Childhood and Adolescent Immunization Schedule: United States, 2023

Publication Date: February 9, 2023

Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger, United States, 2023

Recommended Catch-up Immunization Schedule for Children and Adolescents Who Start Late or Who Are More than 1 Month Behind, United States, 2023

Recommended Child and Adolescent Immunization Schedule by Medical Indication, United States, 2023

Guide to Contraindications and Precautions to Commonly Used Vaccines

Vaccine Contraindications Precautions
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)
Pregnancy
HIV infection without evidence of severe immunosuppression
Moderate or severe acute illness with or without fever
Diphtheria, tetanus, pertussis (DTaP)
Tetanus, diphtheria (DT)
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
For Hiberix, ActHib, and PedvaxHIB only: History of severe allergic reaction to dry natural latex
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
For Heplisav-B only: Pregnancy
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 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
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 IIV4 or LAIV4, 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
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 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.
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, recombinant injectable
[(RIV4), Flublok® Quadrivalent]
Severe allergic reaction (e.g., anaphylaxis) to any RIV of any valency, or to any component3 of RIV4 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.
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, 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 healthcare 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)
Adults age 50 years or older
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
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 aged 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
Measles, mumps, rubella (MMR) 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
Meningococcal ACWY (MenACWY)
[MenACWY-CRM (Menveo®); MenACWY-D (Menactra®); MenACWY-TT (MenQuadfi®)]
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
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
Pneumococcal conjugate (PCV15)
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 to its vaccine component3
Moderate or severe acute illness with or without fever
Pneumococcal conjugate (PCV20)
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 to its vaccine 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
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

Vaccines in the Child and Adolescent Immunization Schedule

Vaccine Abbreviation(s) Trade name(s)
Dengue vaccine
DEN4CYD
Dengvaxia®
COVID-19 1vCOV-mRNA
2vCOV-mRNA
1vCOV-aPS
Comirnaty®/Pfizer- BioNTech COVID-19 Vaccine
SPIKEVAX®/Moderna COVID-19 Vaccine
Pfizer-BioNTech COVID-19 Vaccine, Bivalent
Moderna COVID-19 Vaccine, Bivalent
Novavax
Diphtheria, tetanus vaccine
DT
No Trade Name
Diphtheria, tetanus, and acellular pertussis vaccine
DTaP
Daptacel®
Infanrix®
DTaP and inactivated poliovirus vaccine
DTaP-IPV
Kinrix®
Quadracel®
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, inactivated poliovirus, Haemophilus influenzae type b, and hepatitis B vaccine
DTaP-IPV-Hib-HepB
Vaxelis®
Haemophilus influenzae type B vaccine
Hib (PRP-T)
Hib (PRP-OMP)
ActHIB®
Hiberix®
PedvaxHIB®
Hepatitis A vaccine HepA Havrix®
Vaqta®
Hepatitis B vaccine HepB Engerix-B®
Recombivax HB®
Human papillomavirus vaccine HPV Vaccine Gardasil 9®
Influenza vaccine (inactivated) IIV4 Many brands
Influenza vaccine (live, attenuated) LAIV4 FluMist® Quadrivalent
Measles, mumps, and rubella vaccine MMR M-M-R® II
Priorix
Measles, mumps, rubella, and varicella vaccines
MMRV
ProQuad®
Meningococcal serogroup B vaccine MenB-4C
MenB-FHbp
Bexsero®
Trumenba®
Meningococcal serogroups A, C, W, Y vaccine MenACWY-D
MenACWY-CRM
MenACWY-TT
Menactra®
Menveo®
MenQuadfi®
Pneumococcal 20-valent conjugate vaccine PCV20 Prevnar 13™
Pneumococcal 23-valent polysaccharide vaccine PPSV23 Pneumovax 23®
Pneumococcal conjugate vaccine PCV15 Vaxneuvance
Poliovirus vaccine (inactivated)
IPV
IPOL®
Rotavirus vaccine
RV1
RV5
Rotarix®
RotaTeq®
Tetanus and diphtheria toxoids Td Tenivac®
Tdvax™
Tetanus and diphtheria toxoids and acellular pertussis vaccine Tdap Adacel®
Boostrix®
Varicella vaccine VAR Varivax®

