Vaccination Information

Routine vaccination

•  ActHIB, Hiberix, or Pentacel: 4-dose series at 6, 10, and 14 weeks, 16–18 months

Catch-up vaccination

• 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) 8 weeks after dose 2.

• 2 doses of HIB 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

Special situations

• Chemotherapy or radiation treatment:

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 the 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):

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 the 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 the procedure)

• HIV infection:

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 the previous dose

Unvaccinated* persons age 5–18 years

• 1 dose

• Immunoglobulin deficiency, early component complement deficiency:

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 the previous dose

*Unvaccinated = Less than routine series (through age 14 months) OR no doses (age 15 months or older)

Routine vaccination

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

Catch-up vaccination

• 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).

Hepatitis AInfants 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.

Birth dose (monovalent HepB vaccine only)

• Mother is HBsAg-negative: 1 dose within 24 hours of birth for all medically stable infants ≥2,000 grams. Infants <2,000 grams: Administer 1 dose at chronological age 1 month or hospital discharge (whichever is earlier and even if weight is still <2,000 grams).

• Mother is HBsAg-positive:

  • Administer HepB vaccine and hepatitis B immune globulin (HBIG) (in separate limbs) within 12 hours of birth, regardless of birth weight. For infants <2,000 grams, administer 3 additional doses of vaccine (total of 4 doses) beginning at age 1 month.

  • Test for HBsAg and anti-HBs at age 9–12 months. If HepB series is delayed, test 1–2 months after final dose.

• Mother’s HBsAg status is unknown:

  • Administer HepB vaccine within 12 hours of birth, regardless of birth weight.

  • For infants <2,000 grams, administer HBIG in addition to HepB vaccine (in separate limbs) within 12 hours of birth. Administer 3 additional doses of vaccine (total of 4 doses) beginning at age 1 month.

  • Determine mother’s HBsAg status as soon as possible. If mother is HBsAg-positive, administer HBIG to infants ≥2,000 grams as soon as possible, but no later than 7 days of age.

Routine series

• 3-dose series at 0, 1–2, 6–18 months (use monovalent HepB vaccine for doses administered before age 6 weeks)

• Infants who did not receive a birth dose should begin the series as soon as feasible

• Administration of 4 doses is permitted when a combination vaccine containing HepB is used after the birth dose.

• Minimum age for the final (3rd or 4th ) dose: 24 weeks

• Minimum intervals: dose 1 to dose 2: 4 weeks / dose 2 to dose 3: 8 weeks / dose 1 to dose 3: 16 weeks (when 4 doses are administered, substitute “dose 4” for “dose 3” in these calculations)

Catch-up vaccination

• Unvaccinated persons should complete a 3-dose series at 0, 1–2, 6 months.

• Adolescents age 11–15 years may use an alternative 2-dose schedule with at least 4 months between doses (adult formulation only).

• Adolescents age 18 years or older may receive a 2-dose series of HepB at least 4 weeks apart.

• 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).

Special situations

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

• Revaccination may be recommended for certain populations, including:

  • Infants born to HBsAg-positive mothers

  • Hemodialysis patients

  • Other immunocompromised persons

• For detailed revaccination recommendations, see http://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/hepb.html.

Routine and catch-up vaccination

• 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)

• Interrupted schedules: If the vaccination schedule is interrupted, the series does not need to be restarted.

• No additional dose recommended after completing the series with recommended dosing intervals using any HPV vaccine.

Special situations

• Immunocompromising conditions, including HIV infection: 3-dose series as above

• History of sexual abuse or assault: Start at age 9 years.

• Pregnancy: HPV vaccination not recommended until after pregnancy; no intervention needed if vaccinated while pregnant; pregnancy testing not needed before vaccination

Routine vaccination

• 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, 2020, 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

  • 1 dose for all persons age 9 years or older

Special situations

• Egg allergy, hives only: Any influenza vaccine appropriate for age and health status annually

• Egg allergy with symptoms other than hives (e.g., angioedema, respiratory distress, need for emergency medical services, or epinephrine): Any influenza vaccine appropriate for age and health status annually. If using an influenza vaccine other than Flublok or Flucelvax, administered in a medical setting under the supervision of a health care provider who can recognize and manage severe allergic reactions.

