child vaccine schedule table 1
Vaccine	Birth	1 mo	2 mos	4 mos	6 mos	12 mos	15 mos
Hepatitis B (HepB)	1^st dose	←2^nd dose→			←3^rd dose→
Rotavirus (RV) RV1 (2-dose series); RV5 (3-dose series)			1^st dose	2^nd dose	See notes
Diphtheria, tetanus, & acellular pertussis (DTaP: <7 yrs)			1^st dose	2^nd dose	3^rd dose		←4^th dose→
Haemophilus influenzae type b (Hib)			1^st dose	2^nd dose	See notes	←3^rd or 4^th dose, See notes→
Pneumococcal conjugate (PCV13, PCV15)			1^st dose	2^nd dose	3^rd dose	←4^th dose→
Inactivated poliovirus (IPV: <18 yrs)			1^st dose	2^nd dose	←3^rd dose→
COVID-19 (1vCOV-mRNA, 2vCOV-mRNA, 1vCOV-aPS)					2- or 3-dose primary series and booster (See notes)
Influenza (IIV4)					Annual vaccination 1 or 2 doses
Influenza (LAIV4)
Measles, mumps, rubella (MMR)					See notes	←1^st dose→
Varicella (VAR)						←1^st dose→
Hepatitis A (HepA)					See notes	←2-dose series, See notes→
Tetanus, diphtheria, & acellular pertussis (Tdap: ≥7 yrs)
Human papillomavirus (HPV)
Meningococcal (MenACWY-D: ≥9 mos, MenACWY-CRM: ≥2 mos, MenACWY-TT: ≥2years)			See notes
Meningococcal B (MenB-4C, MenB-FHbp)
Pneumococcal polysaccharide (PPSV23)
Dengue (DEN4CYD: 9-16 yrs)

18 Months to 18 Years

child vaccine schedule table 2
Vaccines	18 mos	2-3 yrs	4-6 yrs	11-12 yrs	16 yrs
Hepatitis B (HepB)	←3^rd dose→
Rotavirus (RV) RV1 (2-dose series); RV5 (3-dose series)
Diphtheria, tetanus, & acellular pertussis (DTaP: <7 yrs)	←4^th dose→		5^th dose
Haemophilus influenzae type b (Hib)
Pneumococcal conjugate (PCV13, PCV15)
Inactivated poliovirus (IPV: <18 yrs)	←3^rd dose→		4^th dose			See notes
COVID-19 (1vCOV-mRNA, 2vCOV-mRNA, 1vCOV-aPS)	2- or 3- dose primary series and booster (See notes)
Influenza (IIV4)	Annual vaccination 1 or 2 doses			Annual vaccination 1 dose only
Influenza (LAIV4)		Annual vaccination 1 or 2 doses		Annual vaccination 1 dose only
Measles, mumps, rubella (MMR)			2^nd dose
Varicella (VAR)			2^nd dose
Hepatitis A (HepA)	← 2-dose series, See notes→
Tetanus, diphtheria, & acellular pertussis (Tdap: ≥7 yrs)				1 dose
Tetanus, diphtheria, & acellular pertussis (Tdap: ≥7 yrs)				1 dose
Human papillomavirus (HPV)				See notes
Human papillomavirus (HPV)				See notes
Meningococcal (MenACWY-D: ≥9 mos, MenACWY-CRM: ≥2 mos, MenACWY-TT: ≥2years)	See notes			1^st dose	2^nd dose
Meningococcal B (MenB-4C, MenB-FHbp)				See notes
Meningococcal B (MenB-4C, MenB-FHbp)
Pneumococcal polysaccharide (PPSV23)		See notes
Dengue (DEN4CYD: 9-16 yrs)				Seropositive in endemic dengue areas (See notes)

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Administer recommended vaccines if immunization history is incomplete or unknown. Do not restart or add doses to vaccine series for extended intervals between doses. When a vaccine is not administered at the recommended age, administer at a subsequent visit. The use of trade names is for identification purposes only and does not imply endorsement by the ACIP or CDC.

Notes

For vaccination recommendations for persons ages 19 years or older, see the Recommended Adult Immunization Schedule, 2023.

Additional information

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.
Within a number range (e.g., 12–18), a dash (–) should be read as “through.”
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, see Table 3-2, Recommended and minimum ages and intervals between vaccine doses, in General Best Practice Guidelines for Immunization.
Information on travel vaccination requirements and recommendations is available at https://www.cdc.gov/travel/.
For vaccination of persons with immunodeficiencies, see Table 8-1, Vaccination of persons with primary and secondary immunodeficiencies, in General Best Practice Guidelines for Immunization, Immunization in Special Clinical Circumstances (In: Kimberlin DW, Barnett ED, Lynfield Ruth, Sawyer MH, eds. Red Book: 2021–2024 Report of the Committee on Infectious Diseases. 32nd ed. Itasca, IL: American Academy of Pediatrics; 2021:72–86).
For information about vaccination in the setting of a vaccine-preventable disease outbreak, contact your state or local health department.
The National Vaccine Injury Compensation Program (VICP) is a no-fault alternative to the traditional legal system for resolving vaccine injury claims. All vaccines included in the child and adolescent vaccine schedule are covered by VICP except for dengue, PPSV23 and COVID-19 vaccines. COVID-19 vaccines that are authorized or approved by the FDA are covered by the Countermeasures Injury Compensation Program (CICP). For more information, see www.hrsa.gov/vaccinecompensation or www.hrsa.gov/cicp.

COVID-19 vaccination
(minimum age: 6 months [Moderna and Pfizer-BioNTech COVID-19 vaccines], 12 years [Novavax COVID-19 Vaccine])

COVID-19 vaccination recommendations have changed. See the latest recommendations.

Primary series:
- Age 6 months–4 years: 2-dose series at 0, 4-8 weeks (Moderna) or 3-dose series at 0, 3-8, 11-16 weeks (Pfizer-BioNTech)
- Age 5–11 years: 2-dose series at 0, 4-8 weeks (Moderna) or 2-dose series at 0, 3-8 weeks (Pfizer-BioNTech)
- Age 12–18 years: 2-dose series at 0, 4-8 weeks (Moderna) or 2-dose series at 0, 3-8 weeks (Novavax, Pfizer-BioNTech)
For booster dose recommendations see www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us.html

Persons who are moderately or severely immunocompromised

Primary series
- Age 6 months–4 years: 3-dose series at 0, 4, 8 weeks (Moderna) or 3-dose series at 0, 3, 11 weeks (Pfizer-BioNTech)
- Age 5–11 years: 3-dose series at 0, 4, 8 weeks (Moderna) or 3-dose series at 0, 3, 7 weeks (Pfizer-BioNTech)
- Age 12–18 years: 3-dose series at 0, 4, 8 weeks (Moderna) or 2-dose series at 0, 3 weeks (Novavax) or 3-dose series at 0, 3, 7 weeks (Pfizer-BioNTech)
Booster dose: see www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us.html
Pre-exposure prophylaxis (monoclonal antibodies) may be considered to complement COVID-19 vaccination. See www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us.html#immunocompromised

For Janssen COVID-19 Vaccine recipients see COVID-19 schedule at www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us.html

Note: Administer an age-appropriate vaccine product for each dose. Current COVID-19 schedule and dosage formulation available at www.cdc.gov/vaccines/covid-19/downloads/COVID-19-immunization-schedule-ages-6months-older.pdf. For more information on Emergency Use Authorization (EUA) indications for COVID-19 vaccines, see www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/covid-19-vaccines.

For contraindications and precautions to COVID-19 vaccination, see COVID-19 Appendix

Dengue Vaccination
(minimum age: 9 years)

Age 9–16 years living in areas with endemic dengue 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, US Virgin Islands, Federated States of Micronesia, Republic of Marshall Islands, and the Republic of Palau. For updated guidance on dengue endemic areas and pre-vaccination laboratory testing see https://www.cdc.gov/mmwr/volumes/70/rr/rr7006a1.htm and https://www.cdc.gov/dengue/vaccine/hcp/index.html.
Dengue vaccine should not be administered to children traveling to or visiting endemic dengue areas.

For contraindications and precautions to dengue vaccination, see Dengue Appendix

Diphtheria, tetanus, and pertussis (DTaP) vaccination
(minimum age: 6 weeks [4 years for Kinrix® or Quadracel®])

5-dose series at age 2, 4, 6, 15–18 months, 4–6 years
- Prospectively: Dose 4 may be administered as early as age 12 months if at least 6 months have elapsed since dose 3.
- Retrospectively: A 4th dose that was inadvertently administered as early as age 12 months may be counted if at least 4 months have elapsed since dose 3.

