Rebecca Rundle, an LPN at the Southern Nevada Health District, gives a vaccination to 12-year-old Mamie Tarlue. Photo by Gary Thompson.

Your own childhood vaccinations are a distant -- very distant -- memory, and your kids have just received the last of their required childhood shots, too.

That means vaccinations now are officially in your past, right?

Wrong. And not just for your kids, but for you, too.

Fact is, vaccinations are a lifetime affair that begins with the standard menu of immunizations of childhood and continues through the flu vaccinations, tetanus boosters and pneumococcal shots of adulthood.

Don't feel embarrassed, though. For most adults, vaccinations do tend to be hit-or-miss kinds of things: Get a flu shot every fall and, maybe, a tetanus booster in the emergency room whenever you're unlucky enough to step on a rusty nail.

But how about that HPV vaccination for your teenager? The rubella vaccination for your hopefully someday-pregnant wife? That meningitis vaccination for your college-bound kid?

When it comes to such lower profile vaccinations, "I'm sure most people aren't as up-to-date as they ought to be," said Dr. Jason Pollock, a Las Vegas obstetrician/gynecologist.

That's true even with kids, that needle-stuck demographic that endures most of the preventive vaccinations in the U.S.

"Most people, even parents with kids, all they know when they come in is they get shots, but they have no idea when they need them and what they need and how often they should be getting them," said Dr. Constantine George, a Las Vegas internal medicine and pediatric physician.

Often, it takes an outbreak of something -- measles, chickenpox, whooping cough -- to remind parents of just how important vaccinations are.

"When you have an outbreak -- like in the Midwest, with pertussis (whooping cough) -- then it comes more in the spotlight," George said. "Then they start asking, 'Did I have that? Should my kid have that?' "

To make all of this even more confusing, vaccination recommendations -- the guidelines about what vaccines should be given, how often they should be given and who should be getting them -- are apt to change a bit every year.

For 2007, for example, the U.S. Centers for Disease Control and Prevention has added to its childhood vaccination calendar oral rotavirus vaccines to be administered to kids at 2, 4 and 6 months of age.

Rotavirus is "the No. 1 cause of childhood diarrhea," said Dr. Echezona Ezeanolue, an assistant professor of pediatrics and epidemiology with the University of Nevada School of Medicine. It's a condition that'll certainly send a child home from school and, if it's severe enough, can even land a child in the hospital.

Changes also are made to vaccination schedules to make vaccines that already are given more effective. For example, this year's recommendations include giving children a second dose of Varicella vaccine for chickenpox -- the first dose is given when a child is between 12 and 15 months old -- when the child is 4 to 6 years of age. The reason: Cases of chicken pox have been seen in children who previously had received only one dose of the vaccine.

That change hits particularly close to home, Ezeanolue noted: About 30 cases of chicken pox have been recorded in Las Vegas over the past month or so.

Also new for 2007 is the recommendation that all children ages 6 to 59 months of age receive annual influenza vaccinations, because the flu virus can case severe illness and even death in that age group.

"In 2004, there was one child who died from flu here in Las Vegas," Ezeanolue noted.

The annual schedule of recommended vaccinations also is tweaked when an entirely new vaccine becomes available. That's the case this year for human papillomavirus (HPV) vaccine, now recommended to be given in a three-dose series for girls ages 11 to 12, and as catch-up immunizations for girls and women 13 to 26.

HPV is the leading cause of cervical cancer in women. Pollock said the HPV vaccine protects against specific strains of HPV that account for most cases of genital warts, as well as specific strains of HPV that cause cervical cancers.

Thanks in part to a marketing campaign by the manufacturer of the vaccine, Pollock said awareness of the new HPV vaccine among his patients has been "phenomenal."

"Last year nobody was talking about it," he said. "This year, sometimes patients are beating me to the conversation."

Pollock added that women who've already had an abnormal Pap smear or genital warts still can receive the HPV vaccine.

However, the vaccine has become a controversial one. Because HPV is transmitted through sexual contact, opponents have argued that administering the HPV vaccine to pre-teen girls -- it's meant to be administered before sexual activity begins -- could encourage sexual activity among girls.

"I think that's an interesting philosophical or religious discussion, however you want to phrase it," Pollock said. "But in a real-world sense, this is the deal: About 50 percent of people will come into contact with the virus as far as we know, and it may be higher than that ... and it's just a matter of whether you're willing to take that chance."

Even as vaccination schedules are revised regularly, there remains the menu of tried-and-true vaccinations that continue to be recommended for children, teenagers, young adults, adults and the elderly. Among them are vaccines for: Hepatitis A and B; diphtheria, tetanus and pertussis; pneumococcal disease; polio; influenza; measles, mumps and rubella; and meningococcal disease.

Some are given across-the-board, a few require boosters throughout adulthood, and some are particularly important for specific groups of people.

For example, rubella vaccinations are particularly timportant for women, Pollock said. "This virus is exceedingly rare -- maybe two dozen cases or less each year -- but if you contract it during pregnancy it can have particularly devastating effects on fetal development."

Martha Cates, senior public health nurse with the Southern Nevada Health District's immunization project, said a vaccine for shingles also is now available for persons ages 60 and over.

Shingles is a painful condition to begin with, she noted, but "if you have an immune system that's compromised, it can be pretty major."

The district has had the vaccine on-hand for several months, Cates said. "Before we even received it, I think we had close to 40 or 50 people calling, wanting the vaccine."

One practical barrier to vaccinations of any sort is the cost, which health insurers may or may not cover or may not cover fully. Cates said the health district's "Vaccine for Children" program offers vaccinations for children at reduced cost if a family does not have insurance or if their insurance doesn't cover the vaccination.

Vaccinations typically range in cost from $25 to $140, Cates said. But, under the program, parents pay only an administrative fee of $16 for one child or $20 for two or more children

Most of the children who come in to the district's shot clinics in Las Vegas, North Las Vegas, eastern Las Vegas and Henderson qualify for the program, Cates said. "But one thing about the health district: We will never turn a child away for not having the ability to pay for their vaccination or for the administrative charge."