Recommended immunization schedule for children and adolescents age 7 through 18 years - United States, 2022 (for those who fall behind or start late, refer to UpToDate content related to the catch-up schedule)

anti-HBs: hepatitis B surface antibody; mIU: milli-international units; MMRV: combined measles, mumps, rubella and varicella; MMWR: Morbidity and Mortality Weekly Report.

* Adolescent vaccine age groups.

¶ Tetanus and diphtheria toxoids, and acellular pertussis (Tdap) vaccination

• Adolescents age 11 through 12 years: 1 dose Tdap.
• Pregnancy: 1 dose Tdap during each pregnancy, preferably in early part of gestational weeks 27 through 36.
• Tdap may be administered regardless of the interval since the last tetanus- and diphtheria-toxoid-containing vaccine.

Δ Human papillomavirus (HPV) vaccination

• Routine vaccination:
  • HPV vaccination routinely recommended at age 11 through 12 years (can start at age 9 years) and catch-up HPV vaccination recommended for all persons through age 18 years if not adequately vaccinated.
  • Two- or 3-dose series depending on age at initial vaccination:
    • Age 9 through 14 years at initial vaccination: 2-dose series at 0 and 6 to 12 months (minimum interval: 5 months; repeat dose if administered too soon).
    • Age 15 years or older at initial vaccination: 3-dose series at 0, 1 to 2 months, and 6 months (minimum intervals: dose 1 to dose 2: 4 weeks; dose 2 to dose 3: 12 weeks; dose 1 to dose 3: 5 months; repeat dose if administered too soon).
  • Interrupted schedules: If vaccination schedule is interrupted, the series does not need to be restarted.
  • No additional dose recommended after completing series with recommended dosing intervals.
• Special situations:
  • Immunocompromising conditions, including HIV infection: 3-dose series as above.
  • History of sexual abuse or assault: Start at age 9 years.
  • Pregnancy: Pregnancy testing not needed before vaccination. HPV vaccination not recommended until after pregnancy; no intervention needed if vaccinated while pregnant.

◊ Meningococcal serogroup A, C, W, Y (MenACWY) vaccination

• Routine vaccination:
  • Two-dose series at 11 through 12 years and 16 years.
• Special situations:
  • Refer to UpToDate content related to meningococcal vaccines and immunization in the specific high-risk group, and the ACIP recommendations. High-risk conditions include anatomic or functional asplenia (including sickle cell disease); HIV infection; persistent complement component deficiency; complement inhibitor (eg, eculizumab, ravulizumab) use; travel in countries with hyperendemic or epidemic meningococcal disease, including countries in the African meningitis belt or during the Hajj (refer to wwwnc.cdc.gov/travel); first-year college students who live in residential housing (if not previously vaccinated at age 16 years or older); and military recruits.

§ Meningococcal serogroup B (MenB) vaccination

• Shared clinical decision-making:
  • Adolescents not at increased risk age 16 through 23 years (preferred age 16 through 18 years) based on shared clinical decision-making:
    • Bexsero: 2-dose series at least 1 month apart.
    • Trumenba: 2-dose series at least 6 months apart; if dose 2 is administered earlier than 6 months, administer a third dose at least 4 months after dose 2.
• Special situations:
  • Anatomic or functional asplenia (including sickle cell disease), persistent complement component deficiency, complement inhibitor (eg, eculizumab, ravulizumab) use:
    • Bexsero: 2-dose series at least 1 month apart.
    • Trumenba: 3-dose series at 0, 1 to 2, and 6 months.
• NOTE: Bexsero and Trumenba are not interchangeable; the same product should be used for all doses in a series.
• For additional information, refer to UpToDate content on meningococcal vaccines and immunization in the specific high-risk group and the ACIP recommendations.

¥ Influenza vaccines

• Use any influenza vaccine appropriate for age and health status annually (refer to UpToDate content on influenza vaccination in children and ACIP recommendations):
  • Two doses, separated by at least 4 weeks, for children age 6 months through 8 years who have received fewer than 2 influenza vaccine doses before July 1, 2021, or whose influenza vaccination history is unknown (administer dose 2 even if the child turns 9 between receipt of dose 1 and dose 2).
  • One dose for children age 6 months through 8 years who have received at least 2 influenza vaccine doses before July 1, 2021.
  • One dose for all persons age 9 years or older.
• For the 2022-2023 season, see the 2022-2023 ACIP influenza vaccine recommendations.

