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Guideline Summary
Guideline Title
Advisory Committee on Immunization Practices recommended immunization schedule for persons aged 0 through 18 years — United States, 2014.
Bibliographic Source(s)
Centers for Disease Control and Prevention (CDC). Advisory committee on immunization practices recommended immunization schedules for persons aged 0 through 18 years - United States, 2014. MMWR Morb Mortal Wkly Rep. 2014 Feb 7;63(5):108-9. PubMed External Web Site Policy
Guideline Status

This is the current release of the guideline.

This guideline updates a previous version: Centers for Disease Control and Prevention. Advisory Committee on Immunization Practices (ACIP) recommended immunization schedule for persons aged 0 through 18 years -- United States, 2013. MMWR Morb Mortal Wkly Rep. 2013 Feb 1;62(Suppl 1):2-8.

Scope

Disease/Condition(s)

Vaccine-preventable diseases:

  • Diphtheria
  • Hepatitis A virus infection
  • Hepatitis B virus infection
  • Haemophilus influenzae infection
  • Human papillomavirus infection
  • Influenza
  • Measles
  • Meningococcal disease
  • Mumps
  • Pertussis
  • Pneumococcal infection and invasive pneumococcal disease
  • Polio
  • Rotavirus infection
  • Rubella
  • Tetanus
  • Varicella (chickenpox)
Guideline Category
Prevention
Clinical Specialty
Family Practice
Infectious Diseases
Pediatrics
Preventive Medicine
Intended Users
Advanced Practice Nurses
Allied Health Personnel
Health Care Providers
Health Plans
Hospitals
Managed Care Organizations
Nurses
Pharmacists
Physician Assistants
Physicians
Public Health Departments
Guideline Objective(s)

To update recommendations for currently licensed vaccines for persons aged 0 through 18 years

Target Population

Children and adolescents aged 0 through 18 years residing in the United States

Interventions and Practices Considered

Immunization schedules for persons aged 0 through 18 years, and catch-up schedules using the following vaccines (see the "Major Recommendations" field for 2014 schedules):

  • Hepatitis B vaccine
  • Rotavirus vaccine
  • Diphtheria, tetanus, acellular pertussis vaccine (DTaP)
  • Tetanus, diphtheria, acellular pertussis vaccine (Tdap)
  • Haemophilus influenzae type b vaccine
  • Pneumococcal vaccine (pneumococcal conjugate [PCV13] and pneumococcal polysaccharide [PPSV23])
  • Inactivated poliovirus vaccine
  • Influenza vaccine
  • Measles, mumps, rubella (MMR) vaccine
  • Varicella vaccine
  • Hepatitis A vaccine
  • Meningococcal vaccine
  • Human papillomavirus (HPV) vaccine (HPV2: females only; HPV4: males and females)
Major Outcomes Considered

Not stated

Methodology

Methods Used to Collect/Select the Evidence
Searches of Electronic Databases
Searches of Unpublished Data
Description of Methods Used to Collect/Select the Evidence

To formulate policy recommendations, the Advisory Committee on Immunization Practices (ACIP) reviews many factors, including morbidity and mortality associated with the disease in the general U.S. population and in specific risk groups; available scientific literature (both published and unpublished) on the safety, efficacy, effectiveness, cost-effectiveness, and acceptability of the immunizing agent, with consideration of the relevant quality and quantity of published and unpublished data; clinical trial results and use information provided in the manufacturer's labeling or package insert; recommendations of other professional liaison organizations; and the feasibility of incorporating the vaccine into existing domestic immunization programs.

Source: Smith JC, Snider DE, Pickering LK; Advisory Committee on Immunization Practices. Immunization policy development in the United States: the role of the Advisory Committee on Immunization Practices. Ann Intern Med. 2009 Jan 6;150(1):45-9.

Number of Source Documents

Not stated

Methods Used to Assess the Quality and Strength of the Evidence
Expert Consensus
Rating Scheme for the Strength of the Evidence

Not applicable

Methods Used to Analyze the Evidence
Systematic Review with Evidence Tables
Description of the Methods Used to Analyze the Evidence

Using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework, the Advisory Committee on Immunization Practices (ACIP) systematically assesses the type or quality of evidence about a vaccine's expected health impacts and the balance of health benefits and risks, along with the values and preferences of persons affected, and health economic analyses. The evidence is grouped into four categories, with the order reflecting the level of confidence in the estimated effect of vaccination on health outcomes: 1) randomized controlled trials, or overwhelming evidence from observational studies; 2) randomized controlled trials with important limitations, or exceptionally strong evidence from observational studies; 3) observational studies, or randomized controlled trials with notable limitations; and 4) clinical experience and observations, observational studies with important limitations, or randomized controlled trials with several major limitations.

Randomized trials often cannot be used to assess the safety and efficacy of vaccination on rare or long-term outcomes, and such trials might be unethical to conduct for vaccines that are already licensed. Observational studies frequently are conducted for such assessments. The GRADE framework allows evaluation of evidence derived from immunogenicity or other intermediate outcomes as well as evaluation of evidence based on extrapolations from findings with similar vaccines in similar populations or other indirect forms of evidence. The balance of benefits and harms is assessed through review of the baseline risk for disease and the expected relative and absolute effects of vaccination on health outcomes. Health economic analyses include computations of cost per quality-adjusted life year gained. Determination of values includes assessing the relative importance of outcomes related to benefits, harms, and health economic analyses. Evidence tables are used to summarize the type of evidence for a vaccine's health impacts and its expected health benefits and risks.

Source: CDC. New framework (GRADE) for development of evidence-based recommendations by the Advisory Committee on Immunization Practices. MMWR. 2012;61(18):327-327.

