Child and Adolescent Immunization Schedule by Medical Indication

Recommendations for Ages 18 Years or Younger, United States, 2024

Using the schedule

To make vaccination recommendations, healthcare providers should:

Determine recommended vaccine by age (Table 1)
Determine recommended interval for catch-up vaccination (Table 2)
Assess need for additional recommended vaccines by medical condition or other indication (Table 3)
Review vaccine types, frequencies, intervals, and considerations for special situations (Notes)
Review contraindications and precautions for vaccine types (Appendix)
Review new or updated ACIP guidance (Addendum)

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The Immunization Schedule

Vaccines in the schedule

Table 1. By age

Table 2. Catch-up schedule

Table 3. By medical indications

Vaccination notes

Appendix

Addendum

Download the Schedule

More Schedule Resources

Legend

Recommended for all age-eligible children who lack documentation of a complete vaccination series

Not recommended for all children, but is recommended for some children based on increased risk for or severe outcomes from disease

Recommended for all age-eligible children, and additional doses may be necessary based on medical condition or other indications. See Notes.

Precaution: Might be indicated if benefit of protection outweighs risk of adverse reaction

Contraindicated or not recommended *Vaccinate after pregnancy, if indicated

No Guidance/Not Applicable

Always use this table in conjunction with Table 1 and the Notes that follow. Medical conditions are often not mutually exclusive. If multiple conditions are present, refer to guidance in all relevant columns. See Notes for medical conditions not listed.

child indications vaccine schedule
Vaccine and other immunizing agents
	Pregnancy	Immunocompromised status (excluding HIV infection)	HIV infection CD4 percentage and count^a		CSF leak or cochlear implant	Asplenia or persistent complement component deficiencies	Heart disease or chronic lung disease	Kidney failure, End-stage renal disease or on Dialysis	Chronic liver disease	Diabetes
	Pregnancy	Immunocompromised status (excluding HIV infection)	<15% or <200mm	≥15% and ≥200/mm³	CSF leak or cochlear implant	Asplenia or persistent complement component deficiencies	Heart disease or chronic lung disease	Kidney failure, End-stage renal disease or on Dialysis	Chronic liver disease	Diabetes
RSV-mAb (nirsevimab)		2nd RSV season		1 dose depending on maternal RSV vaccination status, See notes			2nd RSV season for chronic lung disease (See notes)	1 dose depending on maternal RSV vaccination status, See notes
Hepatitis B
Rotavirus
Rotavirus		SCID^b
DTaP/Tdap	DTaP
DTaP/Tdap	Tdap: 1 dose each pregnancy
Hib			See notes			See notes
Hib		HSCT: 3 doses	See notes			See notes
Pneumococcal
IPV
COVID-19		See notes
IIV4
LAIV4
LAIV4							Asthma, wheezing: 2–4 years^c
Measles, mumps, rubella	*
VAR	*
Hepatitis A
Human papillomavirus	*	3 dose series. See notes
Meningococcal ACWY
Meningococcal B
RSV (Abrysvo)	Seasonal administration, See notes
Dengue
Mpox	See notes

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

Determine recommended vaccine by age (Table 1)

Determine recommended interval for catch-up vaccination (Table 2)

Top of Page

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, 2024.

Additional information

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, RSV, Mpox, and COVID-19 vaccines. Mpox and COVID-19 vaccines 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])

Age 6 months–4 years

Unvaccinated:
- 2-dose series of updated (2023–2024 Formula) Moderna at 0, 4-8 weeks
- 3-dose series of updated (2023–2024 Formula) Pfizer- BioNTech at 0, 3-8, 11-16 weeks
Previously vaccinated* with 1 dose of any Moderna: 1 dose of updated (2023–2024 Formula) Moderna 4-8 weeks after the most recent dose.
Previously vaccinated* with 2 or more doses of any Moderna: 1 dose of updated (2023–2024 Formula) Moderna at least 8 weeks after the most recent dose.
Previously vaccinated* with 1 dose of any Pfizer- BioNTech: 2-dose series of updated (2023–2024 Formula) Pfizer-BioNTech at 0, 8 weeks (minimum interval between previous Pfizer-BioNTech and dose 1: 3-8 weeks).
Previously vaccinated* with 2 or more doses of any Pfizer- BioNTech: 1 dose of updated (2023–2024 Formula) Pfizer- BioNTech at least 8 weeks after the most recent dose.

