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Childhood Vaccination Schedule

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by Michael J. Smith, MD, MSCE

Vaccination follows a schedule recommended by the Centers for Disease Control and Prevention, the American Academy of Pediatrics, and the American Academy of Family Physicians ( Recommended Immunization Schedule for Ages 0–6 yr, see Table: Recommended Immunization Schedule for Ages 7–18 yr, and see Table: Catch-up Immunization Schedule for Ages 4 mo–18 yr). The latest recommendations can be obtained at www.cdc.gov/vaccines and are available as a free mobile app ; vaccination status should be reassessed at every visit. For adverse effects and details of administration of specific vaccines, see Immunization (see Immunization).

Recommended Immunization Schedule for Ages 0–6 yr

Age

Vaccine

Birth

1 mo

2 mo

4 mo

6 mo

9 mo

12 mo

15 mo

18 mo

19–23 mo

2–3 yr

4–6 yr

Hepatitis B (HepB) a

1st dose

2nd dose

*

3rd dose

*

Rotavirus (RV) b

1st dose

2nd dose

See footnote b

Diphtheria, tetanus, pertussis (DTaP) c

1st dose

2nd dose

3rd dose

*

4th dose

*

5th dose

Haemophilus influenzae type b (Hib) d

1st dose

2nd dose

See footnote d

*

3rd or 4th dose d

*

Pneumococcal conjugate vaccine (PCV13) e

1st dose

2nd dose

3rd dose

*

4th dose

*

Pneumococcal polysaccharide vaccine (PPSV23) e

Inactivated polio virus (IPV) f

1st dose

2nd dose

3rd dose

*

4th dose

Influenza (inactivated influenza vaccine [IIV] or live-attenuated influenza vaccine [LAIV] g

Yearly (IIV)

Yearly (IIV or LAIV)

Measles, mumps, rubella (MMR) h

1st dose

*

2nd dose

Varicella (VAR) i

1st dose

*

2nd dose

Hepatitis A (HepA) j

2-dose series j

Meningococcal conjugate vaccines (Hib-Men-CY, MenACWY-D, and MenACWY-CRM) k

See footnote k

?= Range of recommended ages for all children except certain high-risk groups.

* = Range of recommended ages for catch-up immunization.

= Range of recommended ages for certain high-risk groups.

= Range of recommended ages for catch-up and for certain high-risk groups.

This schedule includes recommendations in effect as of January 1, 2014. Any dose not administered at the recommended age should be administered at a subsequent visit, when indicated and feasible. The use of a combination vaccine is generally preferred over separate injections of its equivalent component vaccines. Considerations should include provider assessment, patient preference, and the potential for adverse events. Providers should consult the relevant ACIP statement for detailed recommendations at http://www.cdc.gov/vaccines/hcp/acip-recs/index.html . Clinically significant adverse events that follow immunization should be reported to the Vaccine Adverse Event Reporting System (VAERS) at http://www.vaers.hhs.gov or by telephone, 800-822-7967 . Suspected cases of vaccine-preventable diseases should be reported to the state or local health department. If children fall behind or start late, a catch-up schedule should be followed.

a Hepatitis B (HepB) vaccine. Minimum age is at birth.

At birth:

  • Administer monovalent HepB to all newborns before hospital discharge.

  • If the mother is hepatitis B surface antigen (HBsAg)–positive, administer HepB and 0.5 mL of hepatitis B immune globulin (HBIG) within 12 h of birth. These infants should be tested for HBsAg and antibody to HBsAg (anti-HBs) 1–2 mo after completion of the HepB series, at age 9–18 mo (preferably at the next well-child visit).

  • If the mother’s HBsAg status is unknown, administer HepB vaccine to all infants within 12 h of birth, regardless of birth weight. If infants weigh < 2000 g, administer HBIG in addition to HepB vaccine within 12 h of birth. Determine the mother’s HBsAg status as soon as possible, and if she is HBsAg-positive, administer HBIG to infants weighing ≥ 2000 g (no later than age 7 days).

After the birth dose:

  • The 2nd dose should be administered at age 1–2 mo. Monovalent HepB vaccine should be used for doses administered before age 6 wk.

  • Administration of a total of 4 doses of HepB vaccine is permissible when a combination vaccine containing HepB is administered after the birth dose.

  • Infants who did not receive a birth dose should receive 3 doses of a HepB-containing vaccine on a schedule of 0 mo, 1–2 mo, and 6 mo starting as soon as feasible (see Table: Catch-up Immunization Schedule for Ages 4 mo–18 yr).