Methods Used to Formulate the Recommendations
Expert Consensus
Description of Methods Used to Formulate the Recommendations

Workgroups

Committee workgroups are formed as a resource for gathering, analyzing, and preparing information for presentation to the Committee. Workgroups must be chaired by an Advisory Committee on Immunization Practices (ACIP) member and must include at least 2 ACIP members and a Centers for Disease Control and Prevention (CDC) subject-matter expert. Other workgroup members include relevant ex officio members, liaison representatives, members of academia, and invited consultants as required. Vaccine manufacturer representatives may not serve as workgroup members. Workgroups meet throughout the year to do in-depth reviews of vaccine-related data and to develop options for policy recommendations for presentation to the Committee. Four ACIP workgroups are permanent (Adult Immunization Schedule, Childhood/Adolescent Immunization Schedule, General Recommendations, Influenza Vaccines), and the remaining workgroups, which typically focus on 1 vaccine or a group of vaccines, are established and then disbanded as appropriate. All workgroup findings and options are presented to the ACIP in an open meeting, and this information is deliberated until members reach a majority decision. A recommendation, when voted on and approved by a majority of voting ACIP members, includes guidance on target groups for immunization, route of administration and dosing intervals, and precautions and contraindications.

Factors and Evidence Considered in Immunization Policy Development

When data permit, specific rules of evidence, such as those followed by the U.S. Preventive Services Task Force, are used to judge the quality of data and make decisions regarding the nature and strength of recommendations. In the absence of data or when data are inadequate, expert opinions of voting members and other experts are used to make recommendations. Depending on the relative importance of the issue, either formal (for example, Delphi, nominal group techniques) or informal methods for soliciting expert opinions are used. Published statements of the ACIP explicitly describe the methods used for developing recommendations and provide the evidence used to develop the recommendations (for example, results of controlled trials, case–control studies, case series, expert opinion, meta-analyses, Delphi surveys, focus groups, cost-effectiveness analyses, and other inputs).

Source: Smith JC, Snider DE, Pickering LK; Advisory Committee on Immunization Practices. Immunization policy development in the United States: the role of the Advisory Committee on Immunization Practices. Ann Intern Med. 2009 Jan 6;150(1):45-9.

During the October 2010 ACIP meeting, the ACIP voted to adopt a new framework for developing evidence-based recommendations that is based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Key factors considered in the development of recommendations include the balance of benefits and harms, type of evidence, values and preferences of the people affected, and health economic analyses.

Formulating Recommendations

Category A recommendations will apply to all persons in an age- or risk-factor-based group, with the exception of persons who have a contraindication. Category B recommendations do not apply to all members of an age- or risk-based subgroup of the population, but in the context of a clinician-patient interaction, vaccination may be found to be appropriate for a person. The category B recommendation is similar to what was previously referred to by the ACIP as permissive recommendation. In some instances, the ACIP may decide not to make a recommendation if further information is needed.

The recommendation category depends on the balance between desirable (benefits, savings) and undesirable (harms, costs) effects of vaccination. A category A recommendation is one for which the desirable effects outweigh the undesirable effects (recommendation for) or that the undesirable effects outweigh the desirable effects (recommendation against). Key factors that can lead to a category B recommendation include smaller net benefit (e.g., low baseline risk, small relative or absolute effects); lower confidence in the estimated effect of vaccination on health outcomes (e.g., wide confidence intervals); variability in values attributed to benefits and harms; and lower cost-effectiveness or uncertainty about whether the net benefits are worth the costs (e.g., because of lack of data on input assumptions that substantially affect the results of economic models). Examples of category A recommendations include the ACIP recommendation to vaccinate all U.S. infants with rotavirus vaccine; recommendation to administer pneumococcal polysaccharide vaccine to all children aged 2 years or older with certain underlying medical conditions; and recommendation against use of the 2010–2011 Afluria influenza vaccine among children aged 6 months through 8 years. An example of a category B recommendation is the recommendation that the 2010–2011 Afluria vaccine may be used for a child aged 5–8 years with a medical condition that increases the child's risk for influenza complications if no other age-appropriate, seasonal influenza vaccine is available; providers should discuss with the parents or caregivers the benefits and risks of Afluria vaccination before use of the vaccine.

ACIP members consider all relevant factors for making recommendations. ACIP Work Groups include ACIP members and multiple external experts and stakeholders in the preparation of options for immunization to present to ACIP. ACIP meetings are open to the public, and experts and stakeholders from liaison organizations and other entities provide input during the ACIP decision-making process. Recommendations to the CDC/Health and Human Services (HHS) are passed by majority vote among committee members; recommendations are provisional pending acceptance by the Director of CDC/Secretary of HHS. Existing ACIP recommendations are updated on a periodic basis.

Source: Ahmed F, Temte JL, Campos-Outcalt D, Schünemann HJ; ACIP Evidence Based Recommendations Work Group (EBRWG). Methods for developing evidence-based recommendations by the Advisory Committee on Immunization Practices (ACIP) of the U.S. Centers for Disease Control and Prevention (CDC). Vaccine. 2011 Nov 15;29(49):9171-6. Epub 2011 Aug 11.

Rating Scheme for the Strength of the Recommendations

Not applicable

Cost Analysis

Economic analysis is an important factor that informs judgments in formulating recommendations (e.g., cost-benefit, cost-utility, cost-effectiveness). Use of a fixed cut-off threshold such as $50,000 or $100,000 per quality adjusted life year (QALY) for determining cost-effectiveness, however, ignores other determinants of value. The methodology described above for assessing the type or quality of evidence is not intended to be applied to health economic analyses based on modeling. The Advisory Committee on Immunization Practices (ACIP) Work Group on Economic Analysis has published a document titled Guidance for Health Economic Studies Presented to the ACIP that provides a framework for the description and presentation of the methods and results, and that stipulates technical review by anonymous peer reviewers of any economic materials presented to the ACIP. Presentation of health economic data should be undertaken using the guidelines in that document.