Age 5–11 years

Unvaccinated: 1 dose of updated (2023–2024 Formula) Moderna or Pfizer-BioNTech vaccine.
Previously vaccinated* with 1 or more doses of Moderna or Pfizer-BioNTech: 1 dose of updated (2023–2024 Formula) Moderna or Pfizer-BioNTech at least 8 weeks after the most recent dose.

Age 12–18 years

Unvaccinated:
- 1 dose of updated (2023–2024 Formula) Moderna or Pfizer- BioNTech vaccine
- 2-dose series of updated (2023–2024 Formula) Novavax at 0, 3-8 weeks
Previously vaccinated* with any COVID-19 vaccine(s): 1 dose of any updated (2023–2024 Formula) COVID-19 vaccine at least 8 weeks after the most recent dose.

*Note: Previously vaccinated is defined as having received any Original monovalent or bivalent COVID-19 vaccine (Janssen, Moderna, Novavax, Pfizer-BioNTech) prior to the updated 2023–2024 formulation.

There is no preferential recommendation for the use of one COVID-19 vaccine over another when more than one recommended age-appropriate vaccine is available.

Administer an age-appropriate COVID-19 vaccine product for each dose. For information about transition from age 4 years to age 5 years or age 11 years to age 12 years during COVID-19 vaccination series, see Tables 1 and 2 at www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us.html#covid-vaccines.

Current COVID-19 schedule and dosage formulation available at www.cdc.gov/covidschedule. 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

Persons who are moderately or severely immunocompromised**

Age 6 months–4 years

Unvaccinated:
- 3-dose series of updated (2023–2024 Formula) Moderna at 0, 4, 8 weeks
- 3-dose series of updated (2023–2024 Formula) Pfizer- BioNTech at 0, 3, 11 weeks.
Previously vaccinated* with 1 dose of any Moderna: 2-dose series of updated (2023–2024 Formula) Moderna at 0, 4 weeks (minimum interval between previous Moderna and dose 1: 4 weeks).
Previously vaccinated* with 2 doses of any Moderna: 1 dose of updated (2023–2024 Formula) Moderna at least 4 weeks after the most recent dose.
Previously vaccinated* with 3 or more doses of any Moderna: 1 dose of updated (2023–2024 Formula) Moderna at least 8 weeks after the most recent dose.
Previously vaccinated* with 1 dose of any Pfizer- BioNTech: 2-dose series of updated (2023–2024 Formula) Pfizer-BioNTech at 0, 8 weeks (minimum interval between previous Pfizer-BioNTech and dose 1: 3 weeks).
Previously vaccinated* with 2 or more doses of any Pfizer- BioNTech: 1 dose of updated (2023–2024 Formula) Pfizer- BioNTech at least 8 weeks after the most recent dose.

