Some illnesses or health conditions indicate that you may need to delay or not get some vaccines for your child. Talk to your child’s health care provider and see the Health Conditions area for more information.
If you have more questions about childhood immunization, read the "Schedule Explained" tab, see the CDC Parent’s Guide to Childhood Immunization, or ask your child’s health care provider.
- Hepatitis B vaccine (HepB). (Minimum age: birth)
- Rotavirus vaccine (RV). (Minimum age: 6 weeks)
- Diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP). (Minimum age: 6 weeks)
- Haemophilus influenzae type b conjugate vaccine (Hib). (Minimum age: 6 weeks)
- Pneumococcal vaccine. (Minimum age: 6 weeks for pneumococcal conjugate vaccine [PCV]; 2 years for pneumococcal polysaccharide vaccine [PPSV])
- Inactivated poliovirus vaccine (IPV). (Minimum age: 6 weeks)
- Influenza vaccine (seasonal). (Minimum age: 6 months for trivalent inactivated influenza vaccine [TIV]; 2 years for live, attenuated influenza vaccine [LAIV])
- Measles, mumps, and rubella vaccine (MMR). (Minimum age: 12 months)
- Varicella vaccine. (Minimum age: 12 months)
- Hepatitis A vaccine (HepA). (Minimum age: 12 months)
- Meningococcal conjugate vaccine, quadrivalent (MCV4). (Minimum age: 2 years)
1. Hepatitis B vaccine (HepB). (Minimum age: birth)
At birth:
- Administer monovalent HepB to all newborns before hospital discharge.
- If mother is hepatitis B surface antigen (HBsAg)-positive, administer HepB and 0.5 mL of hepatitis B immune globulin (HBIG) within 12 hours of birth.
- If mother’s HBsAg status is unknown, administer HepB within 12 hours of birth. Determine mother’s HBsAg status as soon as possible and, if HBsAg-positive, administer HBIG (no later than age 1 week).
Doses following the birth dose:
- The second dose should be administered at age 1 or 2 months. Monovalent HepB should be used for doses administered before age 6 weeks.
- Infants born to HBsAg-positive mothers should be tested for HBsAg and antibody to HBsAg 1 to 2 months after completion of at least 3 doses of the HepB series, at age 9 through 18 months (generally at the next well-child visit).
- Administration of 4 doses of HepB to infants is permissible when a combination vaccine containing HepB is administered after the birth dose.
- Infants who did not receive a birth dose should receive 3 doses of HepB on a schedule of 0, 1, and 6 months.
- The final (3rd or 4th) dose in the HepB series should be administered no earlier than age 24 weeks.
2. Rotavirus vaccine (RV). (Minimum age: 6 weeks)
- Administer the first dose at age 6 through 14 weeks (maximum age: 14 weeks 6 days). Vaccination should not be initiated for infants aged 15 weeks 0 days or older.
- The maximum age for the final dose in the series is 8 months 0 days.
- If Rotarix is administered at ages 2 and 4 months, a dose at 6 months is not indicated.
3. Diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP). (Minimum age: 6 weeks)
- The fourth dose may be administered as early as age 12 months, provided at least 6 months have elapsed since the third dose.
4. Haemophilus influenzae type b conjugate vaccine (Hib). (Minimum age: 6 weeks)
- If PRP-OMP (PedvaxHIB or Comvax [HepB-Hib]) is administered at ages 2 and 4 months, a dose at age 6 months is not indicated.
- Hiberix should not be used for doses at ages 2, 4, or 6 months for the primary series but can be used as the final dose in children aged 12 months through 4 years.
5. Pneumococcal vaccine. (Minimum age: 6 weeks for pneumococcal conjugate vaccine [PCV]; 2 years for pneumococcal polysaccharide vaccine [PPSV])
- PCV is recommended for all children aged younger than 5 years. Administer 1 dose of PCV to all healthy children aged 24 through 59 months who are not completely vaccinated for their age.
- A PCV series begun with 7-valent PCV (PCV7) should be completed with 13-valent PCV (PCV13).
- A single supplemental dose of PCV13 is recommended for all children aged 14 through 59 months who have received an age-appropriate series of PCV7.
- A single supplemental dose of PCV13 is recommended for all children aged 60 through 71 months with underlying medical conditions who have received an age-appropriate series of PCV7.
- The supplemental dose of PCV13 should be administered at least 8 weeks after the previous dose of PCV7. See MMWR 2010:59(No. RR-11).
- Administer PPSV at least 8 weeks after last dose of PCV to children aged 2 years or older with certain underlying medical conditions, including a cochlear implant.
6. Inactivated poliovirus vaccine (IPV). (Minimum age: 6 weeks)
- If 4 or more doses are administered prior to age 4 years an additional dose should be administered at age 4 through 6 years.
- The final dose in the series should be administered on or after the fourth birthday and at least 6 months following the previous dose.
