# CONTENTS
C D C encourages organizations that have previously relied on copying and posting PDFs o f the schedules to their websites to instead use a safer m ethod to consistently display current schedules. This form o f "content syndication" ensures that the most current and accurate immunization schedule information is on each organization's website. This one-time step assures that your website displays current yearly schedules as soon as they are published, or revised.
To place the schedules on a website, organizations simply include two lines o f CDC-furnished com puter code on their Web page. Each organization's Web developer places the code into their existing website; the code automatically loads the current C D C schedule and footnotes. T he schedule is visible within the organization's Web page, and all other images and Web navigation display unchanged. Any C D C revisions or updates will automatically and immediately be reflected on the organization's Web page.
This form o f content syndication also gives organizations the ability to offer a PDF o f each schedule on their website. Staff members and Web visitors can print as well as view im m unization schedules and be confident they have the most current versions. Instructions for copying and placing syndication code are available at / schedules/syndicate.html.
C D C offers technical assistance for organizations implementing this form o f content syndication. For assistance, readers can complete the e-mail form on the N C IR D Web support page (), and a N CIRD Web team staff member will contact them and provide assistance.  Each year, the Advisory Committee on Immunization Practices (ACIP) reviews the current recom m ended im m unization schedules for persons aged 0 through 18 years to ensure that the schedule reflects current recommendations for licensed vaccines. In October 2012, ACIP approved the recommended immunization schedules for persons aged 0 through 18 years for 2013, which includes several changes from 2012.

# Advisory C o m m itte e on Im m u n iza tio n Practices (ACIP) R ecom m ended Im m u n iza tio n Schedule fo r Persons
Health-care providers are advised to use both the recommended schedule and the catch-up schedule (Figures 1 and 2) in com bination w ith their footnotes (pages 6-8) and not as stand-alones. For guidance on the use o f all the vaccines in the schedules, including contraindications and precautions to use o f a vaccine, providers are referred to the respective ACIP vaccine recommendations.
Printable versions o f the regular and catch-up schedules are available at  in various formats, including landscape and pocket-sized, in regular paper or laminated versions. A "parent friendly" regular schedule is available at  l#print.
For 2013, several new references and links to additional inform ation have been added, including one for travel vaccine requirements and recommendations (1). New references also are provided for vaccination o f persons w ith prim ary and secondary im m unodeficiencies. Changes to the previous schedules (2) include the following:
- Figure 1, "Recommended immunization schedule for persons aged 0 through 18 years" replaces "Recommended immunization schedule for persons aged 0 through 6 years" and "Recommended immunization schedule for persons aged 7 through 18 years." -W ording was added to bars to represent the respective vaccine dose numbers in the series.
-T he meningococcal conjugate vaccine (MCV4) purple bar was extended to age 6 weeks, to reflect licensure of Hib-M enCY vaccine.  These recom m endationsmu st be read with the footnotes that foilow. For those w h o fa ll behind or start late, provide catch-up va ccination at the earliest opportunity as indica ted by the greet bars in Figure 1. To determine minimum intesvals between doses,see the catch-up schedule (Figute 2). School entry and adolescent vaccine age groups are in bold.    The figure 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, regfrdl ess o fth e tim e that has elapsed between doces. Use the sectior appropriate for thechild'sage. Alwcys use this table in co n ju n ition wieh Figure 1 and the footnotes that follow.

# Footnotes: Recommended Immunization Schedule for Persons Aged 0 Through 18 Years -United States, 2013

# Additional guidance for use o f the vaccines described in this publication is available at 

# Hepatitis B (HepB) vaccine. (Minimum age: birth)
Routine vaccination: At birth - Administer monovalent HepB vaccine to all newborns before hospital discharge. - For infants born to hepatitis B surface antigen (HBsAg)-positive mothers, administer HepB vaccine and 0.5 mL o f hepatitis B im mune globulin (HBIG) w ithin 12 hours o f birth. These infants should be tested for HBsAg and antibody to HBsAg (anti-HBs) 1 to 2 months after completion o f the HepB series, at age 9 through 18 months (preferably at the next well-child visit). - If mother's HBsAg status is unknown, w ithin 12 hours o f birth administer HepB vaccine to all infants regardless o f birth weight. For infants weigh ing 2,000 grams (no later than age 1 week).

