What vaccines are recommended for a 4-year-old child, including Diphtheria, Tetanus, and Pertussis (DTaP) and Measles, Mumps, and Rubella (MMR) vaccines?

Recommended Vaccines for a 4-Year-Old Child

A 4-year-old child should receive the DTaP (5th dose), IPV (4th dose), MMR (2nd dose), and Varicella (2nd dose) vaccines as part of their routine pre-school immunization schedule. 1

Core Vaccines Required at Age 4

DTaP (Diphtheria, Tetanus, and acellular Pertussis)

• The 5th dose of DTaP is administered at age 4-6 years as a booster
• This is the final dose in the childhood DTaP series 1
• Can be given as a combination vaccine (DTaP-IPV) to reduce the number of injections 1

IPV (Inactivated Poliovirus Vaccine)

• The 4th dose of IPV is given at age 4-6 years
• This completes the polio vaccination series for children 1

MMR (Measles, Mumps, and Rubella)

• The 2nd dose of MMR is recommended at age 4-6 years
• This dose may be administered during any visit, provided at least 4 weeks have elapsed since the first dose 1

Varicella (Chickenpox)

• The 2nd dose of varicella vaccine is recommended at age 4-6 years
• Can be administered at the same visit as other vaccines 1

Combination Vaccine Options

To reduce the number of injections, combination vaccines may be used:

• DTaP-IPV (Kinrix): Combines the 5th dose of DTaP and 4th dose of IPV in a single injection 1
  • Licensed specifically for children aged 4-6 years
  • Can be co-administered with MMR and varicella vaccines 2, 3

Special Considerations

Timing and Administration

• All these vaccines can be administered at the same visit at separate injection sites 1, 2
• Studies show that co-administration of DTaP-IPV with MMR and varicella vaccines is safe and does not reduce immunogenicity 2, 3

Safety Profile

• The most common side effects of the DTaP-IPV vaccine are local pain at the injection site and fever 2, 3
• Large injection site reactions (≥50mm redness/swelling) occur in approximately 17% of children receiving DTaP-IPV 4

Catch-up Considerations

• If a child has missed previous doses, catch-up vaccination should follow minimum interval requirements 1
• The 4-year visit provides an important opportunity to ensure the child is up-to-date on all recommended vaccines

Common Pitfalls to Avoid

1. Delaying vaccination: The 4-year visit is critical for completing pre-school immunizations before school entry
2. Missing combination opportunities: Using combination vaccines like DTaP-IPV reduces the number of injections and may improve compliance
3. Brand inconsistency: When possible, use the same manufacturer's DTaP product for the entire series, though vaccination should not be deferred if the previous brand is unknown 1
4. Overlooking co-administration: All vaccines recommended at this age can be given during the same visit, which improves vaccination rates

The 4-year-old visit represents an important immunization milestone that provides protection against serious childhood diseases before school entry and helps maintain population immunity to prevent disease outbreaks.