What is the recommended pediatric vaccination schedule?

From the Guidelines

The recommended pediatric vaccination schedule in the United States includes multiple vaccines administered from birth through adolescence, with the most recent and highest quality evidence supporting the schedule outlined in the 2017 guidelines 1.

Overview of the Schedule

Here's a simplified overview of the recommended pediatric vaccine schedule:

• Birth: Hepatitis B (1st dose)
• 2 months: DTaP, Hib, IPV, PCV13, Rotavirus (1st doses)
• 4 months: DTaP, Hib, IPV, PCV13, Rotavirus (2nd doses)
• 6 months: DTaP, Hib, IPV, PCV13, Rotavirus (3rd doses), Influenza (annually)
• 12 months: MMR, Varicella, Hepatitis A (1st doses)
• 15 months: Hib, PCV13 (4th doses)
• 18 months: DTaP (4th dose), Hepatitis A (2nd dose)
• 4-6 years: DTaP, IPV, MMR, Varicella (final doses)
• 11-12 years: Tdap, HPV, Meningococcal conjugate (MenACWY)
• 16 years: Meningococcal conjugate (MenACWY) booster This schedule is designed to provide optimal protection against preventable diseases at the most appropriate ages, as supported by the 2017 guidelines 1.

Key Considerations

Some key considerations for parents and healthcare providers include:

• Catch-up vaccination schedules for children who start late or are behind on their vaccinations, as outlined in Figure 2 of the 2017 guidelines 1
• Vaccines for specific medical indications, such as immunocompromising conditions or certain medical conditions, as outlined in Figure 3 of the 2017 guidelines 1
• Footnotes containing recommendations for routine vaccination, catch-up vaccination, and vaccination of children and adolescents with high-risk conditions or in special circumstances, as outlined in the 2017 guidelines 1

Consultation and Record-Keeping

Parents should consult with their pediatrician for the most up-to-date schedule and to address any individual considerations, and always keep a record of their child's vaccinations and bring it to each doctor's visit. The 2017 guidelines provide the most recent and highest quality evidence to support the recommended pediatric vaccine schedule, and should be consulted for the most up-to-date information 1.

From the Research

Recommended Pediatric Vaccination Schedule

The recommended pediatric vaccination schedule is outlined by the US Advisory Committee on Immunization Practices and includes various vaccines to protect against infectious diseases. Key points of the schedule include:

• Starting at 12 to 15 months of life, children should receive the two-dose measles-mumps-rubella vaccine series and the two-dose varicella vaccine series 2
• In the second year of life, infants should begin the two-dose hepatitis A vaccine series and complete the Haemophilus influenzae type B vaccine series as well as the pneumococcal conjugate vaccine series 2
• Before 19 months of life, infants should receive the third dose of the poliovirus vaccine and the fourth dose of diphtheria-tetanus-acellular pertussis (DTaP) vaccine 2
• The final doses of poliovirus and tetanus-diphtheria-acellular pertussis vaccines are both due at 4 to 6 years of life 2
• Before each influenza season, every child should receive the influenza vaccine, with those less than 9 years of age who previously received less than two doses needing two doses a month apart 2
• At 11 to 12 years of life, all should get two doses of the human papillomavirus vaccine, the adolescent/adult version of the tetanus-diphtheria-acellular pertussis vaccine, and begin a two-dose series of meningococcal ACWY vaccine 2

Updates to the Schedule

The Advisory Committee on Immunization Practices (ACIP) approved the Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger-United States, 2022, which includes several changes from the 2021 immunization schedule 3

• The 2022 child and adolescent immunization schedule summarizes ACIP recommendations and includes a newly created appendix that lists the contraindications and precautions for all vaccine types in the schedule 3

Adherence to the Schedule

Studies have shown that adherence to the recommended immunization schedule is crucial to prevent vaccine-preventable diseases. For example:

• A study found that the majority of children's patterns were classified as "recommended" (63%), with 23% and 14% following alternate or unknown or unclassifiable patterns, respectively 4
• Another study found that all-cause mortality rates among children following the schedule were not significantly different from those of undervaccinated children 5

Combination Vaccines

Combination vaccines, such as the DTaP5-HBV-IPV-Hib pediatric hexavalent combination vaccine, have been shown to be safe and effective in reducing the number of injections received by children, improving timeliness and coverage, and general acceptability among caregivers and health-care providers 6

• The DTaP5-HBV-IPV-Hib vaccine has demonstrated good immunogenic and safety profiles, with a low incidence of severe adverse events similar to other combination vaccines 6