Dose 5 is not necessary if dose 4 was administered at age 4 years or older and at least 6 months after dose 3.
For other catch-up guidance, see Table 2.

Wound management in children less than age 7 years with history of 3 or more doses of tetanus-toxoid-containing vaccine: For all wounds except clean and minor wounds, administer DTaP if more than 5 years since last dose of tetanus-toxoid-containing vaccine. For detailed information, see www.cdc.gov/mmwr/volumes/67/rr/rr6702a1.htm.

For contraindications and precautions to Diphtheria, tetanus, pertussis (DTaP) vaccination, see DTaP Appendix

Haemophilus influenzae type b vaccination
(minimum age: 6 weeks)

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 12–15 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)

Dose 1 at age 7–11 months: Administer dose 2 at least 4 weeks later and dose 3 (final dose) at age 12–15 months or 8 weeks after dose 2 (whichever is later).
Dose 1 at age 12–14 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) at least 8 weeks after dose 2.
2 doses of PedvaxHIB^® before age 12 months: Administer dose 3 (final dose) at age 12–59 months and at least 8 weeks after dose 2.
1 dose administered at age 15 months or older: No further doses needed
Unvaccinated at age 15–59 months: Administer 1 dose.
Previously unvaccinated children age 60 months or older who are not considered high risk: Do not require catch-up vaccination

For other catch-up guidance, see Table 2. 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. For detailed information on use of Vaxelis^® see www.cdc.gov/mmwr/volumes/69/wr/mm6905a5.htm.

Chemotherapy or radiation treatment:
Age 12–59 months
- Unvaccinated or only 1 dose before age 12 months: 2 doses, 8 weeks apart
- 2 or more doses before age 12 months: 1 dose at least 8 weeks after previous dose
Doses administered within 14 days of starting therapy or during therapy should be repeated at least 3 months after therapy completion.
Hematopoietic stem cell transplant (HSCT):
- 3-dose series 4 weeks apart starting 6 to 12 months after successful transplant regardless of Hib vaccination history
Anatomic or functional asplenia (including sickle cell disease):
Age 12–59 months
- Unvaccinated or only 1 dose before age 12 months: 2 doses, 8 weeks apart
- 2 or more doses before age 12 months: 1 dose at least 8 weeks after previous dose
Unvaccinated* persons age 5 years or older
- 1 dose
Elective splenectomy:
Unvaccinated* persons age 15 months or older
- 1 dose (preferably at least 14 days before procedure)
HIV infection:
Age 12–59 months
- Unvaccinated or only 1 dose before age 12 months: 2 doses, 8 weeks apart
- 2 or more doses before age 12 months: 1 dose at least 8 weeks after previous dose
Unvaccinated* persons age 5–18 years
- 1 dose
Immunoglobulin deficiency, early component complement deficiency:
Age 12–59 months
- Unvaccinated or only 1 dose before age 12 months: 2 doses, 8 weeks apart
- 2 or more doses before age 12 months: 1 dose at least 8 weeks after previous dose

*Unvaccinated = Less than routine series (through age 14 months) OR no doses (age 15 months or older)

For contraindications and precautions to Haemophilus influenzae type b (Hib) vaccination, see Hib Appendix

Hepatitis A vaccination
(minimum age: 12 months for routine vaccination)

2-dose series (minimum interval: 6 months) at age 12–23 months

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 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 (3 doses at 0, 7, and 21–30 days, followed by a booster dose at 12 months).

Persons traveling to or working in countries with high or intermediate endemic hepatitis A
(http://www.cdc.gov/travel/)
- Infants age 6–11 months: 1 dose before departure; revaccinate with 2 doses (separated by at least 6 months) between age 12–23 months.
- Unvaccinated age 12 months or older: Administer dose 1 as soon as travel is considered.

For contraindications and precautions to Hepatitis A (HepA) vaccination, see HepA Appendix

Hepatitis B vaccination
(minimum age: birth)

3-dose series at age 0, 1–2, 6–18 months (use monovalent HepB vaccine for doses administered before age 6 weeks)
- Birth weight ≥2,000 grams: 1 dose within 24 hours of birth if medically stable
- Birth weight <2,000 grams: 1 dose at chronological age 1 month or hospital discharge (whichever is earlier and even if weight is still <2,000 grams).
Infants who did not receive a birth dose should begin the series as soon as possible (see Table 2 for minimum intervals).
Administration of 4 doses is permitted when a combination vaccine containing HepB is used after the birth dose.
Minimum intervals (see Table 2): when 4 doses are administered, substitute “dose 4” for “dose 3” in these calculations
Final (3rd or 4th) dose: age 6–18 months (minimum age 24 weeks)
Mother is HBsAg-positive
- Birth dose (monovalent HepB vaccine only): administer HepB vaccine and hepatitis B immune globulin (HBIG) (in separate limbs) within 12 hours of birth, regardless
  of birth weight.
- Birth weight <2000 grams: administer 3 additional doses of HepB vaccine beginning at age 1 month (total of 4 doses)
- Final (3rd or 4th) dose: administer at age 6 months (minimum age 24 weeks)
- Test for HBsAg and anti-HBs at age 9–12 months. If HepB series is delayed, test 1–2 months after final dose. Do not test before age 9 months.
Mother is HBsAg-unknown
If other evidence suggestive of maternal hepatitis B infection exists (e.g., presence of HBV DNA, HBeAg-positive, or mother known to have chronic hepatitis B infection), manage infant as if mother is HBsAg-positive
- Birth dose (monovalent HepB vaccine only):
  - Birth weight ≥2,000 grams: administer HepB vaccine within 12 hours of birth. Determine mother’s HBsAg status as soon as possible. If mother is determined to be HBsAg-positive, administer HBIG as soon as possible (in separate limb), but no later than 7 days of age.
  - Birth weight <2,000 grams: administer HepB vaccine and HBIG (in separate limbs) within 12 hours of birth. Administer 3 additional doses of HepB vaccine beginning at age 1 month (total of 4 doses)
- Final (3rd or 4th) dose: administer at age 6 months (minimum age 24 weeks)
- If mother is determined to be HBsAg-positive or if status remains unknown, test for HBsAg and anti-HBs at age 9–12 months. If HepB series is delayed, test 1–2 months after final dose. Do not test before age 9 months.

Unvaccinated persons should complete a 3-dose series at 0, 1–2, 6 months. See Table 2 for minimum intervals
Adolescents age 11–15 years may use an alternative 2-dose schedule with at least 4 months between doses (adult formulation Recombivax HB^® only).
Adolescents age 18 years or older may receive:
- Heplisav-B^®: 2-dose series at least 4 weeks apart
- PreHevbrio^®: 3-dose series at 0, 1, and 6 months
- Combined HepA and HepB vaccine, Twinrix^®: 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).

Revaccination is not generally recommended for persons with a normal immune status who were vaccinated as infants, children, adolescents, or adults.
Post-vaccination serology testing and revaccination (if anti-HBs < 10mlU/mL) is recommended for certain populations, including:
- Infants born to HBsAg-positive mothers
- Persons who are predialysis or on maintenance dialysis
- Other immunocompromised persons
- For detailed revaccination recommendations, see http://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/hepb.html.

Note: Heplisav-B and PreHevbrio are not recommended in pregnancy due to lack of safety data in pregnant persons.

For contraindications and precautions to Hepatitis B (HepB) vaccination, see HepB Appendix

Human papillomavirus vaccination
(minimum age: 9 years)

HPV vaccination routinely recommended at age 11–12 years (can start at age 9 years) and catch-up HPV vaccination recommended for all persons through age 18 years if not adequately vaccinated
2- or 3-dose series depending on age at initial vaccination:
- Age 9 –14 years at initial vaccination: 2-dose series at 0, 6–12 months (minimum interval: 5 months; repeat dose if administered too soon)
- Age 15 years or older at initial vaccination: 3-dose series at 0, 1–2 months, 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 when any HPV vaccine series has been completed using the recommended dosing intervals.

