Child Immunization Schedule Notes

Age 6 months–4 years

• Unvaccinated:
  • 2-dose series of updated (2023–2024 Formula) Moderna at 0, 4-8 weeks
  • 3-dose series of updated (2023–2024 Formula) Pfizer- BioNTech at 0, 3-8, 11-16 weeks
• Previously vaccinated* with 1 dose of any Moderna: 1 dose of updated (2023–2024 Formula) Moderna 4-8 weeks after the most recent dose.
• Previously vaccinated* with 2 or more doses of any Moderna: 1 dose of updated (2023–2024 Formula) Moderna at least 8 weeks after the most recent dose.
• Previously vaccinated* with 1 dose of any Pfizer- BioNTech: 2-dose series of updated (2023–2024 Formula) Pfizer-BioNTech at 0, 8 weeks (minimum interval between previous Pfizer-BioNTech and dose 1: 3-8 weeks).
• Previously vaccinated* with 2 or more doses of any Pfizer- BioNTech: 1 dose of updated (2023–2024 Formula) Pfizer- BioNTech at least 8 weeks after the most recent dose.

Age 5–11 years

• Unvaccinated: 1 dose of updated (2023–2024 Formula) Moderna or Pfizer-BioNTech vaccine.
• Previously vaccinated* with 1 or more doses of Moderna or Pfizer-BioNTech: 1 dose of updated (2023–2024 Formula) Moderna or Pfizer-BioNTech at least 8 weeks after the most recent dose.

Age 12–18 years

• Unvaccinated:
  • 1 dose of updated (2023–2024 Formula) Moderna or Pfizer- BioNTech vaccine
  • 2-dose series of updated (2023–2024 Formula) Novavax at 0, 3-8 weeks
• Previously vaccinated* with any COVID-19 vaccine(s): 1 dose of any updated (2023–2024 Formula) COVID-19 vaccine at least 8 weeks after the most recent dose.

*Note: Previously vaccinated is defined as having received any Original monovalent or bivalent COVID-19 vaccine (Janssen, Moderna, Novavax, Pfizer-BioNTech) prior to the updated 2023–2024 formulation.

There is no preferential recommendation for the use of one COVID-19 vaccine over another when more than one recommended age-appropriate vaccine is available.

Administer an age-appropriate COVID-19 vaccine product for each dose. For information about transition from age 4 years to age 5 years or age 11 years to age 12 years during COVID-19 vaccination series, see Tables 1 and 2 at www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us.html#covid-vaccines.

Current COVID-19 schedule and dosage formulation available at www.cdc.gov/covidschedule. For more information on Emergency Use Authorization (EUA) indications for COVID-19 vaccines, see www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/covid-19-vaccines

Persons who are moderately or severely immunocompromised**

Age 6 months–4 years

• Unvaccinated:
  • 3-dose series of updated (2023–2024 Formula) Moderna at 0, 4, 8 weeks
  • 3-dose series of updated (2023–2024 Formula) Pfizer- BioNTech at 0, 3, 11 weeks.
• Previously vaccinated* with 1 dose of any Moderna: 2-dose series of updated (2023–2024 Formula) Moderna at 0, 4 weeks (minimum interval between previous Moderna and dose 1: 4 weeks).
• Previously vaccinated* with 2 doses of any Moderna: 1 dose of updated (2023–2024 Formula) Moderna at least 4 weeks after the most recent dose.
• Previously vaccinated* with 3 or more doses of any Moderna: 1 dose of updated (2023–2024 Formula) Moderna at least 8 weeks after the most recent dose.
• Previously vaccinated* with 1 dose of any Pfizer- BioNTech: 2-dose series of updated (2023–2024 Formula) Pfizer-BioNTech at 0, 8 weeks (minimum interval between previous Pfizer-BioNTech and dose 1: 3 weeks).
• Previously vaccinated* with 2 or more doses of any Pfizer- BioNTech: 1 dose of updated (2023–2024 Formula) Pfizer- BioNTech at least 8 weeks after the most recent dose.