  • The minimum interval between dose 1 and dose 2 is 4 wk, and between dose 2 and 3, it is 8 wk. The final (3rd or 4th) dose in the HepB vaccine series should be administered no earlier than age 24 wk and at least 16 wk after the first dose.

b Rotavirus (RV) vaccines. Minimum age is 6 wk for RV-1 (Rotarix®) and RV-5 (RotaTeq®).

  • If RV-1 (Rotarix®) is used, administer 2 doses: at ages 2 mo and 4 mo.

  • If RV-5 (RotaTeq®) is used, administer 3 doses: at ages 2 mo, 4 mo, and 6 mo.

  • If any dose in a series was RV-5 (RotaTeq®) or is unknown, 3 doses should be administered.

  • The maximum age is 14 wk, 6 days for the first dose in the series and is 8 mo, 0 days for the final dose in the series. Vaccination should not be initiated for infants aged 15 wk, 0 days or older.

  • If RV-1 (Rotarix®) is administered for the first and 2nd doses, a 3rd dose is not indicated.

c Diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine. Minimum age is 6 wk, except for DTaP-IPV (Kinrix®), which has a minimum age of 4 yr.

  • The 4th dose may be administered as early as age 12 mo, provided at least 6 mo have elapsed since the 3rd dose.

  • A 5th dose of DTaP vaccine is not needed if the 4th dose was administered at age ≥ 4 yr.

d Haemophilus influenzae type b (Hib) conjugate vaccine. Minimum age is 6 wk for PRP-T (ActHIB®, DTaP-IPV/Hib [Pentacel®], and Hib-MenCY [MenHibrix®]) and PRP-OMP (PedvaxHIB® or COMVAX®) and 12 mo for PRP-T (Hiberix®).

  • Administer a 2- or 3-dose Hib vaccine primary series with a booster dose (dose 3 or 4 depending on the vaccine used in the primary series) at age 12–15 mo to complete the full Hib series. The primary series consists of 3 doses given at ages 2, 4, and 6 mo for PRP-T and consists of 2 doses given at ages 2 and 4 mo for PRP-OMP.
  • If PRP-OMP (PedvaxHIB® or ComVax® [HepB-Hib]) is administered at ages 2 and 4 mo, a dose at age 6 mo is not indicated.

  • One booster dose (dose 3 or 4 depending on the vaccine used in the primary series) should be given at age 12–15 mo. An exception is Hiberix®, which should only be used for the booster (final) dose in children aged 12 mo–4 yr who have received at least 1 dose of Hib.

  • Hib vaccine is not routinely given to patients > 5 yr. However, 1 dose should be administered to unvaccinated or partially vaccinated patients aged ≥ 5 yr if they have certain immunocompromising conditions.

  • Administer only 1 dose to unvaccinated children aged ≥ 15 mo.

e Pneumococcal vaccines. Minimum age is 6 wk for 13-valent pneumococcal conjugate vaccine (PCV13) and 2 yr for 23-valent pneumococcal polysaccharide vaccine (PPSV23).

  • Administer 1 dose of PCV13 to all healthy children aged 24–59 mo who are not completely vaccinated for their age.

  • For all children aged 14–59 mo who have received an age-appropriate series of 7-valent PCV (PCV7), administer a single supplemental dose of PCV13.

  • For children aged 2–5 yr with certain medical conditions, administer 1 dose of PCV13 if they have received 3 doses of PCV (PCV7 and/or PCV13) previously, or administer 2 doses ≥ 8 wk apart if they have received < 3 doses of PCV (PCV7 and/or PCV13). Administer 1 supplemental dose of PCV13 to children who have received 4 doses of PCV7 or completed another age-appropriate PCV7 series.

  • If children aged 6–18 yr with certain medical conditions (including a cochlear implant) have not received PCV13 nor PPSV23, administer 1 dose of PCV13, followed by 1 dose of PPSV23 at least 8 wk later (see MMWR 59 [RR-11]:1–19, 2010, available at http://www.cdc.gov/mmwr/pdf/rr/rr5911.pdf ).

  • Administer PPSV23 at least 8 wk after the last dose of PCV13 to children aged 2 yr with certain medical conditions, including a cochlear implant. A single revaccination with PPSV23 should be administered 5 yr after the first dose to children with anatomic or functional asplenia or an immunocompromising condition.

f Inactivated poliovirus vaccine (IPV). Minimum age is 6 wk.

