Recommended Child and Adolescent Immunization Schedule

for ages 18 years or younger

How to use the child and adolescent immunization 

schedule

Recommended by the Advisory Committee on Immunization Practices (www.cdc.gov/vaccines/acip) 

and approved by the Centers for Disease Control and Prevention (www.cdc.gov), American Academy 

of Pediatrics (www.aap.org), American Academy of Family Physicians (www.aafp.org), American 

College of Obstetricians and Gynecologists (www.acog.org), American College of Nurse-Midwives 

(www.midwife.org), American Academy of Physician Associates (www.aapa.org), and National 

Association of Pediatric Nurse Practitioners (www.napnap.org).

2022

UNITED STATES

Vaccines in the Child and Adolescent Immunization Schedule*

Vaccine Abbreviation(s) Trade name(s)

Dengue vaccine DEN4CYD Dengvaxia®

Diphtheria, tetanus, and acellular pertussis vaccine DTaP Daptacel®

Infanrix®

Diphtheria, tetanus vaccine DT No trade name

Haemophilus influenzae type b vaccine Hib (PRP-T)

Hib (PRP-OMP)

ActHIB®

Hiberix®

PedvaxHIB®

Hepatitis A vaccine HepA Havrix®

Vaqta®

Hepatitis B vaccine HepB Engerix-B®

Recombivax HB®

Human papillomavirus vaccine HPV Gardasil 9®

Influenza vaccine (inactivated) IIV4 Multiple

Influenza vaccine (live, attenuated) LAIV4 FluMist® Quadrivalent

Measles, mumps, and rubella vaccine MMR M-M-R II®

Meningococcal serogroups A, C, W, Y vaccine MenACWY-D Menactra®

MenACWY-CRM Menveo®

MenACWY-TT MenQuadfi®

Meningococcal serogroup B vaccine MenB-4C Bexsero®

MenB-FHbp Trumenba®

Pneumococcal 13-valent conjugate vaccine PCV13 Prevnar 13®

Pneumococcal 23-valent polysaccharide vaccine PPSV23 Pneumovax 23®

Poliovirus vaccine (inactivated) IPV IPOL®

Rotavirus vaccine RV1

RV5

Rotarix®

RotaTeq®

Tetanus, diphtheria, and acellular pertussis vaccine Tdap Adacel®

Boostrix®

Tetanus and diphtheria vaccine Td Tenivac®

TdvaxTM

Varicella vaccine VAR Varivax®

Combination vaccines (use combination vaccines instead of separate injections when appropriate)

DTaP, hepatitis B, and inactivated poliovirus vaccine DTaP-HepB-IPV Pediarix®

DTaP, inactivated poliovirus, and Haemophilus influenzae type b vaccine DTaP-IPV/Hib Pentacel®

DTaP and inactivated poliovirus vaccine DTaP-IPV Kinrix®

Quadracel®

DTaP, inactivated poliovirus, Haemophilus influenzae type b, and 

hepatitis B vaccine

DTaP-IPV-HibHepBVaxelis®

Measles, mumps, rubella, and varicella vaccine MMRV ProQuad®

*Administer recommended vaccines if immunization history is incomplete or unknown. Do not restart or add doses to vaccine series for 

extended intervals between doses. When a vaccine is not administered at the recommended age, administer at a subsequent visit. 

The use of trade names is for identification purposes only and does not imply endorsement by the ACIP or CDC. 

Report

y Suspected cases of reportable vaccine-preventable diseases or outbreaks to your state or local health 

department

y Clinically significant adverse events to the Vaccine Adverse Event Reporting System (VAERS) at 

www.vaers.hhs.gov or 800-822-7967

Questions or comments

Contact www.cdc.gov/cdc-info or 800-CDC-INFO (800-232-4636), in English or Spanish, 8 a.m.–8 p.m. ET, 

Monday through Friday, excluding holidays

Helpful information

y Complete Advisory Committee on Immunization Practices (ACIP) recommendations: 

www.cdc.gov/vaccines/hcp/acip-recs/index.html

y General Best Practice Guidelines for Immunization (including contraindications and precautions):

www.cdc.gov/vaccines/hcp/acip-recs/general-recs/index.html

y Vaccine information statements: 

www.cdc.gov/vaccines/hcp/vis/index.html

y Manual for the Surveillance of Vaccine-Preventable Diseases 

(including case identification and outbreak response):

www.cdc.gov/vaccines/pubs/surv-manual

y ACIP Shared Clinical Decision-Making Recommendations

www.cdc.gov/vaccines/acip/acip-scdm-faqs.html

1

Determine 

recommended 

vaccine by age 

(Table 1)

2

Determine 

recommended 

interval for catch

up vaccination 

(Table 2)

3

Assess need 

for additional 

- recommended 

vaccines by 

medical condition 

or other indication 

(Table 3)

4

Review vaccine 

types, frequencies, 

intervals, and 

considerations for 

special situations 

(Notes)

5

Review 

contraindications 

and precautions 

for vaccine types 

(Appendix)

Download the CDC Vaccine Schedules app for providers at 

www.cdc.gov/vaccines/schedules/hcp/schedule-app.html

CS310020-A

Scan QR code 

for access to 

online schedule
Table 1 Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger, United States, 2022

These recommendations must be read with the notes that follow. For those who fall behind or start late, provide catch-up vaccination at the earliest opportunity as indicated by the green bars. 

To determine minimum intervals between doses, see the catch-up schedule (Table 2).

Vaccine Birth 1 mo 2 mos 4 mos 6 mos 9 mos 12 mos 15 mos 18 mos 19–23 mos 2–3 yrs 4–6 yrs 7–10 yrs 11–12 yrs 13–15 yrs 16 yrs 17–18 yrs

Hepatitis B (HepB) 1st dose ----- 2nd dose ----- ---------------------------- 3rd dose ----------------------------

Rotavirus (RV): RV1 (2-dose series), 

RV5 (3-dose series) 1st dose 2nd dose See Notes

Diphtheria, tetanus, acellular pertussis 

(DTaP <7 yrs) 1st dose 2nd dose 3rd dose ----- 4th dose ------ 5th dose

Haemophilus influenzae type b (Hib) 1st dose 2nd dose See Notes 3rd or 4th dose, -- See Notes --

Pneumococcal conjugate (PCV13) 1st dose 2nd dose 3rd dose ----- 4th dose -----

Inactivated poliovirus 

(IPV <18 yrs) 1st dose 2nd dose ---------------------------- 3rd dose ---------------------------- 4th dose

Influenza (IIV4) Annual vaccination 1 or 2 doses Annual vaccination 1 dose only

Influenza (LAIV4) Annual vaccination 

1 or 2 doses Annual vaccination 1 dose only

Measles, mumps, rubella (MMR) See Notes ----- 1st dose ----- 2nd dose

Varicella (VAR) ----- 1st dose ----- 2nd dose

Hepatitis A (HepA) See Notes 2-dose series, See Notes

Tetanus, diphtheria, acellular pertussis 

(Tdap ≥7 yrs) 1 dose

Human papillomavirus (HPV) See 

Notes

Meningococcal (MenACWY-D ≥9 mos, 

MenACWY-CRM ≥2 mos, MenACWY-TT 

≥2years)

See Notes 1st dose 2nd dose

Meningococcal B (MenB-4C, MenBFHbp)

See Notes

Pneumococcal polysaccharide 

(PPSV23) See Notes

Dengue (DEN4CYD; 9-16 yrs) Seropositive in endemic areas only

(See Notes)

or or

Range of recommended 

ages for all children Range of recommended ages for catch-up vaccination Range of recommended ages for certain high-risk groups Recommended vaccination can begin in this age group Recommended vaccination based on shared clinical decision-making No recommendation/

not applicable
The table below provides catch-up schedules and minimum intervals between doses for children whose vaccinations have been delayed. A vaccine series does not need to be restarted, regardless of the time that has 

elapsed between doses. Use the section appropriate for the child’s age. Always use this table in conjunction with Table 1 and the Notes that follow.

