Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger, United States, 2025

Identification of Vaccines and Immunizing Agents

  • Monoclonal Antibodies (Immunizing Agents)

    • Respiratory syncytial virus monoclonal antibody (Nirsevimab): Abbreviated as RSV-mAb; Trade name: Beyfortus.

  • Individual Vaccines and Trade Names

    • COVID-19 vaccine: Abbreviated as 1vCOV-mRNA or 1vCOV-aPS; Trade names: Comirnaty/Pfizer-BioNTech, Spikevax/Moderna, Novavax COVID-19 Vaccine.

    • Dengue vaccine: Abbreviated as DEN4CYD; Trade name: Dengvaxia.

    • Diphtheria, tetanus, and acellular pertussis vaccine: Abbreviated as DTaP; Trade names: Daptacel, Infanrix.

    • Haemophilus influenzae type b vaccine:

      • Hib (PRP-T): ActHIB, Hiberix.

      • Hib (PRP-OMP): PedvaxHIB.

    • Hepatitis A vaccine: Abbreviated as HepA; Trade names: Havrix, Vaqta.

    • Hepatitis B vaccine: Abbreviated as HepB; Trade names: Engerix-B, Recombivax HB.

    • Human papillomavirus vaccine: Abbreviated as HPV; Trade name: Gardasil 9.

    • Influenza vaccine (inactivated: egg-based): Abbreviated as IIV3; Multiple trade names.

    • Influenza vaccine (inactivated: cell-culture): Abbreviated as ccIIV3; Trade name: Flucelvax.

    • Influenza vaccine (live, attenuated): Abbreviated as LAIV3; Trade name: FluMist.

    • Measles, mumps, and rubella vaccine: Abbreviated as MMR; Trade names: M-M-R II, Priorix.

    • Meningococcal serogroups A, C, W, Y vaccine:

      • MenACWY-CRM: Menveo.

      • MenACWY-TT: MenQuadfi.

    • Meningococcal serogroup B vaccine:

      • MenB-4C: Bexsero.

      • MenB-FHbp: Trumenba.

    • Meningococcal serogroup A, B, C, W, Y vaccine: Abbreviated as MenACWY-TT/MenB-FHbp; Trade name: Penbraya.

    • Mpox vaccine: Abbreviated as Mpox; Trade name: Jynneos.

    • Pneumococcal conjugate vaccine:

      • PCV15: Vaxneuvance.

      • PCV20: Prevnar 20.

    • Pneumococcal polysaccharide vaccine: Abbreviated as PPSV23; Trade name: Pneumovax 23.

    • Poliovirus vaccine (inactivated): Abbreviated as IPV; Trade name: Ipol.

    • Respiratory syncytial virus vaccine: Abbreviated as RSV; Trade name: Abrysvo.

    • Rotavirus vaccine: Abbreviated as RV1 (Rotarix) or RV5 (RotaTeq).

    • Tetanus, diphtheria, and acellular pertussis vaccine (for $\ge 7$ years): Abbreviated as Tdap; Trade names: Adacel, Boostrix.

    • Tetanus and diphtheria vaccine: Abbreviated as Td; Trade names: Tenivac, Tdvax.

    • Varicella vaccine: Abbreviated as VAR; Trade name: Varivax.

  • Combination Vaccines (Preferred over separate injections when appropriate)

    • DTaP-HepB-IPV: Pediarix.

    • DTaP-IPV/Hib: Pentacel.

    • DTaP-IPV: Kinrix, Quadracel.

    • DTaP-IPV-Hib-HepB: Vaxelis.

    • MMRV: ProQuad.

Standard Methodology for Immunization Scheduling

  1. Determine Vaccine by Age: Consult Table 1 to see the recommended window for each vaccine type.

  2. Determine Catch-up Interval: If a dose was missed or the series started late, use Table 2 to find the minimum intervals between doses.

  3. Assess Medical Contraindications: Use Table 3 to adjust the schedule based on high-risk conditions (e.g., Pregnancy, HIV, Asplenia).

