Child and Adolescent Immunization Schedule by Medical Indication

Recommendations for Ages 18 Years or Younger, United States, 2022

COVID-19 Vaccination

ACIP recommends use of COVID-19 vaccines for everyone ages 6 months and older. COVID-19 vaccine and other vaccines may be administered on the same day. See the COVID-19 Vaccine: Interim COVID-19 Immunization Schedule for additional information.

Using the schedule

To make vaccination recommendations, healthcare providers should:

  1. Determine needed vaccines based on age (Table 1)
  2. Determine appropriate intervals for catch-up, if needed (Table 2)
  3. Assess for medical conditions and other indications (Table 3)
  4. Review special situations (Vaccination Notes)
  5. Review contraindications and precautions to vaccination (Appendix)
More schedule resources

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 or vaccine. See Notes. Precaution—vaccine might be indicated if benefit of protection outweighs risk of adverse reaction Contraindicated or not recommended—vaccine should not be administered
*Vaccinate after pregnancy
No recommendation/Not applicable
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% or 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. (IIV4)
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.
Dengue 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. LAIV4 contraindicated for children 2–4 years of age with asthma or wheezing during the preceding 12 months

Administer recommended vaccines if immunization history is incomplete or unknown. Do not restart or add doses to vaccine series for extended intervals between doses. When a vaccine is not administered at the recommended age, administer at a subsequent visit. The use of trade names is for identification purposes only and does not imply endorsement by the ACIP or CDC.

Notes

For vaccination recommendations for persons ages 19 years or older, see the Recommended Adult Immunization Schedule, 2022.

Additional information

  • Consult relevant ACIP statements for detailed recommendations.
  • For calculating intervals between doses, 4 weeks = 28 days. Intervals of ≥4 months are determined by calendar months.
  • Within a number range (e.g., 12–18), a dash (–) should be read as “through.”
  • Vaccine doses administered ≤4 days before the minimum age or interval are considered valid. Doses of any vaccine administered ≥5 days earlier than the minimum age or minimum interval should not be counted as valid and should be repeated as age-appropriate. The repeat dose should be spaced after the invalid dose by the recommended minimum interval. For further details, see Table 3-1, 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, and Immunization in Special Clinical Circumstances (In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book: 2018 report of the Committee on Infectious Diseases. 31st ed. Itasca, IL: American Academy of Pediatrics, 2018:67–111).
  • 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 routine child and adolescent vaccines are covered by VICP except for pneumococcal polysaccharide vaccine (PPSV23). For more information, see www.hrsa.gov/vaccinecompensation/index.htmlexternal icon.

Dengue Vaccination

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

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

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

Hepatitis B vaccination
(minimum age: birth)

Human papillomavirus vaccination
(minimum age: 9 years)

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

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

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

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

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

Poliovirus vaccination
(minimum age: 6 weeks)

Rotavirus vaccination
(minimum age: 6 weeks)

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

Varicella vaccination
(minimum age: 12 months)


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 and ACIP’s Recommendations for the Prevention and Control of 2021-22 seasonal influenza with Vaccines.

Vaccine

Contraindications1

Precautions2

Vaccine

Dengue (DEN4CYD)

Contraindications1

  • 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)

Precautions2

  • Pregnancy
  • HIV infection without evidence of severe immunosuppression
  • Moderate or severe acute illness with or without fever

Vaccine

Diphtheria, tetanus, pertussis (DTaP)

Tetanus, diphtheria (DT)

Contraindications1

  • 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

Precautions2

  • 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

Vaccine

Haemophilus influenzae type b (Hib)

Contraindications1

  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
  • For Hiberix, ActHib, and PedvaxHIB only: History of severe allergic reaction to dry natural latex
  • Age <6 weeks

Precautions2

  • Moderate or severe acute illness with or without fever

Vaccine

Hepatitis A (HepA)

Contraindications1

  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 including neomycin

Precautions2

  • Moderate or severe acute illness with or without fever

Vaccine

Hepatitis B (HepB)

Contraindications1

  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 including yeast
  • For Heplisav-B only: Pregnancy

