Resources and tips for finding immunizations for children:

Navigating vaccines can feel overwhelming. Talk to your pediatrician.

• Schedule an appointment through Cook Children's.
• Find your nearest Texas Department of State Health service clinic for information on clinics.
• Call 211 for help.
• Call Tarrant County Public Health at 817-248-6299 to make an appointment or to find a walk-in clinic.
• Check with your local school district for vaccine events.

Raising a child brings up endless questions, especially when it comes to their health and well-being. As back-to-school season approaches, immunizations may be top of mind for families, and searching for clear, honest answers about what goes into their child's body and why. With so much conflicting information online, sorting facts from fear can feel overwhelming. Cook Children’s Health Care System helps parents and caregivers cut through the noise with trusted guidance from medical experts who are parents themselves.

Among the recommended shots, the Human papillomavirus (HPV) vaccine often raises questions.

Hospitalist Laura Romano, D.O., explains the key facts about HPV and the vaccine that prevents it.

What is HPV?

HPV is a viral infection that causes flesh-colored warts on certain mucous membranes, most commonly affecting the mouth, throat and genitals.

HPV infections can lead to cervical cancer in women, as well as head-and-neck and anal cancers in both men and women

Most people with HPV have no symptoms and don't realize they carry the virus, yet they can still pass it to others.

How can the disease be prevented?

Vaccinating older children and teenagers can provide lifelong protection against HPV and helps prevent several types of cancer as well.

What would you like families to know about the virus or the vaccine?

Vaccinating boys and girls offers lifelong protection against a virus that can cause warts but also against deadly cancers. The vaccine protects your child now and helps safeguard their future partners down the road.

Last year, for the first time, the United Kingdom announced zero deaths from cervical cancer among women under age 30. Australia and New Zealand have seen similar results alongside increased vaccination rates.

Other countries have also reported declines in cervical cancer among women, as well as head and neck cancer among men.

RELATED STORIES:
Cook Children's Back to School Checklist
What Families Should Know About Hepatitis B
Back-to-School Breakdown: Preparing for Class with the MMR Vaccine

Resources and tips for finding immunizations for children:

Navigating vaccines can feel overwhelming. Talk to your pediatrician.

• Schedule an appointment through Cook Children's.
• Find your nearest Texas Department of State Health service clinic for information on clinics.
• Call 211 for help.
• Call Tarrant County Public Health at 817-248-6299 to make an appointment or to find a walk-in clinic.
• Check with your local school district for vaccine events.

Raising a child brings up endless questions, especially when it comes to their health and well-being. As back-to-school season approaches, immunizations may be top of mind for families, and searching for clear, honest answers about what goes into their child's body and why. With so much conflicting information online, sorting facts from fear can feel overwhelming. Cook Children’s Health Care System helps parents and caregivers cut through the noise with trusted guidance from medical experts who are parents themselves.

Among the required school shots, the Hepatitis B vaccine often raises the most questions, especially when it comes to why infants and young kids need protection so early.

Hospitalist Laura Romano, D.O., explains the key facts about hepatitis B and the vaccine that prevents it.

What is Hepatitis B?

Hepatitis B is a serious liver disease that is caused by the hepatitis B virus (HBV).

In adults, hepatitis B is usually spread through blood or intimate contact. In young children, however, the virus usually spreads through contact with infected bodily fluids. Transmission most commonly occurs during labor and delivery, but it can also happen through everyday activities, such as sharing a toothbrush or being bitten by a person who has the virus.

People infected with hepatitis B can spread the virus even if they show no symptoms. In fact, children often remain asymptomatic for years while still being contagious. This is especially concerning because infants and young children are more likely than adults to develop chronic, lifelong liver conditions, including permanent liver damage, cirrhosis (severe scarring), and liver cancer.

Treatment options for chronic hepatitis B are limited and focus primarily on halting the progression of liver damage rather than curing the virus itself. For severe cases where the liver has sustained significant damage, a liver transplant may ultimately be necessary.

How can the disease be prevented?