# Doses following the birth dose

# Rotavirus (RV) vaccines. (Minimum age: 6 weeks for both RV-1  and RV-5 ). Routine vaccination:
- Administer a series of RV vaccine to all infants as follows:
1. If RV-1 is used, administer a 2-dose series at 2 and 4 months o f age.
2. If RV-5 is used, administer a 3-dose series at ages 2, 4, and 6 months.
3. If any dose in series was RV-5 or vaccine product is unknown for any dose in the series, a total o f 3 doses o f RV vaccine should be administered.

# Catch-up vaccination:
- The maximum age for the first dose in the series is 14 weeks, 6 days. - Vaccination should not be initiated for infants aged 15 weeks 0 days or older. - The maximum age for the final dose in the series is 8 months, 0 days. - If RV-1(Rotarix) is administered for the first and second doses, a third dose is not indicated. - For other catch-up issues, see Figure 2. S u p p le m e n t Please note: An erratum has been published for this issue. To view the erratum, please click here. - Administer 2 doses o f MMR vaccine to children aged 12 months and older, before departure from the United States for international travel. The first dose should be administered on or after age 12 months and the second dose at least 4 weeks later.

# Diphtheria and tetanus toxoids and acellular pertussis (

# Catch-up vaccination:
- Ensure that all school-aged children and adolescents have had 2 doses of MMR vaccine; the minimum interval between the 2 doses is 4 weeks. months to all adolescents aged 11-12 years. Either HPV4 or HPV2 may be used for females, and only HPV4 may be used for males. - The vaccine series can be started beginning at age 9 years. - Administer the second dose 1 to 2 months after the first dose and the third dose 6 months after the first dose (at least 24 weeks after the first dose).

# Catch-up vaccination:
- Administer the vaccine series to females (either HPV2 or HPV4) and males (HPV4) at age 13 through 18 years if not previously vaccinated. Please note: An erratum has been published for this issue. To view the erratum, please click here.   The Advisory Committee on Immunization Practices (ACIP) annually reviews and updates the adult immunization schedule, which is designed to provide vaccine providers with a summary o f existing ACIP recommendations regarding the routine use o f vaccines for adults (Figures 1 and 2). The adult schedule also includes a table summarizing the primary contraindications and precautions for routinely recommended vaccines (Table ). In October 2012, ACIP approved the adult immunization schedule for 2013. This schedule also incorporates changes to vaccine recommendations voted on by ACIP at its October 24-25, 2012 meeting.

# Additional Vaccine Information
The primary updates include adding information for the first time on the use o f 13-valent pneumococcal conjugate vaccine (PCV13) and the timing of administration ofPCV13 relative to the 23-valent pneumococcal polysaccharide vaccine (PPSV23) in adults (4). PCV13 is recommended for adults aged 19 years and older with immunocompromising conditions (including chronic renal failure and nephrotic syndrome), functional or anatomic asplenia, cerebrospinal fluid leaks, or cochlear implants. The schedule also clarifies which adults need 1 or 2 doses of PPSV23 before age 65 years. O ther changes to the PPSV23 footnote include adding information regarding recommendations for vaccination when vaccination status is unknown.
For tetanus, diphtheria, and acellular pertussis (Tdap) vaccine, recom m endations have been expanded to include routine vaccination o f adults aged 65 years and older and for pregnant women to receive Tdap vaccine with each pregnancy. T he ideal tim ing o f Tdap vaccination during pregnancy is during 27-36 weeks' gestation. This recom m endation was made to increase the likelihood o f optimal protection for the pregnant woman and her infant during the first few m onths of the infant's life, when the child is too young for vaccination but at highest risk for severe illness and death from pertussis (5,6).
M anufacturers o f the live, attenuated influenza vaccine (LAIV) have obtained Food and Drug Administration (FDA) approval for a quadrivalent influenza vaccine that contains one influenza A (H 3N 2), one influenza A (H 1N 1) and two influenza B vaccine virus strains, one from each lineage o f circulating influenza B viruses. In approxim ately h alf of the recent influenza seasons, the trivalent influenza vaccine has included an influenza B vaccine virus from the lineage different from the predom inant circulating influenza B strains (7). Inclusion o f both lineages o f influenza B virus is intended to increase the likelihood that the vaccine provides cross reactive antibody against a higher proportion o f circulating influenza B viruses. For LAIV, beginning with the 2013-14 season, it is expected that only the quadrivalent formulation will be available and manufacture o f the trivalent formulation will cease. It is possible that quadrivalent inactivated influenza vaccine formulations might be available for the 2013-14 season as well. Because a mix o f quadrivalent and trivalent influenza vaccines might be available in 2013-14, the abbreviation for inactivated influenza vaccine has been changed from trivalent inactivated influenza vaccine (TIV) to inactivated influenza vaccine (IIV). T he abbreviation for LAIV remains unchanged.
M inor wording changes, clarifications, or simplifications have been made to footnotes for measles, m um ps, rubella vaccine (MMR), hum an papillomavirus vaccine (HPV), zoster vaccine, and hepatitis A and hepatitis B vaccines. A correction has been made to Figure 1 for M M R vaccine: the bar that indicated the vaccine might be used in certain situations by persons born before 1957 has been removed. Persons born before 1957 are considered im mune, and routine vaccination is not recommended. Considerations for the possible use of M M R vaccine in outbreak situations are included in the 2011 M M W R publication on vaccination o f health-care personnel (8). In addition, a correction was made to Figure 2 for PPSV23. This vaccine is indicated for men who have sex with men if they have another risk factor (e.g., age or underlying condition); the bar has been changed from yellow to purple to more accurately reflect the recommendation.
Vaccine providers are reminded to consult the full ACIP vaccine recommendations if they have questions and to bear in m ind that additional updates might be made for specific vaccines during the year between updates to the adult schedule. Printable versions o f the 2013 adult im m unization schedule and other inform ation is available at / vaccines/schedules/hcp/adult.html. Inform ation about adult vaccination is available at . h tm . ACIP statements and inform ation for specific vaccines is available at  .cdc.gov/vaccines/pubs/acip-list. h tm . Adverse events from vaccination should be reported at  or by telephone, 800-822-7967. This schedule has been approved by the American Academy o f Family Physicians, the American College o f Physicians, the American College o f Obstetricians and Gynecologists, and the American College o f Nurse-Midwives. T he adult im m unization schedule is published in the Annals o f Internal Medicine at the same time that it is published in M M W R.

