Immunization
ACIP Pediatric Immunization Schedule Guidance
COVID-19 Vaccination Guidance 2023-2024
- Routine vaccination
- Recommended for all ages 6 months and up
- Pfizer
- Not previously vaccinated
- 6 mo-4 yo: 0.3 mL IM x3
- Given on wk 0, 3, and ≥8 wks after Dose 2
- If turning 4 to 5 yo during series, pt should receive all doses
- 5-11 yo: 0.3 mL IM x1
- ≥12 yo: as adult
- Previously vaccinated
- 6 mo-4 yo
- 1 previous dose: 0.3 mL IM x2
- Dose 1 given 3 wks after last dose
- Dose 2 given ≥8 wks after Dose 1
- If turning 4 to 5 yo during series, pt should receive all doses
- 2-4 previous doses: 0.3 mL IM x1
- Given ≥8 wks after last dose
- 5-11 yo: 0.3 mL IM x1
- Given ≥2 mths after last dose
- ≥12 yo: as adult
- Immunocompromised
- ≥12 yo
- 6 mo-11 yo
- 0.3 mL IM; admin ≥3-dose series
- 6 mo-4 yo: given on wk 0, 3, and ≥8 wks after Dose 2
- 5-11 yo: given on wk 0, 3, and ≥4 wks after Dose 2
- Not previously vaccinated:
- Complete full 3-dose series
- Previously vaccinated with 1-2 dose(s):
- Complete remaining dose(s) in 3-dose series
- Previously vaccinated with ≥3 doses:
- Admin single dose, given ≥2 mth after last dose
- Additional 0.3 mL dose may be admin ≥2 mth after completion of series
- Subsequent doses may be admin at provider discretion
- Moderna
- Not previously vaccinated
- 6 mo-4 yo: 0.25 mL IM x2 (given 1 mth apart)
- If turning 4 to 5 yo during series, pt should receive both doses
- 5-11 yo: 0.25 mL IM x1
- ≥12 yo: as adult
- Previously vaccinated
- 6 mo-4 yo
- Single previous dose: 0.25 mL IM x1, given 1 mth after previous dose
- ≥2 previous doses: 0.25 mL IM x1, given ≥2 mth after previous dose
- 5-11 yo: 0.25 mL IM x1, given ≥2 mth after previous dose
- ≥12 yo: as adult
- Immunocompromised
- ≥12 yo
- 6 mo-11 yo
- 0.25 mL IM; should receive ≥3 doses, each given 1 mth apart
- Not previously vaccinated:
- Complete full 3-dose series
- Previously vaccinated with 1-2 dose(s):
- Complete remaining dose(s) in 3-dose series
- Previously vaccinated with ≥3 doses:
- Admin single dose, given ≥2 mth after last dose
- Additional 0.25 mL dose may be admin ≥2 mth after completion of series
- Subsequent doses may be admin at provider discretion
- Booster recommendations, see: www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us.html
- See COVID-19 vaccination
Hepatitis B
- Routine vaccination
- The minimum age for dose 1: birth
- Birth dose (monovalent HepB vaccine only)
- If the mother is HBsAg-negative
- 1 dose within 24 hours of birth for medically stable infants ≥ 2,000 grams
- Infants < 2,000 grams administer 1 dose at chronological age 1 month or hospital discharge
- If the mother is HBsAg-positive
- Administer 1 dose HepB vaccine and HBIG (at separate anatomic sites) within 12 hours of birth, regardless of birth weight
- Test for HBsAg and anti-HBs at age 9–12 months
- If HepB series is delayed, test 1–2 months after the final dose
- If the mother’s HBsAg status is unknown
- Give HepB vaccine within 12 hours of birth, regardless of birth weight
- For infants < 2,000 grams, give 0.5 mL of HBIG in addition to HepB vaccine within 12 hours of birth
- Administer 3 additional doses of vaccine (total of 4 doses) beginning at age 1 month
- Determine mother’s HBsAg status as soon as possible
- If the mother is HBsAg-positive, give 0.5 mL of HBIG to infants ≥ 2,000 grams as soon as possible, but no later than 7 days of age
- Routine series
- A complete series is 3 doses at 0, 1–2, and 6–18 months
- Monovalent HepB vaccine should be used for doses given before age 6 weeks
- Infants who did not receive a birth dose should begin the series as soon as feasible (see catch–up schedule below)
- Administration of 4 doses is permitted when a combination vaccine containing HepB is used after the birth dose
- Minimum age for the final (3rd or 4th) dose: 24 weeks (give at age 6 months)
- Minimum intervals
- Dose 1 to Dose 2: 4 weeks
- Dose 2 to Dose 3: 8 weeks
