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Child Immunization Schedule NotesRecommendations for Ages 18 Years or Younger, United States, 2024						Print
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Vaccines and Other Immunizing Agents in the Child Immunization Schedule
**How to use the schedule**
To make vaccination recommendations, healthcare providers should:
Determine recommended vaccine by age (**Table 1 - By Age**)
Determine recommended interval for catch-up vaccination (**Table 2 - Catch-up**)
Assess need for additional recommended vaccines by medical condition or other indication (**Table 3 - By Medical Indication**)
Review vaccine types, frequencies, intervals, and considerations for special situations (**Notes**)
Review contraindications and precautions for vaccine types (**Appendix**)
Review new or updated ACIP guidance (**Addendum**)
Administer recommended vaccines if immunization history is incomplete or unknown. Do not restart or add doses to vaccine series for extended intervals between doses. When a vaccine is not administered at the recommended age, administer at a subsequent visit. The use of trade names is for identification purposes only and does not imply endorsement by the ACIP or CDC.
Notes
For vaccination recommendations for persons ages 19 years or older, see the Recommended Adult Immunization Schedule, 2024.
**Additional information**
For calculating intervals between doses, 4 weeks = 28 days. Intervals of ≥4 months are determined by calendar months.
Within a number range (e.g., 12–18), a dash (–) should be read as “through.”
Vaccine doses administered ≤4 days before the minimum age or interval are considered valid. Doses of any vaccine administered ≥5 days earlier than the minimum age or minimum interval should not be counted as valid and should be repeated as age appropriate. **The repeat dose should be spaced after the invalid dose by the recommended minimum interval.**For further details, see Table 3-2, Recommended and minimum ages and intervals between vaccine doses, in *General Best Practice Guidelines for Immunization*.
Information on travel vaccination requirements and recommendations is available at https://www.cdc.gov/travel/.
For vaccination of persons with immunodeficiencies, see Table 8-1, Vaccination of persons with primary and secondary immunodeficiencies, in *General Best Practice Guidelines for Immunization*, Immunization in Special Clinical Circumstances (In: Kimberlin DW, Barnett ED, Lynfield Ruth, Sawyer MH, eds. Red Book: 2021–2024 Report of the Committee on Infectious Diseases. 32nd ed. Itasca, IL: American Academy of Pediatrics; 2021:72–86).
For information about vaccination in the setting of a vaccine-preventable disease outbreak, contact your state or local health department.
The National Vaccine Injury Compensation Program (VICP) is a no-fault alternative to the traditional legal system for resolving vaccine injury claims. All vaccines included in the child and adolescent vaccine schedule are covered by VICP except for dengue, PPSV23, RSV, Mpox, and COVID-19 vaccines. Mpox and COVID-19 vaccines are covered by the Countermeasures Injury Compensation Program (CICP). For more information, see www.hrsa.gov/vaccinecompensation or www.hrsa.gov/cicp.Open All Close All

**COVID-19 vaccination**(minimum age: 6 months [Moderna and Pfizer-BioNTech COVID-19 vaccines], 12 years [Novavax COVID-19 Vaccine])Routine vaccination
	**Age 6 months–4 years**
**Unvaccinated:**
2-dose series of updated (2023–2024 Formula) Moderna at 0, 4-8 weeks
3-dose series of updated (2023–2024 Formula) Pfizer- BioNTech at 0, 3-8, 11-16 weeks
**Previously** **vaccinated*** **with** **1** **dose** **of** **any** **Moderna:** 1 dose of updated (2023–2024 Formula) Moderna 4-8 weeks after the most recent dose.
**Previously** **vaccinated*** **with** **2** **or** **more** **doses** **of** **any****Moderna:** 1 dose of updated (2023–2024 Formula) Moderna at least 8 weeks after the most recent dose.
**Previously** **vaccinated*** **with** **1** **dose** **of** **any** **Pfizer-****BioNTech:**2-dose series of updated (2023–2024 Formula) Pfizer-BioNTech at 0, 8 weeks (minimum interval between previous Pfizer-BioNTech and dose 1: 3-8 weeks).
**Previously vaccinated* with 2 or more doses of any Pfizer-****BioNTech:** 1 dose of updated (2023–2024 Formula) Pfizer- BioNTech at least 8 weeks after the most recent dose.**Age 5–11 years**
**Unvaccinated:**1 dose of updated (2023–2024 Formula) Moderna or Pfizer-BioNTech vaccine.
**Previously** **vaccinated*** **with** **1** **or** **more** **doses** **of** **Moderna****or** **Pfizer-BioNTech:** 1 dose of updated (2023–2024 Formula) Moderna or Pfizer-BioNTech at least 8 weeks after the most recent dose.**Age 12–18 years**
**Unvaccinated:**
1 dose of updated (2023–2024 Formula) Moderna or Pfizer- BioNTech vaccine
2-dose series of updated (2023–2024 Formula) Novavax at 0, 3-8 weeks
**Previously vaccinated* with any COVID-19 vaccine(s):**1 dose of any updated (2023–2024 Formula) COVID-19 vaccine at least 8 weeks after the most recent dose.***Note:**Previously vaccinated is defined as having received any Original monovalent or bivalent COVID-19 vaccine (Janssen, Moderna, Novavax, Pfizer-BioNTech) prior to the updated 2023–2024 formulation.
There is no preferential recommendation for the use of one COVID-19 vaccine over another when more than one recommended age-appropriate vaccine is available.
Administer an age-appropriate COVID-19 vaccine product for each dose. For information about transition from age 4 years to age 5 years or age 11 years to age 12 years during COVID-19 vaccination series, see Tables 1 and 2 at www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us.html#covid-vaccines.
Current COVID-19 schedule and dosage formulation available at www.cdc.gov/covidschedule. For more information on Emergency Use Authorization (EUA) indications for COVID-19 vaccines, see www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/covid-19-vaccinesSpecial situations
	Persons who are moderately or severely immunocompromised**
**Age 6 months–4 years**
**Unvaccinated:**
3-dose series of updated (2023–2024 Formula) Moderna at 0, 4, 8 weeks
3-dose series of updated (2023–2024 Formula) Pfizer- BioNTech at 0, 3, 11 weeks.
