Vaccines in the Child and Adolescent Immunization Schedule*

Vaccine Abbreviation(s) Trade name(s)

COVID-19† 1vCOV-mRNA Comirnaty®/PfizerBioNTech COVID-19 

Vaccine

SPIKEVAX®/Moderna 

COVID-19 Vaccine

2vCOV-mRNA Pfizer-BioNTech 

COVID-19 Vaccine, 

Bivalent

Moderna COVID-19 

Vaccine, Bivalent

1vCOV-aPS Novavax COVID-19 

Vaccine

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®

Priorix®

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 conjugate vaccine† PCV13

PCV15

Prevnar 13®

VaxneuvanceTM

Pneumococcal 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-Hib-HepB Vaxelis®

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

New Vaccines and Other Immunizing Agents added to the Schedule since February 2023 (See Addendum)

RSV monoclonal antibody (Nirsevimab) RSV-mAb BeyfortusTM

Pneumococcal conjugate vaccine PCV20 Prevnar 20TM

*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. 

† COVID-19, Poliovirus, Influenza, and Pneumococcal vaccines have new or updated ACIP recommendations. Please see Addendum for more details.

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).

UNITED STATES

2023

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 catchup 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)

6

Review new or

updated ACIP

guidance

(Addendum)

Download the CDC Vaccine Schedules app for providers at 

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

CS310020-C

Scan QR code 

for access to 

online schedule

See Addendum for new or updated ACIP vaccine recommendations
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, PCV15) 1st dose 2nd dose 3rd dose ----- 4th dose -----

Inactivated poliovirus 

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

Notes

COVID-19 (1vCOV-mRNA, 

2vCOV-mRNA, 1vCOV-aPS) 2- or 3- dose primary series and booster (See Notes)

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, MenB-FHbp)

See Notes

Pneumococcal polysaccharide 

(PPSV23) See Notes

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

dengue areas (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

See Addendum for new or updated ACIP vaccine recommendations Table 1 Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger, United States, 2023
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 is only necessary for 

children aged 12 through 59 

months regardless of risk, or age 

60 through 71 months with any 

risk, who received 3 doses before 

age 12 months.

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, 2023
Always use this table in conjunction with Table 1 and the Notes that follow. 

VACCINE

INDICATION

Pregnancy

Immunocompromised status 

(excluding HIV 

infection)

HIV infection CD4+ counta 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

SCIDb

Diphtheria, tetanus, and 

acellular pertussis (DTaP)

Haemophilus influenzae 

type b

Pneumococcal conjugate

Inactivated poliovirus

COVID-19 See Notes See Notes

Influenza (IIV4)

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

Measles, mumps, rubella *

Varicella *

Hepatitis A

Tetanus, diphtheria, and 

acellular pertussis (Tdap)

Human papillomavirus *

Meningococcal ACWY

Meningococcal B

Pneumococcal 

polysaccharide

Dengue

a. 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.

b. Severe Combined Immunodeficiency

c. 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, 2023

or
For vaccination recommendations for persons ages 

19 years or older, see the Recommended 

Adult Immunization Schedule, 2023.

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 3-2, 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, Barnett ED, 

Lynfield Ruth, Sawyer MH, eds. Red Book: 2021–2024 Report 

of the Committee on Infectious Diseases. 32nd ed. Itasca, IL: 

American Academy of Pediatrics; 2021:72–86).

y For information about vaccination in the setting of a 

vaccine-preventable 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 vaccines included in the 

child and adolescent vaccine schedule are covered by VICP 

except dengue, PPSV23, and COVID-19 vaccines. COVID-19 

vaccines that are authorized or approved by the FDA are 

covered by the Countermeasures Injury Compensation 

Program (CICP). For more information, see www.hrsa.gov/

vaccinecompensation or www.hrsa.gov/cicp.

Dengue vaccination 

(minimum age: 9 years)

Routine vaccination

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

have laboratory confirmation of previous dengue infection

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

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

y Dengue vaccine should not be administered to children 

traveling to or visiting endemic dengue areas.

