Appendix A

A

Appendix A-1

Appendix A: Schedule and Recommendations

Catch-up Schedule Job Aids for Persons Aged 0 Through 18 Years:

Diphtheria-, Tetanus-, and Pertussis-Containing Vaccines Catch-Up Guidance for Children 

4 Months through 6 Years of Age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-

Hib vaccine products: ActHIB, Pentacel, Hiberix, or unknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-

Hib vaccine products: PedvaxHIB vaccine only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  A-

Inactivated Polio Vaccine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-1

Pneumococcal Conjugate Vaccine (PCV) Catch-Up Guidance for Children 4 Months through 4 Years 

of Age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-1

Tetanus-, Diphtheria-, and Pertussis-Containing Vaccines Catch-Up Guidance for 

Children 7 through 9 Years of Age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-1

Tetanus-, Diphtheria-, and Pertussis-Containing Vaccines Catch-Up Guidance 

for Children 10 through 18 Years of Age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-1

Healthcare Personnel Vaccination Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-1

Recommended and Minimum Ages and Intervals Between Doses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-2

Recommended Intervals between Administration of Antibody-containing Products and Measlesor Varicella-containing Vaccine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-2

Vaccination of Persons with Primary and Secondary Immune Deficiencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-2

Contraindications and Precautions to Commonly Used Vaccines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-2

Additional Resources for Schedules and Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-3
Appendix A

A

Appendix A-2
Appendix A

A

3

The table below provides guidance for children whose vaccinations have been delayed. Start with the child’s

age and information on previous doses (previous doses must be documented and must meet minimum 

age requirements and minimum intervals between doses). Use this table in conjunction with table 2 of the

Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger, found at 

www.cdc.gov/vaccines/schedules/hcp/child-adolescent.ht

IF current 

age is

AND # of 

previous doses of 

DTaP or DT is

AND THEN Next dose due

4 months 

through

11 months

Unknown or 0  Give Dose 1

(DTaP) today

Give Dose 2 (DTaP) at least 

4 weeks after Dose 1

1

It has been at least 

4 weeks since Dose 1

Give Dose 2 (DTaP) 

today

Give Dose 3 (DTaP) at least 

4 weeks after Dose 2

It has not been at least 4 

weeks since Dose 1 No dose today Give Dose 2 (DTaP) at least 4 weeks after Dose 1

2

It has been at least 

4 weeks since Dose 2

Give Dose 3 (DTaP) 

today

Give Dose 4 (DTaP) at least 

6 calendar months after Dose 3 and

at 15 months of age or older2

It has not been at least 4 

weeks since Dose 2 No dose today Give Dose 3 (DTaP) at least 

4 weeks after Dose 2

1 through

3 years

Unknown or 0  Give Dose 1 (DTaP) 

today

Give Dose 2 (DTaP) at least 

4 weeks after Dose 1

1

It has been at least 

4 weeks since Dose 1

Give Dose 2 (DTaP) 

today

Give Dose 3 (DTaP) at least 

4 weeks after Dose 2

It has not been

4 weeks since Dose 1 No dose today Give Dose 2 (DTaP) at least 

4 weeks after Dose 1

2

It has been at least 

4 weeks since Dose 2

Give Dose 3 (DTaP) 

today

Give Dose 4 (DTaP) at least 

6 calendar months after Dose 3

It has not been

4 weeks since Dose 2 No dose today Give Dose 3 (DTaP) at least 

4 weeks after Dose 2

3

It has been at least 

6 calendar months

since Dose 3

If 12 through 14 

months of age, 

no dose today2

Give Dose 4 (DTaP) at

15 through 18 months of age

If 15 months of age 

or older, give Dose 4 

(DTaP) today

Give Dose 5 (DTaP) at least

6 months after Dose 4 and at

4 through 6 years of age

It has not been 

6 calendar months 

since Dose 3

No dose today Give Dose 4 (DTaP) at least 

6 months after Dose 3

1

Vaccine information: DTaP–Administer to children 6 weeks through 6 years of age without a contraindication or precaution to diphtheria, tetanus, or pertussis vaccine. 

DTaP products include Daptacel, Kinrix, Infanrix, Pediarix, Pentacel, and Quadracel. Use the correct product based on the approved age indications. DT–Administer to 

children 6 weeks through 6 years of age with a contraindication to pertussis vaccine.

2

The fourth dose may be administered as early as age 12 months, provided at least 6 months have elapsed since the third dose. 

Reference: Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger—United States, 2021. www.cdc.gov/vaccines/schedules/

downloads/child/0-18yrs-child-combined-schedule.pdf

Catch-Up Guidance for Children 

4 Months through 6 Years of Age

Diphtheria-, Tetanus-, and Pertussis-Containing Vaccines: DTaP/DT1

Revised February 2021
Appendix A

A

Appendix A-4

Catch-Up Guidance for Children 

4 Months through 6 Years of Age

Diphtheria-, Tetanus-, and Pertussis-Containing Vaccines: DTaP/DT1

IF current 

age is

AND # of 

previous 

doses of 

DTaP or

 DT is1

AND AND THEN Next dose due

4 through 

6 years

Unknown or 0   Give Dose 1

(DTaP) today

Give Dose 2 (DTaP) at least 

4 weeks after Dose 1

1

It has been at least

4 weeks since Dose 1  Give Dose 2 

(DTaP) today

Give Dose 3 (DTaP) at least 

4 weeks after Dose 2

It has not been

 4 weeks since Dose 1  No dose today Give Dose 2 (DTaP) at least 

4 weeks after Dose 1

2

It has been at least 

4 weeks since Dose 2  Give Dose 3 

(DTaP) today

Give Dose 4 (DTaP) at least 

6 calendar months after Dose 3

It has not been at least 

4 weeks since Dose 2  No dose today Give Dose 3 (DTaP) at least

4 weeks after Dose 2

3

It has been at least 

6 calendar months 

since Dose 3

 Give Dose 4 

(DTaP) today

Give Tdap at 

11 to 12 years of age

It has not been at least 

6 calendar months 

since Dose 3

 No dose today Give Dose 4 (DTaP) at least 

6 calendar months after Dose 3 

4

All doses were 

given prior to the 

4th birthday

It has not been 

at least 

6 months since 

Dose 4 

No dose today Give Dose 5 (DTaP) at least 

6 calendar months after Dose 4

It has been at 

least 6 months 

since Dose 4 

Give Dose 5 

(DTaP) today Give Tdap at 

At least one dose was 11 to 12 years of age

given at/after the 

4th birthday

 No dose today

1

Vaccine information: DTaP–Administer to children 6 weeks through 6 years of age without a contraindication or precaution to diphtheria, tetanus, or pertussis vaccine. DTaP 

products include Daptacel, Kinrix, Infanrix, Pediarix, Pentacel, and Quadracel. Use the correct product based on the approved age indications. DT–Administer to children 6 weeks 

through 6 years of age with a contraindication to pertussis vaccine. 

Reference: Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger—United States, 2021. 

www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-child-combined-schedule.pdf
Appendix A

A

Appendix A-5

Catch-Up Guidance for Healthy1 Children

4 Months through 4 Years of Age

Haemophilus influenzae type B Vaccines: 

ActHIB, Pentacel, Hiberix, or Unknown

The table below provides guidance for children whose vaccinations have been delayed. Start with the child’s

age and information on previous doses (previous doses must be documented and must meet minimum 

age requirements and minimum intervals between doses). Use this table in conjunction with table 2 of the

Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger, found at 

www.cdc.gov/vaccines/schedules/hcp/child-adolescent.h

IF current 

age is

AND # of 

previous 

doses is

AND THEN Next dose due

4 through 

6 months

Unknown 

or 0  Give Dose 1 

today

Give Dose 2 at least

4 weeks after Dose 1

1

It has been at least

4 weeks since Dose 1

Give Dose 2 

today

Give Dose 3 at least

4 weeks after Dose 2

It has not been

4 weeks since Dose 1

No dose 

today

Give Dose 2 at least

4 weeks after Dose 1

2

It has been at least

4 weeks since Dose 2

Give Dose 3 

today

Give Dose 4 (Final Dose) at

12 months of age or older

It has not been

4 weeks since Dose 2

No dose 

today

Give Dose 3 at least

4 weeks after Dose 2

7 through 

11 months

Unknown 

or 0   Give Dose 1 

today

Give Dose 2 at least

4 weeks after Dose 1

1

It has been at least

4 weeks since Dose 1  Give Dose 2 

today

IF Dose 1 was given before 7 months 

of age, give Dose 3 at least 

4 weeks after Dose 2

IF Dose 1 was given at 7 months of age or 

older, give Dose 3 (Final Dose) at least 8 

weeks after Dose 2 and no earlier than 12 

months of age

It has not been

4 weeks since Dose 1  No dose 

today

Give Dose 2 at least

4 weeks after Dose 1

2

Dose 1 was given 

before 

7 months of age

It has been at least 

4 weeks since Dose 2

Give Dose 3 

today

Give Dose 4 (Final Dose) at least

8 weeks after Dose 3 and no earlier 

than 12 months of age

It has not been

4 weeks since Dose 2

No dose 

today

Give Dose 3 at least

4 weeks after Dose 2

Dose 1 was given at 

7 months of age

or older

 No dose 

today

Give Dose 3 (Final Dose) at least

8 weeks after Dose 2 and no earlier 

than 12 months of age

1 Refer to notes of the Recommended Child and Adolescent Immunization 

Schedule for Ages 18 Years or Younger–United States, 2021, for immunization guidance for children at increased risk for Haemophilus influenzae type b disease.

Reference: Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger–United States, 2021. 

www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-child-combined-schedule.pdf
Appendix A

A

Appendix A-6

Catch-Up Guidance for Healthy1 Children

4 Months through 4 Years of Age

Haemophilus influenzae type B Vaccines: 

ActHIB, Pentacel, Hiberix, or Unknown

IF current 

age is

AND # of 

previous 

doses is

AND AND AND THEN Next dose due

12 through 

14 months

Unknown 

or 0    Give Dose 1 

today

Give Dose 2 (Final Dose) at 

least 8 weeks after Dose 1

1

Dose 1 was 

given before 

12 months of age

It has been at 

least 4 weeks 

since Dose 1

 Give Dose 2 

today

Give Dose 3 (Final Dose) at 

least 8 weeks after Dose 2

It has not been 

4 weeks since 

Dose 1

 No dose today Give Dose 2 at least 

4 weeks after Dose 1

Dose 1 was 

given at 

12 months 

of age or older

It has been at 

least 8 weeks 

since Dose 1



Give Dose 2 

(Final Dose) 

today

No additional 

doses needed

It has not been 

8 weeks since 

Dose 1

 No dose today Give Dose 2 (Final Dose) at 

least 8 weeks after Dose 1

2

Dose 1 was 

given before

12 months of age

It has been at 

least 8 weeks 

since Dose 2



Give Dose 3 

(Final Dose)

today

No additional 

doses needed

It has not been 

8 weeks since 

Dose 2

 No dose today Give Dose 3 (Final Dose) at 

least 8 weeks after Dose 2

Dose 1 was given 

at 12 months 

of age or older

  No dose today No additional 

doses needed

3

All doses were 

given before

12 months of age



It has been at 

least 8 weeks 

since Dose 3

Give Dose 4 

(Final Dose) 

today 

No additional 

doses needed

It has not been 

8 weeks since 

Dose 3

No dose today Give Dose 4 (Final Dose) at 

least 8 weeks after Dose 3

At least one dose 

was given at 

12 months of 

age or older

  No dose today No additional 

doses needed

1 Refer to notes of the Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger–United States, 2021, 

for children at increased risk for Haemophilus influenzae type b disease.

