Recommended immunization schedule for children age 0 through 6 years - United States, 2022 (for those who fall behind or start late, refer to UpToDate content related to the catch-up schedule)

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.
When a vaccine is not administered at the recommended age, administer at a subsequent visit.
Use combination vaccines instead of separate injections when appropriate.
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.
Report suspected cases of reportable vaccine-preventable diseases or outbreaks to your state or local health department.
For information about precautions and contraindications, refer to https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/contraindications.html.
For information regarding vaccination in the setting of a vaccine-preventable disease outbreak, contact your state or local health department.
COVID-19 vaccines are recommended for use within the scope of the Emergency Use Authorization or Biologics License Application for the particular vaccine. ACIP recommendations for the use of COVID-19 vaccines can be found at https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/covid-19.html. Interim clinical considerations for use of COVID-19 vaccines can be found at https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html.

MenACWY-CRM: Menveo; MenACWY-D: Menactra; MenACWY-TT: MenQuadfi; COVID-19: coronavirus disease 2019; HBsAg: hepatitis B surface antigen; HBIG: hepatitis B immune globulin; anti-HBs: hepatitis B surface antibody; mIU: milli-international units; MMRV: combined measles, mumps, rubella, and varicella vaccine.

* School entry age group.

¶ Hepatitis B (HepB) vaccination

(Minimum age: Birth)

Birth dose (monovalent HepB vaccine only):
- Mother is HBsAg-negative:
  - All medically stable infants ≥2 kg: 1 dose within 24 hours of birth.
  - Infants <2 kg: Administer 1 dose at chronologic age 1 month or hospital discharge (whichever is earlier and even if weight is still <2 kg).
- Mother is HBsAg-positive:
  - Administer HepB vaccine and HBIG (in separate limbs) within 12 hours of birth, regardless of birth weight. For infants <2 kg, administer 3 additional doses of vaccine (total of 4 doses) beginning at age 1 month.
  - Test for HBsAg and anti-HBs at age 9 through 12 months. If HepB series is delayed, test 1 to 2 months after final dose.
- Mother's HBsAg status is unknown:
  - Administer HepB vaccine within 12 hours of birth, regardless of birth weight.
  - For infants <2 kg, administer HBIG in addition to HepB vaccine (in separate limbs) 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 mother is HBsAg-positive, administer HBIG to infants ≥2 kg as soon as possible, but no later than 7 days of age.
Routine vaccination:
- Three-dose series at ages 0, 1 through 2, and 6 through 18 months (use monovalent HepB vaccine for doses administered before age 6 weeks).
- Infants who did not receive a birth dose should begin the series as soon as feasible. Refer to UpToDate content related to the catch-up immunization schedule.
- Administration of 4 doses is permitted when a combination vaccine containing HepB is used after the birth dose.
- Minimum age for the final (third or fourth) dose: 24 weeks.
- 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 administered, substitute "dose 4" for "dose 3" in these calculations).
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:
  - Infants born to HBsAg-positive mothers.
  - Hemodialysis patients.
  - Other immunocompromised persons.
- Refer to the ACIP recommendations for detailed revaccination recommendations.

Δ Rotavirus (RV) vaccination

(Minimum age: 6 weeks)

RV1 (Rotarix): 2-dose series at 2 and 4 months.
RV5 (RotaTeq): 3-dose series at 2, 4, and 6 months.
If any dose in the series is either RV5 or unknown, default to 3-dose series.

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

(Minimum age: 6 weeks; exception: 4 years for DTaP-inactivated poliovirus [Kinrix, Quadracel])

Five-dose series at 2, 4, 6, and 15 through 18 months, and 4 through 6 years:
- Prospectively: Dose 4 may be given as early as age 12 months if at least 6 months have elapsed since dose 3.
- Retrospectively: A fourth dose that was inadvertently given as early as 12 months may be counted if at least 4 months have elapsed since dose 3.

§ Haemophilus influenzae type b (Hib) vaccination

(Minimum age: 6 weeks)

Routine vaccination:
- ActHIB, Hiberix, Pentacel, or Vaxelis: 4-dose series (3-dose primary series at age 2, 4, and 6 months, followed by a booster dose at age 12 through 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 at age 12 through 15 months).
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 complement component deficiency.

¥ Pneumococcal vaccination

(Minimum age: 6 weeks [PCV13], 2 years [PPSV23])

Routine vaccination with PCV13:
- Four-dose series at age 2, 4, 6, and 12 through 15 months.
Special situations:
- Refer to UpToDate content related to pneumococcal vaccines in children and immunization in the specific high-risk condition 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.
- When both PCV13 and PPSV23 are indicated, administer PCV13 first. PCV13 and PPSV23 should not be administered during the same visit.

‡ Inactivated poliovirus (IPV) vaccination

(Minimum age: 6 weeks)

Four-dose series at ages 2, 4, and 6 through 18 months, and 4 through 6 years; administer the final dose on or after age 4 years and at least 6 months after the previous dose.
Four or more doses of IPV can be administered before age 4 years when a combination vaccine containing IPV is used. However, a dose is still recommended at or after age 4 years and at least 6 months after the previous dose.

† Influenza vaccination

(Minimum age: 6 months for inactivated influenza vaccine [IIV]; 2 years for live attenuated influenza vaccine [LAIV4])

Use any influenza vaccine appropriate for age and health status annually (refer to UpToDate content related to influenza vaccination in children and the 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, refer to the 2022-2023 ACIP influenza vaccine recommendations.

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

(Minimum age: 12 months for routine vaccination)

Routine vaccination:
- Two-dose series at age 12 through 15 months and age 4 through 6 years.
- MMR or MMRV may be administered. For dose 1 in children age 12 through 47 months, it is recommended to administer MMR and varicella vaccines separately. MMRV may be used if parents or caregivers express a preference.
International travel:
- Infants age 6 through 11 months: 1 dose before departure; revaccinate with 2-dose series at age 12 through 15 months (12 months for children in high-risk areas) and dose 2 as early as 4 weeks later.
- Unvaccinated children age 12 months or older: 2 doses at least 4 weeks apart before departure.

¶¶ Varicella (VAR) vaccination

(Minimum age: 12 months)

Two-dose series at 12 through 15 months and 4 through 6 years.
VAR or MMRV may be administered. For dose 1 in children age 12 through 47 months, it is recommended to administer MMR and varicella vaccines separately. MMRV may be used if parents or caregivers express a preference.
Dose 2 may be administered as early as 3 months after dose 1 (a dose administered after a 4-week interval may be counted).

ΔΔ Hepatitis A (HepA) vaccination

(Minimum age: 12 months for routine vaccination)

Routine vaccination:
- Two-dose series (minimum interval: 6 months) at age 12 through 23 months.
International travel:
- Persons traveling to or working in countries with high or intermediate endemic hepatitis A (refer to wwwnc.cdc.gov/travel):
  - Infants age 6 through 11 months: 1 dose before departure; revaccinate with 2 doses, separated by at least 6 months, between age 12 and 23 months.
  - Unvaccinated age 12 months or older: Administer dose 1 as soon as travel is considered.

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

(Minimum age: 2 months for MenACWY-CRM [Menveo]; 9 months for MenACWY-D [Menactra]; 2 years for MenACWY-TT [MenQuadfi])

Special situations:
- Refer to UpToDate content related to meningococcal vaccines and immunization in the specific high-risk group and the ACIP recommendations. High-risk groups 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).
NOTE: MenACWY-D should be administered before or at the same time as DTaP.

Adapted from: Centers for Disease Control and Prevention. Immunization schedules. Available at: https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html (Accessed on September 29, 2022).

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