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.

COVID-19 vaccination

(minimum age: 6 months [Moderna and PfizerBioNTech COVID-19 vaccines], 12 years [Novavax 

COVID-19 Vaccine])

Routine vaccination

y Primary series: 

-Age 6 months–4 years: 2-dose series at 0, 4-8 weeks 

(Moderna) or 3-dose series at 0, 3-8, 11-16 weeks 

(Pfizer-BioNTech)

-Age 5–11 years: 2-dose series at 0, 4-8 weeks (Moderna) 

or 2-dose series at 0, 3-8 weeks (Pfizer-BioNTech)

-Age 12–18 years: 2-dose series at 0, 4-8 weeks (Moderna) 

or 2-dose series at 0, 3-8 weeks (Novavax, Pfizer-BioNTech)

y For booster dose recommendations see www.cdc.

gov/vaccines/covid-19/clinical-considerations/interimconsiderations-us.html

Special situations

Persons who are moderately or severely 

immunocompromised

y Primary series

-Age 6 months–4 years: 3-dose series at 0, 4, 8 weeks 

(Moderna) or 3-dose series at 0, 3, 11 weeks 

(Pfizer-BioNTech) 

-Age 5–11 years: 3-dose series at 0, 4, 8 weeks (Moderna) or 

3-dose series at 0, 3, 7 weeks (Pfizer-BioNTech) 

-Age 12–18 years: 3-dose series at 0, 4, 8 weeks (Moderna) 

or 2-dose series at 0, 3 weeks (Novavax) or 3-dose series at 

0, 3, 7 weeks (Pfizer-BioNTech) 

y Booster dose: see www.cdc.gov/vaccines/covid-19/clinicalconsiderations/interim-considerations-us.html

y Pre-exposure prophylaxis (monoclonal antibodies) may be 

considered to complement COVID-19 vaccination. See 

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

interim-considerations-us.html#immunocompromised

For Janssen COVID-19 Vaccine recipients see COVID-19 

schedule at www.cdc.gov/vaccines/covid-19/clinicalconsiderations/interim-considerations-us.html

Note: Administer an age-appropriate vaccine product for each 

dose. Current COVID-19 schedule and dosage formulation 

available at www.cdc.gov/vaccines/covid-19/downloads/

COVID-19-immunization-schedule-ages-6months-older.

pdf. For more information on Emergency Use Authorization 

(EUA) indications for COVID-19 vaccines, see www.fda.gov/

emergency-preparedness-and-response/coronavirus-disease2019-covid-19/covid-19-vaccines. 

See Addendum for new or updated ACIP vaccine recommendations Notes Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger, United States, 2023
Notes Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger, United States, 2023

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

yDose 1 at age 7–11 months: Administer dose 2 at least 4 

weeks later and dose 3 (final dose) at age12–15 months or 

8 weeks after dose 2 (whichever is later).

yDose 1 at age 12–14 months: Administer dose 2 (final dose) 

at least 8 weeks after dose 1.

yDose 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 age12–59 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 catch-up vaccination in children less than age 5 years. 

Follow the catch-up schedule even if Vaxelis® is used for one 

or more doses. For detailed information on use of Vaxelis® see 

www.cdc.gov/mmwr/volumes/69/wr/mm6905a5.htm.

Special situations

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)

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)

Routine vaccination

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

HepB vaccine for doses administered before age 6 weeks)

- Birth weight ≥2,000 grams: 1 dose within 24 hours of birth 

if medically stable

- Birth weight <2,000 grams: 1 dose at chronological age 1 

month or hospital discharge (whichever is earlier and 

even if weight is still <2,000 grams). 

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

series as soon as possible (see Table 2 for minimum intervals).

y Administration of 4 doses is permitted when a combination 

vaccine containing HepB is used after the birth dose.

y Minimum intervals (see Table 2): when 4 doses 

are administered, substitute “dose 4” for “dose 3” 

in these calculations

y Final (3rd or 4th) dose: age 6–18 months 

(minimum age 24 weeks)

y Mother is HBsAg-positive 

- Birth dose (monovalent HepB vaccine only): administer 

HepB vaccine and hepatitis B immune globulin (HBIG)

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

of birth weight. 