Reference: Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger–United States, 2021.

www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-child-combined-schedule.pdf
Appendix A

A

Appendix A-7

Catch-Up Guidance for Healthy1 Children

4 Months through 4 Years of Age

Haemophilus influenzae type B Vaccines: 

ActHIB, Pentacel, Hiberix, or Unknown

IF current 

age is

AND # of 

previous 

doses is

AND AND AND THEN Next dose due

15 through 

59 months

Unknown 

or 0   

Give Dose 1 

(Final Dose) 

today

No additional 

doses needed

1

Dose 1 was given 

before 

12 months of age

 

Give Dose 2 

(Final Dose) 

today

No additional 

doses needed

Dose 1 was given 

at 12 through 

14 months of age

It has been at least 

8 weeks since 

Dose 1



Give Dose 2 

(Final Dose) 

today

No additional 

doses needed

It has not been

8 weeks since 

Dose 1

 No dose today

Give Dose 2 

(Final Dose) at least 

8 weeks after Dose 1

Dose 1 was given 

at 15 months of 

age or older

  No dose today No additional 

doses needed

2

Dose 1 was given 

before

12 months of age

Dose 2 was given 

before

15 months of age

It has been at 

least 8 weeks 

since Dose 2

Give Dose 3 

(Final Dose) 

today

No additional 

doses needed

It has not been

8 weeks since 

Dose 2

No dose today

Give Dose 3 

(Final Dose) at least 

8 weeks after Dose 2

Dose 2 was given 

at 15 months of 

age or older

 No dose today No additional 

doses needed

Dose 1 was given 

at 12 months of 

age or older

  No dose today No additional 

doses needed

3

Dose 3 was given 

before

15 months of age

All doses were 

given before 

12 months of age



Give Dose 4 

(Final Dose) 

today 

No additional 

doses needed

At least one dose 

was given at 

12 months of age 

or older

 No dose today No additional 

doses needed

Dose 3 was given 

at 15 months of 

age or older

  No dose today No additional 

doses needed

1 Refer to notes of the Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger–United States, 2021, for 

immunization guidance for children at increased risk for Haemophilus influenzae type b disease.

Reference: Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger–United States, 2021.

www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-child-combined-schedule.pdf
Appendix A

A

Appendix A-8

Catch-Up Guidance for Healthy1 Children

4 Months through 4 Years of Age

Haemophilus influenzae type b Vaccines: PedvaxHIB Vaccine Only

The table below provides guidance for children whose vaccinations have been delayed. Start with the child’s

age and information on previous doses (previous doses must be documented and must meet minimum 

age requirements and minimum intervals between doses). Use this table in conjunction with table 2 of the

Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger, found at 

www.cdc.gov/vaccines/schedules/hcp/child-adolescent.h

IF current 

age is

AND # of 

previous 

doses is

AND AND THEN Next dose due

4 through 

6 months

0   Give Dose 1 today Give Dose 2 at least 

4 weeks after Dose 1

1

 It has been at least 

4 weeks since Dose 1 Give Dose 2 today Give Dose 3 (Final Dose) at 12 months of age or older

 It has not been

4 weeks since Dose 1 No dose today Give Dose 2 at least 4 weeks after Dose 1

7 through 

11 months

0   Give Dose 1 today Give Dose 2 at least 4

 weeks after Dose 1

1

 It has been at least 

4 weeks since Dose 1 Give Dose 2 today

Give Dose 3 (Final Dose) at least 8 

weeks after Dose 2 and at 

12 months of age or older

 It has not been

4 weeks since Dose 1 No dose today Give Dose 2 at least 4 weeks after Dose 1

12 through 

14 months

0   Give Dose 1 today Give Dose 2 (Final Dose) at

least 8 weeks after Dose 1

1

Dose 1 was 

given before

12 months of age

It has been at least 

4 weeks since Dose 1 Give Dose 2 today Give Dose 3 (Final Dose) 

at least 8 weeks after Dose 2

It has not been

4 weeks since Dose 1 No dose today Give Dose 2 at least 

4 weeks after Dose 1

Dose 1 was given 

at 12 months of 

age or older

It has been at least 

8 weeks since Dose 1

Give Dose 2 

(Final Dose) today No additional doses needed

It has not been 

8 weeks since Dose 1 No dose today Give Dose 2 (Final Dose) 

at least 8 weeks after Dose 1

2

Dose 1 was 

given before 

12 months of age

It has been at least 

8 weeks since Dose 2

Give Dose 3 

(Final Dose) today No additional doses needed

It has not been 

8 weeks since Dose 2 No dose today Give Dose 3 (Final Dose) 

at least 8 weeks after Dose 2

Dose 1 was given 

at 12 months of 

age or older

 No dose today No additional doses needed

1

 Refer to notes of the Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger–United States, 2021, 

for immunization guidance for children at increased risk for Haemophilus influenzae type b disease.

Reference: Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger–United States, 2021.

www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-child-combined-schedule.
Appendix A

A

Appendix A-9

Catch-Up Guidance for Healthy1 Children

4 Months through 4 Years of Age

Haemophilus influenzae type b Vaccines: PedvaxHIB Vaccine Only

IF current 

age is

AND # of 

previous 

doses is

AND AND AND THEN Next dose due

15 through 

59 months

0   

Give Dose 1 

(Final Dose) 

today

No additional 

doses needed

1

Dose 1 was 

given before

12 months 

of age

 

Give Dose 2 

(Final Dose) 

today

No additional 

doses needed

Dose 1 was 

given at 

12 through 

14 months

 of age 

It has been at 

least 8 weeks 

since Dose 1 

Give Dose 2 

(Final Dose) 

today

No additional 

doses needed

It has not been

8 weeks since 

Dose 1

 No dose today Give Dose 2 (Final Dose) at 

least 8 weeks after Dose 1 

Dose 1 was 

given at 

15 months of 

age or older

  No dose today No additional 

doses needed

2

Dose 1 was 

given before

12 months 

of age

Dose 2 was 

given before

15 months 

of age

It has been at 

least 8 weeks 

since Dose 2

Give Dose 3 

(Final Dose) 

today

No additional 

doses needed

It has not been

8 weeks since 

Dose 2 No dose today Give dose 3 (Final Dose) at 

least 8 weeks after Dose 2

Dose 2 was 

given at 

15 months of 

age or older

 No dose today No additional 

doses needed

Dose 1 was 

given at 

12 months or 

older

  No dose today No additional 

doses needed

1 Refer to notes of the Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger–United States, 2021, 

for immunization guidance for children at increased risk for Haemophilus influenzae type b disease.

Reference: Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger–United States, 2021.

www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-child-combined-schedule.pdf
Appendix A

A

Appendix A-10

Catch-Up Guidance for Children

4 Months through 17 Years of Age

Inactivated Polio Vaccine (IPV)

The table below provides guidance for children whose vaccinations have been delayed. Start with the child’s

age and information on previous doses (previous doses must be documented and must meet minimum 

age requirements and minimum intervals between doses). Use this table in conjunction with table 2 of the

Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger, found at 

www.cdc.gov/vaccines/schedules/hcp/child-adolescent.h

IF current 

age is

AND # of 

previous 

doses1

 is

AND THEN Next dose due2

4 through 

18 months

Unknown 

or 0  Give Dose 1 

today

Give Dose 2 at least 

4 weeks after Dose 1

1

It has been at least 4 weeks since Dose 1 Give Dose 2 

today

Give Dose 3 at least 4 weeks after Dose 2 

and at 6 months of age or older

It has not been at least 4 weeks since Dose 1 No dose 

today

Give Dose 2 at least 

4 weeks after Dose 1

2

It has been at least 

4 weeks since 

Dose 2

Child is 6 months of 

age or older

Give Dose 3 

today

Give Dose 4 (Final Dose) at 

4 through 6 years of age

Child is younger than 

6 months 

of age

No dose 

today Give Dose 3 at 6 months of age

It has not been at least 

4 weeks since Dose 2  No dose 

today

Give Dose 3 at least 4 weeks after Dose 2 

and at 6 months of age or older

19 months 

through

3 years

Unknown 

or 0  Give Dose 1 

today

Give Dose 2 at least 

4 weeks after Dose 1

1

It has been at least 4 weeks since Dose 1 Give Dose 2 

today

Give Dose 3 at least 

4 weeks after Dose 2

It has not been at least 4 weeks since Dose 1 No dose 

today

Give Dose 2 at least 

4 weeks after Dose 1

2

It has been at least 4 weeks since Dose 2 Give Dose 3 

today

Give Dose 4 (Final Dose) at least 

6 months after Dose 3 and at 

4 through 6 years of age 

It has not been 4 weeks since Dose 2 No dose 

today

Give Dose 3 at least 

4 weeks after Dose 2

1

 Series containing oral polio vaccine (OPV), either mixed OPV-IPV or OPV only: Total number of doses needed to complete the series is the same as that recommended 

for the U.S. IPV schedule. www.cdc.gov/mmwr/volumes/66/wr/mm6601a6.htm

2 Next dose due is not the final dose in the series unless explicitly stated. 

Reference: Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger—United States, 2021.

www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-child-combined-schedule.pdf

Revised February 2021
Appendix A

A

Appendix A-11

Catch-Up Guidance for Children

4 Months through 17 Years of Age

Inactivated Polio Vaccine (IPV)

IF current 

age is

AND # of 

previous 

doses1

 is

AND THEN Next dose due2

4 through 

17 years

Unknown 

or 0  Give Dose 1 

today 

Give Dose 2 at least 4 weeks 

after Dose 1

1

It has been at least 4 weeks since Dose 1 Give Dose 2 

today 

Give Dose 3 (Final Dose) at least 

6 months after Dose 2

It has not been 4 weeks since Dose 1 No dose 

today

Give Dose 2 at least 4 weeks

 after Dose 1

2

It has been at least 6 months since Dose 2

Give Dose 3 

(Final Dose) 

today 

No additional doses needed

It has not been 6 months since Dose 2 No dose 

today

Give Dose 3 (Final Dose) at least 

6 months after Dose 2

3

Dose 3 was 

given before

4 years of age

It has been at 

least 6 months 

since Dose 3



Give Dose 4 

(Final dose) 

today

No additional doses needed

It has not

been at least 6 

months since 

Dose 3

 No dose 

today

Give Dose 4 (Final Dose) at least 

6 months after Dose 3

Dose 3 was 

given at 4 

years of age 

or older

Dose 3 was 

given at least 

6 months from 

previous dose

 No dose 

today No additional doses needed

Dose 3 was not

given at least 

6 months from 

previous dose

It has been 

at least 6 

months since 

Dose 3

Give Dose 4 

(Final dose) 

today

No additional doses needed

It has not 

been at least 

6 months 

since Dose 3

No dose 

today

Give Dose 4 (Final Dose) at least 

6 months after Dose 3

1

 Series containing oral polio vaccine (OPV), either mixed OPV-IPV or OPV only: Total number of doses needed to complete the series is the same as that recommended 

for the U.S. IPV schedule. www.cdc.gov/mmwr/volumes/66/wr/mm6601a6.htm

2 Next dose due is not the final dose in the series unless explicitly stated. 

Reference: Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger—United States, 2021. 

www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-child-combined-schedule.pdf
Appendix A

A

Appendix A-12

Catch-Up Guidance for Healthy1 Children

4 Months through 4 Years of Age

Pneumococcal Conjugate Vaccine: PCV

The table below provides guidance for children whose vaccinations have been delayed. Start with the child’s

age and information on previous doses (previous doses must be documented and must meet minimum 

age requirements and minimum intervals between doses). Use this table in conjunction with table 2 of the

Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger, found at 

www.cdc.gov/vaccines/schedules/hcp/child-adolescent.h

IF current 

age is

AND # of 

previous 

doses is

AND THEN Next dose due

4 through 

6 months

0 or 

unknown   Give Dose 1 today Give Dose 2 at least 4 weeks after Dose 1 

1

 It has been at least 

4 weeks since Dose 1 Give Dose 2 today Give Dose 3 at least 4 weeks after Dose 2

 It has not been at least 

4 weeks since Dose 1 No dose today Give Dose 2 at least 4 weeks after Dose 1

2

 It has been at least 

4 weeks since Dose 2 Give Dose 3 today Give Dose 4 (Final Dose) at 12 months of age or older 

 It has not been at least 

4 weeks since Dose 2 No dose today Give Dose 3 at least 4 weeks after Dose 2

7 through 

11 months

0   Give Dose 1 today Give Dose 2 at least 

4 weeks after Dose 1

1

Dose 1 was given 

before 7 months 

of age

It has been at least 

4 weeks since Dose 1 Give Dose 2 today

Give Dose 3 (Final Dose) at least 

8 weeks after Dose 2 and at 

12 months of age or older

It has not been 

4 weeks since Dose 1 No dose today Give Dose 2 at least 

4 weeks after Dose 1

Dose 1 was 

given at 

7 months or older

It has been at least 

4 weeks since Dose 1 Give Dose 2 today 

Give Dose 3 (Final Dose) at least 

8 weeks after Dose 2 and at 

12 months of age or older

It has not been

 4 weeks since Dose 1 No dose today Give Dose 2 at least 

4 weeks after Dose 1 

2

Dose 2 was given 

before 

7 months of age

It has been at least 

4 weeks since Dose 2 Give Dose 3 today

Give Dose 4 (Final Dose) at least 

8 weeks after Dose 3 and at 

12 months of age or older

It has not been 

4 weeks since Dose 2 No dose today Give Dose 3 at least 4 weeks after Dose 2

Dose 2 was 

given at 

7 months or older

 No dose today

Give Dose 3 (Final Dose) at least 

8 weeks after Dose 2 and at 

12 months of age or older

1 Refer to the notes of the Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger–United States, 2021, for immunization guidance 

for children at increased risk for pneumococcal disease. 

Reference: Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger–United States, 2021. 

www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-child-combined-schedule.pdf.

Revised February 2021
Appendix A

A

Appendix A-13

Catch-Up Guidance for Healthy1 Children

4 Months through 4 Years of Age

Pneumococcal Conjugate Vaccine: PCV

The table below provides guidance for children whose vaccinations have been delayed. Start with the child’s

age and information on previous doses (previous doses must be documented and must meet minimum 

age requirements and minimum intervals between doses). Use this table in conjunction with table 2 of the

Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger, found at 

www.cdc.gov/vaccines/schedules/hcp/child-adolescent.h

IF current 

age is

AND # of 

previous 

doses is

AND AND THEN Next dose due

12 through 

23 months 

0 or 

unknown   Give Dose 1 today Give Dose 2 (Final Dose) at least 8 weeks after Dose 1

1

Dose 1 was 

given before

12 months of age

It has been at least 

4 weeks since Dose 1 Give Dose 2 today Give Dose 3 (Final Dose) at least 

8 weeks after Dose 2

It has not been 

4 weeks since Dose 1 No dose today Give Dose 2 at least 4 weeks 

after Dose 1

Dose 1 was given 

at 12 months of 

age or older

It has been at least 

8 weeks since Dose 1

Give Dose 2 

(Final Dose) today No additional doses needed

It has not been 

8 weeks since Dose 1 No dose today Give Dose 2 (Final Dose) at least 

8 weeks after Dose 1

2

Both doses were 

given before 

12 months of age

It has been at least 

8 weeks since Dose 2

Give Dose 3 

(Final Dose) today No additional doses needed

It has not been 

8 weeks since Dose 2 No dose today Give Dose 3 (Final Dose) at least 

8 weeks after Dose 2

At least one dose 

was given at 12 

months or older

It has been at least 

8 weeks since Dose 2

Give Dose 3 

(Final Dose) today No additional doses needed

It has not been 

8 weeks since Dose 2 No dose today Give Dose 3 (Final Dose) at least 

8 weeks after Dose 2

Both doses 

were given at 12 

months or older2  No dose today No additional doses needed

3

All doses were 

given before

12 months of age

It has been at least 

8 weeks since Dose 3

Give Dose 4 

(Final Dose) today No additional doses needed

It has not been 

8 weeks since Dose 3 No dose today Give Dose 4 (Final Dose) at least 

8 weeks after Dose 3

1 or more doses 

were given at 

12 months of age 

or older

 No dose today No additional doses needed

1 Refer to the notes of the Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger–United States, 2021, for immunization guidance 

for children at increased risk for pneumococcal disease. 

2 Separated by at least 8 weeks.

Reference: Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger–United States, 2021. 

www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-child-combined-schedule.pdf.
Appendix A

A

Appendix A-14

Catch-Up Guidance for Healthy1 Children

4 Months through 4 Years of Age

Pneumococcal Conjugate Vaccine: PCV

IF current

age is

AND # of

previous

doses is

AND AND AND THEN Next dose due

24 through 

59 months

0    Give Dose 1

today

No additional 

doses needed

1

Dose 1 was

given before

1st birthday

 

Give Dose 2

(Final Dose)

today

No additional 

doses needed

Dose 1 was given

after 1st birthday

Dose 1 was given

before 2nd 

birthday

It has been at

least 8 weeks

since Dose 1

Give Dose 2

(Final Dose)

today

No additional 

doses needed

It has not been

at least 8 weeks

since Dose 1

No dose today

Give Dose 2 

(Final Dose)

at least 8 weeks 

after Dose 1

Dose 1 was given

after 2nd 

birthday

 No dose today No additional 

doses needed

2

Dose 1 was

given before

12 months of age

Dose 2 was given

before 1st 

birthday



Give Dose 3

(Final Dose)

today

No additional 

doses needed

Dose 2 was given

after 1st birthday

Dose 2 was

given before

2nd birthday

Give Dose 3

(Final Dose)

today

No additional 

doses needed

Dose 2 was

given after

2nd birthday

No dose today No additional 

doses needed

Dose 1 was

given after

12 months of age

  No dose today No additional 

doses needed

3

All 3 doses were

given before

12 months of age

 

Give Dose 4

(Final Dose)

today

No additional 

doses needed

1 or more doses

were given at

12 months or older

  No dose today No additional 

doses needed

1 Refer to the notes of the Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger–United States, 2021, for immunization guidance 

for children at increased risk for pneumococcal disease.

Reference: Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger–United States, 2021.

www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-child-combined-schedule.pdf.
Appendix A

A

Appendix A-15

The table below provides guidance for children whose vaccinations have been delayed. Start with the child’s

age and information on previous doses (previous doses must be documented and must meet minimum 

age requirements and minimum intervals between doses). Use this table in conjunction with table 2 of the

Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger, found at 

www.cdc.gov/vaccines/schedules/hcp/child-adolescent.h

IF current 

age is

AND # of 

previous 

doses of 

DTaP, DT, Td, 

or Tdap is

AND AND AND THEN Next dose due

7 through 

9 years1

Unknown or 0    Give Dose 1 

(Tdap) today

Give Dose 2 (Td or Tdap) at 

least 4 weeks after Dose 1

1

Dose 1 was 

given before

12 months 

of age 

  Give Dose 2 

(Tdap) today

Give Dose 3 (Td or Tdap) at 

least 4 weeks after Dose 2

Dose 1 was 

given at 12 

months of 

age or older 

It has been at 

least 4 weeks 

since Dose 1

Dose 1 was Tdap Give Dose 2 

(Td or Tdap) today Give Dose 3 (Td or Tdap) 

at least 6 calendar months 

Dose 1 was after Dose 2

not Tdap

Give Dose 2 

(Tdap) today 

It has not been

 4 weeks since 

Dose 1

Dose 1 was Tdap No dose today Give Dose 2 (Td or Tdap) at 

least 4 weeks after Dose 1

Dose 1 was 

not Tdap No dose today Give Dose 2 (Tdap) at least 4 weeks after Dose 1

2

Dose 1 was 

given before

12 months 

of age

It has been at 

least 4 weeks 

since Dose 2 

Dose 2 was Tdap1 Give Dose 3 (Td 

or Tdap) today Give Dose 4 (Td or Tdap) 

at least 6 calendar months 

after Dose 3 No dose was Tdap Give Dose 3 

(Tdap) today

It has not been

 4 weeks since 

Dose 2

Dose 2 was Tdap No dose today Give Dose 3 (Td or Tdap) at 

least 4 weeks after Dose 2

No dose was Tdap No dose today Give Dose 3 (Tdap) at least 

4 weeks after Dose 2 

Dose 1 was 

given at 

12 months of 

age or older

It has been at 

least 6 calendar 

months since 

Dose 2

Any dose was Tdap1 Give Dose 3 (Td 

or Tdap) today Give Tdap at 11–12 years 

of age1,2

No dose was Tdap Give Dose 3 

(Tdap) today

It has not been 

6 calendar 

months since 

Dose 2 

Any dose was Tdap1 No dose today

Give Dose 3 (Td or Tdap) 

at least 6 calendar months 

after Dose 21

No dose was Tdap No dose today

Give Dose 3 (Tdap) 

at least 6 calendar months 

after Dose 2

1

For persons 7-9 years of age who receive a dose of Tdap, the routine adolescent Tdap dose should be administered at age 11-12.

2

Tdap may be administered regardless of the interval since the last tetanus- and diphtheria-toxoid-containing vaccine.

Reference: Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger—United States, 2021.

www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-child-combined-schedule.pdf.

Catch-Up Guidance for Children

7 through 9 Years of Age

Tetanus-, Diphtheria-, and Pertussis-Containing Vaccines: Tdap/Td1
Appendix A

A

Appendix A-16

Revised February 2021

Catch-Up Guidance for Children

7 through 9 Years of Age

Tetanus-, Diphtheria-, and Pertussis-Containing Vaccines: Tdap/Td1

IF current 

age is

AND # of 

previous 

doses 

of DTaP, 

DT, Td, or 

Tdap is

AND AND AND THEN Next dose due

7 through 

9 years1

3

Dose 1 was 

given before

12 months of age 

It has been at 

least 6 calendar 

months since 

Dose 3 

Any dose was 

Tdap1

Give Dose 4 (Td 

or Tdap) today Give Tdap at 

11–12 years of age1,2

No dose was Tdap Give Dose 4 

(Tdap) today

It has not been 

6 calendar 

months since 

Dose 3 

Any dose was 

Tdap1 No dose today 

Give Dose 4 (Td or Tdap) 

at least 6 calendar months 

after Dose 31

No dose was Tdap No dose today 

Give Dose 4 (Tdap) at least 

6 calendar months 

after Dose 31

Dose 1 was 

given at 

12 months 

of age or older

No dose 

was Tdap  Give Dose 4 

(Tdap) today 2

Give Tdap at 

11–12 years of age1,2

Any dose 

was Tdap

 No dose today

Give Tdap at 

11–12 years of age1,2 

4 

Dose of DTaP or 

Tdap given after 

4th birthday 

 No dose today Give Tdap at 

11–12 years of age1,2 No DTaP or Tdap 

given after 

4th birthday

 Give a dose of 

Tdap today

1

For persons 7-9 years of age who receive a dose of Tdap, the routine adolescent Tdap dose should be administered at age 11-12.

