Child and Adolescent Immunization Schedule by Medical Indication

Recommendations for Ages 18 Years or Younger, United States, 2024

Purpose

Guide health care providers in determining recommended vaccines for specific medical or other indications.

How to use the schedule

To make vaccination recommendations, healthcare providers should:

  1. Determine recommended vaccine by age (Table 1 – By Age)
  2. Determine recommended interval for catch-up vaccination (Table 2 – Catch-up)
  3. Assess need for additional recommended vaccines by medical condition or other indication (Table 3 - By Medical Indication)
  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)

Medical Indication

Legend

Recommended for all age-eligible children who lack documentation of a complete vaccination series Not recommended for all children, but is recommended for some children based on increased risk for or severe outcomes from disease Recommended for all age-eligible children, and additional doses may be necessary based on medical condition or other indications. See Notes. Precaution: Might be indicated if benefit of protection outweighs risk of adverse reaction Contraindicated or not recommended *Vaccinate after pregnancy, if indicated No Guidance/Not Applicable

Always use this table in conjunction with Table 1 and the Notes that follow. Medical conditions are often not mutually exclusive. If multiple conditions are present, refer to guidance in all relevant columns. See Notes for medical conditions not listed.

Vaccine and other immunizing agents
Pregnancy Immunocompromised status (excluding HIV infection) HIV infection CD4 percentage and counta CSF leak or cochlear implant Asplenia or persistent complement component deficiencies Heart disease or chronic lung disease Kidney failure,
End-stage
renal disease
or on Dialysis
Chronic liver disease Diabetes
<15% or <200mm ≥15% and ≥200/mm3
RSV-mAb more info icon. (nirsevimab) 2nd RSV season 1 dose depending on maternal
RSV vaccination status, See notes
2nd RSV season for
chronic lung disease (See notes)
1 dose depending on maternal RSV vaccination status, See notes
Hepatitis B more info icon.
Rotavirus more info icon.
SCIDb
DTaP/Tdap more info icon. DTaP
Tdap: 1 dose each pregnancy
Hib more info icon. See notes See notes
HSCT: 3 doses
Pneumococcal more info icon.
IPV more info icon.
COVID-19 more info icon. See notes
IIV4 more info icon.
LAIV4 more info icon.
Asthma, wheezing:
2–4 yearsc
Measles, mumps, rubella more info icon. *
VAR more info icon. *
Hepatitis A more info icon.
Human papillomavirus more info icon. * 3 dose series. See notes
Meningococcal ACWY more info icon.
Meningococcal B more info icon.
RSV more info icon. (Abrysvo) Seasonal administration, See notes
Dengue more info icon.
Mpox more info icon. See notes
  1. 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).
  2. Severe Combined Immunodeficiency
  3. LAIV4 contraindicated for children 2–4 years of age with asthma or wheezing during the preceding 12 months

To make vaccination recommendations, healthcare providers should:

  1. Determine recommended vaccine by age (Table 1 – By Age)
  2. Determine recommended interval for catch-up vaccination (Table 2 – Catch-up)
  3. Assess need for additional recommended vaccines by medical condition or other indication (Table 3 - By Medical Indication)
  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)

Additional Information

Recommended by the Advisory Committee on Immunization Practices (ACIP) and approved by the Centers for Disease Control and Prevention (CDC), American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), American College of Obstetricians and Gynecologists (ACOG), American College of Nurse-Midwives (ACNM), American Academy of Physician Associates (AAPA), and National Association of Pediatric Nurse Practitioners (NAPNAP).

The comprehensive summary of the ACIP recommended changes made to the child and adolescent immunization schedule can be found in the January 11, 2024 MMWR.

Report

  • Suspected cases of reportable vaccine-preventable diseases or outbreaks to your state or local health department
  • 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.

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