What is the standard immunization schedule for infants, children, and adults?

Standard Immunization Schedule for Infants, Children, and Adults

The Advisory Committee on Immunization Practices (ACIP), American Academy of Pediatrics (AAP), and American Academy of Family Physicians (AAFP) jointly recommend a comprehensive vaccination schedule that should be followed for all infants, children, and adults to prevent vaccine-preventable diseases and reduce morbidity and mortality. 1

Infant Immunization Schedule (Birth to 12 Months)

Birth

• Hepatitis B (HepB): First dose should be administered to all newborns prior to hospital discharge 1
  • For infants born to HBsAg-positive mothers, HBIG should also be administered within 12 hours of birth 1

2 Months

• DTaP (Diphtheria, Tetanus, acellular Pertussis): First dose
• IPV (Inactivated Poliovirus): First dose
• Hib (Haemophilus influenzae type b): First dose
• PCV (Pneumococcal conjugate): First dose
• RV (Rotavirus): First dose (must start by 12 weeks of age) 1
• HepB: Second dose (can be given between 1-4 months) 2

4 Months

• DTaP: Second dose
• IPV: Second dose
• Hib: Second dose
• PCV: Second dose
• RV: Second dose 1, 3

6 Months

• DTaP: Third dose
• Hib: Third dose (if needed based on vaccine brand)
• PCV: Third dose
• RV: Third dose (if needed based on vaccine brand)
• HepB: Third dose (can be given between 6-18 months) 1, 3
• Influenza: First dose (annually during flu season; children <9 years receiving flu vaccine for first time need two doses separated by at least 4 weeks) 1

Early Childhood Immunization Schedule (12 Months to 6 Years)

12-15 Months

• MMR (Measles, Mumps, Rubella): First dose
• Varicella: First dose
• PCV: Fourth dose
• Hib: Final dose (booster)
• HepA (Hepatitis A): First dose (can be given between 12-23 months) 1, 4

15-18 Months

• DTaP: Fourth dose (can be given as early as 12 months if 6 months have elapsed since third dose) 1, 2

18 Months

• HepA: Second dose (6-18 months after first dose) 4

4-6 Years

• DTaP: Fifth dose (final dose in the series)
• IPV: Fourth dose (final dose in the series)
• MMR: Second dose
• Varicella: Second dose 1, 4

Adolescent Immunization Schedule (7-18 Years)

11-12 Years

• Tdap (Tetanus, diphtheria, acellular pertussis): One dose
• HPV (Human papillomavirus): Two-dose series (if started before age 15, otherwise three doses)
• MenACWY (Meningococcal conjugate ACWY): First dose 2, 4

16 Years

• MenACWY: Second dose (booster) 1
• MenB (Meningococcal B): Two-dose series may be administered based on clinical discretion for ages 16-23 years 2

Adult Immunization Schedule (19+ Years)

• Td/Tdap: Tdap once, then Td or Tdap booster every 10 years
• Influenza: Annually
• HPV: Through age 26 if not previously vaccinated (3-dose series)
• Zoster: Two doses for adults aged 50 years and older
• Pneumococcal (PPSV23/PCV13): For adults 65 years and older or those with certain medical conditions
• MMR: For adults born after 1957 without evidence of immunity (1-2 doses)
• Varicella: For adults without evidence of immunity (2 doses)
• HepA: For adults with risk factors or who want protection
• HepB: For adults with risk factors or who want protection

Special Considerations

Pregnant Adolescents and Women

• Tdap: One dose during each pregnancy, preferably between 27-36 weeks gestation 2

Immunocompromised Individuals

• Additional vaccines may be recommended, including pneumococcal polysaccharide vaccine (PPSV23) for high-risk children ≥2 years 1
• Live vaccines (MMR, Varicella) are generally contraindicated 2

Catch-Up Immunization

• For children and adolescents who start late or are >1 month behind, follow catch-up schedules to bring them current with recommended vaccines 2
• A vaccine series does not need to be restarted, regardless of the time elapsed between doses 2

Important Implementation Principles

• All indicated vaccines should be administered simultaneously when appropriate 2
• Licensed combination vaccines can be administered whenever components are indicated and not contraindicated 2
• Minimum intervals between doses must be respected to ensure adequate immune response 1
• Vaccine delivery should be coordinated with other preventive health care services 2

Pitfalls to Avoid

1. Delaying vaccines unnecessarily: This leaves children vulnerable to vaccine-preventable diseases 5
2. Missing opportunities for simultaneous administration: When multiple vaccines are due, they should be given during the same visit 2
3. Restarting vaccine series: A series never needs to be restarted, regardless of time elapsed between doses 2
4. Not following catch-up schedules: Children who are behind should be brought up-to-date as quickly as possible following minimum interval guidelines 2
5. Ignoring special populations: Children with certain medical conditions may need additional vaccines or modified schedules 1

Following the recommended immunization schedule is crucial for preventing outbreaks of vaccine-preventable diseases and protecting individual and community health 5.