Source: Ahmed F, Temte JL, Campos-Outcalt D, Schünemann HJ; ACIP Evidence Based Recommendations Work Group (EBRWG). Methods for developing evidence-based recommendations by the Advisory Committee on Immunization Practices (ACIP) of the U.S. Centers for Disease Control and Prevention (CDC). Vaccine. 2011 Nov 15;29(49):9171-6. Epub 2011 Aug 11.

Method of Guideline Validation
External Peer Review
Internal Peer Review
Description of Method of Guideline Validation

After formulation by the relevant workgroup, draft recommendations are subjected to further extensive review by staff of the Centers for Disease Control and Prevention (CDC), U.S. Food and Drug Administration (FDA), other relevant federal agencies, Advisory Committee on Immunization Practices (ACIP) members, liaison members, and external expert consultants. Workgroup members or ACIP members may identify a need for additional data, corrections in data content, and modifications of the interpretation of the data, and members may critique and challenge expert opinions. Public comments also are solicited during each ACIP meeting and are considered in the decision-making process. These inputs are synthesized by the workgroup in an iterative process, and options are presented to the ACIP for final consideration and vote.

Source: Smith JC, Snider DE, Pickering LK; Advisory Committee on Immunization Practices. Immunization policy development in the United States: the role of the Advisory Committee on Immunization Practices. Ann Intern Med. 2009 Jan 6;150(1):45-9.

Recommendations

Major Recommendations

Note from the Centers for Disease Control and Prevention (CDC) and the National Guidelines Clearinghouse (NGC): Please see the CDC's Advisory Committee on Immunization Practices (ACIP) Web site External Web Site Policy for any updates to vaccine-specific recommendations that have been approved since the publication of this guideline.

Each year, ACIP reviews the current recommended immunization schedules for persons aged 0 through 18 years to ensure that the schedule reflects current recommendations for Food and Drug Administration-licensed vaccines. In October 2013, ACIP approved the recommended immunization schedules for persons aged 0 through 18 years for 2014, which includes several changes from 2013 immunization schedules.

Health-care providers are advised to use both schedules and the combined footnotes together (see tables below). Printable versions of the 2014 immunization schedules for persons aged 0 through 18 years also are available at the website in several formats, including portrait, landscape, and pocket-sized versions. Ordering instructions for laminated versions also are available at the website. "Parent-friendly" child and adolescent schedules are available at http://www.cdc.gov/vaccines/schedules/easy-to-read/index.html External Web Site Policy.

For further guidance on use of each vaccine included in the schedules, including contraindications and precautions to use of a vaccine, health-care providers are referred to the respective ACIP vaccine recommendations at http://www.cdc.gov/vaccines/hcp/acip-recs External Web Site Policy. In addition, changes in recommendations for specific vaccines might occur between annual updates to the childhood/adolescent immunization schedules.

CDC's National Center for Immunization and Respiratory Diseases (NCIRD) maintains the most current immunization schedules on the Vaccines and Immunizations pages of CDC's website (http://www.cdc.gov/vaccines/schedules External Web Site Policy). If errors or omissions are discovered, CDC posts revised versions on those web pages. CDC encourages organizations that previously have relied on copying the schedules on their websites instead to use content syndication to consistently display current schedules. This is a more reliable and accurate method and ensures that the most current and accurate immunization schedules are on each organization's website.

Changes to the previous schedules* include the following:

  • Several new references were added, including the 2014 adult immunization schedule (http://www.cdc.gov/vaccines/schedules External Web Site Policy) for vaccination recommendations for persons aged ≥19 years. Recommendations for persons who have been vaccinated before the minimum age/interval between doses of vaccine in a series also were added.
  • Figure 1, "Recommended Immunization Schedule for Persons Aged 0 through 18 Years" (see below):
    • Legend for the meningococcal conjugate vaccine row updated to reflect recommendation for use of MenACWY–CRM vaccine as early as age 2 months.
    • Pages 4 through 6 of the immunization schedule contain combined footnotes for each vaccine related to routine vaccination, catch-up vaccination,† and vaccination of persons with high-risk medical conditions or under special circumstances.
  • Standardized formatting used for footnotes for each vaccine to reflect the number of vaccine doses in a particular series.
    • Meningococcal conjugate vaccine footnotes updated to reflect recent recommendations for use of MCV4-CRM in high-risk persons aged 2 months and older.
    • Footnotes organized to reflect vaccine recommendations for each high-risk condition.
    • Influenza vaccine footnotes updated to provide guidance for dosing for children aged 6 months through 8 years for the 2013–14 and 2014–15 seasons.
    • Pneumococcal vaccine footnotes updated to provide guidance for vaccination of persons with high-risk conditions.
    • Hepatitis A vaccine footnotes updated to provide guidance for unvaccinated persons who are at increased risk for infection.
  • Figure 2, Catch-Up Immunization Schedule (see below):
    • Haemophilus influenzae type b (Hib) conjugate vaccine, pneumococcal conjugate vaccine, and tetanus, diphtheria, and acellular pertussis (Tdap) vaccine catch-up schedules updated to provide more clarity.

*Past immunization schedules are available at http://www.cdc.gov/vaccines/schedules/past.html External Web Site Policy.

†For persons aged 4 months through 18 years who start late or who are more than 1 month behind in receiving recommended vaccinations.

Figure 1. Recommended Immunization Schedule for Persons Aged 0 through 18 Years — United States, 2014 (for those who fall behind or start late, see the catch-up schedule, below)

These recommendations must be read with the footnotes that follow. For those who fall behind or start late, provide catch-up vaccination at the earliest opportunity as indicated by the green bars. To determine minimum intervals between doses, see the catch-up schedule below. School entry and adolescent vaccine age groups are in bold.