Age 5–11 years

Unvaccinated:
- 3-dose series of updated (2023–2024 Formula) Moderna at 0, 4, 8 weeks
- 3-dose series updated (2023–2024 Formula) Pfizer-BioNTech at 0, 3, 7 weeks.
Previously vaccinated* with 1 dose of any Moderna: 2-dose series of updated (2023–2024 Formula) Moderna at 0, 4 weeks (minimum interval between previous Moderna and dose 1: 4 weeks).
Previously vaccinated* with 2 doses of any Moderna: 1 dose of updated (2023–2024 Formula) Moderna at least 4 weeks after the most recent dose.
Previously vaccinated* with 1 dose of any Pfizer- BioNTech: 2-dose series of updated (2023–2024 Formula) Pfizer-BioNTech at 0, 4 weeks (minimum interval between previous Pfizer-BioNTech and dose 1: 3 weeks)
Previously vaccinated* with 2 doses of any Pfizer- BioNTech: 1 dose of 2023–2024 Pfizer-BioNTech at least 4 weeks after the most recent dose.
Previously vaccinated* with 3 or more doses of any Moderna or Pfizer-BioNTech: 1 dose of updated (2023–2024 Formula) Moderna or Pfizer-BioNTech at least 8 weeks after the most recent dose.

Age 12–18 years

Unvaccinated:
- 3-dose series of updated (2023–2024 Formula) Moderna at 0, 4, 8 weeks
- 3-dose series of updated (2023–2024 Formula) Pfizer- BioNTech at 0, 3, 7 weeks
- 2-dose series of updated (2023–2024 Formula) Novavax at 0, 3 weeks
Previously vaccinated* with 1 dose of any Moderna: 2-dose series of updated (2023–2024 Formula) Moderna at 0, 4 weeks (minimum interval between previous Moderna dose and dose 1: 4 weeks).
Previously vaccinated* with 2 doses of any Moderna: 1 dose of updated (2023–2024 Formula) Moderna at least 4 weeks after the most recent dose.
Previously vaccinated* with 1 dose of any Pfizer- BioNTech: 2-dose series of updated (2023–2024 Formula) Pfizer-BioNTech at 0, 4 weeks (minimum interval between previous Pfizer-BioNTech dose and dose 1: 3 weeks).
Previously vaccinated* with 2 doses of any Pfizer- BioNTech: 1 dose of updated (2023–2024 Formula) Pfizer- BioNTech at least 4 weeks after the most recent dose.
Previously vaccinated* with 3 or more doses of any Moderna or Pfizer-BioNTech: 1 dose of any updated (2023–2024 Formula) COVID-19 vaccine at least 8 weeks after the most recent dose.
Previously vaccinated* with 1 or more doses of Janssen or Novavax or with or without dose(s) of any Original monovalent or bivalent COVID-19 vaccine: 1 dose of any updated (2023–2024 Formula) COVID-19 vaccine at least 8 weeks after the most recent dose.

There is no preferential recommendation for the use of one COVID-19 vaccine over another when more than one recommended age-appropriate vaccine is available.

**Note: Persons who are moderately or severely immunocompromised have the option to receive one additional dose of updated (2023–2024 Formula) COVID-19 vaccine at least 2 months following the last recommended updated (2023–2024 Formula) COVID-19 vaccine dose. Further additional updated (2023–2024 Formula) COVID-19 vaccine dose(s) may be administered, informed by the clinical judgement of a healthcare provider and personal preference and circumstances. Any further additional doses should be administered at least 2 months after the last updated (2023–2024 Formula) COVID-19 vaccine dose. Moderately or severely immunocompromised children 6 months–4 years of age should receive homologous updated (2023–2024 Formula) mRNA vaccine dose(s) if they receive additional doses.

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 (3-dose primary series at age 2, 4, and 6 months, followed by a booster doses at ages 15–18 months and 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 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)
No additional dose recommended when any HPV vaccine series of any valency has been completed using 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:
- Age 6 months–8 years who have received fewer than 2 influenza vaccine doses before July 1, 2023, or whose influenza vaccination history is unknown: 2 doses, separated by at least 4 weeks. Administer dose 2 even if the child turns 9 years between receipt of dose 1 and dose 2.
- Age 6 months–8 years who have received at least 2 influenza vaccine doses before July 1, 2023: 1 dose
- Age 9 years or older: 1 dose
For the 2023-2024 season, see cdc.gov/mmwr/volumes/72/rr/rr7202a1.htm.
For the 2024–25 season, see the 2024–25 ACIP influenza vaccine recommendations.