Immunocompromising conditions, including HIV infection: 3-dose series, even for those who initiate vaccination at age 9 through 14 years.
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

For contraindications and precautions to Human papillomavirus (HPV) vaccination, see HPV Appendix

Influenza vaccination
(minimum age: 6 months [IIV], 2 years [LAIV4], 18 years [recombinant influenza vaccine, RIV4])

Use any influenza vaccine appropriate for age and health status annually:
- 2 doses, separated by at least 4 weeks, for children age 6 months–8 years who have received fewer than 2 influenza vaccine doses before July 1, 2022, or whose influenza vaccination history is unknown (administer dose 2 even if the child turns 9 between receipt of dose 1 and dose 2)
- 1 dose for children age 6 months–8 years who have received at least 2 influenza vaccine doses before July 1, 2022
- 1 dose for all persons age 9 years or older
For the 2022-2023 season, see www.cdc.gov/mmwr/volumes/71/rr/rr7101a1.htm.
For the 2023–24 season, see the 2023–24 ACIP influenza vaccine recommendations.

Egg allergy, hives only: Any influenza vaccine appropriate for age and health status annually
Egg allergy with symptoms other than hives (e.g., angioedema, respiratory distress) or required epinephrine or another emergency medical intervention: Any influenza vaccine appropriate for age and health status may be administered. If using egg-based IIV4 or LAIV4, administer in medical setting under supervision of health care provider who can recognize and manage severe allergic reactions.
Severe allergic reaction (e.g., anaphylaxis) to a vaccine component or a previous dose of any influenza vaccine: see Appendix listing contraindications and precautions
Close contacts (e.g., caregivers, healthcare personnel) of severely immunosuppressed persons who require a protected environment: these persons should not receive LAIV4. If LAIV4 is given, they should avoid contact with/caring for such immunosuppressed persons for 7 days after vaccination.

For contraindications and precautions to Influenza vaccination, see IIV4 Appendix, LAIV4 Appendix, ccIIV4 Appendix, and RIV4 Appendix.

Measles, mumps, and rubella vaccination
(minimum age: 12 months for routine vaccination)

2-dose series at age 12–15 months, age 4–6 years
MMR or MMRV may be administered

Note: For dose 1 in children age 12–47 months, it is recommended to administer MMR and varicella vaccines separately. MMRV may be used if parents or caregivers express a preference.

Unvaccinated children and adolescents: 2-dose series at least 4 weeks apart
The maximum age for use of MMRV is 12 years.
Minimum interval between MMRV doses: 3 months

International travel
- Infants age 6–11 months: 1 dose before departure; revaccinate with 2-dose series at age 12–15 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-dose series at least 4 weeks apart before departure
In mumps outbreak settings, for information about additional doses of MMR (including 3rd dose of MMR), see www.cdc.gov/mmwr/volumes/67/wr/mm6701a7.htm

For contraindications and precautions to Measles, mumps, rubella (MMR), see MMR Appendix

Meningococcal serogroup A, C, W, Y vaccination (minimum age: 2 months [MenACWY-CRM, Menveo], 9 months [MenACWY-D, Menactra], 2 years [MenACWY-TT, MenQuadfi])

2-dose series at age 11–12 years; 16 years

Age 13–15 years: 1 dose now and booster at age 16–18 years (minimum interval: 8 weeks)
Age 16–18 years: 1 dose

Anatomic or functional asplenia (including sickle cell disease), HIV infection, persistent complement component deficiency, complement inhibitor (e.g., eculizumab, ravulizumab) use:

Menveo^®*
- Dose 1 at age 2 months: 4-dose series (additional 3 doses at age 4, 6, and 12 months)
- Dose 1 at age 3–6 months: 3- or 4- dose series (dose 2 [and dose 3 if applicable] at least 8 weeks after previous dose until a dose is received at age 7 months or older, followed by an additional dose at least 12 weeks later and after age 12 months)
- Dose 1 at age 7–23 months: 2-dose series (dose 2 at least 12 weeks after dose 1 and after age 12 months)
- Dose 1 at age 24 months or older: 2-dose series at least 8 weeks apart
Menactra^®
- Persistent complement component deficiency or complement inhibitor use:
  - Age 9–23 months: 2-dose series at least 12 weeks apart
  - Age 24 months or older: 2-dose series at least 8 weeks apart
- Anatomic or functional asplenia, sickle cell disease, or HIV infection:
  - Age 9–23 months: Not recommended
  - Age 24 months or older: 2-dose series at least 8 weeks apart
  - Menactra^® must be administered at least 4 weeks after completion of PCV series.
MenQuadfi^®
- Dose 1 at age 24 months or older: 2-dose series at least 8 weeks apart

Travel to countries with hyperendemic or epidemic meningococcal disease, including countries in the African meningitis belt or during the Hajj
(www.cdc.gov/travel/):

Children less than age 24 months:
- Menveo^®* (age 2–23 months)
  - Dose 1 at age 2 months: 4-dose series (additional 3 doses at age 4, 6, and 12 months)
  - Dose 1 at age 3–6 months: 3- or 4- dose series (dose 2 [and dose 3 if applicable] at least 8 weeks after previous dose until a dose is received at age 7 months or older, followed by an additional dose at least 12 weeks later and after age 12 months)
  - Dose 1 at age 7–23 months: 2-dose series (dose 2 at least 12 weeks after dose 1 and after age 12 months)
- Menactra^® (age 9–23 months)
  - 2-dose series (dose 2 at least 12 weeks after dose 1; dose 2 may be administered as early as 8 weeks after dose 1 in travelers)
Children age 2 years or older: 1 dose Menveo^®*, Menactra^®, or MenQuadfi^®

First-year college students who live in residential housing (if not previously vaccinated at age 16 years or older) or military recruits:

1 dose Menveo^®*, Menactra^®, or MenQuadfi^®

Adolescent vaccination of children who received MenACWY prior to age 10 years:

Children for whom boosters are recommended because of an ongoing increased risk of meningococcal disease (e.g., those with complement component deficiency, HIV, or asplenia): Follow the booster schedule for persons at increased risk.
Children for whom boosters are not recommended (e.g., a healthy child who received a single dose for travel to a country where meningococcal disease is endemic): Administer MenACWY according to the recommended adolescent schedule with dose 1 at age 11–12 years and dose 2 at age 16 years.

* Menveo has two formulations: lyophilized and liquid. The liquid formulation should not be used before age 10 years.

Note: Menactra^® should be administered either before or at the same time as DTaP. MenACWY may be administered simultaneously with MenB vaccines if indicated, but at a different anatomic site, if feasible.

For MenACWY booster dose recommendations for groups listed under “Special situations” and in an outbreak setting and additional meningococcal vaccination information, see www.cdc.gov/mmwr/volumes/69/rr/rr6909a1.htm.

For contraindications and precautions to Meningococcal ACWY (MenACWY)
[MenACWY-CRM (Menveo^®); MenACWY-D (Menactra^®); MenACWY-TT (MenQuadfi^®)], see MenACWY Appendix

Meningococcal serogroup B vaccination
(minimum age: 10 years [MenB-4C, Bexsero^®; MenB-FHbp, Trumenba^®])

Adolescents not at increased risk age 16–23 years (preferred age 16–18 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 3^rd dose at least 4 months after dose 2)

Anatomic or functional asplenia (including sickle cell disease), persistent complement component deficiency, complement inhibitor (e.g., eculizumab, ravulizumab) use:

Bexsero^®: 2-dose series at least 1 month apart
Trumenba^®: 3-dose series at 0, 1–2, 6 months (if dose 2 was administered at least 6 months after dose 1, dose 3 not needed; if dose 3 is administered earlier than 4 months after dose 2, a 4^th dose should be administered at least 4 months after dose 3)

Note: Bexsero^® and Trumenba^® are not interchangeable; the same product should be used for all doses in a series.

For MenB booster dose recommendations for groups listed under “Special situations” and in an outbreak setting and additional meningococcal vaccination information, see www.cdc.gov/mmwr/volumes/69/rr/rr6909a1.htm.

For contraindications and precautions to Meningococcal B (MenB)
[MenB-4C (Bexsero^®); MenB-FHbp (Trumenba^®)], see MenB Appendix

Pneumococcal vaccination
(minimum age: 6 weeks [PCV13], [PCV15], 2 years [PPSV23])

4-dose series at 2, 4, 6, 12–15 months

Healthy children age 24–59 months with any incomplete* PCV series: 1 dose PCV
For other catch-up guidance, see Table 2.

Note: PCV13 and PCV15 can be used interchangeably for children who are healthy or have underlying conditions. PCV15 is not indicated for children who have received 4 doses of PCV13 or another age appropriate complete PCV13 series.