- Dose 1 to Dose 3: 16 weeks (when 4 doses are given, substitute "Dose 4" for "Dose 3" in these calculations)
- Minimum age for final dose is 24 weeks
- Catch-up vaccination
- Unvaccinated persons should complete a 3-dose series at 0, 1–2, and 6 months
- Adolescents 11–15 years of age may use an alternative 2-dose schedule, with at least 4 months between doses (adult formulation Recombivax HB only)
- Adolescents 18 years and older may receive a 2-dose series of HepB (Heplisav-B) at least 4 weeks apart
- Adolescents 18 years and older may receive the combined HepA and HepB vaccine, Twinrix, as a 3-dose series or 4-dose series
- 3-dose series at 0, 1, and 6 months)
- 4-dose series at 0, 7, and 21–30 days, followed by a dose at 12 months
- The interval between doses (age 7 years through 18 years)
- Dose 1 to dose 2
- Dose 2 to dose 3
- 8 weeks and at least 16 weeks after the first dose
Rotavirus
- Routine vaccination
- The minimum age for dose 1: 6 weeks
- Administer a series of RV vaccine to all infants as follows:
- Rotarix: administer a 2-dose series at ages 2 and 4 months
- RotaTeq: administer a 3-dose series at ages 2, 4, and 6 months
- If any dose in the series was RotaTeq or vaccine product is unknown for any dose in the series, default to 3-dose series
- Catch-up vaccination
- The maximum age for the first dose: 14 weeks, 6 days
- Do not start the series on or after age 15 weeks, 0 days
- The maximum age for the final dose is 8 months, 0 days
- A vaccine series does not need to be restarted, regardless of the time that has elapsed between doses
- Interval between doses
- Dose 1 to dose 2
- Dose 2 to dose 3
Diphtheria, Tetanus, and acellular Pertussis (DTaP) Vaccination Guidance
- Routine vaccination
- The minimum age for the first dose:
- 5-dose series at 2, 4, 6, and 15–18 months and 4–6 years
- Prospectively
- A 4th dose may be given as early as age 12 months if at least 6 months have elapsed since the 3rd dose
- Retrospectively
- A 4th dose that was inadvertently administered given as early as 12 months may be counted if at least 4 months have elapsed since the 3rd dose
- Catch-up vaccination
- Interval between
- Dose 1 to dose 2
- Dose 2 to dose 3
- Dose 3 to dose 4
- Dose 4 to dose 5
- 6 months
- This fifth dose of DTaP vaccine is not necessary if the fourth dose was administered at age 4 years or older and
- At least 6 months after dose 3
Haemophilus influenzae type b
- Routine vaccination
- The minimum age for the first dose: 6 weeks
- ActHIB, Hiberix, or Pentacel: 4-dose series (3-dose primary series at age 2, 4, and 6 months, followed by a booster dose at age 12–15 months)
- Vaxelis is not recommended for use as a booster dose
- A different Hib-containing vaccine should be used for the booster dose
- PedvaxHIB: 3-dose series (2-dose primary series at age 2 and 4 months, followed by a booster dose at age 12–15 months)
- Catch-up vaccination
- 1st dose at 7–11 months: Give 2nd dose at least 4 weeks later and 3rd (final) dose at 12–15 months or 8 weeks after a 2nd dose (whichever is later)
- 1st dose at 12–14 months: Give 2nd (final) dose at least 8 weeks after 1st dose
- 1st dose before 12 months and 2nd dose before 15 months: Give 3rd (final) dose 8 weeks after 2nd dose
- 2 doses of PedvaxHIB before 12 months: Give 3rd (final) dose at 12–59 months and at least 8 weeks after 2nd dose
- Unvaccinated at 15–59 months: 1 dose
- Previously unvaccinated children age 60 months or older who are not considered high risk
- Do not require catch-up vaccination
- Interval between doses
- Dose 1 to dose 2
- 4 weeks if the first dose was administered before the 1st birthday
- 8 weeks (as final dose) if the first dose was administered at age 12 through 14 months
- No further doses needed if the first dose was administered at age 15 months or older
- Dose 2 to dose 3
- 4 weeks if current age is younger than 12 months and the first dose was administered at younger than age 7 months, and at least 1 previous dose was PRP-T (ActHib, Pentacel, Hiberix) or unknown