  • During the first 6 mo of life, minimum age and intervals are recommended only if the infant is at risk of imminent exposure to circulating poliovirus (eg, traveling to a polio-endemic region, during an outbreak).

  • If ≥ 4 doses are administered before age 4 yr, an additional dose should be administered at age 4–6 yr and at least 6 mo after the previous dose.

  • The final dose in the series should be administered on or after the 4th birthday and at least 6 mo after the previous dose.

  • A 4th dose is not necessary if the 3rd dose was administered at age ≥ 4 yr and at least 6 mo after the previous dose.

  • If both oral polio vaccine (OPV) and IPV were administered as part of a series, a total of 4 doses should be administered regardless of the child's current age.

g Influenza vaccine (seasonal). Minimum age is 6 mo for inactivated influenza vaccine (IIV) and 2 yr for live-attenuated influenza vaccine (LAIV).

  • For most healthy children aged ≥ 2 yr, either LAIV or IIV may be used. However, LAIV should not be administered to some children, including children with asthma, children aged 2–4 yr who have had wheezing in the past 12 mo, and children who have any other medical conditions that predispose them to influenza complications. For all other contraindications to use of LAIV, see MMWR 62 (RR-7)1–43, 2013, available at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6207a1.htm .

  • For children aged 6 mo–8 yr:

    For the 2013–14 season, administer 2 doses (separated by at least 4 wk) to children who are receiving the influenza vaccine for the first time. Some children who have been previously vaccinated also need 2 doses. For additional guidance, see the dosing guidelines in the 2013–14 ACIP recommendations for influenza vaccine in MMWR 62 (RR-7):1–43, 2013, available at http://www.cdc.gov/mmwr/pdf/rr/rr6207.pdf .

    For the 2014–15 season, follow the dosing guidelines in the 2014 ACIP recommendations for influenza vaccine (available at http://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/flu.html ).

h Measles, mumps, and rubella (MMR) vaccine. Minimum age is 12 mo.

  • The 2nd dose may be administered before age 4, provided at least 4 wk have elapsed since the first dose.

  • Administer 1 dose of MMR vaccine to infants aged 6–11 mo who are traveling internationally. These children should be revaccinated with 2 doses of MMR vaccine: the first dose at age 12–15 mo (at age 12 mo if the child remains in a high-risk area) and the 2nd dose at least 4 wk after the previous dose.

  • Administer 2 doses of MMR vaccine to children aged ≥ 12 mo who are traveling internationally; the first dose is given at or after age 12 mo, and the 2nd dose is given at least 4 wk after the previous dose.

i Varicella (VAR) vaccine. Minimum age is 12 mo.

  • The 2nd dose may be administered before age 4, provided at least 3 mo have elapsed since the first dose. If the 2nd dose was administered at least 4 wk after the first dose, it can be accepted as valid.

j Hepatitis A (HepA) vaccine. Minimum age is 12 mo.

  • Administer the 2nd (final) dose 6–18 mo after the first.

  • If children have received 1 dose of HepA before age 24 mo, administer a 2nd dose 6–18 mo after the first.

  • Unvaccinated children who are at high risk or who live in areas where vaccination programs target older children should be vaccinated. See MMWR 55 [RR-7], 2006 (available at www.cdc.gov/mmwr/pdf/rr/rr5507.pdf ) and additional information available at http://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/hepa.html .

  • A 2-dose HepA vaccine series is recommended for any people aged ≥ 2 yr if they have not been previously vaccinated and if immunity against hepatitis A is desired for them.

k Meningococcal conjugate vaccines, quadrivalent. Minimum age is 6 wk for Hib-MenCY (MenHibrix®; for H. influenzae type b and Neisseria meningitidis serogroups C and Y), 9 mo for MenACWY-D (Menactra®), and 2 mo for MenACWY-CRM (Menveo®).

  • For children aged 2–18 mo who have persistent complement component deficiency or anatomic or functional asplenia (including sickle cell anemia), administer a 4-dose infant series of Hib-MenCY or MenACWY-CRM at age 2, 4, 6, and 12–15 mo.

  • For children aged 7–23 mo who have persistent complement component deficiency and who have not initiated vaccination, there are two options. MenACWY-CRM may be given at age 7–23 mo in a 2-doses series, with the 2nd dose given after age 12 mo and at least 3 mo after the first dose. Or MenACWY-D may be given at age 9–23 mo given in a 2-dose series, with the doses given at least 3 mo apart.

