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Catch-up Immunization Schedule for Children and Adolescents Who Start Late or Who Are More than 1 Month Behind

Recommendations for Ages 18 Years or Younger, United States, 2022

Using the schedule

To make vaccination recommendations, healthcare providers should:

1. Determine needed vaccines based on age (Table 1)
2. Determine appropriate intervals for catch-up, if needed (Table 2)
3. Assess for medical conditions and other indications (Table 3)
4. Review special situations (Vaccination Notes)
5. Review contraindications and precautions to vaccination (Appendix)

The tables below provide catch-up schedules and minimal intervals between doses for children based on age whose vaccinations have been delayed.

Children Age 4 Months through 6 Years

Vaccine	Minimum Age for Dose 1	Minimum Interval Between Doses
Dose 1 to Dose 2	Dose 2 to Dose 3	Dose 3 to Dose 4	Dose 4 to Dose 5
Hepatitis B	Birth	4 weeks	8 weeks and at least 16 weeks after first dose. Minimum age for the final dose is 24 weeks.
Rotavirus	6 weeks Maximum age for first dose is 14 weeks, 6 days.	4 weeks	4 weeks Maximum age for final dose is 8 months, 0 days.
Diphtheria, tetanus, and acellular pertussis	6 weeks	4 weeks	4 weeks	6 months	6 months
Haemophilus influenzae type b	6 weeks	No further doses needed if first dose was administered at age 15 months or older. 4 weeks if first dose was administered before the 1st birthday. 8 weeks (as final dose) if first dose was administered at age 12 through 14 months.	No further doses needed if previous dose was administered at age 15 months or older. 4 weeks If current age is younger than 12 months and first dose was administered at younger than age 7 months and at least 1 previous dose was PRP-T (ActHib®, Pentacel®, Hiberix®), Vaxelis® or unknown 8 weeks and age 12 through 59 months (as final dose) if current age is younger than 12 months and first dose was administered at age 7 through 11 months; OR if current age is 12 through 59 months and first dose was administered before the 1st birthday, and second dose was administered at younger than 15 months; OR if both doses were PedvaxHIB® and were administered before the 1st birthday	8 weeks (as final dose) This dose only necessary for children age 12 through 59 months who received 3 doses before the 1st birthday.
Pneumococcal conjugate	6 weeks	No further doses needed for healthy children if first dose was administered at age 24 months or older. 4 weeks if first dose administered before the 1st birthday. 8 weeks (as final dose for healthy children) if first dose was administered at the 1st birthday or after.	No further doses needed for healthy children if previous dose was administered at age 24 months or older. 4 weeks if current age is younger than 12 months and previous dose given at <7 months old. 8 weeks (as final dose for healthy children) if previous dose given between 7-11 months (wait until at least 12 months old); OR if current age is 12 months or older and at least 1 dose was administered before age 12 months.	8 weeks (as final dose) This dose only necessary for children age 12 through 59 months who received 3 doses before age 12 months or for children at high risk who received 3 doses at any age.
Inactivated poliovirus	6 weeks	4 weeks	4 weeks if current age is <4 years. 6 months (as final dose) if current age is 4 years or older.	6 months (minimum age 4 years for final dose).
Measles, mumps, rubella	12 months	4 weeks
Varicella	12 months	3 months
Hepatitis A	12 months	6 months
Meningococcal ACWY	2 months MenACWY-CRM 9 months MenACWY-D 2 years MenACWY-TT	8 weeks	See notes	See notes

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Children and Adolescents Age 7 through 18 Years

Administer recommended vaccines if immunization history is incomplete or unknown. Do not restart or add doses to vaccine series for extended intervals between doses. When a vaccine is not administered at the recommended age, administer at a subsequent visit. The use of trade names is for identification purposes only and does not imply endorsement by the ACIP or CDC.

Notes

For vaccination recommendations for persons ages 19 years or older, see the Recommended Adult Immunization Schedule, 2022.

Additional information

• Consult relevant ACIP statements for detailed recommendations.
• For calculating intervals between doses, 4 weeks = 28 days. Intervals of ≥4 months are determined by calendar months.
• Within a number range (e.g., 12–18), a dash (–) should be read as “through.”
• Vaccine doses administered ≤4 days before the minimum age or interval are considered valid. Doses of any vaccine administered ≥5 days earlier than the minimum age or minimum interval should not be counted as valid and should be repeated as age-appropriate. The repeat dose should be spaced after the invalid dose by the recommended minimum interval. For further details, see Table 3-1, Recommended and minimum ages and intervals between vaccine doses, in General Best Practice Guidelines for Immunization.
• Information on travel vaccination requirements and recommendations is available at https://www.cdc.gov/travel/.
• For vaccination of persons with immunodeficiencies, see Table 8-1, Vaccination of persons with primary and secondary immunodeficiencies, in General Best Practice Guidelines for Immunization, and Immunization in Special Clinical Circumstances (In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book: 2018 report of the Committee on Infectious Diseases. 31st ed. Itasca, IL: American Academy of Pediatrics, 2018:67–111).
• For information about vaccination in the setting of a vaccine-preventable disease outbreak, contact your state or local health department.
• The National Vaccine Injury Compensation Program (VICP) is a no-fault alternative to the traditional legal system for resolving vaccine injury claims. All routine child and adolescent vaccines are covered by VICP except for pneumococcal polysaccharide vaccine (PPSV23). For more information, see www.hrsa.gov/vaccinecompensation/index.html.

Dengue Vaccination

• Age 9–16 years living in dengue endemic areas AND have laboratory confirmation of previous dengue infection
  • 3-dose series administered at 0, 6, and 12 months
• Endemic areas include Puerto Rico, American Samoa, US Virgin Islands, Federated States of Micronesia, Republic of Marshall Islands, and the Republic of Palau. For updated guidance on dengue endemic areas and pre-vaccination laboratory testing see https://www.cdc.gov/mmwr/volumes/70/rr/rr7006a1.htm and https://www.cdc.gov/dengue/vaccine/hcp/index.html.