**Previously vaccinated* with 1 dose of any Moderna:**2-dose series of updated (2023–2024 Formula) Moderna at 0, 4 weeks (minimum interval between previous Moderna and dose 1: 4 weeks).
**Previously vaccinated* with 2 doses of any Moderna:** 1 dose of updated (2023–2024 Formula) Moderna at least 4 weeks after the most recent dose.
**Previously** **vaccinated*** **with** **3** **or** **more** **doses** **of** **any****Moderna:** 1 dose of updated (2023–2024 Formula) Moderna at least 8 weeks after the most recent dose.
**Previously** **vaccinated*** **with** **1** **dose** **of** **any** **Pfizer-****BioNTech:**2-dose series of updated (2023–2024 Formula) Pfizer-BioNTech at 0, 8 weeks (minimum interval between previous Pfizer-BioNTech and dose 1: 3 weeks).
**Previously vaccinated* with 2 or more doses of any Pfizer-****BioNTech:** 1 dose of updated (2023–2024 Formula) Pfizer- BioNTech at least 8 weeks after the most recent dose.**Age 5–11 years**
**Unvaccinated:**
3-dose series of updated (2023–2024 Formula) Moderna at 0, 4, 8 weeks
3-dose series updated (2023–2024 Formula) Pfizer-BioNTech at 0, 3, 7 weeks.
**Previously vaccinated* with 1 dose of any Moderna:**2-dose series of updated (2023–2024 Formula) Moderna at 0, 4 weeks (minimum interval between previous Moderna and dose 1: 4 weeks).
**Previously** **vaccinated*** **with** **2** **doses** **of** **any** **Moderna:**1 dose of updated (2023–2024 Formula) Moderna at least 4 weeks after the most recent dose.
**Previously** **vaccinated*** **with** **1** **dose** **of** **any** **Pfizer-****BioNTech:**2-dose series of updated (2023–2024 Formula) Pfizer-BioNTech at 0, 4 weeks (minimum interval between previous Pfizer-BioNTech and dose 1: 3 weeks)
**Previously** **vaccinated*** **with** **2** **doses** **of** **any** **Pfizer-****BioNTech:**1 dose of 2023–2024 Pfizer-BioNTech at least 4 weeks after the most recent dose.
**Previously** **vaccinated*** **with** **3** **or** **more** **doses** **of** **any Moderna** **or** **Pfizer-BioNTech:** 1 dose of updated (2023–2024 Formula) Moderna or Pfizer-BioNTech at least 8 weeks after the most recent dose.**Age 12–18 years**
**Unvaccinated:**
3-dose series of updated (2023–2024 Formula) Moderna at 0, 4, 8 weeks
3-dose series of updated (2023–2024 Formula) Pfizer- BioNTech at 0, 3, 7 weeks
2-dose series of updated (2023–2024 Formula) Novavax at 0, 3 weeks
**Previously vaccinated* with 1 dose of any Moderna:**2-dose series of updated (2023–2024 Formula) Moderna at 0, 4 weeks (minimum interval between previous Moderna dose and dose 1: 4 weeks).
**Previously vaccinated* with 2 doses of any Moderna:**1 dose of updated (2023–2024 Formula) Moderna at least 4 weeks after the most recent dose.
**Previously** **vaccinated*** **with** **1** **dose** **of** **any** **Pfizer-****BioNTech:**2-dose series of updated (2023–2024 Formula) Pfizer-BioNTech at 0, 4 weeks (minimum interval between previous Pfizer-BioNTech dose and dose 1: 3 weeks).
**Previously** **vaccinated*** **with** **2** **doses** **of** **any** **Pfizer-****BioNTech:**1 dose of updated (2023–2024 Formula) Pfizer- BioNTech at least 4 weeks after the most recent dose.
**Previously** **vaccinated*** **with** **3** **or** **more** **doses** **of** **any Moderna** **or** **Pfizer-BioNTech:** 1 dose of any updated (2023–2024 Formula) COVID-19 vaccine at least 8 weeks after the most recent dose.
**Previously vaccinated* with 1 or more doses of Janssen or Novavax or with or without dose(s) of any Original monovalent or bivalent COVID-19 vaccine****:** 1 dose of any updated (2023–2024 Formula) COVID-19 vaccine at least 8 weeks after the most recent dose.There is no preferential recommendation for the use of one COVID-19 vaccine over another when more than one recommended age-appropriate vaccine is available.
Administer an age-appropriate COVID-19 vaccine product for each dose. For information about transition from age 4 years to age 5 years or age 11 years to age 12 years during COVID-19 vaccination series, see Tables 1 and 2 at www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us.html#covid-vaccines.
Current COVID-19 schedule and dosage formulation available at www.cdc.gov/covidschedule. For more information on Emergency Use Authorization (EUA) indications for COVID-19 vaccines, see www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/covid-19-vaccines
***Note:**Previously vaccinated is defined as having received any Original monovalent or bivalent COVID-19 vaccine (Janssen, Moderna, Novavax, Pfizer-BioNTech) prior to the updated 2023–2024 formulation.