- Birth weight <2000 grams: administer 3 additional doses 

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

- Final (3rd or 4th) dose: administer at age 6 months 

(minimum age 24 weeks)

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

series is delayed, test 1–2 months after final dose. Do not 

test before age 9 months.
Notes Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger, United States, 2023

y Mother is HBsAg-unknown

If other evidence suggestive of maternal hepatitis B infection 

exists (e.g., presence of HBV DNA, HBeAg-positive, or mother 

known to have chronic hepatitis B infection), manage infant 

as if mother is HBsAg-positive

- Birth dose (monovalent HepB vaccine only):

 Birth weight ≥2,000 grams: administer HepB vaccine

within 12 hours of birth. Determine mother’s HBsAg status 

as soon as possible. If mother is determined to be HBsAgpositive, administer HBIG as soon as possible (in separate 

limb), but no later than 7 days of age.

 Birth weight <2,000 grams: administer HepB vaccine

and HBIG (in separate limbs) within 12 hours of birth. 

Administer 3 additional doses of HepB vaccine beginning 

at age 1 month (total of 4 doses) 

- Final (3rd or 4th) dose: administer at age 6 months 

(minimum age 24 weeks)

- If mother is determined to be HBsAg-positive or if status 

remains unknown, test for HBsAg and anti-HBs at 

age 9–12 months. If HepB series is delayed, test 1–2 months 

after final dose. Do not test before age 9 months.

Catch-up vaccination

y Unvaccinated persons should complete a 3-dose series at 

0, 1–2, 6 months. See Table 2 for minimum intervals

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:

-Heplisav-B®: 2-dose series at least 4 weeks apart

- PreHevbrio®: 3-dose series at 0, 1, and 6 months

- Combined HepA and HepB vaccine, Twinrix®: 3-dose series 

(0, 1, and 6 months) or 4-dose series (3 doses at 0, 7, and 

21–30 days, followed by a booster dose at 12 months).

Special situations

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

- Persons who are predialysis or on maintenance dialysis

-Other immunocompromised persons

- For detailed revaccination recommendations, see www.cdc.

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

Note: Heplisav-B and PreHevbrio are not recommended in 

pregnancy due to lack of safety data in pregnant persons

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, 2022, 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, 2022

- 1 dose for all persons age 9 years or older

y For the 2022-2023 season, see www.cdc.gov/mmwr/

volumes/71/rr/rr7101a1.htm.

y For the 2023–24 season, see the 2023–24 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: Any 

influenza vaccine appropriate for age and health status may 

be administered. If using egg-based IIV4 or LAIV4, administer 

in medical setting under supervision of health care provider 

who can recognize and manage severe allergic reactions.

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

y Close contacts (e.g., caregivers, healthcare personnel) 

of severely immunosuppressed persons who require a 

protected environment: these persons should not receive 

LAIV4. If LAIV4 is given, they should avoid contact with/

caring for such immunosuppressed persons for 7 days after 

vaccination.

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
Notes Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger, United States, 2023

Special situations

y International travel

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

revaccinate with 2-dose series at age 12–15 months 

(12 months for children in high-risk areas) and dose 2 

as early as 4 weeks later.

-Unvaccinated children age 12 months or older:

2-dose series at least 4 weeks apart before departure

y In mumps outbreak settings, for information about 

additional doses of MMR (including 3rd dose of MMR), see 

www.cdc.gov/mmwr/volumes/67/wr/mm6701a7.htm

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 PCV series.

y MenQuadfi®

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

8 weeks apart

Travel to countries with hyperendemic or epidemic 

meningococcal disease, including countries in the African 

meningitis belt or during the Hajj (www.cdc.gov/travel/):

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 component 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.

*Menveo has two formulations: lyophilized and liquid. The liquid 

formulation should not be used before age 10 years.

