What are the most recent vaccine recommendations for a healthy infant?

Most Recent Infant Vaccine Recommendations

For healthy infants, begin hepatitis B vaccine within 24 hours of birth, followed by a comprehensive vaccination series starting at 2 months of age that includes DTaP, IPV, Hib, PCV, rotavirus, and hepatitis B, with additional doses at 4 and 6 months, plus annual influenza vaccination starting at 6 months. 1, 2, 3

Birth to 2 Months

• Administer the first dose of hepatitis B vaccine within 24 hours of birth, regardless of birthing location, using only monovalent hepatitis B vaccine for this initial dose. 1
• This early timing minimizes risk from maternal HBsAg testing errors or delays and household exposure to chronic HBV infection. 1
• Infants born to HBsAg-positive mothers require both HBIG and hepatitis B vaccine, with follow-up testing at 9-15 months. 1

2-Month Visit

Administer the following vaccines simultaneously at separate anatomic sites: 2, 4

• DTaP (diphtheria, tetanus, acellular pertussis) - first dose 2, 5
• IPV (inactivated poliovirus) - first dose 2, 5
• Hib (Haemophilus influenzae type b) - first dose 2, 5
• PCV (pneumococcal conjugate vaccine) - first dose, now using formulations protecting against more serotypes 2, 3
• Rotavirus vaccine - first dose (either 2-dose or 3-dose series depending on brand) 1, 4
• Hepatitis B - second dose 2, 4

Critical Timing for Rotavirus

• The first dose of rotavirus vaccine must be administered between 6 weeks and 14 weeks, 6 days of age (maximum age for dose 1). 1
• The minimum interval between rotavirus doses is 4 weeks. 1
• All rotavirus doses must be completed by 8 months, 0 days of age. 1

4-Month Visit

Repeat all 2-month vaccines except hepatitis B: 2, 4

• DTaP - second dose 2
• IPV - second dose 2
• Hib - second dose 2
• PCV - second dose 2
• Rotavirus - second dose 1, 4

6-Month Visit

Administer third doses and initiate influenza vaccination: 2, 4

• DTaP - third dose 2
• IPV - third dose 2
• Hib - third dose (depends on vaccine brand; PRP-OMP products like PedvaxHIB or ComVax do not require a 6-month dose if given at 2 and 4 months) 2
• PCV - third dose 2
• Hepatitis B - third dose (must be at least 16 weeks after first dose, at least 8 weeks after second dose, and not before 24 weeks of age) 2
• Influenza vaccine - first dose if during flu season; infants receiving influenza vaccine for the first time require two doses separated by at least 4 weeks 2, 3

Respiratory Syncytial Virus (RSV) Protection

Either maternal RSV immunization between 32-36 weeks gestation (September-January) OR infant monoclonal antibody nirsevimab (October-March) is now recommended for all mother-infant dyads to prevent severe RSV illness. 3

COVID-19 Vaccination

COVID-19 immunizations are now recommended annually for all children (with few exceptions) to prevent disease, hospitalization, and decrease risk of post-COVID-19 condition. 3

Key Administration Principles

• Multiple vaccines should be administered simultaneously when indicated at separate anatomic sites, as this increases likelihood of complete vaccination and provides timely protection. 5, 6
• Individual vaccines should never be mixed in the same syringe unless specifically FDA-licensed for mixing. 6
• Inactivated vaccines can be given at any time before or after other inactivated or live vaccines without interference. 5
• Combination vaccines are preferred over separate injections of equivalent component vaccines. 1

Common Pitfalls to Avoid

• Do not delay the birth dose of hepatitis B vaccine until hospital discharge; it must be given within 24 hours. 1
• Do not start rotavirus vaccine after 14 weeks, 6 days of age for the first dose, as this exceeds the maximum age window. 1
• Do not forget the brand-specific Hib dosing at 6 months; some brands only require 2 doses in the primary series. 2
• Do not administer hepatitis B dose 3 before 24 weeks of age, even if the minimum intervals from previous doses have been met. 2

Post-Vaccination Monitoring

• Monitor for expected local reactions, systemic symptoms, and fever. 2
• Manage common reactions with acetaminophen or ibuprofen for fever/discomfort and cool compresses to injection sites. 2
• Seek immediate medical attention for severe reactions including fever over 105°F, seizures, or severe allergic reactions. 2