“Kindergarten” Vaccines – Age 4-5y

An important part of many well-child visits is vaccination, including booster vaccines. This is a vital way to protect your child against severe illness. Your child’s doctor will discuss vaccines that are recommended for your child during the well-child visit, and can answer any questions you may have. The vaccines covered in this post are those recommended by the CDC (Center for Disease Control) and AAP (American Academy of Pediatrics) to be given during the well-child visits that occur at 4 or 5 years age, often referred to as the “Kinder” or “Kindergarten” vaccines. Infant (from birth until 12mo), toddler (from 1 to 3 years) and adolescent vaccines will be discussed in a separate posts.  

Recommended Kinder vaccines are all booster doses if your child is up to date with vaccinations, and include the following: 

• DTaP (Diphtheria, Tetanus, acellular Pertussis)
• IPV (Polio)
• MMR (Measles, Mumps, Rubella)
• Varicella (Chicken pox)

Why should your preschool age child be vaccinated?

Each of these vaccines protects against very serious, sometimes life-threatening diseases. Let’s look at them individually in more detail. 

DIPHTHERIA is caused by the bacteria Corynebacterium diphtheriae. Infection results in a thick coating in the back of the throat, leading to breathing problems, heart failure, paralysis, and death. Diphtheria spreads from person to person through respiratory droplets, such as exposure to an infected person’s cough or sneeze.

TETANUS (Lockjaw) is caused by the bacteria Clostridium tetani. Infection results in painful muscle tightening and stiffness, usually all over the body. If the muscles in the head or neck are involved, it can progress so that you can’t open your mouth, swallow, or sometimes even breathe. Tetanus bacteria enter the body through “dirty” wounds, such as cuts or punctures that are contaminated by the surrounding environment.

PERTUSSIS (Whooping cough) is caused by the bacteria Bordetella pertussis. Infection results in severe coughing spells, which can cause difficulty sleeping, vomiting, and disturbed sleep. In infants it can cause severe difficulty with breathing and even death. Pertussis is a very contagious disease found only in humans. It spreads from person to person through respiratory droplets, such as exposure to an infected person’s cough or sneeze. 

POLIO (Poliomyolitis) is caused by the polio virus. Infection causes a disabling and potentially life-threatening disease that affects a person’s spinal cord, causing paralysis (the inability of a muscle to move). If this paralysis affects the muscles that are responsible for breathing, death can occur. The polio virus is very contagious. It spread via contact with stool (feces) and respiratory droplets. The polio vaccine is very effective, and the US is currently polio free. However, the disease still occurs in other parts of the world and could be easily brought back through travel to another country by an unvaccinated individual.

MEASLES (Rubeola) is caused by the Measles virus. Infection typically causes high fever, cough, runny nose, watery eyes, and classic measles rash. Measles infection can be serious, especially in children under 5 and adults over 20, and can include pneumonia and encephalitis (inflammation of the brain) that may cause deafness, seizures, and intellectual disability. Measles is highly contagious, spread by coughing and sneezing. The virus can linger and live in the air for up to 2 hours.  

MUMPS is caused by the Mumps virus. It is classically known for swelling and tenderness of the cheeks due to infection of the salivary and parotid glands. Additionally, mumps infection causes complications due to inflammation of the testicles, ovaries, pancreas, and brain, and can lead to deafness. Transmission from person to person is due to direct contact with saliva or respiratory droplets from the mouth, nose, or throat of an infected person via coughing, sneezing, sharing cups, and kissing. 

RUBELLA (German measles) is caused by the Rubella virus. In children this typically causes a mild infection with fever, rash, enlarged lymph nodes. However, infection of an unborn child during pregnancy causes a more significant form of disease called Congenital Rubella Syndrome, which can cause miscarriage, stillbirth, or severe birth defects. These most commonly include deafness, cataracts, heart defects, intellectual disabilities, and liver/spleen damage. Rubella is most commonly transmitted through respiratory droplets,such as exposure to an infected person’s cough or sneeze, or through direct transmission from a pregnant mother to her unborn child. 

VARICELLA (Chicken Pox) is caused by the Varicella-Zoster virus. Infection causes an itchy, blister-like rash along with fever and fatigue. Complications of infection include secondary bacterial infections of the skin, pneumonia, infection/inflammation of the brain, bleeding problems (hemorrhage), and bloodstream infections (sepsis). Transmission occurs through close contact with an infected person, including respiratory droplets, exposure to saliva through kissing or sharing cups, contact with infected skin, and from a pregnant mother to unborn child. 

Schedule of vaccines given at 4-5 years

Vaccine	Number of doses at 4/5y	Recommended ages
DTAP	1	4 or 5 years
IPV	1	4 or 5 years
MMR	1	4 or 5 years
Varicella	1	4 or 5 years

Please see specific Vaccine Information Statements for more details about each vaccine, including who is recommended to receive vaccines, contraindications to vaccines, possible side effects, and more. The VIS can be found at your healthcare provider’s office or online at https://www.cdc.gov/vaccines/hcp/vis/index.html

What about side effects?

The most common side effects of any vaccine are fevers, soreness at the site of injection, and fussiness. Some toddlers are more sleepy than usual or do not eat as well. With any vaccine or medication, there is a small risk of severe allergic reaction. Please talk with your child’s doctor about what to expect and what you can do for common vaccine side effects.  

Who should not be vaccinated?

Talk to your child’s health care provider if your child:

• Has had an allergic reaction after a previous dose of any vaccine, or has any severe, life-threatening allergies.
• Has ever had Guillain-Barré Syndrome (also called GBS).
• Has had severe pain or swelling after a previous dose of any vaccine 
• Has had any vaccines in the past month (MMR and Varicella are live vaccines and this may affect when other vaccines are given). 

People with minor illnesses, such as a cold, may still be vaccinated. People who are moderately or severely ill with fever should usually wait until they recover before receiving vaccinations. 

Further questions?

Though I talk to parents extensively about vaccines at well-checks, I commonly refer parents who still have questions or hesitancies about vaccinations to the CDC’s website. There is a comprehensive list of vaccines, the diseases they protect against, side effects, and more. I also usually recommend the Children’s Hospital of Philadelphia (CHOP) Vaccine Education Center website. It contains great information that is easy to navigate and understand. 

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