Underlying conditions below: When both PCV and PPSV23 are indicated, administer PCV first. PCV and PPSV23 should not be administered during the same visit.

Chronic heart disease (particularly cyanotic congenital heart disease and cardiac failure); chronic lung disease (including asthma treated with high-dose, oral corticosteroids); diabetes mellitus:

Age 2–5 years

Any incomplete* series with:
- 3 PCV doses: 1 dose PCV (at least 8 weeks after any prior PCV dose)
- Less than 3 PCV doses: 2 doses PCV (8 weeks after the most recent dose and administered 8 weeks apart)
No history of PPSV23: 1 dose PPSV23 (at least 8 weeks after completing all recommended PCV doses)

Age 6–18 years

Any incomplete* series with PCV: no further PCV doses needed
No history of PPSV23: 1 dose PPSV23 (at least 8 weeks after completing all recommended PCV doses)

Cerebrospinal fluid leak, cochlear implant:

Age 2–5 years

Any incomplete* series with:
- 3 PCV doses: 1 dose PCV (at least 8 weeks after any prior PCV dose)
- Less than 3 PCV doses: 2 doses PCV (8 weeks after the most recent dose and administered 8 weeks apart)
No history of PPSV23: 1 dose PPSV23 (at least 8 weeks after completing all recommended PCV doses)

Age 6–18 years

No history of either PCV or PPSV23: 1 dose PCV, 1 dose PPSV23 at least 8 weeks later
Any PCV but no PPSV23: 1 dose PPSV23 at least 8 weeks after the most recent dose of PCV
PPSV23 but no PCV: 1 dose PCV at least 8 weeks after the most recent dose of PPSV23

Sickle cell disease and other hemoglobinopathies; anatomic or functional asplenia; congenital or acquired immunodeficiency; HIV infection; chronic renal 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:

Age 2–5 years

Any incomplete* series with:
- 3 PCV doses: 1 dose PCV (at least 8 weeks after any prior PCV dose)
- Less than 3 PCV doses: 2 doses PCV (8 weeks after the most recent dose and administered 8 weeks apart)
No history of PPSV23: 1 dose PPSV23 (at least 8 weeks after completing all recommended PCV doses) and a dose 2 of PPSV23 5 years later

Age 6–18 years

No history of either PCV or PPSV23: 1 dose PCV, 2 doses PPSV23 (dose 1 of PPSV23 administered 8 weeks after PCV and dose 2 of PPSV23 administered at least 5 years after dose 1 of PPSV23)
Any PCV but no PPSV23: 2 doses PPSV23 (dose 1 of PPSV23 administered 8 weeks after the most recent dose of PCV and dose 2 of PPSV23 administered at least 5 years after dose 1 of PPSV23)
PPSV23 but no PCV: 1 dose PCV at least 8 weeks after the most recent PPSV23 dose and a dose 2 of PPSV23 administered 5 years after dose 1 of PPSV23 and at least 8 weeks after a dose of PCV

*Incomplete series = Not having received all doses in either the recommended series or an age-appropriate catch-up series see Table 2 in ACIP pneumococcal recommendations at www.cdc.gov/mmwr/volumes/71/wr/mm7137a3.htm

For guidance on determining which pneumococcal vaccines a patient needs and when, please refer to the mobile app, which can be downloaded here: www.cdc.gov/vaccines/vpd/pneumo/hcp/pneumoapp.html

For contraindications and precautions to Pneumococcal conjugate (PCV), see PCV Appendix and Pneumococcal polysaccharide (PPSV23), see PPSV23 Appendix

Poliovirus vaccination
(minimum age: 6 weeks)

4-dose series at ages 2, 4, 6–18 months, 4–6 years; administer the final dose on or after age 4 years and at least 6 months after the previous dose.
4 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 on or after age 4 years and at least 6 months after the previous dose.

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 age 18 years or older.

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. See www.cdc.gov/mmwr/volumes/66/wr/mm6601a6.htm.
Only trivalent OPV (tOPV) counts toward the U.S. 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,” see www.cdc.gov/mmwr/volumes/66/wr/mm6606a7.htm.
For other catch-up guidance, see Table 2.

Adolescents aged 18 years at increased risk of exposure to poliovirus with:
- No evidence of a complete polio vaccination series (i.e., at least 3 doses): administer remaining doses (1, 2, or 3 doses) to complete a 3-dose series
- Evidence of completed polio vaccination series (i.e., at least 3 doses): may administer one lifetime IPV booster

For detailed information, see: www.cdc.gov/vaccines/vpd/polio/hcp/recommendations.html

For contraindications and precautions to Poliovirus vaccine, inactivated (IPV), see Appendix

Rotavirus vaccination
(minimum age: 6 weeks)

Rotarix^®: 2-dose series at age 2 and 4 months
RotaTeq^®: 3-dose series at age 2, 4, and 6 months
If any dose in the series is either RotaTeq^® or unknown, default to 3-dose series.

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.
For other catch-up guidance, see Table 2.

For contraindications and precautions to Rotavirus (RV) [RV1 (Rotarix®), RV5 (RotaTeq®)], see Rotavirus Appendix

Tetanus, diphtheria, and pertussis (Tdap) vaccination
(minimum age: 11 years for routine vaccination, 7 years for catch-up vaccination)

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

Adolescents age 13–18 years who have not received Tdap: 1 dose Tdap, then Td or Tdap booster every 10 years
Persons age 7–18 years not fully vaccinated* with DTaP: 1 dose 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.
For other catch-up guidance, see Table 2.

*Fully vaccinated = 5 valid doses of DTaP OR 4 valid doses of DTaP if dose 4 was administered at age 4 years or older.

Wound management in persons age 7 years or older with history of 3 or more doses of tetanus-toxoid-containing vaccine: For clean and minor wounds, administer Tdap or Td if more than 10 years since last dose of tetanus-toxoid-containing vaccine; for all other wounds, administer Tdap or Td if more than 5 years since last dose of tetanus-toxoid-containing vaccine. Tdap is preferred for persons age 11 years or older who have not previously received Tdap or whose Tdap history is unknown. If a tetanus-toxoid-containing vaccine is indicated for a pregnant adolescent, use Tdap.
For detailed information, see www.cdc.gov/mmwr/volumes/69/wr/mm6903a5.htm.

For contraindications and precautions to Tetanus, diphtheria, and acellular pertussis (Tdap) and Tetanus, diphtheria (Td), see Tdap and Td Appendix

Varicella vaccination
(minimum age: 12 months)

2-dose series at age 12–15 months, 4–6 years
VAR or MMRV may be administered*
Dose 2 may be administered as early as 3 months after dose 1 (a dose inadvertently administered after at least 4weeks may be counted as valid)

*Note: For dose 1 in children age 12–47 months, it is recommended to administer MMR and varicella vaccines separately. MMRV may be used if parents or caregivers express a preference.

Ensure persons age 7–18 years without evidence of immunity (see MMWR at www.cdc.gov/mmwr/pdf/rr/rr5604.pdf ) have a 2-dose series:
- Age 7–12 years: Routine interval: 3 months (a dose inadvertently administered after at least 4 weeks may be counted as valid)
- Age 13 years and older: Routine interval: 4–8 weeks (minimum interval: 4 weeks)
- The maximum age for use of MMRV is 12 years.

For contraindications and precautions to Varicella (VAR), see VAR Appendix

Appendix - Guide to Contraindications and Precautions to Commonly Used Vaccines

Adapted from Table 4-1 in Advisory Committee on Immunization Practices (ACIP) General Best Practice Guidelines for Immunization: Contraindication and Precautions and ACIP’s Recommendations for the Prevention and Control of 2022-23 seasonal influenza with Vaccines.