2

Tdap may be administered regardless of the interval since the last tetanus- and diphtheria-toxoid-containing vaccine.

Reference: Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger—United States, 2021.

www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-child-combined-schedule.pdf
Appendix A

A

Appendix A-17

Catch-Up Guidance for Children

10 through 18 Years of Age

Tetanus-, Diphtheria-, and Pertussis-Containing Vaccines: Tdap/Td1 

IF current 

age is

AND # of 

previous 

doses of 

DTaP, DT, Td, 

or Tdap is

AND AND AND THEN Next dose due

10 through 

18 years

Unknown or 0    Give Dose 1 

(Tdap) today

Give Dose 2 (Td or Tdap) at 

least 4 weeks after Dose 1

1

Dose 1 was 

given before

12 months 

of age 

  Give Dose 2 

(Tdap) today

Give Dose 3 (Td or Tdap) at 

least 4 weeks after Dose 2

Dose 1 was 

given at 

12 months of 

age or older 

It has been at 

least 4 weeks 

since Dose 1

Dose 1 was Tdap Give Dose 2 (Td 

or Tdap) today Give Dose 3 (Td or Tdap) 

at least 6 calendar months 

Dose 1 was after Dose 2

not Tdap

Give Dose 2 

(Tdap) today 

It has not been

 4 weeks since 

Dose 1

Dose 1 was Tdap No dose today Give Dose 2 (Td or Tdap) at 

least 4 weeks after Dose 1

Dose 1 was 

not Tdap No dose today Give Dose 2 (Tdap) at least 

4 weeks after Dose 1

2

Dose 1 was 

given before

12 months 

of age

It has been at 

least 4 weeks 

since Dose 2 

Any dose 

was Tdap1

Give Dose 3 (Td 

or Tdap) today2 Give Dose 4 (Td or Tdap) 

at least 6 calendar months 

No dose was Tdap3 Give Dose 3 after Dose 3

(Tdap) today

It has not been

 4 weeks since 

Dose 2

Any dose 

was Tdap1 No dose today Give Dose 3 (Td or Tdap) at 

least 4 weeks after Dose 22

No dose was Tdap3 No dose today Give Dose 3 (Tdap) at least 

4 weeks after Dose 2 

Dose 1 was 

given at 

12 months of 

age or older

It has been at 

least 6 calendar 

months since 

Dose 2

Any dose 

was Tdap1

Give Dose 3 (Td 

or Tdap) today2 Give Td or Tdap 10 years 

after Dose 3

No dose was Tdap2 Give Dose 3 

(Tdap) today

It has not been 

6 calendar 

months since 

Dose 2 

Any dose 

was Tdap1 No dose today

Give Dose 3 (Td or Tdap) 

at least 6 calendar months 

after Dose 22

No dose was Tdap3 No dose today

Give Dose 3 (Tdap) at least 

6 calendar months 

after Dose 2

1

Given at 10 years of age or older.

2If the previous Tdap dose(s) was administered before the 10th birthday, then a dose of Tdap is recommended now. 

3

Or Tdap administered at 9 years of age or younger.

Reference: Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger—United States, 2021.

www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-child-combined-schedule.pdf

The table below provides guidance for children whose vaccinations have been delayed . Start with the child’s age and 

information on previous doses (previous doses must be documented and must meet minimum age requirements and 

minimum intervals between doses) . Use this table in conjunction with table 2 of the Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger, found at 

www .cdc .gov/vaccines/schedules/hcp/child-adolescent .html .
Appendix A

A

Appendix A-18

Catch-Up Guidance for Children

10 through 18 Years of Age 

Tetanus-, Diphtheria-, and Pertussis-Containing Vaccines: Tdap/Td1 

IF current age 

is

AND # of 

previous 

doses 

of DTaP, 

DT, Td, or 

Tdap is

AND AND AND THEN Next dose due

10 through 

 18 years

3

Dose 1 was

 given before

12 months of age 

It has been at 

least 6 calendar 

months since 

Dose 3 

Any dose was 

Tdap1

Give Dose 4 

(Td or Tdap) 

today2 Give Td or Tdap 10 years 

after Dose 4 

No dose was 

Tdap3

Give Dose 4 

(Tdap) today

It has not been 

6 calendar 

months since 

Dose 3 

Any dose was 

Tdap1 No dose today 

Give Dose 4 (Td or Tdap) 

at least 6 calendar months 

after Dose 32

No dose was 

Tdap3 No dose today 

Give Dose 4 (Tdap) at least 

6 calendar months 

after Dose 3

Dose 1 was 

given at 

12 months of age 

or older

No dose was 

Tdap1  Give Dose 4 

(Tdap) today 

Give Td or Tdap 10 years 

after Dose 4

Any dose

 was Tdap2  No dose today Give Td or Tdap 10 years 

after Dose 3

4 

No Tdap was 

given after 7th

birthday



Give a dose of 

Tdap today4

Give Td or Tdap 10 years 

after Tdap dose

Any dose of Tdap 

was given at age 

7 years or older1

No Tdap was 

given after 10th

birthday

Tdap was 

given after 10th

birthday No dose today Give Td or Tdap 10 years

after Dose 4

1

Given at 10 years of age or older.

2

If the previous Tdap dose(s) was administered before the 10th birthday, then a dose of Tdap is recommended now. 

3

Or Tdap administered at 9 years of age or younger.

4

The preferred age at administration for this dose is 11–12 years. However, if Tdap is administered at age 10 years, the Tdap dose may count as the adolescent Tdap dose. 

Reference: Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger—United States, 2021.

www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-child-combined-schedule.pdf
Appendix A

A

Appendix A-19

Hepatitis B

Unvaccinated healthcare personnel (HCP) and/

or those who cannot document previous vaccination should receive either a 2-dose series of 

Heplisav-B at 0 and 1 month or a 3-dose series 

of either Engerix-B or Recombivax HB at 0, 1, 

and 6 months. HCP who perform tasks that 

may involve exposure to blood or body fluids 

should be tested for hepatitis B surface antibody (anti-HBs) 1–2 months after dose #2 of 

Heplisav-B or dose #3 of Engerix-B or Recombivax HB to document immunity. 

• If anti-HBs is at least 10 mIU/mL (positive), 

the vaccinee is immune. No further serologic 

testing or vaccination is recommended. 

• If anti-HBs is less than 10 mIU/mL (negative), 

the vaccinee is not protected from hepatitis B 

virus (HBV) infection, and should receive 

another 2-dose or 3-dose series of HepB 

vaccine on the routine schedule, followed by 

anti-HBs testing 1–2 months later. A vaccinee 

whose anti-HBs remains less than 10 mIU/

mL after 2 complete series is considered a 

“non-responder.”

For non-responders: HCP who are non-responders 

should be considered susceptible to HBV and 

should be counseled regarding precautions to 

prevent HBV infection and the need to obtain 

HBIG prophylaxis for any known or probable 

parenteral exposure to hepatitis B surface antigen 

(HBsAg)-positive blood or blood with unknown 

HBsAg status. It is also possible that nonresponders are people who are HBsAg positive. 

HBsAg testing is recommended. HCP found 

to be HBsAg positive should be counseled and 

medically evaluated.

For HCP with documentation of a complete 

2-dose (Heplisav-B) or 3-dose (Engerix-B or Recombivax HB) vaccine series but no documentation of anti-HBs of at least 10 mIU/mL (e.g., 

those vaccinated in childhood): HCP who are at 

risk for occupational blood or body fluid exposure might undergo anti-HBs testing upon hire or 

matriculation. See references 2 and 3 for details.

Influenza 

All HCP, including physicians, nurses, paramedics, 

emergency medical technicians, employees 

of nursing homes and chronic care facilities, 

students in these professions, and volunteers, 

should receive annual vaccination against influenza. Live attenuated influenza vaccine (LAIV) 

may be given only to non-pregnant healthy HCP 

age 49 years and younger. Inactivated injectable 

influenza vaccine (IIV) is preferred over LAIV 

for HCP who are in close contact with severely 

immunosuppressed patients (e.g., stem cell 

transplant recipients) when they require protective isolation. 

Measles, Mumps, Rubella (MMR)

HCP who work in medical facilities should be 

immune to measles, mumps, and rubella. 

• HCP born in 1957 or later can be considered 

immune to measles, mumps, or rubella only 

if they have documentation of (a) laboratory 

confirmation of disease or immunity or 

(b) appropriate vaccination against measles, 

mumps, and rubella (i.e., 2 doses of live 

measles and mumps vaccines given on or after 

the first birthday and separated by 28 days or 

more, and at least 1 dose of live rubella 

vaccine). HCP with 2 documented doses of 

MMR are not recommended to be serologically 

tested for immunity; but if they are tested and 

results are negative or equivocal for measles, 

mumps, and/or rubella, these HCP should be 

considered to have presumptive evidence of 

immunity to measles, mumps, and/or rubella 

and are not in need of additional MMR doses.

• Although birth before 1957 generally is considered acceptable evidence of measles, 

mumps, and rubella immunity, 2 doses of MMR 

vaccine should be considered for unvaccinated HCP born before 1957 who do not have 

laboratory evidence of disease or immunity to 

measles and/or mumps. One dose of MMR 

vaccine should be considered for HCP with no 

laboratory evidence of disease or immunity 

to rubella. For these same HCP who do not 

have evidence of immunity, 2 doses of MMR 

vaccine are recommended during an outbreak 

of measles or mumps and 1 dose during an 

outbreak of rubella.

Varicella 

It is recommended that all HCP be immune to 

varicella. Evidence of immunity in HCP includes 

documentation of 2 doses of varicella vaccine 

given at least 28 days apart, laboratory evidence 

of immunity, laboratory confirmation of disease, 

or diagnosis or verification of a history of varicella or herpes zoster (shingles) by a healthcare 

provider.

Tetanus/Diphtheria/Pertussis (Td/Tdap)

All HCPs who have not or are unsure if they have 

previously received a dose of Tdap should 

receive a dose of Tdap as soon as feasible, without regard to the interval since the previous dose 

of Td. Pregnant HCP should be revaccinated 

during each pregnancy. All HCPs should then 

receive Td or Tdap boosters every 10 years 

thereafter. 

Meningococcal

Vaccination with MenACWY and MenB is 

recommended for microbiologists who are 

routinely exposed to isolates of N. meningitidis. 

The two vaccines may be given concomitantly 

but at different anatomic sites, if feasible.

references

1 CDC. Immunization of Health-Care Personnel: Recommendations of the Advisory Committee on Immunization 

Practices (ACIP). MMWR, 2011; 60(RR-7).

2 CDC. Prevention of Hepatitis B Virus Infection in the United States. Recommendations of the Advisory Committee 

on Immunization Practices. MMWR, 2018; 67(RR1):1–30.

3 IAC. Pre-exposure Management for Healthcare Personnel 

with a Documented Hepatitis B Vaccine Series Who Have 

Not Had Post-vaccination Serologic Testing. Accessed at 

www.immunize.org/catg.d/p2108.pdf.

For additional specific ACIP recommendations, visit CDC’s 

website at www.cdc.gov/vaccines/hcp/acip-recs/vaccspecific/index.html or visit IAC’s website at 

www.immunize.org/acip.

Healthcare Personnel Vaccination Recommendations1

vaccines and recommendations in brief

Hepatitis B – If previously unvaccinated, give a 2-dose (Heplisav-B) or 3-dose (Engerix-B 

or Recombivax HB) series. Give intramuscularly (IM). For HCP who perform tasks 

that may involve exposure to blood or body fluids, obtain anti-HBs serologic testing 

1–2 months after dose #2 (for Heplisav-B) or dose #3 (for Engerix-B or Recombivax HB).

