What happens if a vaccine booster is delayed?

A lot of parents question the timing of vaccines. What happens if a vaccine booster is delayed? Does the series need to be restarted? Is it even worth it if it's late?

There are so many questions about delayed vaccines...

This is not about a delayed schedule.

Intentionally delaying vaccines, especially during the infant schedule, puts kids at risk for catching a disease.

I always recommend giving vaccines according the standard vaccine schedule. This helps protect our children and our communities.

A bit about insurance...

There also might be insurance issues if vaccines are given out of the standard age range. Details of coverage should be in the fine print of your individual contract with your insurance company and your physician will not know coverage specifics. You should talk to your insurance company to see if there are limitations on vaccine coverage if you are vaccinating outside the standard vaccine schedule.

Most insurance companies cover the infant series until 2 years of age. I recommend getting those done prior to the 2nd birthday if at all possible, not only for the protection of your child, but also potential increased costs to you if your insurance company has age restrictions.

The "kindergarten" vaccines are given between 4 and 6 years of age and then there are "tween/teen" vaccines at 11-12 and 16 years. These also might fall into age restrictions of your insurance company, so talk to an insurance company representative if you have questions on payment.

Life happens, and sometimes there are inadvertent delays in vaccinating.

The typical question I'm asked regarding what happens if a vaccine booster is delayed is along the lines of one of these questions:

"He is due for his kindergarten shots on July 5th, but we're on vacation then. Is it okay to wait until the end of July?"

or

"Tweeny is getting her first HPV vaccine today, but she has a big out of town tournament the week she is due for the 2nd dose. Can she come later?"

The answer to both questions: yes.

Vaccines are recommended with minimal intervals. If there's a delay for whatever reason (missed appointments, scheduling conflicts, temporary immune compromise-such as cancer) it's usually recommended to catch up as soon as possible.

Vaccine series do not need to be restarted if the interval has been longer than recommended. You give the next required dose and make sure successive doses fit minimal intervals and age limitations.

Minimal intervals will be discussed in a future post.

Exceptions to completing the series

There are a few vaccines that should not be given if too much time has passed.

Rotavirus vaccine

Rotavirus vaccine is very specific as to when it can be given.

There are two types of rotavirus vaccine. One is typically given at 2, 4, and 6 months. The other is given at 2 and 4 months. Either is considered acceptable. It is recommended to use the same type to complete the series, but they can be interchanged if needed.

The minimum age for the first dose is 6 weeks and the maximum age for dose #1 is 14 weeks 6 days.

Vaccination should not be started for infants age 15 weeks or older due to safety concerns in older infants. If an infant of 15 weeks 1 day or older has not started the rotavirus vaccine, they should not start it.

The maximum age for the last dose of rotavirus vaccine is 8 months and 0 days. If an older infant has not completed the series, it is not recommended to do a catch up.

Hib vaccine

The Hib vaccine also has different versions and a variable schedule due to vaccine types and combination vaccines. It is either a 3 or 4 dose series. The earliest it can be given is 6 weeks, but it standardly starts at 2 months.

At least one dose is recommended after the first birthday for children under 5 years of age.

It is not recommend to give Hib vaccine after 5 years of age to healthy children. Some high risk people should continue to get the vaccine beyond their 5th birthday.

Pneumococcal vaccine

Again, there are various types of pneumoccal vaccine, but the one routinely given to infants is the PCV13.

The youngest an infant can receive this vaccine is 6 weeks, but it's typically given at 2, 4, 6 and 12-15 months. If a child misses doses, they should do catch up vaccines at least 28 days apart and at least one dose after the first birthday, unless they are over 5 years of age.

Only children with underlying health risks require catch up doses if they're over 5 years of age.

Some schools require at least one dose, so children over 5 years who have never had this vaccine may be required to be vaccinated despite the CDC guidelines. While this is safe, it may not be covered by insurance. (Another great reason to stay on the routine schedule as much as possible!)

DTaP and Tdap (D and d = diptheria, T = tetanus, P and p = pertussis/whooping cough)

The DTaP vaccine is typically given at 2, 4, 6 months and then boosters at 15-18 months and 4-6 years of age. If the full series hasn't been given, it is okay to complete it up until the 7th birthday with the DTaP.

If the child is over age 7, the Tdap should be given instead of the Dtap. These cover the same diseases, but the Dtap has a higher diphtheria component than the Tdap (as indicated by the capital letters).

The Tdap is the booster that is usually given at 11-12 years of age, but can be used as early as 7 years if the Dtap series was not completed or if there is a wound requiring a tetanus booster.

If additional doses are needed after one Tdap, Td boosters can be used to complete the primary series.

Tetanus boosters are recommended every 10 years and with each pregnancy. The Td vaccine is recommended for most of these boosters. Exceptions are that the Tdap  should be used during pregnancy and can be used if the Td is not available.

Polio

In the US, the standard polio vaccine schedule is 4 doses at 2, 4, 6-18 months and 4-6 years.

In other countries it is given soon after birth and there are additional doses. Even if a child has had more than 4 doses, if one was not given after the 4th birthday, an additional dose is needed.

Conversely, if the 3rd dose was given after the 4th birthday and 6 months or more after the previous dose, a 4th dose is not needed.

Typhoid

The typhoid vaccine is not on the standard US vaccine schedule. It's recommended for many travelers and it might involve at-home compliance, so I decided to include it.

The injectable typhoid vaccine is recommended for 2 years of age and up and can be repeated every 2 years. Talk to your doctor to see where it is available, since they may or may not keep it in stock.

The oral typhoid vaccine is the one that can be complicated. It can be given to children over 6 years of age through adult years. It is boosted every 5 years. Even though it is a vaccine, it is given in pill form by mouth. It should be given on an empty stomach every other day for a total of 4 doses. The pills should be kept in the refrigerator, which can make them hard to remember. Because they are a live virus vaccine, they should not be taken with antibiotics. If antibiotics are required during the week of administration, the vaccine won't be as effective and doses might need to be repeated. If there are forgotten doses, talk to your physician to be sure the series does not need to be repeated.

So... What happens if a vaccine booster is delayed?

Talk to your pediatrician (or the people where you get your vaccines) to make a plan to catch up on immunizations.

Good news! The CDC has a catch-up schedule that gives a timeline of when to give various vaccines if you're off the typical schedule.

Source: https://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-child-combined-schedule.pdf#page=3

There's even a cool vaccine scheduler that you can use to estimate what vaccines your child needs.

Talk to your physician to help decide how to catch your family up on their vaccines.