Catch-up Vaccination Schedule for a 5-Year-Old Child
For a 5-year-old child who has missed DTaP, MMR, Varicella, and Polio vaccines, all missed vaccines should be administered simultaneously at the earliest opportunity following the CDC's catch-up immunization schedule to provide optimal protection against these preventable diseases. 1
General Principles for Catch-up Vaccination
- A vaccine series does not need to be restarted, regardless of the time elapsed between doses 1
- All indicated vaccines should be administered simultaneously at separate injection sites 1
- The CDC provides a catch-up immunization schedule specifically for children aged 4 months through 6 years who are behind on vaccinations 1
- An interactive computer-based program is available to assist with catch-up scheduling for children from birth through 5 years of age (http://www.cdc.gov/vaccines/scheduler/catchup.htm) 1
Specific Catch-up Recommendations for a 5-Year-Old
DTaP (Diphtheria, Tetanus, and acellular Pertussis)
- The 5-year-old should receive any remaining doses of the DTaP series 1
- The final (4th or 5th) dose in the DTaP series should be administered at age ≥4 years 1
- Minimum interval between doses:
- 4 weeks between doses 1-2 and 2-3
- 6 months between doses 3-4 and 4-5 1
MMR (Measles, Mumps, and Rubella)
- For a 5-year-old who has missed MMR vaccines, both the first and second doses can be administered now 1
- If both doses are needed, they should be separated by at least 4 weeks (28 days) 1
- The second dose is typically given at age 4-6 years, so the child is at the appropriate age for this dose 1
Varicella Vaccine
- For a 5-year-old who has missed varicella vaccine, both the first and second doses can be administered 1
- If both doses are needed, they should be separated by at least 3 months 1
- The second dose is typically given at age 4-6 years, so the child is at the appropriate age for this dose 1
Polio Vaccine (IPV)
- The child should receive any remaining doses of the polio vaccine series 1
- The final dose should be administered at age ≥4 years 1
- Minimum interval between doses:
- 4 weeks between doses 1-2 and 2-3
- 6 months between doses 3-4 1
Implementation Considerations
- All vaccines can be administered during the same visit to maximize efficiency and reduce the likelihood of missed opportunities 1
- Research shows that simultaneous administration of vaccines increases the probability that a child will be appropriately immunized 1
- Studies demonstrate that co-administration of DTaP-IPV with MMR and varicella vaccines in 4-6 year old children is safe and effective 2
- No interference in immune response has been observed when these vaccines are given together 3, 4
Common Pitfalls to Avoid
- Missed opportunities for simultaneous vaccination account for >90% of children falling behind during certain age intervals 5
- Only 18% of children in the United States receive all vaccinations at the recommended times 6
- Do not restart a vaccine series regardless of the time elapsed between doses 1
- Do not administer vaccines at intervals less than the minimum recommended intervals 1
- Vaccine doses administered 4 days before the minimum interval or age can be counted as valid, but doses given 5 or more days early should be repeated 1
Follow-up Recommendations
- Document all administered vaccines and provide the parent with a vaccination record 1
- Provide Vaccine Information Statements before administering each dose as required by the National Childhood Vaccine Injury Act 1
- Schedule follow-up appointments for any subsequent doses needed 1
- Consider annual influenza vaccination, which is recommended for all children aged 6 months through 18 years 1