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Immunization schedule

Last updated: October 31, 2023

Summarytoggle arrow icon

Vaccinations are one of the most effective methods of disease prevention, drastically reducing illness, hospitalizations, and deaths from infectious diseases. In order to prevent a resurgence of vaccine-preventable illnesses in the US, the Centers for Disease Control and Prevention (CDC) and Advisory Committee on Immunization Practices (ACIP) publish yearly immunization schedule recommendations. These schedules are formulated based on extensive research and aim to protect individuals at the age at which they have the highest risk for infection. Specific recommendations are available for the general population (children and adults), individuals with certain health conditions, and those traveling to areas with high rates of infection. Education on the importance of vaccination and the implementation of catch-up schedules for underimmunized individuals are vital to ensuring herd immunity and preventing infectious diseases.

General principlestoggle arrow icon

Routine immunization [1][2][3]

Vaccine dose is not adjusted for weight but may vary based on age.

It is US federal law to provide a Vaccine Information Statement before the administration of every vaccine. [5]

Vaccinations against multiple diseases at the same visit [3]

Simultaneous vaccination

Administration of > 1 vaccine on the same day, but in different syringes and at different anatomical locations

If injectable or nasally administered live vaccines are not administered on the same day, they must be administered ≥ 4 weeks apart. [3]

Live oral vaccines (e.g., rotavirus vaccine) may be administered on the same day or at any interval before or after other live vaccines. [3]

Combination vaccines

Combination of different vaccine components in a single product

  • Preferred over simultaneous single-component vaccines, when feasible
  • Examples of commonly used combination vaccines:
    • DTaP-IPV-Hib
    • DTaP-HepB-IPV
    • DTaP-IPV-HepB-Hib
    • DTaP-IPV
    • MMRV [6]
    • HepA-HepB
    • Hib-MenCY

Timing and spacing of vaccines [3]

  • Follow the ACIP recommendations for the minimum age for the first dose and minimum intervals between doses to ensure optimal protection.
  • Unapproved delayed or alternate immunization schedules put individuals at risk.

Delayed or missed vaccines (undervaccination) [1][2][7]

Vaccines administered before the recommended minimum age or interval [3]

In general, any vaccine administered ≥ 5 days earlier than the minimum age or interval is considered invalid and needs to be repeated.

  • First dose administered ≥ 5 days earlier than the recommended minimum age
    • Repeat the dose when or after the individual attains the minimum recommended age.
    • For live vaccines, repeat the first dose ≥ 28 days after the invalid first dose.
  • Additional doses administered ≥ 5 days earlier than the recommended minimum interval
    • Repeat the dose; the minimum interval restarts from when the invalid dose was administered.

Doses administered ≤ 4 days before the minimum age or interval (grace period) are considered valid. [3]

ACIP immunization scheduletoggle arrow icon

This table provides an overview of the ACIP immunization schedule. See the latest CDC recommendations for detailed guidance.

See also “Special patient groups,” “Travel vaccines,” and “Contraindications for vaccination” as needed.

For catch-up vaccines, continue with the next dose in the immunization series. Do not restart the immunization series from the beginning.

Overview of ACIP immunization schedule [1][2][7]

Routine immunization schedule

Catch-up immunization schedule and immunization schedule by medical indication

 Special considerations

Hepatitis B vaccine
(HepB vaccine)
  • All infants: 3 doses
    • Dose 1 (monovalent HepB)
    • Dose 2: 1–2 months of age
    • Dose 3: 6–18 months of age