Influenza – Give 1 dose of influenza vaccine annually. Inactivated injectable vaccine is 

given IM. Live attenuated influenza vaccine (LAIV) is given intranasally.

MMR – For healthcare personnel (HCP) born in 1957 or later without serologic evidence 

of immunity or prior vaccination, give 2 doses of MMR, 4 weeks apart. For HCP 

born prior to 1957, see below. Give subcutaneously (Subcut).

Varicella (chickenpox) – For HCP who have no serologic proof of immunity, prior 

vaccination, or diagnosis or verification of a history of varicella or herpes zoster 

(shingles) by a healthcare provider, give 2 doses of varicella vaccine, 4 weeks apart. 

Give Subcut.

Tetanus, diphtheria, pertussis – Give 1 dose of Tdap as soon as feasible to all HCP 

who have not received Tdap previously and to pregnant HCP with each pregnancy 

(see below). Give Td or Tdap boosters every 10 years thereafter. Give IM.

Meningococcal – Give both MenACWY and MenB to microbiologists who are routinely exposed to isolates of Neisseria meningitidis. As long as risk continues: boost 

with MenB after 1 year, then every 2–3 years thereafter; boost with MenACWY every 

5 years. Give MenACWY and MenB IM.

Hepatitis A, typhoid, and polio vaccines are not routinely recommended for HCP who may have on-the-job exposure to fecal material.

Immunization Action Coalition Saint Paul, Minnesota • 651-647-9009 • www.immunize.org • www.vaccineinformation.org

www.immunize.org/catg.d/p2017.pdf • Item #P2017 (2/21)
Appendix A

A

Appendix A-20

Recommended and minimum ages and intervals between vaccine doses(a),(b),(c),(d)

Vaccine and dose number Recommended age for this dose Minimum age 

for this dose

Recommended interval 

to next dose

Minimum interval 

to next dose

DTaP-1(e) 2 months 6 weeks 8 weeks 4 weeks

DTaP-2 4 months 10 weeks 8 weeks 4 weeks

DTaP-3 6 months 14 weeks 6-12 months(f) 6 months(f)

DTaP-4 15-18 months 15 months(f) 3 years 6 months

DTaP-5(g) 4-6 years 4 years — —

HepA-1(e) 12-23 months 12 months 6-18 months 6 months

HepA-2 ≥18 months 18 months — —

HepB-1(h) Birth Birth 4 weeks-4 months 4 weeks

HepB-2 1-2 months 4 weeks 8 weeks-17 months 8 weeks

HepB-3(i) 6-18 months 24 weeks — —

Hib-1(j) 2 months 6 weeks 8 weeks 4 weeks

Hib-2 4 months 10 weeks 8 weeks 4 weeks

Hib-3(k) 6 months 14 weeks 6-9 months 8 weeks

Hib-4 12-15 months 12 months — —

HPV-1 (Two-Dose Series)(l) 11-12 years 9 years 6 months 5 months

HPV-2 11-12 years (+6 months) 9 years +5 months(m) — —

HPV-1(n) (Three-Dose 

Series)

11-12 years 9 years 1-2 months 4 weeks

HPV-2 11-12 years (+1-2 

months)

9 years (+4 weeks) 4 months 12 weeks (n)

HPV-3(n) 11-12 years (+6 months) 9 years (+5 months) — —

Influenza, inactivated(o) ≥6 months 6 months(p) 4 weeks 4 weeks

IPV-1(e) 2 months 6 weeks 8 weeks 4 weeks

IPV-2 4 months 10 weeks 8 weeks-14 months 4 weeks

IPV-3 6-18 months 14 weeks 3-5 years 6 months

IPV-4(q) 4-6 years 4 years — —

LAIV(o) 2-49 years 2 years 4 weeks 4 weeks

MenACWY-1(r) 11-12 years 2 months(s) 4-5 years 8 weeks

MenACWY-2 16 years 11 years (+ 8 weeks)(t) — —

MenB-1 Healthy adolescents:

16-23 years

16 years Bexsero: 4 weeks

Trumenba: 6 months(c)

Bexsero: 4 weeks

Trumenba: 6 months(c)

MenB-1 Persons at increased risk:

≥10 years

10 years Bexsero: 4 weeks

Trumenba: 1–2 months(c)

Bexsero: 4 weeks

Trumenba: 1 month

MenB-2 Healthy adolescents: 

16-23 years (+1 month)

16 years (+1 month) — —

MenB-2 Persons at increased risk:

≥10 years (+1 month)

10 years (+1 month) Bexsero: — Bexsero: —

Trumenba: 4-5 month(c) Trumenba: 4 months(c)

MenB-3(u) Persons at increased risk:

≥10 years (+6 months(c))

10 years (+6 months(c)) — —
Appendix A

A

Appendix A-21

Vaccine and dose number Recommended age for this dose Minimum age 

for this dose

Recommended interval 

to next dose

Minimum interval 

to next dose

MMR-1(v) 12-15 months 12 months 3-5 years 4 weeks

MMR-2(v) 4-6 years 13 months — —

PCV13-1(j) 2 months 6 weeks 8 weeks 4 weeks

PCV13-2 4 months 10 weeks 8 weeks 4 weeks

PCV13-3 6 months 14 weeks 6 months 8 weeks

PCV13-4 12-15 months 12 months — —

PPSV23-1 — 2 years 5 years 5 years

PPSV23-2(w) — 7 years — —

Rotavirus-1(x) 2 months 6 weeks 8 weeks 4 weeks

Rotavirus-2 4 months 10 weeks 8 weeks 4 weeks

Rotavirus-3(x) 6 months 14 weeks — —

Td 11-12 years 7 years 10 years 5 years

Tdap(y) ≥11 years 7 years — —

Varicella-1(v) 12-15 months 12 months 3-5 years 12 weeks(z)

Varicella-2(v) 4-6 years 15 months(aa) — —

RZV-1 ≥50 years 50 years(bb) 2-6 months 4 weeks

RZV-2 ≥50 years (+2-6months) 50 years — —

Abbreviations: DTaP = diphtheria and tetanus toxoids and acellular pertussis; HepA = hepatitis A; HepB = hepatitis B; Hib = Haemophilus influenzae type b; HPV = human 

papillomavirus; IPV = inactivated poliovirus; LAIV = live, attenuated influenza vaccine; MenACWY = quadrivalent meningococcal conjugate vaccine; MenB = serogroup 

B meningococcal vaccine; MMR = measles, mumps, and rubella; MMRV = measles, mumps, rubella, and varicella; PCV13 = pneumococcal conjugate vaccine; PPSV23= 

pneumococcal polysaccharide vaccine; PRP-OMP = polyribosylribitol phosphate-meningococcal outer membrane protein conjugate; RZV = recombinant zoster vaccine; Td = 

tetanus and diphtheria toxoids; Tdap = tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis.

(a) Combination vaccines are available. Use of licensed combination vaccines is generally preferred to separate injections of their equivalent component vaccines. When 

administering combination vaccines, the minimum age for administration is the oldest age for any of the individual components. The minimum interval between doses is equal 

to the greatest interval of any of the individual components.

(b)Information on travel vaccines, including typhoid, Japanese encephalitis, and yellow fever, is available at https://www.cdc.gov/travel. Information on other vaccines that are 

licensed in the United States but not distributed, including anthrax and smallpox, is available at http://emergency.cdc.gov/bioterrorism/.

(c) “Months” refers to calendar months.

(d) Within a number range, a hyphen (-) should be read as “through.”

(e) Combination vaccines containing the hepatitis B component are available (Twinrix and Pediarix). These vaccines should not be administered to infants aged <6 weeks because 

of the other vaccine components (i.e., Hib, DTaP, HepA, and IPV).

(f) The minimum recommended age for DTaP-4 is 15 months, with a recommended 6 months from DTaP-3 (the recommended interval between DTaP-3 and DTaP-4 is 6 months). 

However, DTaP4 need not be repeated if given on or after 12 months of age and at least 4 months after DTaP-3. The 4-day grace period can be applied when validating past doses 

and can be applied to the minimum age of 12 months and the minimum interval of 4 months between DTaP-3 and DTaP-4. The 4-day grace period can be used when planning 

doses ahead of time, but should be applied to the minimum age of 15 months and the minimum interval between DTaP-3 and DTaP-4 of 6 months.

(g) If a fourth dose of DTaP is given on or after the fourth birthday, a fifth dose is not needed if the interval between the third dose and fourth dose is at least 6 months.

(h) Adjuvanted Hepatitis B vaccine (HepB-CgG) can be administered to adults 18 years old and older on a two dose schedule, the first and second dose separated by 4 weeks.

(i) HepB-3 should be administered at least 8 weeks after HepB-2 and at least 16 weeks after HepB-1 and should not be administered before age 24 weeks.

(j) For Hib and PCV13, children receiving the first dose of vaccine at age ≥7 months require fewer doses to complete the series.

(k) If PRP-OMP (Pedvax-Hib, Merck Vaccine Division) was administered at ages 2 and 4 months, a dose at age 6 months is not necessary. The final dose has a minimum age of 12 

months.

(l) A two-dose schedule of HPV vaccine is recommended for most persons beginning the series between 9 through 14 years of age. See HPV vaccine-specific recommendations for 

details. www.cdc.gov/mmwr/volumes/65/wr/pdfs/mm6549a5.pdf. 

(m) If a patient is eligible for a 2-dose HPV series, and the second dose is given less than four weeks after the first dose, it is an invalid dose. Administer another dose 6-12 months after 

the first dose. If the second dose is given less than five months after the first dose, but more than four weeks after the first dose, the next dose should be administered at least 12 

weeks after the second dose, and at least 6-12 months after the first dose. The 4-day grace period may be used. If the third dose was administered before December 16, 2016, and 

was administered 12 weeks after the 2nd dose, and 16 weeks after the first dose, it is a valid dose. The 4-day grace period may be used. If the third dose was administered on or after 

December 16, 2016, and was administered 12 weeks after the 2nd dose and 5 months after the first dose, it is a valid dose. The 4-day grace period may be used.
Appendix A

A

Appendix A-22

(n) The minimum age for HPV-3 is based on the baseline minimum age for the first dose (i.e., 9 years) and the minimum interval of 5 months between the first and third dose. If the 

third dose was administered before December 16, 2016, and was administered 12 weeks after the 2nd dose, and 16 weeks after the first dose, it is a valid dose. The 4-day grace 

period may be used. If the third dose was administered on or after December 16, 2016, and was administered 12 weeks after the 2nd dose and 5 months after the first dose, it is a 

valid dose. The 4-day grace period may be used.

(o) One dose of influenza vaccine per season is recommended for most persons. To determine which children younger than 9 years should receive 2 doses in a single season, please 

see influenza vaccine-specific recommendations https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/flu.html. 

(p) The minimum age for inactivated influenza vaccine varies by vaccine manufacturer. See package insert for vaccine-specific minimum ages.

(q) A fourth dose is not needed if the third dose was administered at ≥4 years and at least 6 months after the previous dose.

(r) Revaccination with meningococcal vaccine is recommended for previously vaccinated persons who remain at high risk for meningococcal disease. Cohn AC, MacNeil JR, Clark TA, 

et al. Prevention and control of meningococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2013;62(RR-2):1-28.