Children age 4 months through 6 years

Vaccine Minimum Age for 

Dose 1

Minimum Interval Between Doses

Dose 1 to Dose 2 Dose 2 to Dose 3 Dose 3 to Dose 4 Dose 4 to Dose 5

Hepatitis B Birth 4 weeks 8 weeks and at least 16 weeks after first dose

minimum age for the final dose is 24 weeks

Rotavirus 6 weeks 

Maximum age for first 

dose is 14 weeks, 6 days.

4 weeks 4 weeks

maximum age for final dose is 8 months, 0 days

Diphtheria, tetanus, and 

acellular pertussis

6 weeks 4 weeks 4 weeks 6 months 6 months

Haemophilus influenzae 

type b

6 weeks No further doses needed

if first dose was administered at age 15 

months or older.

4 weeks 

if first dose was administered before the 

1st birthday. 

8 weeks (as final dose) 

if first dose was administered at age 

12 through 14 months.

No further doses needed

if previous dose was administered at age 15 months or older

4 weeks

if current age is younger than 12 months and first dose was administered at younger than age 7 months and at least 

1 previous dose was PRP-T (ActHib®, Pentacel®, Hiberix®), Vaxelis® or unknown

8 weeks and age 12 through 59 months (as final dose)

if current age is younger than 12 months and first dose was administered at age 7 through 11 months; 

OR 

if current age is 12 through 59 months and first dose was administered before the 1st birthday and second dose was 

administered at younger than 15 months; 

OR 

if both doses were PedvaxHIB® and were administered before the 1st birthday

8 weeks (as final dose) 

This dose only necessary 

for children age 12 through 

59 months who received 3 doses 

before the 1st birthday.

Pneumococcal conjugate 6 weeks No further doses needed for healthy 

children if first dose was administered at 

age 24 months or older

4 weeks 

if first dose was administered before the 

1st birthday

8 weeks (as final dose for healthy 

children) 

if first dose was administered at the 

1st birthday or after

No further doses needed 

for healthy children if previous dose was administered at age 24 months or older

4 weeks 

if current age is younger than 12 months and previous dose was administered at <7 months old

8 weeks (as final dose for healthy children) 

if previous dose was administered between 7–11 months (wait until at least 12 months old); 

OR 

if current age is 12 months or older and at least 1 dose was administered before age 12 months

8 weeks (as final dose) 

This dose only necessary 

for children age 12 through 

59 months who received 3 doses 

before age 12 months or for 

children at high risk who received 

3 doses at any age.

Inactivated poliovirus 6 weeks 4 weeks 4 weeks

if current age is <4 years

6 months (as final dose)

if current age is 4 years or older

6 months (minimum age 4 

years for final dose)

Measles, mumps, rubella 12 months 4 weeks

Varicella 12 months 3 months

Hepatitis A 12 months 6 months

Meningococcal ACWY 2 months MenACWY-CRM

9 months MenACWY-D

2 years MenACWY-TT

8 weeks See Notes See Notes

Children and adolescents age 7 through 18 years

Meningococcal ACWY Not applicable (N/A) 8 weeks

Tetanus, diphtheria; 

tetanus, diphtheria, and 

acellular pertussis

7 years 4 weeks 4 weeks

if first dose of DTaP/DT was administered before the 1st birthday

6 months (as final dose) 

if first dose of DTaP/DT or Tdap/Td was administered at or after the 1st birthday

6 months 

if first dose of DTaP/DT was 

administered before the 1st

birthday

Human papillomavirus 9 years Routine dosing intervals are 

recommended.

Hepatitis A N/A 6 months

Hepatitis B N/A 4 weeks 8 weeks and at least 16 weeks after first dose

Inactivated poliovirus N/A 4 weeks 6 months

A fourth dose is not necessary if the third dose was administered at age 4 years or older and at least 6 months after 

the previous dose.

A fourth dose of IPV is indicated 

if all previous doses were 

administered at <4 years or if the 

third dose was administered <6 

months after the second dose.

Measles, mumps, rubella N/A 4 weeks

Varicella N/A 3 months if younger than age 13 years. 

4 weeks if age 13 years or older

Dengue 9 years 6 months 6 months

Table 2 Recommended Catch-up Immunization Schedule for Children and Adolescents Who Start Late or Who Are More 

than 1 Month Behind, United States, 2022
Always use this table in conjunction with Table 1 and the Notes that follow. 

VACCINE

INDICATION

Pregnancy

Immunocom- promised status 

(excluding HIV 

infection)

HIV infection CD4+ count1

Kidney failure, 

end-stage renal 

disease, or on 

hemodialysis

Heart disease or 

chronic lung disease

CSF leak 

or cochlear 

implant

Asplenia or

 persistent complement 

component 

deficiencies

Chronic 

liver 

disease Diabetes

<15% or 

total CD4 

cell count of 

<200/mm3

≥15% and 

total CD4 

cell count of 

≥200/mm3

Hepatitis B

Rotavirus

SCID2

Diphtheria, tetanus, and 

acellular pertussis (DTaP)

Haemophilus influenzae 

type b

Pneumococcal conjugate

Inactivated poliovirus

Influenza (IIV4)

Influenza (LAIV4) Asthma, wheezing: 2–4yrs3

Measles, mumps, rubella *

Varicella *

Hepatitis A

Tetanus, diphtheria, and 

acellular pertussis (Tdap)

Human papillomavirus *

Meningococcal ACWY

Meningococcal B

Pneumococcal 

polysaccharide

Dengue

1 For additional information regarding HIV laboratory parameters and use of live vaccines, see the General Best Practice Guidelines for Immunization, “Altered Immunocompetence,” at 

www.cdc.gov/vaccines/hcp/acip-recs/general-recs/immunocompetence.html and Table 4-1 (footnote J) at www.cdc.gov/vaccines/hcp/acip-recs/general-recs/contraindications.html.

