What vaccinations are recommended for a 6-week-old infant with no known medical conditions or allergies?

Vaccinations Recommended at 6 Weeks of Age

At exactly 6 weeks of age, an infant with no medical conditions or allergies can receive the first dose of rotavirus vaccine, and if not already given, may receive DTaP, IPV, Hib, and pneumococcal conjugate vaccines, though the standard practice is to wait until the 2-month visit (8 weeks) to administer the full series together. 1, 2

Core Vaccines with Minimum Age of 6 Weeks

The following vaccines have a minimum age requirement of 6 weeks and can be administered starting at this age:

• Rotavirus vaccine (RV): Must be initiated between 6-14 weeks of age (maximum age 14 weeks 6 days for first dose) 1, 2
• DTaP (Diphtheria, Tetanus, acellular Pertussis): Minimum age 6 weeks 1, 3, 4
• Haemophilus influenzae type b (Hib): Minimum age 6 weeks 1, 5
• Pneumococcal conjugate vaccine (PCV): Minimum age 6 weeks 1, 5
• Inactivated Poliovirus vaccine (IPV): Minimum age 6 weeks 2, 5

Critical Timing Consideration for Rotavirus

The rotavirus vaccine has the most restrictive timing window and is the primary reason to consider vaccination at exactly 6 weeks. The first dose must be administered between 6-14 weeks of age, and the series cannot be initiated after 14 weeks 6 days. 1, 2 The final dose must be completed by 8 months of age. 1

Standard Practice: The 2-Month Visit

While vaccines can legally be given at 6 weeks, standard practice in the United States is to administer the first series at the 2-month visit (8 weeks of age) to align with well-child visit schedules and ensure simultaneous administration of all vaccines. 2, 5, 6

At the 2-month visit, infants typically receive:

• DTaP (first dose) 5, 6
• IPV (first dose) 5, 6
• Hib (first dose) 5, 6
• PCV (first dose) 5, 6
• Rotavirus (first dose) 5, 6
• Hepatitis B (second dose, if not already given at 1-2 months) 5, 6

Hepatitis B Vaccine Timing

The hepatitis B vaccine follows a different schedule:

• First dose: At birth before hospital discharge 1, 5
• Second dose: At 1-2 months of age (minimum age 4 weeks after birth dose) 1, 2, 5
• Third dose: At 6-18 months (no earlier than 24 weeks of age) 1, 5

At 6 weeks of age, if the infant has not yet received the second hepatitis B dose, it can be administered. 2, 5

Simultaneous Administration

All vaccines recommended at this age can be administered simultaneously at different injection sites without compromising immune response or safety. 1 Rotavirus vaccine may be given concurrently with DTaP, Hib, IPV, hepatitis B, and pneumococcal conjugate vaccines. 1

Common Pitfalls to Avoid

• Do not delay rotavirus vaccination beyond 14 weeks 6 days for the first dose, as initiation after this age is contraindicated due to theoretical increased risk of intussusception. 1, 2
• Do not administer vaccines before 6 weeks of age (except hepatitis B at birth), as this is the minimum age for immune system readiness. 1, 2
• Ensure minimum 4-week intervals between doses in the same vaccine series. 1, 2
• Do not use combination vaccines containing hepatitis B for the birth dose; only monovalent hepatitis B should be used at birth. 5

Special Populations

For preterm infants (<2000g birth weight) born to HBsAg-negative mothers, the hepatitis B birth dose should be deferred until 1 month of age or hospital discharge, but all other vaccines should be given at chronological age (not corrected gestational age) starting at 6-8 weeks. 5