(s) MenACWY-D (Menactra) can be given as young as 9 months for high-risk persons. MenACWY-CRM (Menveo) can be given as young as 2 months for high-risk persons. HibMenCY can be given as young as 6 weeks for high-risk persons. Hib-MenCY is given as a 4-dose series at 2 months, 4 months, 6 months and 12-18 months. MenACWY-TT 

(MenQuadfi) can be given as young as 2 years for high-risk persons.

(t) For routine non-high risk adolescent vaccination, the minimum age for the booster dose is 16 years.

(u) This dose is not necessary if Bexsero is correctly administered, or if Trumenba is correctly administered to healthy adolescents.

(v) Combination MMRV vaccine can be used for children aged 12 months-12 years.

(w) A second dose of PPSV23 5 years after the first dose is recommended for persons aged ≤65 years at highest risk for serious pneumococcal infection and those who are likely to 

have a rapid decline in pneumococcal antibody concentration. See https://www.cdc.gov/mmwr/volumes/69/rr/rr6909a1.htm. 

(x) The first dose of rotavirus must be administered at age 6 weeks through 14 weeks and 6 days. The vaccine series should not be started for infants aged ≥15 weeks, 0 days. 

Rotavirus should not be administered to children older than 8 months, 0 days of age regardless of the number of doses received between 6 weeks and 8 months, 0 days of age. If 

2 doses of Rotarix (GlaxoSmithKline) are administered as age appropriate, a third dose is not necessary.

(y) Only 1 dose of Tdap is recommended. Subsequent doses should be given as Td or Tdap. For management of a tetanus-prone wound in persons who have received a primary 

series of tetanus-toxoid–containing vaccine, the minimum interval after a previous dose of any tetanus-containing vaccine is 5 years.

(z) A special grace period of 2 months, based on expert opinion, can be applied to the minimum interval of 3 months, when evaluating records retrospectively, which results in an 

acceptable minimum interval of 4 weeks. An additional 4 days should not be added on to this grace period.

(aa) A special grace period of 2 months, based on expert opinion, can be applied to the minimum age of 15 months when evaluating records retrospectively, which results in an 

acceptable minimum age of 13 months. An additional 4 days should not be added on to this grace period.

 (bb) If a 1st dose of recombinant zoster vaccine is administered to someone 18-49 years of age, the dose does not need to be repeated. A 4 day grace period can be added to the 

absolute minimum age of 18 years when evaluating records retrospectively.

Adapted from Table 3-1, ACIP General Best Practice Guidelines for Immunization. January 2021

Grace Period: Vaccine doses administered ≤4 days before the minimum interval or age are 

considered valid; however, local or state mandates might supersede this 4-day guideline.
Appendix A

A

Appendix A-23

Recommended intervals between administration of antibody-containing products and 

measles- or varicella-containing vaccine, by product and indication for vaccination

Product/Indication Dose (mg IgG/kg) and route(a)

Recommended interval 

before measles- or live 

varicella-containing vaccine(b)

administration

Blood transfusion—RBCs, washed 10 mL/kg, negligible IgG/kg IV None

Blood transfusion—RBCs, adenine-saline added 10 mL/kg (10 mg IgG/kg) IV 3 months

Blood transfusion—Packed RBCs (hematocrit 65%)(c) 10 mL/kg (60 mg IgG/kg) IV 6 months

Blood transfusion—Whole blood (hematocrit 35%-50%)(c) 10 mL/kg (80-100 mg IgG/kg) IV 6 months

Blood transfusion—Plasma/platelet products 10 mL/kg (160 mg IgG/kg) IV 7 months

Botulinum Immune Globulin Intravenous (Human) 1.0 mL/kg (50 mg IgG/kg) IV 6 month

Cytomegalovirus IGIV 150 mg/kg maximum 6 months

Hepatitis A IG—Contact prophylaxis 0.1 mL/kg (16.5 mg IgG/kg) IM 6 months (

Hepatitis A IG—International travel, <1 month stay 0.1 mL/kg (16.5 mg IgG/kg) IM 6 months (

Hepatitis A IG—International travel, ≥1 month stay 0.2 mL/kg (33 mg IgG/kg) IM 6 months (d

Hepatitis B IG 0.06 mL/kg (10 mg IgG/kg) IM 3 month

IGIV—Replacement therapy for immune deficiencies(e) 300-400 mg/kg IV 8 months

IGIV—Immune thrombocytopenic purpura treatment 400 mg/kg IV 8 months

IGIV—Postexposure varicella prophylaxis 400 mg/kg IV 8 months

IGIV—Postexposure measles prophylaxis for 

immunocompromised contacts 400 mg/kg IV 8 months

IGIV—Immune thrombocytopenic purpura treatment 1000 mg/kg IV 10 months

IGIV—Kawasaki disease 2 g/kg IV 11 months

Measles prophylaxis IG—Standard 

(i.e., nonimmunocompromised) contact 0.50 mL/kg (80 mg IgG/kg) IM 6 month

Monoclonal antibody to respiratory syncytial virus F 

protein (e.g., Synagis [MedImmune])(f) 15 mg/kg IM None

Rabies IG 20 IU/kg (22 mg IgG/kg) IM 4 months

Tetanus IG 250 units (10 mg IgG/kg) IM 3 months

Varicella IG 125 units/10 kg (60-200 mg IgG/kg) IM, 

maximum 625 units 5 months

Abbreviations: HIV = human immunodeficiency virus; IG = immune globulin; IgG = immune globulin G; IGIV = intravenous immune globulin; mg IgG/kg = milligrams of 

immune globulin G per kilogram of body weight; IM = intramuscular; IV = intravenous; RBCs = red blood cells.

(a) This table is not intended for determining the correct indications and dosages for using antibody-containing products. Unvaccinated persons might not be protected fully 

against measles during the entire recommended interval, and additional doses of IG or measles vaccine might be indicated after measles exposure. Concentrations of measles 

antibody in an IG preparation can vary by manufacturer’s lot. Rates of antibody clearance after receipt of an IG preparation also might vary. Recommended intervals are 

extrapolated from an estimated half-life of 30 days for passively acquired antibody and an observed interference with the immune response to measles vaccine for 5 months after 

a dose of 80 mg IgG/kg. Sources: Mason W, Takahashi M, Schneider T. Persisting passively acquired measles antibody following gamma globulin therapy for Kawasaki disease and 

response to live virus vaccination [Abstract 311]. Presented at the 32 meeting of the Interscience Conference on Antimicrobial Agents and Chemotherapy, Los Angeles, California, 

October, 1992, AND Siber GR, Werner BG, Halsey NA, et al. Interference of immune globulin with measles and rubella immunization. J Pediatr. 1993;122(2):204-211. DOI: 10.1016/

S0022-3476(06)80114-9, AND Mason WH, Schneider TL, Takahashi M. Duration of passively acquired measles antibody and response to live virus vaccination allowing gamma 

globulin therapy for Kawasaki syndrome. Prog Pediatr Cardiol. 1992;1(1):82. DOI: 10.1016/S1058-9813(06)80067-6. The extrapolation is performed by counting months from 80 

mg down to (1-3 mg) (e.g. 80 >>> 40 >> >20 >> >10 >>> 5>>>2.5....equal to FIVE intervals) and adding a grace month, so 80 mg values take a “6 month” interval).

(b) Does not include zoster vaccine recombinant because this vaccine is non-live.

(c) Assumes a serum IgG concentration of 16 mg/mL.

(d) The reason the interval is 6 months (and not 4 months) is that the quantity of 16.5 IgG/kg does not reflect the upper ceiling of the quantity of measles IgG in the product.

(e) Measles vaccination is recommended for children with mild or moderate immunosuppression from HIV infection, and varicella vaccination may be considered for children with mild

or moderate immunosuppression from HIV infection, but both are contraindicated for persons with severe immunosuppression from HIV or any other immunosuppressive disorder.

(f) Contains antibody only to respiratory syncytial virus.

Adapted from Table 3-5, ACIP General Best Practice Guidelines for Immunization. January 2021

Revised February 2021
Appendix A

A

Appendix A-24

Vaccination of persons with primary and secondary immunodeficiencies

Vaccination of persons with primary immunodeficiencies

Primary 

immunodeficiency

Specific 

Immunodeficiency

Contraindicated 

vaccines(a)

Risk-specific 

recommended 

vaccines(a)

Effectiveness and 

comments

B-lymphocyte 

(humoral)

Severe antibody 

deficiencies (e.g., X-linke

agammaglobulinemia 

and common variable 

immunodeficiency)

OPV(b)

Smallpox(c)

LAIV

BCG

Ty21a (live typhoid)

Yellow fever

MMR

MMRV

Pneumococcal 

Hib (children 12-59 

months of age)(d)

The effectiveness of any 

vaccine is uncertain if 

it depends only on the 

humoral response 

(e.g., PPSV2

IGIV interferes with the 

immune response to 

measles vaccine and 

possibly varicella vaccine

Less severe antibody 

deficiencies (e.g., selectiv

IgA deficiency and IgG 

subclass deficiency)

OPV(b)

BCG

Yellow fever(e)

Other live vaccines 

appear to be safe

Pneumococcal

Hib (children 12-59 

months of age)(d)

All vaccines likely effective; 

immune response might 

be attenuated

T-lymphocyte 

(cell-mediated 

and humoral)

Complete defects (e.g., SCI

disease, complete DiGeorge 

syndrome)

All live vaccines(f),(g),(h)

Pneumococcal

Hib (children 12-59 

months of age)(d)

Vaccines likely 

to be effective

Partial defects (e.g., mos

patients with DiGeorge 

syndrome, Wiskott-Aldrich 

syndrome, ataxiatelangiectasia)

All live vaccines(f),(g),(h)

Pneumococcal

Meningococcal

Hib (children 12-59 

months of age)(d)

Effectiveness of any 

vaccine depends on 

degree of immune 

suppression

Interferon-gamma/ 

Interleukin 12 axis 

deficiencies

All live bacterial 

vaccines (All live 

vaccines contraindicated 

in Interferon-gamma 

or interferon-alpha 

deficiencies)

None —

Complement

Persistent complement, 

properdin, or 

factor B deficiency

None

Pneumococcal

Meningococcal

Hib (children 12-59 

months of age)(d)

All routine vaccines 

likely effective

Taking eculizumab (Soliris) 

and/or ravulizumab 

(Ultomiris)

None Meningococcal —

Phagocytic 

function Chronic granulomatous 

disease Live bacterial vaccines(f) None Live viral vaccines likely 

safe and effective

Phagocytic deficiencies 

that are undefined or 

accompanied by defects 

in T-cell and NK cell 

dysfunction (such as a 

Chediak-Higashi syndrome, 

Leukocyte Adhesion 

Deficiency [LAD], and 

myeloperoxidase deficiency)

MMR

MMRV

Varicella

OPV(b)

Smallpox

BCG

LAIV

Ty21a

Yellow Fever and 

bacterial vaccines(f), (g)

Pneumococcal All inactivated vaccines 

safe and likely effective
Appendix A

A

Appendix A-25

Vaccination of persons with secondary immunodeficiencies

Secondary 

immunodeficiency Contraindicated vaccines(a)

Risk-specific 

recommended 

vaccines(a)

Effectiveness and 

comments

HIV/AIDS

OPV(b)

Smallpox

BCG

LAIV

MMRV

Withhold MMR and varicella in severely 

immunocompromised persons

Yellow fever vaccine might have a 

contraindication or a precaution depending 

on clinical parameters of immune function(i)

Pneumococcal

Hib(d), (j)

HepB

MenACWY

MMR and Varicella 

vaccine in those with 

mild immunosuppression, 

rotavirus, and all 

inactivated vaccines, 

including inactivated 

influenza as per routine 

vaccination schedule, 

might be effective(k)

Generalized 

malignant neoplasm, 

transplantation, 

immunosuppressive 

or radiation therapy

Live viral and bacterial, depending on immune 

status(f),(g),(l)

Pneumococcal

Hib(m)

Effectiveness of any vaccine 

depends on degree of 

immune suppression

Asplenia LAIV

Pneumococcal

Meningococcal

Hib(d),(n)

All routine vaccines 

likely effective

Chronic renal disease None

Pneumococcal

HepB(o)

All routine vaccines 

likely effective

Abbreviations: AIDS = acquired immunodeficiency syndrome; BCG = bacille CalmetteGuérin; HepB = hepatitis B; Hib = Haemophilus influenzae type b; HIV = human 

immunodeficiency virus; IG = immunoglobulin; IGIV = immune globulin intravenous; 

IgA = immune globulin A; IgG = immune globulin G; LAIV = live, attenuated influenza 

vaccine; MMR = measles, mumps, and rubella; MMRV = measles, mumps, rubella, and 

varicella; OPV = oral poliovirus vaccine (live); PPSV23= pneumococcal polysaccharide 

vaccine; SCID = severe combined immunodeficiency; Ty21a = live oral typhoid vaccine.