For contraindications and precautions to dengue vaccination, see Dengue Appendix

Diphtheria, tetanus, and pertussis (DTaP) vaccination
(minimum age: 6 weeks [4 years for Kinrix® or Quadracel®])

• 5-dose series at age 2, 4, 6, 15–18 months, 4–6 years
  • Prospectively: Dose 4 may be administered as early as age 12 months if at least 6 months have elapsed since dose 3.
  • Retrospectively: A 4th dose that was inadvertently administered as early as age 12 months may be counted if at least 4 months have elapsed since dose 3.

• Dose 5 is not necessary if dose 4 was administered at age 4 years or older and at least 6 months after dose 3.
• For other catch-up guidance, see Table 2.

• Wound management in children less than age 7 years with history of 3 or more doses of tetanus-toxoid-containing vaccine: For all wounds except clean and minor wounds, administer DTaP if more than 5 years since last dose of tetanus-toxoid-containing vaccine. For detailed information, see www.cdc.gov/mmwr/volumes/67/rr/rr6702a1.htm.

For contraindications and precautions to Diphtheria, tetanus, pertussis (DTaP) vaccination, see DTaP Appendix

Haemophilus influenzae type b vaccination
(minimum age: 6 weeks)

•  ActHIB®, Hiberix®, Pentacel®, or Vaxelis®: 4-dose series (3 dose primary series at age 2, 4, and 6 months, followed by a booster dose* at age 12–15 months)
  • *Vaxelis® is not recommended for use as a booster dose. A different Hib-containing vaccine should be used for the booster dose.
• PedvaxHIB®: 3-dose series (2-dose primary series at age 2 and 4 months, followed by a booster dose at age 12–15 months)

• Dose 1 at age 7–11 months: Administer dose 2 at least 4 weeks later and dose 3 (final dose) at age 12–15 months or 8 weeks after dose 2 (whichever is later).
• Dose 1 at age 12–14 months: Administer dose 2 (final dose) at least 8 weeks after dose 1.
• Dose 1 before age 12 months and dose 2 before age 15 months: Administer dose 3 (final dose) at least 8 weeks after dose 2.
• 2 doses of PedvaxHIB® before age 12 months: Administer dose 3 (final dose) at age 12–59 months and at least 8 weeks after dose 2.
• 1 dose administered at age 15 months or older: No further doses needed
• Unvaccinated at age 15–59 months: Administer 1 dose.
• Previously unvaccinated children age 60 months or older who are not considered high risk: Do not require catch-up vaccination

For other catch-up guidance, see Table 2. Vaxelis® can be used for catch-up vaccination in children less than age 5 years. Follow the catch-up schedule even if Vaxelis® is used for one or more doses. For detailed information on use of Vaxelis see www.cdc.gov/mmwr/volumes/69/wr/mm6905a5.htm.

• Chemotherapy or radiation treatment:

  Age 12–59 months

  • Unvaccinated or only 1 dose before age 12 months: 2 doses, 8 weeks apart
  • 2 or more doses before age 12 months: 1 dose at least 8 weeks after previous dose

  Doses administered within 14 days of starting therapy or during therapy should be repeated at least 3 months after therapy completion.

• Hematopoietic stem cell transplant (HSCT):
  • 3-dose series 4 weeks apart starting 6 to 12 months after successful transplant regardless of Hib vaccination history
• Anatomic or functional asplenia (including sickle cell disease):

  Age 12–59 months

  • Unvaccinated or only 1 dose before age 12 months: 2 doses, 8 weeks apart
  • 2 or more doses before age 12 months: 1 dose at least 8 weeks after previous dose

  Unvaccinated* persons age 5 years or older

  • 1 dose
• Elective splenectomy:

  Unvaccinated* persons age 15 months or older

  • 1 dose (preferably at least 14 days before procedure)
• HIV infection:

  Age 12–59 months

  • Unvaccinated or only 1 dose before age 12 months: 2 doses, 8 weeks apart
  • 2 or more doses before age 12 months: 1 dose at least 8 weeks after previous dose

  Unvaccinated* persons age 5–18 years

  • 1 dose
• Immunoglobulin deficiency, early component complement deficiency:

  Age 12–59 months

  • Unvaccinated or only 1 dose before age 12 months: 2 doses, 8 weeks apart
  • 2 or more doses before age 12 months: 1 dose at least 8 weeks after previous dose

*Unvaccinated = Less than routine series (through age 14 months) OR no doses (age 15 months or older)

For contraindications and precautions to Haemophilus influenzae type b (Hib) vaccination, see Hib Appendix

Hepatitis A vaccination
(minimum age: 12 months for routine vaccination)

• 2-dose series (minimum interval: 6 months) at age 12–23 months

• Unvaccinated persons through age 18 years should complete a 2-dose series (minimum interval: 6 months).
• Persons who previously received 1 dose at age 12 months or older should receive dose 2 at least 6 months after dose 1.
• Adolescents age 18 years or older may receive the combined HepA and HepB vaccine, Twinrix®, as a 3-dose series (0, 1, and 6 months) or 4-dose series (3 doses at 0, 7, and 21–30 days, followed by a booster dose at 12 months).

• Persons traveling to or working in countries with high or intermediate endemic hepatitis A
  (http://www.cdc.gov/travel/)
  • Infants age 6–11 months: 1 dose before departure; revaccinate with 2 doses, separated by at least 6 months, between age 12–23 months.
  • Unvaccinated age 12 months or  older: Administer dose 1 as soon as travel is considered.