  • For children aged 19–23 mo who have anatomic or functional asplenia and who have not been completely vaccinated with Hib-MenCY or MenACWY-CRM, administer 2 primary doses of Men-ACWY-CRM at least 3 mo apart.

  • For children aged ≥ 24 mo who have persistent complement component deficiency or anatomic or functional asplenia and who have not been completely vaccinated, administer 2 primary doses of either MenACWY-D or MenACWY-CRM vaccine at least 2 mo apart.

  • If MenACWY-D is used in children with anatomic or functional asplenia, administer at a minimum age of 2 yr and at least 4 wk after completion of all PCV13 doses.

  • If children with a high-risk condition live in or are traveling to countries where meningococcal disease is hyperendemic or epidemic (eg, the African meningitis belt, the Hajj), administer at age-appropriate formulation and series of MenACWY-D or MenACWY-CRM for protection against serogroups A and W. Prior vaccination with Hib-MenCY is not sufficient for children traveling to these areas (see MMWR 62 (RR2):1‒22, 2013; available at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6202a1.htm ).

  • If children with a high-risk condition are present during outbreaks caused by a vaccine serogroup, administer or complete an age- and formula-appropriate series of Hib-MenCY, MenACWY-D, or MenACWY-CRM.

  • If children with a high-risk condition receive the first dose of Hib-MenCY at or after age 12 mo, administer a total of 2 doses at least 8 wk apart to ensure protection against serogroups C and Y meningococcal disease.

  • If children with a high-risk condition receive the first dose of MenACWY-CRM at age 7–9 mo, administer a 2-dose series, with the 2nd dose given after age 12 mo and at least 3 mo after the first dose.

  • For further guidance, including revaccination guidelines, see MMWR 62 (RR2):1–22, 2013 (available at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6202a1.htm ) and Meningococcal ACIP Vaccine Recommendations (available at http://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/mening.html ).

ACIP = Advisory Committee on Immunization Practices; MMWR = Morbidity and Mortality Weekly Review; PRP-OMP = Neisseria meningitidis polyribosyl ribitol phosphate/outer membrane protein.

Adapted from the Centers for Disease Control and Prevention: Recommended Immunization Schedule for Persons Aged 0 Through 18 Years, United States—2014. See MMWR 63 (5):108–109, 2014, available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6305a6.htm?s_cid=mm6305a6_w .

Recommended Immunization Schedule for Ages 7–18 yr

Age

Vaccine

7–10 yr

11–12 yr

13–18 yr

Tetanus, diphtheria, pertussis (Tdap) a

*

Tdap

*

Human papillomavirus (HPV) b

See footnote b

3 doses

*

Meningococcal conjugate vaccines, quadrivalent (Hib-Men-CY, MenACWY-D, and MenACWY-CRM) c

1st dose

*Booster at age 16 yr

Influenza d

Yearly (IIV or LAIV)

Pneumococcal conjugate vaccine (PCV13) and pneumococcal polysaccharide vaccine (PPSV23) e

See footnote e

Hepatitis A (HepA) f

Complete 2-dose series

Hepatitis B (HepB) g

*Complete 3-dose series

Inactivated poliovirus (IPV) h

*See footnote h

Measles, mumps, rubella (MMR) i

*Complete 2-dose series

Varicella (VAR) j

*Complete 2-dose series

? = Range of recommended ages for all children except certain high-risk groups.

* = Range of recommended ages for catch-up immunization.

= Range of recommended ages for certain high-risk groups.

= Range of recommended ages for catch-up and for certain high-risk groups.

This schedule includes recommendations in effect as of January 1, 2014. Any dose not administered at the recommended age should be administered at a subsequent visit, when indicated and feasible. The use of a combination vaccine is generally preferred over separate injections of its equivalent component vaccines. Vaccination providers should consult the relevant ACIP statement for detailed recommendations available at http://www.cdc.gov/vaccines/pubs/acip-list.htm . Clinically significant adverse events that follow immunization should be reported to the Vaccine Adverse Event Reporting System (VAERS) at http://www.vaers.hhs.gov or by telephone, 800-822-7967 . Suspected cases of vaccine-preventable diseases should be reported to the state or local health department. If children fall behind or start late, a catch-up schedule should be followed.

a Tetanus and diphtheria toxoids and acellular pertussis (Tdap) vaccine. Minimum age is 10 yr for Boostrix® and 11 yr for Adacel®.

