CDC – All about Immunizations

Diphtheria, tetanus, and pertussis (DTaP) vaccination (minimum age: 6 weeks [4 years for Kinrix or Quadracel]) Routine vaccination y 5-dose series at 2, 4, 6, 15–18 months, 4–6 years – Prospectively: Dose 4 may be given as early as age 12 months if at least 6 months have elapsed since dose 3. – Retrospectively: A 4th dose that was inadvertently given as early as 12 months may be counted if at least 4 months have elapsed since dose 3. Catch-up vaccination y Dose 5 is not necessary if dose 4 was administered at age 4 years or older. y For other catch-up guidance, see Above Table

Haemophilus influenzae type b vaccination (minimum age: 6 weeks) Routine vaccination  y ActHIB, Hiberix, or Pentacel: 4-dose series at 2, 4, 6, 12–15 months y PedvaxHIB: 3-dose series at 2, 4, 12–15 months Catch-up vaccination y Dose 1 at 7–11 months: Administer dose 2 at least 4 weeks later and dose 3 (final dose) at 12–15 months or 8 weeks after dose 2 (whichever is later). y Dose 1 at 12–14 months: Administer dose 2 (final dose) at least 8 weeks after dose 1. y Dose 1 before 12 months and dose 2 before 15 months: Administer dose 3 (final dose) 8 weeks after dose 2. y 2 doses of PedvaxHIB before 12 months: Administer dose 3 (final dose) at 12–59 months and at least 8 weeks after dose 2. y Unvaccinated at 15–59 months: 1 dose  y For other catch-up guidance, see Table. Special situations y Chemotherapy or radiation treatment: 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. y Hematopoietic stem cell transplant (HSCT): – 3-dose series 4 weeks apart starting 6 to 12 months after successful transplant regardless of Hib vaccination history y Anatomic or functional asplenia (including sickle cell disease): 12–59 months – Unvaccinated or only 1 dose before 12 months: 2 doses, 8 weeks apart – 2 or more doses before 12 months:1 dose at least 8 weeks after previous dose Unvaccinated* persons age 5 years or older – 1 dose  y Elective splenectomy: Unvaccinated* persons age 15 months or older – 1 dose (preferably at least 14 days before procedure) y HIV infection: 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  y Immunoglobulin deficiency, early component complement deficiency: 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 14 months) OR no doses (14 months or older)

Hepatitis A vaccination (minimum age: 12 months for routine vaccination) Routine vaccination y 2-dose series (Havrix 6–12 months apart or Vaqta 6–18 months apart, minimum interval 6 months); a series begun before the 2nd birthday should be completed even if the child turns 2 before the second dose is administered. Catch-up vaccination y Anyone 2 years of age or older may receive HepA vaccine if desired. Minimum interval between doses: 6 months y Adolescents 18 years and older may receive the combined HepA and HepB vaccine, Twinrix, as a 3-dose series (0, 1, and 6 months) or 4-dose series (0, 7, and 21–30 days, followed by a dose at 12 months). International travel y Persons traveling to or working in countries with high or intermediate endemic hepatitis A (wwwnc.cdc.gov/travel/):  – Infants age 6–11 months: 1 dose before departure; revaccinate with 2 doses, separated by 6–18 months, between 12 to 23 months of age. – Unvaccinated age 12 months and older: 1st dose as soon as travel considered Special situations At risk for hepatitis A infection: 2-dose series as above  y Chronic liver disease y Clotting factor disorders yMen who have sex with men y Injection or non-injection drug use y Homelessness yWork with hepatitis A virus in research laboratory or nonhuman primates with hepatitis A infection y Travel in countries with high or intermediate endemic hepatitis A  y Close, personal contact with international adoptee (e.g., household or regular babysitting) in first 60 days after arrival from country with high or intermediate endemic hepatitis A (administer dose 1 as soon as adoption is planned, at least 2 weeks before adoptee’s arrival)

