Questions and answers on childhood vaccination
All EU/EEA countries have a vaccination schedule. This recommends which vaccines should be given at various ages during childhood. However, too many children in Europe go unvaccinated and remain vulnerable to potentially life-threatening diseases.
Below are some commonly asked questions with suggested answers that can be used to assist with conversations with patients, parents or caregivers, or made into information sheets to be shared with them ahead of their visit.
General
As some children could receive as many as 14 injections by the time they are two years old, many parents wonder whether it is safe to give children so many vaccines.
How do vaccines work?
Most vaccines contain either a very weakened or inactive form of the whole germ that causes a disease, or a small part of the pathogen (this is called an antigen). Some newer vaccines deliver instructions for the body to produce an antigen (DNA or RNA).
When a person gets vaccinated, their immune system recognises the antigen as foreign. This activates immune cells to produce antibodies and create a memory of the virus or bacterium.
Later, if the person comes into contact with the actual virus or bacterium, their immune system will remember it and then produce the right antibodies and activate the right immune cells quickly to kill the virus or bacterium. This protects the person from the disease.
Vaccination is a tool to protect the vaccinated person, to prevents disease and serious illness. In addition, it also protects against spreading those diseases to others in close contact who may have lower immunity, for example older people, those with chronic diseases, or young infants, or those very few people who may have contraindications for vaccination. This way, vaccination of most people in a community provides indirect protection to the most vulnerable members of that community. This is sometimes referred to as ‘community immunity’ or ‘herd immunity’.
Do children receive too many vaccines too soon?
No. Newborns successfully manage many challenges to their immune systems at the same time. The mother’s womb is free from bacteria and viruses, so newborns immediately face a host of different challenges to their immune systems.
Vaccines act like ‘natural exposures’, presenting the most important parts of pathogens to the body, to imitate the appearance of the real-life threat and ensure that the defence starts to develop in the infant. Vaccines do this in a controlled way, without risk of disease.
Vaccination recommendations take into account the optimal age to receive vaccines. Factors considered for this include the age when the disease is most dangerous for children, and when their immune system is best able to respond properly to the vaccine and develop protection against the disease.
Why are childhood vaccination schedules different between countries?
In the EU/EEA, each country is responsible for its own national public health policy. This includes the national immunisation programme and vaccination schedule. The national schedules in EU/EEA countries outline the recommended vaccines at specific ages and for specific populations. They also provide recommendations for people with chronic diseases. In some countries, such recommendations are done at state or even regional level.
Decisions on the vaccination schedule take into account factors such as how common the disease that is prevented by a specific vaccine is, the characteristics of the healthcare system, and resources. This leads to some variations across the countries.
Other variations in national vaccination schedules can include:
- the age of those getting vaccinated;
- the population groups getting vaccinated;
- the number and timing of doses; and
- whether vaccines are given alone or in combination with others.
However, despite differences, vaccination ensures the same level of protection in each EU/EEA country.
Should my child get vaccinated ?
What if my child is ill?
There are very few medical reasons to delay immunisation. Babies and children with minor coughs and colds, or those on antibiotics, can be vaccinated safely and effectively. However, if your child has a high temperature indicating active infection, vaccination should be put off until your child is better. If you are worried about whether your child is fit to be vaccinated, talk it over with the doctor or nurse before putting off the vaccination.
What if my child was premature, had a low birth weight or had jaundice?
In general, premature babies should be vaccinated as normal. It is important that premature babies are protected because they are more vulnerable to certain infections. If your child had a very low birth weight, you should discuss their immunisation needs with your paediatrician. Babies who had jaundice after being born and those who are being breast fed should be vaccinated as normal.
What if my child has a serious disease?
It is very important that children with serious diseases are vaccinated, because they are often more at risk from complications of infections. Children with stable neurological conditions such as cerebral palsy or Down syndrome should be vaccinated as usual.
However, care is needed if either the child’s illness or the treatment of their illness might lower their immunity. Vaccination should be carefully considered for children with cancer or an immune-deficiency disorder, or who are taking medicines that might reduce their ability to fight infection. Discuss this with your doctor.
Children who have had a blood transfusion or received blood products should delay their combination measles-mumps-rubella (MMR) vaccination.
Can my child get the MMR vaccine and other vaccines if they have allergies?
Vaccination is considered safe for almost everyone. Contraindications or the need to delay vaccination are exceptional, and usually limited to cases such as confirmed hypersensitivity to one of the vaccine components. In these cases, or where there is doubt, advice should be sought from the doctor or nurse responsible for the vaccination rather than not vaccinating at first glance.
In very specific circumstances, and where the contraindication for receiving a vaccine is indicated by a health professional and based on an individual risk benefit assessment, vaccination should not be administered. Nevertheless, this recommendation should only apply to the specific vaccine or vaccines of concern and not to all life course vaccines.
Sometimes, parents may consider an egg allergy as a contraindication to receive vaccination, such as with the MMR and flu vaccines.
The MMR vaccine can be given to children with an egg allergy. Only children that develop allergic shock when in contact with eggs should avoid the MMR vaccination. Your child simply disliking eggs or having diarrhoea or stomach pains after eating eggs is not a reason to avoid it, and you do not need to take any special precautions.
The flu vaccines manufactured using an egg-based process should not be given to those who have a severe allergy to eggs. Please consult the vaccine’s ‘Summary of Product Characteristics’ and talk with your physician in case of doubt.
What if my child has epilepsy or has had convulsions (fits)?
