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Parents will often come into well-child visits with their little ones and are shocked to learn that their child is due for shots, or they're pleasantly surprised to find out their child doesn't need any shots. So here are the basics on when kids are due for childhood immunizations.

This is the schedule from the Centers for Disease Control in conjunction with the Advisory Committee on Immunization Practices, which help set out the schedule based on a ton of research.

First, it's the hepatitis B vaccine, and that's normally given with the vitamin K shot at birth.

The next set of vaccines is given at 2, 4, and 6 months old. Now, this will seem like a lot of shots, but it's designed to give babies the maximum protection against bacterial and viral illnesses that hit infants and toddlers most and provide protection after they lose the natural immunity they got from their mothers through the placenta before birth.

At the 2-, 4-, and 6-month well-visits, they get three shots and they get one oral vaccine. The shots are Pediarix, which is a combination vaccine containing DTaP for diphtheria, tetanus, and whooping cough. It also contains hepatitis B and polio.

The second is Hib, for Haemophilus influenza type B, which can cause ear infections and meningitis, a bacterial infection of the lining of the brain and spinal cord, which can be fatal.

The third is Prevnar, and that protects against streptococcal pneumonia bacteria that cause ear infections, meningitis, pneumonia, and infections of the bloodstream.

The oral vaccine is called RotaTeq and protects against rotavirus, which is a nasty viral infection that causes vomiting and diarrhea severe enough to hospitalize babies due to dehydration. This is a virus that I saw a lot when I was in residency. The vaccine didn't come out until just after my oldest son was 4 months old. The first dose has to be given before 3 months old, so he didn't get it. I was pregnant with him when I caught rotavirus after being on the inpatient service and he got it at 5 months old. It was definitely not fun.

At 9 months, unless it's influenza season, babies get a break from shots, but they are still due for a well-visit.

The next well-visit is at 12 months. At that age, they get their fourth Prevnar, and then they have completed that series. They also get their first hepatitis A vaccine and they get vaccines to protect them from measles, mumps, rubella, and varicella, also known as chicken pox.

Then at 15 months, they get the DTaP and the Hib again, which completes the Hib series.

And at 18 months, they get the second hepatitis vaccine and complete that series.

Then we give kids a break again.

The next vaccines are what most parents call the kindergarten shots. We give them at age 4, but they can be given any time after age 4 and before the child starts kindergarten. The schools will need documentation that your child has had these when you register them.

The kindergarten shots are combination vaccines also, which is good because, again, it means fewer pokes for more protection.

The first is Kinrix, which is DTaP and polio. The second is called ProQuad, which is measles, mumps, rubella, and varicella. This finishes the polio, measles, mumps, rubella, and varicella series.

The next vaccines are given at 11, and many parents call these the junior high vaccines.

Now, let me clarify. There are current recommendations to start the HPV, human papillomavirus vaccine, at age 9. That is a new recommendation that is just now being put out. The HPV vaccine protects them from a virus that causes warts and cancer in the mouth, throat, and genitals. It's the one that causes cervical cancer in women, and one of the biggest causes of oral cancer in men.

The other junior high vaccines include the first dose of Tdap, which is the adult dose of tetanus, diphtheria, and whooping cough. The P stands for pertussis, which is whooping cough.

And people still need them every 10 years pretty much for the rest of their lives. This is the one that everyone asks about if they have a puncture wound. The whole "if you step on a rusty nail, you have to have this vaccine." Yeah, it's that one.

They also get one for meningitis groups A, C, W, and Y. There are several brand names for this vaccine. Menveo is the one we give at our clinic. This vaccine protects against the Neisseria meningitidis bacteria that causes meningitis. They get the second dose at 16.

There is an additional vaccine for meningitis group B that some teens need for college. It can be given from ages 16 to 23.

So those are the basic vaccines, the ones that are needed for school specifically. Of course, there are always other vaccines like for influenza and COVID.

Also, if you are traveling outside of the United States, there may be other vaccines you need to visit other parts of the world. For those, you would be best to check with the health department or a travel clinic of your local hospital, as your pediatrician would not have those vaccines at their office.