- 8 weeks and age 12 through 59 months (as final dose) if
- Current age is younger than 12 months and the first dose was administered at age 7 through 11 months
OR
- Current age is 12 through 59 months and the first dose was administered before the 1st birthday, and the second dose administered at younger than 15 months
OR
- Both doses were PRP-OMP (PedvaxHIB; Comvax) and were administered before the 1st birthday
- No further doses needed if the previous dose was administered at age 15 months or older
- Dose 3 to dose 4
- 8 weeks (as final dose)
- This dose only necessary for children age 12 through 59 months who received 3 doses before the 1st birthday
- Vaxelis can be used for catch-up vaccination in children less than age 5 years
- Follow the catch-up schedule even if Vaxelis is used for one or more doses
Pneumococcal Vaccine
- Routine vaccination
- The minimum age for the first dose:
- PCV13: 6 weeks
- PPSV23: 2 years
- PCV13: 4-dose series at 2, 4, 6, and 12–15 months
- Catch-up vaccination
- 1 dose for healthy children aged 24–59 months with any incomplete* PCV13 schedule
- *Incomplete schedules are any schedules where PCV13 doses have not been completed according to ACIP recommended catch-up schedules; the total number and timing of doses for complete PCV13 series are dictated by the age at first vaccination
- Interval between doses
- Dose 1 to dose 2
- 4 weeks if the first dose administered before the 1st birthday
- 8 weeks (as a final dose for healthy children) if the first dose was administered at the 1st birthday or after
- No further doses needed for healthy children if the first dose was administered at age 24 months or older
- Dose 2 to dose 3
- 4 weeks if current age is younger than 12 months and the previous dose given at < 7 months old
- 8 weeks (as a final dose for healthy children) if
- Previous dose is given between 7-11 months (wait until at least 12 months old)
OR
- Current age is 12 months or older and at least 1 dose was given before age 12 months
- No further doses needed for healthy children if the previous dose administered at age 24 months or older
- Dose 3 to dose 4
- 8 weeks (as final dose)
- This dose only necessary for children aged 12 through 59 months regardless of risk or
- Age 60 to 71 months w/ any risk, who received 3 doses before age 12 months
- For medical indications and special populations, click here
Inactivated Poliovirus Vaccination
- Routine vaccination
- Minimum age: 6 weeks
- 4-dose series at ages 2, 4, 6–18 months, and 4–6 years
- Administer the final dose on or after the 4th birthday and at least 6 months after the previous dose
- 4 or more doses of IPV can be administered before the 4th year when a combination vaccine containing IPV is used
- A dose is still recommended after the 4th year and at least 6 months after the previous dose
- Series containing oral polio vaccine (OPV), either mixed OPV-IPV or OPV-only series
- Total number of doses needed to complete the series is the same as that recommended for the U.S. IPV schedule
- Only trivalent OPV (tOPV) counts toward the U.S. vaccination requirements
- Catch-up vaccination
- In the first 6 months of life, use minimum ages and intervals only for travel to a polio-endemic region or during an outbreak
- IPV is not routinely recommended for U.S. residents aged 18 years or older
- Interval between doses
- Dose 1 to dose 2
- Dose 2 to dose 3
- 4 weeks if < 4 yo
- 6 months (as final dose) if < 4 yo or older
- Dose 3 to dose 4
- 6 months (minimum age 4 years for final dose)
Influenza Vaccination
Measles, Mumps, Rubella (MMR) Vaccination Guidance
- Routine vaccination
- The minimum age for routine vaccination: 12 months
- 2-dose series at 12–15 months and 4–6 years
- The 2nd dose may be given as early as 4 weeks after the 1st dose
- MMR or MMRV may be administered
- International travel
- Infants 6–11 months
