2020 Vaccination Schedule: 0-18 Years of Age

  1. Hepatitis B (HepB) vaccine. (Min age: birth)
At birth:

• HBsAg-negative mother: administer 1 dose of monovalent HepB vaccine within 24hrs of birth for all medically stable infants ≥2,000g. For infants <2000g, give 1 dose at chronological age 1 month or hospital discharge.

• HBsAg-positive mother: administer 1 dose of monovalent HepB vaccine and 0.5mL of hepatitis B immune globulin (HBIG) within 12hrs of birth, regardless of birth weight. For infants <2000g, administer 3 more doses of vaccine (4 total) beginning at age 1 month. Test for HBsAg and antibody to HBsAg (anti-HBs) at age 9–12mos or 1–2mos after final dose if the series was delayed.

• Unknown HBsAg status: administer monovalent HepB vaccine within 12hrs of birth, regardless of birth weight. For infants <2000g, add 0.5mL of HBIG within 12hrs of birth, and 3 more doses of vaccine (4 total) beginning at age 1 month. Determine mother’s HBsAg status as soon as possible and, if she is HBsAg-positive, also give 0.5mL HBIG for infants weighing ≥2000g (no later than age 1wk).

   Doses after the birth dose:

• The 2nd dose should be administered at age 1–2mos and the 3rd dose at 6–18mos. Monovalent HepB vaccine should be used for doses administered before age 6wks.

• Infants who did not receive a birth dose should receive 3 doses of a HepB-containing vaccine as soon as feasible.

• The minimum interval is 4wks for the 1st and 2nd dose, 8wks for the 2nd and 3rd dose, and 16wks for the 1st and 3rd dose (if 4 doses, substitute 4th dose for 3rd dose in these calculations). The final (3rd or 4th) dose in the HepB vaccine series should be administered no earlier than age 24wks.

• Administration of a total of 4 doses of HepB vaccine is permitted when a combination vaccine containing HepB is administered after the birth dose.

• Revaccination may be recommended for: infants born to HBsAg-positive mothers, hemodialysis patients, or other immunocompromised persons.

• For catch-up vaccination recommendations, refer to the 2020 Catch-Up Vaccination Schedule: 4 Months–18 years chart.

  2. Rotavirus (RV) vaccine. (Min age: 6wks for both RV1 [Rotarix] and RV5 [RotaTeq])

• Administer a series of RV vaccine to all infants as follows:

1. If RV1 is used, administer a 2-dose series at 2 and 4mos of age.

2. If RV5 is used, administer a 3-dose series at ages 2, 4, and 6mos.

3. If any dose in series was RV5 or vaccine product is unknown for any dose in the series, a total of 3 doses of RV vaccine should be given.

  3. Diphtheria, tetanus, and acellular pertussis (DTaP) vaccine. (Min age: 6wks. Exception: DTaP-IPV [Kinrix, Quadracel]: 4yrs)

• Administer a 5-dose series of DTaP vaccine at ages 2, 4, 6, 15−18mos, and 4−6yrs. The 4th dose may be administered as early as age 12mos, provided at least 6mos have elapsed since the 3rd dose. If the 4th dose was inadvertently given as early as 12mos, it may be counted if given ≥4mos after the 3rd dose.

• 5th dose of DTaP vaccine is not needed if 4th dose was given at age ≥4yrs and ≥6mos after 3rd dose.

  4. Haemophilus influenzae type b (Hib) conjugate vaccine. (Minimum age: 6wks for PRP-T [ACTHIB, DTaP-IPV/Hib (Pentacel), Hiberix] and PRP-OMP [PedvaxHIB])

• Administer a 4-dose Hib vaccine series at 2, 4, 6, and 12−15mos for ActHIB, Hiberix, or Pentacel. For PedvaxHIB, administer a 3-dose series at 2, 4, and 12−15mos.

• For catch-up vaccination recommendations, refer to the 2020 Catch-Up Vaccination Schedule: 4 Months−18 years chart.

• Persons with high-risk conditions: refer to the ACIP 2020 Immunization Schedule footnotes.

  5. Pneumococcal vaccines. (Min age: 6wks for PCV13, 2yrs for PPSV23)
Routine vaccination with PCV13:

• Administer a 4-dose series of PCV13 vaccine at ages 2, 4, 6mos and at age 12−15mos.

• Persons with high-risk conditions: refer to the ACIP 2020 Immunization Schedule footnotes.

  6. Inactivated poliovirus vaccine (IPV). (Min age: 6wks)

• Administer a 4-dose series of IPV at ages 2, 4, 6−18mos and 4−6yrs. The final dose in the series should be administered on or after the 4th birthday and at least 6mos after the previous dose.

• If ≥4 doses of IPV-containing combination vaccine are given before age 4yrs, an additional dose should be given on or after the 4th birthday and ≥6mos after the previous dose.

• If both trivalent OPV (tOPV) and IPV were given as part of a series, a total of 4 doses should be given to complete the series. Doses should be at least 4wks apart, with the final dose given on or after the 4th birthday and at least 6mos after the previous dose. If only OPV were given, and all doses given before 4yrs of age, 1 dose of IPV should be given at age ≥4yrs, at least 6mos after last OPV dose.

• Only tOPV counts toward the US vaccination requirements. Doses of OPV given before 4/1/2016 should be counted (unless noted as given during a campaign). Doses of OPV given on or after 4/1/2016 should not be counted.

• IPV is not routinely recommended for U.S. residents aged ≥18yrs.