Hepatitis B vaccination (minimum age: birth) Birth dose (monovalent HepB vaccine only) yMother is HBsAg-negative: 1 dose within 24 hours of birth for all medically stable infants ≥2,000 grams. Infants <2,000 grams: administer 1 dose at chronological age 1 month or hospital discharge. yMother is HBsAg-positive: – Administer HepB vaccine and 0.5 mL of hepatitis B immune globulin (HBIG) (at separate anatomic sites) within 12 hours of birth, regardless of birth weight. For infants <2,000 grams, administer 3 additional doses of vaccine (total of 4 doses) beginning at age 1 month. – Test for HBsAg and anti-HBs at age 9–12 months. If HepB series is delayed, test 1–2 months after final dose. yMother’s HBsAg status is unknown:  – Administer HepB vaccine within 12 hours of birth, regardless of birth weight.  – For infants <2,000 grams, administer 0.5 mL of HBIG in addition to HepB vaccine within 12 hours of birth. Administer 3 additional doses of vaccine (total of 4 doses) beginning at age 1 month. – Determine mother’s HBsAg status as soon as possible. If mother is HBsAg-positive, administer 0.5 mL of HBIG to infants ≥2,000 grams as soon as possible, but no later than 7 days of age. Routine series  y 3-dose series at 0, 1–2, 6–18 months (use monovalent HepB vaccine for doses administered before age 6 weeks) y Infants who did not receive a birth dose should begin the series as soon as feasible (see Table). y Administration of 4 doses is permitted when a combination vaccine containing HepB is used after the birth dose. yMinimum age for the final (3rd or 4th ) dose: 24 weeks  yMinimum intervals: dose 1 to dose 2: 4 weeks / dose 2 to dose 3: 8 weeks / dose 1 to dose 3: 16 weeks (when 4 doses are administered, substitute “dose 4” for “dose 3” in these calculations) Catch-up vaccination y Unvaccinated persons should complete a 3-dose series at 0, 1–2, 6 months. y Adolescents age 11–15 years may use an alternative 2-dose schedule with at least 4 months between doses (adult formulation Recombivax HB only).  y Adolescents 18 years and older may receive a 2-dose series of HepB (Heplisav-B) at least 4 weeks apart. y Adolescents 18 years and older may receive the combined HepA and HepB vaccine, Twinrix, as a 3-dose series (0, 1, and 6 months) or 4-dose series (0, 7, and 21–30 days, followed by a dose at 12 months). y For other catch-up guidance, see Table.

Human papillomavirus vaccination (minimum age: 9 years) Routine and catch-up vaccination y HPV vaccination routinely recommended for all adolescents age 11–12 years (can start at age 9 years) and through age 18 years if not previously adequately vaccinated  y 2- or 3-dose series depending on age at initial vaccination:  – Age 9 through 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)  y If completed valid vaccination series with any HPV vaccine, no additional doses needed Special situations y Immunocompromising conditions, including HIV infection: 3-dose series as above y History of sexual abuse or assault: Start at age 9 years y Pregnancy: HPV vaccination not recommended until after pregnancy; no intervention needed if vaccinated while pregnant; pregnancy testing not needed before vaccination Inactivated poliovirus vaccination (minimum age: 6 weeks) Routine vaccination y 4-dose series at ages 2, 4, 6–18 months, 4–6 years; administer the final dose on or after the 4th birthday and at least 6 months after the previous dose. y 4 or more doses of IPV can be administered before the 4th birthday when a combination vaccine containing IPV is used. However, a dose is still recommended after the 4th birthday and at least 6 months after the previous dose. Catch-up vaccination y In the first 6 months of life, use minimum ages and intervals only for travel to a polio-endemic region or during an outbreak. y IPV is not routinely recommended for U.S. residents 18 years and older. Series containing oral polio vaccine (OPV), either mixed OPV- IPV or OPV-only series: y 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?s_ cid=mm6601a6_w.  Only trivalent OPV (tOPV) counts toward the U.S. vaccination requirements. For guidance to assess doses documented as “OPV,” see www.cdc.gov/mmwr/volumes/66/wr/mm6606a7. htm?s_cid=mm6606a7_w.  y For other catch-up guidance, see Table.

Influenza vaccination (minimum age: 6 months [IIV], 2 years [LAIV], 18 years [RIV]) Routine vaccination y 1 dose any influenza vaccine appropriate for age and health status annually (2 doses separated by at least 4 weeks for children 6 months–8 years who did not receive at least 2 doses of influenza vaccine before July 1, 2018) Special situations y Egg allergy, hives only: Any influenza vaccine appropriate for age and health status annually y Egg allergy more severe than hives (e.g., angioedema, respiratory distress): Any influenza vaccine appropriate for age and health status annually in medical setting under supervision of health care provider who can recognize and manage severe allergic conditions y LAIV should not be used for those with a history of severe allergic reaction to any component of the vaccine (excluding egg) or to a previous dose of any influenza vaccine, children and adolescents receiving concomitant aspirin or salicylate-containing medications, children age 2 through 4 years with a history of asthma or wheezing, those who are immunocompromised due to any cause (including immunosuppression caused by medications and HIV infection), anatomic and functional asplenia, cochlear implants, cerebrospinal fluid-oropharyngeal communication, close contacts and caregivers of severely immunosuppressed persons who require a protected environment, pregnancy, and persons who have received influenza antiviral medications within the previous 48 hours.