  • People aged 11–18 yr who have not received Tdap vaccine should receive a dose followed by tetanus and diphtheria toxoids (Td) booster doses every 10 yr thereafter.

  • Children aged 7–10 yr who are not fully immunized with the childhood DTaP vaccine series should be given Tdap vaccine as the first dose of Td in the catch-up series. If additional doses are needed, Td vaccine is used. These children should not be given adolescent Tdap vaccine.

  • An inadvertent dose of DTaP vaccine administered to children aged 7–10 yr can count as part of the catch-up series. This dose can count as the adolescent Tdap dose, or the child can later receive a Tdap booster dose at age 11–12 yr.

  • An inadvertent dose of DTaP vaccine administered to adolescents aged 11–18 yr should be counted as the adolescent Tdap dose.

  • Tdap vaccine can be administered regardless of the interval since the last tetanus and diphtheria toxoid–containing vaccine.

b Human papillomavirus (HPV) vaccines (HPV4 [Gardasil®] and HPV2 [Cervarix®]). Minimum age is 9 yr.

  • Either HPV4 or HPV2 is recommended in a 3-dose series for females aged 11 or 12 yr. HPV4 is recommended in a 3-dose series for males aged 11 or 12 yr. The doses are given on a schedule of 0, 1–2, and 6 mo.

  • The vaccine series can be started beginning at age 9 yr.

  • Administer the 2nd dose 1–2 mo after the first dose (minimum interval of 4 wk) and the 3rd dose 24 wk after the first dose and 16 wk after the 2nd dose (minimum interval of 12 wk).

  • Administer the vaccine series to previously unvaccinated females (HPV4 or HPV2) and males (HPV4) at age 13–18 yr.

c Meningococcal conjugate vaccines, quadrivalent (Hib-MenCY [MenHibrix®], MenACWY-D [Menactra®], and MenACWY-CRM [Menveo®]) .

  • Administer MenACWY-D or MenACWY-CRM at age 11–12 yr with a booster dose at age 16 yr.

  • Administer MenACWY-D or MenACWY-CRM at age 13–18 yr if patients have not been previously vaccinated.

  • If the first dose is administered at age 13–15 yr, a booster dose should be administered at age 16–18 yr with a minimum interval of at least 8 wk after the preceding dose.

  • If the first dose is administered at age ≥ 16 yr, a booster dose is not needed.

  • If patients have persistent complement component deficiency or anatomic or functional asplenia and have not been completely vaccinated, administer 2 primary doses either MenACWY-D or MenACWY-CRM vaccine at least 2 mo apart and 1 dose every 5 yr thereafter. Children who receive the primary series before their 7th birthday should receive the first booster dose in 3 yr and subsequent doses every 5 yr (for additional information, see Prevention and Control of Meningococcal Disease : Recommendations of the Advisory Committee on Immunization Practices [ACIP]).

  • Adolescents aged 11–18 yr with HIV infection should receive a 2-dose primary series of MenACWY-D or MenACWY-CRM with at least 8 wk between doses.

  • For further guidance, including revaccination guidelines, see MMWR 62 (RR2):1–22, 2013 (available at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6202a1.htm ) and Meningococcal ACIP Vaccine Recommendations (available at http://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/mening.html ).

d Influenza vaccines (inactivated influenza vaccine [IIV] and live-attenuated influenza vaccine [LAIV]).

  • For most healthy, nonpregnant people aged 2–49 yr, either LAIV or IIV may be used. However, LAIV should not be administered to some people, including those with asthma or any other medical conditions that predispose them to influenza complications. For all other contraindications to use of LAIV, see MMWR 62 (RR-7):1–43, 2013, available at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6207a1.htm .

  • Administer 1 dose to people aged ≥ 9 yr.

  • For children aged 6 mo–8 yr:

    For the 2013–14 season, administer 2 doses (separated by at least 4 wk) to children who are receiving the influenza vaccine for the first time. Some children who have been previously vaccinated also need 2 doses. For additional guidance, see the dosing guidelines in the 2013–14 ACIP recommendations for influenza vaccine in MMWR 62 (RR-7):1–43, 2013, available at http://www.cdc.gov/mmwr/pdf/rr/rr6207.pdf .

    For the 2014–15 season, follow the dosing guidelines in the 2014 ACIP recommendations for influenza vaccine (available at http://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/flu.html ).

e Pneumococcal vaccines (13-valent pneumococcal conjugate vaccine [PCV13] and 23-valent pneumococcal polysaccharide vaccine [PPSV23]).