****Note:**Persons who are moderately or severely immunocompromised have the option to receive one additional dose of updated (2023–2024 Formula) COVID-19 vaccine at least 2 months following the last recommended updated (2023–2024 Formula) COVID-19 vaccine dose. Further additional updated (2023–2024 Formula) COVID-19 vaccine dose(s) may be administered, informed by the clinical judgement of a healthcare provider and personal preference and circumstances. Any further additional doses should be administered at least 2 months after the last updated (2023–2024 Formula) COVID-19 vaccine dose. Moderately or severely immunocompromised children 6 months–4 years of age should receive homologous updated (2023–2024 Formula) mRNA vaccine dose(s) if they receive additional doses.Contraindications and Precautions
	For contraindications and precautions to COVID-19 vaccination, see COVID-19 Appendix
**Dengue Vaccination**(minimum age: 9 years)Routine vaccination
	Age 9–16 years living in areas with endemic dengue **AND** have laboratory confirmation of previous dengue infection
3-dose series administered at 0, 6, and 12 months
Endemic areas include Puerto Rico, American Samoa, US Virgin Islands, Federated States of Micronesia, Republic of Marshall Islands, and the Republic of Palau. For updated guidance on dengue endemic areas and pre-vaccination laboratory testing see https://www.cdc.gov/mmwr/volumes/70/rr/rr7006a1.htm and https://www.cdc.gov/dengue/vaccine/hcp/index.html.
Dengue vaccine should not be administered to children traveling to or visiting endemic dengue areas.Contraindications and Precautions
	For contraindications and precautions to dengue vaccination, see Dengue Appendix
**Diphtheria, tetanus, and pertussis (DTaP) vaccination**(minimum age: 6 weeks [4 years for Kinrix® or Quadracel®])Routine vaccination
	5-dose series (3-dose primary series at age 2, 4, and 6 months, followed by a booster doses at ages 15–18 months and 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.
**Retrospectively:** A 4th dose that was inadvertently administered as early as age 12 months may be counted if at least 4 months have elapsed since dose 3.Catch-up vaccination
	Dose 5 is not necessary if dose 4 was administered at age 4 years or older **and** at least 6 months after dose 3.
For other catch-up guidance, see Table 2.Special situations
	**Wound management** in children less than age 7 years with history of 3 or more doses of tetanus-toxoid-containing vaccine: For all wounds except clean and minor wounds, administer DTaP if more than 5 years since last dose of tetanus-toxoid-containing vaccine. For detailed information, see www.cdc.gov/mmwr/volumes/67/rr/rr6702a1.htm.Contraindications and Precautions
	For contraindications and precautions to Diphtheria, tetanus, pertussis (DTaP) vaccination, see DTaP Appendix
***Haemophilus influenzae* type b vaccination**(minimum age: 6 weeks)Routine vaccination
	**ActHIB®, Hiberix®, Pentacel®, or Vaxelis®:** 4-dose series (3-dose primary series at age 2, 4, and 6 months, followed by a booster dose* at age 12–15 months)
*Vaxelis® is not recommended for use as a booster dose. A different Hib-containing vaccine should be used for the booster dose.
**PedvaxHIB®:** 3-dose series (2-dose primary series at age 2 and 4 months, followed by a booster dose at age 12–15 months)Catch-up vaccination
	**Dose 1 at age 7**–**11 months:**Administer dose 2 at least 4 weeks later and dose 3 (final dose) at age 12–15 months or 8 weeks after dose 2 (whichever is later).
**Dose 1 at age 12**–**14 months:**Administer dose 2 (final dose) at least 8 weeks after dose 1.
**Dose 1 before age 12 months and dose 2 before age 15 months:**Administer dose 3 (final dose) at least 8 weeks after dose 2.
**2 doses of PedvaxHIB® before age 12 months:**Administer dose 3 (final dose) at age 12–59 months and at least 8 weeks after dose 2.
**1 dose administered at age 15 months or older:**No further doses needed
**Unvaccinated at age 15–59 months:**Administer 1 dose.
**Previously unvaccinated children age 60 months or older** **who are not considered high risk:**Do not require catch-up vaccinationFor other catch-up guidance, see Table 2. Vaxelis® can be used for catch-up vaccination in children less than age 5 years. Follow the catch-up schedule even if Vaxelis® is used for one or more doses. For detailed information on use of Vaxelis® see www.cdc.gov/mmwr/volumes/69/wr/mm6905a5.htm.Special situations
	**Chemotherapy or radiation treatment:**
**Age 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.*
**Hematopoietic stem cell transplant (HSCT):**
3-dose series 4 weeks apart starting 6 to 12 months after successful transplant regardless of Hib vaccination history
**Anatomic or functional asplenia (including sickle cell disease):**
**Age 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 years or older***
1 dose
**Elective splenectomy:**
***Unvaccinated* persons age 15 months or older***
1 dose (preferably at least 14 days before procedure)
**HIV infection:**
**Age 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
**Immunoglobulin deficiency, early component complement deficiency:**
**Age 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 age 14 months) **OR** no doses (age 15 months or older)Contraindications and Precautions
	For contraindications and precautions to Haemophilus influenzae type b (Hib) vaccination, see Hib Appendix
**Hepatitis A vaccination**(minimum age: 12 months for routine vaccination)Routine vaccination
	2-dose series (minimum interval: 6 months) at age 12–23 monthsCatch-up vaccination
	Unvaccinated persons through age 18 years should complete a 2-dose series (minimum interval: 6 months).
Persons who previously received 1 dose at age 12 months or older should receive dose 2 at least 6 months after dose 1.
Adolescents age 18 years or older may receive the combined HepA and HepB vaccine, **Twinrix®**, as a 3-dose series (0, 1, and 6 months) or 4-dose series (3 doses at 0, 7, and 21–30 days, followed by a booster dose at 12 months).International travel
	Persons traveling to or working in countries with high or intermediate endemic hepatitis A
(http://www.cdc.gov/travel/)
**Infants age 6**–**11 months**: 1 dose before departure; revaccinate with 2 doses (separated by at least 6 months) between age 12–23 months.
**Unvaccinated age 12 months or  older**: Administer dose 1 as soon as travel is considered.Contraindications and Precautions
	For contraindications and precautions to Hepatitis A (HepA) vaccination, see HepA Appendix
**Hepatitis B vaccination**(minimum age: birth)Routine vaccination
	3-dose series at age 0, 1–2, 6–18 months **(use monovalent HepB vaccine for doses administered before age 6 weeks)**
Birth weight ≥2,000 grams: 1 dose within 24 hours of birth if medically stable
Birth weight <2,000 grams: 1 dose at chronological age 1 month or hospital discharge (whichever is earlier and even if weight is still <2,000 grams).