(a) Other vaccines that are universally or routinely recommended should be given 

if not contraindicated. An exception is patients with B-cell deficiencies receiving 

immunoglobulins, who should not receive either live or inactivated vaccines, due to 

safety (live vaccines) and efficacy (live and inactivated vaccines) concerns.

(b) OPV is no longer available in the United States.

(c) This table refers to contraindications for nonemergency vaccination (i.e., the ACIP 

recommendations); emergency response recommendations are addressed in the 

clinical guidance for smallpox vaccine use in an emergency.

(d) Children 12-59 months: if unimmunized or received zero or only 1 dose, and that dose 

was administered before 12 months of age, should receive 2 Hib doses, 8 weeks apart; 

if received 2 or more doses before age 12 months, and none after 12 months, should 

receive 1 Hib dose 8 weeks after the last dose; if completed a primary series and received 

a booster dose at age 12 months or older, no additional Hib doses are recommended.

(e) There are no data to support IgA deficiency as a contraindication for yellow fever vaccine.

(f) Live bacterial vaccines: BCG and oral Ty21a Salmonella Typhi vaccine.

(g) Live viral vaccines: MMR, MMRV, OPV, LAIV, yellow fever, rotavirus, varicella, and 

vaccinia (smallpox). Nonemergency smallpox vaccination is not recommended for 

children younger than 18 years or the general public.

(h) Regarding T-lymphocyte immunodeficiency as a contraindication for rotavirus 

vaccine, data exist only for SCID.

(i) Symptomatic HIV infection or CD4+ T-lymphocyte count of <200/mm3

 or <15% of 

total lymphocytes for children aged <6 years is a contraindication to yellow fever 

vaccine administration. Asymptomatic HIV infection with CD4+ T-lymphocyte count of 

200-499/mm3 for persons aged ≥6 years or 15%-24% of total lymphocytes for children 

aged <6 years is a precaution for yellow fever vaccine administration. Details of yellow 

fever vaccine recommendations are available from CDC. 

(j) Patients 5-18 years of age who have not received a Hib primary series and a booster 

dose or at least one Hib dose after 14 months of age.

(k) HIV-infected children should be considered for varicella vaccine if CD4+ T-lymphocyte 

count is ≥15% and should receive MMR vaccine if they are aged ≥12 months and 

do not have 1) evidence of current severe immunosuppression (i.e., individuals 

aged ≤5 years must have CD4+T lymphocyte [CD4] percentages ≥15% for ≥6 

months; and individuals aged >5 years must have CD4+percentages ≥15% and 

CD4+≥200 lymphocytes/mm3 for ≥6 months) and 2) other current evidence of 

measles, rubella, and mumps immunity. In cases when only CD4+cell counts or only 

CD4+percentages are available for those older than age 5 years, the assessment of 

severe immunosuppression can be based on the CD4+values (count or percentage) 

that are available. In cases when CD4+percentages are not available for those aged 

≤5 years, the assessment of severe immunosuppression can be based on agespecific CD4+counts at the time CD4+counts were measured; i.e., absence of severe 

immunosuppression is defined as ≥6 months above age-specific CD4+count criteria: 

CD4+count >750 lymphocytes/mm3 while aged ≤12 months and CD4+count ≥500 

lymphocytes/mm3 while aged 1 through 5 years. See McLean HQ, Fiebelkorn AP, 

Temte JL, Wallace GS. Prevention of measles, rubella, congenital rubella syndrome, 

and mumps, 2013: summary recommendations of the Advisory Committee on 

Immunization Practices (ACIP). MMWR Recomm Rep. 2013;62(RR-4):1-34.

(l) Withholding inactivated vaccines also is recommended with some forms of 

immunosuppressive therapy, like anti-CD20 antibodies, induction or consolidation 

chemotherapy, or patients with major antibody deficiencies receiving 

immunoglobulins. Inactivated influenza vaccine is an exception, but consideration 

should be given to repeating doses of any inactivated vaccine administered during 

these therapies.

(m) Persons younger than 60 months undergoing chemotherapy or radiation therapy 

who have not received a Hib primary series and a booster dose or at least one Hib dose 

after 14 months of age; HCT patients of any ages, regardless of Hib vaccine history.

(n) Persons older than 59 months who are asplenic and persons 15 months or older who 

are undergoing elective splenectomy who have not received a Hib primary series and a 

booster dose or at least one Hib dose after 14 months of age.

(o) Indicated based on the risk from dialysis-based bloodborne transmission.

Adapted from Table 8-1, ACIP General Best Practice Guidelines for Immunization. 

 January 2021
Appendix A

A

Appendix A-26

Contraindications and Precautions(a) to Commonly Used Vaccines

Vaccine Contraindications Precautions

DT, Td Severe allergic reaction (e.g., anaphylaxis) after a previou

dose or to a vaccine component

GBS <6 weeks after previous dose of tetanustoxoid–containing vaccine

History of Arthus-type hypersensitivity reactions 

after a previous dose of diphtheria-toxoidcontaining or tetanus-toxoid–containing 

vaccine; defer vaccination until at least 10 years 

have elapsed since the last tetanus-toxoidcontaining vaccine

Moderate or severe acute illness with or 

without fever

DTaP Severe allergic reaction (e.g., anaphylaxis) after a previou

dose or to a vaccine component

Encephalopathy (e.g., coma, decreased level o

consciousness, prolonged seizures), not attributable to 

another identifiable cause, within 7 days of administration of 

previous dose of DTP or DTaP

Progressive neurologic disorder, including 

infantile spasms, uncontrolled epilepsy, 

progressive encephalopathy; defer DTaP until 

neurologic status clarified and stabilized

GBS <6 weeks after previous dose of tetanustoxoid–containing vaccine

History of Arthus-type hypersensitivity reactions 

after a previous dose of diphtheria-toxoid–

containing or tetanus-toxoid–containing 

vaccine; defer vaccination until at least 10 years 

have elapsed since the last tetanus-toxoid–

containing vaccine

Moderate or severe acute illnes with or 

without fever

Hepatitis A Severe allergic reaction (e.g., anaphylaxis) after a previou

dose or to a vaccine component

Moderate or severe acute illness with or 

without fever

Hepatitis B Severe allergic reaction (e.g., anaphylaxis) after a previou

dose or to a vaccine component

Hypersensitivity to yeast

Moderate or severe acute illness with or 

without fever

Hib Severe allergic reaction (e.g., anaphylaxis) after a previou

dose or to a vaccine component

Age <6 weeks

Moderate or severe acute illness with or 

without fever

HPV(b) Severe allergic reaction (e.g., anaphylaxis) after a previou

dose or to a vaccine component, including yeast

Moderate or severe acute illness with or 

without fever

IIV Severe allergic reaction (e.g., anaphylaxis) after previous dos

of influenza vaccine or to vaccine component

GBS <6 weeks after a previous dose of 

influenza vaccine

Moderate or severe acute illness with or 

without fever

Egg allergy other than hives (e.g., angioedema

respiratory distress, lightheadedness, recurrent 

emesis; or required epinephrine or another 

emergency medical intervention). If a vaccine

other than RIV or ccIIV is used, the selected 

vaccine should be administered in an inpatient 

or outpatient medical setting (including but not 

necessarily limited to hospitals, clinics, health 

departments, and physician offices). Vaccine

administration should be supervised by a health 

care provider who is able to recognize and 

manage severe allergic reactions
Appendix A

A

Appendix A-27

Vaccine Contraindications Precautions

IPV Severe allergic reaction (e.g., anaphylaxis) after a previou

dose or to a vaccine component

Pregnancy

Moderate or severe acute illness 

with or without fever

LAIV(c) Severe allergic reaction (e.g., anaphylaxis) after a previou

dose or to a vaccine component

Concomitant use of aspirin or aspirin-containing medication 

in children and adolescents

LAIV4 should not be administered to persons who have 

taken oseltamivir or zanamivir within the previous 48 hours, 

peramivir within the previous 5 days, or baloxavir within the 

previous 17 days

(e)

Pregnancy

Children aged 2 through 4 years who have received 

a diagnosis of asthma or whose parents or caregivers 

report that a health care provider has told them during 

the preceding 12 months that their child had wheezing 

or asthma or whose medical record indicates a wheezing 

episode has occurred during the preceding 12 months

Persons with active cerebrospinal fluid/oropharyngeal 

communications/leaks

Close contacts and caregivers of severely immunosuppressed 

persons who require a protected environment

Persons with cochlear implants (due to the potential for 

CSF leak, which might exist for some period of time after 

implantation. Providers might consider consultation with

a specialist concerning risk of persistent CSF leak if an 

age-appropriate inactivated or recombinant vaccine cannot 

be used)

Altered Immunocompetence

Anatomic or functional asplenia (e.g. sickle cell diseas

GBS <6 weeks after a previous dose 

of influenza vaccine

Asthma in persons aged 5 years old or older

Medical conditions which might predispose to 

higher risk of complications attributable 

to influenza(d)

Moderate or severe acute illness with or 

without fever

MenACWY Severe allergic reaction (e.g., anaphylaxis) after a previou

dose or to a vaccine component, including yeast

Moderate or severe acute illness with or 

without fever

Preterm birth (MenACWY-CRM)(f)

MenB Severe allergic reaction (e.g., anaphylaxis) after a previou

dose or to a vaccine component

Moderate or severe acute illness with or 

without fever

Pregnancy

Latex sensitivity (MenB-4C)
Appendix A

A

Appendix A-28

Vaccine Contraindications Precautions

MMR(g),(h) Severe allergic reaction (e.g., anaphylaxis) after a previou

dose or to a vaccine component

Pregnancy

Known severe immunodeficiency (e.g., from hematologi

and solid tumors, receipt of chemotherapy, congenital 

immunodeficiency, long-term immunosuppressive 

therapy(i) or patients with HIV infection who are severely 

immunocompromised)

Family history of altered immunocompetence(j)

Recent (≤11 months) receipt of antibodycontaining blood product (specific interval 

depends on product) 

History of thrombocytopenia or 

thrombocytopenic purpura

Need for tuberculin skin testing or 

interferon-gamma release assay (IGRA) testing(k)