Age 5–11 years

• Unvaccinated:
  • 3-dose series of updated (2023–2024 Formula) Moderna at 0, 4, 8 weeks
  • 3-dose series updated (2023–2024 Formula) Pfizer-BioNTech at 0, 3, 7 weeks.
• Previously vaccinated* with 1 dose of any Moderna: 2-dose series of updated (2023–2024 Formula) Moderna at 0, 4 weeks (minimum interval between previous Moderna and dose 1: 4 weeks).
• Previously vaccinated* with 2 doses of any Moderna: 1 dose of updated (2023–2024 Formula) Moderna at least 4 weeks after the most recent dose.
• Previously vaccinated* with 1 dose of any Pfizer- BioNTech: 2-dose series of updated (2023–2024 Formula) Pfizer-BioNTech at 0, 4 weeks (minimum interval between previous Pfizer-BioNTech and dose 1: 3 weeks)
• Previously vaccinated* with 2 doses of any Pfizer- BioNTech: 1 dose of 2023–2024 Pfizer-BioNTech at least 4 weeks after the most recent dose.
• Previously vaccinated* with 3 or more doses of any Moderna or Pfizer-BioNTech: 1 dose of updated (2023–2024 Formula) Moderna or Pfizer-BioNTech at least 8 weeks after the most recent dose.

Age 12–18 years

• Unvaccinated:
  • 3-dose series of updated (2023–2024 Formula) Moderna at 0, 4, 8 weeks
  • 3-dose series of updated (2023–2024 Formula) Pfizer- BioNTech at 0, 3, 7 weeks
  • 2-dose series of updated (2023–2024 Formula) Novavax at 0, 3 weeks
• Previously vaccinated* with 1 dose of any Moderna: 2-dose series of updated (2023–2024 Formula) Moderna at 0, 4 weeks (minimum interval between previous Moderna dose and dose 1: 4 weeks).
• Previously vaccinated* with 2 doses of any Moderna: 1 dose of updated (2023–2024 Formula) Moderna at least 4 weeks after the most recent dose.
• Previously vaccinated* with 1 dose of any Pfizer- BioNTech: 2-dose series of updated (2023–2024 Formula) Pfizer-BioNTech at 0, 4 weeks (minimum interval between previous Pfizer-BioNTech dose and dose 1: 3 weeks).
• Previously vaccinated* with 2 doses of any Pfizer- BioNTech: 1 dose of updated (2023–2024 Formula) Pfizer- BioNTech at least 4 weeks after the most recent dose.
• Previously vaccinated* with 3 or more doses of any Moderna or Pfizer-BioNTech: 1 dose of any updated (2023–2024 Formula) COVID-19 vaccine at least 8 weeks after the most recent dose.
• Previously vaccinated* with 1 or more doses of Janssen or Novavax or with or without dose(s) of any Original monovalent or bivalent COVID-19 vaccine: 1 dose of any updated (2023–2024 Formula) COVID-19 vaccine at least 8 weeks after the most recent dose.

There is no preferential recommendation for the use of one COVID-19 vaccine over another when more than one recommended age-appropriate vaccine is available.

Administer an age-appropriate COVID-19 vaccine product for each dose. For information about transition from age 4 years to age 5 years or age 11 years to age 12 years during COVID-19 vaccination series, see Tables 1 and 2 at www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us.html#covid-vaccines.

Current COVID-19 schedule and dosage formulation available at www.cdc.gov/covidschedule. For more information on Emergency Use Authorization (EUA) indications for COVID-19 vaccines, see www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/covid-19-vaccines

*Note: Previously vaccinated is defined as having received any Original monovalent or bivalent COVID-19 vaccine (Janssen, Moderna, Novavax, Pfizer-BioNTech) prior to the updated 2023–2024 formulation.

**Note: Persons who are moderately or severely immunocompromised have the option to receive one additional dose of updated (2023–2024 Formula) COVID-19 vaccine at least 2 months following the last recommended updated (2023–2024 Formula) COVID-19 vaccine dose. Further additional updated (2023–2024 Formula) COVID-19 vaccine dose(s) may be administered, informed by the clinical judgement of a healthcare provider and personal preference and circumstances. Any further additional doses should be administered at least 2 months after the last updated (2023–2024 Formula) COVID-19 vaccine dose. Moderately or severely immunocompromised children 6 months–4 years of age should receive homologous updated (2023–2024 Formula) mRNA vaccine dose(s) if they receive additional doses.

