Does your child need a booster before school starts?

It might seem too early to think about the back-to-school season, but kids will be boarding school buses and heading off to their first day before you know it. As a parent, you’ll probably try to get them ready by making sure they have brand-new backpacks, sneakers, lunch boxes, and notebooks…but will you make sure they have all their required childhood immunizations?

Most kids enrolled in any school outside of the house—whether public or private—are required to be vaccinated against a handful of diseases before they can attend. Laws vary by state, but most kindergartener students need, at minimum, immunization against diphtheria, tetanus, and pertussis (DTaP), measles, mumps, and rubella (MMR), hepatitis B, chickenpox, and polio.

Many people forget or overlook older kids, though, when planning for back-to-school immunizations: TDaP booster shots are due at age 11, and initial vaccinations against several forms of meningitis begin at age 12, too. And don’t forget about flu shots every fall and COVID-19 vaccines!

Basically, if your child is heading to school this fall, making sure they receive all the necessary vaccinations beforehand is an important step in your preparations. Here’s how to know if your child needs to get caught up before the school year.

What are the benefits of vaccinating kids before they head to school?

However old your child is, there are benefits to getting them immunized against common illnesses before the school year starts. If your child has ever brought a cold home during the first week of school, you know that putting kids together in a small classroom is a prime opportunity for germs to spread—when that illness is minor, it’s easy to shrug it off, but more serious illnesses can also spread like wildfire in a school setting.

The good news is that kids can be vaccinated against most of these more serious illnesses, preventing not only personal illness but the spread of illness to others at school, at home, and in the community. Most vaccinations require about two weeks to become fully effective because the body needs time to make antibodies. Therefore, vaccinating before school starts means your child will be protected on their first school day. 

For older kids especially, the run-up to back-to-school season is a great time to check off multiple wellness boxes with your child’s healthcare provider.

“The summer months bring a lot of older kids to the office,” says Gary Kramer, MD, a Miami-based pediatrician. “Babies come in regularly but older kids get busy with life, so we tend to see them in the summer for their well checkups, pre-participation sports physicals, and that’s also our opportunity to bring them current with their vaccines.”

RELATED: Immunization and vaccination statistics

What shots do kids need before school?

There is no federal law requiring childhood immunizations, but every U.S. state has its own laws about which vaccinations are required for children attending school. 

“There are childhood immunizations that are required by law to attend public schools and some private schools, [though] these laws can vary state by state [and] there are exceptions to include medical exemptions, religious exemptions, and philosophical exemptions,” says Ashanti Woods, MD, a pediatrician at Mercy Family Care Physicians in Baltimore.

Per a 2022 analysis by Health Affairs, there is a lot of variation among the states as far as which vaccines are mandatory, which locations those mandates apply (if daycare and child care facilities are included, for example), what medical exemptions are possible, if any, and how these mandates are enforced. But nearly every state, reports Health Affairs, requires the same basic set of childhood immunizations even when there are differences in how and where those mandates are put into effect.

Vaccinations required for kindergarteners

According to Emily Wisniewski, MD, a pediatrician at Mercy Medical Center in Baltimore, most schools require vaccines for incoming students unless they have some sort of religious or medical exemption. Typical immunizations include:

• Diphtheria, tetanus, and pertussis (DTaP)
• Hepatitis B
• Haemophilus influenzae type B, or Hib (which is not the same as seasonal influenza)
• Inactivated poliovirus
• Rotavirus 
• Measles, mumps, and rubella (MMR)
• Pneumococcal conjugate
• Varicella, aka chickenpox

Many of these illnesses may sound familiar to you; the DTaP, MMR, polio, and Hib vaccines have all largely been mandated since the early 1990s (so if you’re a parent today, you probably received these immunizations yourself). The hepatitis B vaccine was widely recommended for all babies and children around 1991, and the varicella vaccine was made available in 1995.

The immunizations likely to be less familiar to you are rotavirus and pneumococcal conjugate. The pneumococcal vaccine protects against illnesses caused by the pneumococcal bacteria, which includes pneumonia, meningitis, and some blood infections; it became a recommended childhood vaccine in most states in 2000. The rotavirus vaccine is an oral vaccine given to infants less than 8 months of age. This vaccine protects against a form of gastrointestinal disease that can be severe in very young children and was recommended as part of routine immunizations in 2006.