  • If children aged 6–18 yr with certain medical conditions (including a cochlear implant) have not received PCV13 nor PPSV23, administer 1 dose of PCV13, followed by 1 dose of PPSV23 at least 8 wk later (see MMWR 59 [RR-11]:1–19, 2010, available at http://www.cdc.gov/mmwr/pdf/rr/rr5911.pdf ).

  • Administer PPSV23 at least 8 wk after the last dose of PCV13 to children aged ≥ 2 yr with certain medical conditions, including a cochlear implant. A single revaccination with PPSV23 should be administered 5 yr after the first dose to children with anatomic or functional asplenia or an immunocompromising condition.

f Hepatitis A (HepA) vaccine.

  • A 2-dose HepA vaccine series is recommended for previously unvaccinated children if they live in areas where vaccination programs target older children, if they are at increased risk of infection, or if immunity against hepatitis A is desired for them.

  • Administer 2 doses at least 6 mo apart to unvaccinated people.

g Hepatitis B (HepB) vaccine.

  • Administer the 3-dose series to children not previously vaccinated.

  • For children with incomplete vaccination, follow the catch-up recommendations (see Table: Catch-up Immunization Schedule for Ages 4 mo–18 yr).

  • A 2-dose series (doses separated by at least 4 mo) of adult formulation Recombivax HB® is licensed for use in children aged 11–15 yr.

h Inactivated poliovirus vaccine (IPV).

  • The final dose in the series should be administered at least 6 mo after the previous dose.

  • If both oral poliovirus (OPV) and IPV were administered as part of a series, a total of 4 doses should be administered, regardless of the child’s current age.

  • IPV is not routinely recommended for US residents aged ≥ 18 yr.

i Measles, mumps, and rubella (MMR) vaccine.

  • The minimum interval between 2 doses of MMR vaccine is 4 wk.

  • Make sure all school-aged children and adolescents have had 2 doses of MMR vaccine.

j Varicella (VAR) vaccine.

  • For people aged 7–18 yr without evidence of immunity (see MMWR 56 [RR-4], 2007, available at www.cdc.gov/mmwr/pdf/rr/rr5604.pdf , and ACIP recommendations, available at www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/varicella.html ), administer 2 doses if they were not previously vaccinated or the 2nd dose if only 1 dose has been administered.

  • For children aged 7–12 years, the recommended minimum interval between doses is 3 mo. However, if the 2nd dose was administered at least 4 wk after the first dose, it can be accepted as valid.

  • For children aged 13 yr, the minimum interval between doses is 4 wk.

ACIP = Advisory Committee on Immunization Practices; MMWR = Morbidity and Mortality Weekly Review.

Adapted from the Centers for Disease Control and Prevention: Recommended Immunization Schedule for Persons Aged 0 Through 18 Years, United States—2014. See MMWR 63 (5):108–109, 2014, available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6305a6.htm?s_cid=mm6305a6_w .

Catch-up Immunization Schedule for Ages 4 mo–18 yr

Vaccine

Minimum Age for Dose 1

Minimum Interval Between Doses

Doses 1 and 2

Doses 2 and 3

Doses 3 and 4

Doses 4 and 5

For ages 4 mo–6 yr

Hepatitis B (HepB)

Birth

4 wk

8 wk and at least 16 wk after the first dose

Minimum age for the final dose: 24 wk

Rotavirus (RV) a

6 wk

4 wk

4 wk a

Diphtheria, tetanus, pertussis (DTaP) b

6 wk

4 wk

4 wk

6 mo

6 mo b

Haemophilus influenzae type b (Hib) c

6 wk

4 wk if the first dose is administered at age < 12 mo

8 wk (as the final dose) if the first dose is administered at age 12–14 mo

No further doses needed if the first dose is administered at age 15 mo

4 wk c if the current age is < 12 mo and the first dose is administered at age < 7 mo

8 wk and age 12–59 mo (as the final dose) c if the current age is < 12 mo and the first dose was administered at age 7–11 mo (regardless of Hib vaccine used for the first dose), if the current age is 12–59 mo and the first dose was administered at age < 12 mo, or if the first 2 doses were PRP-OMP and administered at age < 12 mo

No further doses needed if the previous dose is administered at age 15 mo

8 wk (as the final dose)

