and 2 months of age. The second dose is recommended at 1 to 4 months, and the third at 6 to 18 months. These three doses should protect children for life.
  • Hib or Haemophilus Influenza Type B: Children should get either three or four doses. The vaccine is recommended at 2, 4, 6 and 12 to 15 months of age. The 6-month dose is not given with one brand of vaccine.
  • Influenza: One dose is recommended annually, around October or November. Children younger than 9 who are getting influenza vaccine for the first time are recommended to get two doses at least a month apart, depending on the type of vaccine.
  • MMR: Combines vaccines for measles, mumps and rubella into one shot. Most children who get the vaccine develop immunity to all three diseases, and protection is believed to last a lifetime. Two doses of vaccine are recommended, with the first dose given at 12 to 15 months of age. The second may be given four weeks after the first, but it is usually given at 4 to 6 years. No boosters are needed.
  • Pneumococcal: Four doses are recommended at 2, 4, 6 and 12 to 15 months of age. Children who are late starting the series may need fewer doses. Children age 5 and older usually should not get pneumococcal conjugate vaccine, but older children with certain chronic diseases or damaged immune systems should still get a pneumococcal vaccine. There is a different vaccine, called pneumococcal polysaccharide vaccine, that can be given to these children and to adults.
  • Polio: Children should get four doses of polio vaccine, the first three doses at 2, 4, and 6 to 18 months of age, and a booster dose at 4 to 6 years.
  • Varicella: A separate varicella vaccine prevents chicken pox in 70 percent to 80 percent of people who receive it, and is expected to provide lifelong immunity. A single dose of the vaccine is recommended for children at 12 to 18 months of age, usually at the same time as the MMR vaccine. Children who miss this shot can still get a single dose of the vaccine until their thirteenth birthday. After the thirteenth birthday, two doses are recommended, given four to eight weeks apart.

Two additional vaccines to consider include:

  • Human papillomavirus or HPV Vaccine: Recommended for girls 11 and 12 years old to prevent cervical cancer, precancerous genital lesions and genital warts due to HPV. The vaccine, called Gardasil, gives protection against four different strains of HPV. The inoculation is administered in a series of three injections over a six-month period. The second and third doses should be given two and six months, respectively, after the first dose. HPV vaccine may be given at the same time as other vaccines.
  • Rotavirus Vaccine: Vaccine will immunize children against rotavirus, a viral infection that can cause severe diarrhea, vomiting, fever and dehydration (gastroenteritis) in infants and young children.