2 Severe Combined Immunodeficiency

3 LAIV4 contraindicated for children 2–4 years of age with asthma or wheezing during the preceding 12 months

Vaccination according to the 

routine schedule

recommended

Recommended for 

persons with an additional risk 

factor for which the vaccine 

would be indicated

Vaccination is recommended, 

and additional doses may be 

necessary based on medical 

condition or vaccine. See Notes.

Precaution—vaccine 

might be indicated if benefit 

of protection outweighs risk 

of adverse reaction

Contraindicated or not 

recommended—vaccine should 

not be administered

*Vaccinate after pregnancy

No recommendation/not 

applicable

Table 3 Recommended Child and Adolescent Immunization Schedule by Medical Indication, 

United States, 2022

or
Dengue vaccination 

(minimum age: 9 years)

Routine vaccination

y Age 9–16 years living in dengue endemic areas AND have laboratory 

confirmation of previous dengue infection

- 3-dose series administered at 0, 6, and 12 months 

y Endemic areas include Puerto Rico, American Samoa, US Virgin Islands, 

Federated States of Micronesia, Republic of Marshall Islands, and the 

Republic of Palau. For updated guidance on dengue endemic areas 

and pre-vaccination laboratory testing see www.cdc.gov/mmwr/

volumes/70/rr/rr7006a1.htm?s_cid=rr7006a1_w and www.cdc.gov/

dengue/vaccine/hcp/index.html

Diphtheria, tetanus, and pertussis (DTaP) 

vaccination (minimum age: 6 weeks [4 years 

for Kinrix® or Quadracel®])

Routine vaccination

y 5-dose series at age 2, 4, 6, 15–18 months, 4–6 years

- Prospectively: Dose 4 may be administered as early as age 

12 months if at least 6 months have elapsed since dose 3.

- Retrospectively: A 4th dose that was inadvertently administered as 

early as age 12 months may be counted if at least 4 months have 

elapsed since dose 3.

Catch-up vaccination

y Dose 5 is not necessary if dose 4 was administered at age 4 years or 

older and at least 6 months after dose 3.

y For other catch-up guidance, see Table 2.

Special situations

y Wound management in children less than age 7 years with history of 

3 or more doses of tetanus-toxoid-containing vaccine: For all wounds 

except clean and minor wounds, administer DTaP if more than 5 years 

since last dose of tetanus-toxoid-containing vaccine. For detailed 

information, see www.cdc.gov/mmwr/volumes/67/rr/rr6702a1.htm.

Haemophilus influenzae type b vaccination 

(minimum age: 6 weeks)

Routine vaccination 

y ActHIB®, Hiberix®, Pentacel®, or Vaxelis®: 4-dose series (3 dose 

primary series at age 2, 4, and 6 months, followed by a booster dose* 

at age 12–15 months)

- *Vaxelis® is not recommended for use as a booster dose. A different 

Hib-containing vaccine should be used for the booster dose.

y PedvaxHIB®: 3-dose series (2-dose primary series at age 2 and 4 

months, followed by a booster dose at age 12–15 months)

Catch-up vaccination

y Dose 1 at age 7–11 months: Administer dose 2 at least 4 weeks later 

and dose 3 (final dose) at age 12–15 months or 8 weeks after dose 2 

(whichever is later).

y Dose 1 at age 12–14 months: Administer dose 2 (final dose) at least 

8 weeks after dose 1.

y Dose 1 before age 12 months and dose 2 before age 15 months: 

Administer dose 3 (final dose) at least 8 weeks after dose 2.

y 2 doses of PedvaxHIB® before age 12 months: Administer dose 3 

(final dose) at 12–59 months and at least 8 weeks after dose 2.

y 1 dose administered at age 15 months or older: No further doses 

needed

y Unvaccinated at age 15–59 months: Administer 1 dose.

y Previously unvaccinated children age 60 months or older who 

are not considered high risk: Do not require catch-up vaccination

For other catch-up guidance, see Table 2. Vaxelis® can be used for catchup vaccination in children less than age 5 years. Follow the catch-up 

schedule even if Vaxelis® is used for one or more doses. For detailed 

information on use of Vaxelis® see www.cdc.gov/mmwr/volumes/69/

wr/mm6905a5.htm.

Special situations

y Chemotherapy or radiation treatment: 

Age 12–59 months 

- Unvaccinated or only 1 dose before age 12 months: 2 doses, 

8 weeks apart

- 2 or more doses before age 12 months: 1 dose at least 8 weeks after 

previous dose

Doses administered within 14 days of starting therapy or during therapy 

should be repeated at least 3 months after therapy completion.

y Hematopoietic stem cell transplant (HSCT):

- 3-dose series 4 weeks apart starting 6 to 12 months after successful 

transplant, regardless of Hib vaccination history

y Anatomic or functional asplenia (including sickle cell disease):

Age 12–59 months

- Unvaccinated or only 1 dose before age 12 months: 2 doses, 

8 weeks apart

- 2 or more doses before age 12 months: 1 dose at least 8 weeks after 

previous dose

Unvaccinated* persons age 5 years or older

- 1 dose

y Elective splenectomy:

Unvaccinated* persons age 15 months or older

- 1 dose (preferably at least 14 days before procedure)

y HIV infection:

Age 12–59 months

- Unvaccinated or only 1 dose before age 12 months: 2 doses, 

8 weeks apart

- 2 or more doses before age 12 months: 1 dose at least 8 weeks after 

previous dose

Unvaccinated* persons age 5–18 years

- 1 dose

y Immunoglobulin deficiency, early component complement 

deficiency:

Age 12–59 months

- Unvaccinated or only 1 dose before age 12 months: 2 doses, 

8 weeks apart

- 2 or more doses before age 12 months: 1 dose at least 8 weeks after 

previous dose

*Unvaccinated = Less than routine series (through age 14 months) OR 

no doses (age 15 months or older)

For vaccination recommendations for persons ages 19 years or older, see 

the Recommended Adult Immunization Schedule, 2022.

Additional information

y Consult relevant ACIP statements for detailed recommendations at 

www.cdc.gov/vaccines/hcp/acip-recs/index.html.

y For calculating intervals between doses, 4 weeks = 28 days. Intervals of 

≥4 months are determined by calendar months.

y Within a number range (e.g., 12–18), a dash (–) should be read as 

“through.”

y Vaccine doses administered ≤4 days before the minimum age or 

interval are considered valid. Doses of any vaccine administered 

≥5 days earlier than the minimum age or minimum interval should 

not be counted as valid and should be repeated as age appropriate. 

The repeat dose should be spaced after the invalid dose by the 

recommended minimum interval. For further details, see Table 3-1, 

Recommended and minimum ages and intervals between vaccine 

doses, in General Best Practice Guidelines for Immunization at 

www.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html.

y Information on travel vaccination requirements and recommendations 

is available at www.cdc.gov/travel/.

y For vaccination of persons with immunodeficiencies, see 

Table 8-1, Vaccination of persons with primary and secondary 

immunodeficiencies, in General Best Practice Guidelines for 

Immunization at www.cdc.gov/vaccines/hcp/acip-recs/general-recs/

immunocompetence.html, and Immunization in Special Clinical 

Circumstances (In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. 

