Recommended by the Advisory Committee on Immunization Practices (www.cdc.gov/vaccines/acip) and approved by the Centers for Disease Control and Prevention (www.cdc.gov), American Academy of Pediatrics (www.aap.org), American Academy of Family Physicians (www.aafp.org), American College of Obstetricians and Gynecologists (www.acog.org), and American College of Nurse-Midwives (www.midwife.org).y Complete ACIP recommendations: www.cdc.gov/vaccines/hcp/acip-recs/index.html y General Best Practice Guidelines for Immunization: www.cdc.gov/vaccines/hcp/acip-recs/general-recs/index.html y Outbreak information (including case identification and outbreak response), see Manual for the Surveillance of Vaccine-Preventable Diseases: www.cdc.gov/vaccines/pubs/surv-manual Download the CDC Vaccine Schedules App for providers at www.cdc.gov/vaccines/schedules/hcp/schedule-app.html.#
These recommendations must be read with the notes that follow. For those who fall behind or start late, provide catch-up vaccination at the earliest opportunity as indicated by the green bars. To determine minimum intervals between doses, see the catch-up schedule (Table 2). School entry and adolescent vaccine age groups are shaded in gray.   The table below provides catch-up schedules and minimum intervals between doses for children whose vaccinations have been delayed. A vaccine series does not need to be restarted, regardless of the time that has elapsed between doses. Use the section appropriate for the child's age. Always use this table in conjunction with Table 1 and the notes that follow.    at 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.

# Vaccine

# Children age 4 months through 6 years
-Retrospectively: A 4 th dose that was inadvertently administered 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 and at least 6 months after dose 3.
y For other catch-up guidance, see Table 2.

# 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 Persons who previously received 1 dose at age 12 months or older should receive dose 2 at least 6 months after dose 1.
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). -Infants age 6-11 months: 1 dose before departure; revaccinate with 2 doses, separated by at least 6 months, between 12 and 23 months of age -Unvaccinated age 12 months and older: Administer dose 1 as soon as travel is considered.

# International travel

# Hepatitis B vaccination (minimum age: birth)

# Birth dose (monovalent HepB vaccine only)
y Mother 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.
y Mother is HBsAg-positive:
-Administer HepB vaccine and hepatitis B immune globulin (HBIG) (in separate limbs) 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.
y Mother's HBsAg status is unknown: -Administer HepB vaccine within 12 hours of birth, regardless of birth weight.
-For infants <2,000 grams, administer HBIG in addition to HepB vaccine (in separate limbs) 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 HBIG to infants 2,000 grams as soon as possible, but no later than 7 days of age.
Routine series 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 2.

# Special situations

# Human papillomavirus vaccination (minimum age: 9 years)

# Routine and catch-up vaccination y 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 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) -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, 2019, or whose influenza vaccination history is unknown (administer dose 2 even if the child turns 9 between receipt of dose 1 and dose 2) Notes Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger, United States, 2020
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-dose series 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-dose series with dose 1 at 12-15 months (12 months for children in high-risk areas) and dose 2 as early as 4 weeks later. Travel in countries with hyperendemic or epidemic meningococcal disease, including countries in the African meningitis belt or during the Hajj (www.cdc.gov/travel/): y Children less than age 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 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) y Children for whom boosters are not recommended (e.g., those 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. 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" and in an outbreak setting and for additional meningococcal vaccination information, see www.cdc.gov/vaccines/hcp/aciprecs/vacc-specific/mening.html. -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 3 rd dose at least 4 months after dose 2.
y

# Meningococcal serogroup B vaccination

# Special situations
Anatomic or functional asplenia (including sickle cell disease), persistent complement component deficiency, complement inhibitor (e.g., eculizumab, ravulizumab) 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 MenB booster dose recommendations for groups listed under "Special situations" and in an outbreak setting and for additional meningococcal vaccination information, see www. cdc.gov/vaccines/acip/recommendations.html and www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/mening.html.   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 2 nd 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) - Incomplete series = 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 at www.cdc.gov/mmwr/pdf/rr/rr5911.pdf for complete schedule details.

# Pneumococcal vaccination

# 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 at or after age 4 years and at least 6 months after the previous dose. y 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 at or after age 4 years 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.

# 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 y 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 Table 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 or Tdap booster every 10 years y 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.
y Tdap administered at 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 to receive the routine Tdap dose at age 11-12 years.
y DTaP inadvertently administered at or after age 7 years:
-Children age 7-9 years: DTaP may count as part of catchup series. Routine Tdap dose at age 11-12 years should be administered.

# Routine vaccination
y 2-dose series at 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). -Age 7-12 years: routine interval: 3 months (a dose administered after a 4-week interval may be counted)

# Catch-up vaccination
-Age 13 years and older: routine interval: 4-8 weeks (minimum interval: 4 weeks)
-The maximum age for use of MMRV is 12 years.
Notes Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger, United States, 2020