For contraindications and precautions to COVID-19 vaccination, see COVID-19 Appendix

• 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
• 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 https://www.cdc.gov/mmwr/volumes/70/rr/rr7006a1.htm and https://www.cdc.gov/dengue/vaccine/hcp/index.html.
• Dengue vaccine should not be administered to children traveling to or visiting endemic dengue areas.

For contraindications and precautions to dengue vaccination, see Dengue Appendix

• 5-dose series (3-dose primary series at age 2, 4, and 6 months, followed by a booster doses at ages 15–18 months and 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.

• Dose 5 is not necessary if dose 4 was administered at age 4 years or older and at least 6 months after dose 3.
• For other catch-up guidance, see Table 2.

• 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.

For contraindications and precautions to Diphtheria, tetanus, pertussis (DTaP) vaccination, see DTaP Appendix

•  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.
• PedvaxHIB^®: 3-dose series (2-dose primary series at age 2 and 4 months, followed by a booster dose at age 12–15 months)

• Dose 1 at age 7–11 months: Administer dose 2 at least 4 weeks later and dose 3 (final dose) at age 12–15 months or 8 weeks after dose 2 (whichever is later).
• Dose 1 at age 12–14 months: Administer dose 2 (final dose) at least 8 weeks after dose 1.
• Dose 1 before age 12 months and dose 2 before age 15 months: Administer dose 3 (final dose) at least 8 weeks after dose 2.
• 2 doses of PedvaxHIB^® before age 12 months: Administer dose 3 (final dose) at age 12–59 months and at least 8 weeks after dose 2.
• 1 dose administered at age 15 months or older: No further doses needed
• Unvaccinated at age 15–59 months: Administer 1 dose.
• 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.

• 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.

• Hematopoietic stem cell transplant (HSCT):
  • 3-dose series 4 weeks apart starting 6 to 12 months after successful transplant regardless of Hib vaccination history
• 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
• Elective splenectomy:
  Unvaccinated* persons age 15 months or older
  • 1 dose (preferably at least 14 days before procedure)
• 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
• 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)

For contraindications and precautions to Haemophilus influenzae type b (Hib) vaccination, see Hib Appendix

• 2-dose series (minimum interval: 6 months) at age 12–23 months

• Unvaccinated persons through age 18 years should complete a 2-dose series (minimum interval: 6 months).
• Persons who previously received 1 dose at age 12 months or older should receive dose 2 at least 6 months after dose 1.
• 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).

• Persons traveling to or working in countries with high or intermediate endemic hepatitis A
  (http://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.

For contraindications and precautions to Hepatitis A (HepA) vaccination, see HepA Appendix

• 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).
• Infants who did not receive a birth dose should begin the series as soon as possible (see Table 2 for minimum intervals).
• Administration of 4 doses is permitted when a combination vaccine containing HepB is used after the birth dose.
• Minimum intervals (see Table 2): when 4 doses are administered, substitute “dose 4” for “dose 3” in these calculations
• Final (3rd or 4th) dose: age 6–18 months (minimum age 24 weeks)
• 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.
• 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 HBsAg-positive, 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.

• Unvaccinated persons should complete a 3-dose series at 0, 1–2, 6 months. See Table 2 for minimum intervals
• Adolescents age 11–15 years may use an alternative 2-dose schedule with at least 4 months between doses (adult formulation Recombivax HB^® only).
• Adolescents age 18 years 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).

• Revaccination is not generally recommended for persons with a normal immune status who were vaccinated as infants, children, adolescents, or adults.
• 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 http://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.

For contraindications and precautions to Hepatitis B (HepB) vaccination, see HepB Appendix

• 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
• 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)
• No additional dose recommended when any HPV vaccine series of any valency has been completed using recommended dosing intervals.

• Immunocompromising conditions, including HIV infection: 3-dose series, even for those who initiate vaccination at age 9 through 14 years.
• History of sexual abuse or assault: Start at age 9 years.
• Pregnancy: Pregnancy testing not needed before vaccination; HPV vaccination not recommended until after pregnancy; no intervention needed if vaccinated while pregnant

For contraindications and precautions to Human papillomavirus (HPV) vaccination, see HPV Appendix

• Use any influenza vaccine appropriate for age and health status annually:
  • Age 6 months–8 years who have received fewer than 2 influenza vaccine doses before July 1, 2023, or whose influenza vaccination history is unknown: 2 doses, separated by at least 4 weeks. Administer dose 2 even if the child turns 9 years between receipt of dose 1 and dose 2.
  • Age 6 months–8 years who have received at least 2 influenza vaccine doses before July 1, 2023: 1 dose
  • Age 9 years or older: 1 dose
• For the 2023-2024 season, see cdc.gov/mmwr/volumes/72/rr/rr7202a1.htm.
• For the 2024–25 season, see the 2024–25 ACIP influenza vaccine recommendations.