Tetanus, diphtheria, and acellular pertussis vaccines

Diphtheria, tetanus, acellular pertussis vaccine
(DTaP)
  • All infants: 4 doses (DTaP primary series)
    • Dose 1: 2 months of age
    • Dose 2: 4 months of age
    • Dose 3: 6 months of age
    • Dose 4: 15–18 months of age
  • Boosters
    • 1 dose at 4–6 years of age
    • Proceed to Tdap boosters after 11–12 years of age.
  • If < 7 years of age: 4–5 doses of DTaP [7]
  • If ≥ 7 years of age: See catch-up schedule for Tdap. [7]
Tetanus, diphtheria, acellular pertussis vaccine (Tdap)
and tetanus, diphtheria vaccine (Td)
  • 1 dose Tdap at 11–12 years of age ; followed by 1 dose Tdap OR Td every 10 years
  • Individuals ≥ 7 years of age with:
    • Incomplete DTaP series: 1 dose of Tdap; followed by either Tdap OR Td for subsequent doses as needed. [7]
    • Complete DTap series (with incomplete Tdap): 1 dose of Tdap; then Tdap OR Td boosters every 10 years
Inactivated poliovirus vaccine (IPV)
  • All infants: 3 doses (primary IPV series)
    • Dose 1: 2 months of age
    • Dose 2: 4 months of age
    • Dose 3: 6–18 months of age
  • Booster dose: 1 dose at 4–6 years of age
Rotavirus vaccine (RV)
  • All infants: 2 or 3 doses (varies by vaccine)
    • Dose 1: 2 months of age
    • Dose 2: 4 months of age
    • Dose 3 (for the 3-dose vaccine only): 6 months of age
  • Age < 8 months: 1–3 doses (depending on age and vaccine) [7]
  • Minimum age for the first dose: 6 weeks
  • Maximum age for the first dose: 14 weeks 6 days
  • Maximum age for final dose: 8 months
Haemophilus influenzae type b vaccine (Hib vaccine)
  • All infants: 2 or 3 doses (Hib primary series varies by vaccine)
    • Dose 1: 2 months of age
    • Dose 2: 4 months of age
    • Dose 3: 6 months of age (for all series except PedvaxHIB)
  • Booster: 1 dose at 12–15 months of age
  • Children < 5 years of age AND no dose administered at ≥ 15 months of age: Dosing differs based on the number of prior doses, current age, and age at the time of prior doses. [7]

Pneumococcal vaccines

 Children
  • All infants: 3 doses (primary series with PCV13 or PCV15):
    • Dose 1: 2 months of age
    • Dose 2: 4 months of age
    • Dose 3: 6 months of age
  • Booster (PCV13 or PCV15): 1 dose at 12–15 months of age

Adults
  • Adults ≥ 65 years of age with complete childhood primary series [2][12][13]
    • Prior PCV13 only (at any age): 1 dose of PCV20 OR PPSV23 ≥ 1 year after last dose
    • Prior PPSV23 only (at any age): 1 dose of PCV20 OR PCV15 ≥ 1 year after last dose
    • Prior PPSV23 at < 65 years of age PLUS PCV13 at any age: 1 dose of PCV20 OR PPSV23 ≥ 5 years after last dose
Hepatitis A vaccine (HepA vaccine)
  • All children: 2 doses
    • Dose 1: between 12 and 23 months of age
    • Dose 2: ≥ 6 months apart
Measles, mumps, rubella vaccine (MMR)
or
Measles, mumps, rubella, varicella vaccine (MMRV)
  • All children: 2 doses
    • Dose 1: 12–15 months of age (MMR preferred over MMRV) [6]
    • Dose 2: 4–6 years of age
  • Undervaccinated children and adolescents: 2 doses
  • Accelerated series for children traveling internationally:
    • Infants 6–11 months of age: Administer 1 dose of of MMR.
    • Children ≥ 12 months of age: Administer the 2-dose MMR series 4 weeks apart
    • See the latest CDC recommendations for further guidance. [7]
  • Adults with no evidence of immunity to measles, mumps, or rubella:
    • Not at increased risk of infection: 1 dose
    • At increased risk of infection : 2 doses (≥ 4 weeks apart)
Varicella vaccine (VAR)
  • All children: 2 doses
    • Dose 1: 12–15 months of age (VAR preferred over MMRV)
    • Dose 2: 4–6 years of age
Human papillomavirus 9-valent vaccine (HPV vaccine)
  • All children (male and female): 2 doses
    • Dose 1: between 11 and 12 years of age
    • Dose 2: ≥ 6 months after dose 1
  • Individuals ≤ 26 years of age: Catch-up is recommended; dosage depends on age at initial vaccination.
    • 9–14 years of age at initial dose : Administer an additional dose.
    • ≥ 15 years of age at initial dose: 3-dose series at 0, 1–2 months, and 6 months
  • Adults 27–45 years of age: Use shared decision-making.
  • Immunocompromised individuals: Use a 3-dose series regardless of age at first dose.
  • Minimum age for the first dose: 9 years
  • History of sexual abuse: Administer dose 1 at 9 years of age.
Meningococcal vaccines Meningococcal conjugate vaccines (MenACWY vaccines)
  • All children: 2 doses
    • Dose 1: 11–12 years of age
    • Dose 2: 16 years of age
  • 13–15 years of age: 2 doses
    • Dose 1: 13–15 years of age
    • Dose 2: at ≥ 16 years of age and ≥ 8 weeks after dose 1
  • 16–18 years of age : 1 dose
  • Individuals with risk factors for invasive meningococcal disease [15][16]
    • Children: minimum age for the first dose varies by vaccine used and indication
    • Adults with complete childhood series: further 2–3-dose series (varies by vaccine)
    • Ongoing risk [16]
      • Age < 7 years: Administer a booster 3 years after the primary series; then a booster every 5 years
      • Age ≥ 7 years: booster every 5 years
  • MenACWY vaccines are interchangeable. [16]
  • MenACWY-D (Menactra) should be administered:
    • At least 4 weeks after completion of PCV primary series.
    • Before or at the same time as DTaP.
Meningococcal B vaccine (MenB vaccine)
Pentavalent meningococcal vaccine (MenABCWY vaccine) [17]
  • Received FDA approval in October 2023; indications may change
Zoster recombinant vaccine (RZV)
Adults only
  • Adults > 50 years of age: 2 doses, 2–6 months apart
  • Individuals ≥ 19 years of age with current or anticipated immunocompromise : 2 doses, 2–6 months apart [18]
  • Minimum age for the first dose: 19 years
Influenza vaccine [19]
  • All individuals ≥ 6 months of age: 1 dose annually during flu season (unless there are contraindications)
  • Individuals traveling to areas with influenza activity [20]
  • Children aged 6 months–8 years who received < 2 doses of the annual influenza vaccine before July 1st of the preceding year: Administer a 2nd dose ≥ 4 weeks after the 1st annual dose.