For contraindications and precautions to Hepatitis A (HepA) vaccination, see HepA Appendix

Hepatitis B vaccination
(minimum age: birth)

• Mother is HBsAg-negative:
  • All medically stable infants ≥2,000 grams: 1 dose within 24 hours of birth
  • Infants <2,000 grams: Administer 1 dose at chronological age 1 month or hospital discharge (whichever is earlier and even if weight is still <2,000 grams).
• Mother is HBsAg-positive:
  • Administer HepB vaccine and hepatitis B immune globulin (HBIG) (in separate limbs) within 12 hours of birth, regardless of birth weight. For infants <2,000 grams, administer 3 additional doses of vaccine (total of 4 doses) beginning at age 1 month.
  • Test for HBsAg and anti-HBs at age 9–12 months. If HepB series is delayed, test 1–2 months after final dose.
• Mother's HBsAg status is unknown:
  • Administer HepB vaccine within 12 hours of birth, regardless of birth weight.
  • For infants <2,000 grams, administer HBIG in addition to HepB vaccine (in separate limbs) within 12 hours of birth. Administer 3 additional doses of vaccine (total of 4 doses) beginning at age 1 month.
  • Determine mother’s HBsAg status as soon as possible. If mother is HBsAg-positive, administer HBIG to infants ≥2,000 grams as soon as possible, but no later than 7 days of age.

• 3-dose series at age 0, 1–2, 6–18 months (use monovalent HepB vaccine for doses administered before age 6 weeks)
• Infants who did not receive a birth dose should begin the series as soon as feasible (see Table 2).
• Administration of 4 doses is permitted when a combination vaccine containing HepB is used after the birth dose.
• Minimum age for the final (3rd or 4th ) dose: 24 weeks
• Minimum intervals: dose 1 to dose 2: 4 weeks / dose 2 to dose 3: 8 weeks / dose 1 to dose 3: 16 weeks (when 4 doses are administered, substitute “dose 4” for “dose 3” in these calculations)

• Unvaccinated persons should complete a 3-dose series at 0, 1–2, 6 months.
• Adolescents age 11–15 years may use an alternative 2-dose schedule with at least 4 months between doses (adult formulation Recombivax HB® only).
• Adolescents age 18 years or older may receive a 2-dose series of HepB (Heplisav-B®) at least 4 weeks apart.
• Adolescents age 18 years or older may receive the combined HepA and HepB vaccine, Twinrix®, as a 3-dose series (0, 1, and 6 months) or 4-dose series (3 doses at 0, 7, and 21–30 days, followed by a booster dose at 12 months).
• For other catch-up guidance, see Table 2.

• Revaccination is not generally recommended for persons with a normal immune status who were vaccinated as infants, children, adolescents, or adults.
• Post-vaccination serology testing and revaccination (if anti-HBs < 10mlU/mL) is recommended for certain populations, including:
  • Infants born to HBsAg-positive mothers
  • Hemodialysis patients
  • Other immunocompromised persons

For detailed revaccination recommendations, see http://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/hepb.html.

For contraindications and precautions to Hepatitis B (HepB) vaccination, see HepB Appendix

Human papillomavirus vaccination
(minimum age: 9 years)

• HPV vaccination routinely recommended at age 11–12 years (can start at age 9 years) and catch-up HPV vaccination recommended for all persons through age 18 years if not adequately vaccinated
• 2- or 3-dose series depending on age at initial vaccination:
  • Age 9 –14 years at initial vaccination: 2-dose series at 0, 6–12 months (minimum interval: 5 months; repeat dose if administered too soon)
  • Age 15 years or older at initial vaccination: 3-dose series at 0, 1–2 months, 6 months (minimum intervals: dose 1 to dose 2: 4 weeks / dose 2 to dose 3: 12 weeks / dose 1 to dose 3: 5 months; repeat dose if administered too soon)
• Interrupted schedules: If vaccination schedule is interrupted, the series does not need to be restarted.
• No additional dose recommended when any HPV vaccine series has been completed using the recommended dosing intervals.

• Immunocompromising conditions, including HIV infection: 3-dose series, even for those who initiate vaccination at age 9 through 14 years.
• History of sexual abuse or assault: Start at age 9 years.
• Pregnancy: Pregnancy testing not needed before vaccination; HPV vaccination not recommended until after pregnancy; no intervention needed if vaccinated while pregnant

For contraindications and precautions to Human papillomavirus (HPV) vaccination, see HPV Appendix

Influenza vaccination
(minimum age: 6 months [IIV], 2 years [LAIV4], 18 years [recombinant influenza vaccine, RIV4])

• Use any influenza vaccine appropriate for age and health status annually:
  • 2 doses, separated by at least 4 weeks, for children age 6 months–8 years who have received fewer than 2 influenza vaccine doses before July 1, 2021, or whose influenza vaccination history is unknown (administer dose 2 even if the child turns 9 between receipt of dose 1 and dose 2)
  • 1 dose for children age 6 months–8 years who have received at least 2 influenza vaccine doses before July 1, 2021
  • 1 dose for all persons age 9 years or older
• For the 2021-2022 season, see www.cdc.gov/mmwr/volumes/70/rr/rr7005a1.htm.
• For the 2022–23 season, see the 2022–23 ACIP influenza vaccine recommendations.

• Egg allergy, hives only: Any influenza vaccine appropriate for age and health status annually
• Egg allergy with symptoms other than hives (e.g., angioedema, respiratory distress) or required epinephrine or another emergency medical intervention: see Appendix listing contraindications and precautions.
• Severe allergic reaction (e.g., anaphylaxis) to a vaccine component or a previous dose of any influenza vaccine: see Appendix listing contraindications and precautions

Measles, mumps, and rubella vaccination
(minimum age: 12 months for routine vaccination)

• 2-dose series at age 12–15 months, age 4–6 years
• MMR or MMRV may be administered

Note: For dose 1 in children age 12–47 months, it is recommended to administer MMR and varicella vaccines separately. MMRV may be used if parents or caregivers express a preference.