For COVID-19 vaccine contraindications and precautions see www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us.html#contraindications

Vaccine

Contraindicated or Not Recommended¹

Precautions²

Influenza, egg-based, inactivated injectable (IIV4)

Vaccine

Influenza, egg-based, inactivated injectable (IIV4)

Severe allergic reaction (e.g., anaphylaxis) after previous dose of any influenza vaccine (i.e., any egg-based IIV, ccIIV, RIV, or LAIV of any valency)
Severe allergic reaction (e.g., anaphylaxis) to any vaccine component³ (excluding egg)

Contraindicated or Not Recommended¹

Severe allergic reaction (e.g., anaphylaxis) after previous dose of any influenza vaccine (i.e., any egg-based IIV, ccIIV, RIV, or LAIV of any valency)
Severe allergic reaction (e.g., anaphylaxis) to any vaccine component³ (excluding egg)

Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any type of influenza vaccine
Moderate or severe acute illness with or without fever

Precautions²

Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any type of influenza vaccine
Moderate or severe acute illness with or without fever

Influenza, cell culture-based inactivated injectable
[(ccIIV4), Flucelvax^® Quadrivalent]

Vaccine

Influenza, cell culture-based inactivated injectable
[(ccIIV4), Flucelvax^® Quadrivalent]

Severe allergic reaction (e.g., anaphylaxis) to any ccIIV of any valency, or to any component³ of ccIIV4

Contraindicated or Not Recommended¹

Severe allergic reaction (e.g., anaphylaxis) to any ccIIV of any valency, or to any component³ of ccIIV4

Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any type of influenza vaccine
Persons with a history of severe allergic reaction (e.g., anaphylaxis) after a previous dose of any egg-based IIV, RIV, or LAIV of any valency. If using ccIV4, administer in medical setting under supervision of healthcare provider who can recognize and manage severe allergic reactions. May consult an allergist.
Moderate or severe acute illness with or without fever

Precautions²

Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any type of influenza vaccine
Persons with a history of severe allergic reaction (e.g., anaphylaxis) after a previous dose of any egg-based IIV, RIV, or LAIV of any valency. If using ccIV4, administer in medical setting under supervision of healthcare provider who can recognize and manage severe allergic reactions. May consult an allergist.
Moderate or severe acute illness with or without fever

Influenza, recombinant injectable
[(RIV4), Flublok^® Quadrivalent]

Vaccine

Influenza, recombinant injectable
[(RIV4), Flublok^® Quadrivalent]

Severe allergic reaction (e.g., anaphylaxis) to any RIV of any valency, or to any component³ of RIV4

Contraindicated or Not Recommended¹

Severe allergic reaction (e.g., anaphylaxis) to any RIV of any valency, or to any component³ of RIV4

Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any type of influenza vaccine
Persons with a history of severe allergic reaction (e.g., anaphylaxis) after a previous dose of any egg- based IIV, ccIIV, or LAIV of any valency. If using RIV4, administer in medical setting under supervision of healthcare provider who can recognize and manage severe allergic reactions. May consult an allergist.
Moderate or severe acute illness with or without fever

Precautions²

Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any type of influenza vaccine
Persons with a history of severe allergic reaction (e.g., anaphylaxis) after a previous dose of any egg- based IIV, ccIIV, or LAIV of any valency. If using RIV4, administer in medical setting under supervision of healthcare provider who can recognize and manage severe allergic reactions. May consult an allergist.
Moderate or severe acute illness with or without fever

Influenza, live attenuated [LAIV4, Flumist^® Quadrivalent]

Vaccine

Influenza, live attenuated [LAIV4, Flumist^® Quadrivalent]

Severe allergic reaction (e.g., anaphylaxis) after previous dose of any influenza vaccine (i.e., any egg-based IIV, ccIIV, RIV, or LAIV of any valency)
Severe allergic reaction (e.g., anaphylaxis) to any vaccine component³ (excluding egg)
Children age 2 – 4 years with a history of asthma or wheezing
Anatomic or functional asplenia
Immunocompromised due to any cause including medications and HIV infection
Close contacts or caregivers of severely immunosuppressed persons who require a protected environment
Pregnancy
Cochlear implant
Active communication between the cerebrospinal fluid (CSF) and the oropharynx, nasopharynx, nose, ear or any other cranial CSF leak
Children and adolescents receiving aspirin or salicylate-containing medications
Received influenza antiviral medications oseltamivir or zanamivir within the previous 48 hours, peramivir within the previous 5 days, or baloxavir within the previous 17 days

Contraindicated or Not Recommended¹

Severe allergic reaction (e.g., anaphylaxis) after previous dose of any influenza vaccine (i.e., any egg-based IIV, ccIIV, RIV, or LAIV of any valency)
Severe allergic reaction (e.g., anaphylaxis) to any vaccine component³ (excluding egg)
Children age 2 – 4 years with a history of asthma or wheezing
Anatomic or functional asplenia
Immunocompromised due to any cause including medications and HIV infection
Close contacts or caregivers of severely immunosuppressed persons who require a protected environment
Pregnancy
Cochlear implant
Active communication between the cerebrospinal fluid (CSF) and the oropharynx, nasopharynx, nose, ear or any other cranial CSF leak
Children and adolescents receiving aspirin or salicylate-containing medications
Received influenza antiviral medications oseltamivir or zanamivir within the previous 48 hours, peramivir within the previous 5 days, or baloxavir within the previous 17 days

Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any type of influenza vaccine
Asthma in persons aged 5 years old or older
Persons with underlying medical conditions (other than those listed under contraindications) that might predispose to complications after wild-type influenza virus infection [e.g., chronic pulmonary, cardiovascular (except isolated hypertension), renal, hepatic, neurologic, hematologic, or metabolic disorders (including diabetes mellitus)]
Moderate or severe acute illness with or without fever

Precautions²

Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any type of influenza vaccine
Asthma in persons aged 5 years old or older
Persons with underlying medical conditions (other than those listed under contraindications) that might predispose to complications after wild-type influenza virus infection [e.g., chronic pulmonary, cardiovascular (except isolated hypertension), renal, hepatic, neurologic, hematologic, or metabolic disorders (including diabetes mellitus)]
Moderate or severe acute illness with or without fever

Dengue (DEN4CYD)

Vaccine

Dengue (DEN4CYD)

Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component³
Severe immunodeficiency (e.g., hematologic and solid tumors, receipt of chemotherapy, congenital immunodeficiency, long- term immunosuppressive therapy or patients with HIV infection who are severely immunocompromised)
Lack of laboratory confirmation of a previous Dengue infection

Contraindicated or Not Recommended¹

Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component³
Severe immunodeficiency (e.g., hematologic and solid tumors, receipt of chemotherapy, congenital immunodeficiency, long- term immunosuppressive therapy or patients with HIV infection who are severely immunocompromised)
Lack of laboratory confirmation of a previous Dengue infection

Pregnancy
HIV infection without evidence of severe immunosuppression
Moderate or severe acute illness with or without fever

Precautions²

Pregnancy
HIV infection without evidence of severe immunosuppression
Moderate or severe acute illness with or without fever

Diphtheria, tetanus, pertussis (DTaP)

Tetanus, diphtheria (DT)

Vaccine

Diphtheria, tetanus, pertussis (DTaP)

Tetanus, diphtheria (DT)

Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component³
For DTaP only: Encephalopathy (e.g., coma, decreased level of consciousness, prolonged seizures) not attributable to another identifiable cause within 7 days of administration of previous dose of DTP or DTaP

Contraindicated or Not Recommended¹

Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component³
For DTaP only: Encephalopathy (e.g., coma, decreased level of consciousness, prolonged seizures) not attributable to another identifiable cause within 7 days of administration of previous dose of DTP or DTaP

Guillain-Barré syndrome (GBS) within 6 weeks after previous dose of tetanus-toxoid–containing vaccine
History of Arthus-type hypersensitivity reactions after a previous dose of diphtheria-toxoid— containing or tetanus-toxoid– containing vaccine; defer vaccination until at least 10 years have elapsed since the last tetanus-toxoid- containing vaccine
For DTaP only: Progressive neurologic disorder, including infantile spasms, uncontrolled epilepsy, progressive encephalopathy; defer DTaP until neurologic status clarified and stabilized
Moderate or severe acute illness with or without fever

Precautions²

Guillain-Barré syndrome (GBS) within 6 weeks after previous dose of tetanus-toxoid–containing vaccine
History of Arthus-type hypersensitivity reactions after a previous dose of diphtheria-toxoid— containing or tetanus-toxoid– containing vaccine; defer vaccination until at least 10 years have elapsed since the last tetanus-toxoid- containing vaccine
For DTaP only: Progressive neurologic disorder, including infantile spasms, uncontrolled epilepsy, progressive encephalopathy; defer DTaP until neurologic status clarified and stabilized
Moderate or severe acute illness with or without fever

Haemophilus influenzae type b (Hib)

Vaccine

Haemophilus influenzae type b (Hib)

Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component³
For Hiberix, ActHib, and PedvaxHIB only: History of severe allergic reaction to dry natural latex
Age <6 weeks

Contraindicated or Not Recommended¹

Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component³
For Hiberix, ActHib, and PedvaxHIB only: History of severe allergic reaction to dry natural latex
Age <6 weeks

Moderate or severe acute illness with or without fever

Precautions²

Moderate or severe acute illness with or without fever

Hepatitis A (HepA)

Vaccine

Hepatitis A (HepA)

Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component³ including neomycin

Contraindicated or Not Recommended¹

Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component³ including neomycin

Moderate or severe acute illness with or without fever

Precautions²

Moderate or severe acute illness with or without fever

Hepatitis B (HepB)

Vaccine

Hepatitis B (HepB)

Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component³ including yeast
Pregnancy: Heplisav-B and PreHevbrio are not recommended due to lack of safety data in pregnant persons. Use other hepatitis B vaccines if HepB is indicated.