Vaccine Birth 1
mo
2
mos
4
mos
6
mos
9
mos
12
mos
15
mos
18
mos
19-23
mos
2-3
yrs
4-6
yrs
7-10
yrs
11-12
yrs
13-15
yrs
16-18
yrs
Hepatitis B1 (HepB) 1st dose 2nd dose   3rd dose  
Rotavirus2 (RV)
RV1 (2-dose series); RV5 (3-dose series)
    1st dose 2nd dose See footnote 2                      
Diphtheria, tetanus, & acellular pertussis3
(DTaP: <7 yrs)
    1st dose 2nd dose 3rd dose   4th dose   5th dose        
Tetanus, diphtheria, & acellular pertussis4
(Tdap: ≥7 yrs)
                          (Tdap)  
Haemophilus influenzae type b5 (Hib)     1st dose 2nd dose See footnote 5   3rd or 4th dose
See footnote 5
           
Pneumococcal conjugate6 (PCV13)     1st dose 2nd dose 3rd dose   4th dose    
Pneumococcal polysaccaride6 (PPSV23)                      
Inactivated poliovirus7 (IPV)
(<18 years)
    1st dose 2nd dose 3rd dose   4th dose    
Influenza8 (IIV; LAIV)
2 doses for some: See footnote 8
        Annual vaccination (IIV only) Annual vaccination (IIV or LAIV)
Measles, mumps, rubella9 (MMR)             1st dose   2nd dose  
Varicella10 (VAR)             1st dose   2nd dose  
Hepatitis A11 (HepA)             2 dose series, See footnote 11  
 
Human papillomavirus12
(HPV2: females only; HPV4: males and females)
                          (3-dose series)  
Meningococcal13 (Hib-MenCY ≥6 weeks; MenACWY-D ≥9 mos; MenACWY-CRM ≥2 mos)     See footnote 13   1 dose   booster  

  Range of recommended ages for all children   Range of recommended ages for catch-up immunizations   Range of recommended ages for certain high-risk groups   Range of recommended ages during which catch-up is encouraged and for certain high-risk groups   Not routinely recommended
       

This schedule includes recommendations in effect as of January 1, 2014. Any dose not administered at the recommended age should be administered at a subsequent visit, when indicated and feasible. The use of a combination vaccine generally is preferred over separate injections of its equivalent component vaccines. Vaccination providers should consult the relevant ACIP statement for detailed recommendations, available online at: http://www.cdc.gov/vaccines/pubs/acip-list.htm External Web Site Policy. Clinically significant adverse events that follow immunization should be reported to the Vaccine Adverse Event Reporting System (VAERS) online http://www.vaers.hhs.gov/ External Web Site Policy or by telephone, 800-822-7967. Suspected cases of vaccine-preventable diseases should be reported to the state or local health department. Additional information, including precautions and contraindications for vaccination, is available from CDC online (http://www.cdc.gov/vaccines/vac-admin/contraindications.htm External Web Site Policy) or by telephone (800-CDC-INFO [800-232-4636]).

This schedule is approved by the ACIP (http://www.cdc.gov/vaccines/acip/index.html External Web Site Policy), the American Academy of Pediatrics (http://www.aap.org) External Web Site Policy, the American Academy of Family Physicians (http://www.aafp.org External Web Site Policy), and the American College of Obstetricians and Gynecologists (http://www.acog.org External Web Site Policy).

Note: The above recommendations must be read along with the footnotes of this schedule (see below).

Figure 2. Catch-up Immunization Schedule for Persons Aged 4 Months through 18 Years Who Start Late or Who Are More Than 1 Month Behind – United States, 2014

The figure below provides catch-up schedules and minimum intervals between doses for children whose vaccinations have been delayed. A vaccine series does not need to be restarted, regardless of the time that has elapsed between doses. Use the section appropriate for the child's age. Always use this table in conjunction with Figure 1 (see above) and the footnotes that follow (see below).

Persons Aged 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 B1 Birth 4 weeks 8 weeks and at least 16 weeks after first dose; minimum age for the final dose is 24 weeks    
Rotavirus2 6 weeks 4 weeks 4 weeks2    
Diphtheria, tetanus, & acellular pertussis3 6 weeks 4 weeks 4 weeks 6 months 6 months3
Haemophilus influenzae type b5 6 weeks 4 weeks if first dose administered at younger than age 12 months
8 weeks (as final dose)
if first dose administered at age 12 through 14 months

No further doses needed
if first dose administered at age 15 months or older
4 weeks5 if current age is younger than 12 months and first dose administered at <7 months old
8 weeks and age 12 months through 59 months (as final dose)5 if current age is younger than 12 months and first dose administered between 7 through 11 months (regardless of Hib vaccine [PRP-T or PRP-OMP] used for first dose); OR if current age is 12 through 59 months and first dose administered at younger than age 12 months; OR first 2 doses were PRP-OMP and administered at younger than 12 months.
No further doses needed if previous dose administered at age 15 months or older
8 weeks (as final dose)
This dose only necessary for children aged 12 through 59 months who received 3 (PRP-T) doses before age 12 months and started the primary series before age 7 months
 
Pneumococcal6 6 weeks 4 weeks if first dose administered at younger than age 12 months
8 weeks (as final dose for healthy children) if first dose administered at age 12 months or older
No further doses needed for healthy children if previous dose administered at age 24 months or older
4 weeks if current age is younger than 12 months
8 weeks (as final dose for healthy children) if current age is 12 months or older
No further doses needed for healthy children if previous dose administered at age 24 months or older
8 weeks (as final dose)
This dose only necessary for children aged 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 poliovirus7 6 weeks 4 weeks7 4 weeks7 6 months7 minimum age 4 years for final dose  
Meningococcal13 6 weeks 8 weeks13 See footnote 13 See footnote 13  
Measles, mumps, rubella9 12 months 4 weeks      
Varicella10 12 months 3 months      
Hepatitis A11 12 months 6 months      
Persons Aged 7 through 18 Years
Tetanus, diphtheria; tetanus, diphtheria, & acellular pertussis4 7 years4 4 weeks 4 weeks if first dose of DTaP/DT administered at younger than age 12 months
6 months if first dose of DTaP/DT administered at age 12 months or older and then no further doses needed for catch-up
6 months if first dose of DTaP/DT administered at younger than age 12 months  
Human papillomavirus12 9 years Routine dosing intervals are recommended12
Hepatitis A11 12 months 6 months      
Hepatitis B1 Birth 4 weeks 8 weeks (and at least 16 weeks after first dose)    
Inactivated poliovirus7 6 weeks 4 weeks 4 weeks7 6 months7  
Meningococcal13 6 weeks 8 weeks13      
Measles, mumps, rubella9 12 months 4 weeks      
Varicella10 12 months 3 months if person is younger than age 13 years
4 weeks if person is age 13 years or older
     