• Unvaccinated children and adolescents: 2-dose series at least 4 weeks apart
• The maximum age for use of MMRV is 12 years.
• Minimum interval between MMRV doses: 3 months

International travel

• Infants age 6–11 months: 1 dose before departure; revaccinate with 2-dose series at age 12–15 months (12 months for children in high-risk areas) and dose 2 as early as 4 weeks later.
• Unvaccinated children age 12 months or older: 2-dose series at least 4 weeks apart before departure

For contraindications and precautions to Measles, mumps, rubella (MMR), see MMR Appendix

Meningococcal serogroup A, C, W, Y vaccination (minimum age: 2 months [MenACWY-CRM, Menveo], 9 months [MenACWY-D, Menactra], 2 years [MenACWY-TT, MenQuadfi])

• 2-dose series at age 11–12 years, 16 years

• Age 13–15 years: 1 dose now and booster at age 16–18 years (minimum interval: 8 weeks)
• Age 16–18 years: 1 dose

Anatomic or functional asplenia (including sickle cell disease), HIV infection, persistent complement component deficiency, complement inhibitor (e.g., eculizumab, ravulizumab) use:

• Menveo
  • Dose 1 at age 2 months: 4-dose series (additional 3 doses at age 4, 6 and 12 months)
  • Dose 1 at age 3–6 months: 3- or 4- dose series (dose 2 [and dose 3 if applicable] at least 8 weeks after previous dose until a dose is received at age 7 months or older, followed by an additional dose at least 12 weeks later and after age 12 months)
  • Dose 1 at age 7–23 months: 2-dose series (dose 2 at least 12 weeks after dose 1 and after age 12 months)
  • Dose 1 at age 24 months or older: 2-dose series at least 8 weeks apart
• Menactra
  • Persistent complement component deficiency or complement inhibitor use:
    • Age 9–23 months: 2-dose series at least 12 weeks apart
    • Age 24 months or older: 2-dose series at least 8 weeks apart
  • Anatomic or functional asplenia, sickle cell disease, or HIV infection:
    • Age 9–23 months: Not recommended
    • Age 24 months or older: 2-dose series at least 8 weeks apart
    • Menactra® must be administered at least 4 weeks after completion of PCV13 series.
• MenQuadfi®
  • Dose 1 at age 24 months or older: 2-dose series at least 8 weeks apart

Travel in countries with hyperendemic or epidemic meningococcal disease, including countries in the African meningitis belt or during the Hajj
(www.cdc.gov/travel/):

• Children less than age 24 months:
  • Menveo® (age 2–23 months)
    • Dose 1 at age 2 months: 4-dose series (additional 3 doses at age 4, 6 and 12 months)
    • Dose 1 at age 3–6 months: 3- or 4- dose series (dose 2 [and dose 3 if applicable] at least 8 weeks after previous dose until a dose is received at age 7 months or older, followed by an additional dose at least 12 weeks later and after age 12 months)
    • Dose 1 at age 7–23 months: 2-dose series (dose 2 at least 12 weeks after dose 1 and after age 12 months)
  • Menactra® (age 9–23 months)
    
    • 2-dose series (dose 2 at least 12 weeks after dose 1; dose 2 may be administered as early as 8 weeks after dose 1 in travelers)
• Children age 2 years or older: 1 dose Menveo®, Menactra®, or MenQuadfi®

First-year college students who live in residential housing (if not previously vaccinated at age 16 years or older) or military recruits:

• 1 dose Menveo®,, Menactra®, or MenQuadfi®

Adolescent vaccination of children who received MenACWY prior to age 10 years:

• Children for whom boosters are recommended because of an ongoing increased risk of meningococcal disease (e.g., those with complement deficiency, HIV, or asplenia): Follow the booster schedule for persons at increased risk.
• Children for whom boosters are not recommended (e.g., a healthy child who received a single dose for travel to a country where meningococcal disease is endemic): Administer MenACWY according to the recommended adolescent schedule with dose 1 at age 11–12 years and dose 2 at age 16 years.

Note: Menactra® should be administered either before or at the same time as DTaP. MenACWY vaccines may be administered simultaneously with MenB vaccines if indicated, but at a different anatomic site, if feasible.

For MenACWY booster dose recommendations for groups listed under “Special situations” and in an outbreak setting and  additional meningococcal vaccination information, see www.cdc.gov/mmwr/volumes/69/rr/rr6909a1.htm.

For contraindications and precautions to Meningococcal ACWY (MenACWY)
[MenACWY-CRM (Menveo®); MenACWY-D (Menactra®); MenACWY-TT (MenQuadfi®)], see MenACWY Appendix

Meningococcal serogroup B vaccination
(minimum age: 10 years [MenB-4C, Bexsero®; MenB-FHbp, Trumenba®])

• Adolescents not at increased risk age 16–23 years (preferred age 16–18 years) based on shared clinical decision-making:
  • Bexsero®: 2-dose series at least 1 month apart
  • Trumenba®: 2-dose series at least 6 months apart; if dose 2 is administered earlier than 6 months, administer a 3rd dose at least 4 months after dose 2.

Anatomic or functional asplenia (including sickle cell disease), persistent complement component deficiency, complement inhibitor (e.g., eculizumab, ravulizumab) use:

• Bexsero®: 2-dose series at least 1 month apart
• Trumenba®: 3-dose series at 0, 1–2, 6 months

Note: Bexsero® and Trumenba® are not interchangeable; the same product should be used for all doses in a series.

For MenB booster dose recommendations for groups listed under “Special situations” and in an outbreak setting and additional meningococcal vaccination information, see www.cdc.gov/mmwr/volumes/69/rr/rr6909a1.htm.

For contraindications and precautions to Meningococcal B (MenB)
[MenB-4C (Bexsero®); MenB-FHbp (Trumenba®)], see MenB Appendix

Pneumococcal vaccination
(minimum age: 6 weeks [PCV13], 2 years [PPSV23])

• 4-dose series at age 2, 4, 6, 12–15 months

• 1 dose for healthy children age 24–59 months with any incomplete* PCV13 series
• For other catch-up guidance, see Table 2.

* Incomplete series = Not having received all doses in either the recommended series or an age-appropriate catch-up series See Tables 8, 9, and 11 in the ACIP pneumococcal vaccine recommendations (www.cdc.gov/mmwr/pdf/rr/rr5911.pdf) for complete schedule details.