• Severe allergic reactions to vaccines can occur even in the absence of a history of previous allergic reactions. All vaccination providers should be familiar with the office emergency plan and certified in cardiopulmonary resuscitation.

• A previous severe allergic reaction to the influenza vaccine is a contraindication to future receipt of any influenza vaccine.

• LAIV4 should not be used in persons with the following conditions or situations:

  • History of severe allergic reaction to a previous dose of any influenza vaccine or to any vaccine component (excluding egg, see details above)

  • Receiving aspirin or salicylate-containing medications

  • Age 2–4 years with a history of asthma or wheezing

  • Immunocompromised due to any cause (including medications and HIV infection)

  • Anatomic or functional asplenia

  • Close contacts or caregivers of severely immunosuppressed persons who require a protected environment

  • Pregnancy

  • Cochlear implant

  • Cerebrospinal fluid-oropharyngeal communication

  • Children less than age 2 years

  • 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

Routine vaccination

• 3-dose series at 9 months,12-15 months, 4–6 years

• Dose 2 may be administered as early as 4 weeks after dose 1.

Catch-up vaccination

• Unvaccinated children and adolescents: 2-dose series at least 4 weeks apart

• The maximum age for use of MMRV is 12 years.

Special situations

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

Routine vaccination

• 2-dose series at 11–12 years, 16 years

• 2 dose series at 9 months and 2 years for Menactra

• One dose for Menveo at 2 years of age

Catch-up vaccination

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

• 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:

• 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 the PCV13 series.

Travel in countries with hyperendemic or epidemic meningococcal disease, including countries in the African meningitis belt or during the Hajj
(http://www.cdc.gov/travel/):

• Children age less than 24 months:

  • Menveo (age 2–23 months)

    • Dose 1 at age 8 weeks: 4-dose series at 2, 4, 6, 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)

• Children age 2 years or older: 1 dose Menveo or Menactra

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 Menactra

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 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.

Note: Menactra should be administered either before or at the same time as DTaP. For MenACWY booster dose recommendations for groups listed under “Special situations” and in an outbreak setting and additional meningococcal vaccination information, see https://www.cdc.gov/mmwr/volumes/69/rr/rr6909a1.htm.

Routine vaccination with PCV13

• 4-dose series at 6,10 and 14weeksand 12–15 months

Catch-up vaccination with PCV13

• 1 dose for healthy children age 24–59 months with any incomplete* PCV13 series

• 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) 8 weeks after dose 2.

• 2 doses of PCV before age 23 months: Administer dose 3 (final dose) at age 12–59 months and at least 8 weeks after dose 2.

• 1 dose administered at age 24 months or older: No further doses needed

• Unvaccinated at age 24–59 months: Administer 1 dose of PCV13 or 2 dose of PCV10.

• Previously unvaccinated children age 60 months or older who are not considered high risk: Do not require catch-up vaccination. Can be given 1 dose of PCV13 thereafter.

Special situations

Underlying conditions below: When both PCV13 and PPSV23 are indicated, administer PCV13 first. PCV13 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

• Any incomplete* series with:

  • 3 PCV13 doses: 1 dose PCV13 (at least 8 weeks after any prior PCV13 dose)

  • Less than 3 PCV13 doses: 2 doses PCV13 (8 weeks after the most recent dose and administered 8 weeks apart)

• No history of PPSV23: 1 dose PPSV23 (at least 8 weeks after completing all recommended PCV13 doses)

Age 6–18 years

• No history of PPSV23: 1 dose PPSV23 (at least 8 weeks after completing all recommended PCV13 doses)

Cerebrospinal fluid leak, cochlear implant:

Age 2–5 years

• Any incomplete* series with:

  • 3 PCV13 doses: 1 dose PCV13 (at least 8 weeks after any prior PCV13 dose)

  • Less than 3 PCV13 doses: 2 doses PCV13 (8 weeks after the most recent dose and administered 8 weeks apart)

• No history of PPSV23: 1 dose PPSV23 (at least 8 weeks after any prior PCV13 dose)

Age 6–18 years

• No history of either PCV13 or PPSV23: 1 dose PCV13, 1 dose PPSV23 at least 8 weeks later

• Any PCV13 but no PPSV23: 1 dose PPSV23 at least 8 weeks after the most recent dose of PCV13

• PPSV23 but no PCV13: 1 dose PCV13 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

• Any incomplete* series with:

  • 3 PCV13 doses: 1 dose PCV13 (at least 8 weeks after any prior PCV13 dose)

  • Less than 3 PCV13 doses: 2 doses PCV13 (8 weeks after the most recent dose and administered 8 weeks apart)

• No history of PPSV23: 1 dose PPSV23 (at least 8 weeks after any prior PCV13 dose) and a 2nd dose of PPSV23 5 years later

Age 6–18 years

• No history of either PCV13 or PPSV23: 1 dose PCV13, 2 doses PPSV23 (dose 1 of PPSV23 administered 8 weeks after PCV13 and dose 2 of PPSV23 administered at least 5 years after dose 1 of PPSV23)

• Any PCV13 but no PPSV23: 2 doses PPSV23 (dose 1 of PPSV23 administered 8 weeks after the most recent dose of PCV13 and dose 2 of PPSV23 administered at least 5 years after dose 1 of PPSV23)

• PPSV23 but no PCV13: 1 dose PCV13 at least 8 weeks after the most recent PPSV23 dose and the 2nd dose of PPSV23 administered 5 years after dose 1 of PPSV23 and at least 8 weeks after a dose of PCV13

Chronic liver disease, alcoholism:

Age 6–18 years

• No history of PPSV23: 1 dose PPSV23 (at least 8 weeks after any prior PCV13 dose)

*Incomplete series = Not having received all doses in either the recommended series or an age-appropriate catch-up series (https://www.cdc.gov/mmwr/pdf/rr/rr5911.pdfpdf icon) for complete schedule details.

Routine vaccination

• 4-dose series at ages 6,10 and 14 weeks, 16–18 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.

Catch-up vaccination

• In the first 6 months of life, use minimum ages and intervals only for travel to a polio-endemic region or during an outbreak.

Series containing oral polio 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 IPV schedule.

• Only bivalent OPV (tOPV) counts toward the Indian vaccination requirements.

Routine vaccination

• Rotarix: 2-dose series at 10 and 14 weeks

• RotaTeq, Rorasil,Rotasure,Rotavac: 3-dose series at 6,10 and 14 weeks

• If any dose in the series is either RotaTeq or unknown, default to 3-dose series.

Catch-up vaccination

• 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.

Routine vaccination

• Adolescents age 11–12 years: 1 dose Tdap

• Pregnancy: 1 dose Tdap during each pregnancy, preferably during the early part of gestational weeks 27–36

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

Catch-up vaccination

• Adolescents age 13–18 years who have not received Tdap: 1 dose Tdap, then Td or Tdap booster every 10 years

• 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.

• 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.

• DTaP 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.

Special situations

• Wound management in persons age 7 years or older with a 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 https://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.

Routine vaccination

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

• Dose 2 may be administered as early as 3 months after dose 1 (a dose administered after a 4-week interval may be counted).

Catch-up vaccination

• Ensure persons age 7–18 years without evidence of immunity (see MMWR at http://www.cdc.gov/mmwr/pdf/rr/rr5604.pdfpdf icon ) have a 2-dose series:

  • Age 7–12 years: routine interval: 3 months (a dose administered after a 4-week interval may be counted)

  • Age 13 years or older: routine interval: 4–8 weeks (minimum interval: 4 weeks)

  • The maximum age for use of MMRV is 12 years.