Only necessary for children aged 12–59 mo who received 3 doses (PRP-T) before age 12 mo and started the primary series before age 7 mo

Pneumococcal vaccine d

6 wk

4 wk if the first dose is administered at age < 12 mo

8 wk (as the final dose for healthy children) if the first dose is administered at age 12 mo

No further doses needed for healthy children if the first dose is administered at age 24 mo

4 wk if the current age is < 12 mo

8 wk (as the final dose for healthy children) if the current age is 12 mo

No further doses needed for healthy children if the previous dose is administered at age 24 mo

8 wk (as the final dose)

Only necessary for children aged 12–59 mo who received 3 doses before age 12 mo or for high-risk children who received 3 doses at any age

Inactivated polio virus (IPV) e

6 wk

4 wk

4 wk

6 mo e

Minimum age: 4 yr for the final dose

Meningococcal f

6 wk

8 wk f

See footnote f

See footnote f

Measles, mumps, rubella (MMR) g

12 mo

4 wk

Varicella (VAR) h

12 mo

3 mo

Hepatitis A (HepA) i

12 mo

6 mo

For ages 7–18 yr

Tetanus, diphtheria (Td)

Tetanus, diphtheria, pertussis (Tdap) j

7 yr j

4 wk

4 wk if the first dose of DTaP/DT is administered at age < 12 mo

6 mo if the first dose of DTaP/DTis administered at age 12 mo

6 mo if the first dose of DTaP/DT is administered at age < 12 mo

Human papillomavirus (HPV) k

9 yr

Routine dosing intervals recommended k

Hepatitis A (HepA) i

12 mo

6 mo

Hepatitis B (HepB)

Birth

4 wk

8 wk and at least 16 wk after the first dose

Inactivated polio virus (IPV) e

6 wk

4 wk

4 wk e

6 mo e

Meningococcal f

6 wk

8 wk f

Measles, mumps, rubella (MMR) g

12 mo

4 wk

Varicella (VAR) h

12 mo

3 mo if age is < 13 yr

4 wk if age is 13 yr

N ote : For children whose vaccinations were started late or are > 1 mo behind, the table provides catch-up schedules and minimum intervals between doses (available at www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html ). A vaccine series does not need to be restarted, regardless of the time that has elapsed between doses. Use the section appropriate for the child’s age. Always use this table in conjunction with the childhood and adolescent immunization schedules, including their footnotes ( Recommended Immunization Schedule for Ages 0–6 yr and Recommended Immunization Schedule for Ages 7–18 yr). Information about reporting reactions after immunization is available online at http://www.vaers.hhs.gov or by telephone, 800-822-7967 . Suspected cases of vaccine-preventable diseases should be reported. Additional information, including precautions and contraindications for vaccination, is available from the CDC at www.cdc.gov/vaccines or by telephone (800-232-4636 [800-CDC-INFO]).

For contraindications and precautions to use of a vaccine and for additional information, see ACIP recommendations, available at www.cdc.gov/vaccines/hcp/acip-recs/index.html .

a Rotavirus (RV) vaccines (RV-1 [Rotarix®] and RV-5 [RotaTeq®]).

  • The maximum age is 14 wk 6 days for the first dose in the series and 8 mo 0 days for the final dose in the series. Vaccination should not be initiated for infants aged 15 wk 0 days.

  • If RV-1 was administered for the first and 2nd doses, a 3rd dose is not indicated.

b Diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine.

  • The 5th dose is not necessary if the 4th dose was administered at age 4 yr.

c Haemophilus influenzae type b (Hib) conjugate vaccine.

  • One dose of Hib vaccine should be administered to unvaccinated or partially vaccinated children aged 5 yr who have sickle cell disease, leukemia, HIV infection, anatomic or functional asplenia, or another immunocompromising condition.

  • If the first 2 doses were PRP-OMP (PedvaxHIB® or ComVax® [HepB-Hib]) and were administered at age 11 mo, the 3rd (and final) dose should be administered at age 12–15 mo and at least 8 wk after the 2nd dose.

  • If the first dose was administered at age 12–14 mo, administer the 2nd dose at least 8 wk after the first dose.

  • If the first dose was administered at age 7–11 mo, administer the 2nd dose at least 4 wk later and a final dose at age 12–15 mo regardless of the Hib vaccine used for the first dose.

  • Administer only 1 dose to unvaccinated children aged ≥ 15 mo.

d Pneumococcal vaccines. Minimum age is 6 wk for 13-valent pneumococcal conjugate vaccine (PCV13) and 2 yr for 23-valent pneumococcal polysaccharide vaccine (PPSV23).