  4. Review Specific Clinical Notes: Consult the detailed notes (Sections 5–15) regarding vaccine types, frequencies, and special situational protocols.

  5. Review Precise Contraindications: Consult the Appendix to confirm circumstances where a vaccine must not be administered.

Routine Vaccination Schedule by Age (Table 1 Summary)

  • Birth: 1st dose HepB.

  • 1 month1\,month: 2nd dose HepB window starts.

  • 2 months2\,months: 1st dose of RV, DTaP, Hib, PCV, IPV. 2nd dose HepB window continues.

  • 4 months4\,months: 2nd dose of RV, DTaP, Hib, PCV, IPV.

  • 6 months6\,months: 3rd dose of DTaP, PCV. Window starts for 3rd dose HepB, 3rd dose Hib, 3rd dose IPV, and annual Influenza.

  • 12–15 months12–15\,months: 1st dose MMR, VAR. 4th dose DTaP, PCV. Booster Hib. Window for 2nd dose HepA (12–23 months12–23\,months).

  • 4–6 years4–6\,years: 5th dose DTaP, 4th dose IPV, 2nd dose MMR, 2nd dose VAR.

  • 11–12 years11–12\,years: 1st dose Tdap, HPV (2-dose series), 1st dose MenACWY.

  • 16 years16\,years: 2nd dose MenACWY.

  • High-Risk/Decision-Based:

    • MenB: 16–18 years16–18\,years (Shared clinical decision-making).

    • Dengue: 9–16 years9–16\,years (If seropositive in endemic area).

    • Mpox: 18 years18\,years (If at risk).

Catch-up Immunization Schedule (Table 2)

  • General Rule: A vaccine series does not need to be restarted, regardless of elapsed time.

  • Hepatitis B (Birth to 6 years6\,years): Dose 1 to 2 interval is 4 weeks4\,weeks; Dose 2 to 3 interval is 8 weeks8\,weeks (and at least 16 weeks16\,weeks after 1st dose). Final dose age must be $\ge 24\,weeks$.

  • Rotavirus: Maximum age for 1st dose: 14 weeks,6 days14\,weeks, 6\,days. Maximum age for final dose: 8 months,0 days8\,months, 0\,days. Interval is 4 weeks4\,weeks.

  • DTaP:

    • Dose 1 to 2: 4 weeks4\,weeks.

    • Dose 2 to 3: 4 weeks4\,weeks.

    • Dose 3 to 4: 6 months6\,months.

    • Dose 4 to 5: 6 months6\,months. 5th dose unnecessary if 4th dose given at $\ge 4\,years$ and $\ge 6\,months$ after Dose 3.

  • Hib: If first dose given at $\ge 15\,months$, no further doses needed. For others, intervals vary from 44 to 8 weeks8\,weeks depending on age and previous product (PRP-T vs. PRP-OMP).

  • Pneumococcal (PCV): Healthy children $\ge 24\,months$ need no further doses if 1st dose given at $\ge 24\,months$. Otherwise, interval is generally 8 weeks8\,weeks for the final dose.

  • IPV: A 4th dose is not necessary if 3rd dose given at $\ge 4\,years$ and $\ge 6\,months$ after previous dose.

  • MMR/Varicella: Minimum interval of 4 weeks4\,weeks.

  • Dengue: 3-dose series at 00, 66, and 12 months12\,months.

Clinical Notes: Respiratory Syncytial Virus (RSV)

  • Nirsevimab (RSV-mAb):

    • Infants born Oct–Mar: Administer 1 dose within 1 week1\,week of birth if mother was not vaccinated $\ge 14\,days$ before delivery.

    • Infants born Apr–Sept: Administer 1 dose shortly before the start of the season if mother was not vaccinated.

    • Special Situations (8–19 months): 1 dose for American Indian/Alaska Native children or those with chronic lung disease of prematurity, severe immunocompromise, or cystic fibrosis (if manifestation of severe lung disease or weight-for-length $< 10^{th}$ percentile).

  • Abrysvo (RSV Vaccine for Pregnancy):

    • Administered at 32 weeks,0 days32\,weeks, 0\,days through 36 weeks,6 days36\,weeks, 6\,days gestation.