# Changes for 2013

# Footnotes
- Inform ation was added to footnote #1 to direct readers to additional inform ation regarding recommendations for vaccination when vaccination status is unknown. - T he influenza vaccination footnote (#2) now uses the abbreviation IIV for inactivated influenza vaccine and drops the abbreviation T IV for trivalent inactivated vaccine (TIV). For the 2013-14 influenza season, it is expected that the LAIV will be available only in a quadrivalent formulation; IIV might be available in both trivalent and quadrivalent formulations. - The tetanus, diphtheria, and acellular pertussis (Td/Tdap) vaccination footnote (#3) is updated to include the recommendation to vaccinate pregnant women with Tdap during each pregnancy, regardless of the interval since prior Td/Tdap vaccination and to include the recommendation for all other adults, including persons aged 65 years and older, to receive 1 dose of Tdap vaccine.
- T he varicella (#4) and H PV (#5) footnotes were simplified; no changes in recommendations were made. Additional inform ation was added to the H P V footnote regarding H PV vaccination and pregnancy. - T he zoster footnote (#6) was changed to clarify that ACIP recommends vaccination o f persons beginning at age 60 years both for persons with and w ithout underlying health conditions for whom the vaccine is not contraindicated. - The measles, mumps, rubella (MMR) vaccine footnote (#7) was modified to reflect the new recommendation that a provider diagnosis of measles, mumps, or rubella is not considered acceptable evidence of immunity. Previously, a provider diagnosis of measles or mumps, but not rubella, was considered acceptable evidence of immunity. - Inform ation was added to the pneumococcal polysaccharide (PPSV23) vaccination footnote (#8) and PPSV23 revaccination footnote (#9) to clarify that persons with certain medical conditions are recommended to receive 2 doses o f PPSV23 before age 65 years. In addition, even those who receive 2 doses of PPSV23 before age 65 years are recommended to receive PPSV23 at age 65 years, as long as it has been 5 years since the most recent dose. T he PPSV23 footnote refers to footnote #10 for pneumococcal conjugate 13-valent vaccine (PCV13) regarding the timing of PCV13 vaccine relative to PPSV23 for those persons recommended to be vaccinated with both pneumococcal vaccines. - A new footnote (#10) was added for PCV13 vaccine.
This vaccine is recommended for adults aged 19 years and older with im m unocomprom ising conditions (including chronic renal failure and nephrotic syndrome), functional or anatomic asplenia, cerebrospinal fluid leaks, or cochlear implants. Those not previously vaccinated with PCV13 or PPSV23 should receive a single dose o f PCV13, followed by a dose o f PPSV23 at least 8 weeks later. Those previously vaccinated with PPSV23 should be vaccinated with PCV13 one year or more after PPSV23 vaccination (4). - The hepatitis A vaccine footnote (#12) was updated to clarify that vaccination is recommended for persons with a history o f either injection or noninjection illicit drug use.
- The hepatitis B vaccine footnote (#13) includes minor wording changes and adds information on the vaccine schedule for hepatitis B vaccine series for the Recombivax HB vaccine. The dosing schedules for other hepatitis B vaccines were included in prior years' schedules.