Red Book: 2018 Report of the Committee on Infectious Diseases. 31st ed. 

Itasca, IL: American Academy of Pediatrics; 2018:67–111).

y For information about vaccination in the setting of a vaccinepreventable disease outbreak, contact your state or local health 

department. 

y The National Vaccine Injury Compensation Program (VICP) is a no-fault 

alternative to the traditional legal system for resolving vaccine injury 

claims. All routine child and adolescent vaccines are covered by VICP 

except for pneumococcal polysaccharide vaccine (PPSV23). For more 

information, see www.hrsa.gov/vaccinecompensation/index.html.

COVID-19 Vaccination

COVID-19 vaccines are recommended for use within the scope 

of the Emergency Use Authorization or Biologics License 

Application for the particular vaccine. ACIP recommendations 

for the use of COVID-19 vaccines can be found at www.cdc.gov/

vaccines/hcp/acip-recs/vacc-specific/covid-19.html. 

CDC’s interim clinical considerations for use of COVID-19 

vaccines can be found at www.cdc.gov/vaccines/covid-19/clinicalconsiderations/covid-19-vaccines-us.html.

Notes Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger, United States, 2022
Hepatitis A vaccination 

(minimum age: 12 months for routine vaccination)

Routine vaccination

y 2-dose series (minimum interval: 6 months) at age 12–23 months

Catch-up vaccination

y Unvaccinated persons through age 18 years should complete a 

2-dose series (minimum interval: 6 months). 

y Persons who previously received 1 dose at age 12 months or older 

should receive dose 2 at least 6 months after dose 1.

y Adolescents age 18 years or older may receive the combined HepA 

and HepB vaccine, Twinrix®, as a 3-dose series (0, 1, and 6 months) or 

4-dose series (3 doses at 0, 7, and 21–30 days, followed by a booster 

dose at 12 months).

International travel

y Persons traveling to or working in countries with high or intermediate 

endemic hepatitis A (www.cdc.gov/travel/):

- Infants age 6–11 months: 1 dose before departure; revaccinate 

with 2 doses, separated by at least 6 months, between age 12–23 

months.

- Unvaccinated age 12 months or older: Administer dose 1 as soon 

as travel is considered.

Hepatitis B vaccination 

(minimum age: birth)

Birth dose (monovalent HepB vaccine only)

y Mother is HBsAg-negative: 

- All medically stable infants ≥2,000 grams: 1 dose within 24 hours of 

birth 

- Infants <2,000 grams: Administer 1 dose at chronological age 

1 month or hospital discharge (whichever is earlier and even if 

weight is still <2,000 grams).

y Mother is HBsAg-positive:

- Administer HepB vaccine and hepatitis B immune globulin (HBIG) 

(in separate limbs) within 12 hours of birth, regardless of birth 

weight. For infants <2,000 grams, administer 3 additional doses of 

vaccine (total of 4 doses) beginning at age 1 month.

- Test for HBsAg and anti-HBs at age 9–12 months. If HepB series is 

delayed, test 1–2 months after final dose.

y Mother’s HBsAg status is unknown: 

- Administer HepB vaccine within 12 hours of birth, regardless of 

birth weight. 

- For infants <2,000 grams, administer HBIG in addition to HepB 

vaccine (in separate limbs) within 12 hours of birth. Administer 3 

additional doses of vaccine (total of 4 doses) beginning at age 1 

month.

- Determine mother’s HBsAg status as soon as possible. If mother is 

HBsAg-positive, administer HBIG to infants ≥2,000 grams as soon as 

possible, but no later than 7 days of age.

Routine series

y 3-dose series at age 0, 1–2, 6–18 months (use monovalent HepB 

vaccine for doses administered before age 6 weeks)

y Infants who did not receive a birth dose should begin the series as 

soon as feasible (see Table 2).

y Administration of 4 doses is permitted when a combination vaccine 

containing HepB is used after the birth dose.

y Minimum age for the final (3rd or 4th ) dose: 24 weeks 

y Minimum intervals: dose 1 to dose 2: 4 weeks / dose 2 to dose 3: 

8 weeks / dose 1 to dose 3: 16 weeks (when 4 doses are administered, 

substitute “dose 4” for “dose 3” in these calculations)

Catch-up vaccination

y Unvaccinated persons should complete a 3-dose series at 0, 1–2, 6 

months.

y Adolescents age 11–15 years may use an alternative 2-dose 

schedule with at least 4 months between doses (adult formulation 

Recombivax HB® only).

y Adolescents age 18 years or older may receive a 2-dose series of HepB 

(Heplisav-B®) at least 4 weeks apart.

y Adolescents age 18 years or older may receive the combined HepA 

and HepB vaccine, Twinrix®, as a 3-dose series (0, 1, and 6 months) or 

4-dose series (3 doses at 0, 7, and 21–30 days, followed by a booster 

dose at 12 months).

y For other catch-up guidance, see Table 2.

Special situations

y Revaccination is not generally recommended for persons with a 

normal immune status who were vaccinated as infants, children, 

adolescents, or adults.

y Post-vaccination serology testing and revaccination (if anti-HBs < 

10mlU/mL) is recommended for certain populations, including:

- Infants born to HBsAg-positive mothers

- Hemodialysis patients

- Other immunocompromised persons

For detailed revaccination recommendations, see www.cdc.gov/

vaccines/hcp/acip-recs/vacc-specific/hepb.html.

Human papillomavirus vaccination 

(minimum age: 9 years)

Routine and catch-up vaccination

y HPV vaccination routinely recommended at age 11–12 years (can 

start at age 9 years) and catch-up HPV vaccination recommended for 

all persons through age 18 years if not adequately vaccinated 

y 2- or 3-dose series depending on age at initial vaccination: 

- Age 9–14 years at initial vaccination: 2-dose series at 0, 6–12 

months (minimum interval: 5 months; repeat dose if administered 

too soon) 

- Age 15 years or older at initial vaccination: 3-dose series at 0, 1–2 

months, 6 months (minimum intervals: dose 1 to dose 2: 4 weeks / 

dose 2 to dose 3: 12 weeks / dose 1 to dose 3: 5 months; repeat dose 

if administered too soon) 

y Interrupted schedules: If vaccination schedule is interrupted, the 

series does not need to be restarted.

y No additional dose recommended when any HPV vaccine series has 

been completed using the recommended dosing intervals.