These children should be vaccinated if their condition is stable. Some children get fits if they have a high temperature or a fever. If they get a high fever (over 39.5°C) after they have been vaccinated, consult with your doctor for advice on appropriate medication. You may have also received information about what to do in such cases during the vaccination appointment. Children with a family history of fits or epilepsy should be vaccinated as normal.
What if my child has recently had, or is due to have, surgery?
Do not delay vaccination if your child is due to have an operation or has recently had one. Having surgery is not a reason to put off vaccination, and a recent vaccination is not a reason to put off surgery.
What if my child has already had one of the vaccine-preventable diseases?
You should still vaccinate your child against these diseases, even if they have had them. It is important to be protected against all the diseases the vaccine covers, even if the child has caught one of the diseases before. This is very important as children under two years old do not get enough natural immunity following illnesses such as haemophilus influenzae, meningococcal or pneumococcal disease.
Can my child be vaccinated while they are in close contact with someone who is pregnant?
Yes. There is no problem with giving routine vaccinations to a child who is in close contact with someone who is pregnant. In fact, vaccinating the child will protect the pregnant person from being exposed to diseases like rubella.
Do some children also need other vaccines outside of the routine vaccination schedule?
Yes. Children who have had their spleens removed or have cystic fibrosis, an immune deficiency, chronic heart, lung, liver or kidney disease, sickle cell disease or diseases such as diabetes are more vulnerable to some infections and to experience complications. If your child has any long-term illness, ask your doctor about any other vaccines that may be specifically recommended for them.
If you are travelling to another country, remember to find out if your child needs any vaccines which are specifically recommended for travellers.
Delaying vaccination
Is it okay to delay vaccination?
No evidence to date suggests any benefits to delaying vaccines. A study in 2010 showed that children who received delayed vaccinations performed no better on behavioural and cognitive assessments between the ages of seven to 10 years than children who received their vaccines on time. Delaying vaccines will increase the period of time during which children are at risk for vaccine-preventable diseases. Following the recommended vaccination schedule is important, because it ensures that the children get the protection when they most need it.
Several vaccine-preventable diseases, like chickenpox, pertussis (whooping cough) and pneumococcus (which causes bloodstream infections, pneumonia and meningitis) are very common and can severely affect very young children. Although the vaccine schedule can look intimidating, it is based on the best scientific information available.
Vaccination recommendations take into account the optimal age to receive vaccines. Factors considered for this include the age when the disease is most dangerous for children, and when their immune system is best able to respond properly to the vaccine and develop protection against the disease.
Children could catch up with the schedule if they missed some vaccines, but there’s no reason to delay vaccines unless the child has a medical contraindication.
Is it okay to take the vaccines that come as combination vaccines separately instead?
When a combined vaccination is possible (e.g. for diphtheria, pertussis and tetanus), this means fewer injections and reduced discomfort for the child. It also means that there are no delays in vaccination and thus better protection against potentially deadly diseases.
More visits for individual injections will mean more stressful situations for the child, more potential administration errors, more time and travel needed for appointments, and potentially increased costs.
Autism
Some parents of children with autism spectrum disorder are concerned that vaccines are the cause. Their concerns centre mainly on the MMR vaccine and thiomersal, a mercury-containing preservative previously contained in several vaccines.
Does the MMR vaccine cause autism?
No. In 1998, a British researcher named Andrew Wakefield raised the notion that the MMR vaccine might cause autism. In the medical journal The Lancet, he reported the stories of eight children who developed autism and intestinal problems soon after receiving the MMR vaccine. This study was widely discredited and the journal retracted it. To determine whether Wakefield’s suspicion was correct, researchers performed a series of studies comparing hundreds of thousands of children who had received the MMR vaccine with hundreds of thousands who had never received the vaccine. They found that the risk of autism was the same in both groups. The MMR vaccine didn’t cause autism.
Many children have their first symptoms of the autism spectrum disorder identified by their caregivers in the second year of life, which often coincides with when the first dose of the MMR vaccine is recommended. As almost all children get that vaccine, some can express their first symptoms at a similar time, and this can lead to a false sense of causality.
Examples of recent research on this topic include a study of more than 650 000 children (a nationwide cohort study done in Denmark), published in 2019, which found no increased risk of developing autism in children who received the MMR vaccine when compared with children who were not vaccinated against MMR, including those with a family history of autism or other risk factors. Further, a large review of studies published in 2021 looked at safety, effectiveness and any unwanted effects from MMR vaccination. It included 13 studies covering around two million children, specifically looking at risk of autism, and these studies did not find any association between MMR vaccination and autism spectrum disorders.
Does thiomersal cause autism?
No. Multiple studies have shown that thiomersal in vaccines does not cause autism. Thiomersal is a mercury-containing preservative that was commonly used in vaccines to prevent contamination when using multi-dose vials. It is currently only still used in a small number of flu vaccines – those that come in multi-dose vials and in a few locally produced vaccines in some EU countries.
In 1999, professional groups called for thiomersal to be removed from vaccines as a precaution. Unfortunately, the precipitous removal of thiomersal from all but some multi-dose preparations of influenza vaccine scared some parents. Clinicians were also confused by the recommendation. Since the removal of thiomersal, studies have been performed to determine whether thiomersal causes autism. Hundreds of thousands of children who received thiomersal-containing vaccines were compared to hundreds of thousands of children who received the same vaccines free of thiomersal. The results were clear: the studies found that the vaccines did not increase the risk of autism.
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This content is based on the ECDC guide ‘Let’s talk about protection: enhancing childhood vaccination uptake’, published in 2016 and the related references in the guide. The information has been updated where appropriate as of 25 November 2025.