Precautions2

  • Moderate or severe acute illness with or without fever

Vaccine

Hepatitis A- Hepatitis B vaccine [HepA-HepB, (Twinrix®)]

Contraindications1

  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 including neomycin and yeast

Precautions2

  • Moderate or severe acute illness with or without fever

Vaccine

Human papillomavirus (HPV)

Contraindications1

  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3

Precautions2

  • Moderate or severe acute illness with or without fever

Vaccine

Influenza, egg-based, inactivated injectable (IIV4)

Contraindications1

  • 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)

Precautions2

  • Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any type of influenza vaccine
  • Persons with 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, administer in medical setting under supervision of healthcare provider who can recognize and manage severe allergic reactions
  • Moderate or severe acute illness with or without fever

Vaccine

Influenza, cell culture-based inactivated injectable
[(ccIIV4), Flucelvax® Quadrivalent]

Contraindications1

  • Severe allergic reaction (e.g., anaphylaxis) to any ccIIV of any valency, or to any component3 of ccIIV4

Precautions2

  • 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 healthcare provider who can recognize and manage severe allergic reactions. May consult an allergist.
  • Moderate or severe acute illness with or without fever

Vaccine

Influenza, recombinant injectable
[(RIV4), Flublok® Quadrivalent]

Contraindications1

  • Severe allergic reaction (e.g., anaphylaxis) to any RIV of any valency, or to any component3 of RIV4

Precautions2

  • 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 healthcare provider who can recognize and manage severe allergic reactions. May consult an allergist.
  • Moderate or severe acute illness with or without fever

Vaccine

Influenza, live attenuated [LAIV4, Flumist® Quadrivalent]

Contraindications1

  • 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 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.

Precautions2

  • Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any type of influenza vaccine
  • Asthma in persons aged 5 years old or older
  • Persons with 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 LAIV4 (which is egg based), administer in medical setting under supervision of healthcare provider who can recognize and manage severe allergic reactions. May consult an allergist.
  • 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

Vaccine

Measles, mumps, rubella (MMR)

Contraindications1

  • 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

Precautions2

  • 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

Vaccine

Meningococcal ACWY (MenACWY)
[MenACWY-CRM (Menveo®); MenACWY-D (Menactra®); MenACWY-TT (MenQuadfi®)]

Contraindications1

  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
  • For MenACWY-D and Men ACWY-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

Precautions2

  • For MenACWY-CRM only: Preterm birth if less than age 9 months
  • Moderate or severe acute illness with or without fever

Vaccine

Meningococcal B (MenB)
[MenB-4C (Bexsero®); MenB-FHbp (Trumenba®)]

Contraindications1

  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3

Precautions2

  • Pregnancy
  • For MenB-4C only: Latex sensitivity
  • Moderate or severe acute illness with or without fever

Vaccine

Pneumococcal conjugate (PCV13)

Contraindications1

  • 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

Precautions2

  • Moderate or severe acute illness with or without fever

Vaccine

Pneumococcal polysaccharide (PPSV23)

Contraindications1

  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3

Precautions2

  • Moderate or severe acute illness with or without fever

Vaccine

Poliovirus vaccine, inactivated (IPV)

Contraindications1

  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3

Precautions2

  • Pregnancy
  • Moderate or severe acute illness with or without fever

Vaccine

Rotavirus (RV) [RV1 (Rotarix®), RV5 (RotaTeq®)]

Contraindications1

  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
  • Severe combined immunodeficiency (SCID)
  • History of intussusception

Precautions2

  • Altered immunocompetence other than SCID
  • Chronic gastrointestinal disease
  • RV1 only: Spina bifida or bladder exstrophy
  • Moderate or severe acute illness with or without fever

Vaccine

Tetanus, diphtheria, and acellular pertussis (Tdap)

Tetanus, diphtheria (Td)

Contraindications1

  • 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

Precautions2

  • 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

Vaccine

Varicella (VAR)

Contraindications1

  • 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

Precautions2

  • 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
  1. When a contraindication is present, a vaccine should NOT be administered. Kroger A, Bahta L, Hunter P. ACIP General Best Practice Guidelines for Immunization.
  2. 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.
  3. 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 vaccinesexternal icon.

