What is the national immunisation schedule?

National Immunisation Schedule in the United States

Current Childhood and Adolescent Schedule (Birth through 18 Years)

The United States follows a comprehensive immunization schedule approved by the American Academy of Pediatrics (AAP), the Advisory Committee on Immunization Practices (ACIP), and the American Academy of Family Physicians (AAFP), with vaccines administered from birth through adolescence to protect against 16+ vaccine-preventable diseases. 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 1
• Rotavirus (RV): Doses at 2,4, and 6 months (must start by 14 weeks 6 days of age and complete by 8 months) 1
• Diphtheria, Tetanus, acellular Pertussis (DTaP): Doses at 2,4, and 6 months 1
• Haemophilus influenzae type b (Hib): Doses at 2,4, and 6 months (6-month dose not needed if PRP-OMP vaccine used) 1
• Pneumococcal conjugate (PCV): Doses at 2,4, and 6 months 1
• Inactivated Poliovirus (IPV): Doses at 2 and 4 months 1
• Influenza: Annually starting at 6 months; children under 9 years receiving for first time need two doses 4 weeks apart 1

12-18 Months

• Measles, Mumps, Rubella (MMR): First dose at 12-15 months 1, 2
• Varicella (VAR): First dose at 12-15 months 1, 2
• Hepatitis A (HepA): Two-dose series starting at 12-23 months, second dose 6 months later 1, 2
• DTaP: Fourth dose at 15-18 months (can be given at 12 months if 6 months elapsed since third dose) 1
• Hib: Fourth dose at 12-15 months 2
• PCV: Fourth dose at 12-15 months 2

4-6 Years (School Entry)

• DTaP: Fifth dose at 4-6 years 1
• IPV: Fourth dose at 4-6 years 1, 2
• MMR: Second dose at 4-6 years 1, 2
• Varicella: Second dose at 4-6 years 1, 2

11-12 Years (Adolescent Visit)

• Tetanus, diphtheria, acellular pertussis (Tdap): Single booster dose 1, 2
• Human Papillomavirus (HPV): Two-dose series (0,6-12 months apart) 2, 3
• Meningococcal conjugate (MenACWY): First dose at 11-12 years, booster at 16 years 2, 3
• Meningococcal B (MenB): May be given at 16-23 years based on shared clinical decision-making 3

Adult Immunization Schedule

Adults require ongoing vaccination throughout life, with specific vaccines recommended based on age, health conditions, occupation, and lifestyle factors. 4

Routine Adult Vaccines

• Influenza: Annual vaccination for all adults 4
• Tetanus, diphtheria, pertussis (Td/Tdap): Tdap once if not previously received, then Td booster every 10 years 4
• Zoster (Shingles): Two-dose series of recombinant zoster vaccine (RZV) at age 50+ years, doses 2-6 months apart 4
• Pneumococcal: PCV13 followed by PPSV23 at age 65+ years; specific timing and additional doses based on risk factors 4
• Human Papillomavirus (HPV): Through age 26 years if not previously vaccinated; may vaccinate males 22-26 years based on individual decision 4

Special Populations

• Pregnancy: Tdap during each pregnancy, preferably at 27-36 weeks gestation 4
• Healthcare personnel: MMR, varicella, hepatitis B, annual influenza, and Tdap if not previously received 4
• Immunocompromised persons: Modified schedules with additional doses and contraindications for live vaccines 4

Critical Implementation Points

Catch-Up Vaccination

• Vaccine series never need to be restarted regardless of time elapsed between doses 5
• Minimum intervals between doses must be respected, but longer intervals do not reduce final antibody response 5
• All indicated vaccines can and should be administered simultaneously at the same visit to improve completion rates 5
• Combination vaccines are preferred when any component is indicated and none are contraindicated 5

Special Considerations

• Preterm infants born to HBsAg-positive mothers must receive both HepB vaccine and HBIG within 12 hours of birth regardless of birth weight 1
• Rotavirus vaccination has strict age restrictions due to intussusception risk if started late 1
• Children with immunocompromising conditions require modified schedules and cannot receive live vaccines 5
• Vaccine adverse events must be reported to VAERS as required by the National Childhood Vaccine Injury Act 1, 5

Common Pitfalls to Avoid

• Do not delay catch-up vaccination due to misconceptions about contraindications; mild illness is not a contraindication 5
• Do not restart vaccine series when doses are delayed; continue from where the child left off 5
• Do not use combination vaccines containing hepatitis B for the birth dose; only monovalent HepB vaccine should be used 1
• Do not administer DTaP booster before age 4 years for the fifth dose, as this may not provide adequate long-term protection 1