COVID-19 vaccination

Routine vaccination
  • Primary series:
    • Age 6 months–4 years: 2-dose series at 0, 4-8 weeks (Moderna) or 3-dose series at 0, 3-8, 11-16 weeks (Pfizer-BioNTech)
    • Age 5–11 years: 2-dose series at 0, 4-8 weeks (Moderna) or 2-dose series at 0, 3-8 weeks (Pfizer-BioNTech)
    • Age 12–18 years: 2-dose series at 0, 4-8 weeks (Moderna) or 2-dose series at 0, 3-8 weeks (Novavax, Pfizer-BioNTech)
  • For booster dose recommendations see www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us.html

Special situations

Persons who are moderately or severely immunocompromised

For Janssen COVID-19 Vaccine recipients see COVID-19 schedule at www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us.html

Note: Administer an age-appropriate vaccine product for each dose. Current COVID-19 schedule and dosage formulation available at www.cdc.gov/vaccines/covid-19/downloads/COVID-19-immunization-schedule-ages-6months-older.pdf. 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.

(minimum age: 6 months [Moderna and Pfizer-BioNTech COVID-19 vaccines], 12 years [Novavax COVID-19 Vaccine])

Dengue Vaccination

Routine Vaccination
  • 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.

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

Routine Vaccination
  • 5-dose series at age 2, 4, 6, 15–18 months, 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.

Catch-up Vaccination
  • 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.

Special Situations
  • 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.

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

Routine Vaccination
  • 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)

Catch-up Vaccination
  • Dose 1 at age 711 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 1214 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.



Special Situations
  • 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)

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

Routine Vaccination
  • 2-dose series (minimum interval: 6 months) at age 12–23 months

Catch-up Vaccination
  • 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).

International Travel
  • Persons traveling to or working in countries with high or intermediate endemic hepatitis A
    (http://www.cdc.gov/travel/)
    • Infants age 611 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.

Hepatitis B vaccination (minimum age: birth)

Routine Vaccination
  • 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.

Catch-up Vaccination
  • 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 or older 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).

Special Situations
  • 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:
  • Note: Heplisav-B and PreHevbrio are not recommended in pregnancy due to lack of safety data in pregnant persons.

Human papillomavirus vaccination (minimum age: 9 years)

Routine and Catch-Up Vaccination
  • 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)
  • Interrupted schedules: If vaccination schedule is interrupted, the series does not need to be restarted.
  • No additional dose recommended when any HPV vaccine series has been completed using the recommended dosing intervals.

Special Situations
  • 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

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

Routine Vaccination
  • Use any influenza vaccine appropriate for age and health status annually:
    • 2 doses, separated by at least 4 weeks, for children age 6 months–8 years who have received fewer than 2 influenza vaccine doses before July 1, 2022, or whose influenza vaccination history is unknown (administer dose 2 even if the child turns 9 between receipt of dose 1 and dose 2)
    • 1 dose for children age 6 months–8 years who have received at least 2 influenza vaccine doses before July 1, 2022
    • 1 dose for all persons age 9 years or older
  • For the 2022-2023 season, see www.cdc.gov/mmwr/volumes/71/rr/rr7101a1.htm.
  • For the 2023–24 season, see the 2023–24 ACIP influenza vaccine recommendations.

Special Situations
  • Egg allergy, hives only: Any influenza vaccine appropriate for age and health status annually
  • 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 or LAIV4, administer in medical setting under supervision of health care provider who can recognize and manage severe allergic reactions.
  • Severe allergic reaction (e.g., anaphylaxis) to a vaccine component or a previous dose of any influenza vaccine: see Appendix listing contraindications and precautions
  • Close contacts (e.g., caregivers, healthcare personnel) of severely immunosuppressed persons who require a protected environment: these persons should not receive LAIV4. If LAIV4 is given, they should avoid contact with/caring for such immunosuppressed persons for 7 days after vaccination.

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

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.


