Childhood immunization schedule 2007

Hepatitis B vaccine (HepB). (Minimum age: birth)

At birth:

• Administer monovalent HepB to all newborns before hospital discharge.
• If mother is hepatitis surface antigen (HBsAg)-positive, administer HepB and 0.5 mL of hepatitis B immune globulin (HBIG) within 12 hours of birth.
• If mother's HBsAg status is unknown, administer HepB within 12 hours of birth. Determine the HBsAg status as soon as possible and if HBsAg-positive, administer HBIG (no later than age 1 week).
• If mother is HBsAg-negative, the birth dose can only be delayed with physician's order and mother's negative HBsAg laboratory report documented in the infant's medical record.

After the birth dose:

• The HepB series should be completed with either monovalent HepB or a combination vaccine containing HepB. The second dose should be administered at age 1-2 months. The final dose should be administered at age 24 weeks or older. Infants born to HBsAg-positive mothers should be tested for HBsAg and antibody to HBsAg after completion of 3 or more doses of a licensed HepB series, at age 9–18 months (generally at the next well-child visit).

4-month dose:

• It is permissible to administer 4 doses of HepB when combination vaccines are administered after the birth dose. If monovalent HepB is used for doses after the birth dose, a dose at age 4 months is not needed.

Rotavirus vaccine (Rota). (Minimum age: 6 weeks)

• Administer the first dose at age 6–12 weeks. Do not start the series later than age 12 weeks.
• Administer the final dose in the series by age 32 weeks. Do not administer a dose later than age 32 weeks.
• Data on safety and efficacy outside of these age ranges are insufficient.

Diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP). (Minimum age: 6 weeks)

• The fourth dose of DTaP may be administered as early as age 12 months, provided 6 months have elapsed since the third dose
• Administer the final dose in the series at age 4–6 years.

Haemophilus influenzae type b conjugate vaccine (Hib). (Minimum age: 6 weeks)

• If PRP-OMP (PedvaxHIB® or ComVax® [Merck]) is administered at ages 2 and 4 months, a dose at age 6 months is not required.
• TriHiBit® (DTaP/Hib) combination products should not be used for primary immunization but can be used as boosters following any Hib vaccine in children aged 12 months or older.

Pneumococcal vaccine. (Minimum age: 6 weeks for pneumococcal conjugate vaccine [PCV]; 2 years for pneumococcal polysaccharide vaccine [PPV])

• Administer PCV at ages 24–59 months in certain high-risk groups. Administer PPV to children aged 2 years or older in certain high-risk groups. See MMWR 2000; 49(No. RR-9):1-35.

Influenza vaccine. (Minimum age: 6 months for trivalent inactivated influenza vaccine [TIV]; 5 years for live, attenuated influenza vaccine [LAIV])

• All children aged 6–59 months and close contacts of all children aged 0–59 months are recommended to receive influenza vaccine.
• Influenza vaccine is recommended annually for children aged 59 months or older with certain risk factors, health-care workers, and other persons (including household members) in close contact with persons in groups at high risk. See MMWR 2006; 55(No. RR-10):1–41.
• For healthy persons aged 5–49 years, LAIV may be used as an alternative to TIV.
• Children receiving TIV should receive 0.25 mL if aged 6–35 months or 0.5 mL if aged 3 years or older.
• Children aged under age 9 who are receiving influenza vaccine for the first time should receive 2 doses (separated by 4 weeks or more for TIV and 6 weeks or more for LAIV).

Measles, mumps, and rubella vaccine (MMR). (Minimum age: 12 months)

• Administer the second dose of MMR at age 4–6 years. MMR may be administered before age 4-6 years, provided at least 4 weeks have elapsed since the first dose and both doses are administered at age 12 months or older.

Varicella vaccine. (Minimum age: 12 months)

• Administer the second dose of varicella vaccine at age 4-6 years. Varicella vaccine may be administered before age 4–6 years, provided that 3 months or more have elapsed since the first dose and both doses are administered at age 12 months or older. If the second dose was administered 28 days or more following the first dose, the second dose does not need to be repeated.

