Department of Health and Human…

                                 Department of Health and Human Services · Centers for Disease Control and Prevention

Recommended Childhood and Adolescent Immunization Schedule UNITED STATES · 2006
                  Age       Birth       1     2      4      6      12     15     18     24    4­6                                                  11­12       13­14         15         16­18
 Vaccine                              month months months months months months months months years                                                 years       years        years       years

 Hepatitis B1              HepB              HepB              HepB 1                        HepB                                                   HepB Series

 Diphtheria,                                       DTaP        DTaP        DTaP                           DTaP                         DTaP        Tdap                     Tdap
 Tetanus, Pertussis2
 Haemophilus                                        Hib          Hib        Hib3               Hib
 influenzae typeb3
 Inactivated                                        IPV         IPV                            IPV                                       IPV
 Poliovirus
 Measles, Mumps,                                                                               MMR                                     MMR                            MMR
 Rubella4
 Varicella5                                                                                       Varicella                                            Varicella

                                                                                                          Vaccines within                          MCV4                    MCV4
 Meningococcal6                                                                                        broken line are for
                                                                                                                                MPSV4                                      MCV4
                                                                                                     selected populations

 Pneumococcal7                                      PCV         PCV         PCV                PCV                             PCV                        PPV


 Influenza8                                                                         Influenza (Yearly)                                          Influenza (Yearly)


 Hepatitis A9                                                                                                                     HepA Series

This schedule indicates the recommended ages for routine administration of currently               any components of the combination are indicated and other components of the vaccine are
licensed childhood vaccines, as of December 1, 2005, for children through age 18 years. Any        not contraindicated and if approved by the Food and Drug Administration for that dose of the
dose not administered at the recommended age should be administered at any subsequent              series. Providers should consult the respective ACIP statement for detailed recommendations.
visit when indicated and feasible.       Indicates age groups that warrant special effort to       Clinically significant adverse events that follow immunization should be reported to the
administer those vaccines not previously administered. Additional vaccines may be licensed         Vaccine Adverse Event Reporting System (VAERS). Guidance about how to obtain and
and recommended during the year. Licensed combination vaccines may be used whenever                complete a VAERS form is available at www.vaers.hhs.gov or by telephone, 800-822-7967.
                                           Range of recommended ages                    Catch-up immunization                  11­12 year old assessment