Measles, mumps, and rubella vaccination (minimum age: 12 months for routine vaccination) Routine vaccination y 2-dose series at 12–15 months, 4–6 years y Dose 2 may be administered as early as 4 weeks after dose 1. Catch-up vaccination y Unvaccinated children and adolescents: 2 doses at least 4 weeks apart y The maximum age for use of MMRV is 12 years. Special situations International travel y Infants age 6–11 months: 1 dose before departure; revaccinate with 2 doses at 12–15 months (12 months for children in high-risk areas) and dose 2 as early as 4 weeks later. y Unvaccinated children age 12 months and older: 2-dose series at least 4 weeks apart before departure

Meningococcal serogroup A,C,W,Y vaccination (minimum age: 2 months [MenACWY-CRM, Menveo], 9 months [MenACWY-D, Menactra]) Routine vaccination y 2-dose series: 11–12 years, 16 years Catch-up vaccination y Age 13–15 years: 1 dose now and booster at age 16–18 years (minimum interval: 8 weeks) y Age 16–18 years: 1 dose Special situations Anatomic or functional asplenia (including sickle cell disease), HIV infection, persistent complement component deficiency, eculizumab use: yMenveo – Dose 1 at age 8 weeks: 4-dose series at 2, 4, 6, 12 months – Dose 1 at age 7–23 months: 2-dose series (dose 2 at least 12 weeks after dose 1 and after the 1st birthday) – Dose 1 at age 24 months or older: 2-dose series at least 8 weeks apart yMenactra – Persistent complement component deficiency:   Age 9–23 months: 2 doses at least 12 weeks apart  Age 24 months or older: 2 doses at least 8 weeks apart – Anatomic or functional asplenia, sickle cell disease, or HIV infection:   Age 9–23 months: Not recommended   24 months or older: 2 doses at least 8 weeks apart   Menactra must be administered at least 4 weeks after completion of PCV13 series. Travel in countries with hyperendemic or epidemic meningococcal disease, including countries in the African meningitis belt or during the Hajj (wwwnc.cdc.gov/travel/):  y Children age less than 24 months: –Menveo (age 2–23 months):  Dose 1 at 8 weeks: 4-dose series at 2, 4, 6, 12 months  Dose 1 at 7–23 months: 2-dose series (dose 2 at least 12 weeks after dose 1 and after the 1st birthday) –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) y Children age 2 years or older: 1 dose Menveo or Menactra First-year college students who live in residential housing (if not previously vaccinated at age 16 years or older) or military recruits: y 1 dose Menveo or Menactra Note: Menactra should be administered either before or at the same time as DTaP. For MenACWY booster dose recommendations for groups listed under “Special situations” above and additional meningococcal vaccination information, see meningococcal MMWR publications at www.cdc.gov/ vaccines/hcp/acip-recs/vacc-specific/mening.html.

Meningococcal serogroup B vaccination (minimum age: 10 years [MenB-4C, Bexsero; MenB-FHbp, Trumenba]) Clinical discretion yMenB vaccine may be administered based on individual clinical decision to adolescents not at increased risk age 16–23 years (preferred age 16–18 years): y Bexsero: 2-dose series at least 1 month apart y 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, eculizumab use:  y Bexsero: 2-dose series at least 1 month apart y Trumenba: 3-dose series at 0, 1–2, 6 months Bexsero and Trumenba are not interchangeable; the same product should be used for all doses in a series. For additional meningococcal vaccination information, see meningococcal MMWR publications at www.cdc.gov/vaccines/ hcp/acip-recs/vacc-specific/mening.html.

