Child and Adolescent Immunization Schedule by Medical Indication
Recommendations for Ages 18 Years or Younger, United States, 2024
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)
Parent-friendly schedules
Vaccines your child may need: Get a personalized list of recommended vaccines
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.
Vaccine and other immunizing agents | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|
Pregnancy | Immunocompromised status (excluding HIV infection) | HIV infection CD4 percentage and counta | 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 | ||
<15% or <200mm | ≥15% and ≥200/mm3 | |||||||||
RSV-mAb ![]() |
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 ![]() |
||||||||||
SCIDb | ||||||||||
DTaP/Tdap ![]() |
DTaP | |||||||||
Tdap: 1 dose each pregnancy | ||||||||||
Hib ![]() |
See notes | See notes | ||||||||
HSCT: 3 doses | ||||||||||
Pneumococcal ![]() |
||||||||||
IPV ![]() |
||||||||||
COVID-19 ![]() |
See notes | |||||||||
IIV4 ![]() |
||||||||||
LAIV4 ![]() |
||||||||||
Asthma, wheezing: 2–4 yearsc | ||||||||||
Measles, mumps, rubella ![]() |
* | |||||||||
VAR ![]() |
* | |||||||||
Hepatitis A ![]() |
||||||||||
Human papillomavirus ![]() |
* | 3 dose series. See notes | ||||||||
Meningococcal ACWY ![]() |
||||||||||
Meningococcal B ![]() |
||||||||||
RSV ![]() |
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
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])
Diphtheria, tetanus, and pertussis (DTaP) vaccination
(minimum age: 6 weeks [4 years for Kinrix® or Quadracel®])
Influenza vaccination
(minimum age: 6 months [IIV], 2 years [LAIV4], 18 years [recombinant influenza vaccine, RIV4])
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])
Meningococcal serogroup B vaccination
(minimum age: 10 years [MenB-4C, Bexsero®; MenB-FHbp, Trumenba®; MenACWY-TT/MenB-FHbp, Penbraya™])
Tetanus, diphtheria, and pertussis (Tdap) vaccination
(minimum age: 11 years for routine vaccination, 7 years for catch-up vaccination)
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.
- 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
- 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
Vaccines
Recommendations
Recommendations
Effective Date of
Recommendation*
Effective Date of
Recommendation*
No new vaccines or vaccine recommendations to report
No new vaccines or vaccine recommendations to report
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 | Abbreviation(s) | Trade name(s) |
---|---|---|
Respiratory syncytial virus monoclonal antibody (Nirsevimab) | RSV-mAb | Beyfortus™ |
Vaccines | Abbreviation(s) | Trade name(s) |
---|---|---|
COVID-19† | 1vCOV-mRNA | Comirnaty®/Pfizer- BioNTech COVID-19 Vaccine |
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® |
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® |
MenACWY-TT | MenQuadfi® | |
Meningococcal serogroup B vaccine | MenB-4C | Bexsero® |
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™ |
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.
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
- Complete Advisory Committee on Immunization Practices (ACIP) recommendations
- ACIP Shared Clinical Decision-Making Recommendations
- General Best Practice Guidelines for Immunization (including contraindications and precautions)
- Vaccine information statements
- Manual for the Surveillance of Vaccine-Preventable Diseases (including case identification and outbreak response)