# Figures
- For figure 1, the bar for T dap/T d for persons aged 65 years and older has been changed to solid yellow because all adults, including those 65 years and older, are now recommended to receive one dose of Tdap vaccine (5). - T he bar for M M R vaccine for persons born before 1957 has been removed. M M R vaccine is not recommended routinely for persons born before 1957. Considerations for vaccination in measles or mumps outbreak settings are discussed in the ACIP recommendations for health care personnel (8).
- A new row for PCV13 vaccine has been added.
- For Figure 2, the recom m endation for Tdap vaccination with each pregnancy is included, with a single dose of Tdap recommended for all other groups (6). - A correction was made to change the color for PPSV23 from yellow to purple for men who have sex with men (MSM). PPSV23 is recommended for M SM who have another risk factor such as age group or medical condition. - A row for PCV13 was added (4).

# Contraindications and Precautions Table
- T he inactivated influenza vaccine precautions were updated to indicate that persons who experience only hives with exposure to eggs should receive IIV rather than LAIV.
- Pregnancy was removed as a precaution for hepatitis A vaccine. This is an inactivated vaccine, and similar to hepatitis B vaccines, is recommended if another high risk condition or other indication is present. - Language was clarified regarding the precaution for use o f antiviral medications and vaccination with varicella or zoster vaccines.

# ACIP Adult Immunization Work Group
Work

# Human papillomavirus (HPV) vaccination
- Two vaccines are licensed for use in females, bivalent HPV vaccine (HPV2) and quadrivalent HPV vaccine (HPV4), and one HPV vaccine for use in males (HPV4). - For females, either HPV4 or HPV2 is recommended in a 3-dose series for routine vaccination at age 11 or 12 years, and for those aged 13 through 26 years, if not previously vaccinated. - For males, HPV4 is recommended in a 3-dose series for routine vaccination at age 11 or 12 years, and for those aged 13 through 21 years, if not previ ously vaccinated. Males aged 22 through 26 years may be vaccinated. - HPV4 is recommended for men who have sex with men (MSM) through age 26 years for those who did not get any or all doses when they were younger. - Vaccination is recommended for immunocompromised persons (including those with HIV infection) through age 26 years for those who did not get any or all doses when they were younger. - A complete series for either HPV4 or HPV2 consists o f 3 doses. The second dose should be administered 1-2 months after the first dose; the third dose should be administered 6 months after the first dose (at least 24 weeks after the first dose). - HPV vaccines are not recommended for use in pregnant women. However, pregnancy testing is not needed before vaccination. If a woman is found to be pregnant after initiating the vaccination series, no intervention is needed; the remainder o f the 3-dose series should be delayed until completion o f pregnancy. - Although HPV vaccination is not specifically recommended for health-care personnel (HCP) based on their occupation, HCP should receive the HPV vaccine as recommended (see above).

# Zoster vaccination
- A single dose o f zoster vaccine is recommended for adults aged 60 years and older regardless o f whether they report a prior episode o f herpes zoster.
Although the vaccine is licensed by the Food and Drug Administration (FDA) for use among and can be administered to persons aged 50 years and older, ACIP recommends that vaccination begins at age 60 years. - Persons aged 60 years and older with chronic medical conditions may be vaccinated unless their condition constitutes a contraindication, such as pregnancy or severe immunodeficiency. - Although zoster vaccination is not specifically recommended for HCP, they should receive the vaccine if they are in the recommended age group.

# Measles, mumps, rubella (MMR) vaccination
- Adults born before 1957 generally are considered immune to measles and mumps. dose should be administered 1 month after the first dose; the third dose should be given at least 2 months after the second dose (and at least 4 months after the first dose). If the combined hepatitis A and hepatitis B vaccine (Twinrix) is used, give 3 doses at 0, 1, and 6 months; alternatively, a 4-dose Twinrix schedule, administered on days 0, 7, and 21-30 followed by a booster dose at month 12 may be used. - Adult patients receiving hemodialysis or with other immunocompromising conditions should receive 1 dose o f 40 pg/mL (Recombivax HB) adminis tered on a 3-dose schedule at 0, 1, and 6 months or 2 doses o f 20 ^g/m L (Engerix-B) administered simultaneously on a 4-dose schedule at 0, 1, 2, and 6 months.  Recent (within 11 months) receipt o f antibody-containing blood product (specific interval depends on product).6,7

# Selected conditions for which
Moderate or severe acute illness with or w ithout fever.
Receipt o f specific antivirals (i.e., acyclovir, famciclovir, or valacyclovir) 24 hours before vaccination; avoid use o f these antiviral drugs for 14 days after vaccination.