    • Seasonality: September through January in most continental areas.

    • Only 1 dose; additional doses in subsequent pregnancies are not recommended.

Clinical Notes: COVID-19 Vaccination (2024–2025)

  • General Guidelines: Minimum age 6 months (mRNA) or 12 years (Novavax). All initial doses should be from the same manufacturer.

  • Shared Clinical Decision-Making (6 months–17 years6\,months–17\,years): Recommended for children who are NOT moderately or severely immunocompromised.

    • Age 6 months–4 years6\,months–4\,years (Unvaccinated): 2 doses Moderna (0,4–8 weeks0, 4–8\,weeks) or 3 doses Pfizer-BioNTech (0,3–80, 3–8, and $\ge 8\,weeks$ after dose 2).

    • Age 5–11 years5–11\,years (Unvaccinated): 1 dose 2024–25 mRNA vaccine.

    • Age 12–17 years12–17\,years (Unvaccinated): 1 dose mRNA or 2 doses Novavax (0,3–8 weeks0, 3–8\,weeks).

  • Moderately or Severely Immunocompromised:

    • Age 6 months–4 years6\,months–4\,years (Unvaccinated): 3-dose initial series (Moderna 0, 4, 4 weeks or Pfizer 0, 3, 8 weeks), followed by 1 dose 6 months later (minimum interval 2 monthsminimum\,interval\,2\,months).

    • Additional Doses: May be administered based on clinical judgment at least 2 months2\,months after the most recent dose.

  • Timing Accuracy: 4 weeks = 28 days. Doses $\le 4\,days$ before minimum age/interval are valid. Doses $\ge 5\,days$ early are invalid and must be repeated.

Clinical Notes: Diphtheria, Tetanus, and Pertussis (DTaP/Tdap)

  • Routine DTaP: 5-dose series. Dose 4 can be given as early as 12 months12\,months if 6 months6\,months have passed since Dose 3.

  • Tdap Routine: Adolescent booster at 11–12 years11–12\,years.

  • Pregnancy: 1 dose Tdap during EACH pregnancy (27–36 weeks27–36\,weeks gestation).

  • Special Situations: Encephalopathy within 7 days7\,days of a dose is a contraindication specific to pertussis. Use Td instead.

  • Wound Management (7–18 years7–18\,years):

    • Clean/Minor: Administer Tdap/Td if $> 10\,years$ since last dose.

    • Other Wounds: Administer Tdap/Td if $> 5\,years$ since last dose.

Clinical Notes: Hepatitis Profiling

  • Hepatitis A: Routine 2-dose series starting at 12–23 months12–23\,months, separated by $\ge 6\,months$.

    • Travelers (6–11 months6–11\,months): 1 dose before departure (does not count toward series; must revaccinate at $\ge 12\,months$).

  • Hepatitis B (Birth logic):

    • HBsAg-Negative Mother: Birth dose within 24 hours24\,hours if stable and weight $\ge 2,000\,g$. If weight $< 2,000\,g$, dose at 1 month1\,month or discharge.

    • HBsAg-Positive Mother: Administer HepB vaccine and HBIG within 12 hours12\,hours of birth in separate limbs. Regardless of weight, infants $< 2,000\,g$ require a 4-dose series.

    • Post-vaccination testing: Measure HBsAg and anti-HBs at 9–12 months9–12\,months.

    • Heplisav-B: 2-dose series permitted for adolescents aged 18 years18\,years.

Clinical Notes: Meningococcal Vaccination

  • MenACWY: Primary doses at 11–12 years11–12\,years and 16 years16\,years.

    • High-risk (Asplenia, HIV, Complement deficiency): Menveo (4-dose starting at 2 months2\,months or 2-dose starting after 7 months7\,months) or MenQuadfi (2-dose starting after 24 months24\,months).

  • MenB: Shared clinical decision-making for ages 16–23 years16–23\,years (preferred age 16–18 years16–18\,years).

    • Bexsero: 2-dose series $\ge 6\,months$ apart.