Infants who did not receive a birth dose should begin the series as soon as possible (see Table 2 for minimum intervals).
Administration of 4 doses is permitted when a combination vaccine containing HepB is used after the birth dose.
**Minimum intervals (see Table 2):**when 4 doses are administered, substitute “dose 4” for “dose 3” in these calculations
**Final (3rd or 4th) dose:**age 6–18 months**(minimum age 24 weeks)**
**Mother is HBsAg-positive**
**Birth dose (monovalent HepB vaccine only):** administer **HepB vaccine** and **hepatitis B immune globulin (HBIG)** (in separate limbs) within 12 hours of birth, regardless
of birth weight.
**Birth weight <2000 grams:** administer 3 additional doses of HepB vaccine beginning at age 1 month (total of 4 doses)
**Final (3rd or 4th) dose:** administer at age 6 months **(minimum age 24 weeks)**
Test for HBsAg and anti-HBs at age 9–12 months. If HepB series is delayed, test 1–2 months after final dose. Do not test before age 9 months.
**Mother is HBsAg-unknown**If other evidence suggestive of maternal hepatitis B infection exists (e.g., presence of HBV DNA, HBeAg-positive, or mother known to have chronic hepatitis B infection), manage infant as if mother is HBsAg-positive****
**Birth dose (monovalent HepB vaccine only):**
Birth weight ≥2,000 grams: administer **HepB vaccine** within 12 hours of birth. Determine mother’s HBsAg status as soon as possible. If mother is determined to be HBsAg-positive, administer **HBIG** as soon as possible (in separate limb), but no later than 7 days of age.
Birth weight <2,000 grams: administer **HepB vaccine** and **HBIG** (in separate limbs) within 12 hours of birth. Administer 3 additional doses of **HepB vaccine** beginning at age 1 month (total of 4 doses)
**Final (3rd or 4th) dose:** administer at age 6 months **(minimum age 24 weeks)**
If mother is determined to be HBsAg-positive or if status remains unknown, test for HBsAg and anti-HBs at age 9–12 months. If HepB series is delayed, test 1–2 months after final dose. Do not test before age 9 months.Catch-up vaccination
	Unvaccinated persons should complete a 3-dose series at 0, 1–2, 6 months. See Table 2 for minimum intervals
Adolescents age 11–15 years may use an alternative 2-dose schedule with at least 4 months between doses (adult formulation **Recombivax HB®** only).
Adolescents age 18 years may receive:
**Heplisav-B**®: 2-dose series at least 4 weeks apart
**PreHevbrio**®: 3-dose series at 0, 1, and 6 months
Combined HepA and HepB vaccine, **Twinrix**®: 3-dose series (0, 1, and 6 months) or 4-dose series (3 doses at 0, 7, and 21–30 days, followed by a booster dose at 12 months).Special situations
	Revaccination is not generally recommended for persons with a normal immune status who were vaccinated as infants, children, adolescents, or adults.
**Post-vaccination serology testing and revaccination** (if anti-HBs<10mlU/mL) is recommended for certain populations, including:
Infants born to HBsAg-positive mothers
Persons who are predialysis or on maintenance dialysis
Other immunocompromised persons
For detailed revaccination recommendations, see http://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/hepb.html.**Note:** Heplisav-B and PreHevbrio are not recommended in pregnancy due to lack of safety data in pregnant persons.Contraindications and Precautions
	For contraindications and precautions to Hepatitis B (HepB) vaccination, see HepB Appendix**Human papillomavirus vaccination**(minimum age: 9 years)Routine and catch-up vaccination
	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
2- or 3-dose series depending on age at initial vaccination:
**Age 9 –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)
No additional dose recommended when any HPV vaccine series of any valency has been completed using recommended dosing intervals.Special situations
	**Immunocompromising conditions, including HIV infection:** 3-dose series, even for those who initiate vaccination at age 9 through 14 years.
**History of sexual abuse or assault:** Start at age 9 years.
**Pregnancy:** Pregnancy testing not needed before vaccination; HPV vaccination not recommended until after pregnancy; no intervention needed if vaccinated while pregnantContraindications and Precautions
	For contraindications and precautions to Human papillomavirus (HPV) vaccination, see HPV Appendix
**Influenza vaccination**(minimum age: 6 months [IIV], 2 years [LAIV4], 18 years [recombinant influenza vaccine, RIV4])Routine vaccination
	Use any influenza vaccine appropriate for age and health status annually:
**Age** **6** **months–8** **years** who have received **fewer** than 2 influenza vaccine doses before July 1, 2023, or whose influenza vaccination history is unknown: 2 doses, separated by at least 4 weeks. Administer dose 2 even if the child turns 9 years between receipt of dose 1 and dose 2.
**Age 6 months–8 years**who have received **at least**2 influenza vaccine doses before July 1, 2023: 1 dose
**Age 9 years or older:** 1 dose
For the 2023-2024 season, see cdc.gov/mmwr/volumes/72/rr/rr7202a1.htm.
For the 2024–25 season, see the 2024–25 ACIP influenza vaccine recommendations.**Note:**Persons with an egg allergy can receive any influenza vaccine (egg-based and non-egg-based) appropriate for age and health status.Special situations
	**Close contacts (e.g., household contacts) of severely immunosuppressed persons who require a protected****environment:** should not receive If LAIV4 is given, they should avoid contact with for such immunosuppressed persons for 7 days after vaccination.**Note:**Persons with an egg allergy can receive any influenza vaccine (egg-based and non-egg-based) appropriate for age and health status.Contraindications and Precautions
	For contraindications and precautions to Influenza vaccination, see IIV4 Appendix, LAIV4 Appendix, ccIIV4 Appendix, and RIV4 Appendix.
