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Childhood Vaccination Schedule

By

Michael J. Smith

, MD, MSCE, Duke University School of Medicine

Last full review/revision Nov 2021
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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 [birth through 6 years] and the CDC schedule for older children [7 to 18 years old]). 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 Hepatitis B Vaccine The hepatitis B vaccine helps protect against hepatitis B and its complications (chronic hepatitis, cirrhosis, and liver cancer). Generally, hepatitis B is more serious than hepatitis A and... read more : 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 Rotavirus Vaccine The rotavirus vaccine is a live-virus vaccine that helps protect against gastroenteritis caused by rotavirus, which causes vomiting, diarrhea, and, if symptoms persist, dehydration and organ... read more : 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 Haemophilus influenzae Type b Vaccine The Haemophilus influenzae type b (Hib) vaccine helps protect against bacterial infections due to Hib, such as pneumonia and meningitis. These infections may be serious in children. Use of the... read more : 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 Polio Vaccine The polio vaccine protects against polio, a very contagious viral infection that affects the spinal cord and brain. Polio can cause permanent muscle weakness, paralysis, and sometimes death... read more : 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 Diphtheria-Tetanus-Pertussis Vaccine The diphtheria, tetanus, and pertussis vaccine is a combination vaccine that protects against these three diseases: Diphtheria usually causes inflammation of the throat and mucous membranes... read more : 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 dose of a tetanus, diphtheria, and pertussis (Tdap) Administration The tetanus-diphtheria (Td) vaccine protects against toxins produced by the tetanus and diphtheria bacteria, not against the bacteria themselves. There is also a combination vaccine that adds... read more 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 or Tdap booster every 10 years.

[f] Pneumococcal vaccine Pneumococcal Vaccine Pneumococcal vaccines help protect against bacterial infections caused by Streptococcus pneumoniae (pneumococci). Pneumococcal infections include ear infections, sinusitis, pneumonia, bloodstream... read more : 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.

[h] Influenza (flu) vaccine Influenza Vaccine The influenza virus vaccine helps protect against influenza. Two types of influenza virus, type A and type B, regularly cause seasonal epidemics of influenza in the United States. There are... read more : 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.

[k] Hepatitis A vaccine Hepatitis A Vaccine The hepatitis A vaccine helps protect against hepatitis A. Typically, hepatitis A is less serious than hepatitis B. Hepatitis A often causes no symptoms, although it can cause fever, nausea... read more : 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 months after the first. All children over age 24 months who have not been vaccinated should be given 2 doses of the hepatitis A vaccine.

[l] Human papillomavirus (HPV) vaccine Human Papillomavirus (HPV) Vaccine The human papillomavirus (HPV) vaccine helps protect against infection by the strains of HPV that are most likely to cause the following: Cervical cancer, vaginal cancer, and vulvar cancer in... read more : 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.

COVID-19 vaccination in children

In addition to the immunizations noted in the vaccination schedule, children in the United States in certain age groups are now eligible for COVID-19 vaccination COVID-19 Vaccine Coronavirus disease 2019 (COVID-19) vaccines provide protection against COVID-19. COVID-19 is the disease caused by infection with the SARS-CoV-2 virus. There are multiple COVID-19 vaccines... read more . The Pfizer-BioNTech COVID-19 vaccine (mRNA) has received an Emergency Use Authorization (EUA) for children 5 to 15 years of age and is fully approved for use in people 16 years of age and older. The Pfizer-BioNTech vaccine is given as 2 injections 3 weeks apart (the dose for children ages 5 to 11 is smaller than that for those 12 and older). Also authorized under EUA is an additional dose for people 12 years of age and older who have certain disorders that affect their immune system. COVID-19 vaccine may be given at the same time as routine immunizations.

Children who have had an allergic reaction after a previous dose of a COVID-19 vaccine or are allergic to any ingredient in a COVID-19 vaccine should not get COVID-19 vaccines.

The Moderna COVID-19 vaccine (mRNA) is also being studied for use in children under 18 years of age but does not currently have approval or EUA.

Malaria vaccination in children

On October 6, 2021, the World Health Organization (WHO) recommended widespread use of the RTS,S/AS01 (RTS,S) malaria vaccine among children in sub-Saharan Africa and in other regions with moderate to high Plasmodium falciparum malaria Malaria Malaria is infection of red blood cells with one of five species of Plasmodium, a protozoan. Malaria causes fever, chills, sweating, a general feeling of illness (malaise), and sometimes diarrhea... read more transmission. (See WHO recommends groundbreaking malaria vaccine for children at risk.)

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.

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