Special situations

y Immunocompromising conditions, including HIV infection:

3-dose series, even for those who initiate vaccination at age 9 through 

14 years.

y History of sexual abuse or assault: Start at age 9 years.

y Pregnancy: Pregnancy testing not needed before vaccination; HPV 

vaccination not recommended until after pregnancy; no intervention 

needed if vaccinated while pregnant

Influenza vaccination 

(minimum age: 6 months [IIV], 2 years [LAIV4], 

18 years [recombinant influenza vaccine, RIV4])

Routine vaccination

y Use any influenza vaccine appropriate for age and health status 

annually:

- 2 doses, separated by at least 4 weeks, for children age 6 months–8 

years who have received fewer than 2 influenza vaccine doses 

before July 1, 2021, or whose influenza vaccination history is 

unknown (administer dose 2 even if the child turns 9 between 

receipt of dose 1 and dose 2)

- 1 dose for children age 6 months–8 years who have received at 

least 2 influenza vaccine doses before July 1, 2021

- 1 dose for all persons age 9 years or older

y For the 2021-2022 season, see www.cdc.gov/mmwr/volumes/70/rr/

rr7005a1.htm.

y For the 2022–23 season, see the 2022–23 ACIP influenza vaccine 

recommendations.

Special situations

y Egg allergy, hives only: Any influenza vaccine appropriate for age 

and health status annually

y Egg allergy with symptoms other than hives (e.g., angioedema, 

respiratory distress) or required epinephrine or another emergency 

medical intervention: see Appendix listing contraindications and 

precautions

y Severe allergic reaction (e.g., anaphylaxis) to a vaccine 

component or a previous dose of any influenza vaccine: see 

Appendix listing contraindications and precautions

Measles, mumps, and rubella vaccination 

(minimum age: 12 months for routine vaccination)

Routine vaccination

y 2-dose series at age 12–15 months, age 4–6 years

y MMR or MMRV may be administered

Note: For dose 1 in children age 12–47 months, it is recommended to 

administer MMR and varicella vaccines separately. MMRV may be used if 

parents or caregivers express a preference.

Catch-up vaccination

y Unvaccinated children and adolescents: 2-dose series at least 4 weeks 

apart

y The maximum age for use of MMRV is 12 years.

y Minimum interval between MMRV doses: 3 months

Special situations

International travel

y Infants age 6–11 months: 1 dose before departure; revaccinate with 

2-dose series at age 12–15 months (12 months for children in high-risk 

areas) and dose 2 as early as 4 weeks later.

y Unvaccinated children age 12 months or older: 2-dose series at least 

4 weeks apart before departure

Notes Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger, United States, 2022
Meningococcal serogroup A,C,W,Y vaccination

(minimum age: 2 months [MenACWY-CRM, 

Menveo], 9 months [MenACWY-D, Menactra], 2 years 

[MenACWY-TT, MenQuadfi])

Routine vaccination

y 2-dose series at age 11–12 years; 16 years

Catch-up vaccination

y Age 13–15 years: 1 dose now and booster at age 16–18 years 

(minimum interval: 8 weeks)

y Age 16–18 years: 1 dose 

Special situations

Anatomic or functional asplenia (including sickle cell disease), 

HIV infection, persistent complement component deficiency, 

complement inhibitor (e.g., eculizumab, ravulizumab) use:

y Menveo

- Dose 1 at age 2 months: 4-dose series (additional 3 doses at age 4, 6 

and 12 months)

- Dose 1 at age 3–6 months: 3- or 4- dose series (dose 2 [and dose 

3 if applicable] at least 8 weeks after previous dose until a dose is 

received at age 7 months or older, followed by an additional dose at 

least 12 weeks later and after age 12 months)

- Dose 1 at age 7–23 months: 2-dose series (dose 2 at least 12 weeks 

after dose 1 and after age 12 months)

- Dose 1 at age 24 months or older: 2-dose series at least 8 weeks apart

y Menactra

- Persistent complement component deficiency or complement 

inhibitor use: 

 Age 9–23 months: 2-dose series at least 12 weeks apart

 Age 24 months or older: 2-dose series at least 8 weeks apart

- Anatomic or functional asplenia, sickle cell disease, or HIV 

infection: 

 Age 9–23 months: Not recommended 

 Age 24 months or older: 2-dose series at least 8 weeks apart 

 Menactra® must be administered at least 4 weeks after completion 

of PCV13 series.

y MenQuadfi®

- Dose 1 at age 24 months or older: 2-dose series at least 8 weeks apart

Travel in countries with hyperendemic or epidemic meningococcal 

disease, including countries in the African meningitis belt or during 

the Hajj (www.cdc.gov/travel/):

y Children less than age 24 months:

- Menveo® (age 2–23 months)

 Dose 1 at age 2 months: 4-dose series (additional 3 doses at age 4, 6 

and 12 months)

 Dose 1 at age 3–6 months: 3- or 4- dose series (dose 2 [and dose 

3 if applicable] at least 8 weeks after previous dose until a dose is 

received at age 7 months or older, followed by an additional dose at 

least 12 weeks later and after age 12 months)

 Dose 1 at age 7–23 months: 2-dose series (dose 2 at least 12 weeks 

after dose 1 and after age 12 months)

- Menactra® (age 9–23 months)

 2-dose series (dose 2 at least 12 weeks after dose 1; dose 2 may be 

administered as early as 8 weeks after dose 1 in travelers)

y Children age 2 years or older: 1 dose Menveo®, Menactra®, or 

MenQuadfi®

First-year college students who live in residential housing (if not 

previously vaccinated at age 16 years or older) or military recruits:

y 1 dose Menveo®, Menactra®, or MenQuadfi®

Adolescent vaccination of children who received MenACWY prior to 

age 10 years:

y Children for whom boosters are recommended because of an 

ongoing increased risk of meningococcal disease (e.g., those with 

complement deficiency, HIV, or asplenia): Follow the booster schedule 

for persons at increased risk.

y Children for whom boosters are not recommended (e.g., a healthy 

child who received a single dose for travel to a country where 

meningococcal disease is endemic): Administer MenACWY according 

to the recommended adolescent schedule with dose 1 at age 11–12 

years and dose 2 at age 16 years.

Note: Menactra® should be administered either before or at the same 

time as DTaP. MenACWY vaccines may be administered simultaneously 

with MenB vaccines if indicated, but at a different anatomic site, if 

feasible.

For MenACWY booster dose recommendations for groups listed 

under “Special situations” and in an outbreak setting and additional 

meningococcal vaccination information, see www.cdc.gov/mmwr/

volumes/69/rr/rr6909a1.htm.

Meningococcal serogroup B vaccination

(minimum age: 10 years [MenB-4C, Bexsero®; 

MenB-FHbp, Trumenba®])

Shared clinical decision-making

y Adolescents not at increased risk age 16–23 years (preferred age 

16–18 years) based on shared clinical decision-making:

- Bexsero®: 2-dose series at least 1 month apart

- Trumenba®: 2-dose series at least 6 months apart; if dose 2 is 

administered earlier than 6 months, administer a 3rd dose at least 4 

months after dose 2. 

Special situations

Anatomic or functional asplenia (including sickle cell disease), 

persistent complement component deficiency, complement 

inhibitor (e.g., eculizumab, ravulizumab) use:

y Bexsero®: 2-dose series at least 1 month apart

y Trumenba®: 3-dose series at 0, 1–2, 6 months

Note: Bexsero® and Trumenba® are not interchangeable; the same 

product should be used for all doses in a series.