1. Hepatitis B vaccine (HepB). AT BIRTH: All newborns should receive monovalent                   5. Varicella vaccine. Varicella vaccine is recommended at any visit at or after age 12
   HepB soon after birth and before hospital discharge. Infants born to mothers who are              months for susceptible children (i.e., those who lack a reliable history of chickenpox). Sus-
   HBsAg-positive should receive HepB and 0.5 mL of hepatitis B immune globulin (HBIG)               ceptible persons aged 13 years should receive 2 doses administered at least 4 weeks apart.
   within 12 hours of birth. Infants born to mothers whose HBsAg status is unknown                6. Meningococcal vaccine (MCV4). Meningococcal conjugate vaccine (MCV4)
   should receive HepB within 12 hours of birth. The mother should have blood drawn as soon          should be given to all children at the 11­12 year old visit as well as to unvaccinated
   as possible to determine her HBsAg status; if HBsAg-positive, the infant should receive           adolescents at high school entry (15 years of age). Other adolescents who wish to
   HBIG as soon as possible (no later than age 1 week). For infants born to HBsAg-negative           decrease their risk for meningococcal disease may also be vaccinated. All college fresh-
   mothers, the birth dose can be delayed in rare circumstances but only if a physician's            men living in dormitories should also be vaccinated, preferably with MCV4, although
   order to withhold the vaccine and a copy of the mother's original HBsAg-negative laborato-        meningococcal polysaccharide vaccine (MPSV4) is an acceptable alternative. Vaccination
   ry report are documented in the infant's medical record. FOLLOWING THE BIRTHDOSE:                 against invasive meningococcal disease is recommended for children and adolescents aged
   The HepB series should be completed with either monovalent HepB or a combination vac-             2 years with terminal complement deficiencies or anatomic or functional asplenia and
   cine containing HepB. The second dose should be administered at age 1­2 months. The               certain other high risk groups (see MMWR 2005;54 [RR-7]:1-21); use MPSV4 for children
   final dose should be administered at age 24 weeks. It is permissible to administer 4              aged 2­10 years and MCV4 for older children, although MPSV4 is an acceptable alternative.
   doses of HepB (e.g., when combination vaccines are given after the birth dose); however, if    7. Pneumococcal vaccine. The heptavalent pneumococcal conjugate
   monovalent HepB is used, a dose at age 4 months is not needed. Infants born to HBsAg-             vaccine (PCV) is recommended for all children aged 2­23 months and for certain
   positive mothers should be tested for HBsAg and antibody to HBsAg after completion of             children aged 24­59 months. The final dose in the series should be given at age 12
   the HepB series, at age 9­18 months (generally at the next well-child visit after completion      months. Pneumococcal polysaccharide vaccine (PPV) is recommended in
   of the vaccine series).                                                                           addition to PCV for certain high-risk groups. See MMWR 2000; 49(RR-9):1-35.
2. Diphtheria and tetanus toxoids and acellular pertussis vaccine
                                                                                                  8. Influenza vaccine. Influenza vaccine is recommended annually for children aged
   (DTaP). The fourth dose of DTaP may be administered as early as age 12 months,
                                                                                                     6 months with certain risk factors (including, but not limited to, asthma, cardiac disease,
   provided 6 months have elapsed since the third dose and the child is unlikely to return at
                                                                                                     sickle cell disease, human immunodeficiency virus [HIV], diabetes, and conditions that can
   age 15­18 months. The final dose in the series should be given at age 4 years.
                                                                                                     compromise respiratory function or handling of respiratory secretions or that can increase
   Tetanus and diphtheria toxoids and acellular pertussis vaccine                                    the risk for aspiration), healthcare workers, and other persons (including household members)
   (Tdap ­ adolescent preparation) is recommended at age 11­12 years for those                       in close contact with persons in groups at high risk (see MMWR 2005;54[RR-8]:1-55). In
   who have completed the recommended childhood DTP/DTaP vaccination series and have                 addition, healthy children aged 6­23 months and close contacts of healthy children aged
   not received a Td booster dose. Adolescents 13­18 years who missed the 11­12-year                 0­5 months are recommended to receive influenza vaccine because children in this age
   Td/Tdap booster dose should also receive a single dose of Tdap if they have completed the         group are at substantially increased risk for influenza-related hospitalizations. For healthy
   recommended childhood DTP/DTaP vaccination series. Subsequent tetanus and                         persons aged 5­49 years, the intranasally administered, live, attenuated influenza vaccine
   diphtheria toxoids (Td) are recommended every 10 years.                                           (LAIV) is an acceptable alternative to the intramuscular trivalent inactivated influenza vac-
3. Haemophilus influenzae type b conjugate vaccine (Hib). Three Hib                                  cine (TIV). See MMWR 2005;54(RR-8):1-55. Children receiving TIV should be administered
   conjugate vaccines are licensed for infant use. If PRP-OMP (PedvaxHIB® or ComVax®                 a dosage appropriate for their age (0.25 mL if aged 6­35 months or 0.5 mL if aged 3
   [Merck]) is administered at ages 2 and 4 months, a dose at age 6 months is not required.          years). Children aged 8 years who are receiving influenza vaccine for the first time should
   DTaP/Hib combination products should not be used for primary immunization in infants at           receive 2 doses (separated by at least 4 weeks for TIV and at least 6 weeks for LAIV).
   ages 2, 4 or 6 months but can be used as boosters after any Hib vaccine. The final dose in     9. Hepatitis A vaccine (HepA). HepA is recommended for all children at 1 year of
   the series should be administered at age 12 months.                                               age (i.e.,12­23 months). The 2 doses in the series should be administered at least 6 months
4. Measles, mumps, and rubella vaccine (MMR). The second dose of MMR is                              apart. States, counties, and communities with existing HepA vaccination programs for
   recommended routinely at age 4­6 years but may be administered during any visit,                  children 2­18 years of age are encouraged to maintain these programs. In these areas,
   provided at least 4 weeks have elapsed since the first dose and both doses are                    new efforts focused on routine vaccination of 1-year-old children should enhance, not
   administered beginning at or after age 12 months. Those who have not previously received          replace, ongoing programs directed at a broader population of children. HepA is also
   the second dose should complete the schedule by age 11­12 years.                                  recommended for certain high risk groups (see MMWR 1999; 48[RR-12]1-37).

                                                          The Childhood and Adolescent Immunization Schedule is approved by:
Advisory Committee on Immunization Practices www.cdc.gov/nip/acip · American Academy of Pediatrics www.aap.org · American Academy of Family Physicians www.aafp.org