Note: Persons with an egg allergy can receive any influenza vaccine (egg-based and non-egg-based) appropriate for age and health status.

Close contacts (e.g., household contacts) of severely immunosuppressed persons who require a protected environment: should not receive If LAIV4 is given, they should avoid contact with for such immunosuppressed persons for 7 days after vaccination.

Note: Persons with an egg allergy can receive any influenza vaccine (egg-based and non-egg-based) appropriate for age and health status.

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.

*Note: If MMRV is used, the minimum interval between MMRV doses is 3 months

Unvaccinated children and adolescents: 2-dose series at least 4 weeks apart*
The maximum age for use of MMRV^* is 12 years.

*Note: If MMRV is used, the minimum interval between MMRV doses is 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

*Note: If MMRV is used, the minimum interval between MMRV doses is 3 months

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], 2 years [MenACWY-TT, MenQuadfi]), 10 years [MenACWY-TT/MenB-FHbp, Penbraya])

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
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)
Children age 2 years or older: 1 dose Menveo^®*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^®*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. See www.cdc.gov/vaccines/vpd/mening/downloads/menveo-single-vial-presentation.pdf.

Note: 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.

Children age 10 years or older may receive a single dose of Penbraya™ as an alternative to separate administration of MenACWY and MenB when both vaccines would be given on the same clinic day, (see “Meningococcal serogroup B vaccination” section below for more information).

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

For contraindications and precautions to Meningococcal ABCWY, (MenACWY-TT/MenB-FHbp) [Penbraya], see Meningococcal ABCWY Appendix

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

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)

For additional information on shared clinical decision-making for MenB, see www.cdc.gov/vaccines/hcp/admin/downloads/isd-job-aid-scdm-mening-b-shared-clinical-decision-making.pdf

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.

Children age 10 years or older may receive a dose of Penbraya™ as an alternative to separate administration of MenACWY and MenB when both vaccines would be given on the same clinic day. For age-eligible children not at increased risk, if Penbraya^™ is used for dose 1 MenB, MenB-FHbp (Trumenba) should be administered for dose 2 MenB. For age-eligible children at increased risk of meningococcal disease, Penbraya^™ may be used for additional MenACWY and MenB doses (including booster doses) if both would be given on the same clinic day and at least 6 months have elapsed since most recent Penbraya^™ dose.

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

For contraindications and precautions to Meningococcal ABCWY, (MenACWY-TT/MenB-FHbp) [Penbraya], see Meningococcal ABCWY Appendix

Mpox vaccination
(minimum age: 18 years [Jynneos®])

Age 18 years and at risk for Mpox infection: 2-dose series, 28 days apart.
- Risk factors for Mpox infection include:
  - Persons who are gay, bisexual, and other MSM, transgender or nonbinary people who in the past 6 months have had:
    - A new diagnosis of at least 1 sexually transmitted disease
    - More than 1 sex partner
    - Sex at a commercial sex venue
    - Sex in association with a large public event in a geographic area where Mpox transmission is occurring
  - Persons who are sexual partners of the persons described above
  - Persons who anticipate experiencing any of the situations described above
Pregnancy: There is currently no ACIP recommendation for Jynneos use in pregnancy due to lack of safety data in pregnant. Pregnant persons with any risk factor described above may receive Jynneos.

For detailed information, see: www.cdc.gov/vaccines/acip/meetings/downloads/slides-2023-10-25-26/04-MPOX-Rao-508.pdf

For contraindications and precautions to Mpox vaccination, see Mpox Appendix

Pneumococcal vaccination
(minimum age: 6 weeks [PCV15], [PCV 20]; 2 years [PPSV23])

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

Healthy children ages 2–4 years with any incomplete*
PCV series: 1 dose PCV
For other catch-up guidance, see Table 2.