Underlying conditions below: When both PCV13 and PPSV23 are indicated, administer PCV13 first. PCV13 and PPSV23 should not be administered during same visit.

Chronic heart disease (particularly cyanotic congenital heart disease and cardiac failure); chronic lung disease (including asthma treated with high-dose, oral corticosteroids); diabetes mellitus:

Age 2–5 years

• Any incomplete* series with:
  • 3 PCV13 doses: 1 dose PCV13 (at least 8 weeks after any prior PCV13 dose)
  • Less than 3 PCV13 doses: 2 doses PCV13 (8 weeks after the most recent dose and administered 8 weeks apart)
• No history of PPSV23: 1 dose PPSV23 (at least 8 weeks after completing all recommended PCV13 doses)

Age 6–18 years

• No history of PPSV23: 1 dose PPSV23 (at least 8 weeks after completing all recommended PCV13 doses)

Cerebrospinal fluid leak, cochlear implant:

Age 2–5 years

• Any incomplete* series with:
  • 3 PCV13 doses: 1 dose PCV13 (at least 8 weeks after any prior PCV13 dose)
  • Less than 3 PCV13 doses: 2 doses PCV13 (8 weeks after the most recent dose and administered 8 weeks apart)
• No history of PPSV23: 1 dose PPSV23 (at least 8 weeks after any prior PCV13 dose)

Age 6–18 years

• No history of either PCV13 or PPSV23: 1 dose PCV13, 1 dose PPSV23 at least 8 weeks later
• Any PCV13 but no PPSV23: 1 dose PPSV23 at least 8 weeks after the most recent dose of PCV13
• PPSV23 but no PCV13: 1 dose PCV13 at least 8 weeks after the most recent dose of PPSV23

Sickle cell disease and other hemoglobinopathies; anatomic or functional asplenia; congenital or acquired immunodeficiency; HIV infection; chronic renal failure; nephrotic syndrome; malignant neoplasms, leukemias, lymphomas, Hodgkin disease, and other diseases associated with treatment with immunosuppressive drugs or radiation therapy; solid organ transplantation; multiple myeloma:

Age 2–5 years

• Any incomplete* series with:
  • 3 PCV13 doses: 1 dose PCV13 (at least 8 weeks after any prior PCV13 dose)
  • Less than 3 PCV13 doses: 2 doses PCV13 (8 weeks after the most recent dose and administered 8 weeks apart)
• No history of PPSV23: 1 dose PPSV23 (at least 8 weeks after any prior PCV13 dose) and a dose 2 of PPSV23 5 years later

Age 6–18 years

• No history of either PCV13 or PPSV23: 1 dose PCV13, 2 doses PPSV23 (dose 1 of PPSV23 administered 8 weeks after PCV13 and dose 2 of PPSV23 administered at least 5 years after dose 1 of PPSV23)
• Any PCV13 but no PPSV23: 2 doses PPSV23 (dose 1 of PPSV23 administered 8 weeks after the most recent dose of PCV13 and dose 2 of PPSV23 administered at least 5 years after dose 1 of PPSV23)
• PPSV23 but no PCV13: 1 dose PCV13 at least 8 weeks after the most recent PPSV23 dose and a dose 2 of PPSV23 administered 5 years after dose 1 of PPSV23 and at least 8 weeks after a dose of PCV13

Chronic liver disease, alcoholism:

Age 6–18 years

• No history of PPSV23: 1 dose PPSV23 (at least 8 weeks after any prior PCV13 dose)

*Incomplete series = Not having received all doses in either the recommended series or an age-appropriate catch-up series. See Tables 8, 9, and 11 in the ACIP pneumococcal vaccine recommendations (www.cdc.gov/mmwr/pdf/rr/rr5911.pdf) for complete schedule details.

For contraindications and precautions to Pneumococcal conjugate (PCV13), see PCV13 Appendix and Pneumococcal polysaccharide (PPSV23), see PPSV23 Appendix

Poliovirus vaccination
(minimum age: 6 weeks)

• 4-dose series at ages 2, 4, 6–18 months, 4–6 years; administer the final dose on or after age 4 years and at least 6 months after the previous dose.
• 4 or more doses of IPV can be administered before age 4 years when a combination vaccine containing IPV is used. However, a dose is still recommended on or after age 4 years and at least 6 months after the previous dose.

• In the first 6 months of life, use minimum ages and intervals only for travel to a polio-endemic region or during an outbreak.
• IPV is not routinely recommended for U.S. residents age 18 years or older.

Series containing oral polio vaccine (OPV), either mixed OPV-IPV or OPV-only series:

• Total number of doses needed to complete the series is the same as that recommended for the U.S. IPV schedule. See www.cdc.gov/mmwr/volumes/66/wr/mm6601a6.htm.
• Only trivalent OPV (tOPV) counts toward the U.S. vaccination requirements.
  • Doses of OPV administered before April 1, 2016, should be counted (unless specifically noted as administered during a campaign).
  • Doses of OPV administered on or after April 1, 2016, should not be counted.
  • For guidance to assess doses documented as “OPV,” see www.cdc.gov/mmwr/volumes/66/wr/mm6606a7.htm.
• For other catch-up guidance, see Table 2.

For contraindications and precautions to Poliovirus vaccine, inactivated (IPV), see Appendix

Rotavirus vaccination
(minimum age: 6 weeks)

• Rotarix®: 2-dose series at age 2 and 4 months
• RotaTeq®: 3-dose series at age 2, 4, and 6 months
• If any dose in the series is either RotaTeq® or unknown, default to 3-dose series.

• Do not start the series on or after age 15 weeks, 0 days.
• The maximum age for the final dose is 8 months, 0 days.
• For other catch-up guidance, see Table 2.