  • For children aged 24–71 mo with certain medical conditions, administer 1 dose of PCV if 3 doses were received previously, or administer 2 doses of PCV at least 8 wk apart if < 3 doses were received previously.

  • A single dose of PCV may be administered to previously unvaccinated children aged 6–18 yr with certain medical conditions ( Recommended Immunization Schedule for Ages 0–6 yr and Recommended Immunization Schedule for Ages 7–18 yr for details).

  • Administer PPSV23 at least 8 wk after the last dose of PCV to children aged 2 yr with certain medical conditions. A single revaccination with PPSV23 should be administered after 5 yr to children with anatomic or functional asplenia or an immunocompromising condition. See MWR 59 [RR-11], 2010 (available at www.cdc.gov/mmwr/pdf/rr/rr5911.pdf ).

e Inactivated poliovirus vaccine (IPV).

  • A 4th dose is not necessary if the 3rd dose was administered at age 4 yr and at least 6 mo after the previous dose.

  • A ≥ 4 doses are administered before age 4 yr, an additional dose should be administered at age 4–6 yr.

  • In the first 6 mo of life, minimum age and minimum intervals are recommended only if the infant is at risk of imminent exposure to circulating poliovirus (eg, traveling to a polio-endemic region, during an outbreak).

  • IPV is not routinely recommended for US residents age ≥ 18 yr.

  • If both oral polio vaccine (OPV) and IPV were administered as part of a series, a total of 4 doses should be administered regardless of the child's current age.

f Meningococcal conjugate vaccine, quadrivalent (MCV4). Minimum age is 6 wk for Hib-MenCY (for H. influenzae type b and Neisseria meningitidis serogroups C and Y), 9 mo for MCV4-D (Menactra®), and 2 yr for MCV4-CRM (Menveo®).

g Measles, mumps, and rubella (MMR) vaccine.

  • Administer the 2nd dose routinely at age 4–6 yr.

  • Make sure all school-aged children and adolescents have had 2 doses of MMR vaccine. The minimal interval between doses is 4 wk.

h Varicella (VAR) vaccine.

  • Administer the 2nd dose routinely at age 4–6 yr. If the 2nd dose was administered at least 4 wk after the first dose, it can be accepted as valid.

  • For people aged 7–18 yr without evidence of immunity (see MMWR 56 [RR-4], 2007, available at Morbidity and Mortality Weekly Review ), administer 2 doses if they were not previously vaccinated or the 2nd dose if only 1 dose has been administered.

  • For children aged 7–12 yr, the recommended minimum interval between doses is 3 mo. However, if the 2nd dose was administered at least 4 wk after the first dose, it can be accepted as valid. For people aged ≥ 13 yr, the minimum interval between doses is 4 wk.

i Hepatitis A (HepA) vaccine.

  • For people ≥ 2 yr who have not received the HepA vaccine series, administer 2 doses separated by 6–18 mo if immunity against hepatitis A is desired for them.

j Tetanus and diphtheria toxoids (Td) and tetanus and diphtheria toxoids and acellular pertussis (Tdap) vaccines.

  • People aged 11–18 yr who have not received Tdap vaccine should receive a dose followed by tetanus and diphtheria toxoids (Td) booster doses every 10 yr thereafter.

  • Children aged 7–10 yr who are not fully immunized with the childhood DTaP vaccine series, should receive Tdap vaccine as the first dose in the catch-up series; if additional doses are needed, use Td vaccine. An adolescent Tdap vaccine dose should not be given to these children.

  • An inadvertent dose of DTaP vaccine administered to children aged 7–10 yr can count as part of the catch-up series. This dose can count as the adolescent Tdap dose, or the child can later receive a Tdap booster dose at age 11–12 yr.

  • An inadvertent dose of DTaP vaccine administered to adolescents aged 11–18 yr should be counted as the adolescent Tdap dose.

k Human papillomavirus (HPV) vaccines (HPV4 [Gardasil®] and HPV2 [Cervarix®]).

  • Administer the vaccine series to previously unvaccinated females (either HPV2 or HPV4) and males (HPV4) at age 13–18 yr.

  • Use recommended routine dosing intervals for vaccine series catch-up (see Table: Recommended Immunization Schedule for Ages 7–18 yr).

MMWR = Morbidity and Mortality Weekly Review.

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