**Measles, mumps, and rubella vaccination**(minimum age: 12 months for routine vaccination)Routine vaccination
	2-dose series at age 12–15 months, age 4–6 years
MMR or MMRV* may be administered***Note:*** For dose 1 in children age 12–47 months, it is recommended to administer MMR and varicella vaccines separately. MMRV* may be used if parents or caregivers express a preference.
***Note:** If MMRV is used, the minimum interval between MMRV doses is 3 monthsCatch-up vaccination
	Unvaccinated children and adolescents: 2-dose series at least 4 weeks apart*
The maximum age for use of MMRV* is 12 years.***Note:** If MMRV is used, the minimum interval between MMRV doses is 3 monthsSpecial situations
	**International travel**
**Infants age 6**–**11 months:**1 dose before departure; revaccinate with 2-dose series at age 12–15 months (12 months for children in high-risk areas) and dose 2 as early as 4 weeks later.*
**Unvaccinated children age 12 months or older:**2-dose series at least 4 weeks apart before departure*
In mumps outbreak settings, for information about additional doses of MMR (including 3rd dose of MMR), see www.cdc.gov/mmwr/volumes/67/wr/mm6701a7.htm***Note:** If MMRV is used, the minimum interval between MMRV doses is 3 monthsContraindications and Precautions
	For contraindications and precautions to Measles, mumps, rubella (MMR), see MMR Appendix
**Meningococcal serogroup A,C,W,Y vaccination**(minimum age: 2 months [MenACWY-CRM, Menveo], 2 years [MenACWY-TT, MenQuadfi]), 10 years [MenACWY-TT/MenB-FHbp, Penbraya])Routine vaccination
	2-dose series at age 11–12 years; 16 yearsCatch-up vaccination
	Age 13–15 years: 1 dose now and booster at age 16–18 years (minimum interval: 8 weeks)
Age 16–18 years: 1 doseSpecial situations
	**Anatomic or functional asplenia (including sickle cell disease), HIV infection, persistent complement component deficiency, complement inhibitor (e.g., eculizumab, ravulizumab) use:**
**Menveo®***
Dose 1 at age 2 months: 4-dose series (additional 3 doses at age 4, 6, and 12 months)
Dose 1 at age 3–6 months: 3- or 4- dose series (dose 2 [and dose 3 if applicable] at least 8 weeks after previous dose until a dose is received at age 7 months or older, followed by an additional dose at least 12 weeks later and after age 12 months)
Dose 1 at age 7–23 months: 2-dose series (dose 2 at least 12 weeks after dose 1 and after age 12 months)
Dose 1 at age 24 months or older: 2-dose series at least 8 weeks apart
**MenQuadfi®**
Dose 1 at age 24 months or older: 2-dose series at least 8 weeks apart**Travel to countries with hyperendemic or epidemic meningococcal disease, including countries in the African meningitis belt or during the Hajj
(www.cdc.gov/travel/):**
Children less than age 24 months:
**Menveo®* (age 2–23 months)**
Dose 1 at age 2 months: 4-dose series (additional 3 doses at age 4, 6, and 12 months)
Dose 1 at age 3–6 months: 3- or 4- dose series (dose 2 [and dose 3 if applicable] at least 8 weeks after previous dose until a dose is received at age 7 months or older, followed by an additional dose at least 12 weeks later and after age 12 months)
Dose 1 at age 7–23 months: 2-dose series (dose 2 at least 12 weeks after dose 1 and after age 12 months)
Children age 2 years or older: 1 dose Menveo®*or MenQuadfi®**First-year college students who live in residential housing (if not previously vaccinated at age 16 years or older) or military recruits:**
1 dose **Menveo**®*or **MenQuadfi**®**Adolescent vaccination of children who received MenACWY prior to age 10 years:**
**Children for whom boosters are recommended** because of an ongoing increased risk of meningococcal disease (e.g., those with complement component deficiency, HIV, or asplenia): Follow the booster schedule for persons at increased risk**.**
**Children for whom boosters are not recommended** (e.g., a healthy child 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**.**** Menveo has two formulations: lyophilized and liquid. The liquid formulation should not be used before age 10 years. See www.cdc.gov/vaccines/vpd/mening/downloads/menveo-single-vial-presentation.pdf.*
**Note:**For MenACWY booster dose recommendations for groups listed under “Special situations” and in an outbreak setting and additional meningococcal vaccination information, see www.cdc.gov/mmwr/volumes/69/rr/rr6909a1.htm.
Children age 10 years or older may receive a single dose of PenbrayaTM as an alternative to separate administration of MenACWY and MenB when both vaccines would be given on the same clinic day, (see “Meningococcal serogroup B vaccination” section below for more information).Contraindications and Precautions
	For contraindications and precautions to Meningococcal ACWY (MenACWY)
[MenACWY-CRM (Menveo®); MenACWY-D (Menactra®); MenACWY-TT (MenQuadfi®)], see Meningococcal ACWY (MenACWY) Appendix
For contraindications and precautions to Meningococcal ABCWY, (MenACWY-TT/MenB-FHbp) [Penbraya], see Meningococcal ABCWY Appendix
**Meningococcal serogroup B vaccination**(minimum age: 10 years [MenB-4C, Bexsero®; MenB-FHbp, Trumenba®; MenACWY-TT/MenB-FHbp, PenbrayaTM])Shared Clinical Decision-Making
	**Adolescents not at increased risk** age 16–23 years (preferred age 16–18 years) based on shared clinical decision-making:
**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 3rd dose at least 4 months after dose 2)For additional information on shared clinical decision-making for MenB, see www.cdc.gov/vaccines/hcp/admin/downloads/isd-job-aid-scdm-mening-b-shared-clinical-decision-making.pdfSpecial situations
	**Anatomic or functional asplenia (including sickle cell disease), persistent complement component deficiency, complement inhibitor (e.g., eculizumab, ravulizumab) use:**
**Bexsero®:** 2-dose series at least 1 month apart
**Trumenba®:** 3-dose series at 0, 1–2, 6 months (if dose 2 was administered at least 6 months after dose 1, dose 3 not needed; if dose 3 is administered earlier than 4 months after dose 2, a  4th dose should be administered at least 4 months after dose 3)**Note: 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 additional meningococcal vaccination information, see www.cdc.gov/mmwr/volumes/69/rr/rr6909a1.htm.