For MenB booster dose recommendations for groups listed under 

“Special situations” and in an outbreak setting and additional 

meningococcal vaccination information, see www.cdc.gov/mmwr/

volumes/69/rr/rr6909a1.htm.

Pneumococcal vaccination 

(minimum age: 6 weeks [PCV13], 2 years [PPSV23])

Routine vaccination with PCV13

y 4-dose series at age 2, 4, 6, 12–15 months

Catch-up vaccination with PCV13

y 1 dose for healthy children age 24–59 months with any incomplete* 

PCV13 series

y For other catch-up guidance, see Table 2.

Special situations

Underlying conditions below: When both PCV13 and PPSV23 are 

indicated, administer PCV13 first. PCV13 and PPSV23 should not 

be administered during same visit.

Chronic heart disease (particularly cyanotic congenital heart 

disease and cardiac failure); chronic lung disease (including 

asthma treated with high-dose, oral corticosteroids); diabetes 

mellitus:

Age 2–5 years

y Any incomplete* series with:

- 3 PCV13 doses: 1 dose PCV13 (at least 8 weeks after any prior PCV13 

dose)

- Less than 3 PCV13 doses: 2 doses PCV13 (8 weeks after the most 

recent dose and administered 8 weeks apart)

y No history of PPSV23: 1 dose PPSV23 (at least 8 weeks after completing 

all recommended PCV13 doses)

Age 6–18 years

y No history of PPSV23: 1 dose PPSV23 (at least 8 weeks after completing 

all recommended PCV13 doses)

Cerebrospinal fluid leak, cochlear implant:

Age 2–5 years

y Any incomplete* series with:

- 3 PCV13 doses: 1 dose PCV13 (at least 8 weeks after any prior PCV13 

dose)

- Less than 3 PCV13 doses: 2 doses PCV13 (8 weeks after the most 

recent dose and administered 8 weeks apart)

y No history of PPSV23: 1 dose PPSV23 (at least 8 weeks after any prior 

PCV13 dose) 

Age 6–18 years

y No history of either PCV13 or PPSV23: 1 dose PCV13, 1 dose PPSV23 at 

least 8 weeks later

y Any PCV13 but no PPSV23: 1 dose PPSV23 at least 8 weeks after the 

most recent dose of PCV13

y PPSV23 but no PCV13: 1 dose PCV13 at least 8 weeks after the most 

recent dose of PPSV23

Sickle cell disease and other hemoglobinopathies; anatomic or 

functional asplenia; congenital or acquired immunodeficiency; HIV 

infection; chronic renal failure; nephrotic syndrome; malignant 

neoplasms, leukemias, lymphomas, Hodgkin disease, and other 

diseases associated with treatment with immunosuppressive 

drugs or radiation therapy; solid organ transplantation; multiple 

myeloma:

Age 2–5 years

y Any incomplete* series with:

- 3 PCV13 doses: 1 dose PCV13 (at least 8 weeks after any prior PCV13 

dose)

- Less than 3 PCV13 doses: 2 doses PCV13 (8 weeks after the most 

recent dose and administered 8 weeks apart)

y No history of PPSV23: 1 dose PPSV23 (at least 8 weeks after any prior 

PCV13 dose) and a dose 2 of PPSV23 5 years later

Age 6–18 years

y No history of either PCV13 or PPSV23: 1 dose PCV13, 2 doses PPSV23 

(dose 1 of PPSV23 administered 8 weeks after PCV13 and dose 2 of 

PPSV23 administered at least 5 years after dose 1 of PPSV23)

y Any PCV13 but no PPSV23: 2 doses PPSV23 (dose 1 of PPSV23 

administered 8 weeks after the most recent dose of PCV13 and dose 2 

of PPSV23 administered at least 5 years after dose 1 of PPSV23)

y PPSV23 but no PCV13: 1 dose PCV13 at least 8 weeks after the most 

recent PPSV23 dose and a dose 2 of PPSV23 administered 5 years after 

dose 1 of PPSV23 and at least 8 weeks after a dose of PCV13

Notes Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger, United States, 2022
Chronic liver disease, alcoholism:

Age 6–18 years

y No history of PPSV23: 1 dose PPSV23 (at least 8 weeks after any prior 

PCV13 dose)

*Incomplete series = Not having received all doses in either the 

recommended series or an age-appropriate catch-up series 

See Tables 8, 9, and 11 in the ACIP pneumococcal vaccine 

recommendations (www.cdc.gov/mmwr/pdf/rr/rr5911.pdf) for 

complete schedule details.

Poliovirus vaccination 

(minimum age: 6 weeks)

Routine vaccination

y 4-dose series at ages 2, 4, 6–18 months, 4–6 years; administer the 

final dose on or after age 4 years and at least 6 months after the 

previous dose.

y 4 or more doses of IPV can be administered before age 4 years when 

a combination vaccine containing IPV is used. However, a dose is still 

recommended on or after age 4 years and at least 6 months after the 

previous dose.

Catch-up vaccination

y In the first 6 months of life, use minimum ages and intervals only 

for travel to a polio-endemic region or during an outbreak.

y IPV is not routinely recommended for U.S. residents age 18 years 

or older.

Series containing oral polio vaccine (OPV), either mixed OPV-IPV or 

OPV-only series:

y Total number of doses needed to complete the series is the same 

as that recommended for the U.S. IPV schedule. See www.cdc.gov/

mmwr/volumes/66/wr/mm6601a6.htm?s_%20cid=mm6601a6_w.

y Only trivalent OPV (tOPV) counts toward the U.S. vaccination 

requirements. 

- Doses of OPV administered before April 1, 2016, should be 

counted (unless specifically noted as administered during a 

campaign). 

- Doses of OPV administered on or after April 1, 2016, should not 

be counted.

- For guidance to assess doses documented as “OPV,” see 

www.cdc.gov/mmwr/volumes/66/wr/mm6606a7.htm?s_

cid=mm6606a7_w.

y For other catch-up guidance, see Table 2.

Rotavirus vaccination 

(minimum age: 6 weeks)

Routine vaccination

y Rotarix®: 2-dose series at age 2 and 4 months

y RotaTeq®: 3-dose series at age 2, 4, and 6 months

y If any dose in the series is either RotaTeq® or unknown, default to 

3-dose series.

Catch-up vaccination

y Do not start the series on or after age 15 weeks, 0 days.

y The maximum age for the final dose is 8 months, 0 days.

y For other catch-up guidance, see Table 2.

Tetanus, diphtheria, and pertussis (Tdap) 

vaccination 

(minimum age: 11 years for routine vaccination, 

7 years for catch-up vaccination)

Routine vaccination 

y Adolescents age 11–12 years: 1 dose Tdap

y Pregnancy: 1 dose Tdap during each pregnancy, preferably in 

early part of gestational weeks 27–36.

y Tdap may be administered regardless of the interval since the last 

tetanus- and diphtheria-toxoid-containing vaccine.