Catch-Up Vaccination
  • Unvaccinated children and adolescents: 2-dose series at least 4 weeks apart
  • The maximum age for use of MMRV is 12 years.
  • Minimum interval between MMRV doses: 3 months

Special Situations
  • International travel
    • Infants age 611 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

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

Routine Vaccination
  • 2-dose series at age 11–12 years, 16 years

Catch-Up Vaccination
  • Age 13–15 years: 1 dose now and booster at age 16–18 years (minimum interval: 8 weeks)
  • Age 16–18 years: 1 dose

Special Situations
  • 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
  • Menactra®
    • Persistent complement component deficiency or complement inhibitor use:
      • Age 9–23 months: 2-dose series at least 12 weeks apart
      • Age 24 months or older: 2-dose series at least 8 weeks apart
    • Anatomic or functional asplenia, sickle cell disease, or HIV infection:
      • Age 9–23 months: Not recommended
      • Age 24 months or older: 2-dose series at least 8 weeks apart
      • Menactra® must be administered at least 4 weeks after completion of PCV series.
  • 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)
    • Menactra® (age 9–23 months)
      • 2-dose series (dose 2 at least 12 weeks after dose 1; dose 2 may be administered as early as 8 weeks after dose 1 in travelers)
  • Children age 2 years or older: 1 dose Menveo®*, Menactra®, 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®*, Menactra®, 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.

    Note: Menactra® should be administered either before or at the same time as DTaP. MenACWY may be administered simultaneously with MenB vaccines if indicated, but at a different anatomic site, if feasible.

    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.

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

Shared Clinical Decision-Making
  • 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 3rd dose at least 4 months after dose 2.

Special Situations
  • 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 4th 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.

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

Routine Vaccination with PCV
  • 4-dose series at age 2, 4, 6, 12–15 months

Catch-Up Vaccination with PCV
  • Healthy children age 24–59 months with any incomplete* PCV series: 1 dose PCV
  • For other catch-up guidance, see Table 2.
  • Note: PCV13 and PCV15 can be used interchangeably for children who are healthy or have underlying conditions. PCV15 is not indicated for children who have received 4 doses of PCV13 or another age appropriate complete PCV13 series

Special Situations
  • Underlying conditions below: When both PCV and PPSV23 are indicated, administer PCV first. PCV and PPSV23 should not be administered during the same visit.

    Chronic heart disease (particularly cyanotic congenital heart disease and cardiac failure); chronic lung disease (including asthma treated with high-dose, oral corticosteroids); diabetes mellitus:

    Age 2–5 years
  • Any incomplete* series with:
    • 3 PCV doses: 1 dose PCV (at least 8 weeks after any prior PCV dose)
    • Less than 3 PCV doses: 2 doses PCV (8 weeks after the most recent dose and administered 8 weeks apart)
  • No history of PPSV23: 1 dose PPSV23 (at least 8 weeks after completing all recommended PCV doses)
  • Age 6–18 years
  • Any incomplete* series with PCV: no further PCV doses needed
  • No history of PPSV23: 1 dose PPSV23 (at least 8 weeks after completing all recommended PCV doses)
  • Cerebrospinal fluid leak, cochlear implant:

    Age 2–5 years
  • Any incomplete* series with:
    • 3 PCV doses: 1 dose PCV (at least 8 weeks after any prior PCV dose)
    • Less than 3 PCV doses: 2 doses PCV (8 weeks after the most recent dose and administered 8 weeks apart)
  • No history of PPSV23: 1 dose PPSV23 (at least 8 weeks after completing all recommended PCV doses)
  • Age 6–18 years
  • No history of either PCV or PPSV23: 1 dose PCV, 1 dose PPSV23 at least 8 weeks later
  • Any PCV but no PPSV23: 1 dose PPSV23 at least 8 weeks after the most recent dose of PCV
  • PPSV23 but no PCV: 1 dose PCV at least 8 weeks after the most recent dose of PPSV23
  • Sickle cell disease and other hemoglobinopathies; anatomic or functional asplenia; congenital or acquired immunodeficiency; HIV infection; chronic renal failure; nephrotic syndrome; malignant neoplasms, leukemias, lymphomas, Hodgkin disease, and other diseases associated with treatment with immunosuppressive drugs or radiation therapy; solid organ transplantation; multiple myeloma:

