Child and Adolescent Immunization Schedule by Medical Indication

• 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

• 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

• 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

•  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

• 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

• 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

• 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

• 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.

• 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

• 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

• 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

• 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:

• 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)

• 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:

• 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)

• 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:

• 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

• 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

• 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

• 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

• 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

• 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