Catch-up vaccination

y Adolescents age 13–18 years who have not received Tdap:

1 dose Tdap, then Td or Tdap booster every 10 years

y Persons age 7–18 years not fully vaccinated* with DTaP: 1 dose 

Tdap as part of the catch-up series (preferably the first dose); if 

additional doses are needed, use Td or Tdap.

y Tdap administered at age 7–10 years:

- Children age 7–9 years who receive Tdap should receive the 

routine Tdap dose at age 11–12 years.

- Children age 10 years who receive Tdap do not need the routine 

Tdap dose at age 11–12 years. 

y DTaP inadvertently administered on or after age 7 years:

- Children age 7–9 years: DTaP may count as part of catch-up 

series. Administer routine Tdap dose at age 11–12 years.

- Children age 10–18 years: Count dose of DTaP as the adolescent 

Tdap booster.

y For other catch-up guidance, see Table 2.

Special situations

y Wound management in persons age 7 years or older with history 

of 3 or more doses of tetanus-toxoid-containing vaccine: For clean 

and minor wounds, administer Tdap or Td if more than 10 years 

since last dose of tetanus-toxoid-containing vaccine; for all other 

wounds, administer Tdap or Td if more than 5 years since last dose of 

tetanus-toxoid-containing vaccine. Tdap is preferred for persons age 

11 years or older who have not previously received Tdap or whose 

Tdap history is unknown. If a tetanus-toxoid-containing vaccine is 

indicated for a pregnant adolescent, use Tdap. 

y For detailed information, see www.cdc.gov/mmwr/volumes/69/wr/

mm6903a5.htm.

*Fully vaccinated = 5 valid doses of DTaP OR 4 valid doses of DTaP if 

dose 4 was administered at age 4 years or older

Varicella vaccination 

(minimum age: 12 months)

Routine vaccination

y 2-dose series at age 12–15 months, 4–6 years 

y VAR or MMRV may be administered*

y Dose 2 may be administered as early as 3 months after dose 1 

(a dose inadvertently administered after at least 4weeks may be 

counted as valid)

*Note: For dose 1 in children age 12–47 months, it is recommended to 

administer MMR and varicella vaccines separately. MMRV may be used 

if parents or caregivers express a preference.

Catch-up vaccination

y Ensure persons age 7–18 years without evidence of immunity (see 

MMWR at www.cdc.gov/mmwr/pdf/rr/rr5604.pdf) have a 2-dose 

series:

- Age 7–12 years: routine interval: 3 months (a dose inadvertently 

administered after at least 4 weeks may be counted as valid)

- Age 13 years and older: routine interval: 4–8 weeks (minimum 

interval: 4 weeks)

- The maximum age for use of MMRV is 12 years.

Notes Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger, United States, 2022

2/17/2022 Centers for Disease Control and Prevention | Recommended Child and Adolescent Immunization Schedule, United States, 2022
Vaccine Contraindications1 Precautions2

Influenza, egg-based, 

inactivated injectable (IIV4)

• Severe allergic reaction (e.g., anaphylaxis) after previous dose of any influenza vaccine (i.e., 

any egg-based IIV, ccIIV, RIV, or LAIV of any valency) 

• Severe allergic reaction (e.g., anaphylaxis) to any vaccine component3 (excluding egg)

• Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any type of 

influenza vaccine

• Persons with egg allergy with symptoms other than hives (e.g., angioedema, respiratory 

distress) or required epinephrine or another emergency medical intervention: Any 

influenza vaccine appropriate for age and health status may be administered. If using 

egg-based IIV4, administer in medical setting under supervision of health care provider 

who can recognize and manage severe allergic reactions. May consult an allergist.

• Moderate or severe acute illness with or without fever

Influenza, cell culture-based 

inactivated injectable 

[(ccIIV4), Flucelvax® 

Quadrivalent]

• Severe allergic reaction (e.g., anaphylaxis) to any ccIIV of any valency, or to any component3

of ccIIV4

• Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any type of 

influenza vaccine

• Persons with a history of severe allergic reaction (e.g., anaphylaxis) after a previous dose 

of any egg-based IIV, RIV, or LAIV of any valency. If using ccIV4, administer in medical 

setting under supervision of health care provider who can recognize and manage severe 

allergic reactions. May consult an allergist.

• Moderate or severe acute illness with or without fever

Influenza, recombinant 

injectable 

[(RIV4), Flublok® 

Quadrivalent]

• Severe allergic reaction (e.g., anaphylaxis) to any RIV of any valency, or to any component3 of 

RIV4

• Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any type of 

influenza vaccine

• Persons with a history of severe allergic reaction (e.g., anaphylaxis) after a previous dose 

of any egg- based IIV, ccIIV, or LAIV of any valency. If using RIV4, administer in medical 

setting under supervision of health care provider who can recognize and manage severe 

allergic reactions. May consult an allergist.

• Moderate or severe acute illness with or without fever

Influenza, live attenuated 

[LAIV4, Flumist® 

Quadrivalent]

• Severe allergic reaction (e.g., anaphylaxis) after previous dose of any influenza vaccine (i.e., 

any egg-based IIV, ccIIV, RIV, or LAIV of any valency) 

• Severe allergic reaction (e.g., anaphylaxis) to any vaccine component3 (excluding egg)

• Children age 2 – 4 years with a history of asthma or wheezing

• Anatomic or functional asplenia

• Immunocompromised due to any cause including, but not limited to, medications and HIV 

infection

• Close contacts or caregivers of severely immunosuppressed persons who require a protected 

environment

• Pregnancy

• Cochlear implant

• Active communication between the cerebrospinal fluid (CSF) and the oropharynx, 

nasopharynx, nose, ear or any other cranial CSF leak

• Children and adolescents receiving aspirin or salicylate-containing medications

• 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

• Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any type of 

influenza vaccine

• Asthma in persons aged 5 years old or older

• Persons with egg allergy with symptoms other than hives (e.g., angioedema, respiratory 

distress) or required epinephrine or another emergency medical intervention: Any 

influenza vaccine appropriate for age and health status may be administered. If using 

LAIV4 (which is egg based), administer in medical setting under supervision of health 

care provider who can recognize and manage severe allergic reactions. May consult an 

allergist.

• Persons with underlying medical conditions (other than those listed under 

contraindications) that might predispose to complications after wild-type influenza virus 

infection [e.g., chronic pulmonary, cardiovascular (except isolated hypertension), renal, 

hepatic, neurologic, hematologic, or metabolic disorders (including diabetes mellitus)]

• Moderate or severe acute illness with or without fever

1. When a contraindication is present, a vaccine should NOT be administered. Kroger A, Bahta L, Hunter P. ACIP General Best Practice Guidelines for Immunization. www.cdc.gov/vaccines/hcp/acip-recs/general-recs/

contraindications.html

2. When a precaution is present, vaccination should generally be deferred but might be indicated if the benefit of protection from the vaccine outweighs the risk for an adverse reaction. Kroger A, Bahta L, Hunter P. ACIP 

General Best Practice Guidelines for Immunization. www.cdc.gov/vaccines/hcp/acip-recs/general-recs/contraindications.html

3. Vaccination providers should check FDA-approved prescribing information for the most complete and updated information, including contraindications, warnings, and precautions. Package inserts for U.S.-licensed 

vaccines are available at www.fda.gov/vaccines-blood-biologics/approved-products/vaccines-licensed-use-united-states

Guide to Contraindications and Precautions to Commonly Used Vaccines

Adapted from Table 4-1 in Advisory Committee on Immunization Practices (ACIP) General Best Practice Guidelines for Immunization: Contraindication and Precautions available at www.cdc.gov/vaccines/hcp/aciprecs/general-recs/contraindications.html and ACIP’s Recommendations for the Prevention and Control of 2021-22 seasonal influenza with Vaccines available at www.cdc.gov/mmwr/volumes/70/rr/rr7005a1.htm.