Note: Menactra® should be administered either before or 

at the same time as DTaP. MenACWY 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 (if dose 2 

was administered at least 6 months after dose 1, dose 3 

not needed; if dose 3 is administered earlier than 4 months 

after dose 2, a 4th dose should be administered at least 

4 months after dose 3)

Note: Bexsero® and Trumenba® are not interchangeable; 

the same product should be used for all doses in a series.

For MenB booster dose recommendations for groups listed 

under “Special situations” and in an outbreak setting and 

additional meningococcal vaccination information, see 

www.cdc.gov/mmwr/volumes/69/rr/rr6909a1.htm.
Notes Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger, United States, 2023

Pneumococcal vaccination 

(minimum age: 6 weeks [PCV13], [PCV15], 2 years 

[PPSV23])

Routine vaccination with PCV

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

Catch-up vaccination with PCV

y Healthy children age 24–59 months with any 

incomplete* PCV series: 1 dose PCV

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

Note: PCV13 and PCV15 can be used interchangeably for 

children who are healthy or have underlying conditions. 

PCV15 is not indicated for children who have received 4 doses 

of PCV13 or another age appropriate complete PCV13 series.

Special situations

Underlying conditions below: When both PCV and PPSV23 

are indicated, administer PCV first. PCV and PPSV23 should 

not be administered during the 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 PCV doses: 1 dose PCV (at least 8 weeks after 

any prior PCV dose)

- Less than 3 PCV doses: 2 doses PCV (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 PCV doses)

Age 6–18 years

y Any incomplete* series with PCV: no further 

PCV doses needed

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

completing all recommended PCV doses)

Cerebrospinal fluid leak, cochlear implant:

Age 2–5 years

y Any incomplete* series with:

- 3 PCV doses: 1 dose PCV (at least 8 weeks after 

any prior PCV dose)

- Less than 3 PCV doses: 2 doses PCV (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 PCV doses) 

Age 6–18 years

y No history of either PCV or PPSV23: 1 dose PCV, 1 dose 

PPSV23 at least 8 weeks later

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

the most recent dose of PCV

y PPSV23 but no PCV: 1 dose PCV 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 PCV doses: 1 dose PCV (at least 8 weeks after 

any prior PCV dose)

- Less than 3 PCV doses: 2 doses PCV (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 PCV doses) and a dose 2 of 

PPSV23 5 years later

Age 6–18 years

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

PPSV23 (dose 1 of PPSV23 administered 8 weeks after 

PCV and dose 2 of PPSV23 administered at least 

5 years after dose 1 of PPSV23)

y Any PCV but no PPSV23: 2 doses PPSV23 

(dose 1 of PPSV23 administered 8 weeks after the 

most recent dose of PCV and dose 2 of PPSV23 

administered at least 5 years after dose 1 of PPSV23)

y PPSV23 but no PCV: 1 dose PCV 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 PCV

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

recommended series or an age-appropriate catch-up series 

see Table 2 in ACIP pneumococcal recommendations at www.

cdc.gov/mmwr/volumes/71/wr/mm7137a3.htm

For guidance on determining which pneumococcal vaccines 

a patient needs and when, please refer to the mobile app, 

which can be downloaded here: www.cdc.gov/vaccines/vpd/

pneumo/hcp/pneumoapp.html

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_%20

cid=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.

Special situations 

y Adolescents aged 18 years at increased risk of exposure 

to poliovirus with:

-No evidence of a complete polio vaccination series (i.e., at 

least 3 doses): administer remaining doses (1, 2, or 3 doses) 

to complete a 3-dose series 

- Evidence of completed polio vaccination series (i.e., at least 

3 doses): may administer one lifetime IPV booster

For detailed information, see: www.cdc.gov/vaccines/vpd/

polio/hcp/recommendations.html
Notes Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger, United States, 2023

9/27/2023 Centers for Disease Control and Prevention | Recommended Child and Adolescent Immunization Schedule, United States, 2023

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. 

yDTaP 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-toxoidcontaining vaccine; for all other wounds, administer Tdap 

or Td if more than 5 years since last dose of tetanus-toxoidcontaining 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 4 weeks 

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.
Vaccine Contraindicated or Not Recommended1 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

• 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 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 2022-23 seasonal influenza with Vaccines available at www.cdc.gov/mmwr/volumes/71/rr/rr7101a1.htm.