Note: Persons with an egg allergy can receive any influenza vaccine (egg-based and non-egg-based) appropriate for age and health status.

• Close contacts (e.g., household contacts) of severely immunosuppressed persons who require a protected environment: should not receive If LAIV4 is given, they should avoid contact with for such immunosuppressed persons for 7 days after vaccination.

Note: Persons with an egg allergy can receive any influenza vaccine (egg-based and non-egg-based) appropriate for age and health status.

For contraindications and precautions to Influenza vaccination, see IIV4 Appendix, LAIV4 Appendix, ccIIV4 Appendix, and RIV4 Appendix.

• 2-dose series at age 12–15 months, age 4–6 years
• 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.

*Note: If MMRV is used, the minimum interval between MMRV doses is 3 months

• Unvaccinated children and adolescents: 2-dose series at least 4 weeks apart*
• The maximum age for use of MMRV^* is 12 years.

*Note: If MMRV is used, the minimum interval between MMRV doses is 3 months

• 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^*
• 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

*Note: If MMRV is used, the minimum interval between MMRV doses is 3 months

For contraindications and precautions to Measles, mumps, rubella (MMR), see MMR Appendix

• 2-dose series at age 11–12 years; 16 years

• Age 13–15 years: 1 dose now and booster at age 16–18 years (minimum interval: 8 weeks)
• Age 16–18 years: 1 dose

Anatomic or functional asplenia (including sickle cell disease), HIV infection, persistent complement component deficiency, complement inhibitor (e.g., eculizumab, ravulizumab) use:

• 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
• 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/):

• 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)
• Children age 2 years or older: 1 dose Menveo^®* or MenQuadfi^®

First-year college students who live in residential housing (if not previously vaccinated at age 16 years or older) or military recruits:

• 1 dose Menveo^®* or MenQuadfi^®

Adolescent vaccination of children who received MenACWY prior to age 10 years:

• 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.
• 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. See www.cdc.gov/vaccines/vpd/mening/downloads/menveo-single-vial-presentation.pdf.

Note: 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.

Children age 10 years or older may receive a single dose of Penbraya™ as an alternative to separate administration of MenACWY and MenB when both vaccines would be given on the same clinic day, (see “Meningococcal serogroup B vaccination” section below for more information).

For contraindications and precautions to Meningococcal ACWY (MenACWY)
[MenACWY-CRM (Menveo^®); MenACWY-D (Menactra^®); MenACWY-TT (MenQuadfi^®)], see Meningococcal ACWY (MenACWY) Appendix

For contraindications and precautions to Meningococcal ABCWY, (MenACWY-TT/MenB-FHbp) [Penbraya], see Meningococcal ABCWY Appendix

• 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 3^rd dose at least 4 months after dose 2)

For additional information on shared clinical decision-making for MenB, see www.cdc.gov/vaccines/hcp/admin/downloads/isd-job-aid-scdm-mening-b-shared-clinical-decision-making.pdf

Anatomic or functional asplenia (including sickle cell disease), persistent complement component deficiency, complement inhibitor (e.g., eculizumab, ravulizumab) use:

• Bexsero^®: 2-dose series at least 1 month apart
• 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  4^th 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.

Children age 10 years or older may receive a dose of Penbraya™ as an alternative to separate administration of MenACWY and MenB when both vaccines would be given on the same clinic day. For age-eligible children not at increased risk, if Penbraya^™ is used for dose 1 MenB, MenB-FHbp (Trumenba) should be administered for dose 2 MenB. For age-eligible children at increased risk of meningococcal disease, Penbraya^™ may be used for additional MenACWY and MenB doses (including booster doses) if both would be given on the same clinic day and at least 6 months have elapsed since most recent Penbraya^™ dose.