For contraindications and precautions to Rotavirus (RV) [RV1 (Rotarix®), RV5 (RotaTeq®)], see Rotavirus Appendix

Tetanus, diphtheria, and pertussis (Tdap) vaccination
(minimum age: 11 years for routine vaccination, 7 years for catch-up vaccination)

• Adolescents age 11–12 years: 1 dose Tdap
• Pregnancy: 1 dose Tdap during each pregnancy, preferably in early part of gestational weeks 27–36.
• Tdap may be administered regardless of the interval since the last tetanus- and diphtheria-toxoid-containing vaccine.

• Adolescents age 13–18 years who have not received Tdap: 1 dose Tdap, then Td or Tdap booster every 10 years
• Persons age 7–18 years not fully vaccinated* with DTaP: 1 dose Tdap as part of the catch-up series (preferably the first dose); if additional doses are needed, use Td or Tdap.
• Tdap administered at age 7–10 years
  • Children age 7–9 years who receive Tdap should receive the routine Tdap dose at age 11–12 years.
  • Children age 10 years who receive Tdap do not need  the routine Tdap dose at age 11–12 years.
• DTaP inadvertently administered  on or after age 7 years:
  • Children age 7–9 years: DTaP may count as part of catch-up series. Administer routine Tdap dose at age 11–12 years.
  • Children age 10–18 years: Count dose of DTaP as the adolescent Tdap booster.
• For other catch-up guidance, see Table 2.

*Fully vaccinated = 5 valid doses of DTaP OR 4 valid doses of DTaP if dose 4 was administered at age 4 years or older.

• Wound management in persons age 7 years or older with history of 3 or more doses of tetanus-toxoid-containing vaccine: For clean and minor wounds, administer Tdap or Td if more than 10 years since last dose of tetanus-toxoid-containing vaccine; for all other wounds, administer Tdap or Td if more than 5 years since last dose of tetanus-toxoid-containing vaccine. Tdap is preferred for persons age 11 years or older who have not previously received Tdap or whose Tdap history is unknown. If a tetanus-toxoid-containing vaccine is indicated for a pregnant adolescent, use Tdap.
• For detailed information, see www.cdc.gov/mmwr/volumes/69/wr/mm6903a5.htm.

For contraindications and precautions to Tetanus, diphtheria, and acellular pertussis (Tdap) and Tetanus, diphtheria (Td), see Tdap and Td Appendix

Varicella vaccination
(minimum age: 12 months)

• 2-dose series at age 12–15 months, 4–6 years
• VAR or MMRV may be administered*
• Dose 2 may be administered as early as 3 months after dose 1 (a dose inadvertently administered after at least 4weeks may be counted as valid)

*Note: For dose 1 in children age 12–47 months, it is recommended to administer MMR and varicella vaccines separately. MMRV may be used if parents or caregivers express a preference.

• Ensure persons age 7–18 years without evidence of immunity (see MMWR at www.cdc.gov/mmwr/pdf/rr/rr5604.pdf ) have a 2-dose series:
  • Age 7–12 years: routine interval: 3 months (a dose inadvertently administered after at least 4 weeks may be counted as valid)
  • Age 13 years and older: routine interval: 4–8 weeks (minimum interval: 4 weeks)
  • The maximum age for use of MMRV is 12 years.

For contraindications and precautions to Varicella (VAR), see VAR Appendix

Appendix - Guide to Contraindications and Precautions to Commonly Used Vaccines

Adapted from Table 4-1 in Advisory Committee on Immunization Practices (ACIP) General Best Practice Guidelines for Immunization: Contraindication and Precautions and ACIP’s Recommendations for the Prevention and Control of 2021-22 seasonal influenza with Vaccines.

Contraindications1

• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
• Severe immunodeficiency (e.g., hematologic and solid tumors, receipt of chemotherapy, congenital immunodeficiency, long- term immunosuppressive therapy or patients with HIV infection who are severely immunocompromised)

Precautions2

• Pregnancy
• HIV infection without evidence of severe immunosuppression
• Moderate or severe acute illness with or without fever

Vaccine

Diphtheria, tetanus, pertussis (DTaP)

Tetanus, diphtheria (DT)

Contraindications1

• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
• For DTaP only: Encephalopathy (e.g., coma, decreased level of consciousness, prolonged seizures) not attributable to another identifiable cause within 7 days of administration of previous dose of DTP or DTaP

Precautions2

• Guillain-Barré syndrome (GBS) within 6 weeks after previous dose of tetanus-toxoid–containing vaccine
• History of Arthus-type hypersensitivity reactions after a previous dose of diphtheria-toxoid— containing or tetanus-toxoid– containing vaccine; defer vaccination until at least 10 years have elapsed since the last tetanus-toxoid- containing vaccine
• For DTaP only: Progressive neurologic disorder, including infantile spasms, uncontrolled epilepsy, progressive encephalopathy; defer DTaP until neurologic status clarified and stabilized
• Moderate or severe acute illness with or without fever

Vaccine

Haemophilus influenzae type b (Hib)

Contraindications1

• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
• For Hiberix, ActHib, and PedvaxHIB only: History of severe allergic reaction to dry natural latex
• Age <6 weeks

Precautions2

• Moderate or severe acute illness with or without fever

Vaccine

Hepatitis A (HepA)

Contraindications1

• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 including neomycin

Precautions2

• Moderate or severe acute illness with or without fever

Vaccine

Hepatitis B (HepB)

Contraindications1

• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 including yeast
• For Heplisav-B only: Pregnancy

Precautions2

• Moderate or severe acute illness with or without fever

Vaccine

Hepatitis A- Hepatitis B vaccine [HepA-HepB, (Twinrix®)]

Contraindications1

• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 including neomycin and yeast

Precautions2

• Moderate or severe acute illness with or without fever

Vaccine

Human papillomavirus (HPV)

Contraindications1

• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3

Precautions2

• Moderate or severe acute illness with or without fever

Vaccine

Influenza, egg-based, inactivated injectable (IIV4)

