What is the recommended pediatric immunization schedule?

Recommended Pediatric Immunization Schedule

The American Academy of Pediatrics recommends a comprehensive childhood vaccination schedule that includes hepatitis B vaccine at birth, followed by multiple vaccines at 2,4,6,12-15, and 18 months of age, with additional vaccines and boosters at 4-6 years and 11-12 years of age to protect against serious infectious diseases. 1

Birth to 6 Months

• First dose of Hepatitis B (HepB) should be administered at birth before hospital discharge, with the second dose at 1-2 months of age, and the third dose at 6-18 months 1
• First dose of Rotavirus (Rota) at 2 months, second dose at 4 months, and third dose at 6 months; should not be started after 14 weeks 6 days of age and final dose should be administered by 8 months of age 1, 2
• First dose of Diphtheria, Tetanus, and acellular Pertussis (DTaP) at 2 months, second dose at 4 months, third dose at 6 months 1
• First dose of Haemophilus influenzae type b (Hib) at 2 months, second dose at 4 months, third dose at 6 months (note: if PRP-OMP is used, the dose at 6 months is not required) 1
• First dose of Pneumococcal conjugate vaccine (PCV) at 2 months, second dose at 4 months, third dose at 6 months 1
• First dose of Inactivated Poliovirus (IPV) at 2 months, second dose at 4 months 1, 3
• Annual influenza vaccine beginning at 6 months of age; children under 9 years receiving influenza vaccine for the first time need two doses separated by at least 4 weeks 1

12-18 Months

• First dose of Measles, Mumps, Rubella (MMR) at 12-15 months 1, 4
• First dose of Varicella at 12-15 months 1, 4
• First dose of Hepatitis A (HepA) at 12-23 months with second dose 6 months later 1
• Fourth dose of DTaP at 15-18 months (can be given as early as 12 months if 6 months have elapsed since the third dose) 1
• Fourth dose of Hib at 12-15 months 1, 4
• Fourth dose of PCV at 12-15 months 1
• Third dose of IPV at 6-18 months 3

4-6 Years

• Fifth dose of DTaP at 4-6 years 1, 3
• Fourth dose of IPV at 4-6 years 1, 3
• Second dose of MMR at 4-6 years 1, 3
• Second dose of Varicella at 4-6 years 1, 3

11-12 Years

• Human papillomavirus vaccine (HPV) for all children at 11-12 years of age 3, 4
• Tetanus, diphtheria, and acellular pertussis (Tdap) booster at 11-12 years 1, 4
• Meningococcal ACWY vaccine (MenACWY) first dose at 11-12 years 4

Special Considerations

• Preterm infants born to HBsAg-positive mothers should receive hepatitis B vaccine and hepatitis B immune globulin (HBIG) within 12 hours of birth regardless of birth weight 1, 2
• Children who start late or fall behind on vaccinations should follow catch-up schedules to ensure they receive all recommended vaccines 1, 5
• Minimum intervals between doses must be maintained to ensure adequate immune response 1, 5
• Only monovalent hepatitis B vaccine should be used for the birth dose; combination vaccines containing hepatitis B can be used for subsequent doses 1
• Administering all indicated vaccines at the same visit increases the likelihood of complete vaccination and provides timely protection against preventable diseases 5, 6
• Delays in immunization can have serious health consequences, including increased risk of vaccine-preventable diseases during vulnerable periods and decreased likelihood of completing the full vaccination series 6
• The immune response to one vaccine is not negatively affected by another vaccine when administered simultaneously 5

Importance of Timely Vaccination

• Infants infected perinatally with hepatitis B have a 90% risk of developing chronic infection, and up to 25% will die from chronic liver disease as adults 2
• Children infected with hepatitis B between ages 1-5 years have a 30-60% risk of developing chronic infection 2
• Failure to adhere to scheduled booster immunizations, not just the initial inoculation, can result in resurgence of disease 6
• Although vaccination rates are near 95% for school-aged children in the US, the rate of timely vaccination is much lower 6, 7

Vaccine Administration

• A vaccine series does not need to be restarted, regardless of the time that has elapsed between doses 5
• Using combination vaccines is preferred over separate injections of equivalent component vaccines to reduce the number of injections 5
• Before administering multiple vaccines, check for contraindications such as immunodeficiency, severe allergic reactions to vaccine components, or moderate to severe acute illness 5