Children age 10 years or older may receive a dose of PenbrayaTM as an alternative to separate administration of MenACWY and MenB when both vaccines would be given on the same clinic day. For age-eligible children not at increased risk, if PenbrayaTM is used for dose 1 MenB, MenB-FHbp (Trumenba) should be administered for dose 2 MenB. For age-eligible children at increased risk of meningococcal disease, PenbrayaTM may be used for additional MenACWY and MenB doses (including booster doses) if both would be given on the same clinic day **and** at least 6 months have elapsed since most recent PenbrayaTM dose.Contraindications and Precautions
	For contraindications and precautions to Meningococcal B (MenB), MenB-4C [Bexsero], MenB-FHbp [Trumenba], see MenB Appendix
For contraindications and precautions to Meningococcal ABCWY, (MenACWY-TT/MenB-FHbp) [Penbraya], see Meningococcal ABCWY Appendix
**Mpox vaccination**(minimum age: 18 years [Jynneos®])Special situations
	**Age 18 years and at risk for Mpox infection:**2-dose series, 28 days apart.
**Risk factors for Mpox infection include:**
Persons who are gay, bisexual, and other MSM, transgender or nonbinary people who in the past 6 months have had:
A new diagnosis of at least 1 sexually transmitted disease
More than 1 sex partner
Sex at a commercial sex venue
Sex in association with a large public event in a geographic area where Mpox transmission is occurring
Persons who are sexual partners of the persons described above
Persons who anticipate experiencing any of the situations described above
**Pregnancy:** There is currently no ACIP recommendation for Jynneos use in pregnancy due to lack of safety data in pregnant. Pregnant persons with any risk factor described above may receive Jynneos.For detailed information, see: www.cdc.gov/vaccines/acip/meetings/downloads/slides-2023-10-25-26/04-MPOX-Rao-508.pdfContraindications and Precautions
	For contraindications and precautions to Mpox vaccination, see Mpox Appendix**Pneumococcal vaccination**(minimum age: 6 weeks [PCV15], [PCV 20]; 2 years [PPSV23])Routine vaccination with PCV
	4-dose series at 2, 4, 6, 12–15 monthsCatch-up vaccination with PCV
	Healthy children ages 2–4 years with any incomplete*
PCV series: 1 dose PCV
For other catch-up guidance, see Table 2.**Note:** Either PCV15 or PCV20 can be used when PCV is indicated. For children **without** risk conditions, PCV20 is not indicated if they have received 4 doses of PCV13 or PCV15 or another age appropriate complete PCV series.Special situations
	**Children and adolescents with cerebrospinal fluid leak; chronic heart disease; chronic kidney disease (excluding maintenance dialysis and nephrotic syndrome); chronic liver disease; chronic lung disease (including moderate persistent or severe persistent asthma); cochlear implant; or diabetes mellitus:**
**Age 2–5 years**
Any incomplete* PCV series with:
3 PCV doses: 1 dose PCV (at least 8 weeks after the most recent PCV dose)
Less than 3 PCV doses: 2 doses PCV (at least 8 weeks after the most recent dose and administered at least 8 weeks apart)
Completed recommended PCV series but have not received PPSV23
Previously received at least 1 dose of PCV20: no further PCV or PPSV23 doses needed
Not previously received PCV20: administer 1 dose PCV20 OR 1 dose PPSV23 administer at least 8 weeks after the most recent PCV dose.**Age 6–18 years**
Not previously received any dose of PCV13, PCV15, or PCV20: administer 1 dose of PCV15 or PCV20. If PCV15 is used and no previous receipt of PPSV23, administer 1 dose of PPSV23 at least 8 weeks after the PCV15 dose.**
Received PCV before age 6 years but have not received PPSV23
Previously received at least 1 dose of PCV20: no further PCV or PPSV23 doses needed
Not previously received PCV20: administer 1 dose PCV20 OR 1 dose PPSV23 at least 8 weeks after the most recent PCV dose. If PPSV23 is used, administer either PCV20 or dose 2 PPSV23 at least 5 years after dose 1 PPSV23.
Received PCV13 only at or after age 6 years: administer 1 dose PCV20 OR 1 dose PPSV23 at least 8 weeks after the most recent PCV13 dose.
Received 1 dose PCV13 and 1 dose PPSV23 at or after age 6 years: no further doses of any PCV or PPSV23 indicated.**Children and adolescents on maintenance dialysis, or with immunocompromising conditions such as nephrotic syndrome; congenital or acquired asplenia or splenic dysfunction; congenital or acquired immunodeficiencies; diseases and conditions treated with immunosuppressive drugs or radiation therapy, including malignant neoplasms, leukemias, lymphomas, Hodgkin disease, and solid organ transplant; HIV infection; or sickle cell disease or other hemoglobinopathies:**
**Age 2–5 years**
Any incomplete* PCV series:
3 PCV doses: 1 dose PCV (at least 8 weeks after the most recent PCV dose)
Less than 3 PCV doses: 2 doses PCV (at least 8 weeks after the most recent dose and administered at least 8 weeks apart)
Completed recommended PCV series but have not received PPSV23
Previously received at least 1 dose of PCV20: no further PCV or PPSV23 doses needed
Not previously received PCV20: administer 1 dose PCV20 OR 1 dose PPSV23 at least 8 weeks after the most recent PCV. If PPSV23 is used, administer 1 dose of PCV20 or dose 2 PPSV23 at least 5 years after dose 1 PPSV23.**Age 6–18 years**
Not previously received any dose of PCV13, PCV15, or PCV20: administer 1 dose of PCV15 or 1 dose of PCV20. If PCV15 is used and no previous receipt of PPSV23, administer 1 dose of PPSV23 at least 8 weeks after the PCV15 dose.**
Received PCV before age 6 years but have not received PPSV23
Previously received at least 1 dose of PCV20: no additional dose of PCV or PPSV23
Not previously received PCV20: administer 1 dose PCV20 OR 1 dose PPSV23 at least 8 weeks after the most recent PCV dose. If PPSV23 is used, administer either PCV20 or dose 2 PPSV23 at least 5 years after dose 1 PPSV23.