Note: The above recommendations must be read along with the footnotes (see below).

Footnotes: Recommended Immunization Schedule for Persons Aged 0 Through 18 Years — United States, 2014

For further guidance for use of the vaccines described in this publication see http://www.cdc.gov/vaccines/hcp/acip-resc/index.htm External Web Site Policy.

For vaccine recommendations for persons 19 years of age and older, see the NGC summary of the CDC guideline Advisory Committee on Immunization Practices (ACIP) recommended immunization schedule for adults aged 19 years and older — United States, 2014.

Additional Information

  • For contraindications and precautions to use of a vaccine and for additional information regarding that vaccine, vaccination providers should consult the relevant ACIP statement available online at http://www.cdc.gov/vaccines/hcp/acip-recs/index.html. External Web Site Policy
  • For purposes of calculating intervals between doses, 4 weeks = 28 days. Intervals of 4 months or greater are determined by calendar months.
  • Vaccine doses administered 4 days or less before the minimum interval are considered valid. Doses of any vaccine administered ≥5 days earlier than the minimum interval or minimum age should not be counted as valid doses 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 MMWR, General Recommendations on Immunization and Reports Vol. 60/No. 2; Table 1. Recommended and minimum ages and intervals between vaccine doses available online at http://www.cdc.gov/mmwr/pdf/rr/rr6002.pdf External Web Site Policy.
  • Information on travel vaccine requirements and recommendations is available at http://wwwnc.cdc.gov/travel/destinations/list External Web Site Policy.
  • For vaccination of persons with primary and secondary immunodeficiencies, see Table 13, "Vaccination of persons with primary and secondary immunodeficiencies," in General Recommendations on Immunization (ACIP), available at http://www.cdc.gov/mmwr/pdf/rr/rr6002.pdf External Web Site Policy; and American Academy of Pediatrics. Immunization in Special Clinical Circumstances, in Pickering LK, Baker CJ, Kimberlin DW, Long SS eds. Red Book: 2012 report of the Committee on Infectious Diseases. 29th ed. Elk Grove Village, IL: American Academy of Pediatrics.
  1. Hepatitis B (HepB) vaccine (Minimum age: birth)

    Routine vaccination:

    At birth

    • Administer monovalent HepB vaccine to all newborns before hospital discharge.
    • For infants born to hepatitis B surface antigen (HBsAg)–positive mothers, administer HepB vaccine and 0.5 mL of hepatitis B immune globulin (HBIG) within 12 hours of birth. These infants should be tested for HBsAg and antibody to HBsAg (anti-HBs) 1 to 2 months after completion of the HepB series, at age 9 through 18 months (preferably at the next well-child visit).
    • If mother's HBsAg status is unknown, within 12 hours of birth administer HepB vaccine regardless of birth weight. For infants weighing <2,000 grams, administer HBIG in addition to HepB within 12 hours of birth. Determine mother's HBsAg status as soon as possible and, if she is HBsAg-positive, also administer HBIG for infants weighing 2,000 grams or more as soon as possible but no later than age 7 days.

    Doses following the birth dose

    • The second dose should be administered at age 1 or 2 months. Monovalent HepB vaccine should be used for doses administered before age 6 weeks.
    • Infants who did not receive a birth dose should receive 3 doses of a HepB-containing vaccine on a schedule of 0, 1 to 2 months, and 6 months starting as soon as feasible.
    • Administer the second dose 1 to 2 months after the first dose (minimum interval of 4 weeks), administer the third dose at least 8 weeks after the second dose AND at least 16 weeks after the first dose. The final (third or fourth) dose in the HepB vaccine series should be administered no earlier than age 24 weeks.
    • Administration of a total of 4 doses of HepB vaccine is permitted when a combination vaccine containing HepB is administered after the birth dose.

    Catch-up vaccination:

    • Unvaccinated persons should complete a 3-dose series.
    • A 2-dose series (doses separated by at least 4 months) of adult formulation Recombivax HB is licensed for use in children aged 11 through 15 years.
    • For other catch-up issues, see "Catch-up Immunization Schedule for Persons Aged 4 Months through 18 Years Who Start Late or Who Are More Than 1 Month Behind – United States, 2014."
  1. Rotavirus (RV) vaccines (Minimum age: 6 weeks for both RV-1 [Rotarix] and RV5 [RotaTeq]).

    Routine vaccination:

    • Administer a series of RV vaccine to all infants as follows:
      1. If Rotarix is used, administer a 2-dose series at 2 and 4 months of age.
      2. If RotaTeq is used, administer a 3-dose series at ages 2, 4, and 6 months.
      3. If any dose in series was RotaTeq or vaccine product is unknown for any dose in the series, a total of 3 doses of RV vaccine should be administered.