For contraindications and precautions to Meningococcal B (MenB), MenB-4C [Bexsero], MenB-FHbp [Trumenba], see MenB Appendix

For contraindications and precautions to Meningococcal ABCWY, (MenACWY-TT/MenB-FHbp) [Penbraya], see Meningococcal ABCWY Appendix

• Age 18 years and at risk for Mpox infection: 2-dose series, 28 days apart.
  • Risk factors for Mpox infection include:
    • Persons who are gay, bisexual, and other MSM, transgender or nonbinary people who in the past 6 months have had:
      • A new diagnosis of at least 1 sexually transmitted disease
      • More than 1 sex partner
      • Sex at a commercial sex venue
      • Sex in association with a large public event in a geographic area where Mpox transmission is occurring
    • Persons who are sexual partners of the persons described above
    • Persons who anticipate experiencing any of the situations described above
• Pregnancy: There is currently no ACIP recommendation for Jynneos use in pregnancy due to lack of safety data in pregnant. Pregnant persons with any risk factor described above may receive Jynneos.

For detailed information, see: www.cdc.gov/vaccines/acip/meetings/downloads/slides-2023-10-25-26/04-MPOX-Rao-508.pdf

For contraindications and precautions to Mpox vaccination, see Mpox Appendix

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

• Healthy children ages 2–4 years with any incomplete* PCV series: 1 dose PCV
• For other catch-up guidance, see Table 2.

Note: Either PCV15 or PCV20 can be used when PCV is indicated. For children without risk conditions, PCV20 is not indicated if they have received 4 doses of PCV13 or PCV15 or another age appropriate complete PCV series.

Children and adolescents with cerebrospinal fluid leak; chronic heart disease; chronic kidney disease (excluding maintenance dialysis and nephrotic syndrome); chronic liver disease; chronic lung disease (including moderate persistent or severe persistent asthma); cochlear implant; or diabetes mellitus:

Age 2–5 years

• Any incomplete* PCV series with:
  • 3 PCV doses: 1 dose PCV (at least 8 weeks after the most recent PCV dose)
  • Less than 3 PCV doses: 2 doses PCV (at least 8 weeks after the most recent dose and administered at least 8 weeks apart)
• Completed recommended PCV series but have not received PPSV23
  • Previously received at least 1 dose of PCV20: no further PCV or PPSV23 doses needed
  • Not previously received PCV20: administer 1 dose PCV20 OR 1 dose PPSV23 administer at least 8 weeks after the most recent PCV dose.

Age 6–18 years

• Not previously received any dose of PCV13, PCV15, or PCV20: administer 1 dose of PCV15 or PCV20. If PCV15 is used and no previous receipt of PPSV23, administer 1 dose of PPSV23 at least 8 weeks after the PCV15 dose.**
• Received PCV before age 6 years but have not received PPSV23
  • Previously received at least 1 dose of PCV20: no further PCV or PPSV23 doses needed
  • Not previously received PCV20: administer 1 dose PCV20 OR 1 dose PPSV23 at least 8 weeks after the most recent PCV dose. If PPSV23 is used, administer either PCV20 or dose 2 PPSV23 at least 5 years after dose 1 PPSV23.
• Received PCV13 only at or after age 6 years: administer 1 dose PCV20 OR 1 dose PPSV23 at least 8 weeks after the most recent PCV13 dose.
• Received 1 dose PCV13 and 1 dose PPSV23 at or after age 6 years: no further doses of any PCV or PPSV23 indicated.

Children and adolescents on maintenance dialysis, or with immunocompromising conditions such as 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; or sickle cell disease or other hemoglobinopathies:

Age 2–5 years

• Any incomplete* PCV series:
  • 3 PCV doses: 1 dose PCV (at least 8 weeks after the most recent PCV dose)
  • Less than 3 PCV doses: 2 doses PCV (at least 8 weeks after the most recent dose and administered at least 8 weeks apart)
• Completed recommended PCV series but have not received PPSV23
  • Previously received at least 1 dose of PCV20: no further PCV or PPSV23 doses needed
  • Not previously received PCV20: administer 1 dose PCV20 OR 1 dose PPSV23 at least 8 weeks after the most recent PCV. If PPSV23 is used, administer 1 dose of PCV20 or dose 2 PPSV23 at least 5 years after dose 1 PPSV23.