Hepatitis A vaccine (HepA). (Minimum age: 12 months)

• HepA is recommended for all children aged 1 year (i.e. aged 12–23 months). The 2 doses in the series should be administered at least 6 months apart.
• Children not fully vaccinated by age 2 years can be vaccinated at subsequent visits.
• HepA is recommended for certain other groups of children, including in areas where vaccination programs target older children. See MMWR 2006; 55(No. RR-7):1–23.

Meningococcal polysaccharide vaccine (MPSV4). (Minimum age: 2 years)

• Administer MPSV4 to children aged 2–10 years with terminal complement deficiencies or anatomic or functional asplenia and certain other high-risk groups. See MMWR 2005; 54 (No. RR-7):1-21.

Tetanus and diphtheria toxoids and acellular pertussis vaccine (Tdap). (Minimum age: 10 years for BOOSTRIX® and 11 years for ADACEL™)

• Administer at age 11–12 years for those who have completed the recommended childhood DTP/DTaP vaccination series and have not received a tetanus and diphtheria toxoids vaccine (Td) booster dose.
• Adolescents aged 13–18 years who missed the 11–12 year Td/Tdap booster dose should also receive a single dose of Tdap if they have completed the recommended childhood DTP/DTaP vaccination series.

Human papillomavirus vaccine (HPV). (Minimum age: 9 years)

• Administer the first dose of the HPV vaccine series to females at age 11–12 years.
• Administer the second dose 2 months after the first dose and the third dose 6 months after the first dose.
• Administer the HPV vaccine series to females at age 13–18 years if not previously vaccinated.

Meningococcal vaccine. (Minimum age: 11 years for meningococcal conjugate vaccine [MCV4]; 2 years for meningococcal polysaccharide vaccine [MPSV4])

• Administer MCV4 at age 11–12 years and to previously unvaccinated adolescents at high school entry (at approximately age 15 years).
• Administer MCV4 to previously unvaccinated college freshmen living in dormitories; MPSV4 is an acceptable alternative.
• Vaccination against invasive meningococcal disease is recommended for children and adolescents aged 2 years or older with terminal complement deficiencies or anatomic or functional asplenia and certain other high-risk groups. See MMWR 2005; 54 (No. RR–7):1–21. Use MPSV4 for children aged 2–10 years and MCV4 or MPSV4 for older children.

Pneumococcal polysaccharide vaccine (PPV) (Minimum age: 2 years)

• Administer for certain high-risk groups. See MMWR 1997; 46 (No. RR-8):1–24, and MMWR 2000; 49 (No. RR-9):1–35.

Influenza vaccine. (Minimum age: 6 months for trivalent inactivated influenza vaccine [TIV]; 5 years for live, attenuated influenza vaccine [LAIV])

• Influenza vaccine is recommended annually for persons with certain risk factors, health-care workers, and other persons (including household members) in close contact with persons in groups at high risk. See MMWR 2006; 55 (No. RR–10):1–41.
• For healthy persons aged 5–49 years, LAIV may be used as an alternative to TIV.
• Children aged under age 9 who are receiving influenza vaccine for the first time should receive 2 doses (separated by 4 weeks or more for TIV and 6 weeks or more for LAIV).

Hepatitis A vaccine (HepA). (Minimum age: 12 months)

• The 2 doses in the series should be administered at least 6 months apart.
• HepA is recommended for certain other groups of children, including in areas where vaccination programs target older children. See MMWR 2006; 55 (No. RR–7):1–23.

Hepatitis B vaccine (HepB). (Minimum age: birth)

• Administer the 3-dose series to those who were not previously vaccinated.
• A 2-dose series of Recombivax HB® is licensed for children aged 11–15 years.

Inactivated poliovirus vaccine (IPV). (Minimum age: 6 weeks)

• For children who received an all-IPV or all-oral poliovirus (OPV) series, a fourth dose is not necessary if the third dose was administered at age 4 years or older.
• If both OPV and IPV were administered as part of a series, a total of 4 doses should be administered, regardless of the child's current age.