Vaccines in the Child and Adolescent Immunization Schedule

Vaccine

Abbreviation(s)

Trade name(s)

Vaccine

Dengue vaccine

Abbreviation(s)

DEN4CYD

Trade name(s)

Dengvaxia®

Vaccine

Diphtheria, tetanus, and acellular pertussis vaccine

Abbreviation(s)

DTaP

Trade name(s)

Daptacel®
Infanrix®

Vaccine

Diphtheria, tetanus vaccine

Abbreviation(s)

DT

Trade name(s)

No Trade Name

Vaccine

Haemophilus influenzae type B vaccine

Abbreviation(s)

Hib (PRP-T)
Hib (PRP-OMP)

Trade name(s)

ActHIB®
Hiberix®
PedvaxHIB®

Vaccine

Hepatitis A vaccine

Abbreviation(s)

HepA

Trade name(s)

Havrix®
Vaqta®

Vaccine

Hepatitis B vaccine

Abbreviation(s)

HepB

Trade name(s)

Engerix-B®
Recombivax HB®

Vaccine

Human papillomavirus vaccine

Abbreviation(s)

HPV

Trade name(s)

Gardasil 9®

Vaccine

Influenza vaccine (inactivated)

Abbreviation(s)

IIV4

Trade name(s)

Multiple

Vaccine

Influenza vaccine (live, attenuated)

Abbreviation(s)

LAIV4

Trade name(s)

FluMist® Quadrivalent

Vaccine

Measles, mumps, and rubella vaccine

Abbreviation(s)

MMR

Trade name(s)

M-M-R® II

Vaccine

Meningococcal serogroups A, C, W, Y vaccine

Abbreviation(s)

MenACWY-D
MenACWY-CRM
MenACWY-TT

Trade name(s)

Menactra®
Menveo®
MenQuadfi®

Vaccine

Meningococcal serogroup B vaccine

Abbreviation(s)

MenB-4C
MenB-FHbp

Trade name(s)

Bexsero®
Trumenba®

Vaccine

Pneumococcal 13-valent conjugate vaccine

Abbreviation(s)

PCV13

Trade name(s)

Prevnar 13®

Vaccine

Pneumococcal 23-valent polysaccharide vaccine

Abbreviation(s)

PPSV23

Trade name(s)

Pneumovax® 23

Vaccine

Poliovirus vaccine (inactivated)

Abbreviation(s)

IPV

Trade name(s)

IPOL®

Vaccine

Rotavirus vaccine

Abbreviation(s)

RV1
RV5

Trade name(s)

Rotarix®
RotaTeq®

Vaccine

Tetanus, diphtheria, and acellular pertussis vaccine

Abbreviation(s)

Tdap

Trade name(s)

Adacel®
Boostrix®

Vaccine

Tetanus and diphtheria vaccine

Abbreviation(s)

Td

Trade name(s)

Tenivac®
TDvax™

Vaccine

Varicella vaccine

Abbreviation(s)

VAR

Trade name(s)

Varivax®

Combination Vaccines

(Use combination vaccines instead of separate injections when appropriate)

Vaccine

Abbreviation(s)

Trade name(s)

Vaccine

DTaP, hepatitis B, and inactivated poliovirus vaccine

Abbreviation(s)

DTaP-HepB-IPV

Trade name(s)

Pediarix®

Vaccine

DTaP, inactivated poliovirus, and Haemophilus influenzae type B vaccine

Abbreviation(s)

DTaP-IPV/Hib

Trade name(s)

Pentacel®

Vaccine

DTaP and inactivated poliovirus vaccine

Abbreviation(s)

DTaP-IPV

Trade name(s)

Kinrix®
Quadracel®

Vaccine

DTaP, inactivated poliovirus, Haemophilus influenzae type b, and hepatitis B vaccine

Abbreviation(s)

DTaP-IPV-Hib-HepB

Trade name(s)

Vaxelis®

Vaccine

Measles, mumps, rubella, and varicella vaccines

Abbreviation(s)

MMRV

Trade name(s)

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 Associates (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 18, 2022 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)

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

Page last reviewed: February 17, 2022