COVID-19 vaccines [24]

 Pfizer-BioNTech COVID-19 vaccine
  • Primary series (monovalent): 2 or 3 doses
    • 6 months–4 years of age: 3 doses
      • Dose 2: 3–8 weeks after dose 1
      • Dose 3: ≥ 8 weeks after dose 2
    • ≥ 5 years of age: 2 doses, 3–8 weeks apart
  • Do not mix vaccines for the primary series; the booster dose can be from a different manufacturer than the primary series.
  • Minimum age for the booster
    • Moderna): ≥ 5 years
    • Pfizer: ≥ 6 years
  • Booster series : 1 dose, ≥ 2 months after any primary series or last booster
  • Recommendations differ for immunocompromised individuals: Refer to the latest CDC recommendations. [25]
Moderna COVID-19 vaccine
  • Primary series (monovalent)
    • ≥ 6 months of age: 2 doses, 4–8 weeks apart
Novavax COVID-19 vaccine
  • Primary series (monovalent)
    • ≥ 12 years of age: 2 doses, 3–8 weeks apart
Dengue vaccine [26]
  • Indicated in children 9–16 years of age who:
    • Reside in a dengue-endemic region
    • AND have laboratory evidence of previous dengue infection, i.e.: [27]
  • 3-dose series: 0, 6, and 12 months
Respiratory syncytial virus vaccine [28]

Unapproved delayed or alternate immunization schedules put individuals at risk for vaccine-preventable conditions and complications. [3]

Egg allergy is not a contraindication for influenza vaccination. For those with a severe reaction (e.g., angioedema, respiratory distress), administer the vaccine in a monitored setting. [22][23]

Immunizations at each health maintenance or well-visit encountertoggle arrow icon

The youngest recommended age for routine immunization is shown in this table. Refer to the ACIP immunization schedule for details on age ranges, catch-up immunizations, and special considerations.

For individuals ≥ 6 months of age, recommend age-appropriate COVID-19 vaccination and yearly influenza vaccination during influenza season.

The use of combination vaccines can decrease the number of injections needed at each encounter. Combination vaccines are frequently used for the 2-month, 4-month, 6-month, and 4–6-year immunizations. They may also be used for catch-up immunizations.

Immunizations at each health maintenance or well-visit encounter [1][2]
Newborn follow-up at 2 weeks

2 months
4 months
6 months
9 months
12 months
15 months

18 months
24, 30, and 36 months

4–6 years

6–10 years

11 years
12–15 years
16 years
17 years
Adults

Special patient groupstoggle arrow icon

Immunizations in individuals with HIV [29][30][32]

Exceptions to the routine immunization schedule

The routine ACIP immunization schedule is applicable to individuals with HIV with the following exceptions:

Live vaccines are contraindicated if CD4 count is < 200 cells/mm3 or CD4 percentage is < 15%. [29][30]

The efficacy of immunizations is reduced in individuals with HIV as a result of impaired immune function. [34]

Immunizations in preterm infants [35]

Immunizations in pregnancy and lactation [36][37][38]

Prior to pregnancy [36][39]

During pregnancy [36][37][38]

For all pregnant individuals, recommend:

Consider additional immunizations based on risk factors, e.g.: [36][37][45]

Avoid contraindicated immunizations.

