What is the recommended vaccination schedule from birth to 5 years old based on clinical practice guidelines?

Recommended Childhood Vaccination Schedule from Birth to 5 Years

The American Academy of Pediatrics, Advisory Committee on Immunization Practices, and American Academy of Family Physicians recommend a comprehensive vaccination schedule starting at birth through age 5 years to protect against serious infectious diseases, with specific vaccines administered at 2,4,6,12-15,18 months, and 4-6 years of age. 1

Birth to 6 Months

• Hepatitis B (HepB): First dose at birth before hospital discharge, second dose at 1-2 months, third dose at 6-18 months 2, 1

  • For infants born to HBsAg-positive mothers: Administer HepB and hepatitis B immune globulin (HBIG) within 12 hours of birth 2
  • For infants born to mothers with unknown HBsAg status: Administer HepB within 12 hours of birth and determine mother's status as soon as possible 2

• Rotavirus (Rota): First dose at 2 months, second dose at 4 months, third dose at 6 months 2, 1

  • Do not start series later than 12 weeks of age 2
  • Complete series by 32 weeks (8 months) of age 2, 1
  • If using Rotarix, only 2 doses are needed (at 2 and 4 months) 2

• Diphtheria, Tetanus, acellular Pertussis (DTaP): First dose at 2 months, second dose at 4 months, third dose at 6 months 2, 1

• Haemophilus influenzae type b (Hib): First dose at 2 months, second dose at 4 months, third dose at 6 months 2, 1

  • If PRP-OMP (PedvaxHIB or ComVax) is used at 2 and 4 months, the dose at 6 months is not required 2

• Pneumococcal conjugate (PCV): First dose at 2 months, second dose at 4 months, third dose at 6 months 2, 1

• Inactivated Poliovirus (IPV): First dose at 2 months, second dose at 4 months 2

• Influenza: Annual vaccination beginning at 6 months of age 2, 1

  • Children under 9 years receiving influenza vaccine for the first time need two doses separated by at least 4 weeks 2, 1

12-18 Months

• Measles, Mumps, Rubella (MMR): First dose at 12-15 months 2, 1

• Varicella: First dose at 12-15 months 2, 1

• Hepatitis A (HepA): First dose at 12-23 months, second dose 6 months later 2, 1

• DTaP: Fourth dose at 15-18 months (can be given as early as 12 months if 6 months have elapsed since the third dose) 2

• Hib: Final dose at 12-15 months 2

• PCV: Fourth dose at 12-15 months 2

• IPV: Third dose at 6-18 months 2

4-6 Years

• DTaP: Fifth and final dose at 4-6 years 2, 1

• IPV: Fourth and final dose at 4-6 years 2, 1

  • If third dose was administered at age ≥4 years, a fourth dose is not necessary 2

• MMR: Second dose at 4-6 years 2, 1

  • May be administered earlier if at least 4 weeks have elapsed since the first dose 2

• Varicella: Second dose at 4-6 years 2, 1

  • May be administered earlier if at least 3 months have elapsed since the first dose 2

Important Considerations

• There is no need to restart a vaccine series regardless of the time elapsed between doses; use catch-up schedules for children who fall behind 2

• Minimum intervals between doses must be maintained to ensure adequate immune response 1

• Only monovalent HepB vaccine should be used for the birth dose; combination vaccines containing HepB can be used for subsequent doses 1

• Children with certain medical conditions may require additional vaccines or modified schedules 1

• For children with HIV infection or other immunocompromising conditions, special considerations apply:

  • Only inactivated influenza vaccine should be used 2
  • MMR is recommended for asymptomatic HIV-infected children who are not severely immunosuppressed 2
  • Additional pneumococcal vaccination may be indicated 2

• Meningococcal vaccination is recommended for children at increased risk (complement deficiency, asplenia, travel to endemic areas) 2

• Adverse reactions to vaccines should be reported to the Vaccine Adverse Event Reporting System (VAERS) 2, 1

Common Pitfalls to Avoid

• Delaying the birth dose of HepB vaccine beyond hospital discharge increases the risk of missing this critical vaccination 1, 3

• Starting rotavirus vaccination after 14 weeks 6 days of age is not recommended 2, 1

• Administering live vaccines (MMR, varicella) to severely immunocompromised children can cause serious adverse events 2

• Not completing the full vaccination series leaves children vulnerable to preventable diseases 4

• Failure to maintain minimum intervals between doses may result in suboptimal immune response 1

• Delaying vaccinations unnecessarily increases the period of vulnerability to vaccine-preventable diseases 4