Interim clinical considerations for use of COVID-19 vaccines including contraindications and precautions can be found at 

www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html

Appendix Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger, United States, 2022
Appendix Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger, United States, 2022

Vaccine Contraindications1 Precautions2

Dengue (DEN4CYD) • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3

• Severe immunodeficiency (e.g., hematologic and solid tumors, receipt of chemotherapy, congenital 

immunodeficiency, long- term immunosuppressive therapy or patients with HIV infection who are severely 

immunocompromised)

• Pregnancy

• HIV infection without evidence of severe immunosuppression

• Moderate or severe acute illness with or without fever

Diphtheria, tetanus, pertussis (DTaP)

Tetanus, diphtheria (DT)

• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3

• For DTaP only: Encephalopathy (e.g., coma, decreased level of consciousness, prolonged seizures) not 

attributable to another identifiable cause within 7 days of administration of previous dose of DTP or DTaP

• Guillain-Barré syndrome (GBS) within 6 weeks after previous dose of tetanus-toxoid–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

• For DTaP only: Progressive neurologic disorder, including infantile spasms, uncontrolled epilepsy, 

progressive encephalopathy; defer DTaP until neurologic status clarified and stabilized

• Moderate or severe acute illness with or without fever

Haemophilus influenzae type b (Hib) • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3

• For Hiberix, ActHib, and PedvaxHIB only: History of severe allergic reaction to dry natural latex

• Less than age 6 weeks

• Moderate or severe acute illness with or without fever

Hepatitis A (HepA) • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 including 

neomycin

• Moderate or severe acute illness with or without fever

Hepatitis B (HepB) • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 including yeast • For Heplisav-B only: Pregnancy• Moderate or severe acute illness with or without fever

Hepatitis A- Hepatitis B vaccine 

[HepA-HepB, (Twinrix®)]

• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 including 

neomycin and yeast

• Moderate or severe acute illness with or without fever

Human papillomavirus (HPV) • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 • Moderate or severe acute illness with or without fever

Measles, mumps, rubella (MMR) • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3

• Severe immunodeficiency (e.g., hematologic and solid tumors, receipt of chemotherapy, congenital 

immunodeficiency, long-term immunosuppressive therapy or patients with HIV infection who are severely 

immunocompromised)

• Pregnancy 

• Family history of altered immunocompetence, unless verified clinically or by laboratory testing as 

immunocompetent

• Recent (≤11 months) receipt of antibody-containing 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

• Moderate or severe acute illness with or without fever

Meningococcal ACWY (MenACWY)

[MenACWY-CRM (Menveo®); 

MenACWY-D (Menactra®); 

MenACWY-TT (MenQuadfi®)]

• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3

• For MenACWY-D and Men ACWY-CRM only: severe allergic reaction to any diphtheria toxoid– or CRM197–

containing vaccine

• For MenACWY-TT only: severe allergic reaction to a tetanus toxoid-containing vaccine

• For MenACWY-CRM only: Preterm birth if less than age 9 months

• Moderate or severe acute illness with or without fever

Meningococcal B (MenB)

[MenB-4C (Bexsero®); 

MenB-FHbp (Trumenba®)]

• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 • Pregnancy

• For MenB-4C only: Latex sensitivity 

• Moderate or severe acute illness with or without fever

Pneumococcal conjugate (PCV13) • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3

• Severe allergic reaction (e.g., anaphylaxis) to any diphtheria-toxoid– containing vaccine or its component3

• Moderate or severe acute illness with or without fever

Pneumococcal polysaccharide 

(PPSV23) 

• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 • Moderate or severe acute illness with or without fever

Poliovirus vaccine, inactivated (IPV) • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 • Pregnancy

• Moderate or severe acute illness with or without fever

Rotavirus (RV) [RV1 (Rotarix®), 

RV5 (RotaTeq®)]

• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3

• Severe combined immunodeficiency (SCID)

• History of intussusception

• Altered immunocompetence other than SCID

• Chronic gastrointestinal disease

• RV1 only: Spina bifida or bladder exstrophy

• Moderate or severe acute illness with or without fever

Tetanus, diphtheria, and acellular 

pertussis (Tdap) 

 Tetanus, diphtheria (Td)

• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3

• For Tdap only: Encephalopathy (e.g., coma, decreased level of consciousness, prolonged seizures) not 

attributable to another identifiable cause within 7 days of administration of previous dose of DTP, DTaP, or 

Tdap

• Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of tetanus-toxoid–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

• For Tdap only: Progressive or unstable neurological disorder, uncontrolled seizures, or progressive 

encephalopathy until a treatment regimen has been established and the condition has stabilized

• Moderate or severe acute illness with or without fever

Varicella (VAR) • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3

• Severe immunodeficiency (e.g., hematologic and solid tumors, receipt of chemotherapy, congenital 

immunodeficiency, long- term immunosuppressive therapy or patients with HIV infection who are severely 

immunocompromised)

• Pregnancy

• Family history of altered immunocompetence, unless verified clinically or by laboratory testing as 

immunocompetent

• Recent (≤11 months) receipt of antibody-containing blood product (specific interval depends on product)

• Receipt of specific antiviral drugs (acyclovir, famciclovir, or valacyclovir) 24 hours before vaccination (avoid 

use of these antiviral drugs for 14 days after vaccination)

• Use of aspirin or aspirin-containing products

• Moderate or severe acute illness with or without fever

1. When a contraindication is present, a vaccine should NOT be administered. Kroger A, Bahta L, Hunter P. ACIP General Best Practice Guidelines for Immunization. www.cdc.gov/vaccines/hcp/acip-recs/general-recs/contraindications.html

2. When a precaution is present, vaccination should generally be deferred but might be indicated if the benefit of protection from the vaccine outweighs the risk for an adverse reaction. Kroger A, Bahta L, Hunter P. ACIP General Best Practice 

Guidelines for Immunization. www.cdc.gov/vaccines/hcp/acip-recs/general-recs/contraindications.html

3. Vaccination providers should check FDA-approved prescribing information for the most complete and updated information, including contraindications, warnings, and precautions. Package inserts for U.S.-licensed vaccines are available at 

www.fda.gov/vaccines-blood-biologics/approved-products/vaccines-licensed-use-united-states.