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Child Immunization Schedule AppendixRecommendations for Ages 18 Years or Younger, United States, 2024						Print
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Vaccines and Other Immunizing Agents in the Child Immunization Schedule
**How to use the schedule**
To make vaccination recommendations, healthcare providers should:
Determine recommended vaccine by age (**Table 1 - By Age**)
Determine recommended interval for catch-up vaccination (**Table 2 - Catch-up**)
Assess need for additional recommended vaccines by medical condition or other indication (**Table 3 - By Medical Indication**)
Review vaccine types, frequencies, intervals, and considerations for special situations (**Notes**)
Review contraindications and precautions for vaccine types (**Appendix**)
Review new or updated ACIP guidance (**Addendum**)
Appendix – 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, Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2023–24 Influenza Season*,*Contraindications and Precautions for COVID-19 Vaccination, and Contraindications and Precautions for JYNNEOS Vaccination.
COVID-19 and Flu Vaccineschild schedule appendix for COVID-19 and Influenza vaccines
Vaccines and other
Immunizing Agents
Contraindicated or Not Recommended1
Precautions2COVID-19 mRNA vaccines
[Pfizer-BioNTech, Moderna]
Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a component of an mRNA COVID-19 vaccine5
Diagnosed non-severe allergy (e.g., urticaria beyond the injection site) to a component of an mRNA COVID-19 vaccine5; or non-severe, immediate (onset less than 4 hours) allergic reaction after administration of a previous dose of an mRNA COVID-19 vaccine
Myocarditis or pericarditis within 3 weeks after a dose of any COVID-19 vaccine
Multisystem inflammatory syndrome in children (MIS-C) or multisystem inflammatory syndrome in adults (MIS-A)
Moderate or severe acute illness, with or without feverCOVID-19 protein subunit vaccine
[Novavax]
Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a component of a Novavax COVID-19 vaccine5
Diagnosed non-severe allergy (e.g., urticaria beyond the injection site) to a component of Novavax COVID-19 vaccine5; or non-severe, immediate (onset less than 4 hours) allergic reaction after administration of a previous dose of a Novavax COVID-19 vaccine
Myocarditis or pericarditis within 3 weeks after a dose of any COVID-19 vaccine
Multisystem inflammatory syndrome in children (MIS-C) or multisystem inflammatory syndrome in adults (MIS-A)
Moderate or severe acute illness, with or without feverInfluenza, 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
Moderate or severe acute illness with or without feverInfluenza, 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 feverInfluenza, 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 feverInfluenza, 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 age 5 years old or older
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 feverWhen a contraindication is present, a vaccine should **NOT** be administered. Kroger A, Bahta L, Hunter P. ACIP General Best Practice Guidelines for Immunization.
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.
Vaccination providers should check FDA-approved prescribing information for the most complete and updated information, including contraindications, warnings, and precautions. See Package inserts for U.S.-licensed vaccines.
See package inserts and FDA EUA fact sheets for a full list of vaccine ingredients. mRNA COVID-19 vaccines contain polyethylene glycol (PEG).
Other Vaccineschild schedule appendix for other vaccines
Vaccines and other
Immunizing Agents
Contraindicated or Not Recommended1
Precautions2Dengue (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)
Lack of laboratory confirmation of a previous Dengue infection
Pregnancy
HIV infection without evidence of severe immunosuppression
Moderate or severe acute illness with or without feverDiphtheria, tetanus, pertussis (DTaP)
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
Less than age 6 weeks
Moderate or severe acute illness with or without feverHepatitis 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 feverHepatitis B (HepB)
Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 including yeast
Pregnancy: Heplisav-B and PreHevbrio are not recommended due to lack of safety data in pregnant persons. Use other hepatitis B vaccines if HepB is indicated4.
Moderate or severe acute illness with or without feverHepatitis 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 feverHuman papillomavirus (HPV)
Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
Pregnancy: HPV vaccination not recommended
Moderate or severe acute illness with or without feverMeasles, mumps, rubella (MMR)
Measles, mumps, rubella, and varicella (MMRV)
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
For MMRV only: Personal or family (i.e., sibling or parent) history of seizures of any etiologyMeningococcal ACWY (MenACWY)
(MenACWY-CRM) [Menveo]
(MenACWY-TT) [MenQuadfi]
Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
For MenACWY-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 feverMeningococcal 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 feverMeningococcal ABCWY
(MenACWY-TT/MenB-FHbp) [Penbraya]
Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
Severe allergic reaction to a tetanus toxoid-containing vaccine
Moderate or severe acute illness, with or without feverMpox [Jynneos]
Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
Moderate or severe acute illness, with or without feverPneumococcal conjugate (PCV)
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 feverPneumococcal 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 feverPoliovirus 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 feverRSV monoclonal antibody (RSV-mAb)
Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component5
Moderate or severe acute illness with or without feverRespiratory syncytial virus vaccine (RSV)
Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
Moderate or severe acute illness with or without feverRotavirus (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 feverTetanus, 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 feverVaricella (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
If using MMRV, see MMR/MMRV for additional precautionsWhen a contraindication is present, a vaccine should NOT be administered. Kroger A, Bahta L, Hunter P. ACIP General Best Practice Guidelines for Immunization.
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.
Vaccination providers should check FDA-approved prescribing information for the most complete and updated information, including contraindications, warnings, and precautions. See package inserts for U.S.-licensed vaccines.
For information on the pregnancy exposure registries for persons who were inadvertently vaccinated with Heplisav-B or PreHevbrio while pregnant, please visit heplisavbpregnancyregistry.com/ or www.prehevbrio.com/#safety.
Full prescribing information for BEYFORTUS (nirsevimab-alip) www.accessdata.fda.gov/drugsatfda_docs/label/2023/761328s000lbl.pdf
							
					
							Last Reviewed:  December 6, 2023						Source: 	National Center for Immunization and Respiratory Diseases
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        Syndicate homeSchedules Home
For Healthcare Providersplus icon
Child & Adolescent Immunization Scheduleplus icon
Vaccines in the Schedule
Table 1 – By Age
Table 2 – Catch-up
Table 3 – By Medical Indication
Notes
Appendix
Addendum
Adult Immunization Scheduleplus icon
Vaccines in the Schedule
Table 1 – By Age
Table 2 – By Medical Indication
Notes
Appendix
Addendum
Schedule Changes & Guidance
Resourcesplus icon
Schedule-Related Resources
For You and Your Familyplus icon
Schedule for Infants and Children (Birth – 6 Years)
Schedule for Preteens and Teens (7 Years – 18 Years) Vaccines & ImmunizationsACIP Vaccination RecommendationsGeneral Acronyms and AbbreviationsVaccine Guidelines and Recommendations for Emergency SituationsDelays in Vaccine Supply


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