Age

Vaccine

Birth

1 mo

2 mo

4 mo

6 mo

12 mo

15 mo

18 mo

19–23 mo

2–3 yr

4–6 yr

Rotavirus (RV)^b

RV

RV

RV^b

Haemophilus influenzae type b (Hib)^d

Hib

Hib

Hib^d

Hib

Inactivated polio virus (IPV)^f

IPV

IPV

IPV

IPV

Measles, mumps, rubella (MMR)^h

MMR

See footnote h

MMR

Hepatitis A (HepA) ^j

HepA (2 doses)

HepA series

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

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

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

• The HepB series should be completed with either monovalent HepB or a combination vaccine containing HepB. The 2nd dose should be administered at age 1 or 2 mo. Monovalent HepB vaccine should be used for doses administered before age 6 wk. The final dose should be administered no earlier than age 24 wk.
• Infants born to HBsAg-positive mothers should be tested for HBsAg and antibody to HBsAg 1–2 mo after completion of at least 3 doses of the HepB series, at age 9–18 mo (generally at the next well-child visit).
• Administration of 4 doses of HepB to infants is permissible when a combination vaccine containing HepB is administered after the birth dose. The 4th dose should be administered no earlier than age 24 wk.

^c Diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP). Minimum age is 6 wk.

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

^e Pneumococcal vaccine. Minimum age is 6 wk for pneumococcal conjugate vaccine (PCV) and 2 yr for pneumococcal polysaccharide vaccine (PPSV).

• PCV is recommended for all children aged < 5 yr. Administer 1 dose of PCV to all healthy children aged 24–59 mo who are not completely vaccinated for their age.
• Administer PPSV ≥ 2 mo after the last dose of PCV to children aged ≥ 2 yr with certain medical conditions, including a cochlear implant (see Morbidity and Mortality Weekly Review 46 [RR-8], 1997).

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

• Administer annually to children aged 6 mo–18 yr.
• Healthy children aged 2–6 yr who do not have medical conditions that predispose them to influenza complications may be given either LAIV or TIV, except LAIV should not be given to children aged 2–4 yr who have had wheezing in the past 12 mo.
• Children receiving TIV should receive 0.25 mL if they are aged 6–35 mo or 0.5 mL if they are aged ≥ 3 yr.
• Administer 2 doses (separated by at least 4 wk) to children aged < 9 yr who are receiving influenza vaccine for the first time or who were vaccinated for the first time during the previous influenza season but only received 1 dose.
• For recommendations for use of influenza A (H1N1) 2009 monovalent vaccine, see Morbidity and Mortality Weekly Review 58 (RR-10), 2009.

ⁱ Varicella vaccine. Minimum age is 12 mo.

• Administer the 2nd dose routinely at age 4–6 yr. However, the 2nd dose may be administered before age 4, provided at least 3 mo have elapsed since the first dose.
• For children aged 12 mo–12 yr, the minimum interval between doses is 3 mo. However, if the 2nd dose was administered at least 28 days after the first dose, it can be accepted as valid.

^k Meningococcal vaccine. Minimum age is 2 yr for meningococcal conjugate vaccine (MCV4) and for meningococcal polysaccharide vaccine (MPSV4).

• Administer MCV4 to children aged 2–10 yr with persistent complement component deficiency, anatomic or functional asplenia, or certain other conditions placing them at high risk.
• Administer MCV4 to children previously vaccinated with MCV4 or MPSV4 after 3 yr if the first dose was administered at age 2–6 yr (see Morbidity and Mortality Weekly Review 58:1042–1043, 2009).

Age

Vaccine

7–10 yr

11–12 yr

13–18 yr

Human papillomavirus (HPV)^b

See footnote b

HPV (3 doses)

HPV series

Influenza^d

Influenza (yearly)

Hepatitis A (HepA)^f

HepA series

Inactivated poliovirus (IPV)^h

IPV series

Varicella^j

Varicella series

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

This schedule includes recommendations in effect as of December 15, 2009. 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 Advisory Committee on Immunization Practices statement for detailed recommendations 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. If children fall behind or start late, a catch-up schedule should be followed.

^b Human papillomavirus vaccine (HPV). Minimum age is 9 yr.

• Two HPV vaccines are licensed: a quadrivalent vaccine (HPV4) for the prevention of cervical, vaginal, and vulvar cancers in females and genital warts in females and males and a bivalent vaccine (HPV2) for the prevention of cervical cancers in females.
• HPV vaccines are most effective (for males and females) when given before exposure to HPV through sexual contact.
• HPV4 or HPV2 is recommended for the prevention of cervical precancers and cancers in females.
• HPV4 is recommended for the prevention of cervical, vaginal, and vulvar precancers and cancers and genital warts in females.
• Administer the first dose to females at age 11 or 12 yr.
• Administer the 2nd dose 1 to 2 mo after the first dose and the 3rd dose 6 mo after the first dose (at least 24 wk after the first dose).
• Administer the series to females at age 13–18 yr if not previously vaccinated.
• HPV4 may be administered in a 3-dose series to males aged 9–18 yr to reduce their likelihood of acquiring genital warts.