- Administer 1 dose before departure
- Revaccinate with 2 doses at 12–15 months (12 months for children in high-risk areas) and 2nd dose as early as 4 weeks later
- Unvaccinated children 12 months and older
- Administer 2 doses at least 4 weeks apart before departure
- In mumps outbreak settings
- Information about additional doses of MMR (including 3rd dose of MMR)
- See www.cdc.gov/mmwr/volumes/67/wr/mm6701a7.htm
- Catch-up vaccination
- Unvaccinated children and adolescents: 2 doses at least 4 weeks apart
- Maximum age for use of MMRV is 12 years
- Minimum interval between MMRV doses is 3 months
Varicella Vaccination Guidance
- Routine vaccination
- Minimum age: 12 months
- 2-dose series: 12–15 months and 4–6 years
- The second dose may be given as early as 3 months after the first dose (a dose given after a 4-week interval may be counted)
- For dose 1 in children age 12–47 months
- Recommended to administer MMR and varicella vaccines separately
- MMRV may be used if parents or caregivers express a preference
- Catch-up vaccination
- Ensure that all persons aged 7 through 18 years without evidence of immunity have 2 doses of varicella vaccine
- (See MMWR 2007;56[No. RR-4], available at www.cdc.gov/mmwr/pdf/rr/rr5604.pdf )
- Interval between doses
- For children aged 7 through 12 years: 3 months (minimum interval: 4 weeks)
- For persons aged 13 years and older: 4-8 weeks (minimum interval: 4 weeks)
- Maximum age for use of MMRV is 12 years
Hepatitis A Vaccination Guidance
- Routine vaccination
- Minimum age: 12 months
- 2-dose series (minimum interval: 6 months) at age 12-23 months
- Havrix 6–12 months apart or Vaqta 6–18 months apart (minimum interval 6 months)
- A series begun before the 2nd birthday should be completed even if the child turns 2 before the second dose is administered
- International travel
- Persons traveling to or working in countries with high or intermediate endemic hepatitis
- Infants age 6–11 months: 1 dose before departure
- Revaccinate with 2 doses, separated by at least 6 months, between 12 to 23 months of age
- Unvaccinated age 12 months and older: 1st dose as soon as travel considered
- See: http://www.cdc.gov/travel/
- Catch-up vaccination
- Unvaccinated persons through age 18 years
- Should complete a 2-dose series (minimum interval: 6 months)
- Persons who previously received 1 dose at age 12 months or older
- Should receive dose 2 at least 6 months after dose 1
- Adolescents age 18 or older
- May received combined HepA and HepB vaccine, Twinrix, as a 3-dose series (0, 1 and 6 months) or
- 4-dose series (3 doses at 0, 7 and 21-30 days, followed by a booster dose at 12 months)
- Special populations
- Previously unvaccinated persons in whom the following apply should be vaccinated
- Persons traveling to or working in countries that have high or intermediate endemicity of infection
- Men having sex with men
- Persons with clotting-factor disorders
- Persons with chronic liver disease; and
- Persons who anticipate close, personal contact (e.g., household or regular babysitting) with an international adoptee during the first 60 days after arrival in the United States from a country with high or intermediate endemicity
- The first dose should be administered as soon as the adoption is planned, ideally, 2 or more weeks before the arrival of the adoptee
Meningococcal Vaccination Guidance
- Serogroup A, C, W, Y meningococcal vaccines
- Routine vaccination
- Serogroup A, C, W, Y meningococcal vaccines; minimum age: 2 months (Menveo), 9 months (Menactra), 2 years (MenQuadfi)
- 2-dose series: 11-12 years and 16 years
- Catch-up vaccination
- Age 13-15 years
- Administer 1 dose now and a booster at age 16-18 years; minimum interval 8 weeks
- Age 16-18 years
- For medical indications and special populations, click here
- Serogroup B meningococcal vaccines
- Clinical discretion: adolescents not at increased risk for meningococcal B infection who want MenB vaccine