Note: Either PCV15 or PCV20 can be used when PCV is indicated. For children without risk conditions, PCV20 is not indicated if they have received 4 doses of PCV13 or PCV15 or another age appropriate complete PCV series.

Children and adolescents with cerebrospinal fluid leak; chronic heart disease; chronic kidney disease (excluding maintenance dialysis and nephrotic syndrome); chronic liver disease; chronic lung disease (including moderate persistent or severe persistent asthma); cochlear implant; or diabetes mellitus:

Age 2–5 years

Any incomplete* PCV series with:
- 3 PCV doses: 1 dose PCV (at least 8 weeks after the most recent PCV dose)
- Less than 3 PCV doses: 2 doses PCV (at least 8 weeks after the most recent dose and administered at least 8 weeks apart)
Completed recommended PCV series but have not received PPSV23
- Previously received at least 1 dose of PCV20: no further PCV or PPSV23 doses needed
- Not previously received PCV20: administer 1 dose PCV20 OR 1 dose PPSV23 administer at least 8 weeks after the most recent PCV dose.

Age 6–18 years

Not previously received any dose of PCV13, PCV15, or PCV20: administer 1 dose of PCV15 or PCV20. If PCV15 is used and no previous receipt of PPSV23, administer 1 dose of PPSV23 at least 8 weeks after the PCV15 dose.**
Received PCV before age 6 years but have not received PPSV23
- Previously received at least 1 dose of PCV20: no further PCV or PPSV23 doses needed
- Not previously received PCV20: administer 1 dose PCV20 OR 1 dose PPSV23 at least 8 weeks after the most recent PCV dose. If PPSV23 is used, administer either PCV20 or dose 2 PPSV23 at least 5 years after dose 1 PPSV23.
Received PCV13 only at or after age 6 years: administer 1 dose PCV20 OR 1 dose PPSV23 at least 8 weeks after the most recent PCV13 dose.
Received 1 dose PCV13 and 1 dose PPSV23 at or after age 6 years: no further doses of any PCV or PPSV23 indicated.

Children and adolescents on maintenance dialysis, or with immunocompromising conditions such as 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; or sickle cell disease or other hemoglobinopathies:

Age 2–5 years

Any incomplete* PCV series:
- 3 PCV doses: 1 dose PCV (at least 8 weeks after the most recent PCV dose)
- Less than 3 PCV doses: 2 doses PCV (at least 8 weeks after the most recent dose and administered at least 8 weeks apart)
Completed recommended PCV series but have not received PPSV23
- Previously received at least 1 dose of PCV20: no further PCV or PPSV23 doses needed
- Not previously received PCV20: administer 1 dose PCV20 OR 1 dose PPSV23 at least 8 weeks after the most recent PCV. If PPSV23 is used, administer 1 dose of PCV20 or dose 2 PPSV23 at least 5 years after dose 1 PPSV23.

Age 6–18 years

Not previously received any dose of PCV13, PCV15, or PCV20: administer 1 dose of PCV15 or 1 dose of PCV20. If PCV15 is used and no previous receipt of PPSV23, administer 1 dose of PPSV23 at least 8 weeks after the PCV15 dose.**
Received PCV before age 6 years but have not received PPSV23
- Previously received at least 1 dose of PCV20: no additional dose of PCV or PPSV23
- Not previously received PCV20: administer 1 dose PCV20 OR 1 dose PPSV23 at least 8 weeks after the most recent PCV dose. If PPSV23 is used, administer either PCV20 or dose 2 PPSV23 at least 5 years after dose 1 PPSV23.
Received PCV13 only at or after age 6 years: administer 1 dose PCV20 OR 1 dose PPSV23 at least 8 weeks after the most recent PCV13 dose. If PPSV23 is used, administer 1 dose of PCV20 or dose 2 PPSV23 at least 5 years after dose 1 PPSV23.
Received 1 dose PCV13 and 1 dose PPSV23 at or after age 6 years: administer 1 dose PCV20 OR 1 dose PPSV23 at least 8 weeks after the most recent PCV13 dose and at least 5 years after dose 1 PPSV23.