7. Influenza vaccine (seasonal). (Minimum age: 6 months for trivalent inactivated influenza vaccine [TIV]; 2 years for live, attenuated influenza vaccine [LAIV])
- For healthy children aged 2 years and older (i.e., those who do not have underlying medical conditions that predispose them to influenza complications), either LAIV or TIV may be used, except LAIV should not be given to children aged 2 through 4 years who have had wheezing in the past 12 months.
- Administer 2 doses (separated by at least 4 weeks) to children aged 6 months through 8 years who are receiving seasonal influenza vaccine for the first time or who were vaccinated for the first time during the previous influenza season but only received 1 dose.
- Children aged 6 months through 8 years who received no doses of monovalent 2009 H1N1 vaccine should receive 2 doses of 2010–2011 seasonal influenza vaccine. See MMWR 2010;59(No. RR-8):33–34.
8. Measles, mumps, and rubella vaccine (MMR). (Minimum age: 12 months)
- The second dose may be administered before age 4 years, provided at least 4 weeks have elapsed since the first dose.
9. Varicella vaccine. (Minimum age: 12 months)
- The second dose may be administered before age 4 years, provided at least 3 months have elapsed since the first dose.
- For children aged 12 months through 12 years the recommended minimum interval between doses is 3 months. However, if the second dose was administered at least 4 weeks after the first dose, it can be accepted as valid.
10. Hepatitis A vaccine (HepA). (Minimum age: 12 months)
- Administer 2 doses at least 6 months apart.
- HepA is recommended for children aged older than 23 months who live in areas where vaccination programs target older children, who are at increased risk for infection, or for whom immunity against hepatitis A is desired.
11. Meningococcal conjugate vaccine, quadrivalent (MCV4). (Minimum age: 2 years)
- Administer 2 doses of MCV4 at least 8 weeks apart to children aged 2 through 10 years with persistent complement component deficiency and anatomic or functional asplenia, and 1 dose every 5 years thereafter.
- Persons with human immunodeficiency virus (HIV) infection who are vaccinated with MCV4 should receive 2 doses at least 8 weeks apart.
- Administer 1 dose of MCV4 to children aged 2 through 10 years who travel to countries with highly endemic or epidemic disease and during outbreaks caused by a vaccine serogroup.
- Administer MCV4 to children at continued risk for meningococcal disease who were previously vaccinated with MCV4 or meningococcal polysaccharide vaccine after 3 years if the first dose was administered at age 2 through 6 years.
Vaccines and the Childhood Immunization Schedule
There are ten routine childhood vaccines that protect young children from these 14 diseases:
- DTaP: Protects against Diphtheria, Tetanus & Pertussis
- MMR: Protects against Measles, Mumps & Rubella
- HepA: Protects against Hepatitis A
- HepB: Protects against Hepatitis B
- Hib: Protects against Haemophilus influenzae type b
- Flu: Protects against Influenza
- PCV13: Protects against Pneumococcal disease
- Polio: Protects against Polio
- RV: Protects against Rotavirus
- Varicella: Protects against Chickenpox
Some bacteria or viruses – for example, pneumococcal, rotavirus, and influenza – have many strains, and existing vaccines protect only against selected strains. Usually vaccines contain the strains that are most common or those most likely to cause illness in children.
All of these vaccines are injections (shots), except for rotavirus, which is given orally (swallowed), and one type of influenza vaccine, which is sprayed into the nose.
The Vaccine Schedule
All childhood vaccines are given as a series of 2 or more doses. The childhood vaccine schedule shows the recommended ages at which each vaccine dose should be given.
- For some of these vaccines, a booster dose at 4-6 years is also recommended.
- Influenza (flu) vaccine is recommended every winter for children 6 months of age and older.
Flexibility in the Vaccine Schedule
Vaccine doses are recommended at specific ages. These recommendations are based on studies showing when children are at highest risk for the different diseases and at what ages vaccines work best. But the schedule is not “one size fits all,” as it has been described by some people. It can be modified in several ways:
- Some of the doses on the childhood vaccine schedule may be given over a range of ages. For example, the 6-month dose of Polio vaccine can actually be given anywhere between 6 and 18 months without making it less effective.
- A number of “combination” vaccines are also available. Combination vaccines contain several vaccines in a single injection. Combination vaccines include:
- DTaP-Polio-Hepatitis B (also called Pediarix®)
- DTaP-Hib (also called TriHIBit®)
- DTaP-Polio-Hib (also called Pentacel®)
- DTaP-Polio (also called Kinrix®)
- Hib-Hepatitis B (also called Comvax®)
- MMR-Varicella (also called MMRV or Proquad®)
- Finally, for every vaccine there are “contraindications” and “precautions.” These are conditions that make a child ineligible to get certain vaccines, or cause vaccine doses to be postponed. For example, a child who has a severe allergy to eggs should not get flu vaccine (which contains egg protein); or a child with a weakened immune system should not get live-virus vaccines. A child who is moderately or seriously ill should usually wait until he recovers before getting any vaccine.
You can talk with your doctor or nurse about using combination vaccines and taking advantage of the age ranges for certain vaccine doses to customize your baby’s personal immunization schedule, reducing the number of shots she gets at a given visit. They will also help you determine if any contraindications or precautions apply to your baby.