Age 6–18 years

• Not previously received any dose of PCV13, PCV15, or PCV20: administer 1 dose of PCV15 or 1 dose of PCV20. If PCV15 is used and no previous receipt of PPSV23, administer 1 dose of PPSV23 at least 8 weeks after the PCV15 dose.**
• Received PCV before age 6 years but have not received PPSV23
  • Previously received at least 1 dose of PCV20: no additional dose of PCV or PPSV23
  • Not previously received PCV20: administer 1 dose PCV20 OR 1 dose PPSV23 at least 8 weeks after the most recent PCV dose. If PPSV23 is used, administer either PCV20 or dose 2 PPSV23 at least 5 years after dose 1 PPSV23.
• Received PCV13 only at or after age 6 years: administer 1 dose PCV20 OR 1 dose PPSV23 at least 8 weeks after the most recent PCV13 dose. If PPSV23 is used, administer 1 dose of PCV20 or dose 2 PPSV23 at least 5 years after dose 1 PPSV23.
• Received 1 dose PCV13 and 1 dose PPSV23 at or after age 6 years: administer 1 dose PCV20 OR 1 dose PPSV23 at least 8 weeks after the most recent PCV13 dose and at least 5 years after dose 1 PPSV23.

*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 stacks.cdc.gov/view/cdc/133252

**When both PCV15 and PPSV23 are indicated, administer all doses of PCV15 first. PCV15 and PPSV23 should not be administered during the same visit.

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

For contraindications and precautions to Pneumococcal conjugate (PCV), see PCV Appendix and Pneumococcal polysaccharide (PPSV23), see PPSV23 Appendix

• 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.
• 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.

• In the first 6 months of life, use minimum ages and intervals only for travel to a polio-endemic region or during an outbreak.
• Adolescents age 18 years known or suspected to be unvaccinated or incompletely vaccinated: administer remaining doses (1, 2, or 3 IPV doses) to complete a 3-dose primary series.* Unless there are specific reasons to believe they were not vaccinated, most persons aged 18 years or older born and raised in the United States can assume they were vaccinated against polio as children.

Series containing oral poliovirus vaccine (OPV), either mixed OPV-IPV or OPV-only series:

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

• Adolescents age18 years at increased risk of exposure to poliovirus and completed primary series*: may administer one lifetime IPV booster

*Note: Complete primary series consist of at least 3 doses of IPV or trivalent oral poliovirus vaccine (tOPV) in any combination.

For detailed information, see: www.cdc.gov/vaccines/vpd/polio/hcp/recommendations.html

For contraindications and precautions to Poliovirus vaccine, inactivated (IPV), see Appendix

• Infants born October – March in most of the continental United States*
  • Mother did not receive RSV vaccine OR mother’s RSV vaccination status is unknown: administer 1 dose nirsevimab within 1 week of birth in hospital or outpatient setting
  • Mother received RSV vaccine less than 14 days prior to delivery: administer 1 dose nirsevimab within 1 week of birth in hospital or outpatient setting
  • Mother received RSV vaccine at least 14 days prior to delivery: nirsevimab not needed but can be considered in rare circumstances at the discretion of healthcare providers (see special populations and situations at cdc.gov/vaccines/vpd/rsv/hcp/child-faqs.html)
• Infants born April–September in most of the continental United States*
  • Mother did not receive RSV vaccine OR mother’s RSV vaccination status is unknown: administer 1 dose nirsevimab shortly before start of RSV season*
  • Mother received RSV vaccine less than 14 days prior to delivery: administer 1 dose nirsevimab shortly before start of RSV season*
  • Mother received RSV vaccine at least 14 days prior to delivery: nirsevimab not needed but can be considered in rare circumstances at the discretion of healthcare providers (see special populations and situations at cdc.gov/vaccines/vpd/rsv/hcp/child-faqs.html)

Infants with prolonged birth hospitalization** (e.g., for prematurity) discharged October through March should be immunized shortly before or promptly after discharge.