    Catch-up vaccination:

    • The maximum age for the first dose in the series is 14 weeks, 6 days; vaccination should not be initiated for infants aged 15 weeks, 0 days or older.
    • The maximum age for the final dose in the series is 8 months, 0 days.
    • For other catch-up guidance, see "Catch-up Immunization Schedule for Persons Aged 4 Months through 18 Years Who Start Late or Who Are More Than 1 Month Behind – United States, 2014."
  1. Diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine (Minimum age: 6 weeks. Exception: DTaP-IPV [Kinrix]: 4 years)

    Routine vaccination:

    • Administer a 5-dose series of DTaP vaccine at ages 2, 4, 6, 15 through 8 months, and 4 through 6 years. The fourth dose may be administered as early as age 12 months, provided at least 6 months have elapsed since the third dose.

    Catch-up vaccination:

    • The fifth dose of DTaP vaccine is not necessary if the fourth dose was administered at age 4 years or older.
    • For other catch-up issues, see "Catch-up Immunization Schedule for Persons Aged 4 Months through 18 Years Who Start Late or Who Are More Than 1 Month Behind – United States, 2014."
  1. Tetanus and diphtheria toxoids and acellular pertussis (Tdap) vaccine (Minimum age: 10 years for Boostrix, 11 years for Adacel).

    Routine vaccination:

    • Administer 1 dose of Tdap vaccine to all adolescents aged 11 through 12 years.
    • Tdap may 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 (preferred during 27 through 36 weeks gestation) regardless of time since prior Td or Tdap vaccination.

    Catch-up vaccination:

    • Persons aged 7 years or older who are not fully immunized with DTaP vaccine, should receive Tdap vaccine as as 1 (preferably the first) dose in the catch-up series; if additional doses are needed, use Td vaccine. For children 7 through 10 years who receive a dose of Tdap as part of the catch-up series, an adolescent Tdap vaccine dose at age 11 through 12 years should NOT be administered. Td should be administered instead 10 years after the Tdap dose.
    • Persons aged 11 through 18 years who have not received Tdap vaccine should receive a dose followed by tetanus and diphtheria toxoids (Td) booster doses every 10 years thereafter.
    • Inadvertent doses of DTaP vaccine:
      • If administered inadvertently to a child aged 7 through 10 years may count as part of the catch-up series. This dose may count as the adolescent Tdap dose, or the child can later receive a Tdap booster dose at age 11 through 12 years
      • If administered inadvertently to an adolescent aged 11 through 18 years, the dose should be counted as the adolescent Tdap booster.
    • For other catch-up issues, see "Catch-up Immunization Schedule for Persons Aged 4 Months through 18 Years Who Start Late or Who Are More Than 1 Month Behind – United States, 2014."
  1. Haemophilus influenzae type b (Hib) conjugate vaccine (Minimum age: 6 weeks for PRP-T [ACTHIB, DTaP-IPV/Hib (Pentacel) and Hib-MenCY (MenHibrix)], PRP-OMP [PedvaxHIB or COMVAX], 12 months for PRP-T [Hiberix])

    Routine vaccination:

    • Administer a 2- or 3-dose Hib vaccine primary series and a booster dose (dose 3 or 4 depending on vaccine used in primary series) at age 12 through 15 months to complete a full Hib vaccine series. 
    • The primary series with ActHIB, MenHibrix, or Pentacel consists of 3 doses and should be administered at 2, 4, and 6 months of age. The primary series with PedvaxHib or COMVAX consists of 2 doses and should be administered at 2 and 4 months of age; a dose at age 6 months is not indicated.
    • One booster dose (dose 3 or 4 depending on vaccine used in primary series) of any Hib vaccine should be administered at age 12 through 15 months. An exception is Hiberix vaccine. Hiberix should only be used for the booster (final) dose in children aged 12 months through 4 years who have received at least 1 prior dose of Hib-containing vaccine.
    • For recommendations on the use of MenHibrix in patients at increased risk for meningococcal disease, please refer to the meningococcal vaccine footnotes and also to MMWR March 22, 2013; 62(RR02);1-22, available at http://www.cdc.gov/mmwr/pdf/rr/rr6202.pdf External Web Site Policy.

    Catch-up vaccination:

    • If dose 1 was administered at ages 12-14 months, administer a second (final) dose at least 8 weeks after dose 1, regardless of Hib vaccine used in the primary series.
    • If the first 2 doses were PRP-OMP (PedvaxHIB or COMVAX), and were administered at age 11 months or younger, the third (and final) dose should be administered at age 12 through 15 months and at least 8 weeks after the second dose.
    • If the first dose was administered at age 7 through 11 months, administer the second dose at least 4 weeks later, and a third (and final) dose should be administered at age 12 through 15 months or 8 weeks after second dose, whichever is later, regardless of Hib vaccine used for first dose.
    • If first dose is administered at younger than 12 months of age and second dose is given between 12 through 14 months of age, a third (and final) dose should be given 8 weeks later.
    • For unvaccinated children aged 15 months or older, administer only 1 dose.
    • For other catch-up guidance, see "Catch-up Immunization Schedule for Persons Aged 4 Months through 18 Years Who Start Late or Who Are More Than 1 Month Behind – United States, 2014." For catch-up guidance related to MenHibrix, please see the meningococcal vaccine footnotes and also MMWR March 22, 2013; 62(RR02);1-22, available at http://www.cdc.gov/mmwr/pdf/rr/rr6202.pdf External Web Site Policy.

