Catch-Up Vaccination Schedule for a 19-Month-Old Child
This 19-month-old child who has only received 2-month vaccinations should immediately receive DTaP, IPV, Hib, PCV, MMR, Varicella, and Hepatitis B vaccines simultaneously at the first visit, then follow minimum interval guidelines to complete the catch-up series without restarting any vaccine series. 1, 2
Immediate First Visit Vaccinations (Now, at 19 Months)
At the first catch-up visit, administer all of the following vaccines simultaneously at separate anatomic sites: 1, 2
- DTaP (dose #3 of the series)
- IPV (dose #3 of the series)
- Hib (dose #3 of the series)
- PCV (dose #3 of the series)
- MMR (dose #1 - now age-appropriate at >12 months) 3
- Varicella (dose #1 - now age-appropriate at >12 months) 3
- Hepatitis B (dose #3, completing the series) 1, 4
- Hepatitis A (dose #1 - now recommended for all children 12-23 months) 5
- Influenza vaccine (2 doses separated by ≥4 weeks for first-time recipients) 5, 2
The rationale for simultaneous administration is that immune response to one vaccine is not negatively affected by others, and giving multiple vaccines maximizes protection while minimizing required visits. 1
Follow-Up Schedule After First Visit
4 weeks after first visit:
- DTaP (dose #4)
- IPV (dose #4, completing the series if given at age ≥4 years) 5
- Hib booster (completing the series) 2, 3
- PCV booster (completing the series) 2, 3
- Influenza vaccine (dose #2, completing the initial 2-dose series) 2
3 months after first MMR dose (around 22 months):
- MMR (dose #2) - can be given as early as 4 weeks after dose #1 5
- Varicella (dose #2) - minimum interval is 3 months for children <13 years 5
6 months after first Hepatitis A dose:
- Hepatitis A (dose #2, completing the series) 5
At 4-6 years of age:
Critical Principles to Follow
Never restart the vaccine series regardless of time elapsed between doses - simply continue from where the child left off. 5, 1, 2 This is a fundamental principle that prevents unnecessary repeat vaccinations and delays in achieving full protection.
Respect minimum intervals strictly - doses given earlier than minimum intervals should not be counted as valid doses. 1, 2 For this child:
- Most vaccines require 4-week minimum intervals between doses 1
- Hepatitis B dose #3 requires minimum 8 weeks after dose #2 AND minimum 16 weeks after dose #1 1
- Varicella doses require 3 months apart for children <13 years 5
Document all vaccines meticulously to avoid unnecessary repeat doses and ensure proper tracking of the catch-up schedule. 1
Vaccines NOT Needed for This Child
Rotavirus vaccine is contraindicated at 19 months of age because it must be initiated between 6-14 weeks of age and completed by 8 months due to increased intussusception risk if started later. 1, 6 This vaccine cannot be given as part of catch-up at this age.
Common Pitfalls to Avoid
- Do not delay vaccination waiting for "the right time" - start immediately at the first visit. 6
- Do not give doses too close together - respect minimum intervals or the dose will not count. 1, 2
- Do not assume the child needs to "start over" - continue from where they left off after the 2-month visit. 5, 1
- Do not miss the opportunity to give multiple vaccines simultaneously - this is safe and maximizes protection. 1
Urgency and Counseling
Counsel parents about the urgency of catching up on vaccinations, as this child is at significantly increased risk for vaccine-preventable diseases until fully caught up. 1 The child has been unprotected against measles, mumps, rubella, varicella, and inadequately protected against diphtheria, tetanus, pertussis, polio, Hib, and pneumococcal disease for over a year. 3, 4
Vaccine-preventable diseases like measles remain highly contagious, and pertussis requires hospitalization in approximately 69% of infected infants. 7 Achieving timely protection reduces both individual risk and community transmission. 8