‡ Pneumococcal vaccination

• Special situations:
  • Refer to UpToDate content on pneumococcal vaccines and immunization in the specific high-risk group and the ACIP recommendations. High-risk groups include chronic heart disease (particularly cyanotic congenital heart disease and cardiac failure); chronic lung disease (including asthma treated with high-dose, oral corticosteroids); diabetes mellitus; cerebrospinal fluid leak; cochlear implant; sickle cell disease and other hemoglobinopathies; anatomic or functional asplenia; congenital or acquired immunodeficiency; HIV infection; chronic kidney failure; nephrotic syndrome; malignant neoplasms, leukemias, lymphomas, Hodgkin disease, and other diseases associated with treatment with immunosuppressive drugs or radiation therapy; solid organ transplantation; multiple myeloma; chronic liver disease; and alcoholism.
  • When both PCV13 and PPSV23 are indicated, administer PCV13 first. PCV13 and PPSV23 should not be administered during the same visit.

† Haemophilus influenzae type b (Hib) vaccination

• Special situations:
  • Refer to UpToDate content related to Hib vaccination and immunization in the specific high-risk group and the ACIP recommendations. Special situations and high-risk groups include chemotherapy or radiation treatment, hematopoietic cell transplant, anatomic or functional asplenia (including sickle cell disease), elective splenectomy, HIV infection, immunoglobulin deficiency, and early component complement deficiency.

** Hepatitis A (HepA) vaccination

• Catch-up vaccination:
  • Unvacccinated persons through age 18 years should complete a 2-dose series (minimum interval: 6 months).
  • Adolescents 18 years or older may receive the combined HepA and HepB vaccine, Twinrix, as a 3-dose series (0, 1, and 6 months) or a 4-dose series (0, 7, and 21 to 30 days, followed by a booster dose at 12 months).
• International travel: Persons traveling to or working in countries with high or intermediate endemic hepatitis A:
  • Unvaccinated age 12 months or older: Administer dose 1 as soon as travel is considered.

¶¶ Hepatitis B (HepB) vaccination

• Catch-up vaccination:
  • Unvaccinated persons should complete a 3-dose series at 0, 1 to 2, and 6 months.
  • Adolescents 11 through 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 or older may receive a 2-dose series of HepB (Heplisav-B) at least 4 weeks apart.
  • Adolescents 18 years or older may receive the combined HepA and HepB vaccine, Twinrix, as a 3-dose series (0, 1, and 6 months) or 4-dose series (0, 7, and 21 to 30 days, followed by a dose at 12 months).
• Special situations:
  • Revaccination is not generally recommended for persons with a normal immune status who were vaccinated as infants, children, adolescents, or adults.
  • Postvaccination serology testing and revaccination (if anti-HBs <10 mIU/mL) is recommended for certain populations, including:
    • Hemodialysis patients.
    • Other immunocompromised persons.
  • Refer to the ACIP recommendations for detailed vaccination recommendations.

ΔΔ Inactivated poliovirus (IPV) vaccination

• A dose of IPV is indicated if all previous doses were administered at <4 years or if the third dose was administered <6 months after the second dose.
• IPV is not routinely recommended for United States residents age 18 years or older.

◊◊ Measles, mumps, and rubella (MMR) vaccination

• Routine vaccination:
  • Unvaccinated children and adolescents: 2-dose series at least 4 weeks apart.
  • The maximum age for use of MMRV vaccine is 12 years.
  • Minimum interval between MMRV doses: 3 months.
• International travel:
  • Unvaccinated children 12 months or older: 2-dose series at least 4 weeks apart before departure.

§§ Varicella (VAR) vaccination

• Ensure persons 7 through 18 years without evidence of immunity (refer to MMWR Recomm Rep 2007; 56(RR04):1) have a 2-dose series.
  • Ages 7 through 12 years: Routine interval: 3 months (a dose administered after a 4-week interval may be counted).
  • Ages 13 years or older: Routine interval: 4 to 8 weeks (minimum interval: 4 weeks).
  • The maximum age for use of MMRV vaccine is 12 years.

¥¥ Dengue vaccination

• Routine vaccination:
  • Age 9 through 16 years living in dengue endemic areas and have laboratory confirmation of previous dengue infection: 3-dose series administered at 0,6, and 12 months.
  • Endemic areas include Puerto Rico, American Samoa, United States Virgin Islands, Federated States of Micronesia, Republic of Marshall Islands, and the Republic of Palau. For updated guidance on dengue endemic areas and prevaccination laboratory testing refer to the ACIP recommendations and www.cdc.gov/dengue/vaccine/hcp/index.html.