Child and Adolescent Immunization Schedule by Medical Indication
Recommendations for Ages 18 Years or Younger, United States, 2023
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¶ = 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
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 leaks or cochlear implants | 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 | | | ± | ± | | | ¶ | ¶ | ¶ | ¶ | ¶ | ¶ |
- For additional information regarding HIV laboratory parameters and use of live vaccines, see the General Best Practice Guidelines for Immunization, “Altered Immunocompetence,” and Table 4-1 (footnote J).
- Severe Combined Immunodeficiency
- LAIV4 contraindicated for children 2–4 years of age with asthma or wheezing during the preceding 12 months