    • Trumenba: 2-dose series $\ge 6\,months$ apart. For high protection, 3-dose series (0,1–2,6 months0, 1–2, 6\,months).

  • Combination (Penbraya): For children $\ge 10\,years$, Penbraya can replace separate MenACWY and MenB doses on the same day.

  • Addendum (Penmenvy): GSK’s MenABCWY vaccine recommended for high-risk persons $\ge 10\,years$ or healthy persons 16–23 years16–23\,years (effective June 25, 2025).

Clinical Notes: Pneumococcal Vaccination

  • Routine: 4-dose series of PCV (PCV15 or PCV20) at 2,4,6,12–15 months2, 4, 6, 12–15\,months.

  • Medical Indications (Asplenia, Sickle Cell, Immunocompromise):

    • Age 2–5 years2–5\,years: If 3 doses received, give 1 more PCV dose. If $< 3$ doses received, give 2 doses at least 8 weeks8\,weeks apart.

    • PPSV23 Use: Not needed if PCV20 was used. If PCV15 was used, follow with PPSV23 after 8 weeks8\,weeks. If high-risk, a 2nd dose of PPSV23 is given 5 years5\,years after the first.

  • Cochlear Implants/CSF Leak: Same logic as medical indications; PCV20 preferred for simplicity.

Clinical Notes: Polio, MMR, and Varicella

  • Polio (IPV): 4-dose series. Final dose must be at $\ge 4\,years$ and $\ge 6\,months$ after the previous dose. Only trivalent OPV (tOPV) counts (doses before April 1, 2016).

  • MMR: 2-dose series (12–15 months,4–6 years12–15\,months, 4–6\,years). If traveling internationally, infants 6–11 months6–11\,months should receive 1 dose before departure.

  • Varicella: 2-dose series. Dose 2 can be as early as 3 months3\,months after Dose 1.

  • Note on MMRV: Recommended to give MMR and Varicella separately for Dose 1 in children 12–47 months12–47\,months unless parent prefers MMRV.

Clinical Notes: Special Vaccines (Dengue, Mpox, Influenza)

  • Dengue: Routine for ages 9–16 years9–16\,years with lab-confirmed prior infection, living in endemic areas (e.g., Puerto Rico, American Samoa). DO NOT give to travelers.

  • Mpox: 2-dose series (28 days28\,days apart) for those aged 18 years18\,years at risk (e.g., certain MSM, transgender, or nonbinary individuals with recent STD or multiple partners).

  • Influenza: Annual vaccination for all $\ge 6\,months$. Children 6 months–8 years6\,months–8\,years require 2 doses (separated by 4 weeks4\,weeks) if they have received $< 2$ doses before July 1, 2024.

    • Egg Allergy: Can receive any age-appropriate influenza vaccine (egg or non-egg based).

    • LAIV3 (FluMist): Contraindicated for asthma/wheezing (2–4 years2–4\,years), pregnancy, and immunocompromise.

Appendix: Contraindications and Precautions Guide

  • Severe Allergic Reaction (Anaphylaxis): Contraindication for all vaccines if it followed a previous dose or occurred due to a component (e.g., yeast in HepB, neomycin in HepA/MMR).

  • Moderate/Severe Acute Illness: General precaution; vaccination should be deferred.

  • Specific Contraindications:

    • Rotavirus: History of intussusception or Severe Combined Immunodeficiency (SCID).

    • DTaP: Encephalopathy within 7 days7\,days of previous pertussis vaccine.

    • LAIV3 (FluMist): Pregnancy, cochlear implant, CSF leak, or use of aspirin/salicylates in children.

    • MMR/VAR/MMRV: Pregnancy or severe immunodeficiency.

    • Dengue: Lack of previous infection documentation.

  • Specific Precautions:

    • GBS (Guillain-Barré Syndrome): Precaution if it occurred within 6 weeks6\,weeks of a previous influenza or tetanus-toxoid dose.

    • Arthus-type Hypersensitivity: Defer tetanus/diphtheria vaccines for at least 10 years10\,years since last dose.