Table 3. Recommended Child and Adolescent Immunization Schedule by Medical Indication, United States, 2021

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).

COVID-19 Vaccination

ACIP recommends use of COVID-19 vaccines within the scope of the Emergency Use Authorization or Biologics License Application for the particular vaccine.  Interim ACIP recommendations for the use of COVID-19 vaccines can be found on the ACIP Vaccine Recommendations and Guidelines page.

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.
Not recommended/contraindicated—vaccine should not be administered
*Vaccinate after pregnancy.
Precaution—vaccine might be indicated if benefit of protection outweighs risk of adverse reaction
No recommendation/Not applicable
child indications vaccine schedule
Vaccine Indication
Pregnancy Immunocompromised status (excluding HIV infection) HIV infection CD4+ count1 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% 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, and 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. (LAIV4)
Asthma, wheezing: 2-4yrs3
Measles, mumps, rubella more info icon. *
Varicella more info icon. *
Hepatitis A more info icon.
Tetanus, diphtheria, and acellular pertussis more info icon. (Tdap)
Human papillomavirus more info icon. *
Meningococcal ACWY 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 ImmunizationAltered Immunocompetence” and Table 4-1 (footnote D).
  2. Severe Combined Immunodeficiency
  3. 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

Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger, United States, 2021

For vaccination recommendations for persons ages 19 years or older, see the Recommended Adult Immunization Schedule, 2021.

Additional information

COVID-19 Vaccination

ACIP recommends use of COVID-19 vaccines within the scope of the Emergency Use Authorization or Biologics License Application for the particular vaccine.  Interim ACIP recommendations for the use of COVID-19 vaccines can be found on the ACIP Vaccine Recommendations and Guidelines page.

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

Routine vaccination

Catch-up vaccination

Special situations

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

Routine vaccination

Catch-up vaccination

Special situations

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

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

Routine vaccination

Catch-up vaccination

International travel

Hepatitis B vaccination (minimum age: birth)

Birth dose (monovalent HepB vaccine only)

Routine series

Catch-up vaccination

Special situations

Human papillomavirus vaccination (minimum age: 9 years)

Routine and catch-up vaccination

Special situations

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

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], 2 years [MenACWY-TT, MenQuadfi])

Routine vaccination

Catch-up vaccination

Special situations

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

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

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

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

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” and in an outbreak setting and  additional meningococcal vaccination information, see https://www.cdc.gov/mmwr/volumes/69/rr/rr6909a1.htm.

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

Shared Clinical Decision-Making

Special situations

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

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 https://www.cdc.gov/mmwr/volumes/69/rr/rr6909a1.htm.

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

Routine vaccination with PCV13

Catch-up vaccination with PCV13

Special situations

Underlying 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

*Incomplete series = 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 in the ACIP pneumococcal vaccine recommendations (https://www.cdc.gov/mmwr/pdf/rr/rr5911.pdfpdf icon) for complete schedule details.

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:

Rotavirus vaccination (minimum age: 6 weeks)

Routine vaccination

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

Special situations

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

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) LAIV4 FluMist® Quadrivalent
Measles, mumps, and rubella vaccine MMR M-M-R® II
Meningococcal serogroups A, C, W, Y vaccine MenACWY-D
MenACWY-CRM
MenACWY-TT
Menactra®
Menveo®
MenQuadfi®
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® 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 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®
DTaP, inactivated poliovirus, Haemophilus influenzae type b, and hepatitis B vaccine DTaP-IPV-Hib-HepB Vaxelis®
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 icon), American Academy of Family Physicians (AAFPexternal icon)), American College of Obstetricians and Gynecologists (ACOGexternal icon), American College of Nurse-Midwives (ACNMexternal icon), American Academy of Physician Assistants (AAPAexternal icon), and National Association of Pediatric Nurse Practitioners (NAPNAPexternal icon).
The comprehensive summary of the ACIP recommended changes made to the child and adolescent immunization schedule can be found in the February 12, 2021 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)

Helpful information


Page last reviewed: February 12, 2021