*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 stacks.cdc.gov/view/cdc/133252

**When both PCV15 and PPSV23 are indicated, administer all doses of PCV15 first. PCV15 and PPSV23 should not be administered during the same visit.

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.
Adolescents age 18 years known or suspected to be unvaccinated or incompletely vaccinated: administer remaining doses (1, 2, or 3 IPV doses) to complete a 3-dose primary series.* Unless there are specific reasons to believe they were not vaccinated, most persons aged 18 years or older born and raised in the United States can assume they were vaccinated against polio as children.

Series containing oral poliovirus 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 age18 years at increased risk of exposure to poliovirus and completed primary series*: may administer one lifetime IPV booster

*Note: Complete primary series consist of at least 3 doses of IPV or trivalent oral poliovirus vaccine (tOPV) in any combination.

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

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

Respiratory syncytial virus immunization
(minimum age: birth [Nirsevimab, RSV-mAb (Beyfortus™)

Infants born October – March in most of the continental United States*
- Mother did not receive RSV vaccine OR mother’s RSV vaccination status is unknown: administer 1 dose nirsevimab within 1 week of birth in hospital or outpatient setting
- Mother received RSV vaccine less than 14 days prior to delivery: administer 1 dose nirsevimab within 1 week of birth in hospital or outpatient setting
- Mother received RSV vaccine at least 14 days prior to delivery: nirsevimab not needed but can be considered in rare circumstances at the discretion of healthcare providers (see special populations and situations at cdc.gov/vaccines/vpd/rsv/hcp/child-faqs.html )
Infants born April–September in most of the continental United States*
- Mother did not receive RSV vaccine OR mother’s RSV vaccination status is unknown: administer 1 dose nirsevimab shortly before start of RSV season*
- Mother received RSV vaccine less than 14 days prior to delivery: administer 1 dose nirsevimab shortly before start of RSV season*
- Mother received RSV vaccine at least 14 days prior to delivery: nirsevimab not needed but can be considered in rare circumstances at the discretion of healthcare providers (see special populations and situations at cdc.gov/vaccines/vpd/rsv/hcp/child-faqs.html)

Infants with prolonged birth hospitalization** (e.g., for prematurity) discharged October through March should be immunized shortly before or promptly after discharge.

Ages 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 the start of the second RSV season; severe immunocompromise; cystic fibrosis with either weight for length <10th percentile or 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)**:
- 1 dose nirsevimab shortly before start of second RSV season*
Ages 8–19 months who are American Indian or Alaska Native:
- 1 dose nirsevimab shortly before start of second RSV season*
Age-eligible and undergoing cardiac surgery with cardiopulmonary bypass**: 1 additional dose of nirsevimab after surgery. For additional details see special populations and situations at www.cdc.gov/vaccines/vpd/rsv/hcp/child-faqs.html

*Note: While the timing of the onset and duration of RSV season may vary, nirsevimab may be administered October through March in most of the continental United States. Providers in jurisdictions with RSV seasonality that differs from most of the continental United States (e.g., Alaska, jurisdiction with tropical climate) should follow guidance from public health authorities (e.g., CDC, health departments) or regional medical centers on timing of administration based on local RSV seasonality. Although optimal timing of administration is just before the start of the RSV season, nirsevimab may also be administered during the RSV season to infants and children who are age-eligible.

**Note: Nirsevimab can be administered to children who are eligible to receive palivizumab. Children who have received nirsevimab should not receive palivizumab for the same RSV season.