MMR vaccine, varicella vaccine, HPV vaccine, and live attenuated influenza vaccine are not recommended during pregnancy. [46]

After pregnancy and/or during lactation [36]

Lactation is not a contraindication for most vaccines.

Women who lack immunity to rubella and/or varicella on prenatal screening (see “Prenatal care”) should be vaccinated postpartum.

Always consider if the benefits of immunization outweigh the risks during pregnancy and lactation; check contraindications. [39]

Immunizations for health care personnel (HCP) [47][48]

The following immunizations are an essential part of minimizing the risk of occupational exposure to and transmission of vaccine-preventable diseases in HCP.

Vaccine recommendations for all HCP [48][49]

Additional vaccines in high-risk groups [47][49]

Verify immunization requirements with the local occupational health department.

Immunizations in men who have sex with men [30][50]

Immunizations in adults ≥ 50 years of age [52]

Immunizations before traveltoggle arrow icon

Approach [53]

Immunizations are not effective immediately, and certain malaria prophylaxis must be initiated 1–2 weeks before traveling to high-risk areas. [53][54]

Overview of immunizations before travel

This table provides an overview of the pretravel immunizations recommended for individuals from the United States who are planning international travel.

Overview of travel immunizations [53]
Immunization Schedule Minimum age Risk areas Recommendation Other considerations

Meningococcal conjugate vaccine [16][55][56]
  • 2 months–2 years of age: 2 or 4 doses (depending on age and vaccine)
  • ≥ 2 years of age: 1 dose
  • Give ≥ 10 days before traveling.
  • Booster doses every 3–5 years for future travel or if ongoing exposure or reexposure is expected
  • Recommended for individuals traveling to or residing in hyperendemic or epidemic countries who are in close contact with local residents

Typhoid and paratyphoid fever vaccine [57]
  • Inactivated typhoid vaccine (injection): 1 dose
    • Give ≥ 2 weeks before traveling.
    • Booster dose every 2 years
  • Live typhoid vaccine (oral): 4 doses (48 hours between each dose)
    • Give ≥ 10 days before traveling.
    • Booster dose every 5 years
  • Recommended for travelers to most countries
  • Recommended for travelers who may consume potentially contaminated food and beverages
  • Recommended for those staying in rural areas and/or small cities
  • Prevents illness in 50–80% of individuals [57]
Japanese encephalitis vaccine [58]
  • 2 doses, 28 days apart
  • Should be completed ≥ 1 week before travel
  • 1 booster dose ≥ 1 year after dose 2 if ongoing exposure or reexposure is expected
  • 2 months
  • Southeast Asia and the Western Pacific
  • Countries with outbreaks of Japanese encephalitis
  • Endemic areas include rural agricultural areas.
  • In temperate areas, there are seasonal peaks in summer and fall.
  • In the subtropics and tropics, transmission occurs year-round; peaks in the rainy season.
  • Recommended for long-term (≥ 1 month) and frequent travelers to endemic regions
  • Should be considered for short-term travelers to endemic regions

Yellow fever vaccine [59]
  • 1 dose; given ≥ 10 days before departure.
  • A booster dose is recommended in the following situations:
  • 9 months
  • Africa, South America, and parts of Panama
  • Recommended for all travelers visiting or residing in areas with increased risk
  • Many African and South American countries require proof of vaccination from incoming travelers.
  • One dose provides lifelong protection; a booster dose may be required certain high-risk groups.
  • Recommend mosquito bite prevention.

Rabies vaccine [60][61]
  • 2 doses, 7 days apart
  • The series should be completed before travel.
  • Titer levels and booster doses may be needed. [61]
  • None
  • Rabies has been found on all continents except Antarctica.
  • Considered for:
    • Individuals traveling to rural areas
    • Individuals with risk factors
Inactivated poliovirus vaccine (IPV) [62]
  • Adults and children with an incomplete primary series: Complete primary IPV series before travel
  • Adults with a complete primary series: Give a one-time booster dose.
  • 6 weeks
  • Middle East, Africa [63]
  • Recommended for all travelers to endemic regions
  • Accelerated dosing schedules are recommended for those who cannot complete the standard primary IPV series before travel.
  • See the latest CDC recommendations for further guidance.

Referencestoggle arrow icon

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