What is the recommended vaccine schedule for a healthy child from birth to adolescence?

Recommended Childhood Vaccination Schedule from Birth to Adolescence

All healthy children should receive a comprehensive series of vaccinations starting at birth with Hepatitis B vaccine, followed by multiple vaccines at 2,4,6,12-15, and 18 months, with additional boosters at 4-6 years and 11-12 years to protect against 14 serious infectious diseases. 1

Birth to 2 Months

Hepatitis B (HepB):

• Administer the first dose at birth before hospital discharge to all medically stable newborns 2, 3
• For infants born to HBsAg-positive mothers: give HepB vaccine plus hepatitis B immune globulin (HBIG) within 12 hours of birth, regardless of birth weight 2, 3
• If mother's HBsAg status is unknown: administer HepB within 12 hours and determine status as soon as possible; if positive, give HBIG no later than 7 days of age 2
• Second dose should be given at 1-2 months of age 2, 1

Important caveat: Preterm infants weighing <2,000 g born to HBsAg-negative mothers should defer the birth dose until 1 month of age or hospital discharge; this deferred dose will not count toward the series, requiring 4 total doses 1

2,4, and 6 Months

At 2 months, administer simultaneously:

• DTaP (Diphtheria, Tetanus, Pertussis) - first dose 2, 1
• IPV (Inactivated Poliovirus) - first dose 1
• Hib (Haemophilus influenzae type b) - first dose 2, 1
• PCV (Pneumococcal Conjugate Vaccine) - first dose 2, 1
• Rotavirus - first dose (must be started between 6-14 weeks of age) 2, 1

At 4 months, repeat:

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

At 6 months, administer:

• DTaP - third dose 2, 1
• Hib - third dose (note: if PRP-OMP vaccine is used at 2 and 4 months, the 6-month dose is not required) 2, 1
• PCV - third dose 2, 1
• Rotavirus - third dose (must be completed by 8 months of age) 2, 1
• HepB - third dose (can be given anytime from 6-18 months, but earlier completion is preferred) 2, 1

Influenza vaccine:

• Begin annual vaccination at 6 months of age 2, 1
• Children under 9 years receiving influenza vaccine for the first time require two doses separated by at least 4 weeks 1

Critical timing constraint: Rotavirus vaccination must be initiated between 6-14 weeks of age and completed by 8 months due to increased intussusception risk if started later 1, 4

12-18 Months

At 12-15 months, administer:

• MMR (Measles, Mumps, Rubella) - first dose 2, 1
• Varicella - first dose 2, 1
• Hib - fourth dose (final dose must be given after 12 months of age) 1
• PCV - fourth dose 1

At 12-23 months:

• Hepatitis A (HepA) - first dose, with second dose 6 months later 2, 1

At 15-18 months:

• DTaP - fourth dose (can be given as early as 12 months if 6 months have elapsed since the third dose) 2, 1

4-6 Years (School Entry)

Administer the following boosters:

• DTaP - fifth dose (final dose in the series) 2, 1
• IPV - fourth dose (final dose) 1
• MMR - second dose 2, 1
• Varicella - second dose 2, 1

Important note: If the fourth dose of DTaP was given after age 4 years with at least 6 months since the third dose, a fifth dose is not necessary 1, 5

11-12 Years (Adolescent Visit)

Administer:

• Tdap (Tetanus, diphtheria, acellular pertussis) - single booster dose 2, 1
• HPV (Human Papillomavirus) - first dose of three-dose series (second dose at 2 months, third dose at 6 months after first dose) 2
• MCV4 (Meningococcal Conjugate Vaccine) - first dose 2

For adolescents 13-18 years who missed the 11-12 year visit:

• Administer Tdap if they completed the childhood DTaP series but haven't received a Td booster 2
• Complete HPV series if not previously vaccinated 2

Critical Principles for All Ages

Simultaneous administration:

• All indicated vaccines should be administered simultaneously at separate anatomic sites when appropriate 2, 1
• The immune response to one vaccine is not negatively affected by simultaneous administration of others 4

Catch-up vaccination:

• Never restart a vaccine series regardless of time elapsed between doses 2, 1, 4
• Use minimum intervals between doses as specified in catch-up schedules for children who fall behind 2, 1
• Doses administered ≥4 days before the minimum interval or age should be counted as valid 2
• Doses administered ≥5 days before the minimum age should be repeated 2

Special populations:

• Children with certain medical conditions may require additional vaccines (pneumococcal polysaccharide vaccine for high-risk groups, meningococcal vaccine for complement deficiency or asplenia) 2, 1
• Infants born to HBsAg-positive mothers should be tested for HBsAg and anti-HBs at 9-18 months after completing the vaccine series 2

Common pitfall to avoid: Do not defer vaccinations due to minor illnesses, mild upper respiratory infections, or low-grade fever—these are not contraindications to vaccination 2. The only true contraindications are severe allergic reactions to vaccine components, immunodeficiency (for live vaccines), or moderate-to-severe acute illness 4.

Storage and administration:

• All vaccines must be stored and administered as recommended to ensure efficacy 2
• Use combination vaccines when available to reduce the number of injections and improve compliance 2, 4

Vaccine adverse events should be reported to the Vaccine Adverse Event Reporting System (VAERS) 2, 1