Contraindicated or Not Recommended¹

Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component³ including yeast
Pregnancy: Heplisav-B and PreHevbrio are not recommended due to lack of safety data in pregnant persons. Use other hepatitis B vaccines if HepB is indicated.

Moderate or severe acute illness with or without fever

Precautions²

Moderate or severe acute illness with or without fever

Hepatitis A- Hepatitis B vaccine [HepA-HepB, (Twinrix^®)]

Vaccine

Hepatitis A- Hepatitis B vaccine [HepA-HepB, (Twinrix^®)]

Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component³ including neomycin and yeast

Contraindicated or Not Recommended¹

Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component³ including neomycin and yeast

Moderate or severe acute illness with or without fever

Precautions²

Moderate or severe acute illness with or without fever

Human papillomavirus (HPV)

Vaccine

Human papillomavirus (HPV)

Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component³
Pregnancy: HPV vaccination not recommended.

Contraindicated or Not Recommended¹

Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component³
Pregnancy: HPV vaccination not recommended.

Moderate or severe acute illness with or without fever

Precautions²

Moderate or severe acute illness with or without fever

Measles, mumps, rubella (MMR)
Measles, mumps, rubella, and varicella (MMRV)

Vaccine

Measles, mumps, rubella (MMR)
Measles, mumps, rubella, and varicella (MMRV)

Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component³
Severe immunodeficiency (e.g., hematologic and solid tumors, receipt of chemotherapy, congenital immunodeficiency, long-term immunosuppressive therapy or patients with HIV infection who are severely immunocompromised)
Pregnancy
Family history of altered immunocompetence, unless verified clinically or by laboratory testing as immunocompetent

Contraindicated or Not Recommended¹

Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component³
Severe immunodeficiency (e.g., hematologic and solid tumors, receipt of chemotherapy, congenital immunodeficiency, long-term immunosuppressive therapy or patients with HIV infection who are severely immunocompromised)
Pregnancy
Family history of altered immunocompetence, unless verified clinically or by laboratory testing as immunocompetent

Recent (≤11 months) receipt of antibody-containing blood product (specific interval depends on product)
History of thrombocytopenia or thrombocytopenic purpura
Need for tuberculin skin testing or interferon-gamma release assay (IGRA) testing
Moderate or severe acute illness with or without fever
For MMRV only: Personal or family (i.e., sibling or parent) history of seizures of any etiology

Precautions²

Recent (≤11 months) receipt of antibody-containing blood product (specific interval depends on product)
History of thrombocytopenia or thrombocytopenic purpura
Need for tuberculin skin testing or interferon-gamma release assay (IGRA) testing
Moderate or severe acute illness with or without fever
For MMRV only: Personal or family (i.e., sibling or parent) history of seizures of any etiology

Meningococcal ACWY (MenACWY)
[MenACWY-CRM (Menveo^®); MenACWY-D (Menactra^®); MenACWY-TT (MenQuadfi^®)]

Vaccine

Meningococcal ACWY (MenACWY)
[MenACWY-CRM (Menveo^®); MenACWY-D (Menactra^®); MenACWY-TT (MenQuadfi^®)]

Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component³
For MenACWY-D and Men ACWY-CRM only: severe allergic reaction to any diphtheria toxoid– or CRM₁₉₇–containing vaccine
For MenACWY-TT only: severe allergic reaction to a tetanus toxoid-containing vaccine

Contraindicated or Not Recommended¹

Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component³
For MenACWY-D and Men ACWY-CRM only: severe allergic reaction to any diphtheria toxoid– or CRM₁₉₇–containing vaccine
For MenACWY-TT only: severe allergic reaction to a tetanus toxoid-containing vaccine

For MenACWY-CRM only: Preterm birth if less than age 9 months
Moderate or severe acute illness with or without fever

Precautions²

For MenACWY-CRM only: Preterm birth if less than age 9 months
Moderate or severe acute illness with or without fever

Meningococcal B (MenB)
[MenB-4C (Bexsero^®); MenB-FHbp (Trumenba^®)]

Vaccine

Meningococcal B (MenB)
[MenB-4C (Bexsero^®); MenB-FHbp (Trumenba^®)]

Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component³

Contraindicated or Not Recommended¹

Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component³

Pregnancy
For MenB-4C only: Latex sensitivity
Moderate or severe acute illness with or without fever

Precautions²

Pregnancy
For MenB-4C only: Latex sensitivity
Moderate or severe acute illness with or without fever

Pneumococcal conjugate (PCV)

Vaccine

Pneumococcal conjugate (PCV)

Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component³
Severe allergic reaction (e.g., anaphylaxis) to any diphtheria-toxoid– containing vaccine or its component³

Contraindicated or Not Recommended¹

Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component³
Severe allergic reaction (e.g., anaphylaxis) to any diphtheria-toxoid– containing vaccine or its component³

Moderate or severe acute illness with or without fever

Precautions²

Moderate or severe acute illness with or without fever

Pneumococcal polysaccharide (PPSV23)

Vaccine

Pneumococcal polysaccharide (PPSV23)

Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component³

Contraindicated or Not Recommended¹

Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component³

Moderate or severe acute illness with or without fever

Precautions²

Moderate or severe acute illness with or without fever

Poliovirus vaccine, inactivated (IPV)

Vaccine

Poliovirus vaccine, inactivated (IPV)

Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component³

Contraindicated or Not Recommended¹

Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component³

Pregnancy
Moderate or severe acute illness with or without fever

Precautions²

Pregnancy
Moderate or severe acute illness with or without fever

Rotavirus (RV) [RV1 (Rotarix^®), RV5 (RotaTeq^®)]

Vaccine

Rotavirus (RV) [RV1 (Rotarix^®), RV5 (RotaTeq^®)]

Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component³
Severe combined immunodeficiency (SCID)
History of intussusception

Contraindicated or Not Recommended¹

Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component³
Severe combined immunodeficiency (SCID)
History of intussusception

Altered immunocompetence other than SCID
Chronic gastrointestinal disease
RV1 only: Spina bifida or bladder exstrophy
Moderate or severe acute illness with or without fever

Precautions²

Altered immunocompetence other than SCID
Chronic gastrointestinal disease
RV1 only: Spina bifida or bladder exstrophy
Moderate or severe acute illness with or without fever

Tetanus, diphtheria, and acellular pertussis (Tdap)

Tetanus, diphtheria (Td)

Vaccine

Tetanus, diphtheria, and acellular pertussis (Tdap)

Tetanus, diphtheria (Td)

Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component³
For Tdap only: Encephalopathy (e.g., coma, decreased level of consciousness, prolonged seizures) not attributable to another identifiable cause within 7 days of administration of previous dose of DTP, DTaP, or Tdap

Contraindicated or Not Recommended¹

Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component³
For Tdap only: Encephalopathy (e.g., coma, decreased level of consciousness, prolonged seizures) not attributable to another identifiable cause within 7 days of administration of previous dose of DTP, DTaP, or Tdap

Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of tetanus-toxoid–containing vaccine
History of Arthus-type hypersensitivity reactions after a previous dose of diphtheria-toxoid— containing or tetanus-toxoid– containing vaccine; defer vaccination until at least 10 years have elapsed since the last tetanus-toxoid– containing vaccine
For Tdap only: Progressive or unstable neurological disorder, uncontrolled seizures, or progressive encephalopathy until a treatment regimen has been established and the condition has stabilized
Moderate or severe acute illness with or without fever

Precautions²

Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of tetanus-toxoid–containing vaccine
History of Arthus-type hypersensitivity reactions after a previous dose of diphtheria-toxoid— containing or tetanus-toxoid– containing vaccine; defer vaccination until at least 10 years have elapsed since the last tetanus-toxoid– containing vaccine
For Tdap only: Progressive or unstable neurological disorder, uncontrolled seizures, or progressive encephalopathy until a treatment regimen has been established and the condition has stabilized
Moderate or severe acute illness with or without fever