    Vaccination of persons with high risk conditions:

    • Children aged 12 through 59 months who are at increased risk for Hib disease, including chemotherapy recipients and those with anatomic or functional asplenia (including sickle cell disease), human immunodeficiency virus (HIV) infection, immunoglobulin deficiency, or early component complement deficiency, who have received either no doses or only 1 dose of Hib vaccine before 12 months of age, should receive 2 additional doses of Hib vaccine 8 weeks apart; children who received 2 or more doses of Hib vaccine before 12 months of age should receive 1 additional dose.
    • For patients younger than 5 years of age undergoing chemotherapy or radiation treatment who received a Hib vaccine dose(s) within 14 days of starting therapy or during therapy, repeat the dose(s) at least 3 months following therapy completion.
    • Recipients of hematopoietic stem cell transplant (HSCT) should be revaccinated with a 3-dose regimen of Hib vaccine starting 6 to 12 months after successful transplant, regardless of vaccination history; doses should be administered at least 4 weeks apart.
    • A single dose of any Hib-containing vaccine should be administered to unimmunized* children and adolescents 15 months of age and older undergoing an elective splenectomy; if possible, vaccine should be administered at least 14 days before procedure.
    • Hib vaccine is not routinely recommended for patients 5 years or older. However, 1 dose of Hib vaccine should be administered to unimmunized* persons aged 5 years or older who have anatomic or functional asplenia (including sickle cell disease) and unvaccinated persons 5 through 18 years of age with HIV infection.

      *Patients who have not received a primary series and booster dose or at least 1 dose of Hib vaccine after 14 months of age are considered unimmunized.

  1. Pneumococcal vaccines (PCV) (Minimum age: 6 weeks or 13-valent pneumococcal conjugate vaccine [PCV13], 2 years for pneumococcal polysaccharide vaccine [PPSV23])

    Routine vaccination with PCV13:

    • Administer a 4-dose series of PCV13 vaccine at ages 2, 4, and 6 months and at age 12 through 15 months.
    • For children aged 14 through 59 months who have received an age-appropriate series of 7-valent PCV (PCV7), administer a single supplemental dose of 13-valent PCV (PCV13).

    Catch-up vaccination with PCV13:

    • Administer 1 dose of PCV13 to all healthy children aged 24 through 59 months who are not completely vaccinated for their age.
    • For other catch-up issues, see "Catch-up Immunization Schedule for Persons Aged 4 Months through 18 Years Who Start Late or Who Are More Than 1 Month Behind – United States, 2014."

    Vaccination of persons with high-risk conditions with PCV13 and PPSV23:

    • All recommended PCV13 doses should be administered prior to PPSV23 vaccination if possible.
    • For children 2 through 5 years of age with any of the following conditions: chronic heart disease (particularly cyanotic congenital heart disease and cardiac failure); chronic lung disease (including asthma if treated with high-dose oral corticosteroid therapy); diabetes mellitus; cerebrospinal fluid leak; cochlear implant; sickle cell disease and other hemoglobinopathies; anatomic or functional asplenia; HIV infection; chronic renal failure; nephrotic syndrome; diseases associated with treatment with immunosuppressive drugs or radiation therapy, including malignant neoplasms, leukemias, lymphomas, and Hodgkin disease; solid organ transplantation; or congenital immunodeficiency:
      1. Administer 1 dose of PCV13 if 3 doses of PCV (PCV7 and/or PCV13) were received previously.
      2. Administer 2 doses of PCV13 at least 8 weeks apart if fewer than 3 doses of PCV (PCV7 and/or PCV13) were received previously.
      3. Administer 1 supplemental dose of PCV13 if 4 doses of PCV7 or other age-appropriate complete PCV7 series was received previously.
      4. The minimum interval between doses of PCV (PCV7 or PCV13) is 8 weeks.
      5. For children with no history of PPSV23 vaccination, administer PPSV23 at least 8 weeks after the most recent dose of PCV13.
    • For children aged 6 through 18 years who have cerebrospinal fluid leak; cochlear implant; sickle cell disease and other hemoglobinopathies; anatomic or functional asplenia; congenital or acquired immunodeficiencies; HIV infection; chronic renal failure; nephrotic syndrome; diseases associated with treatment with immunosuppressive drugs or radiation therapy, including malignant neoplasms, leukemias, lymphomas, and Hodgkin disease; generalized malignancy; solid organ transplantation; or multiple myeloma:
      1. If neither PCV13 nor PPSV23 has been received previously, administer 1 dose of PCV13 now and 1 dose of PPSV23 at least 8 weeks later.
      2. If PCV13 has been received previously but PPSV23 has not, administer 1 dose of PPSV23 at least 8 weeks after the most recent dose of PCV13.
      3. If PPSV23 has been received but PCV13 has not, administer 1 dose of PCV13 at least 8 weeks after the most recent dose of PPSV23.
    • For children aged 6 through 18 years with chronic heart disease (particularly cyanotic congenital heart disease and cardiac failure), chronic lung disease (including asthma if treated with high-dose oral corticosteroid therapy), diabetes mellitus, alcoholism, or chronic liver disease, who have not received PPSV23, administer 1 dose of PPSV23. If PCV13 has been received previously, then PPSV23 should be administered at least 8 weeks after any prior PCV13 dose.
    • A single revaccination with PPSV23 should be administered 5 years after the first dose to children with sickle cell disease or other hemoglobinopathies; anatomic or functional asplenia; congenital or acquired immunodeficiencies; HIV infection; chronic renal failure; nephrotic syndrome; diseases associated with treatment with immunosuppressive drugs or radiation therapy, including malignant neoplasms, leukemias, lymphomas, and Hodgkin disease; generalized malignancy; solid organ transplantation; or multiple myeloma.
  1. Inactivated poliovirus vaccine (IPV) (Minimum age: 6 weeks)

    Routine vaccination:

    • Administer a 4-dose series of IPV at ages 2, 4, 6 through 18 months, and at age 4 through 6 years. The final dose in the series should be administered on or after the fourth birthday and at least 6 months after the previous dose.

