What is the routine immunization schedule for a healthy child in the United States?

Pediatric Vaccine Schedule for Healthy Children in the United States

The routine immunization schedule for healthy children begins with hepatitis B vaccine at birth, 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 provide comprehensive protection against vaccine-preventable diseases. 1

Birth to 2 Months

• Hepatitis B vaccine must be administered before hospital discharge to all medically stable newborns weighing ≥2,000 g, as this minimizes risk from maternal testing errors, household exposures, and increases series completion rates 1
• Preterm infants weighing less than 2,000 g born to HBsAg-negative mothers should defer the birth dose until 1 month of age or hospital discharge, which will not count toward the series, requiring 4 total doses 1
• Infants born to HBsAg-positive mothers must receive both hepatitis B vaccine and HBIG within 12 hours of birth regardless of weight, with subsequent doses at 1 month and 6 months 1
• Only monovalent hepatitis B vaccine can be used for the birth dose; combination vaccines containing hepatitis B can be used for subsequent doses 1
• The second dose of hepatitis B is given at 1-2 months of age 1

2 Months Visit

• DTaP (Diphtheria, Tetanus, Pertussis) - first dose 1
• IPV (Inactivated Poliovirus) - first dose 1
• Hib (Haemophilus influenzae type b) - first dose 1
• PCV (Pneumococcal conjugate) - first dose 1
• Rotavirus - first dose (must be initiated between 6-14 weeks of age) 1
• Hepatitis B - second dose 1

4 Months Visit

• DTaP - second dose (at least 4 weeks after first dose) 1
• IPV - second dose (at least 4 weeks after first dose) 1
• Hib - second dose (at least 4 weeks after first dose) 1
• PCV - second dose (at least 4 weeks after first dose) 1
• Rotavirus - second dose 1

6 Months Visit

• DTaP - third dose (at least 4 weeks after second dose) 1
• Hib - third dose (note: if PRP-OMP is used, this dose is not required) 1
• PCV - third dose 1
• Rotavirus - third dose (final dose must be administered by 8 months of age) 1
• Hepatitis B - third dose (at least 8 weeks after second dose AND at least 16 weeks after first dose) 1
• Influenza vaccine - begin annual vaccination (children under 9 years receiving influenza vaccine for the first time need two doses separated by at least 4 weeks) 1

12-15 Months Visit

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

15-18 Months Visit

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

18-23 Months

• Hepatitis A - second dose (6 months after first dose) 1

4-6 Years Visit

• DTaP - fifth dose 1
• IPV - fourth dose 1
• MMR - second dose 1
• Varicella - second dose 1

11-12 Years Visit

• Tdap (Tetanus, diphtheria, acellular pertussis) - single adolescent booster dose 1
• HPV vaccine - begin series (3 doses at 0,2, and 6 months) 1
• Meningococcal vaccine (for high-risk children or routine adolescent vaccination) 1

Critical Principles for All Providers

• Multiple vaccines can and should be administered simultaneously at separate anatomic sites when indicated, as this increases the likelihood of complete vaccination 2
• The immune response to one vaccine is not negatively affected by simultaneous administration of others 2
• Never restart a vaccine series regardless of time elapsed between doses - simply continue from where the child left off 2
• Minimum intervals must be respected, but longer-than-recommended intervals do not reduce final antibody concentrations or require additional doses 2
• Preterm infants should be vaccinated at chronological age, not corrected gestational age, with the exception noted above for hepatitis B 1

Annual Vaccination

• Influenza vaccine should be administered annually beginning at 6 months of age 1
• Children under 9 years receiving influenza vaccine for the first time need two doses separated by at least 4 weeks 1

Special Timing Considerations

• Rotavirus vaccine must be initiated between 6-14 weeks of age and completed by 8 months due to intussusception risk if started later 1
• The fourth dose of DTaP is not necessary if the third dose was administered at age 4 years or older with at least 6 months since the second dose 1
• The fourth dose of IPV is not necessary if the third dose was administered at age 4 years or older 1

Common Pitfalls to Avoid

• Do not delay the birth dose of hepatitis B vaccine waiting for maternal HBsAg results - administer before discharge and adjust management if mother tests positive 1
• Do not use combination vaccines containing hepatitis B for the birth dose - only monovalent hepatitis B vaccine is appropriate 1
• Do not start rotavirus vaccine after 14 weeks 6 days of age 1
• Do not give Hib or PCV vaccines to healthy children who reach age 5 years without completing the series - these are not routinely recommended after age 5 in healthy children 3