Varicella (VAR)

Vaccine

Varicella (VAR)

Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component³
Severe immunodeficiency (e.g., hematologic and solid tumors, receipt of chemotherapy, congenital immunodeficiency, long- term immunosuppressive therapy or patients with HIV infection who are severely immunocompromised)
Pregnancy
Family history of altered immunocompetence, unless verified clinically or by laboratory testing as immunocompetent

Contraindicated or Not Recommended¹

Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component³
Severe immunodeficiency (e.g., hematologic and solid tumors, receipt of chemotherapy, congenital immunodeficiency, long- term immunosuppressive therapy or patients with HIV infection who are severely immunocompromised)
Pregnancy
Family history of altered immunocompetence, unless verified clinically or by laboratory testing as immunocompetent

Recent (≤11 months) receipt of antibody-containing blood product (specific interval depends on product)
Receipt of specific antiviral drugs (acyclovir, famciclovir, or valacyclovir) 24 hours before vaccination (avoid use of these antiviral drugs for 14 days after vaccination)
Use of aspirin or aspirin-containing products
Moderate or severe acute illness with or without fever
If using MMRV, see MMR/MMRV for additional precautions

Precautions²

Recent (≤11 months) receipt of antibody-containing blood product (specific interval depends on product)
Receipt of specific antiviral drugs (acyclovir, famciclovir, or valacyclovir) 24 hours before vaccination (avoid use of these antiviral drugs for 14 days after vaccination)
Use of aspirin or aspirin-containing products
Moderate or severe acute illness with or without fever
If using MMRV, see MMR/MMRV for additional precautions

When a contraindication is present, a vaccine should NOT be administered. Kroger A, Bahta L, Hunter P. ACIP General Best Practice Guidelines for Immunization.
When a precaution is present, vaccination should generally be deferred but might be indicated if the benefit of protection from the vaccine outweighs the risk for an adverse reaction. Kroger A, Bahta L, Hunter P. ACIP General Best Practice Guidelines for Immunization.
Vaccination providers should check FDA-approved prescribing information for the most complete and updated information, including contraindications, warnings, and precautions. See Package inserts for U.S.-licensed vaccines.
For information on the pregnancy exposure registries for persons who were inadvertently vaccinated with Heplisav-B or PreHevbrio while pregnant, please visit heplisavbpregnancyregistry.com/ or www.prehevbrio.com/#safety.

Addendum – Child and Adolescent Recommended Immunization Schedule for ages 18 years or younger, United States, 2023

Vaccines and Other
Immunizing Agents

Vaccines and Other Immunizing Agents

Vaccines and Other
Immunizing Agents

Recommendations

Effective Date of
Recommendation*

Effective Date of Recommendation*

Effective Date of
Recommendation*

Respiratory syncytial virus (RSV)

Vaccines and Other Immunizing Agents

Respiratory syncytial virus (RSV)

Maternal Respiratory Syncytial Virus (RSV) vaccine (ABRYSVO™) is recommended for pregnant people during 32 through 36 weeks gestation, using seasonal administration, to prevent RSV lower respiratory tract infection in infants.

Recommendations

Maternal Respiratory Syncytial Virus (RSV) vaccine (ABRYSVO™) is recommended for pregnant people during 32 through 36 weeks gestation, using seasonal administration, to prevent RSV lower respiratory tract infection in infants.

September 22, 2023

Effective Date of Recommendation*

September 22, 2023

COVID-19 (Moderna, Pfizer-BioNTech)

Vaccines and Other Immunizing Agents

COVID-19 (Moderna, Pfizer-BioNTech)

All persons ≥6 months of age should receive 2023–2024 (monovalent, XBB containing) COVID-19 vaccines as authorized under EUA or approved by BLA.
For detailed information, see: www.cdc.gov/covidschedule

Recommendations

All persons ≥6 months of age should receive 2023–2024 (monovalent, XBB containing) COVID-19 vaccines as authorized under EUA or approved by BLA.
For detailed information, see: www.cdc.gov/covidschedule

September 12, 2023

Effective Date of Recommendation*

September 12, 2023

Respiratory syncytial virus [RSV-mAb (Nirsevimab)]

Vaccines and Other Immunizing Agents

Respiratory syncytial virus [RSV-mAb (Nirsevimab)]

All infants younger than 8 months and born shortly before or during the RSV season should receive 1 dose of nirsevimab within 1 week of birth either in hospital or outpatient setting
Infants younger than age 8 months not born during RSV season and now entering their first RSV season should receive 1 dose of nirsevimab shortly before the start of RSV season
Infants aged 8–19 months with chronic lung disease of prematurity requiring medical support (e.g., chronic corticosteroid therapy, diuretic therapy, or supplemental oxygen) any time during the 6-month period before start of the second RSV season; severe immunocompromise; cystic fibrosis with weight for length <10th percentile; or with manifestation of severe lung disease (e.g., previous hospitalization for pulmonary exacerbation in the first year of life or abnormalities on chest imaging that persist when stable) should receive 1 dose of nirsevimab shortly before start of second RSV season
Infants 8–19 months who are American Indian or Alaska Native should receive 1 dose of nirsevimab before start of second RSV season
Infants who are age-eligible and undergoing cardiac surgery with cardiopulmonary bypass should receive 1 additional dose of nirsevimab
after surgery
For detailed information, see: https://www.cdc.gov/mmwr/volumes/72/wr/mm7234a4.htm

Recommendations

All infants younger than 8 months and born shortly before or during the RSV season should receive 1 dose of nirsevimab within 1 week of birth either in hospital or outpatient setting
Infants younger than age 8 months not born during RSV season and now entering their first RSV season should receive 1 dose of nirsevimab shortly before the start of RSV season
Infants aged 8–19 months with chronic lung disease of prematurity requiring medical support (e.g., chronic corticosteroid therapy, diuretic therapy, or supplemental oxygen) any time during the 6-month period before start of the second RSV season; severe immunocompromise; cystic fibrosis with weight for length <10th percentile; or with manifestation of severe lung disease (e.g., previous hospitalization for pulmonary exacerbation in the first year of life or abnormalities on chest imaging that persist when stable) should receive 1 dose of nirsevimab shortly before start of second RSV season
Infants 8–19 months who are American Indian or Alaska Native should receive 1 dose of nirsevimab before start of second RSV season
Infants who are age-eligible and undergoing cardiac surgery with cardiopulmonary bypass should receive 1 additional dose of nirsevimab
after surgery
For detailed information, see: https://www.cdc.gov/mmwr/volumes/72/wr/mm7234a4.htm

August 3, 2023

Effective Date of Recommendation*

August 3, 2023

Poliovirus (IPV)

Vaccines and Other Immunizing Agents

Poliovirus (IPV)

Adolescents age 18 years who are known or suspected to be unvaccinated or incompletely vaccinated against polio should complete a primary vaccination series with inactivated polio vaccine (IPV).
Adolescents age 18 years who have received a primary series of trivalent oral polio vaccine (tOPV) or IPV in any combination and who are at increased risk of poliovirus exposure may receive another dose of IPV. Available data do not indicate the need for more than a single lifetime booster dose with IPV for adults.

Recommendations

Adolescents age 18 years who are known or suspected to be unvaccinated or incompletely vaccinated against polio should complete a primary vaccination series with inactivated polio vaccine (IPV).
Adolescents age 18 years who have received a primary series of trivalent oral polio vaccine (tOPV) or IPV in any combination and who are at increased risk of poliovirus exposure may receive another dose of IPV. Available data do not indicate the need for more than a single lifetime booster dose with IPV for adults.

