Vaccine schedule

• The child and adolescent immunization schedule is recommended by the Advisory Committee on Immunization Practices (ACIP) and approved by several medical organizations
• Vaccines and Other Immunizing Agents in the Child and Adolescent Immunization Schedule

  • Monoclonal antibody
  • Vaccine
• Monoclonal antibody

  Respiratory syncytial virus monoclonal antibody (Nirsevimab)
• Administer recommended vaccines if immunization history is incomplete or unknown. Do not restart or add doses to vaccine series for extended intervals between doses. When a vaccine is not administered at the recommended age, administer at a subsequent visit.
• How to use the child and adolescent immunization schedule

  1. Determine recommended vaccine by age (Table 1)

  2. Determine recommended interval for catch-up vaccination (Table 2)

  3. Assess need for additional recommended vaccines by medical condition or other indication (Table 3)

  4. Review vaccine types, frequencies, intervals, and considerations for special situations (Notes)

  5. Review contraindications and precautions for vaccine types (Appendix)

  6. Review new or updated ACIP guidance (Addendum)
• The Wealth of Nations was written


  1776
• Rational


  (in classical economic theory) economic agents are able to consider the outcome of their choices and recognise the net benefits of each one
• Workers act rationally by

  Balancing welfare at work with consideration of both pay and benefits
• Rationality in classical economic theory is a flawed assumption as people usually don't act rationally
• Marginal utility

  The additional utility (satisfaction) gained from the consumption of an additional product
• If you add up marginal utility for each unit you get total utility
• Minimum age for Dengue vaccination is 9 years
• Routine Dengue vaccination

  • 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
• Dengue vaccine should not be administered to children traveling to or visiting endemic dengue areas
• DTaP vaccination

  1. 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)
• DTaP vaccination catch-up

  1. Dose 5 is not necessary if dose 4 was administered at age 4 years or older and at least 6 months after dose 3

  2. For other catch-up guidance, see Table 2
• Haemophilus influenzae type b (Hib) vaccination

  1. dose series (3-dose primary series at age 2, 4, and 6 months, followed by a booster dose at age 12–15 months)
• Hib vaccination catch-up

  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
• 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.
• Routine Haemophilus influenzae type b vaccination

  • 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)
  • PedvaxHIB®: 3-dose series (2-dose primary series at age 2 and 4 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.
• Catch-up Haemophilus influenzae type b vaccination

  1. Dose 1 at age 7–11 months: Administer dose 2 at least 4 weeks later and dose 3 (final dose) at age12–15 months or 8 weeks after dose 2 (whichever is later)

  2. Dose 1 at age 12–14 months: Administer dose 2 (final dose) at least 8 weeks after dose 1

  3. 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

  4. 2 doses of PedvaxHIB® before age 12 months: Administer dose 3 (final dose) at age12–59 months and at least 8 weeks after dose 2

  5. 1 dose administered at age 15 months or older: No further doses needed

  6. 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
• 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.
• Special situations for Haemophilus influenzae type b vaccination

  • 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
  • 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)
• Routine hepatitis A vaccination

  • 2-dose series (minimum interval: 6 months) at age 12–23 months
• Catch-up hepatitis A vaccination

  1. Unvaccinated persons through age 18 years should complete a 2-dose series (minimum interval: 6 months)

  2. Persons who previously received 1 dose at age 12 months or older should receive dose 2 at least 6 months after dose 1

  3. 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)
• International travel hepatitis A vaccination

  • 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
• Routine hepatitis B vaccination

  • 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
  • Administration of 4 doses is permitted when a combination vaccine containing HepB is used after the birth dose
  • 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: 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
• Catch-up hepatitis B vaccination

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

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

  3. 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)
• Heplisav-B and PreHevbrio are not recommended in pregnancy due to lack of safety data in pregnant persons
• Routine and catch-up human papillomavirus (HPV) 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
  • 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
• Special situations for human papillomavirus (HPV) vaccination

  • 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
• Routine influenza vaccination

  • 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 www.cdc.gov/mmwr/volumes/72/rr/rr7202a1.htm.
• For the 2024–25 season, see the 2024–25 ACIP influenza vaccine recommendations.
• Special situations for influenza vaccination

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