• Ages 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 the start of the second RSV season; severe immunocompromise; cystic fibrosis with either weight for length <10th percentile or 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)**:
  • 1 dose nirsevimab shortly before start of second RSV season*
• Ages 8–19 months who are American Indian or Alaska Native:
  • 1 dose nirsevimab shortly before start of second RSV season*
• Age-eligible and undergoing cardiac surgery with cardiopulmonary bypass**: 1 additional dose of nirsevimab after surgery. For additional details see special populations and situations at www.cdc.gov/vaccines/vpd/rsv/hcp/child-faqs.html

*Note: While the timing of the onset and duration of RSV season may vary, nirsevimab may be administered October through March in most of the continental United States. Providers in jurisdictions with RSV seasonality that differs from most of the continental United States (e.g., Alaska, jurisdiction with tropical climate) should follow guidance from public health authorities (e.g., CDC, health departments) or regional medical centers on timing of administration based on local RSV seasonality. Although optimal timing of administration is just before the start of the RSV season, nirsevimab may also be administered during the RSV season to infants and children who are age-eligible.

**Note: Nirsevimab can be administered to children who are eligible to receive palivizumab. Children who have received nirsevimab should not receive palivizumab for the same RSV season.

For further guidance, see www.cdc.gov/mmwr/volumes/72/wr/mm7234a4.htm and www.cdc.gov/vaccines/vpd/rsv/hcp/ child-faqs.html

For contraindications and precautions to RSV monoclonal antibody (RSV-mAb), see RSV monoclonal antibody Appendix

• Pregnant at 32 weeks 0 days through 36 weeks and 6 days gestation from September through January in most of the continental United States*: 1 dose RSV vaccine (Abrysvo™). Administer RSV vaccine regardless of previous RSV infection.
  • Either maternal RSV vaccination or infant immunization with nirsevimab (RSV monoclonal antibody) is recommended to prevent respiratory syncytial virus lower respiratory tract infection in infants.
• All other pregnant persons: RSV vaccine not recommended.

There is currently no ACIP recommendation for RSV vaccination in subsequent pregnancies. No data are available to inform whether additional doses are needed in later pregnancies.

*Note: Providers in jurisdictions with RSV seasonality that differs from most of the continental United States (e.g., Alaska, jurisdiction with tropical climate) should follow guidance from public health authorities (e.g., CDC, health departments) or regional medical centers on timing of administration based on local RSV seasonality.

For contraindications and precautions to Respiratory syncytial virus vaccine (RSV), see RSV Appendix

• Rotarix^®: 2-dose series at age 2 and 4 months
• RotaTeq^®: 3-dose series at age 2, 4, and 6 months
• If any dose in the series is either RotaTeq^® or unknown, default to 3-dose series.

• Do not start the series on or after age 15 weeks, 0 days.
• The maximum age for the final dose is 8 months, 0 days.
• For other catch-up guidance, see Table 2.

For contraindications and precautions to Rotavirus (RV) [RV1 (Rotarix®), RV5 (RotaTeq®)], see Rotavirus Appendix

• Age 11–12 years: 1 dose Tdap (adolescent booster)
• Pregnancy: 1 dose Tdap during each pregnancy, preferably in early part of gestational weeks 27–36.

Note: Tdap may be administered regardless of the interval since the last tetanus- and diphtheria-toxoid-containing vaccine.

• Age 13–18 years who have not received Tdap: 1 dose Tdap (adolescent booster)
• 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.
• Tdap administered at age 7–10 years:
  • Age 7–9 years who receive Tdap should receive the adolescent Tdap booster dose at age 11–12 years.
  • Age 10 years who receive Tdap do not need the adolescent Tdap booster dose at age 11–12 years.
• DTaP inadvertently administered on or after age 7 years:
  • Age 7–9 years: DTaP may count as part of catch-up. Administer adolescent Tdap booster dose at age 11–12 years.
  • Age 10–18 years: Count dose of DTaP as the adolescent Tdap booster dose.

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

*Fully vaccinated = 5 valid doses of DTaP OR 4 valid doses of DTaP if dose 4 was administered at age 4 years or older

• 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-toxoid-containing vaccine; for all other wounds, administer Tdap or Td if more than 5 years since last dose of tetanus-toxoid-containing 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.
• For detailed information, see www.cdc.gov/mmwr/volumes/69/wr/mm6903a5.htm.

For contraindications and precautions to Tetanus, diphtheria, and acellular pertussis (Tdap) and Tetanus, diphtheria (Td), see Tdap and Td Appendix

• 2-dose series at age 12–15 months, 4–6 years
• VAR or MMRV may be administered*
• Dose 2 may be administered as early as 3 months after dose 1 (a dose inadvertently administered after at least 4weeks 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.

• 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.

For contraindications and precautions to Varicella (VAR), see VAR Appendix