The most effective way to prevent hepatitis B is through vaccination. The vaccine is highly protective, offering about 95% effectiveness in preventing both acute and chronic infections. Since its routine inclusion in infant immunization schedules, rates of hepatitis B cases and associated liver cancer have steadily declined.

What would you like families to know about the hepatitis B vaccine and HBV?

• Hepatitis B is often misunderstood as a disease that only affects people engaging in high-risk or illegal behaviors. Anyone can contract the virus through everyday actions such as sharing a razor or toothbrush with someone who has the infection, even if that person shows no symptoms.
• Prenatal screening and maternal immunity testing alone are not enough to protect all children from hepatitis B. History has shown that targeting only 'high-risk' infants leaves gaps, leading to ongoing infections in both mothers and children that universal vaccination prevents.
• While some countries delay hepatitis B vaccination until children are older, their social and health care infrastructure differs significantly. Longer parental leave in those countries means children spend less time in daycare, where early exposure can occur. Also, universal health care access allows these countries to detect acute infections quickly and manage chronic cases more effectively.

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Wellness

• Schedule a Check-up: The American Academy of Pediatrics (AAP) recommends annual checkups from age 3 through adolescence. Schedule early to secure an appointment before the school year starts.
• Mental Health: Have open and honest conversations with children about their concerns. Speak with the pediatrician on tools to help with anxiety.
  • Parenting & Back-to-School: Emotional Safety Starts at Home
  • Raising Joy Podcast: Back to School Anxiety
• Oral health: Children should visit the dentist every six months. Make sure kids brush twice a day for two minutes and floss daily. Make an appointment.
• Update child vaccinations: Navigating vaccines can feel overwhelming. Talk to your pediatrician. The Texas Department of State Health Services requires certain immunizations before children can attend school.
  • To schedule an appointment, visit Cook Children's website or your county's health department website.
  • If a child is not of school age but attends daycare, other requirements may apply.

  • College students are required to receive the meningococcal vaccination.

    

• Sport physicals: The annual UIL pre-participation physical evaluation form applies to middle school and high school students. Sports physicals give doctors the opportunity to check for a variety of concerns, from vision issues and asthma to a lingering sprain or even a serious heart condition.

Healthy Routines

• Sleep: Sleep fuels a child's memory and concentration. Without consistent rest, children struggle to focus in class and retain what they learn, impacting their academic performance.
• Key elements for building a bedtime routine:
  • Establish a consistent schedule by going to bed at the same time each night.
  • Limit screen time at least one hour before bedtime.
  • Keep bedrooms quiet, cool and dark.
  • Create a calming routine, such as reading together.
• Transportation safety:
  • E-Bike and E-Scooter safety: Always wear a helmet.
  • Driving: Drive slowly through school zones and watch for pedestrians.
  • Car Safety: Ensure your child is in the correct car seat or booster for their age and size.
• Nutritious meals: Plan balanced breakfasts and lunches to keep energy levels stable throughout the day.
• Screen time: According to the American Academy of Child and Adolescent Psychiatry, children ages 8 to 18 in the United States spent an average of 7.5 hours a day using screens in 2025. Set clear daily limits for non-academic screen use.

Make a Plan

• Virtual care: If school district offers it, sign up for the Cook Children’s School-Based Virtual Health Program.
• Allergy action plan: Provide updated emergency allergy plans and medications to the school nurse.
• Medication management plan: Submit required doctor authorization forms for any daily or emergency medications needed during school hours.

Collin County Health Care Services has issued a health alert due to an increase in chickenpox (varicella) across the county. Chickenpox is an infection caused by varicella-zoster virus, leading to a fever and an itchy rash with spots all over the body.

Because it is highly contagious, chickenpox is a reportable condition in Texas and must be disclosed to the local health department. According to health officials, schools and childcare settings are high-risk environments for outbreaks. Prompt identification and exclusion of cases are critical to limiting transmission.

While chickenpox used to be a common illness in the United States, it has become much rarer due to the chickenpox vaccine which helps prevent the infection.

Cook Children’s Health Care System doctors know parents and caregivers may have questions about this, Laura Romano, D.O., a hospitalist at Cook Children’s and mom herself, addresses some concerns.