For further guidance, see www.cdc.gov/mmwr/volumes/72/wr/mm7234a4.htm and www.cdc.gov/vaccines/vpd/rsv/hcp/ child-faqs.html

For contraindications and precautions to RSV monoclonal antibody (RSV-mAb), see RSV monoclonal antibody Appendix

Respiratory syncytial virus vaccination
(RSV [Abrysvo™])

Pregnant at 32 weeks 0 days through 36 weeks and 6 days gestation from September through January in most of the continental United States*: 1 dose RSV vaccine (Abrysvo™). Administer RSV vaccine regardless of previous RSV infection.
- Either maternal RSV vaccination or infant immunization with nirsevimab (RSV monoclonal antibody) is recommended to prevent respiratory syncytial virus lower respiratory tract infection in infants.
All other pregnant persons: RSV vaccine not recommended.

There is currently no ACIP recommendation for RSV vaccination in subsequent pregnancies. No data are available to inform whether additional doses are needed in later pregnancies.

*Note: Providers in jurisdictions with RSV seasonality that differs from most of the continental United States (e.g., Alaska, jurisdiction with tropical climate) should follow guidance from public health authorities (e.g., CDC, health departments) or regional medical centers on timing of administration based on local RSV seasonality.

For contraindications and precautions to Respiratory syncytial virus vaccine (RSV), see RSV 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)

Age 11–12 years: 1 dose Tdap (adolescent booster)
Pregnancy: 1 dose Tdap during each pregnancy, preferably in early part of gestational weeks 27–36.

Note: Tdap may be administered regardless of the interval since the last tetanus- and diphtheria-toxoid-containing vaccine.

Age 13–18 years who have not received Tdap: 1 dose Tdap (adolescent booster)
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:
- Age 7–9 years who receive Tdap should receive the adolescent Tdap booster dose at age 11–12 years.
- Age 10 years who receive Tdap do not need the adolescent Tdap booster dose at age 11–12 years.
DTaP inadvertently administered on or after age 7 years:
- Age 7–9 years: DTaP may count as part of catch-up. Administer adolescent Tdap booster dose at age 11–12 years.
- Age 10–18 years: Count dose of DTaP as the adolescent Tdap booster dose.

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, Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2023–24 Influenza Season, Contraindications and Precautions for COVID-19 Vaccination, and Contraindications and Precautions for JYNNEOS Vaccination.

COVID-19 and Flu Vaccines

child schedule appendix for COVID-19 and Influenza vaccines
Vaccines and other Immunizing Agents	Contraindicated or Not Recommended¹	Precautions²
COVID-19 mRNA vaccines [Pfizer-BioNTech, Moderna]	Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a component of an mRNA COVID-19 vaccine⁵	Diagnosed non-severe allergy (e.g., urticaria beyond the injection site) to a component of an mRNA COVID-19 vaccine⁵; or non-severe, immediate (onset less than 4 hours) allergic reaction after administration of a previous dose of an mRNA COVID-19 vaccine Myocarditis or pericarditis within 3 weeks after a dose of any COVID-19 vaccine Multisystem inflammatory syndrome in children (MIS-C) or multisystem inflammatory syndrome in adults (MIS-A) Moderate or severe acute illness, with or without fever
COVID-19 protein subunit vaccine [Novavax]	Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a component of a Novavax COVID-19 vaccine⁵	Diagnosed non-severe allergy (e.g., urticaria beyond the injection site) to a component of Novavax COVID-19 vaccine⁵; or non-severe, immediate (onset less than 4 hours) allergic reaction after administration of a previous dose of a Novavax COVID-19 vaccine Myocarditis or pericarditis within 3 weeks after a dose of any COVID-19 vaccine Multisystem inflammatory syndrome in children (MIS-C) or multisystem inflammatory syndrome in adults (MIS-A) Moderate or severe acute illness, with or without fever
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)	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]	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 health care 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]	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 health care 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]	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, but not limited to, 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 age 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

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.
See package inserts and FDA EUA fact sheets for a full list of vaccine ingredients. mRNA COVID-19 vaccines contain polyethylene glycol (PEG).

