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Catch-up immunization schedule for children age 4 months through 6 years who start late or who are more than 1 month behind – United States, 2022

Vaccine	Minimum age for dose 1	Minimum interval between doses
Vaccine	Minimum age for dose 1	Dose 1 to dose 2	Dose 2 to dose 3	Dose 3 to dose 4	Dose 4 to dose 5
Hepatitis B (HepB)*	Birth	4 weeks	8 weeks and at least 16 weeks after first dose Minimum age for the final dose is 24 weeks
Rotavirus (RV)^¶	6 weeks (maximum age for first dose is 14 weeks, 6 days)	4 weeks	4 weeks^¶ Maximum age for final dose is 8 months, 0 days
Diphtheria, tetanus, and acellular pertussis (DTaP)^Δ	6 weeks	4 weeks	4 weeks	6 months	6 months^Δ
Haemophilus influenzae type b (Hib)^◊	6 weeks	No further doses needed if first dose was administered at age 15 months or older	No further doses needed if previous dose was administered at age 15 months or older	8 weeks (as final dose) This dose is only necessary for children age 12 through 59 months who received 3 doses before the first birthday
		4 weeks if first dose was administered before the first birthday	4 weeks^◊ if current age is younger than 12 months and first dose was administered at younger than age 7 months and at least 1 previous dose was PRP-T (ActHib, Pentacel, Hiberix), Vaxelis or unknown
		8 weeks (as final dose) if first dose was administered at age 12 through 14 months	8 weeks and age 12 through 59 months (as final dose^◊) If current age is younger than 12 months and first dose was administered at age 7 through 11 months; or If current age is 12 through 59 months and first dose was administered before the first birthday, and second dose was administered at younger than 15 months; or If both doses were PedvaxHIB and were administered before the first birthday
Pneumococcal conjugate (PCV13 or PCV15)^§	6 weeks	No further doses needed for healthy children if first dose was administered at age 24 months or older	No further doses needed for healthy children if previous dose was administered at age 24 months or older	8 weeks (as final dose) This dose is only necessary for children age 12 through 59 months who received 3 doses before age 12 months or for children at high risk who received 3 doses at any age
		4 weeks if first dose was administered before the first birthday	4 weeks if current age is younger than 12 months and previous dose was administered before age 7 months
		8 weeks (as final dose for healthy children) if first dose was administered at the first birthday or after	8 weeks (as final dose for healthy children) If previous dose given between 7 and 11 months (wait until at least 12 months old); or If current age is 12 months or older and at least 1 dose was given before age 12 months
Inactivated poliovirus (IPV)^¥	6 weeks	4 weeks^¥	4 weeks^¥ if current age is younger than 4 years	6 months^¥ (minimum age 4 years for final dose)
Inactivated poliovirus (IPV)^¥	6 weeks	4 weeks^¥	6 months (as final dose) if current age is 4 years or older	6 months^¥ (minimum age 4 years for final dose)
Measles, mumps, and rubella (MMR)^‡	12 months	4 weeks
Varicella (VAR)^†	12 months	3 months
Hepatitis A (HepA)**	12 months	6 months
Meningococcal serogroup A, C, W, Y (MenACWY)^¶¶	MenACWY-CRM: 2 months MenACWY-D: 9 months MenACWY-TT: 2 years	8 weeks	Refer to footnote ¶¶	Refer to footnote ¶¶

The above table provides catch-up schedules and minimum intervals between doses for children whose vaccinations have been delayed. A vaccine series does not need to be restarted, regardless of the time that has elapsed between doses. Use this table in conjunction with its footnotes and related UpToDate content regarding the schedule of recommended childhood immunizations for children 0 through 6 years of age in the United States. This schedule is recommended by the Advisory Committee on Immunization Practices (ACIP) and approved by the Centers for Disease Control and Prevention, American Academy of Pediatrics, American Academy of Family Physicians, American College of Obstetricians and Gynecologists, American College of Nurse-Midwives, American Academy of Physician Associates, and National Association of Pediatric Nurse Practitioners.

Consult relevant ACIP statements for detailed recommendations.
For calculating intervals between doses, 4 weeks = 28 days. Intervals of ≥4 months are determined by calendar months.
Vaccine doses administered ≤4 days before the minimum age or interval are considered valid. Doses of any vaccine administered ≥5 days earlier than the minimum age or minimum interval should not be counted as valid and should be repeated as age appropriate. The repeat dose should be spaced after the invalid dose by the recommended minimum interval. For further details, refer to ACIP's General Best Practice Guidelines for Immunizations.
For information about precautions and contraindications, refer to https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/contraindications.html.
Report clinically significant adverse events to the Vaccine Adverse Event Reporting System (VAERS) online at https://vaers.hhs.gov or by telephone, 800-822-7967.
For information regarding vaccination in the setting of a vaccine-preventable disease outbreak, contact your state or local health department.