- MenB vaccines may be given at clinical discretion to adolescents 16–23 years (preferred age 16–18 years) who are not at increased risk
- Minimum age: 10 years (MenB-4C, Bexsero; MenB-FHbp, Trumenba)
- Bexsero: 2 doses at least 1 month apart
- Trumenba: 2 doses at least 6 months apart
- If the 2nd dose is given earlier than 6 months, administer the 3rd dose at least 4 months after dose 2
- For medical indications and special populations, click here
Tetanus, Diphtheria: Tetanus, diphtheria, and acellular pertussis (Tdap) Vaccination Guidance
- Routine vaccination
- The minimum age for routine vaccination: 11 years
- Adolescents 11–12 years of age: 1 dose Tdap
- Pregnant adolescents: 1 dose during each pregnancy (preferably during the early part of gestational weeks 27–36)
- Tdap may be administered regardless of the interval since last tetanus- and diphtheria-toxoid-containing vaccine
- Catch-up vaccination
- The minimum age for catch-up vaccination: 7 years
- Adolescents 13–18 years who have not received Tdap: 1 dose Tdap, followed by a Td or Tdap booster every 10 years
- Persons aged 7–18 years not fully immunized with DTaP: 1 dose of Tdap as part of the catch-up series (preferably the first dose); if additional doses are needed, use Td or Tdap
- Tdap administered at age 7–10 years
- Children age 7–9 years who receive Tdap should receive the routine Tdap dose at age 11–12 years
- Children age 10 years who receive Tdap do not need the routine Tdap dose at age 11–12 years
- DTaP inadvertently administered on or after age 7 years
- Children age 7–9 years: DTaP may count as part of catch-up series
- Administer routine Tdap dose at age 11–12 years
- Children age 10–18 years: Count dose of DTaP as the adolescent Tdap booster
- Interval between doses
- Dose 1 to dose 2
- Dose 2 to dose 3
- 4 weeks if the first dose of DTaP/DT was administered before the 1st birthday
- 6 months (as final dose) if the first dose of DTaP/DT or Tdap/Td was administered at or after the 1st birthday
- Dose 3 to dose 4
- 6 months if the first dose of DTaP/DT was administered before the 1st birthday
- Fully vaccinated = 5 valid doses of DTaP OR 4 valid doses of DTaP if dose 4 was administered at age 4 years or older
Human Papillomavirus Vaccination Guidance
- Routine and catch-up vaccination
- Minimum age: 9 years
- Routine vaccination for all adolescents at 11–12 years (can start at age 9 years)
- Catch-up vaccination through age 18 years if not previously adequately vaccinated
- Number of doses dependent on age at initial vaccination
- Age 9–14 years at initiation
- 2-dose series at 0 and 6–12 months
- Minimum interval: 5 months (repeat a dose given too soon at least 12 weeks after the invalid dose and at least 5 months after the 1st dose)
- Age 15 years or older at initiatial vaccination
- 3-dose series at 0, 1–2, and 6 months
- Minimum intervals: 4 weeks between 1st and 2nd dose; 12 weeks between 2nd and 3rd dose; 5 months between 1st and 3rd dose (repeat dose(s) given too soon at or after the minimum interval since the most recent dose)
- Interrupted schedules: If vaccination schedule is interrupted, the series does not need to be restarted
- Persons who have completed a valid series with any HPV vaccine do not need any additional doses
- Special populations:
- History of sexual abuse or assault
- Begin series at age 9 years
- Immunocompromised (including HIV) 3 dose series even for those who initiate vaccination at age 9–14 years
- Pregnancy
- Vaccination not recommended until after pregnancy
- Pregnancy testing not needed before vaccination
- No intervention if vaccinated while pregnant
References
- Centers for Disease Control and Prevention (CDC). Child and Adolescent Immunization Schedule by Age. Available at: https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html. [Accessed August 2023]
Contributor(s)
- Hernandez, James, DO
- Singh, Ajaydeep, MD
Updated/Reviewed: August 2023