    Age 2–5 years
  • Any incomplete* series with:
    • 3 PCV doses: 1 dose PCV (at least 8 weeks after any prior PCV dose)
    • Less than 3 PCV doses: 2 doses PCV (8 weeks after the most recent dose and administered 8 weeks apart)
  • No history of PPSV23: 1 dose PPSV23 (at least 8 weeks after completing all recommended PCV doses) and a dose 2 of PPSV23 5 years later
  • Age 6–18 years
  • No history of either PCV or PPSV23: 1 dose PCV, 2 doses PPSV23 (dose 1 of PPSV23 administered 8 weeks after PCV and dose 2 of PPSV23 administered at least 5 years after dose 1 of PPSV23)
  • Any PCV but no PPSV23: 2 doses PPSV23 (dose 1 of PPSV23 administered 8 weeks after the most recent dose of PCV and dose 2 of PPSV23 administered at least 5 years after dose 1 of PPSV23)
  • PPSV23 but no PCV: 1 dose PCV at least 8 weeks after the most recent PPSV23 dose and a dose 2 of PPSV23 administered 5 years after dose 1 of PPSV23 and at least 8 weeks after a dose of PCV
  • *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 www.cdc.gov/mmwr/volumes/71/wr/mm7137a3.htm

    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

Poliovirus vaccination (minimum age: 6 weeks)

Routine Vaccination
  • 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.

Catch-Up Vaccination
  • In the first 6 months of life, use minimum ages and intervals only for travel to a polio-endemic region or during an outbreak.
  • IPV is not routinely recommended for U.S. residents age 18 years or older.
  • Series containing oral polio 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.

Special situations
  • Adolescents aged 18 years at increased risk of exposure to poliovirus with:
    • No evidence of a complete polio vaccination series (i.e., at least 3 doses): administer remaining doses (1, 2, or 3 doses) to complete a 3-dose series
    • Evidence of completed polio vaccination series (i.e., at least 3 doses): may administer one lifetime IPV booster

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

Rotavirus vaccination (minimum age: 6 weeks)

Routine Vaccination
  • 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.

Catch-Up Vaccination
  • 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.

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

Routine Vaccination
  • Adolescents age 11–12 years: 1 dose Tdap
  • Pregnancy: 1 dose Tdap during each pregnancy, preferably in early part of gestational weeks 27–36.
  • Tdap may be administered regardless of the interval since the last tetanus- and diphtheria-toxoid-containing vaccine.

Catch-Up Vaccination
  • Adolescents age 13–18 years who have not received Tdap: 1 dose Tdap, then Td or Tdap booster every 10 years
  • Persons 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
  • Children age 7–9 years who receive Tdap should receive the routine Tdap dose at age 11–12 years.
  • Children age 10 years who receive Tdap do not need the routine Tdap dose at age 11–12 years.
  • DTaP inadvertently administered on or after age 7 years:
  • Children age 7–9 years: DTaP may count as part of catch-up series. Administer routine Tdap dose at age 11–12 years.
  • Children age 10–18 years: Count dose of DTaP as the adolescent Tdap booster.
  • 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.

Special Situations
  • 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.

Varicella vaccination (minimum age: 12 months)

Routine Vaccination
  • 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.

Catch-Up Vaccination
  • Ensure persons age 7–18 years without evidence of immunity (see MMWR at www.cdc.gov/mmwr/pdf/rr/rr5604.pdfpdf icon ) 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.

Recommendation Grading

Disclaimer

Overview

Title

Recommended Childhood and Adolescent Immunization Schedule: United States, 2023

Authoring Organization

Publication Month/Year

February 9, 2023

Document Type

Guideline

Country of Publication

US

Target Patient Population

Patients from birth to 18 years of age.

Target Provider Population

Pediatricians, family medicine providers, pharmacists and other providers

Inclusion Criteria

Male, Female, Adolescent, Child, Infant

Health Care Settings

Ambulatory, Childcare center, School

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Management, Prevention

Diseases/Conditions (MeSH)

D007114 - Immunization, D017589 - Immunization Programs

Keywords

vaccination, immunization, HPV, immunizations, ACIP, TDAP, MMR

Source Citation

COMMITTEE ON INFECTIOUS DISEASES; Recommended Childhood and Adolescent Immunization Schedule: United States, 2023. Pediatrics 2023; e2022061029. 10.1542/peds.2022-061029