Pneumococcal vaccination (minimum age: 6 weeks [PCV13], 2 years [PPSV23]) Routine vaccination with PCV13 y 4-dose series at 2, 4, 6, 12–15 months Catch-up vaccination with PCV13 y 1 dose for healthy children age 24–59 months with any incomplete* PCV13 series y For other catch-up guidance, see Table. Special situations High-risk conditions below: When both PCV13 and PPSV23 are indicated, administer PCV13 first. PCV13 and PPSV23 should not be administered during same visit. Chronic heart disease (particularly cyanotic congenital heart disease and cardiac failure); chronic lung disease (including asthma treated with high-dose, oral corticosteroids); diabetes mellitus: Age 2–5 years y Any incomplete* series with: – 3 PCV13 doses: 1 dose PCV13 (at least 8 weeks after any prior PCV13 dose) – Less than 3 PCV13 doses: 2 doses PCV13 (8 weeks after the most recent dose and administered 8 weeks apart) y No history of PPSV23: 1 dose PPSV23 (at least 8 weeks after any prior PCV13 dose) Age 6–18 years y No history of PPSV23: 1 dose PPSV23 (at least 8 weeks after any prior PCV13 dose) Cerebrospinal fluid leak, cochlear implant: Age 2–5 years y Any incomplete* series with: – 3 PCV13 doses: 1 dose PCV13 (at least 8 weeks after any prior PCV13 dose) – Less than 3 PCV13 doses: 2 doses PCV13, 8 weeks after the most recent dose and administered 8 weeks apart y No history of PPSV23: 1 dose PPSV23 (at least 8 weeks after any prior PCV13 dose) Age 6–18 years y No history of either PCV13 or PPSV23: 1 dose PCV13, 1 dose PPSV23 at least 8 weeks later y Any PCV13 but no PPSV23: 1 dose PPSV23 at least 8 weeks after the most recent dose of PCV13 y PPSV23 but no PCV13: 1 dose PCV13 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 y Any incomplete* series with: – 3 PCV13 doses: 1 dose PCV13 (at least 8 weeks after any prior PCV13 dose) – Less than 3 PCV13 doses: 2 doses PCV13 (8 weeks after the most recent dose and administered 8 weeks apart) y No history of PPSV23: 1 dose PPSV23 (at least 8 weeks after any prior PCV13 dose) and a 2nd dose of PPSV23 5 years later Age 6–18 years y No history of either PCV13 or PPSV23: 1 dose PCV13, 2 doses PPSV23 (dose 1 of PPSV23 administered 8 weeks after PCV13 and dose 2 of PPSV23 administered at least 5 years after dose 1 of PPSV23)  y Any PCV13 but no PPSV23: 2 doses PPSV23 (dose 1 of PPSV23 administered 8 weeks after the most recent dose of PCV13 and dose 2 of PPSV23 administered at least 5 years after dose 1 of PPSV23)  y PPSV23 but no PCV13: 1 dose PCV13 at least 8 weeks after the most recent PPSV23 dose and a 2nd dose of PPSV23 administered 5 years after dose 1 of PPSV23 and at least 8 weeks after a dose of PCV13 Chronic liver disease, alcoholism: Age 6–18 years y No history of PPSV23: 1 dose PPSV23 (at least 8 weeks after any prior PCV13 dose) * An incomplete series is defined as not having received all doses in either the recommended series or an age- appropriate catch-up series. See Tables 8, 9, and 11 in the ACIP pneumococcal vaccine recommendations (www.cdc.gov/ mmwr/pdf/rr/rr5911.pdf) for complete schedule details.

Rotavirus vaccination (minimum age: 6 weeks) Routine vaccination y Rotarix: 2-dose series at 2 and 4 months. y RotaTeq: 3-dose series at 2, 4, and 6 months. If any dose in the series is either RotaTeq or unknown, default to 3-dose series. Catch-up vaccination y Do not start the series on or after age 15 weeks, 0 days. y The maximum age for the final dose is 8 months, 0 days. y For other catch-up guidance, see Figure 2.

Tetanus, diphtheria, and pertussis (Tdap) vaccination (minimum age: 11 years for routine vaccination, 7 years for catch-up vaccination) Routine vaccination  y Adolescents age 11–12 years: 1 dose Tdap y Pregnancy: 1 dose Tdap during each pregnancy, preferably in early part of gestational weeks 27–36 y Tdap may be administered regardless of the interval since the last tetanus- and diphtheria-toxoid-containing vaccine. Catch-up vaccination y Adolescents age 13–18 years who have not received Tdap: 1 dose Tdap, then Td booster every 10 years y Persons age 7–18 years not fully immunized with DTaP: 1 dose Tdap as part of the catch-up series (preferably the first dose); if additional doses are needed, use Td. y Children age 7–10 years who receive Tdap inadvertently or as part of the catch-up series should receive the routine Tdap dose at 11–12 years. y DTaP inadvertently given after the 7th birthday: – Child age 7–10 years: DTaP may count as part of catch-up series. Routine Tdap dose at 11–12 should be administered. – Adolescent age 11–18 years: Count dose of DTaP as the adolescent Tdap booster.  y For other catch-up guidance, see Table. y For information on use of Tdap or Td as tetanus prophylaxis in wound management, see www.cdc.gov/mmwr/volumes/67/ rr/rr6702a1.htm.

Varicella vaccination (minimum age: 12 months) Routine vaccination y 2-dose series: 12–15 months, 4–6 years y Dose 2 may be administered as early as 3 months after dose 1 (a dose administered after a 4-week interval may be counted). Catch-up vaccination y Ensure persons age 7–18 years without evidence of immunity (see MMWR at www.cdc.gov/mmwr/pdf/rr/rr5604.pdf) have 2-dose series: – Ages 7–12 years: routine interval: 3 months (minimum interval: 4 weeks) – Ages 13 years and older: routine interval: 4–8 weeks (minimum interval: 4 weeks). – The maximum age for use of MMRV is 12 years.