# Human papillomavirus (HPV)
Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component.
Moderate or severe acute illness with or w ithout fever. Pregnancy.

# Zoster
Severe allergic reaction (e.g., anaphylaxis) to a vaccine component. Known severe im munodeficiency (e.g., from hematologic and solid tumors, receipt o f chemotherapy, or long-term immunosuppressive therapy5 or patients with HIV infection who are severely immunocompromised). Pregnancy.
Moderate or severe acute illness with or w ithout fever.
Receipt o f specific antivirals (i.e., acyclovir, famciclovir, or valacyclovir) 24 hours before vaccination; avoid use o f these antiviral drugs for 14 days after vaccination.
Measles, mumps, rubella (MMR)3 Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component. Known severe im munodeficiency (e.g., from hematologic and solid tumors, receipt of chemotherapy, congenital immunodeficiency, or long-term immunosuppressive therapy5 or patients with HIV infection who are severely immunocompromised). Pregnancy.
Moderate or severe acute illness with or w ithout fever. Recent (within 11 months) receipt o f antibody-containing blood product (specific interval depends on product).6,7
History o f throm bocytopenia or throm bocytopenic purpura. Need for tuberculin skin testing.8
See footnotes on page 18.

# Supplem ent TABLE. (Continued) Contraindications and precautions to commonly used vaccines in adults1*"*

# Vaccine Contraindications Precautions
Pneumococcal polysaccharide (PPSV) Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component.
Moderate or severe acute illness with or w ithout fever.
Pneumococcal conjugate (PCV13) Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component, including to any vaccine containing diphtheria toxoid.
Moderate or severe acute illness with or w ithout fever.
Meningococcal, conjugate, (MCV4); meningococcal, polysaccharide (MPSV4)
Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component.
Moderate or severe acute illness with or w ithout fever.
Hepatitis A (HepA) Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component.
Moderate or severe acute illness with or w ithout fever.
Hepatitis B (HepB) Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component.
Moderate or severe acute illness with or w ithout fever.
1. Vaccine package inserts and the full ACIP recommendations for these vaccines should be consulted for additional information on vaccine-related contraindications and precautions and for more information on vaccine excipients. Events or conditions listed as precautions should be reviewed carefully. Benefits o f and risks for administering a specific vaccine to a person under these circumstances should be considered. If the risk from the vaccine is believed to outweigh the benefit, the vaccine should not be administered. If the benefit o f vaccination is believed to outweigh the risk, the vaccine should be administered. A contraindication is a condition in a recipient that increases the chance o f a serious adverse reaction. Therefore, a vaccine should not be administered when a contraindication is present. 6. Vaccine should be deferred for the appropriate interval if replacement immune globulin products are being administered.

# Supplem ent
These recommendations must be read w ith the footnotes that follow.    ------------- I --------------  for use among and can be administered to persons aged 50 years and older, ACIP recommends PCV13 for adults aged 19 years and older with the specific medical conditions noted above.

# Meningococcal vaccination
- Administer 2 doses o f meningococcal conjugate vaccine quadrivalent (MCV4) at least 2 months apart to adults w ith functional asplenia or per sistent complement component deficiencies.
- HIV-infected persons who are vaccinated also should receive 2 doses.
- Administer a single dose o f meningococcal vaccine to microbiologists routinely exposed to isolates o f N eisseria m e n in g itid is , military recruits, and persons who travel to or live in countries in which meningococcal disease is hyperendemic or epidemic. - First-year college students up through age 21 years who are living in residence halls should be vaccinated if they have not received a dose on or after their 16th birthday. - MCV4 is preferred for adults w ith any o f the preceding indications who are aged 55 years and younger; meningococcal polysaccharide vaccine (MPSV4) is preferred for adults aged 56 years and older. - Revaccination w ith MCV4 every 5 years is recommended for adults previ ously vaccinated with MCV4 or MPSV4 who remain at increased risk for infection (e.g., adults w ith anatomic or functional asplenia or persistent complem ent component deficiencies).

# Hepatitis A vaccination