• I got chickenpox as a kid. Should I be concerned if my little one gets it?
  • One infection with chicken pox should give you lifelong immunity.
• How effective is the varicella vaccine?
  • Two doses give up to 98% protection and have decreased hospitalizations and death by over 97% since 1995!
• What if my little one only had one dose. What does that mean for them?
  • If your child has already had one dose of the chicken pox vaccine, they will most likely not need another one if they get an actual infection. Please talk with your pediatrician about this.
• What happens if someone is immunocompromised and is around someone who has varicella?
  • The most common complication is a skin infection caused by scratching at the lesions, which may require antibiotics to help treat. Other more serious complications include pneumonia, ataxia (difficulty walking), dehydration, or encephalitis (swelling of the brain). People who also have chicken pox are at risk for shingles later in life. Vaccination against chicken pox helps prevent against all these complications including the furture risk of shingles.
• What complications can arise from chickenpox?
  • The most common chickenpox complications are bacterial infections of the skin and soft tissues in children and pneumonia in adults.
• How do you treat chickenpox?
  • While there is not a single treatment for chicken pox, doctors focus on symptom relief. Doctors recommend Tylenol for fever, calamine lotion or oatmeal baths for itchiness. Lesions should go away in the 10-14 days. 

Symptoms of Chickenpox:

A mild fever may occur 1 to 2 days before rash onset, particularly in adults. In children, the rash is often the first sign of disease.

Seek immediate medical attention when your child:

• has trouble breathing
• has a severe headache
• is very drowsy or has trouble waking up
• has trouble looking at bright lights
• has trouble walking
• seems confused
• seems very ill
• has a stiff neck
• has a fever that lasts for more than 4 days
• has a bad cough
• has an area of rash that leaks pus (thick, yellowish fluid) or becomes red, warm, swollen, or sore
• is vomiting

The first outbreak-related cases were reported on May 13 in Collin and Rockwall counties. Alice Phillips, M.D., director of ambulatory quality and safety, advises parents to be aware but not alarmed.

“These cases remain small in our region. If your children are vaccinated, nothing about activities needs to change,” Dr. Phillips said.

Cook Children’s Health Care System continues to work with local public health departments on any report of measles cases. The Texas Department of State Health Services in April recommended that children between 6 months to 11 months traveling to or living in an area with an active measles outbreak receive a vaccination.

Dr. Phillips explained that the best way to protect a child from measles is the MMR vaccine. One dose offers 93% protection, and two doses provide 97% protection against the virus.

DSHS has designated these counties as outbreak areas: Cochran, Dawson, Gaines, Lamar, Lubbock, Terry, and Yoakum.

Currently, the Tarrant and Denton County health departments, where Cook Children’s Medical Center – Fort Worth and Prosper are located, have not issued this recommendation.

“If that changes due to a rise in cases, we will update,” said Dr. Phillips.

However, Dr. Phillips noted that families planning to travel outside of the United States, should be aware of regions where the MMR and/or Hepatitis A, vaccine is recommended for infants between 6 and 12 months.  She encourages parents to check with their pediatrician.

“If your kids are vaccinated, they are safe and protected,” said Dr. Phillips.

Marc Mazade, M.D., Cook Children’s medical director of Infection Prevention and Control, encourages anyone who has not received the vaccine to do so. Vaccinations not only protect you, but also help limit the spread to others.

As of March 14, the Texas Department of State Health Services reported 259 cases of measles in Texas.

“I'm worried. It's a real dangerous situation right now,” Dr. Mazade said.  “There are lots of people who are eligible to receive the vaccine and haven't. There are areas where vaccine uptake has been really poor and it is likely to rip through these communities like wildfire, like it did in West Texas.”

The best way to prevent getting and spreading the virus is to get the measles, mumps and rubella (MMR) vaccine. We talked with Dr. Mazade about what makes this vaccine effective, who can get it and why vaccination is important.

Measles is one of the most contagious diseases humans have faced. Descriptions of the disease date back to at least the 9th century, according to the World Health Organization (WHO), and became more widespread in the 16th century. Prior to the vaccine, the Centers for Disease Control and Prevention (CDC) estimates three to four million people became infected per year, and 400 to 500 died.

