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Childhood Vaccination Schedule

By

Michael J. Smith

, MD, MSCE, Duke University

Last full review/revision Jul 2020| Content last modified Jul 2020
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Most doctors follow the vaccination schedule recommended by the Centers for Disease Control and Prevention (CDC—see the schedule for infants and children and the schedule for older children and adolescents), which begins with the hepatitis B vaccine given in the hospital nursery. (See also Childhood Vaccinations.)

Parents should try to have their children vaccinated according to the schedule. A significant delay in vaccination puts children at risk of the serious diseases the vaccines could prevent.

If children miss a vaccine dose, parents should talk to their doctor about catching up with the schedule. Missing a dose does not require children to restart the series of injections from the beginning.

Vaccination does not need to be delayed if children have a slight fever resulting from a mild infection, such as an ordinary cold.

Some vaccines are recommended only under special circumstances—for example, only when children have an increased risk of getting the disease the vaccine prevents.

More than one vaccine may be given during a visit to the doctor's office, but several vaccines are often combined into one injection. For example, there is a vaccine that combines pertussis, diphtheria, tetanus, polio, and Haemophilus influenzae type b vaccines in one injection. A combination vaccine simply reduces the number of injections needed and does not reduce the safety or effectiveness of the vaccines.

Routine Vaccinations for Infants, Children, and Adolescents

Following the recommended vaccination schedule is important because it helps protect infants, children, and adolescents against infections that can be prevented. The schedule below is based on the ones recommended by the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC; see also the CDC schedule for infants and children and the CDC schedule for older children and adolescents). The schedule below indicates which vaccines are needed, at what age, and how many doses (indicated by the numbers in the symbols).

There is a range of acceptable ages for many vaccines. A child's doctor can provide specific recommendations, which may vary depending on the child's known health conditions and other circumstances. Often, combination vaccines are used so that children receive fewer injections. If children have not been vaccinated according to the schedule, catch-up vaccinations are recommended, and parents should contact a doctor or health department clinic to find out how to catch up. Parents should report any side effects after vaccinations to their child's doctor.

For more information about this schedule and other vaccination schedules, parents should talk to a doctor or visit the Centers for Disease Control and Prevention's Vaccines & Immunizations web site.

Routine Vaccinations for Infants, Children, and Adolescents

[a] Hepatitis B vaccine: This vaccine is given to most newborns before they are discharged from the hospital. The first dose is typically given at birth, the second dose at age 1 to 2 months, and the third dose at age 6 to 18 months. Infants who did not receive a dose at birth should begin the series as soon as possible.

[b] Rotavirus vaccine: Depending on the vaccine used, two or three doses of the vaccine are required. With one vaccine, the first dose is given at age 2 months and the second dose at age 4 months. With the other vaccine, the first dose is given at age 2 months, the second dose at age 4 months, and the third dose at age 6 months.

[c] Haemophilus influenzae type b (Hib) vaccine: Depending on the vaccine used, three or four doses of the Hib vaccine are required. With one vaccine, the first dose is given at age 2 months, the second dose at age 4 months, and the third dose at age 12 to 15 months. With the other vaccine, the first dose is given at age 2 months, the second dose at age 4 months, the third dose at age 6 months, and the fourth dose at age 12 to 15 months.

[d] Poliovirus vaccine: Four doses of the vaccine are given. The first dose is given at age 2 months, the second dose at age 4 months, the third dose at age 6 to 18 months, and the fourth dose at age 4 to 6 years.

[e] Diphtheria, tetanus, and acellular pertussis (DTaP) vaccine: Before age 7, children are given the DTaP preparation. Five doses of DTaP are given. The first dose is given at age 2 months, the second dose at age 4 months, the third dose at age 6 months, the fourth dose at age 15 to 18 months, and the fifth dose at age 4 to 6 years.

DTaP is followed by one lifetime dose of a tetanus, diphtheria, and pertussis (Tdap) booster given at age 11 to 12 years (shown as the number 6 on the above schedule). This dose is followed by a tetanus-diphtheria booster every 10 years.

[f] Pneumococcal vaccine: Four doses of the vaccine are given. The first dose is given at age 2 months, the second dose at age 4 months, the third dose at age 6 months, and the fourth dose at age 12 to 15 months.

[g] Meningococcal vaccine: Two doses of the vaccine are given. The first dose is given at age 11 to 12 years and the second dose at age 16 years (not shown on the above schedule).

[h] Influenza (flu) vaccine: The influenza vaccine should be given yearly to all children, beginning at age 6 months. There are two types of vaccine available. One or two doses are needed, depending on age and other factors. Most children need only one dose. Children who are 6 months to 8 years old who have received fewer than two doses or whose influenza vaccination history is unknown should receive two doses at least 4 weeks apart .

[i] Measles-mumps-rubella (MMR) vaccine: Two doses of the vaccine are given. The first dose is given at age 12 to 15 months and the second dose at age 4 to 6 years.

[j] Varicella (chickenpox) vaccine: Two doses of the vaccine are given. The first dose is given at age 12 to 15 months and the second dose at age 4 to 6 years.

[k] Hepatitis A vaccine: Two doses of the vaccine are needed for lasting protection. The first dose is given between ages 12 to 23 months, and the second dose 6 to 18 months later. If children over age 24 months have not been vaccinated, they can still be given the hepatitis A vaccine if desired.

[l] Human papillomavirus (HPV) vaccine: Routine vaccination is recommended at age 11 to 12 years (can start at age 9 years) and for previously unvaccinated or not adequately vaccinated people up through age 26 years (not shown on the above schedule). The human papillomavirus vaccine is given to girls and boys in 2 or 3 doses. The number of doses depends on how old the child is when the first dose is given. Those given the first dose at age 9 to 14 years are given 2 doses, separated by at least 5 months. Those given the first dose at age 15 years or older are given 3 doses. The second dose is given at least 1 month after the first, and the third dose is given at least 5 months after the first dose.

More Information

The following are some English-language resources that may be useful. Please note that THE MANUAL is not responsible for the content of these resources.

NOTE: This is the Consumer Version. DOCTORS: Click here for the Professional Version
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