Moderate or severe acute illness with or 

without fever

MPSV4 Severe allergic reaction (e.g., anaphylaxis) after a previou

dose or to a vaccine component

Moderate or severe acute illness with or 

without fever

PCV13 Severe allergic reaction (e.g., anaphylaxis) after a previou

dose of PCV13 or any diphtheria-toxoid–containing vaccine 

or to a component of a vaccine (PCV13 or any diphtheriatoxoid–containing vaccine), including yeast

Moderate or severe acute illness with or 

without fever

PPSV23 Severe allergic reaction (e.g., anaphylaxis) after a previou

dose or to a vaccine component

Moderate or severe acute illness with or 

without fever

RIV Severe allergic reaction (e.g., anaphylaxis) after a previou

dose or to a vaccine component

GBS <6 weeks after a previous dose of 

influenza vaccine

Moderate or severe acute illness with or 

without fever

Rotavirus Severe allergic reaction (e.g., anaphylaxis) after a previou

dose or to a vaccine component

SCID

History of intussusception

Altered immunocompetence other than SCID

Chronic gastrointestinal disease(l)

Spina bifida or bladder exstrophy(l)

Moderate or severe acute illness with or 

without fever

Tdap Severe allergic reaction (e.g., anaphylaxis) after a previou

dose or to a vaccine component

Encephalopathy (e.g., coma, decreased level o

consciousness, prolonged seizures), not attributable to 

another identifiable cause, within 7 days of administration of 

previous dose of DTP, DTaP, or Tdap

GBS <6 weeks after a previous dose of tetanustoxoid–containing vaccine

Progressive or unstable neurological disorder, 

uncontrolled seizures, or progressive 

encephalopathy until a treatment regimen has 

been established and the condition has stabilized

History of Arthus-type hypersensitivity reactions 

after a previous dose of diphtheria-toxoid—

containing or tetanus-toxoid–containing vaccine; 

defer vaccination until at least 10 years have 

elapsed since the last tetanus-toxoid–containing 

vaccine

Moderate or severe acute illness with or 

without fever
Appendix A

A

Appendix A-29

Vaccine Contraindications Precautions

Varicella(g),(h) Severe allergic reaction (e.g., anaphylaxis) after a previous dos

or to a vaccine component

Known severe immunodeficiency (e.g., from hematologi

and solid tumors, receipt of chemotherapy, congenital 

immunodeficiency, long-term immunosuppressive 

therapy(i) or patients with HIV infection who are severely 

immunocompromised)(g)

Pregnancy

Family history of altered immunocompetence(j)

Recent (≤11 months) receipt of antibodycontaining blood product (specific interval depends 

on product)

Moderate or severe acute illness with or without 

fever

Use of aspirin or aspirin-containing products(m)

Receipt of specific antiviral drugs (acyclovir, 

famciclovir, or valacyclovir) 24 hours before 

vaccination (avoid use of these antiviral drugs for 

14 days after vaccination)

Zoster Severe allergic reaction (e.g., anaphylaxis) after a previou

dose or to a vaccine component

Moderate or severe acute illness with or without 

fever

Abbreviations: DT = diphtheria and tetanus toxoids; DTaP = diphtheria and tetanus toxoids and acellular pertussis; DTP = diphtheria toxoid, tetanus toxoid, and pertussis; GBS 

= Guillain-Barré syndrome; Hib = Haemophilus influenzae type b; HIV = human immunodeficiency virus; HPV = human papillomavirus; IIV = inactivated influenza vaccine; IPV 

= inactivated poliovirus; LAIV = live, attenuated influenza vaccine; MenACWY = quadrivalent meningococcal conjugate vaccine; MMR = measles, mumps, and rubella; MPSV4 

= quadrivalent meningococcal polysaccharide vaccine; PCV13 = pneumococcal conjugate vaccine; PPSV23= pneumococcal polysaccharide vaccine; SCID = severe combined 

immunodeficiency; RIV=recombinant influenza vaccine; Td = tetanus and diphtheria toxoids; Tdap = tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis.

(a) Events or conditions listed as precautions should be reviewed carefully. Benefits of 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 of vaccination is believed to outweigh the 

risk, the vaccine should be administered. Whether and when to administer DTaP to children with proven or suspected underlying neurologic disorders should be decided on a 

case-by-case basis.

(b) HPV vaccine is not recommended during pregnancy.

(c) In addition, ACIP recommends LAIV not be used for pregnant women, immunosuppressed persons, and children aged 2-4 years who have asthma or who have had a wheezing 

episode noted in the medical record within the past 12 months, or for whom parents report that a health-care provider stated that they had wheezing or asthma within the last 

12 months. LAIV should not be administered to persons who received influenza antiviral medications oseltamivir or zanamivir within the previous 48 hours, peramivir within the 

previous 5 days, or baloxavir within the previous 17 days. Persons who care for severely immunosuppressed persons who require a protective environment should not receive 

LAIV, or should avoid contact with such persons for 7 days after receipt.

(d) See reference: See reference: Grohskopf L, Alyanak E, Broder KR, et al., Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee 

on Immunization Practices — United States, 2020–21 Influenza Season. MMWR Recomm Rep. 2020;69(No. RR-8):1-26.

(e) These values are based on the clearance of the particular antiviral. LAIV4 should not be administered to persons who have taken oseltamivir or zanamivir within the previous 

48 hours, peramivir within the previous 5 days, or baloxavir within the previous 17 days. This “contraindication” is due to concern with reduced effectiveness of the vaccine. To 

obtain specific information, please refer to Grohskopf LA, Alyanak, E, Broder KR, et. al. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the 

Advisory Committee on Immunization Practices — United States, 2020–21 Influenza Season. MMWR Recomm Rep 2020;69(No. RR-8:1-26. Also at https://www.cdc.gov/mmwr/

volumes/69/rr/pdfs/rr6908a1-H.pdf.

(f) This precaution applies to infants younger than 9 months old.

(g) HIV-infected children may receive varicella vaccine if CD4+ T-lymphocyte count is ≥15% and should receive MMR vaccine if they are aged ≥12 months and do not have evidence 

of current severe immunosuppression (i.e., individuals aged ≤5 years must have CD4+T lymphocyte [CD4] percentages ≥15% for ≥6 months; and individuals aged >5 years 

must have CD4+percentages ≥15% and CD4+≥200 lymphocytes/mm3 for ≥6 months) or other current evidence of measles, rubella, and mumps immunity. In cases when only 

CD4+cell counts or only CD4+percentages are available for those older than age 5 years, the assessment of severe immunosuppression can be based on the CD4+values (count 

or percentage) that are available. In cases when CD4+percentages are not available for those aged ≤5 years, the assessment of severe immunosuppression can be based on 

age-specific CD4+counts at the time CD4+counts were measured; i.e., absence of severe immunosuppression is defined as ≥6 months above age-specific CD4+count criteria: 

CD4+count >750 lymphocytes/mm3 while aged ≤12 months and CD4+count ≥500 lymphocytes/mm3 while aged 1 through 5 years. Sources: 1) McLean HQ, Fiebelkorn AP, 

Temte JL, Wallace GS. Prevention of measles, rubella, congenital rubella syndrome, and mumps, 2013: summary recommendations of the Advisory Committee on Immunization 

Practices (ACIP). MMWR Recomm Rep. 2013;62(RR-4):1-34. 2) CDC. Prevention of pneumococcal disease: recommendations of the Advisory Committee on Immunization Practices 

(ACIP). MMWR Recomm Rep. 1997;46(RR-8):1-24.

(h) MMR and varicella-containing vaccines can be administered on the same day. If not administered on the same day, these vaccines should be separated by at least 28 days.

(i) A substantially immunosuppressive steroid dose is considered to be ≥2 weeks of daily receipt of 20 mg or 2 mg/kg body weight of prednisone or equivalent.

(j) Family history of congenital or hereditary immunodeficiency in first-degree relatives (e.g., parents and siblings), unless the immune competence of the potential vaccine 

recipient has been substantiated clinically or verified by a laboratory.

(k) If active tuberculosis is suspected, MMR should be delayed. Measles vaccination might suppress tuberculin reactivity temporarily. Measles-containing vaccine can be 

administered on the same day as tuberculin skin or IGRA testing. If testing cannot be performed until after the day of MMR vaccination, the test should be postponed for ≥4 

weeks after the vaccination. If an urgent need exists to skin test or IGRA, do so with the understanding that reactivity might be reduced by the vaccine.

(l) For RV1 only, based on latex in product/packaging. Note that anaphylactic allergy to latex is covered in the contraindication, and would also be isolated to RV 1 in the case 

of latex. For more details see Cortese MM, Parashar UD. Prevention of rotavirus gastroenteritis among infants and children: recommendations of the Advisory Committee on 

Immunization Practices (ACIP). MMWR Recomm Rep. 2009;58(RR-2):1-25.

(m) No adverse events associated with the use of aspirin or aspirin-containing products after varicella vaccination have been reported; however, the vaccine manufacturer 

recommends that vaccine recipients avoid using aspirin or aspirin-containing products for 6 weeks after receiving varicella vaccines because of the association between aspirin 

use and Reye syndrome after varicella. Vaccination with subsequent close monitoring should be considered for children who have rheumatoid arthritis or other conditions 

requiring therapeutic aspirin. The risk for serious complications associated with aspirin is likely to be greater in children in whom natural varicella develops than it is in children 

who receive the vaccine containing attenuated VZV. No association has been documented between Reye syndrome and analgesics or antipyretics that do not contain aspirin.

Adapted from Table 4-1, ACIP General Best Practice Guidelines for Immunization. January 2021
Appendix A

A

Appendix A-30

Additional Resources for Schedules and Recommendations

Immunization Schedules

y Recommended Immunization Schedules for Persons Aged 0 Through 18 Years: https://www.cdc.gov/vaccine

schedules/hcp/imz/child-adolescent.htm

y Catch-up Schedule for Persons Aged 0 Through 18 Years: https://www.cdc.gov/vaccines/schedules/hcp/im

catchup.htm

y Recommended Immunization Schedules for Persons Aged 19 Years or Older: https://www.cdc.gov/vaccine

schedules/hcp/imz/adult.htm

y Schedules Changes & Guidance: https://www.cdc.gov/vaccines/schedules/hcp/schedule-changes.h

y Summary of Recommendations for Child/Teen Immunization (Immunization Action Coalition): 

http://www.immunize.org/catg.d/p2010

y Summary of Recommendations for Adult Immunization (Immunization Action Coalition): 

http://www.immunize.org/catg.d/p2011.

y More Schedule-Related Resources (e.g. schedule presentation graphics, prior immunization schedules)

https://www.cdc.gov/vaccines/schedules/hcp/schedule-related-resources.h

Recommendations

y Vaccine-specific ACIP Recommendations and Guidelines: https://www.cdc.gov/vaccines/hcp/acip-recs/index.h

y Vaccines by Disease: https://www.cdc.gov/vaccines/vpd/vaccines-diseases.h

y Adults with Health Conditions: https://www.cdc.gov/vaccines/adults/rec-vac/health-conditions/index.h

y Guide to Contraindications and Precautions to Commonly Used Vaccines (Immunization Action Coalition): 

http://www.immunize.org/catg.d/p3072a

y Guide to Contraindications and Precautions to Commonly Used Vaccines in Adults (Immunization Action 

Coalition): http://www.immunize.org/catg.d/p3072

y Recommended Vaccines for Healthcare Workers: https://www.cdc.gov/vaccines/adults/rec-vac/hcw.h

y Travel Vaccines: https://wwwnc.cdc.gov/travel/page/travel-vaccin

y Vaccines for Immigrants and Refugees: https://www.cdc.gov/vaccines/adults/rec-vac/immigrants-refugees.h