Before the measles vaccine, which became available in its current form in 1968, most everyone got measles, Dr. Mazade said. While measles can be mild, it is “pretty miserable.” The virus can cause a fever from 104 to 106 degrees, congestion, cough and a red rash that spreads across the body. Complications from the measles are not uncommon, including ear infections and pneumonia. As of March 14, one child has died from the current measles outbreak.

“People don’t understand how dangerous it is and how dangerous vaccine preventable diseases are,” Dr. Mazade said. “It can be really serious for people who are pregnant, people with immunodeficiencies and people who are on immunosuppressants that would make them more susceptible.”

Herd Immunity

The current measles outbreak shows just how contagious it is.

In general, measles has not been transmitted within the U.S. for years due to herd immunity.

Herd immunity is the idea that when enough people are vaccinated against a disease, it is much harder for the disease to spread. Herd immunity for measles is reached when 90% of a population is vaccinated, Dr. Mazade said.

Imagine a group of 100 people spread out across a room. Ninety of them have been vaccinated and cannot get or give anyone else measles. One person in the room brings in the virus.

Perhaps the people nearby are all vaccinated; the virus will likely not spread or will only spread to a few people.  But if only half of the people are vaccinated, the infected person is likely standing near at least one other unvaccinated person. The disease can spread through the community, and can do so at an increasing rate.

With measles, face-to-face contact is not required to contract the disease, Dr. Mazade said. The infectious aerosol that is created when someone with measles coughs or sneezes fills the entire air space and even lingers in the air for up to two hours after a person with measles leaves the area. To go off of the room metaphor, measles can spread throughout a space quickly and endanger more people.

For years, the U.S. was like the first room. Sometimes, an unvaccinated person would travel abroad and bring back measles, but it was not able to spread due to herd immunity. In 2000, the U.S. documented zero cases of measles, and the virus was declared eliminated from the United States.

About 92 to 94% of a population needs to be vaccinated in order to achieve herd immunity for measles, according to the American Academy of Pediatrics. The current outbreak is due to that vaccination percentage dropping, Dr. Mazade said. Over the past few years, fewer and fewer people received the MMR vaccine.

Misinformation about vaccines has contributed to that decrease. Mazade encouraged people to seek direct sources for accurate vaccine information. The CDC, WHO and Cook Children’s vaccine resource page are good places to find accurate information.

Asking your doctor directly may be the best way to get information on your vaccine questions.

 “Trust your doctor,” Dr. Mazade said. “He or she is the best source of information about vaccines and vaccine safety.”

Getting Vaccinated

Fortunately, future measles outbreaks are preventable.

The MMR vaccine is safe and available for unvaccinated adults to receive -- and it is extremely effective. The first dose grants about 93% immunity and the second, and final, dose grants 97% immunity. This means that 97 out of 100 vaccinated people exposed to measles will not become sick.

The measles vaccine can be administered to children who are 12 months old and is part of the recommended vaccine schedule that the CDC recommends. If you did not get the vaccine as a child -- or are not sure if you did -- talk to your doctor.

Some people may want their children to get the vaccine early due to the outbreak. As of now, this is not recommended by our local health department. Babies who are younger than six months will likely not respond to the vaccine and not achieve immunity, Dr. Mazade said. Even if the baby has been exposed to measles, the vaccine is not recommended at this age. Dr. Mazade recommends talking to your doctor if you have concerns about measles exposure.

Even if this outbreak slows down, it is still important to get vaccinated.

“If people who are fully eligible are not fully vaccinated, we will be in the spot time and time again,” Dr. Mazade said. “Until we have a huge outbreak with lots of sick people."

Vaccinations and immunizations

Here are a few resources and tips for finding a place to take your child for immunizations. 

• Check with your child’s doctor. Ask which vaccines are due and make an appointment. If your child needs a doctor, see our locations or call 211 for help. 
• Visit a public health vaccine clinic. Anyone from any county can call Tarrant County Public Health at 817-248-6299 to make an appointment or to find a walk-in clinic. 
• Check with your local school district for vaccine events. 
• Enter your zip code at Vaccines.gov to find other options.