Vaccinations required for older children

Most children will get a break from required immunizations between the ages of 6 and 11 as long as they have been vaccinated along the recommended schedule. Physicians and health officials suggest influenza vaccines every fall starting at age 6 months of age, but these are not required. But after that, more frequent required immunizations start up again.

Ages 11 to 12

According to Dr. Kramer, kids typically need a booster shot for DTaP between 11 and 12, and the primary dose of a meningitis vaccine designed to prevent infection from four different strains of bacterial meningitis also between 11 and 12 (this is called the quadrivalent meningococcal conjugate vaccine, or MenACWY).

Your child’s pediatrician may also start talking to you about the HPV vaccine when your child is around 11 years old. HPV is our second vaccine to help decrease cancer. Hepatitis B vaccine decreases the risk of liver cancer, and HPV decreases oropharyngeal, cervical, and anal cancers. Some parents blanch at how early the recommended age is for this vaccine, but there are good reasons to consider it before you think it’s necessary. 

“HPV can be given any time between the ages of 11 and 26, but if you do it before age 15, it’s only two doses,” says Dr. Kramer. “There’s a better immune response at a younger age, so you need fewer doses, plus younger kids [get that] protection before exposure becomes a reality.”

Age 16 and up

At age 16, Dr. Kramer says, kids will need a booster shot for the quadrivalent meningitis vaccine they received at age 11 or 12, as well as a separate meningitis B vaccine required by many colleges and universities for students living on campus. The meningitis B vaccine is boosted again just one month after the initial dose, says Dr. Kramer. 

What about the annual flu shot?

As of 2023, no states require proof of a seasonal flu vaccine for students in grades K-12.

Massachusetts had a mandate in place for flu vaccine administration in the 2020-2021 school year but reversed the decision in early 2021. Currently, six states have flu shot mandates for young children, but they only apply to childcare and pre-K students, not school-aged kids.

“It’s not very common for schools to require flu vaccination, but we still recommend it,” says Dr. Wisniewski, noting that while influenza can have mild, cold-like symptoms, it can also infect school teachers and staff, require ER visits, and even cause hospitalization in severe cases. 

Though flu vaccines are not mandated for K-12, the Centers for Disease Control and Prevention (CDC) recommends that everyone over the age of 6 months receives an annual influenza vaccination. The only caveat is that you might not want to get this vaccine for your child before school starts since the general recommendation is to receive it in early fall for the best protection throughout the entire winter—bookmark this particular shot for sometime in October.

Will my child need to be vaccinated against COVID-19 to go to school? 

Individual states, schools, or school districts may choose to mandate the COVID-19 vaccine, but so far, most haven’t trended that way. Only the District of Columbia has put a state mandate in place requiring K-12 students to get the vaccine, while 21 states have done the opposite by enacting a statewide ban on mandates, per the National Academy for State Health Policy (NASHP).

 “We definitely recommend that age-eligible children get vaccinated or boosted for COVID-19 prior to returning to school,” Dr. Woods says. Currently, the American Academy of Pediatrics recommends that all infants (over 6 months of age), children, and adolescents receive a COVID-19 vaccine. The CDC recommends that children over the age of 6 years receive an updated (bivalent) mRNA vaccine whether or not they received a primary (monovalent) vaccine series.

How can I get my child up-to-date on their immunizations before school starts?

If your child has a designated healthcare provider, talk with them about getting vaccines up to date. Bring your vaccine card to the visit to help with decision-making. If you don’t have a provider for your child, you can check with the local health department, pharmacies, minute clinics, and urgent care centers to see if they’re offering the immunizations your child needs. 

Keep in mind, however, that some of these ancillary locations are unable to administer shots to infants or very young children; this may be a better option if you’re looking for an annual flu shot or COVID-19 booster for an older child. If you don’t know where to start looking, Dr. Kramer advises parents to consult their state’s Department of Public Health for guidance.

As for the cost of vaccines, most insurance companies cover immunizations given at well checkups and all insurance companies are required to provide free annual flu shots.

If you don’t have insurance or need an immunization that’s not covered under your plan, you still have options. A SingleCare savings card can lower the cost of vaccines when used at many pharmacies. Often, the immunizations provided at state health departments are free or low-cost. You may also be eligible to get immunizations for your child through the Vaccines for Children Program.