^d Influenza vaccine (seasonal).

• Administer annually to children aged 6 mo–18 yr.
• Healthy people aged 7–18 yr who are not pregnant and who do not have medical conditions predisposing them to influenza complications may be given either LAIV or TIV.
• Administer 2 doses (separated by at least 4 wk) to children aged < 9 yr who are receiving influenza vaccine for the first time or who were vaccinated for the first time during the previous influenza season but only received 1 dose.
• For recommendations for use of influenza A (H1N1) 2009 monovalent vaccine, see Morbidity and Mortality Weekly Review 58 (RR-10), 2009.

^f Hepatitis A vaccine (HepA).

• Administer 2 doses at least 6 mo apart.
• HepA is recommended for children aged > 23 mo 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.

^h Inactivated poliovirus vaccine (IPV).

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

^j Varicella vaccine.

• For children aged 7–18 yr without evidence of immunity (see Morbidity and Mortality Weekly Review 56 [RR-4], 2007), administer 2 doses if children were not previously vaccinated or the 2nd dose if only 1 dose has been administered.
• For children aged 7–12 yr, the minimum interval between doses is 3 mo. However, if the 2nd dose was administered at least 28 days after the first dose, it can be accepted as valid.
• For children aged ≥ 13 yr, the minimum interval between doses is 28 days.

Adapted from the Centers for Disease Control and Prevention: Recommended Immunization Schedule for Persons Aged 7 Through 18 Years, United States, 2010. Available at www.cdc.gov/vaccines/recs/schedules/default.htm.

Vaccine

Minimum Age for Dose 1

Minimum Interval Between

Doses 1 and 2

Doses 2 and 3

Doses 3 and 4

Doses 4 and 5

Hepatitis B (HepB)^a

Birth

4 wk

8 wk (and at least 16 wk after the first dose)

—

—

Diphtheria, tetanus, pertussis (DTaP)^c

6 wk

4 wk

4 wk

6 mo

6 mo^c

Pneumococcal vaccine^e

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 or current age is 24–59 mo

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

4 wk if current age is < 12 mo

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

No further doses needed for healthy children if 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

Measles, mumps, rubella (MMR)^g

12 mo

4 wk

—

—

—

Hepatitis A (HepA)ⁱ

12 mo

6 mo

—

—

—

Tetanus, diphtheria (Td)

Tetanus, diphtheria, pertussis (Tdap)^j

7 yr^j

4 wk

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

6 mo if the first dose is administered at age ≥ 12 mo

6 mo if the first dose is administered at age < 12 mo

—

Hepatitis A (HepA)ⁱ

12 mo

6 mo

—

—

—

Inactivated polio virus (IPV)^f

6 wk

4 wk

4 wk

6 mo

—

Varicella^h

12 mo

3 mo if age is < 13 yr

4 wk if age is ≥ 13 yr

—

—

—

^a Hepatitis B vaccine (HepB).

• Administer the 3-dose series to children who were not previously vaccinated.
• A 2-dose series (separated by at least 4 mo) of adult-formulation Recombivax HB® is approved for children aged 11–15 yr.

^c Diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP).

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

^e Pneumococcal vaccine.

• Administer 1 dose of pneumococcal conjugate vaccine (PCV) to all healthy children aged 24–59 mo if they have not received at least 1 dose of PCV on or after age 12 mo.
• For children aged 24–59 mo with 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.
• Administer pneumococcal polysaccharide vaccine (PPSV) to children aged ≥ 2 yr with certain medical conditions, including a cochlear implant, at least 8 wk after the last dose of PCV (see Morbidity and Mortality Weekly Review 46 [RR-8], 1997).

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

• Administer the 2nd dose routinely at age 4–6 yr. However, the 2nd dose may be administered before age 4, provided at least 28 days have elapsed since the first dose.
• For children not previously vaccinated, administer 2 doses with at least 28 days between doses.

ⁱ Hepatitis A vaccine (HepA).

• HepA is recommended for children aged > 23 mo 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.

^k Human papillomavirus vaccine (HPV).

• Administer the series to females at age 13–18 yr if not previously vaccinated.
• Use recommended routine dosing intervals for series catch-up (ie, the 2nd and 3rd doses should be administered at 1–2 mo and 6 mo after the first dose). The minimum interval between the first and 2nd doses is 4 wk. The minimum interval between the 2nd and 3rd doses is 12 wk, and the 3rd dose should be administered at least 24 wk after the first dose.