Received PCV13 only at or after age 6 years: administer 1 dose PCV20 OR 1 dose PPSV23 at least 8 weeks after the most recent PCV13 dose. If PPSV23 is used, administer 1 dose of PCV20 or dose 2 PPSV23 at least 5 years after dose 1 PPSV23.
Received 1 dose PCV13 and 1 dose PPSV23 at or after age 6 years: administer 1 dose PCV20 OR 1 dose PPSV23 at least 8 weeks after the most recent PCV13 dose and at least 5 years after dose 1 PPSV23.**Incomplete* *series* = Not having received all doses in either the recommended series or an age-appropriate catch-up series. See Table 2 in ACIP pneumococcal recommendations at stacks.cdc.gov/view/cdc/133252
***When both PCV15 and PPSV23 are indicated, administer all doses of PCV15 first. PCV15 and PPSV23 should not be administered during the same visit.*
For guidance on determining which pneumococcal vaccines a patient needs and when, please refer to the mobile app, which can be downloaded here: www.cdc.gov/vaccines/vpd/pneumo/hcp/pneumoapp.htmlContraindications and Precautions
	For contraindications and precautions to Pneumococcal conjugate (PCV), see PCV Appendix and Pneumococcal polysaccharide (PPSV23), see PPSV23 Appendix
**Poliovirus vaccination**(minimum age: 6 weeks)Routine vaccination
	4-dose series at ages 2, 4, 6–18 months, 4–6 years; administer the final dose on or after age 4 years and at least 6 months after the previous dose.
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 on or after age 4 years and at least 6 months after the previous dose.Catch-up vaccination
	In the first 6 months of life, use minimum ages and intervals only for travel to a polio-endemic region or during an outbreak.
**Adolescents age 18 years known or suspected to be unvaccinated or incompletely vaccinated:** administer remaining doses (1, 2, or 3 IPV doses) to complete a 3-dose primary series.* Unless there are specific reasons to believe they were not vaccinated, most persons aged 18 years or older born and raised in the United States can assume they were vaccinated against polio as children.**Series containing oral poliovirus vaccine (OPV),** either mixed OPV-IPV or OPV-only series:
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.
Only trivalent OPV (tOPV) counts toward the U.S. vaccination requirements.
Doses of OPV administered before April 1, 2016, should be counted (unless specifically noted as administered during a campaign).
Doses of OPV administered on or after April 1, 2016, should not be counted.
For guidance to assess doses documented as “OPV,” see www.cdc.gov/mmwr/volumes/66/wr/mm6606a7.htm.
For other catch-up guidance, see Table 2.Special situations
	**Adolescents age18 years at increased risk of exposure to****poliovirus** **and** **completed** **primary** **series*:** may administer one lifetime IPV booster***Note:**Complete primary series consist of at least 3 doses of IPV or trivalent oral poliovirus vaccine (tOPV) in any combination.
For detailed information, see: www.cdc.gov/vaccines/vpd/polio/hcp/recommendations.htmlContraindications and Precautions
	For contraindications and precautions to Poliovirus vaccine, inactivated (IPV), see Appendix
**Respiratory syncytial virus immunization**(minimum age: birth [Nirsevimab, RSV-mAb (BeyfortusTM)Routine vaccination
	**Infants born October – March in most of the continental United States***
Mother did not receive RSV vaccine OR mother’s RSV vaccination status is unknown: administer 1 dose nirsevimab within 1 week of birth in hospital or outpatient setting
Mother received RSV vaccine **less than 14 days**prior to delivery: administer 1 dose nirsevimab within 1 week of birth in hospital or outpatient setting
Mother received RSV vaccine **at** **least** **14** **days** prior to delivery: nirsevimab not needed but can be considered in rare circumstances at the discretion of healthcare providers (see special populations and situations at cdc.gov/vaccines/vpd/rsv/hcp/child-faqs.html)
**Infants born April–September in most of the continental United States***
Mother did not receive RSV vaccine OR mother’s RSV vaccination status is unknown: administer 1 dose nirsevimab shortly before start of RSV season*
Mother received RSV vaccine **less** **than** **14** **days** prior to delivery: administer 1 dose nirsevimab shortly before start of RSV season*
Mother received RSV vaccine **at** **least** **14** **days** prior to delivery: nirsevimab not needed but can be considered in rare circumstances at the discretion of healthcare providers (see special populations and situations at cdc.gov/vaccines/vpd/rsv/hcp/child-faqs.html)Infants with prolonged birth hospitalization** (e.g., for prematurity) discharged October through March should be immunized shortly before or promptly after discharge.Special situations
	**Ages** **8–19** **months** **with** **chronic** **lung** **disease** **of****prematurity requiring medical support (e.g., chronic corticosteroid therapy, diuretic therapy, or supplemental oxygen) any time during the 6-month****period before the start of the second RSV season; severe immunocompromise; cystic fibrosis with either weight for length <10th percentile or manifestation of severe****lung disease (e.g., previous hospitalization for pulmonary exacerbation in the first year of life or abnormalities on chest imaging that persist when stable)**:**
1 dose nirsevimab shortly before start of second RSV season*
**Ages 8–19 months who are American Indian or Alaska Native:**
1 dose nirsevimab shortly before start of second RSV season*
**Age-eligible** **and** **undergoing** **cardiac** **surgery** **with****cardiopulmonary bypass**:**1 additional dose of nirsevimab after surgery. For additional details see special populations and situations at www.cdc.gov/vaccines/vpd/rsv/hcp/child-faqs.html***Note:**While the timing of the onset and duration of RSV season may vary, nirsevimab may be administered October through March in most of the continental United States. Providers in jurisdictions with RSV seasonality that differs from most of the continental United States (e.g., Alaska, jurisdiction with tropical climate) should follow guidance from public health authorities (e.g., CDC, health departments) or regional medical centers on timing of administration based on local RSV seasonality. Although optimal timing of administration is just before the start of the RSV season, nirsevimab may also be administered during the RSV season to infants and children who are age-eligible.
