Active vs Passive Immunity
Does the body make its own antibodies, or are they handed to it ready-made?
Every immunization question starts here. Active immunity is slow to build but lasting; passive immunity is immediate but temporary.
- Activebody makes its own
- The immune system produces its own antibodies after a vaccine or a real infection. Takes time to develop, but is long-lasting and creates memory cells.
- Passiveantibodies given
- Ready-made antibodies are given to the person — maternal antibodies across the placenta, breast milk, immune globulin, or RSV monoclonal antibodies. Works immediately but is temporary (no memory cells).
Vaccine = active immunity. Immune globulin (rabies HRIG, hepatitis B HBIG, tetanus TIG) = passive immunity — immediate but short-lived. Post-exposure it is often given alongside the vaccine, not instead of it: rabies = HRIG + the vaccine series; hepatitis B exposure in an unvaccinated person = HBIG + starting the HepB series.
Vaccine recommendations are reviewed and updated periodically by the CDC and its advisory committee (ACIP), and several age/dosing rules have shifted recently. This guide reflects current guidance, but always confirm the latest schedule at cdc.gov/vaccines.
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Types of Vaccines
The category drives the safety rules — especially "live."
- Live attenuated
- Weakened live organism. MMR, varicella, rotavirus, intranasal (nasal-spray) flu. Strongest, longest immunity — but avoided in pregnancy and severe immunocompromise.
- Inactivated / subunit / toxoid
- Killed organism or a piece of it. DTaP/Tdap, Hib, HepA, HepB, injectable flu, IPV (polio), PCV. Safe in immunocompromise; often need boosters.
- mRNA / recombinant
- Give the body instructions or a made protein. COVID-19 (mRNA or protein subunit, e.g. Novavax), zoster (RZV/Shingrix, recombinant — not live), HPV.
MMR, Varicella, Rotavirus, and intranasal flu are the live vaccines you must recognize. The injectable flu shot is not live, and today's shingles vaccine (RZV/Shingrix) is not live.
Childhood Schedule (Birth–6 Years)
You don't memorize every date — you recognize the pattern and the standouts.
- HepB
- Birth, 1–2 mo, 6–18 mo (3 doses). The birth dose is universal — given before hospital discharge.
- Rotavirus (RV)
- 2, 4, (±6) mo — oral and live. Dose count depends on brand (2 or 3).
- DTaP
- 2, 4, 6, 15–18 mo, 4–6 yr (5 doses).
- PCV
- 2, 4, 6, 12–15 mo (4 doses; the 6-mo dose is routine). Pneumococcal conjugate.
- Hib
- 2, 4, (6), 12–15 mo — whether the 6-mo dose is given depends on the brand.
- IPV (polio)
- 2 mo, 4 mo, 6–18 mo, 4–6 yr (4 doses; last dose on/after the 4th birthday). Inactivated — the only polio vaccine used in the US.
- MMR & Varicella
- 12–15 mo, then 4–6 yr — both live.
- HepA
- 12–23 mo, 2 doses ≥6 months apart.
- Influenza
- Yearly, starting at 6 months. Some children aged 6 mo–8 yr need 2 doses ≥4 weeks apart, depending on prior flu-vaccination history.
- RSV protection
- One of two paths: the maternal RSV vaccine (Abrysvo) at 32–36 weeks, given seasonally, or an infant monoclonal antibody (nirsevimab or clesrovimab). Most infants need only one path.
Nirsevimab and clesrovimab are monoclonal antibodies (passive immunity given to the baby), not vaccines. The maternal RSV vaccine (Abrysvo), given at 32–36 weeks of pregnancy, is the true vaccine option, and it passes antibodies to the newborn.
Live vaccines (MMR, varicella) are held until 12–15 months because maternal antibodies would otherwise neutralize them, and the infant immune system is ready by then. A catch-up schedule exists for any child who falls behind.
Adolescent Schedule (11–18 Years)
Four big ones cluster around the 11–12 year visit.
- Tdap
- One dose at 11–12 yr (then a Td/Tdap booster every 10 years).
- HPV
- Start at 11–12 yr (can start at 9). 2 doses if the series is started before the 15th birthday; 3 doses if started at 15+ or immunocompromised.
- MenACWY
- 11–12 yr, with a booster at 16 yr.
- MenB
- 16–18 yr (shared clinical decision-making).
The HPV dose count depends on the age the series is started, not the child's current age: under 15 → 2 doses; 15 and older → 3 doses. Also catch up any missed childhood vaccines at these visits.
Adult Schedule
A handful of adult vaccines show up on the exit exam — know the ages.
- Td / Tdap
- Booster every 10 years (one Tdap as an adult; after 5 years for a severe/dirty wound). Give Tdap during every pregnancy at 27–36 weeks (earlier is better) to protect the newborn from pertussis.
