What is the typical vaccine schedule for newborn babies?

Newborn and Infant Vaccination Schedule

Birth (Within 12 Hours)

All newborns should receive the first dose of Hepatitis B vaccine before hospital discharge, ideally within 12 hours of birth, as this timing is critical for preventing vertical transmission and maximizing series completion rates. 1, 2

• Hepatitis B vaccine (HepB) must be administered to all medically stable newborns weighing ≥2,000 g before hospital discharge 1
• For infants born to HBsAg-positive mothers: Both HepB vaccine AND hepatitis B immune globulin (HBIG) must be given within 12 hours of birth, regardless of birth weight, at separate anatomical sites 3, 1, 4
• For infants born to mothers with unknown HBsAg status: Give HepB vaccine within 12 hours while awaiting maternal test results; if mother tests positive, administer HBIG as soon as possible but no later than 7 days of age 3
• Preterm infants <2,000 g born to HBsAg-negative mothers: Defer the birth dose until 1 month of age or hospital discharge (this dose will not count toward the series, requiring 4 total doses) 1, 5

Critical timing note: Delaying the birth dose beyond 24 hours significantly reduces effectiveness in preventing vertical transmission 2, 4

2 Months of Age

At 2 months, infants receive their most comprehensive vaccination visit, with multiple vaccines administered simultaneously to establish early protection during the period of maximum vulnerability. 1, 6

• Hepatitis B (HepB): Second dose 1, 5
• Rotavirus (RV): First dose (must be initiated between 6-14 weeks of age due to intussusception risk if started later) 1
• Diphtheria, Tetanus, acellular Pertussis (DTaP): First dose 1, 6
• Haemophilus influenzae type b (Hib): First dose 1, 6
• Pneumococcal conjugate vaccine (PCV13 or PCV20): First dose 1, 7
• Inactivated Poliovirus (IPV): First dose 1, 6

4 Months of Age

• Rotavirus (RV): Second dose 1
• DTaP: Second dose 1, 6
• Hib: Second dose 1
• PCV: Second dose 1, 7
• IPV: Second dose 1, 6

6 Months of Age

• Hepatitis B (HepB): Third dose (can be given anytime from 6-18 months, but earlier completion is preferred) 3, 1, 5
• Rotavirus (RV): Third dose (depending on brand; some require only 2 doses) 1, 6
• DTaP: Third dose 1, 6
• Hib: Third dose (not required if PRP-OMP brand was used for first two doses) 1
• PCV: Third dose 1, 7
• Influenza: Begin annual vaccination starting at 6 months; children under 9 years receiving for the first time need two doses separated by at least 4 weeks 1, 6

12-15 Months of Age

• Hib: Fourth dose (final dose must be given after 12 months of age) 1
• PCV: Fourth dose 1, 7
• Measles, Mumps, Rubella (MMR): First dose 1, 8
• Varicella: First dose 1, 8
• Hepatitis A (HepA): First dose (12-23 months), with second dose 6 months later 1, 8

15-18 Months of Age

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

4-6 Years of Age

• DTaP: Fifth dose (must be given after age 4 years for adequate long-term protection) 1, 8
• IPV: Fourth dose 1, 8
• MMR: Second dose 1, 8
• Varicella: Second dose 1, 8

Special Considerations for Preterm Infants

Preterm infants should be vaccinated at chronological age, not corrected gestational age, with the single exception of the HepB birth dose for infants <2,000 g born to HBsAg-negative mothers. 1, 9, 10

• Preterm infants <32 weeks gestational age may experience apnea or bradycardia within 48 hours post-vaccination; consider cardiorespiratory monitoring for first vaccine doses, ideally given before hospital discharge 1, 9
• For preterm infants born to HBsAg-positive mothers: Give both HepB vaccine and HBIG within 12 hours regardless of birth weight, then follow standard schedule at 1,2-3, and 6 months 3, 1
• Preterm infants <2,000 g born to HBsAg-negative mothers who receive deferred birth dose will require 4 total HepB doses (the deferred dose does not count toward the series) 1, 10

Critical Timing Principles

The vaccination schedule balances maternal antibody interference with the urgent need to establish infant immunity during maximum vulnerability to life-threatening infections. 1

• Multiple doses spaced 4-8 weeks apart are necessary because a single dose rarely produces adequate or sustained antibody levels in young infants 1
• The three-dose primary series achieves seroconversion rates of 96-100% when the schedule is followed correctly 1
• Minimum intervals between doses must be maintained to ensure adequate immune response; do not restart a vaccine series regardless of time elapsed between doses 1
• All indicated vaccines should be administered simultaneously at the same visit to increase completion rates 2

Common Pitfalls to Avoid

• Never delay the HepB birth dose in infants ≥2,000 g born to HBsAg-negative mothers, as this minimizes risk from maternal testing errors and household exposures 1
• Do not use combination vaccines containing HepB for the birth dose; only monovalent HepB vaccine should be used 1
• Do not initiate rotavirus vaccine after 14 weeks 6 days of age, and ensure completion by 8 months 1
• Do not administer vaccines in the gluteal region, as this may result in suboptimal response 5
• Report all vaccine adverse events to the Vaccine Adverse Event Reporting System (VAERS) as required 1