What routine immunizations should a healthy infant receive according to the standard schedule?

Routine Infant Immunization Schedule

All healthy infants should receive a comprehensive series of vaccinations beginning at birth with hepatitis B vaccine, followed by multiple vaccines at 2,4,6,12-15, and 18 months of age to protect against life-threatening infectious diseases. 1

Birth (Before Hospital Discharge)

• Hepatitis B (HepB) - First Dose: Administer to all medically stable newborns weighing ≥2,000 g before hospital discharge, using only monovalent vaccine for this birth dose. 2

• For infants born to HBsAg-positive mothers: Give both HepB vaccine AND 0.5 mL hepatitis B immune globulin (HBIG) within 12 hours of birth at separate injection sites, regardless of birth weight. 2, 3

• For infants born to mothers with unknown HBsAg status: Administer HepB within 12 hours of birth while maternal blood is tested immediately; if mother tests positive, give HBIG as soon as possible but no later than 7 days of age. 2

• Exception for preterm infants: Infants weighing <2,000 g born to HBsAg-negative mothers should defer the birth dose until 1 month of chronological age or hospital discharge. 1

2 Months of Age (Minimum Age: 6 Weeks)

• Hepatitis B - Second Dose: Minimum 4 weeks after first dose. 2, 1

• DTaP (Diphtheria, Tetanus, Pertussis) - First Dose: Protects against three bacterial diseases. 2, 1

• Haemophilus influenzae type b (Hib) - First Dose: Critical for preventing meningitis and epiglottitis. 2, 1

• Pneumococcal Conjugate Vaccine (PCV) - First Dose: Prevents invasive pneumococcal disease. 1

• Inactivated Poliovirus Vaccine (IPV) - First Dose: All-IPV schedule is standard in the United States. 2

• Rotavirus - First Dose: Must be initiated between 6 weeks and 14 weeks 6 days of age due to intussusception risk if started later. 1

4 Months of Age

• DTaP - Second Dose: Minimum 4 weeks after first dose. 1

• Hib - Second Dose: Minimum 4 weeks after first dose. 1

• PCV - Second Dose: Minimum 4 weeks after first dose. 1

• IPV - Second Dose: Minimum 4 weeks after first dose. 1

• Rotavirus - Second Dose: Minimum 4 weeks after first dose. 1

6 Months of Age

• Hepatitis B - Third Dose: Minimum 8 weeks after second dose, minimum 16 weeks after first dose, and infant must be ≥24 weeks old. 1

• DTaP - Third Dose: Minimum 4 weeks after second dose. 1

• Hib - Third Dose: Minimum 4 weeks after second dose (not required if PRP-OMP vaccine was used at 2 and 4 months). 2, 1

• PCV - Third Dose: Minimum 4 weeks after second dose. 1

• Rotavirus - Third Dose: If using RotaTeq (3-dose series); final dose must be completed by 8 months of age. 1

• Influenza - First Dose: Begin annual influenza vaccination at ≥6 months; children <9 years receiving influenza vaccine for the first time need two doses ≥4 weeks apart. 2, 1

12-15 Months of Age

• MMR (Measles, Mumps, Rubella) - First Dose: Minimum age 12 months; critical for school entry. 1

• Varicella - First Dose: Minimum age 12 months. 1

• Hepatitis A - First Dose: Recommended at 12-23 months, with second dose 6 months later. 1

• DTaP - Fourth Dose: Can be given as early as 12 months if ≥6 months have elapsed since third dose. 2, 1

• Hib - Fourth Dose: Final booster, administered after 12 months of age. 1

• PCV - Fourth Dose: Final booster dose. 1

15-18 Months of Age

• DTaP - Fourth Dose (if not given at 12-15 months): Should be administered during this window. 2

4-6 Years of Age (School Entry)

• DTaP - Fifth Dose: Final childhood dose, must be given after age 4 years. 1

• IPV - Fourth Dose: Not required if third dose was given at ≥4 years of age. 2, 1

• MMR - Second Dose: May be given earlier if ≥28 days after first dose. 1

• Varicella - Second Dose: May be given earlier if ≥3 months after first dose. 1

Critical Safety and Timing Considerations

• Simultaneous administration is safe and recommended: Multiple vaccines at one visit demonstrate no increased adverse effects and significantly improve completion rates. 4

• Do not delay for minor illness: Mild upper respiratory infections, diarrhea, or low-grade fever are NOT contraindications to vaccination. 4

• Never restart a series: If there are interruptions between doses, continue where you left off rather than restarting. 4

• Rotavirus timing is critical: Must not be started after 14 weeks 6 days of age and must be completed by 8 months due to intussusception risk. 1

• Preterm infants: Vaccinate according to chronological age, not corrected gestational age (except for HepB birth dose in infants <2,000 g born to HBsAg-negative mothers). 4, 1

Common Pitfalls to Avoid

• Do not use combination vaccines for birth dose: Only monovalent hepatitis B vaccine should be used at birth; combination vaccines can be used for subsequent doses. 2, 1

• Do not defer vaccines unnecessarily: The birth dose of hepatitis B minimizes risk from maternal testing errors, household exposures, and increases series completion rates. 2

• Monitor infants born to HBsAg-positive mothers: These infants should be tested for HBsAg and anti-HBs at 9-15 months to identify chronic infection or need for revaccination. 2, 1