Contraindications1

• Severe allergic reaction (e.g., anaphylaxis) after previous dose of any influenza vaccine (i.e., any egg-based IIV, ccIIV, RIV, or LAIV of any valency)
• Severe allergic reaction (e.g., anaphylaxis) to any vaccine component3 (excluding egg)

Precautions2

• Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any type of influenza vaccine
• Persons with egg allergy with symptoms other than hives (e.g., angioedema, respiratory distress) or required epinephrine or another emergency medical intervention: Any influenza vaccine appropriate for age and health status may be administered. If using egg-based IIV4, administer in medical setting under supervision of healthcare provider who can recognize and manage severe allergic reactions
• Moderate or severe acute illness with or without fever

Vaccine

Influenza, cell culture-based inactivated injectable
[(ccIIV4), Flucelvax® Quadrivalent]

Contraindications1

• Severe allergic reaction (e.g., anaphylaxis) to any ccIIV of any valency, or to any component3 of ccIIV4

Precautions2

• Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any type of influenza vaccine
• Persons with a history of severe allergic reaction (e.g., anaphylaxis) after a previous dose of any egg-based IIV, RIV, or LAIV of any valency. If using ccIV4, administer in medical setting under supervision of healthcare provider who can recognize and manage severe allergic reactions. May consult an allergist.
• Moderate or severe acute illness with or without fever

Vaccine

Influenza, recombinant injectable
[(RIV4), Flublok® Quadrivalent]

Contraindications1

• Severe allergic reaction (e.g., anaphylaxis) to any RIV of any valency, or to any component3 of RIV4

Precautions2

• Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any type of influenza vaccine
• Persons with a history of severe allergic reaction (e.g., anaphylaxis) after a previous dose of any egg- based IIV, ccIIV, or LAIV of any valency. If using RIV4, administer in medical setting under supervision of healthcare provider who can recognize and manage severe allergic reactions. May consult an allergist.
• Moderate or severe acute illness with or without fever

Vaccine

Influenza, live attenuated [LAIV4, Flumist® Quadrivalent]

Contraindications1

• Severe allergic reaction (e.g., anaphylaxis) after previous dose of any influenza vaccine (i.e., any egg-based IIV, ccIIV, RIV, or LAIV of any valency)
• Severe allergic reaction (e.g., anaphylaxis) to any vaccine component3 (excluding egg)
• Children age 2 – 4 years with a history of asthma or wheezing
• Anatomic or functional asplenia
• Immunocompromised due to any cause including medications and HIV infection
• Close contacts or caregivers of severely immunosuppressed persons who require a protected environment
• Pregnancy
• Cochlear implant
• Active communication between the cerebrospinal fluid (CSF) and the oropharynx, nasopharynx, nose, ear or any other cranial CSF leak
• Children and adolescents receiving aspirin or salicylate-containing medications
• Received influenza antiviral medications oseltamivir or zanamivir within the previous 48 hours, peramivir within the previous 5 days, or baloxavir within the previous 17 days.

Precautions2

• Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any type of influenza vaccine
• Asthma in persons aged 5 years old or older
• Persons with egg allergy with symptoms other than hives (e.g., angioedema, respiratory distress) or required epinephrine or another emergency medical intervention: Any influenza vaccine appropriate for age and health status may be administered. If using LAIV4 (which is egg based), administer in medical setting under supervision of healthcare provider who can recognize and manage severe allergic reactions. May consult an allergist.
• Persons with underlying medical conditions (other than those listed under contraindications) that might predispose to complications after wild-type influenza virus infection [e.g., chronic pulmonary, cardiovascular (except isolated hypertension), renal, hepatic, neurologic, hematologic, or metabolic disorders (including diabetes mellitus)]
• Moderate or severe acute illness with or without fever

Vaccine

Measles, mumps, rubella (MMR)

Contraindications1

• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
• Severe immunodeficiency (e.g., hematologic and solid tumors, receipt of chemotherapy, congenital immunodeficiency, long-term immunosuppressive therapy or patients with HIV infection who are severely immunocompromised)
• Pregnancy
• Family history of altered immunocompetence, unless verified clinically or by laboratory testing as immunocompetent

Precautions2

• Recent (≤11 months) receipt of antibody-containing blood product (specific interval depends on product)
• History of thrombocytopenia or thrombocytopenic purpura
• Need for tuberculin skin testing or interferon-gamma release assay (IGRA) testing
• Moderate or severe acute illness with or without fever

Vaccine

Meningococcal ACWY (MenACWY)
[MenACWY-CRM (Menveo®); MenACWY-D (Menactra®); MenACWY-TT (MenQuadfi®)]

Contraindications1

• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
• For MenACWY-D and Men ACWY-CRM only: severe allergic reaction to any diphtheria toxoid– or CRM197–containing vaccine
• For MenACWY-TT only: severe allergic reaction to a tetanus toxoid-containing vaccine

Precautions2

• For MenACWY-CRM only: Preterm birth if less than age 9 months
• Moderate or severe acute illness with or without fever

Vaccine

Meningococcal B (MenB)
[MenB-4C (Bexsero®); MenB-FHbp (Trumenba®)]

Contraindications1

• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3

Precautions2

• Pregnancy
• For MenB-4C only: Latex sensitivity
• Moderate or severe acute illness with or without fever

Vaccine

Pneumococcal conjugate (PCV13)

Contraindications1

• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
• Severe allergic reaction (e.g., anaphylaxis) to any diphtheria-toxoid– containing vaccine or its component3

Precautions2

• Moderate or severe acute illness with or without fever

Vaccine

Pneumococcal polysaccharide (PPSV23)

Contraindications1

• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3

Precautions2

• Moderate or severe acute illness with or without fever

Vaccine

Poliovirus vaccine, inactivated (IPV)

Contraindications1

• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3

Precautions2

• Pregnancy
• Moderate or severe acute illness with or without fever

Vaccine

Rotavirus (RV) [RV1 (Rotarix®), RV5 (RotaTeq®)]