****Note:**Nirsevimab can be administered to children who are eligible to receive palivizumab. Children who have received nirsevimab should not receive palivizumab for the same RSV season.
For further guidance, see www.cdc.gov/mmwr/volumes/72/wr/mm7234a4.htm and www.cdc.gov/vaccines/vpd/rsv/hcp/ child-faqs.htmlContraindications and Precautions
	For contraindications and precautions to RSV monoclonal antibody (RSV-mAb), see RSV monoclonal antibody Appendix**Respiratory syncytial virus vaccination**(RSV [AbrysvoTM])Routine vaccination
	**Pregnant at 32 weeks 0 days through 36 weeks and 6 days gestation from September through January in most of the continental United States*:** 1 dose RSV vaccine (AbrysvoTM). Administer RSV vaccine regardless of previous RSV infection.
Either maternal RSV vaccination or infant immunization with nirsevimab (RSV monoclonal antibody) is recommended to prevent respiratory syncytial virus lower respiratory tract infection in infants.
**All** **other** **pregnant** **persons:** RSV vaccine not recommended.There is currently no ACIP recommendation for RSV vaccination in subsequent pregnancies. No data are available to inform whether additional doses are needed in later pregnancies.
***Note:**Providers in jurisdictions with RSV seasonality that differs from most of the continental United States (e.g., Alaska, jurisdiction with tropical climate) should follow guidance from public health authorities (e.g., CDC, health departments) or regional medical centers on timing of administration based on local RSV seasonality.Contraindications and Precautions
	For contraindications and precautions to Respiratory syncytial virus vaccine (RSV), see RSV Appendix**Rotavirus vaccination**(minimum age: 6 weeks)Routine vaccination
	**Rotarix®:** 2-dose series at age 2 and 4 months
**RotaTeq®:** 3-dose series at age 2, 4, and 6 months
If any dose in the series is either **RotaTeq®** or unknown, default to 3-dose series.Catch-up vaccination
	Do not start the series on or after age 15 weeks, 0 days.
The maximum age for the final dose is 8 months, 0 days.
For other catch-up guidance, see Table 2.Contraindications and Precautions
	For contraindications and precautions to Rotavirus (RV) [RV1 (Rotarix®), RV5 (RotaTeq®)], see Rotavirus Appendix
**Tetanus, diphtheria, and pertussis (Tdap) vaccination**(minimum age: 11 years for routine vaccination, 7 years for catch-up vaccination)Routine vaccination
	**Age 11–12 years:** 1 dose Tdap (adolescent booster)
**Pregnancy:**1 dose Tdap during each pregnancy, preferably in early part of gestational weeks 27–36.**Note:** Tdap may be administered regardless of the interval since the last tetanus- and diphtheria-toxoid-containing vaccine.Catch-up vaccination
	**Age 13–18 years who have not received Tdap:**1 dose Tdap (adolescent booster)
**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.
**Tdap administered at age 7–10 years:**
**Age 7–9 years** who receive Tdap should receive the adolescent Tdap booster dose at age 11–12 years.
**Age 10 years** who receive Tdap do not need the adolescent Tdap booster dose at age 11–12 years.
**DTaP inadvertently administered on or after age 7 years:**
**Age 7–9 years**: DTaP may count as part of catch-up. Administer adolescent Tdap booster dose at age 11–12 years.
**Age 10–18 years**: Count dose of DTaP as the adolescent Tdap booster dose.For other catch-up guidance, see Table 2.*Fully vaccinated = 5 valid doses of DTaP OR 4 valid doses of DTaP if dose 4 was administered at age 4 years or olderSpecial situations
	**Wound management** in persons age 7 years or older with history of 3 or more doses of tetanus-toxoid-containing vaccine: For clean and minor wounds, administer Tdap or Td if more than 10 years since last dose of tetanus-toxoid-containing vaccine; for all other wounds, administer Tdap or Td if more than 5 years since last dose of tetanus-toxoid-containing vaccine. Tdap is preferred for persons age 11 years or older who have not previously received Tdap or whose Tdap history is unknown. If a tetanus-toxoid-containing vaccine is indicated for a pregnant adolescent, use Tdap.
For detailed information, see www.cdc.gov/mmwr/volumes/69/wr/mm6903a5.htm.Contraindications and Precautions
	For contraindications and precautions to Tetanus, diphtheria, and acellular pertussis (Tdap) and Tetanus, diphtheria (Td), see Tdap and Td Appendix
**Varicella vaccination**(minimum age: 12 months)Routine vaccination
	2-dose series at age 12–15 months, 4–6 years
VAR or MMRV may be administered*
Dose 2 may be administered as early as 3 months after dose 1 (a dose inadvertently administered after at least 4weeks may be counted as valid)***Note:** For dose 1 in children age 12–47 months, it is recommended to administer MMR and varicella vaccines separately. MMRV may be used if parents or caregivers express a preference.Catch-up vaccination
	Ensure persons age 7–18 years without evidence of immunity (see *MMWR*at www.cdc.gov/mmwr/pdf/rr/rr5604.pdf ) have a 2-dose series:
**Age 7–12 years:** Routine interval: 3 months (a dose inadvertently administered after at least 4 weeks may be counted as valid)
**Age 13 years and older**: Routine interval: 4–8 weeks (minimum interval: 4 weeks)
The maximum age for use of MMRV is 12 years.Contraindications and Precautions
	For contraindications and precautions to Varicella (VAR), see VAR Appendix
							
					
							Last Reviewed:  December 6, 2023						Source: 	National Center for Immunization and Respiratory Diseases
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