Other Vaccines

child schedule appendix for other vaccines
Vaccines and other Immunizing Agents	Contraindicated or Not Recommended¹	Precautions²
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	Pregnancy HIV infection without evidence of severe immunosuppression Moderate or severe acute illness with or without fever
Diphtheria, tetanus, pertussis (DTaP)	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
Haemophilus influenzae type b (Hib)	Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component³ Less than age 6 weeks	Moderate or severe acute illness with or without fever
Hepatitis A (HepA)	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
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 indicated⁴.	Moderate or severe acute illness with or without fever
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	Moderate or severe acute illness with or without fever
Human papillomavirus (HPV)	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
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	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-TT) [MenQuadfi]	Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component³ For MenACWY-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
Meningococcal B (MenB) MenB-4C [Bexsero] MenB-FHbp [Trumenba]	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
Meningococcal ABCWY (MenACWY-TT/MenB-FHbp) [Penbraya]	Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component³ Severe allergic reaction to a tetanus toxoid-containing vaccine	Moderate or severe acute illness, with or without fever
Mpox [Jynneos]	Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component³	Moderate or severe acute illness, with or without fever
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	Moderate or severe acute illness with or without fever
Pneumococcal polysaccharide (PPSV23)	Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component³	Moderate or severe acute illness with or without fever
Poliovirus vaccine, inactivated (IPV)	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
RSV monoclonal antibody (RSV-mAb)	Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component⁵	Moderate or severe acute illness with or without fever
Respiratory syncytial virus vaccine (RSV)	Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component³	Moderate or severe acute illness with or without fever
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	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)	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
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	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.
Full prescribing information for BEYFORTUS (nirsevimab-alip) www.accessdata.fda.gov/drugsatfda_docs/label/2023/761328s000lbl.pdf

Addendum – Child and Adolescent Recommended Immunization Schedule for Ages 18 Years or Younger, United States, 2024

In addition to the recommendations presented in the previous sections of this immunization schedule, ACIP has approved the following recommendations by majority vote since October 26, 2023. The following recommendations have been adopted by the CDC Director and are now official. Links are provided if these recommendations have been published in Morbidity and Mortality Weekly Report (MMWR).

Vaccines

Recommendations

Effective Date of
Recommendation*

Effective Date of Recommendation*

Effective Date of
Recommendation*

No new vaccines or vaccine recommendations to report

Vaccines

No new vaccines or vaccine recommendations to report

Recommendations

Effective Date of Recommendation*

Vaccines and Other Immunizing Agents in the Child and Adolescent Immunization Schedule*

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

Monoclonal antibody
Monoclonal antibody	Abbreviation(s)	Trade name(s)
Respiratory syncytial virus monoclonal antibody (Nirsevimab)	RSV-mAb	Beyfortus^™

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
	1vCOV-aPS	Novavax COVID-19 Vaccine
Dengue vaccine	DEN4CYD	Dengvaxia^®
Diphtheria, tetanus, and acellular pertussis vaccine	DTaP	Daptacel^® Infanrix^®
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-CRM	Menveo^®
Meningococcal serogroups A, C, W, Y vaccine	MenACWY-TT	MenQuadfi^®
Meningococcal serogroup B vaccine	MenB-4C	Bexsero^®
Meningococcal serogroup B vaccine	MenB-FHbp	Trumenba^®
Meningococcal serogroup A, B, C, W, Y vaccine	MenACWY-TT/MenB-FHbp	Penbraya^™
Mpox vaccine	Mpox	Jynneos^®
Pneumococcal conjugate vaccine	PCV15	Vaxneuvance^™
Pneumococcal conjugate vaccine	PCV20	Prevnar 20^®
Pneumococcal polysaccharide vaccine	PPSV23	Pneumovax 23^®
Poliovirus vaccine (inactivated)	IPV	Ipol^®
Respiratory syncytial virus vaccine	RSV	Abrysvo^™
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^®

*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.

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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 will be published in an upcoming MMWR in early 2024.

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.gov 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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