Child and Adolescent Immunization Schedule by Medical Indication
Recommendations for Ages 18 Years or Younger, United States, 2023
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¶ = Vaccination according to the routine schedule recommended
§ = Recommended for persons with an additional risk factor for which the vaccine would be indicated
» = Vaccination is recommended, and additional doses may be necessary based on medical condition or vaccine. See Notes.
| = Precaution—vaccine might be indicated if benefit of protection outweighs risk of adverse reaction
± = Contraindicated or not recommended—vaccine should not be administered. *Vaccinate after pregnancy
• = No recommendation/Not applicable
Vaccine | Indication | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
Pregnancy | Immunocompromised status (excluding HIV infection) | HIV infection CD4+ counta | Kidney failure, end-stage renal disease, or on hemodialysis | Heart disease or chronic lung disease | CSF leaks or cochlear implants | Asplenia or persistent complement component deficiencies | Chronic liver disease | Diabetes | ||
<15% or total CD4 cell count of <200/mm3 | ≥15% and total CD4 cell count of ≥200/mm3 | |||||||||
Hepatitis B ![]() |
¶ | ¶ | ¶ | ¶ | ¶ | ¶ | ¶ | ¶ | ¶ | |
Rotavirus ![]() |
• | | | | | ¶ | ¶ | ¶ | ¶ | ¶ | ¶ | |
SCIDb± | ||||||||||
Diphtheria, tetanus, and acellular pertussis ![]() |
• | ¶ | ¶ | ¶ | ¶ | ¶ | ¶ | ¶ | ¶ | |
Haemophilus influenzae type b ![]() |
• | » | » | ¶ | ¶ | ¶ | » | ¶ | ¶ | |
Pneumococcal conjugate ![]() |
• | » | » | » | » | » | » | » | » | |
Inactivated poliovirus ![]() |
| | ¶ | ¶ | ¶ | ¶ | ¶ | ¶ | ¶ | ¶ | |
COVID-19 ![]() |
¶ | (See notes)¶ | (See notes)¶ | ¶ | ¶ | ¶ | ¶ | ¶ | ¶ | |
Influenza ![]() |
¶ | ¶ | ¶ | ¶ | ¶ | ¶ | ¶ | ¶ | ¶ | |
![]() Influenza ![]() |
± | ± | ± | | | | | ± | ± | | | | | |
Asthma, wheezing: 2-4yrsc± | ||||||||||
Measles, mumps, rubella ![]() |
* ± | ± | ± | ¶ | ¶ | ¶ | ¶ | ¶ | ¶ | ¶ |
Varicella ![]() |
* ± | ± | ± | ¶ | ¶ | ¶ | ¶ | ¶ | ¶ | ¶ |
Hepatitis A ![]() |
¶ | ¶ | ¶ | ¶ | ¶ | ¶ | ¶ | ¶ | ¶ | |
Tetanus, diphtheria, and acellular pertussis ![]() |
» | ¶ | ¶ | ¶ | ¶ | ¶ | ¶ | ¶ | ¶ | |
Human papillomavirus ![]() |
* ± | » | » | ¶ | ¶ | ¶ | ¶ | ¶ | ¶ | |
Meningococcal ACWY ![]() |
¶ | ¶ | » | ¶ | ¶ | ¶ | » | ¶ | ¶ | |
Meningococcal B ![]() |
| | § | § | § | § | § | » | § | § | |
Pneumococcal polysaccharide ![]() |
§ | » | » | » | » | » | » | » | » | |
Dengue ![]() |
| | ± | ± | | | ¶ | ¶ | ¶ | ¶ | ¶ | ¶ |
- For additional information regarding HIV laboratory parameters and use of live vaccines, see the General Best Practice Guidelines for Immunization, “Altered Immunocompetence,” and Table 4-1 (footnote J).
- Severe Combined Immunodeficiency
- LAIV4 contraindicated for children 2–4 years of age with asthma or wheezing during the preceding 12 months
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.
Diphtheria, tetanus, and pertussis (DTaP) vaccination
(minimum age: 6 weeks [4 years for Kinrix® or Quadracel®])
Influenza vaccination
(minimum age: 6 months [IIV], 2 years [LAIV4], 18 years [recombinant influenza vaccine, RIV4])
Meningococcal serogroup A, C, W, Y vaccination (minimum age: 2 months [MenACWY-CRM, Menveo], 9 months [MenACWY-D, Menactra], 2 years [MenACWY-TT, MenQuadfi])
Meningococcal serogroup B vaccination
(minimum age: 10 years [MenB-4C, Bexsero®; MenB-FHbp, Trumenba®])
Tetanus, diphtheria, and pertussis (Tdap) vaccination
(minimum age: 11 years for routine vaccination, 7 years for catch-up vaccination)
Vaccines in the Child and Adolescent Immunization Schedule*
Vaccines | Abbreviation(s) | Trade name(s) |
---|---|---|
COVID-19 | 1vCOV-mRNA | Comirnaty®/Pfizer- BioNTech COVID-19 Vaccine |
SPIKEVAX®/Moderna COVID-19 Vaccine | ||
2vCOV-mRNA | Pfizer-BioNTech COVID-19 Vaccine, Bivalent | |
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® |
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® |
MenB-FHbp | Trumenba® | |
Pneumococcal conjugate vaccine | PCV13 | Prevnar 13® |
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)
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® |
* 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.