June 27, 2023

Effective Date of Recommendation*

June 27, 2023

Influenza (IIV4, ccIV4, RIV4, LAIV4)

Vaccines and Other Immunizing Agents

Influenza (IIV4, ccIV4, RIV4, LAIV4)

All persons ages ≥6 months with egg allergy should receive influenza vaccine. Any influenza vaccine (egg based or non-egg based) that is otherwise appropriate for the recipient’s age and health status can be used.
Affirm the updated MMWR Recommendations and Reports, “Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2023-24 Influenza Season”
https://www.cdc.gov/mmwr/volumes/72/rr/rr7202a1.htm

Recommendations

All persons ages ≥6 months with egg allergy should receive influenza vaccine. Any influenza vaccine (egg based or non-egg based) that is otherwise appropriate for the recipient’s age and health status can be used.
Affirm the updated MMWR Recommendations and Reports, “Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2023-24 Influenza Season”
https://www.cdc.gov/mmwr/volumes/72/rr/rr7202a1.htm

June 27, 2023

Effective Date of Recommendation*

June 27, 2023

Pneumococcal (PCV15, PCV20)

Vaccines and Other Immunizing Agents

Pneumococcal (PCV15, PCV20)

Use of either pneumococcal conjugate vaccines (PCV) PCV15 or PCV20 is recommended for all children aged 2–23 months according to
currently recommended PCV dosing and schedules.
For children with an incomplete PCV vaccination status, use of either PCV15 or PCV20 according to currently recommended PCV dosing and
schedules is recommended for:
- Healthy children aged 24–59 months
- Children with specified risk conditions^* aged 24 through 71 months
For children aged 2–18 years with any risk condition who have received all recommended doses of PCV before age 6 years
- Using ≥1 dose(s) of PCV20: No additional doses of any pneumococcal vaccine are indicated. This recommendation may be updated as
  additional data become available.
- Using PCV13 or PCV15 (no PCV20): A dose of PCV20 or PPSV23 using previously recommended dosing and schedules is
  recommended.
For children aged 6–18 years with any risk condition who have not received any dose of PCV13, PCV15, or PCV20, a single dose of PCV15 or
PCV20 is recommended. When PCV15 is used, it should be followed by a dose of PPSV23 at least 8 weeks later if not previously given.

^*Risk conditions include: cerebrospinal fluid leak; chronic heart disease; chronic kidney disease (excluding maintenance dialysis and nephrotic syndrome, which are included in immunocompromising conditions); chronic liver disease; chronic lung disease (including moderate persistent or severe persistent asthma); cochlear implant; diabetes mellitus; immunocompromising conditions (on maintenance dialysis or with nephrotic syndrome; congenital or acquired asplenia or splenic dysfunction; congenital or acquired immunodeficiencies; diseases and conditions treated with immunosuppressive drugs or radiation therapy, including malignant neoplasms, leukemias, lymphomas, Hodgkin disease, and solid organ transplant; HIV infection; and sickle cell disease and other hemoglobinopathies).

Recommendations

Use of either pneumococcal conjugate vaccines (PCV) PCV15 or PCV20 is recommended for all children aged 2–23 months according to
currently recommended PCV dosing and schedules.
For children with an incomplete PCV vaccination status, use of either PCV15 or PCV20 according to currently recommended PCV dosing and
schedules is recommended for:
- Healthy children aged 24–59 months
- Children with specified risk conditions^* aged 24 through 71 months
For children aged 2–18 years with any risk condition who have received all recommended doses of PCV before age 6 years
- Using ≥1 dose(s) of PCV20: No additional doses of any pneumococcal vaccine are indicated. This recommendation may be updated as
  additional data become available.
- Using PCV13 or PCV15 (no PCV20): A dose of PCV20 or PPSV23 using previously recommended dosing and schedules is
  recommended.
For children aged 6–18 years with any risk condition who have not received any dose of PCV13, PCV15, or PCV20, a single dose of PCV15 or
PCV20 is recommended. When PCV15 is used, it should be followed by a dose of PPSV23 at least 8 weeks later if not previously given.

June 27, 2023

Effective Date of Recommendation*

June 27, 2023

Vaccines in the Child and Adolescent Immunization Schedule*

child acronyms
Vaccines	Abbreviation(s)	Trade name(s)
COVID-19^†	1vCOV-mRNA	Comirnaty^®/Pfizer- BioNTech COVID-19 Vaccine
	1vCOV-mRNA	SPIKEVAX^®/Moderna COVID-19 Vaccine
	2vCOV-mRNA	Pfizer-BioNTech COVID-19 Vaccine, Bivalent
	2vCOV-mRNA	Moderna COVID-19 Vaccine, Bivalent
	1vCOV-aPS	Novavax COVID-19 Vaccine
Dengue vaccine	DEN4CYD	Dengvaxia^®
Diphtheria, tetanus, and acellular pertussis vaccine	DTaP	Daptacel^® Infanrix^®
Diphtheria, tetanus vaccine	DT	No Trade Name
Haemophilus influenzae type B vaccine	Hib (PRP-T)	ActHIB^® Hiberix^®
Haemophilus influenzae type B vaccine	Hib (PRP-OMP)	PedvaxHIB^®
Hepatitis A vaccine	HepA	Havrix^® Vaqta^®
Hepatitis B vaccine	HepB	Engerix-B^® Recombivax HB^®
Human papillomavirus vaccine	HPV	Gardasil 9^®
Influenza vaccine (inactivated)	IIV4	Multiple
Influenza vaccine (live, attenuated)	LAIV4	FluMist^® Quadrivalent
Measles, mumps, and rubella vaccine	MMR	M-M-R II^®Priorix^®
Meningococcal serogroups A, C, W, Y vaccine	MenACWY-D	Menactra^®
	MenACWY-CRM	Menveo^®
	MenACWY-TT	MenQuadfi^®
Meningococcal serogroup B vaccine	MenB-4C	Bexsero^®
Meningococcal serogroup B vaccine	MenB-FHbp	Trumenba^®
Pneumococcal conjugate vaccine	PCV13	Prevnar 13^®
Pneumococcal conjugate vaccine	PCV15	Vaxneuvance^™
Pneumococcal polysaccharide vaccine	PPSV23	Pneumovax 23^®
Poliovirus vaccine (inactivated)	IPV	IPOL^®
Rotavirus vaccine	RV1 RV5	Rotarix^® RotaTeq^®
Tetanus, diphtheria, and acellular pertussis vaccine	Tdap	Adacel^® Boostrix^®
Tetanus and diphtheria vaccine	Td	Tenivac^® TDvax™
Varicella vaccine	VAR	Varivax^®

Combination vaccines (use combination vaccines instead of separate injections when appropriate)

(Use combination vaccines instead of separate injections when appropriate)

Vaccines	Abbreviation(s)	Trade name(s)
DTaP, hepatitis B, and inactivated poliovirus vaccine	DTaP-HepB-IPV	Pediarix^®
DTaP, inactivated poliovirus, and Haemophilus influenzae type B vaccine	DTaP-IPV/Hib	Pentacel^®
DTaP and inactivated poliovirus vaccine	DTaP-IPV	Kinrix^® Quadracel^®
DTaP, inactivated poliovirus, Haemophilus influenzae type b, and hepatitis B vaccine	DTaP-IPV-Hib-HepB	Vaxelis^®
Measles, mumps, rubella, and varicella vaccines	MMRV	ProQuad^®

New Vaccines and Other Immunizing Agents added to the Schedule since February 2023 (See Addendum)

Vaccines and other immunizing agents	Abbreviation(s)	Trade name(s)
RSV monoclonal antibody (Nirsevimab)	RSV-mAb	Beyfortus^™
Pneumococcal conjugate vaccine	PCV20	Prevnar 20^™

*Administer recommended vaccines if immunization history is incomplete or unknown. Do not restart or add doses to vaccine series for extended intervals between doses. When a vaccine is not administered at the recommended age, administer at a subsequent visit. The use of trade names is for identification purposes only and does not imply endorsement by the ACIP or CDC.

^†COVID-19, Poliovirus, Influenza, and Pneumococcal vaccines have new or updated ACIP recommendations. Please see Addendum for more details.

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This schedule is recommended by the Advisory Committee on Immunization Practices (ACIP) and approved by the Centers for Disease Control and Prevention (CDC), American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), American College of Obstetricians and Gynecologists (ACOG), American College of Nurse-Midwives (ACNM), American Academy of Physician Associates (AAPA), and National Association of Pediatric Nurse Practitioners (NAPNAP).

The comprehensive summary of the ACIP recommended changes made to the child and adolescent immunization schedule can be found in the February 10, 2023 MMWR.

Report

Suspected cases of reportable vaccine-preventable diseases or outbreaks to your state or local health department
Clinically significant adverse events to the Vaccine Adverse Event Reporting System (VAERS) at www.vaers.hhs.govexternal icon or (800-822-7967)

Questions or comments
Contact www.cdc.gov/cdc-info or 800-CDC-INFO (800-232-4636), in English or Spanish, 8 a.m.–8 p.m. ET, Monday through Friday, excluding holidays.

Helpful information

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