Measles, mumps, and rubella vaccine (MMR). (Minimum age: 12 months)

• If not previously vaccinated, administer 2 doses of MMR during any visit, with 4 weeks or more between the doses.

Varicella vaccine. (Minimum age: 12 months)

• Administer 2 doses of varicella vaccine to persons without evidence of immunity.
• Administer 2 doses of varicella vaccine to persons aged <13 years at least 3 months apart. Do not repeat the second dose, if administered 28 days or more after the first dose.
• Administer 2 doses of varicella vaccine to persons aged 13 years or older at least 4 weeks apart.

Hepatitis B vaccine (HepB). (Minimum age: birth)

• Administer the 3-dose series to those who were not previously vaccinated.
• A 2-dose series of Recombivax HB® is licensed for children aged 11–15 years.

Rotavirus vaccine (Rota). (Minimum age: 6 weeks)

• Do not start the series later than age 12 weeks.
• Administer the final dose in the series by age 32 weeks. Do not administer a dose later than age 32 weeks.
• Data on safety and efficacy outside of these age ranges are insufficient.

Diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP). (Minimum age: 6 weeks)

• The fifth dose is not necessary if the fourth dose was administered at age 4 years or older.
• DTaP is not indicated for persons aged 7 years or older.

Haemophilus influenzae type b conjugate vaccine (Hib). (Minimum age: 6 weeks)

• Vaccine is not generally recommended for children aged 5 years or older.
• If current age is younger than 12 months and the first 2 doses were PRP-OMP (PedvaxHIB® or ComVax® [Merck]), the third (and final) dose should be administered at age 12–15 months and at least 8 weeks after the second dose.
• If first dose was administered at age 7–11 months, administer 2 doses separated by 4 weeks plus a booster at age 12–15 months.

Pneumococcal conjugate vaccine (PCV). (Minimum age: 6 weeks)

• Vaccine is not generally recommended for children aged 5 years or older.

Inactivated poliovirus vaccine (IPV). (Minimum age: 6 weeks)

• For children who received an all-IPV or all-oral poliovirus (OPV) series, a fourth dose is not necessary if third dose was administered at age 4 years or older.
• If both OPV and IPV were administered as part of a series, a total of 4 doses should be administered, regardless of the child's current age.

Measles, mumps, and rubella vaccine (MMR). (Minimum age: 12 months)

• The second dose of MMR is recommended routinely at age 4–6 years but may be administered earlier if desired.
• If not previously vaccinated, administer 2 doses of MMR during any visit with 4 weeks or more between the doses.

Varicella vaccine. (Minimum age: 12 months)

• The second dose of varicella vaccine is recommended routinely at age 4–6 years but may be administered earlier if desired.
• Do not repeat the second dose in persons aged under age 13 if administered 28 days or longer after the first dose.

Hepatitis A vaccine (HepA). (Minimum age: 12 months)

• HepA is recommended for certain groups of children, including in areas where vaccination programs target older children. See MMWR 2006; 55 (No. RR–7):1–23.

Tetanus and diphtheria toxoids vaccine (Td) and tetanus and diphtheria toxoids and acellular pertussis vaccine (Tdap). (Minimum ages: 7 years for Td, 10 years for BOOSTRIX®, and 11 years for ADACEL™)

• Tdap should be substituted for a single dose of Td in the primary catch-up series or as a booster if age appropriate; use Td for other doses.
• A 5-year interval from the last Td dose is encouraged when Tdap is used as a booster dose. A booster (fourth) dose is needed if any of the previous doses were administered at under age 12 months. Refer to ACIP recommendations for further information. See MMWR 2006; 55 (No. RR–3).

Human papillomavirus vaccine (HPV). (Minimum age: 9 years)

• Administer the HPV vaccine series to females at age 13-18 years if not previously vaccinated.