Contraindications1

• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
• Severe combined immunodeficiency (SCID)
• History of intussusception

Precautions2

• Altered immunocompetence other than SCID
• Chronic gastrointestinal disease
• RV1 only: Spina bifida or bladder exstrophy
• Moderate or severe acute illness with or without fever

Vaccine

Tetanus, diphtheria, and acellular pertussis (Tdap)

Tetanus, diphtheria (Td)

Contraindications1

• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
• For Tdap only: Encephalopathy (e.g., coma, decreased level of consciousness, prolonged seizures) not attributable to another identifiable cause within 7 days of administration of previous dose of DTP, DTaP, or Tdap

Precautions2

• Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of tetanus-toxoid–containing vaccine
• History of Arthus-type hypersensitivity reactions after a previous dose of diphtheria-toxoid— containing or tetanus-toxoid– containing vaccine; defer vaccination until at least 10 years have elapsed since the last tetanus-toxoid– containing vaccine
• For Tdap only: Progressive or unstable neurological disorder, uncontrolled seizures, or progressive encephalopathy until a treatment regimen has been established and the condition has stabilized
• Moderate or severe acute illness with or without fever

Contraindications1

• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
• Severe immunodeficiency (e.g., hematologic and solid tumors, receipt of chemotherapy, congenital immunodeficiency, long- term immunosuppressive therapy or patients with HIV infection who are severely immunocompromised)
• Pregnancy
• Family history of altered immunocompetence, unless verified clinically or by laboratory testing as immunocompetent

Precautions2

• Recent (≤11 months) receipt of antibody-containing blood product (specific interval depends on product)
• Receipt of specific antiviral drugs (acyclovir, famciclovir, or valacyclovir) 24 hours before vaccination (avoid use of these antiviral drugs for 14 days after vaccination)
• Use of aspirin or aspirin-containing products
• Moderate or severe acute illness with or without fever

1. When a contraindication is present, a vaccine should NOT be administered. Kroger A, Bahta L, Hunter P. ACIP General Best Practice Guidelines for Immunization.
2. When a precaution is present, vaccination should generally be deferred but might be indicated if the benefit of protection from the vaccine outweighs the risk for an adverse reaction. Kroger A, Bahta L, Hunter P. ACIP General Best Practice Guidelines for Immunization.
3. Vaccination providers should check FDA-approved prescribing information for the most complete and updated information, including contraindications, warnings, and precautions. See Package inserts for U.S.-licensed vaccinesexternal icon.

Vaccines in the Child and Adolescent Immunization Schedule

Vaccine

Diphtheria, tetanus, and acellular pertussis vaccine

Trade name(s)

Daptacel®
Infanrix®

Vaccine

Diphtheria, tetanus vaccine

Trade name(s)

No Trade Name

Vaccine

Haemophilus influenzae type B vaccine

Abbreviation(s)

Hib (PRP-T)
Hib (PRP-OMP)

Trade name(s)

ActHIB®
Hiberix®
PedvaxHIB®

Vaccine

Hepatitis A vaccine

Trade name(s)

Havrix®
Vaqta®

Vaccine

Hepatitis B vaccine

Trade name(s)

Engerix-B®
Recombivax HB®

Vaccine

Human papillomavirus vaccine

Trade name(s)

Gardasil 9®

Vaccine

Influenza vaccine (inactivated)

Vaccine

Influenza vaccine (live, attenuated)

Trade name(s)

FluMist® Quadrivalent

Vaccine

Measles, mumps, and rubella vaccine

Vaccine

Meningococcal serogroups A, C, W, Y vaccine

Abbreviation(s)

MenACWY-D
MenACWY-CRM
MenACWY-TT

Trade name(s)

Menactra®
Menveo®
MenQuadfi®

Vaccine

Meningococcal serogroup B vaccine

Abbreviation(s)

MenB-4C
MenB-FHbp

Trade name(s)

Bexsero®
Trumenba®

Vaccine

Pneumococcal 13-valent conjugate vaccine

Trade name(s)

Prevnar 13®

Vaccine

Pneumococcal 23-valent polysaccharide vaccine

Trade name(s)

Pneumovax® 23

Vaccine

Poliovirus vaccine (inactivated)

Vaccine

Rotavirus vaccine

Trade name(s)

Rotarix®
RotaTeq®

Vaccine

Tetanus, diphtheria, and acellular pertussis vaccine

Trade name(s)

Adacel®
Boostrix®

Vaccine

Tetanus and diphtheria vaccine

Trade name(s)

Tenivac®
TDvax™

Vaccine

Varicella vaccine

Combination Vaccines

(Use combination vaccines instead of separate injections when appropriate)

Vaccine

DTaP, hepatitis B, and inactivated poliovirus vaccine

Abbreviation(s)

DTaP-HepB-IPV

Vaccine

DTaP, inactivated poliovirus, and Haemophilus influenzae type B vaccine

Abbreviation(s)

DTaP-IPV/Hib

Vaccine

DTaP and inactivated poliovirus vaccine

Trade name(s)

Kinrix®
Quadracel®

Vaccine

DTaP, inactivated poliovirus, Haemophilus influenzae type b, and hepatitis B vaccine

Abbreviation(s)

DTaP-IPV-Hib-HepB

Vaccine

Measles, mumps, rubella, and varicella vaccines

This schedule is recommended by the Advisory Committee on Immunization Practices (ACIP) and approved by the Centers for Disease Control and Prevention (CDC), American Academy of Pediatrics (AAPexternal icon), American Academy of Family Physicians (AAFPexternal icon)), American College of Obstetricians and Gynecologists (ACOGexternal icon), American College of Nurse-Midwives (ACNMexternal icon), American Academy of Physician Associates (AAPAexternal icon), and National Association of Pediatric Nurse Practitioners (NAPNAPexternal icon).

The comprehensive summary of the ACIP recommended changes made to the child and adolescent immunization schedule can be found in the February 18, 2022 MMWR.

Page last reviewed: February 17, 2022

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