If you have any questions about any of these vaccines, please talk to your child's pediatrician.

Dr. Jones: If the womb is such a safe place, how does the Zika virus get in? This is Dr. Kirtly Parker Jones from Obstetrics and Gynecology at University of Utah Health Care and this is The Scope.

Announcer: Covering all aspects of women's health. This is "The Seven Domains of Women's Health" with Dr. Kirtly Jones on The Scope.

Dr. Jones: When I was a second-year medical student, I absorbed the idea that the womb was a perfectly safe place. I use the word absorbed because I don't think they taught that to me, I think I just figured that out. The placenta was the perfect mother, serving and protecting the fetus. Serving in that the placenta actively pumps some nutrients like to the developing fetus like oxygen and glucose. Protecting in that it keeps out large molecules and only smaller molecules can get in. Well, this was a rather romantic idea, but I was a rather romantic medical student.

By the time I was a third-year medical student, I was taught about congenital infections, infections in the child that start in the womb. Infections such as toxoplasmosis from uncooked pork and kitty litter, syphilis, well, from you know how. These aren't just molecules, these are whole organisms. They get through the placenta and into the fetus. We also learned about viruses such as chicken pox and rubella infecting the fetus. But in the dazed mind of a totally engaged but overextended third-year medical student, I never really questioned how they did that.

If the womb is a perfect mother protecting the fetus, how do those things get in? Well, first, it's important to remember that viruses are really sneaky. Here's a little bit on virus biology. They're just a little packet of DNA wrapped in a membrane. They don't have the ability to reproduce themselves. They get into cells and hijack the cell's energy and DNA and proteins and make the cell make more virus. The interesting part is that viruses are choosy. They have markers on their covering that attach to specific proteins on certain kinds of cells. Some viruses like the respiratory tract but not the skin. Some viruses like white cells, like the HIV virus.

The Zika virus, which has already found cells in the infected mother to turn into Zika factories, and the virus spreads throughout the mother's body. The virus then may specifically bind to the lining of the placenta, the amnion. Then the virus turns the amniotic membrane into a Zika virus factory. Then the Zika virus hatches out of the amnion cells into the fluid around the fetus and the fetus gets infected. Specifically, the virus likes nerve cells; it likes fetal brain cells. It binds the fetal brain cell, turns it into a Zika factory and then in the process it kills the brain cell.

There is another mechanism by which the Zika virus might get into the womb and that is through the leaky placental cells that are made early in development in the first trimester. The virus then seems to specifically attach to the stem cells of the embryonic brain. Destroying these cells, which have been infected by the virus, may explain why the findings of microcephaly, small brain, in some of the babies that were infected in pregnancy. The virus can get in at any time of pregnancy, but it's particularly successful and potentially damaging in the first trimester.

Researchers also found that different strains of the Zika virus were more infectious, more successful at hijacking placental cells than others. The earlier African strain was less infectious than the current South American strain, which is much more infectious and much more likely to infect the fetus. In fact, it seems it's not just spread through infection by mosquitoes, but it's spread sexually from men to women and now, we think, from women to men. There's the possibility that it might be spread from other body fluids as well.

Actually, it is remarkable that the placenta and the membranes can protect the fetus from as many viruses as it does. Only a few viruses that we know about specifically attack placental cells and then go on to infect and harm the fetus. The chicken pox virus, the measles virus and the cytomegalovirus are examples and we have vaccines for some of these. Understanding the mechanisms by which viruses can infect placental cells can help us develop anti-viral agents and other approaches to treatment.

Viruses are particularly successful and rapidly changing in their molecular appearance, meaning the way their face looks to different cells. So it may be difficult to make a vaccine. Or because the Zika virus belongs to a family of viruses that include Dengue yellow fever and we have a vaccine for some of those, we might be able to make a vaccine for all three or maybe not.

In the meantime, it's important to remember that a womb isn't a completely protected place. And the placenta isn't a perfect mother, letting in only the good in keeping out the bad. We need to remember to offer protection to pregnant women and women who might become pregnant from viruses, drugs and molecules in air and water pollution that can get through the placenta and affect the fetus. Thanks for joining us on The Scope.

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