Table 3. Recommended Child and Adolescent Immunization Schedule by Medical Condition, United States, 2019

Always make recommendations by determining needed vaccines based on age (Table 1), determining appropriate intervals for catch-up, if needed (Table 2), assessing for medical indications (Table 3), and reviewing special situations (Notes).

Legend

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. See Notes.
Contraindicated or use not recommended—
vaccine should not be administered because of risk for
serious adverse reaction
Precaution—vaccine might be indicated if benefit of protection outweighs risk of adverse reaction
Delay vaccination until after pregnancy if vaccine indicated
No recommendation
child indications vaccine schedule
Vaccine Indication
Pregnancy Immunocompromised status (excluding HIV infection) HIV infection CD4+ count1 Kidney failure, end-stage renal disease, on hemodialysis Heart disease, chronic lung disease CSF leaks/cochlear implants Asplenia and persistent complement component deficiencies Chronic liver disease Diabetes
<15% and total CD4 cell count of <200/mm3 ≥15% and total CD4 cell count of ≥200/mm3
Hepatitis B more info icon.
Rotavirus more info icon.
SCID2
Diphtheria, tetanus, & acellular pertussis more info icon. (DTaP)
Haemophilus influenzae type b more info icon.
Pneumococcal conjugate more info icon.
Inactivated poliovirus more info icon.
Influenza more info icon. (IIV)
more info icon.
Influenza more info icon. (LAIV)
Asthma, wheezing: 2-4yrs3
Measles, mumps, rubella more info icon.
Varicella more info icon.
Hepatitis A more info icon.
Meningococcal ACWY more info icon.
Tetanus, diphtheria, & acellular pertussis more info icon. (Tdap)
Human papillomavirus more info icon.
Meningococcal B more info icon.
Pneumococcal polysaccharide more info icon.
  1. 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 D).
  2. Severe Combined Immunodeficiency
  3. LAIV 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

Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger, United States, 2019

For vaccine recommendations for persons 19 years of age and older, see the Recommended Adult Immunization Schedule.

Additional information

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

Routine vaccination

Catch-up vaccination

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

Routine vaccination

Catch-up vaccination

Special situations

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

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

Routine vaccination

Catch-up vaccination

International travel

Special situations

At risk for hepatitis A infection: 2-dose series as above

Hepatitis B vaccination (minimum age: birth)

Birth dose (monovalent HepB vaccine only)

Routine series

Catch-up vaccination

Human papillomavirus vaccination (minimum age: 9 years)

Routine and catch-up vaccination

Special situations

Inactivated poliovirus vaccination (minimum age: 6 weeks)

Routine vaccination

Catch-up vaccination

Series containing oral polio vaccine (OPV), either mixed OPV-IPV or OPV-only series:

Influenza vaccination (minimum age: 6 months [IIV], 2 years [LAIV], 18 years [RIV])

Routine vaccination

Special situations

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

Routine vaccination

Catch-up vaccination

Special situations

International travel

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

Routine vaccination

Catch-up vaccination

Special situations

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

Travel in countries with hyperendemic or epidemic meningococcal disease, including countries in the African meningitis belt or during the Hajj:

First-year college students who live in residential housing (if not previously vaccinated at age 16 years or older) or military recruits: 1 dose of Menveo or Menactra

Note: Menactra should be administered either before or at the same time as DTaP. For MenACWY booster dose
recommendations for groups listed under “Special situations” above and additional meningococcal vaccination information, see meningococcal MMWR publications.

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

Clinical discretion

Special situations

Anatomic or functional asplenia (including sickle cell disease), persistent complement component deficiency, eculizumab use:

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

For additional meningococcal vaccination information, see meningococcal MMWR publications.

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

Routine vaccination with PCV13

Catch-up vaccination with PCV13

Special situations

High-risk conditions below: When both PCV13 and PPSV23 are indicated, administer PCV13 first. PCV13 and PPSV23 should not be administered during 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
Age 6–18 years

Cerebrospinal fluid leak, cochlear implant:

Age 2–5 years
Age 6–18 years

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
Age 6–18 years

Chronic liver disease, alcoholism:

Age 6–18 years

*An incomplete series is defined as not having received all doses in either the recommended series or an age-appropriate catch-up series. See Tables 8, 9, and 11 in the ACIP pneumococcal vaccine recommendations Cdc-pdf PDF [24 pages] for complete schedule details.

Rotavirus vaccination (minimum age: 6 weeks)

Routine vaccination

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

Catch-up vaccination

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

Routine vaccination

Catch-up vaccination

Varicella vaccination (minimum age: 12 months)

Routine vaccination

Catch-up vaccination

Vaccines in the Child and Adolescent Immunization Schedule

child acronyms
Vaccines Abbreviations Trade Names
Diphtheria, tetanus, and acellular pertussis vaccine DTaP Daptacel
Infanrix
Diphtheria, tetanus vaccine DT No Trade Name
Haemophilus influenzae type B vaccine Hib (PRP-T)
Hib (PRP-OMP)
ActHIB Hiberix
PedvaxHIB
Hepatitis A vaccine HepA Havrix
Vaqta
Hepatitis B vaccine HepB Engerix-B
Recombivax HB
Human papillomavirus vaccine HPV Gardasil 9
Influenza vaccine (inactivated) IIV Multiple
Influenza vaccine (live, attenuated) LAIV FluMist
Measles, mumps, and rubella vaccine MMR M-M-R II
Meningococcal serogroups A, C, W, Y vaccine MenACWY-D
MenACWY-CRM
Menactra
Menveo
Meningococcal serogroup B vaccine MenB-4C
MenB-FHbp
Bexsero
Trumenba
Pneumococcal 13-valent conjugate vaccine PCV13 Prevnar 13
Pneumococcal 23-valent polysaccharide vaccine PPSV23 Pneumovax
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
Td vaccine
Varicella vaccine VAR Varivax

Combination Vaccines

(Use combination vaccines instead of separate injections when appropriate)

Vaccines Abbreviations Trade Names
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
Measles, mumps, rubella, and varicella vaccines MMRV ProQuad

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 (AAPExternal file_external ), American Academy of Family Physicians (AAFPExternal file_external ), and American College of Obstetricians and Gynecologists (ACOGExternal file_external ).

The comprehensive summary of the ACIP recommended changes made to the child and adolescent immunization schedule can be found in the February 8, 2019 MMWR.


Page last reviewed: February 5, 2019