Neonatal Vaccination Schedule
Birth Dose (Within 24 Hours)
All healthy newborns should receive the first dose of Hepatitis B vaccine before hospital discharge, regardless of maternal HBsAg status. 1, 2
Hepatitis B Administration at Birth
Infants born to HBsAg-negative mothers should receive monovalent HepB vaccine before discharge (can be delayed only with physician's order and documented negative maternal HBsAg result). 1
Infants born to HBsAg-positive mothers require both HepB vaccine AND 0.5 mL of hepatitis B immune globulin (HBIG) within 12 hours of birth at separate injection sites, regardless of birth weight. 1, 2
Infants born to mothers with unknown HBsAg status must receive HepB vaccine within 12 hours of birth, with maternal blood drawn immediately to determine status. If mother tests positive, administer HBIG as soon as possible (no later than 7 days of age). 1
Special Consideration for Preterm Infants
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 does NOT count toward the series, requiring 4 total doses). 2, 3, 4
Preterm infants <2,000 g born to HBsAg-positive mothers must receive both HepB vaccine and HBIG within 12 hours regardless of weight, as maternal transmission risk overrides immunogenicity concerns. 2
2-Month Visit (Minimum Age: 6 Weeks)
At 2 months of age, infants should receive their second HepB dose plus the first doses of DTaP, Hib, PCV, IPV, and Rotavirus vaccines—all administered simultaneously. 1, 2, 5
Vaccines Due at 2 Months
Hepatitis B (HepB): Second dose (minimum 4 weeks after first dose). 1, 2
DTaP (Diphtheria, Tetanus, Pertussis): First dose (minimum age 6 weeks). 1, 2
Haemophilus influenzae type b (Hib): First dose (minimum age 6 weeks). 1, 2
Pneumococcal conjugate vaccine (PCV): First dose (minimum age 6 weeks). 1, 2
Inactivated Poliovirus (IPV): First dose (minimum age 6 weeks). 1, 2
Rotavirus (Rota): First dose (must be initiated between 6-14 weeks 6 days of age; do NOT start after this window due to intussusception risk). 1, 2
4-Month Visit
Repeat all vaccines given at 2 months except HepB, maintaining minimum 4-week intervals between doses. 1, 2, 5
Vaccines Due at 4 Months
6-Month Visit
Complete the primary series for most vaccines, including the third HepB dose, and initiate annual influenza vaccination. 1, 2, 5
Vaccines Due at 6 Months
Hepatitis B (HepB): Third dose (minimum 8 weeks after second dose AND minimum 16 weeks after first dose; must be ≥24 weeks of age). 1, 2
Hib: Third dose (minimum 4 weeks after second; NOT needed if PRP-OMP [PedvaxHIB] was used at 2 and 4 months). 1, 2
Rotavirus: Third dose if using RotaTeq (NOT needed if using Rotarix 2-dose series; final dose must be completed by 8 months of age). 1, 2
Influenza: First dose (annual vaccination starting at 6 months; children <9 years receiving influenza vaccine for the first time require 2 doses separated by ≥4 weeks). 1, 2
12-15 Month Visit
Introduce live virus vaccines (MMR, Varicella) and complete booster doses for earlier vaccines. 1, 2
Vaccines Due at 12-15 Months
MMR (Measles, Mumps, Rubella): First dose (minimum age 12 months). 1, 2
Hepatitis A (HepA): First dose (recommended at 12-23 months; second dose 6 months later). 1, 2
DTaP: Fourth dose (can be given as early as 12 months if ≥6 months have elapsed since third dose). 1, 2
Hib: Fourth dose (final booster; must be given after 12 months of age). 1, 2
18-Month Visit (If Fourth DTaP Not Given Earlier)
4-6 Year Visit (School Entry)
Administer final booster doses before kindergarten entry. 1, 2
Vaccines Due at 4-6 Years
DTaP: Fifth dose (final dose in childhood series; must be given after age 4 years). 1, 2
IPV: Fourth dose (final dose; not needed if third dose was given at ≥4 years of age). 1, 2
MMR: Second dose (can be given earlier if ≥28 days after first dose). 1, 2
Varicella: Second dose (can be given earlier if ≥3 months after first dose). 1, 2
Critical Contraindications and Safety Considerations
True Contraindications (Do NOT Vaccinate)
Severe allergic reaction (anaphylaxis) to a previous vaccine dose or vaccine component is an absolute contraindication to further doses. 2
Encephalopathy within 7 days of previous DTaP dose (not attributable to another cause) contraindicates further pertussis-containing vaccines. 1
Severe combined immunodeficiency (SCID) contraindicates all live virus vaccines (MMR, Varicella, Rotavirus). 1
NOT Contraindications (Safe to Vaccinate)
Minor illness with or without low-grade fever (<38.5°C) is NOT a contraindication—proceed with vaccination. 2
Mild upper respiratory infection, diarrhea, or otitis media should NOT delay vaccination. 2
Antibiotic therapy is NOT a contraindication to any vaccine. 2
Prematurity is NOT a contraindication; vaccinate according to chronological age (not corrected gestational age), except for the HepB birth dose in infants <2,000 g. 2, 3, 4
Breastfeeding does NOT interfere with vaccination and may enhance vaccine responses. 2
Family history of adverse events or seizures is NOT a contraindication. 2
Special Populations and Modifications
Preterm Infants (<32 Weeks Gestational Age)
Vaccinate at chronological age using the standard schedule (do not correct for gestational age). 2, 3, 4
Consider cardiorespiratory monitoring for 48 hours after first vaccine doses due to risk of apnea/bradycardia in infants <32 weeks gestation. 2, 6
Administer first vaccines before hospital discharge whenever possible to avoid missed opportunities. 6
HIV-Infected Infants
Administer all inactivated vaccines on the standard schedule. 1
MMR can be given to asymptomatic or mildly symptomatic (Category 1) HIV-infected children; contraindicated in severely immunosuppressed (Category 3) children. 1
Varicella vaccine should only be given to asymptomatic, non-immunosuppressed (Category 1) HIV-infected children; contraindicated for all other HIV-infected children. 1
Rotavirus vaccine should NOT be administered to HIV-infected infants due to theoretical risk of prolonged viral shedding. 1
Key Principles for Vaccine Administration
Simultaneous Administration
All indicated vaccines should be given simultaneously at separate anatomic sites during the same visit to maximize protection and completion rates. 2
Multiple vaccines at one visit are safe—studies demonstrate no increased adverse effects and significantly improved completion rates. 2
Interrupted Schedules
Never restart a vaccine series regardless of time elapsed between doses—simply continue where you left off. 2, 7
Minimum intervals must be respected—doses given earlier than minimum intervals do NOT count and must be repeated. 2, 7
Catch-Up Vaccination
- Unvaccinated or under-vaccinated children should follow CDC catch-up schedules with specific minimum ages and intervals, administering multiple vaccines simultaneously to accelerate protection. 2, 7
Common Pitfalls to Avoid
Do NOT delay vaccination for minor illnesses—this is the most common error leading to under-immunization. 2
Do NOT restart vaccine series after interruptions—this wastes doses and delays protection. 2, 7
Do NOT defer the birth HepB dose in term infants ≥2,000 g without documented maternal HBsAg-negative status and physician order. 1, 2
Do NOT start Rotavirus vaccine after 14 weeks 6 days of age due to increased intussusception risk. 1, 2
Do NOT use combination vaccines containing HepB for the birth dose—only monovalent HepB should be used. 2
Do NOT give live virus vaccines (MMR, Varicella) before 12 months of age except in outbreak situations. 1, 2