For COVID-19 vaccine contraindications and precautions see www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us.html#contraindications

Appendix Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger, United States, 2023
Appendix Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger, United States, 2023

Vaccine Contraindicated or Not Recommended1 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)

• 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 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

• 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 fever

Hepatitis A–Hepatitis B vaccine [HepAHepB, (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

• Pregnancy: HPV vaccination not recommended.

• Moderate or severe acute illness with or without fever

Measles, 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 etiology

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 (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 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

• If using MMRV, see MMR/MMRV for additional precautions

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.

4. 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.
Vaccines and Other

Immunizing Agents Recommendation Effective Date ofRecommendation*

Meningococcal Vaccines

Pfizer’s MenABCWY vaccine may be used when both MenACWY and MenB are indicated at the same visit.*

*1) Healthy individuals aged 16–23 years (routine schedule) when shared clinical decision-making favors administration of MenB vaccination, 

2) individuals aged 10 years and older at increased risk of meningococcal disease (e.g., due to persistent complement deficiencies, complement inhibitor 

use, or functional or anatomic asplenia) due for both vaccines.

October 26, 2023

Mpox Vaccines

ACIP recommends vaccination* with the 2-dose§ JYNNEOS vaccine series for persons aged 18 years and older at risk for mpox¶

*This is an interim recommendation that ACIP will revisit in 2-3 years

§

Dose 2 administered 28 days after dose 1

¶

Persons at risk:

• Gay, bisexual, and other men who have sex with men, transgender or nonbinary people who in the past 6 months have had one of the following:

ɦ A new diagnosis of ≥1 sexually transmitted disease

ɦ More than one sex partner

ɦ Sex at a commercial sex venue

ɦ Sex in association with a large public event in a geographic area where mpox transmission is occurring

• Sexual partners of persons with the risks described in above

• Persons who anticipate experiencing any of the above

October 26, 2023

Respiratory syncytial virus 

(RSV)

• Maternal Respiratory Syncytial Virus (RSV) vaccine (ABRYSVOTM) is recommended for pregnant people during 32 through 36 weeks gestation, using seasonal 

administration, to prevent RSV lower respiratory tract infection in infants. September 22, 2023

COVID-19 (Moderna,

Pfizer-BioNTech)

• All persons ≥6 months of age should receive 2023–2024 (monovalent, XBB containing) COVID-19 vaccines as authorized under EUA or approved by BLA.

• Bivalent mRNA COVID-19 vaccines are no longer recommended in the United States

• For detailed information, see: www.cdc.gov/covidschedule

September 12, 2023

Respiratory syncytial virus

[RSV-mAb (Nirsevimab)]

• All infants younger than 8 months and born shortly before or during the RSV season should receive 1 dose of nirsevimab within 

1 week of birth either in hospital or outpatient setting

• Infants younger than age 8 months not born during RSV season and now entering their first RSV season should receive 

1 dose of nirsevimab shortly before the start of RSV season

• Infants aged 8–19 months with chronic lung disease of prematurity requiring medical support (e.g., chronic corticosteroid therapy, diuretic therapy, or 

supplemental oxygen) any time during the 6-month period before start of the second RSV season; severe immunocompromise; cystic fibrosis with weight 

for length <10th percentile; or with manifestation of severe lung disease (e.g., previous hospitalization for pulmonary exacerbation in the first year of life or 

abnormalities on chest imaging that persist when stable) should receive 1 dose of nirsevimab shortly before start of second RSV season

• Infants 8–19 months who are American Indian or Alaska Native should receive 1 dose of nirsevimab before start of second RSV season

• Infants who are age-eligible and undergoing cardiac surgery with cardiopulmonary bypass should receive 1 additional dose of nirsevimab after surgery

• For detailed information, see: www.cdc.gov/mmwr/volumes/72/wr/mm7234a4.htm?s_cid=mm7234a4_w

August 3, 2023

Poliovirus (IPV)

• Adolescents age 18 years who are known or suspected to be unvaccinated or incompletely vaccinated against polio should complete a 

primary vaccination series with inactivated polio vaccine (IPV).