  7. Influenza vaccines. (Min age: 6mos for inactivated influenza vaccine [IIV], 2yrs for live attenuated influenza vaccine [LAIV], 18yrs for recombinant influenza vaccine [RIV])

• For the 2019–2020 season, administer 1 dose of any influenza vaccine appropriate for age and health status annually to all children beginning at age 6mos.

•Administer 2 doses at least 4wks apart to children 6mos–8yrs who have not previously received ≥2 doses of influenza vaccine before July 1, 2019, or whose influenza vaccination history is unknown.

•Contraindications and precautions for LAIV: refer to the ACIP 2020 Immunization Schedule footnotes or the product labeling.

  8. Measles, mumps, and rubella (MMR) vaccine. (Min age: 12mos)

• Administer a 2-dose series of MMR vaccine at ages 12−15mos and 4−6yrs. The 2nd dose may be given as early as 4wks after the 1st dose.

• Administer 1 dose of MMR to infants aged 6−11mos before departure from the U.S. for international travel. These children should be revaccinated with 2 doses, the 1st at age 12−15mos (12mos for children in high-risk areas), and the 2nd dose at least 4wks later. Unvaccinated children ≥12mos should receive 2 doses at least 4 wks apart before departure.

  9. Varicella (VAR) vaccine. (Min age: 12mos)

• Administer a 2-dose series of VAR vaccine at ages 12−15mos and 4−6yrs. The 2nd dose may be administered as early as 3mos after the 1st dose. If the 2nd dose was given at least 4wks after the 1st dose, it can be accepted as valid.

10. Hepatitis A (HepA) vaccine. (Min age: 12mos)

• Initiate the 2-dose HepA vaccine series, separated by ≥6mos beginning at age 12mos.

• Unvaccinated children through 18yrs should complete 2 doses ≥6mos apart. Children who previously received 1 dose at age ≥12mos should receive 2nd dose ≥6mos after 1st dose. Adolescents aged ≥18yrs may receive a 3- or 4-dose series of the combined HepA and HepB vaccine (Twinrix).

• Administer 1 dose of HepA vaccine to infants aged 6–11mos before departure to countries with high or intermediate HepA endemicity; revaccinate with 2 doses, ≥6mos apart, between age 12–23mos. Unvaccinated children aged ≥12mos should receive 1 dose as soon as travel is considered.

11. Meningococcal vaccines. (Min age: 9mos for MenACWY-D [Menactra], 2mos for MenACWY-CRM [Menveo], 10yrs for serogroup B meningococcal [MenB] vaccines: MenB-4C [Bexsero] and MenB-FHbp [Trumenba])

• MenACWY vaccination (Menactra, Menveo): 

— Administer a 2-dose series at 11−12yrs and 16yrs.

— If Menactra is used, give either before or at the same time as DTaP.

— Administer 1 dose to 1st-year college students living in residential housing (if not previously vaccinated at ≥16yrs) or military recruits.

— Children who received MenACWY before age 10yrs may require booster doses due to ongoing increased meningococcal risk (see meningococcal MMWR publications). If booster doses not recommended, administer routine vaccination at 11−12yrs and 16yrs.

• MenB vaccination (Bexsero, Trumenba):

— Persons 16−23yrs (16−18yrs preferred) not at increased risk may receive, based on shared clinical decision-making, 2 doses of Bexsero at least 1 month apart or 2 doses of Trumenba at least 6mos apart (if 2nd Trumenba dose given too soon, administer a 3rd dose at least 4mos after the 2nd dose).

— Children age ≥10yrs with high-risk conditions or during an outbreak may require MenB booster doses (see ACIP recommendations).

— The two MenB vaccines are not interchangeable.

• Persons with high-risk conditions or those traveling to or living in countries where meningococcal disease is hyperendemic or epidemic: refer to the ACIP 2020 Immunization Schedule footnotes.

12. Tetanus, diphtheria, and acellular pertussis (Tdap) vaccine. (Min age: 11yrs for routine vaccination, 7yrs for catch-up)

• Give 1 dose of Tdap vaccine to all adolescents aged 11−12yrs.

• Tdap can be administered regardless of the interval since the last tetanus and diphtheria toxoid-containing vaccine.

• Administer 1 dose of Tdap vaccine to pregnant adolescents during each pregnancy (preferably during the early part of gestational weeks 27–36).

• For catch-up vaccination recommendations, refer to the 2020 Catch-Up Vaccination Schedule: 4 Months−18 years chart.

13. Human papillomavirus (HPV) vaccines. (Minimum age: 9yrs for 9vHPV [Gardasil 9])

• Adolescents age 11−12yrs (can start at age 9yrs) and through 18yrs (if not previously adequately vaccinated) should receive HPV vaccine series. Number of doses is dependent on age at initial vaccination:

— Initiated at age 9−14yrs: administer a 2-dose series at 0, 6–12mos. The minimum interval between doses is 5mos; repeat dose if given too soon.

— Initiated at age ≥15yrs: administer a 3-dose series at 0, 1−2, and 6mos. The 1st and 2nd dose should be at least 4wks apart, the 2nd and 3rd dose at least 12wks apart, and the 1st and 3rd dose at least 5mos apart; repeat dose if given too soon.

• No additional doses are needed for persons who have completed a valid series with any HPV vaccine.

• Administer HPV vaccine beginning at age 9yrs to children with any history of sexual abuse or assault.

• Immunocompromised children should receive a 3-dose series at 0, 1−2, and 6mos, regardless of age at vaccine initiation.

• HPV vaccination is not recommended for pregnancy. However, pregnancy testing is not needed before vaccination. If found to be pregnant after initiating the vaccination series, no intervention is needed; the remainder of the series should be delayed until completion of pregnancy.