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 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 given in the hospital nursery. (See also Childhood Vaccinations Childhood Vaccinations Vaccination protects children against many infectious diseases. Vaccines contain either noninfectious components of bacteria or viruses or whole forms of these organisms that have been weakened... read more .)
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.
[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... 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... 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.
[g] Meningococcal vaccine Meningococcal Vaccine The meningococcal vaccine protects against infections caused by the bacteria Neisseria meningitidis (meningococci). Meningococcal infections can lead to meningitis (an infection of tissue... read more : 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 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.
[i] Measles-mumps-rubella (MMR) vaccine Measles, Mumps, and Rubella Vaccine The measles, mumps, and rubella (MMR) vaccine is a combination vaccine that helps protect against these three serious viral infections. The vaccine contains live but weakened measles, mumps... read more : 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 Varicella Vaccine The varicella vaccine helps protect against chickenpox (varicella), a very contagious infection caused by the varicella-zoster virus. It causes an itchy rash that looks like small blisters with... read more : 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 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 BNT162b2 COVID-19 vaccine (mRNA) made by Pfizer-BioNTech (Comirnaty) has Emergency Use Authorization (EUA) for children 6 months to 15 years of age and is fully approved for use in people 16 years of age and older. This vaccine is given as a primary series of 2 injections given at least 3 weeks apart (the dose for children 5 to 11 years of age is smaller than that for those 12 and older). The vaccine is given as a primary series of 3 injections to children 6 months to 4 years of age. The second injection is given at least 3 to 8 weeks after the first one. The third injection is given at least 8 weeks after the second one. Also authorized under EUA is an additional primary dose, given at least 4 weeks after the second dose, for children 5 years of age and older who have certain disorders that moderately or severely affect their immune system.
Moderately to severely immunocompromised children who are 5 to 17 years of age should also get a booster shot at least 3 months after the third primary dose. If children are 12 to 17 years of age, a second booster dose may be given at least 4 months after the first booster dose. (See Guidance for COVID-19 vaccination for people who are moderately or severely immunocompromised.)
A first booster dose is recommended for all BNT162b2 vaccine recipients 5 years of age and older who are not immunocompromised and who completed their primary 2-dose series 5 or more months ago. Unlike people 18 years of age and older who can choose any available COVID-19 vaccine as a booster shot, only BNT162b2 vaccine has EUA for children 5 to 17 years of age.
The mRNA-1273 COVID-19 vaccine (mRNA) produced by Moderna has EUA for children 6 months to 17 years of age. This vaccine is given as a primary series of 2 injections given at least 4 to 8 weeks apart. EUA has also been granted for an additional primary dose, given at least 4 weeks after the second dose, for children 6 months of age and older who have a moderately to severely compromised 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.
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... read more transmission. (See WHO recommends groundbreaking malaria vaccine for children at risk.)
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.
Centers for Disease Control and Prevention (CDC): Information about vaccines and immunization schedules for infants, children, and adolescents
CDC: Vaccines by age: Information about vaccines broken down by age, from birth through age 18 years
CDC: COVID-19 Vaccine Booster Shots: Information about who can recieve a booster shot, when to receive a booster shot, and which booster shot to receive
World Health Organization (WHO): WHO recommends groundbreaking malaria vaccine for children at risk