• Adolescents age 18 years who have received a primary series of trivalent oral polio vaccine (tOPV) or IPV in any combination and who are at increased risk of 

poliovirus exposure may receive another dose of IPV. Available data do not indicate the need for more than a single lifetime booster dose with IPV for adults.

June 27, 2023

Influenza 

(IIV4, ccIV4, RIV4, LAIV4)

• All persons ages ≥6 months with egg allergy should receive influenza vaccine. Any influenza vaccine (egg based or non-egg based) 

that is otherwise appropriate for the recipient’s age and health status can be used.

• Affirm the updated MMWR Recommendations and Reports, “Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory 

Committee on Immunization Practices—United States, 2023-24 Influenza Season” www.cdc.gov/mmwr/volumes/72/rr/rr7202a1.htm

June 27, 2023

In addition to the recommendations presented in the previous sections of this Immunization Schedule, ACIP has approved the following recommendations by majority vote since October 20, 2022. The following 

recommendations have been adopted by the CDC Director and are now official. Links are provided if these recommendations have been published in Morbidity and Mortality Weekly Report (MMWR).

Addendum Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger, United States, 2023

*The effective date is the date when the CDC director adopted the recommendation and when the ACIP recommendation became official.
Vaccines and Other

Immunizing Agents Recommendation Effective Date ofRecommendation*

Pneumococcal

(PCV15, PCV20)

• Use of either pneumococcal conjugate vaccines (PCV) PCV15 or PCV20 is recommended for all children aged 2–23 months according to 

currently recommended PCV dosing and schedules.

• For children with an incomplete PCV vaccination status, use of either PCV15 or PCV20 according to currently recommended 

PCV dosing and schedules is recommended for:

ɦ Healthy children aged 24–59 months

ɦ Children with specified risk conditions* aged 24 through 71 months

• For children aged 2–18 years with any risk condition who have received all recommended doses of PCV before age 6 years

ɦ Using ≥1 dose(s) of PCV20: No additional doses of any pneumococcal vaccine are indicated. This recommendation may be 

updated as additional data become available.

ɦ Using PCV13 or PCV15 (no PCV20): A dose of PCV20 or PPSV23 using previously recommended dosing and schedules is recommended.

• For children aged 6–18 years with any risk condition who have not received any dose of PCV13, PCV15, or PCV20, a single dose of PCV15 or 

PCV20 is recommended. When PCV15 is used, it should be followed by a dose of PPSV23 at least 8 weeks later if not previously given.

*Risk conditions include: cerebrospinal fluid leak; chronic heart disease; chronic kidney disease (excluding maintenance dialysis and nephrotic syndrome, 

which are included in immunocompromising conditions); chronic liver disease; chronic lung disease (including moderate persistent or severe persistent 

asthma); cochlear implant; diabetes mellitus; immunocompromising conditions (on maintenance dialysis or with nephrotic syndrome; congenital or 

acquired asplenia or splenic dysfunction; congenital or acquired immunodeficiencies; diseases and conditions treated with immunosuppressive drugs or 

radiation therapy, including malignant neoplasms, leukemias, lymphomas, Hodgkin disease, and solid organ transplant; HIV infection; and sickle cell disease 

and other hemoglobinopathies).

June 27, 2023

In addition to the recommendations presented in the previous sections of this Immunization Schedule, ACIP has approved the following recommendations by majority vote since October 20, 2022. The following 

recommendations have been adopted by the CDC Director and are now official. Links are provided if these recommendations have been published in Morbidity and Mortality Weekly Report (MMWR).

Addendum Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger, United States, 2023

*The effective date is the date when the CDC director adopted the recommendation and when the ACIP recommendation became official.