An Overview:
Recommended Child and Adolescent Immunization Schedules
July–December 2004

Below, in simplified form, is the AAP recommended vaccination schedule for routine and catch-up vaccination for children from birth through 18 years (full AAP vaccination schedule, in PDF format). Special effort should be made to vaccinate children within age groups highlighted for “catch-up immunization.”

NOTES
[For complete notes, see full AAP vaccination schedule]

Measles, mumps, rubella (MMR) vaccine is given to children one year old or older. Second dose: At age 4-6 years, but may be given anytime at least 4 weeks after first dose. Older children should have both doses by age 12 years.

Varicella vaccine is given to children one year old or older who do not have a reliable history of chicken pox. Children older than 13 years should get two doses at least 4 weeks apart.

Pneumococcal vaccine. Pneumococcal conjugate vaccine (PCV) is recommended for all children age 2-23 months, and for certain children age 24-59 months. The final dose in the 4-dose series should be given when the child is more than 12 months old. Pneumococcal polysaccharide vaccine (PPV) is recommended in addition to PCV for certain high-risk groups, including native American children and children older than 2 years with heart or lung disease, sickle cell anemia, diabetes, liver dysfunction, or diseases associated with immune system dysfunction.

Influenza vaccine. Who should be vaccinated: l Healthy children age 6-23 months, due to higher risk of hospitalization due to flu l Close contacts of healthy children age 0-23 months l Children older than six months who are at risk due to conditions like asthma, cardiac disease, sickle cell disease, HIV, diabetes l Household members and health care workers in contact with at-risk children

TIV - Trivalent inactivated influenza vaccine can be given (intramuscular) to any child more than 6 months old. It is given in 2 doses, 4 weeks apart for children younger than 9 years: l 0.25 mL for children 6-35 months old l 0.5 mL if older than 36 months

LAIV - Live attenuated influenza vaccine, intranasally administered, is appropriate for anyone older than 5 years who is not at high risk or in contact with others at high risk. It is given in 2 doses 6 weeks apart for children 5-8 years old. People older than 9 years need only one dose.

Hepatitis A vaccine. Recommended for children in selected states and regions, and for certain high-risk groups. Consult your local public health authority.

Hepatitis B (HepB) vaccine - Should be given to all newborns the first day after birth.

Mother is HBsAg negative: l Child’s first dose: Monovalent HepB vaccination soon after birth, and before discharge. l Second dose at least 4 weeks after the first except for combination vaccines, which cannot be administered before age 6 weeks. l Third dose at least 16 weeks after the first dose and at least 8 weeks after the second dose. l Last dose in series after age 24 weeks.

Mother is HBsAg positive: l Child’s first dose: within 12 hours of birth, give HepB and 0.5 mL of hepatitis B immune globulin (HBIG) at separate sites l Second dose at age 1-2 months. l Last dose after age 24 weeks l These infants should be tested for HBsAg and antibody to HBsAg (anti-HBs) at age 9-15 months.

Mother’s HBsAg status is unknown l Child’s first dose of HepB within 12 hours of birth. l If later test shows mother is HBsAg positive, give infant HBIG as soon as possible, and no later than age 1 week l Second dose at age 1-2 months l Last dose after age 24 weeks

Diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine. l Fourth dose as early as age 12 months, provided 6 months have elapsed since the third dose and the child is unlikely to return at age 15-18 months. l Final dose when child is older than 4 years. l Tetanus and diphtheria toxoids (Td) at age 11-12 years if at least 5 years have elapsed since the last dose. l Td boosters are recommended every 10 years.

Haemophilus influenzae type b (Hib) conjugate vaccine. Three Hib conjugate vaccines are licensed for infant use. If PRP-OMP (Pedvax HIB or ComVax [Merck]) is given at ages 2 and 4 months, no dose needed at age 6 months. Final dose after age 12 months.

For additional information about vaccines, precautions, contraindications, and vaccine shortages, visit the National Immunization Program, www.cdc.gov/nip/ or call 800-232-2522 (English) or 800-232-0233 (Spanish). In order to preserve the national vaccine supply in times of shortage so that all children have access to limited vaccine supplies, changes in dosing recommendations may be made by the Advisory Committee on Immunization Practices (ACIP). Physicians should be alert to these time-sensitive changes in the recommended immunization schedule, and comply with recommendations even if they themselves are not experiencing vaccine shortages.

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