- Influenza
- Every year, all adults.
- Pneumococcal (PCV)
- All adults 50+; also 19–49 if high-risk.
- RSV
- Routine at 75+; 50–74 if high-risk. One-time dose (not annual).
- Zoster (RZV / Shingrix)
- 2 doses at 50+; also for immunocompromised adults 19+. Recombinant — not live.
- COVID-19
- Per current CDC guidance (recommendation in flux — check CDC).
Pneumococcal now starts at 50 (lowered from 65), and adult RSV covers 50–74 at high risk as a one-time dose. These are the current CDC/ACIP recommendations — reconfirm at cdc.gov/vaccines, since adult vaccine policy has been shifting.
Live-Vaccine Rules
The safety rules that get tested most.
- Live vaccines: MMR, varicella, rotavirus, intranasal (LAIV) flu
- Contraindicated in pregnancy — and avoid pregnancy for 4 weeks after an MMR or varicella vaccine
- Contraindicated if severely immunocompromised (e.g., active chemotherapy, high-dose steroids, advanced HIV)
- Spacing: two live injectable or intranasal vaccines (MMR, varicella, LAIV) — same day or separate by at least 4 weeks. Oral rotavirus is exempt (any interval).
- Recent blood products or immune globulin can delay the response to MMR/varicella — check the CDC spacing intervals before giving
"Live vaccines and pregnancy don't mix." A pregnant client does not get MMR or varicella — those are given postpartum, and she avoids conceiving for 4 weeks afterward.
Contraindications vs NOT Contraindications
Students over-cancel vaccines. Know what actually stops a dose.
- TRUE contraindication
- Anaphylaxis to a previous dose or a vaccine component. (Plus: live vaccines in pregnancy or severe immunocompromise.)
- NOT a reason to skip
- Mild illness, low-grade fever, current antibiotics, breastfeeding, and prematurity (preemies are vaccinated at their usual chronological age).
- Defer (wait), don't cancel
- Moderate or severe acute illness — defer until the client is better, then give.
Family history is usually not a contraindication — but a family history of an inherited (congenital) immunodeficiency in a close relative means the child's own immune status must be verified before giving live MMR or varicella vaccines.
Routes & Injection Sites
Right route, right site — and it changes with age.
- IM site by age
- Under 12 months: vastus lateralis (anterolateral thigh). Ages 1–2: thigh preferred, deltoid if muscle mass is adequate. Age 3 and up: deltoid preferred.
- SubQ
- Fatty tissue of the upper outer arm — MMR, varicella.
- Oral
- Rotavirus.
- Intranasal
- LAIV (nasal-spray flu).
- Give different vaccines at different sites, each with its own syringe
- Never mix two vaccines in one syringe unless it is a licensed combination product
- Use the correct needle length for the client's age and muscle mass
Storage — The Cold Chain
A vaccine stored wrong is a vaccine that won't work.
- Most vaccines are refrigerated at 2–8°C (36–46°F)
- Some live vaccines are kept frozen — follow the package insert
- Protect light-sensitive vaccines; keep them in the original box
- Log temps; if a reading is out of range, label the vaccine "DO NOT USE," keep it stored and separated, and contact your immunization program or the manufacturer for a viability decision — don't discard or give it until they advise
- Reconstitute only when ready to give; note the expiration/beyond-use time
- Rotate stock — use the shortest-dated vials first
If the fridge loses power or a temperature log shows an out-of-range reading, the nurse does not give those vaccines — quarantine them and contact the manufacturer or health department for guidance.
Nursing Care & Patient Teaching
What you do before, during, and after every dose.
- Give the Vaccine Information Statement (VIS) before every dose; verify consent and allergy history
- Screen for contraindications and current pregnancy (for live vaccines)
- Document lot number, site, route, date, and both the VIS edition date and the date the VIS was given
- Teach expected effects: local soreness and low-grade fever usually within 1–2 days (cool compress, fluids). Live vaccines act later — after MMR, fever or a rash typically appears ~7–12 days out
- Tell parents to report high fever, seizure, or difficulty breathing
- A catch-up schedule exists for children who fall behind — they don't restart the series
- Have epinephrine available and observe for anaphylaxis after administration
? A mother says her 6-month-old has a runny nose and a temperature of 99.8°F (37.7°C) today. She asks if the baby should skip today's scheduled vaccines. What should the nurse do?
Frequently Asked Questions
Common student questions on this topic.
What is the difference between active and passive immunity?
Which vaccines are live and why does it matter?
What are true contraindications versus things that are NOT contraindications?
Which injection site is used at each age?
What should the nurse teach about normal vaccine side effects?
Do vaccine recommendations ever change?
Quick-Reference Cheatsheet
Every key point from this guide on a single printable page.
Immunization Schedule Cheatsheet
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