PRP-T: polyribosylribitol phosphate conjugated to tetanus toxoid; MenACWY-CRM: Menveo; MenACWY-D: Menactra; MenACWY-TT: MenQuadfi; MMWR: Morbidity and Mortality Weekly Report.

* Hepatitis B (HepB) vaccination

Unvaccinated children should complete a 3-dose series at 0, 1 to 2, and 6 months.

¶ Rotavirus (RV) vaccination

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.
If any dose in the series is either RV5 (RotaTeq) or unknown, default to a 3-dose series.

Δ Diphtheria and tetanus toxoids, and acellular pertussis (DTaP) vaccination

Dose 5 is not necessary if dose 4 was administered at age 4 years or older and at least 6 months after dose 3.

◊ Haemophilus influenzae type b (Hib) vaccination

Dose 1 at age 7 through 11 months: Administer dose 2 at least 4 weeks later and dose 3 (final dose) at age 12 through 15 months or 8 weeks after dose 2 (whichever is later).
Dose 1 at age 12 through 14 months: Administer dose 2 (final dose) at least 8 weeks after dose 1.
Dose 1 before age 12 months and dose 2 before age 15 months: Administer dose 3 (final dose) 8 weeks after dose 2.
Two doses of PedvaxHIB before age 12 months: Administer dose 3 (final dose) at 12 through 59 months and at least 8 weeks after dose 2.
One dose administered at age 15 months or older: No further doses needed.
Unvaccinated at age 15 through 59 months: Administer 1 dose. Unvaccinated is defined by less than the routine series (through age 14 months) or no doses (age 15 months or older).
Previously unvaccinated children age 60 months or older who are not considered high risk do not require catch-up vaccination.
DTaP-IPV-Hib-HepB (Vaxelis) can be used for catch-up vaccination in children less than age 5 years. Follow the catch-up schedule even if DTaP-IPV-Hib-HepB is used for one or more doses. For detailed information on use of DTaP-IPV-Hib-HepB refer to MMWR Morb Mortal Wkly Rep 2020; 69:136.
Special situations:
- Refer to UpToDate content related to the routine immunization schedule, Hib vaccination, and immunization in the specific high-risk group, and the ACIP recommendations. High-risk conditions and special situations include chemotherapy or radiation treatment, hematopoietic cell transplant, anatomic or functional asplenia (including sickle cell disease), elective splenectomy, HIV infection, immunoglobulin deficiency, and early complement component deficiency.

§ Pneumococcal conjugate (PCV13 or PCV15) vaccination

One dose for healthy children age 24 through 59 months with any incomplete PCV series. An incomplete series is defined as not having received all doses in either the recommended series or an age-appropriate catch-up series. Refer to the ACIP recommendations for details.
Special situations:
- Refer to UpToDate content related to the routine immunization schedule, pneumococcal vaccines in children, and immunization in the specific high-risk group, and the ACIP recommendations. High-risk conditions 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; and chronic liver disease.

¥ Inactivated poliovirus (IPV) 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.
Four or more doses of IPV can be administered before the fourth birthday when a combination vaccine containing IPV is used. However, a dose is still recommended after the fourth birthday 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 United States IPV schedule. Refer to MMWR Morb Mortal Wkly Rep 2017; 66:23.
- Only trivalent OPV (tOPV) counts toward the United States vaccination requirements.
  - Doses of OPV administered before April 1, 2016, should be counted (unless specifically noted as administered during a campaign).
  - Doses of OPV administered on or after April 1, 2016, should not be counted.
  - For guidance to assess doses documented as "OPV," refer to MMWR Morb Mortal Wkly Rep 2017; 66:180.

‡ Measles, mumps, and rubella (MMR) vaccination

Unvaccinated children: 2-dose series at least 4 weeks apart.

† Varicella (VAR) vaccination

The minimum interval between the 2 doses is 3 months.

** Hepatitis A (HepA) vaccination

Unvaccinated children 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.

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

Special situations:
- Refer to UpToDate content related to the routine immunization schedule, meningococcal vaccination, and immunization in the specific high-risk condition, and the ACIP recommendations. High-risk conditions and conditions that increase the risk of disease include anatomic or functional asplenia (including sickle cell disease), HIV infection, persistent complement component deficiency, complement inhibitor (eg, eculizumab, ravulizumab) use, and 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).

Adapted from: Centers for Disease Control and Prevention. Immunization schedules. Available at: www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html (Accessed on February 23, 2022).

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