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Summary of schedule, dose, route, and preferred site for routinely recommended immunizations for children <18 years of age in the United States

Vaccine	Recommended ages for routine administration	Dose	Route	Preferred site
Inactivated vaccines and/or toxoids
Diphtheria, tetanus, acellular pertussis	2 months 4 months 6 months 15 through 18 months 4 through 6 years	0.5 mL	IM	<3 years: Anterolateral thigh (vastus lateralis) ≥3 years: Deltoid
Haemophilus influenzae type b	2 months 4 months 6 months* 12 through 15 months	0.5 mL	IM	Anterolateral thigh
Hepatitis A	Two doses, at least 6 months apart, between 12 and 24 months	0.5 mL	IM	Anterolateral thigh
Hepatitis B^¶	Within 24 hours of birth 1 to 2 months 6 to 12 months	0.5 mL	IM	Anterolateral thigh
Human papillomavirus^Δ	11 through 12 years: Two doses separated by at least six months	0.5 mL	IM	Deltoid
Influenza, inactivated	One or two doses annually^◊ for children ≥6 months of age	Child 6 through 35 months: 0.25 ( Afluria) or 0.5 mL (Fluarix, FluLaval, or Fluzone) Child ≥36 months: 0.5 mL	IM	<3 years: Anterolateral thigh ≥3 years: Deltoid
Meningococcal conjugate vaccine, quadrivalent	11 through 12 years 16 years	0.5 mL	IM	Deltoid
Meningococcal serogroup B^§	16 to 18 years	0.5 mL	IM	Deltoid
Pneumococcal conjugate vaccine	2 months 4 months 6 months 12 through 15 months	0.5 mL	IM	Anterolateral thigh
Poliovirus, inactivated	2 months 4 months 6 through 18 months 4 through 6 years	0.5 mL	IM or subcutaneous	IM: <3 years: Anterolateral thigh (vastus lateralis) ≥3 years: Deltoid Subcutaneous: <12 months: Fatty tissue over anterolateral thigh ≥12 months: Fatty tissue over upper-outer triceps^¥
Tetanus toxoid, reduced diphtheria toxoid, acellular pertussis	11 through 12 years	0.5 mL	IM	Deltoid
Inactivated combination vaccines
DTaP-HepB-IPV vaccine (Pediarix)	2 months 4 months 6 months	0.5 mL	IM	Anterolateral thigh
DTaP-IPV/Hib vaccine (Pentacel)	2 months 4 months 6 months 15 through 18 months	0.5 mL	IM	Anterolateral thigh
DTaP-IPV-Hib-HepB vaccine (Vaxelis)	2 months 4 months 6 months	0.5 mL	IM	Anterolateral thigh
DTaP-IPV vaccine (Kinrix, Quadricel)	4 through 6 years	0.5 mL	IM	Deltoid
Live attenuated vaccines
Influenza, live attenuated	One or two doses annually^◊ for children ≥2 years of age	0.2 mL (0.1 mL in each nostril)	Intranasal	–
Measles, mumps, and rubella	12 through 15 months 4 through 6 years	0.5 mL	Subcutaneous	Fatty tissue over upper-outer triceps^¥
Rotavirus	RV1: 2 months 4 months	1 mL	Orally	–
Rotavirus	RV5: 2 months 4 months 6 months	2 mL	Orally	–
Varicella	12 through 15 months 4 through 6 years	0.5 mL	Subcutaneous	Fatty tissue over upper-outer triceps^¥
Dengue^‡	9 through 16 years 3 doses separated by 6 months	0.5 mL	Subcutaneous	Fatty tissue over upper-outer triceps^¥
Live attenuated combination vaccines
MMRV vaccine (ProQuad) Available only for children ≤12 years	12 through 15 months^† 4 through 6 years	0.5 mL	Subcutaneous	Fatty tissue over upper-outer triceps^¥
Viral component vaccines
COVID-19 vaccines	Refer to UpToDate content on COVID-19 vaccines.

This table summarizes recommendations for routine childhood immunizations in the United States.

IM: intramuscular; DTaP: diphtheria, tetanus, acellular pertussis; HepB: hepatitis B; IPV: inactivated poliovirus; Hib: H. influenzae type b; Hib-MenCY: Hib-meningococcal serogroups CY combination vaccine; RV1: attenuated human rotavirus vaccine; RV5: pentavalent human-bovine rotavirus reassortant vaccine; MMRV: measles, mumps, rubella, and varicella; COVID-19: coronavirus disease 2019; MMR: measles, mumps, and rubella.

* The 6 month dose may not be necessary, depending upon vaccine formulation.

¶ The recommended schedule varies with birth weight and hepatitis B surface antigen status of the mother. Refer to UpToDate content on hepatitis B vaccines for infants for details.

Δ If the human papillomavirus series is initiated at age ≥15 years, three doses should be administered: The second dose is recommended one to two months after the first dose, and the third dose is recommended six months after the first dose.

◊ Refer to UpToDate content on seasonal influenza vaccines for children for additional information.

§ Meningococcal serogroup B vaccines are not routinely recommended for adolescents who are not at increased risk for meningococcal disease. However, they may be given to adolescents and young adults age 16 through 23 years.

¥ The fatty tissue over the upper-outer triceps is the preferred site. The fatty tissue over the anterolateral thigh is an acceptable alternative.

‡ For children who live in dengue endemic United States territories and sovereign states in free association with the United States (American Samoa, Federated States of Micronesia, Republic of Marshall Islands, Republic of Palau, Puerto Rico, United States Virgin Islands) and have laboratory confirmation of previous Dengue infection. Refer to the ACIP recommendations and www.cdc.gov/dengue/vaccine/hcp/index.html.

† Administration MMRV as the first dose of measles-containing vaccine at age 12 through 15 months has been associated with an increased risk of febrile seizures. The Centers for Disease Control and Prevention and American Academy of Pediatrics suggest that MMR and varicella vaccine be administered as separate injections at age 12 through 15 months unless the parents/caregivers have a preference for MMRV. Refer to UpToDate content on MMR and varicella vaccination for children for additional details

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