    Catch-up vaccination:

    • In the first 6 months of life, minimum age and minimum intervals are only recommended if the person is at risk for imminent exposure to circulating poliovirus (i.e., travel to a polio-endemic region or during an outbreak).
    • If 4 or more doses are administered before age 4 years, an additional dose should be administered at age 4 through 6 years and at least 6 months after the previous dose.
    • A fourth dose is not necessary if the third dose was administered at age 4 years or older and at least 6 months after the previous dose.
    • If both oral live poliovirus vaccine (OPV) and IPV were administered as part of a series, a total of 4 doses should be administered, regardless of the child's current age. IPV is not routinely recommended for U.S. residents aged 18 years or older.
    • For other catch-up guidance, see "Catch-up Immunization Schedule for Persons Aged 4 Months through 18 Years Who Start Late or Who Are More Than 1 Month Behind – United States, 2014."
  1. Influenza vaccines (Minimum age: 6 months for inactivated influenza vaccine [IIV]; 2 years for live, attenuated influenza vaccine [LAIV])

    Routine vaccination:

    • Administer influenza vaccine annually to all children beginning at age 6 months. For most healthy, nonpregnant persons aged 2 through 49 years, either LAIV or IIV may be used. However, LAIV should NOT be administered to some persons, including 1) those with asthma, 2) children 2 through 4 years who had wheezing in the past 12 months, or 3) those who have any other underlying medical conditions that predispose them to influenza complications. For all other contraindications to use of LAIV see MMWR 2013; 62 (No. RR-7):1-43, available at http://www.cdc.gov/mmwr/pdf/rr/rr6207.pdf External Web Site Policy.

    For children aged 6 months through 8 years:

    • For the 2013–14 season, administer 2 doses (separated by at least 4 weeks) to children who are receiving influenza vaccine for the first time. Some children in this age group who have been vaccinated previously will also need 2 doses. For additional guidance, follow dosing guidelines in the 2013-14 ACIP influenza vaccine recommendations, MMWR 2013; 62 (No. RR-7):1-43, available at http://www.cdc.gov/mmwr/pdf/rr/rr6207.pdf External Web Site Policy.
    • For the 2014–15 season, follow dosing guidelines in the 2014 ACIP influenza vaccine recommendations.

    For persons aged 9 years and older:

    • Administer 1 dose
  1. Measles, mumps, and rubella (MMR) vaccine (Minimum age: 12 months for routine vaccination)

    Routine vaccination:

    • Administer a 2-dose series of MMR vaccine at ages 12 through 15 months, and 4 through 6 years. The second dose may be administered before age 4 years, provided at least 4 weeks have elapsed since the first dose.
    • Administer 1 dose of MMR vaccine to infants aged 6 through 11 months before departure from the United States for international travel. These children should be revaccinated with 2 doses of MMR vaccine, the first at age 12 through 15 months (12 months if the child remains in an area where disease risk is high), and the second dose at least 4 weeks later.
    • Administer 2 doses of MMR vaccine to children aged 12 months and older, before departure from the United States for international travel. The first dose should be administered on or after age 12 months and the second dose at least 4 weeks later.

    Catch-up vaccination:

    • Ensure that all school-aged children and adolescents have had 2 doses of MMR vaccine; the minimum interval between the 2 doses is 4 weeks.
  1. Varicella (VAR) vaccine (Minimum age: 12 months)

    Routine vaccination:

    • Administer 2-dose series of VAR vaccine at ages 12 through 15 months, and 4 through 6 years. The second dose may be administered before age 4 years, provided at least 3 months have elapsed since the first dose. If the second dose was administered at least 4 weeks after the first dose, it can be accepted as valid.

    Catch-up vaccination:

    • Ensure that all persons aged 7 through 18 years without evidence of immunity (see MMWR 2007; 56 [No. RR-4], available at http://www.cdc.gov/mmwr/pdf/rr/rr5604.pdf External Web Site Policy) have 2 doses of varicella vaccine. For children aged 7 through 12 years, the recommended minimum interval between doses is 3 months (if the second dose was administered at least 4 weeks after the first dose, it can be accepted as valid); for persons aged 13 years and older, the minimum interval between doses is 4 weeks.
  1. Hepatitis A (HepA) vaccine (Minimum age: 12 months)

    Routine vaccination:

    • Initiate the 2-dose HepA vaccine series at 12 through 23 months; separate the 2 doses by 6 to 18 months.
    • Children who have received 1 dose of HepA vaccine before age 24 months should receive a second dose 6 to 18 months after the first dose.
    • For any person aged 2 years and older who has not already received the HepA vaccine series, 2 doses of HepA vaccine separated by 6 to 18 months may be administered if immunity against hepatitis A virus infection is desired.

    Catch-up vaccination:

    • The minimum interval between the two doses is 6 months.

    Special populations:

    • Administer 2 doses of HepA vaccine at least 6 months apart to previously unvaccinated persons who live in areas where vaccination programs target older children, or who are at increased risk for infection. This includes persons traveling to or working in countries that have high or intermediate endemicity of infection; men having sex with men; users of injection and non-injection illicit drugs; persons who work with hepatitis A virus (HAV)-infected primates or with HAV in a research laboratory; persons with clotting-factor disorders; persons with chronic liver disease; and persons who anticipate close, personal contact (e.g., household or regular babysitting) with an international adoptee during the first 60 days after arrival in the United States from a country with high or intermediate endemicity. The first dose should be administered as soon as the adoption is planned, ideally 2 or more weeks before the arrival of the adoptee.
  1. Human papillomavirus (HPV) vaccine (Minimum age: 9 years for HPV2 [Cervarix] and HPV4 [Gardasil])

    Routine vaccination:

    • Administer a 3-dose series of HPV vaccine on a schedule of 0, 1-2, and 6 months to all adolescents aged 11-12 years. Either HPV4 or HPV2 may be used for females, and only HPV4 may be used for males.
    • The vaccine series can be started at age 9 years.
    • Administer the second dose 1 to 2 months after the first dose (minimum interval of 4 weeks), administer the third dose 24 weeks after the first dose and 16 weeks after the second dose (minimum interval of 12 weeks).

    Catch-up vaccination:

    • Administer the vaccine series to females (either HPV2 or HPV4) and males (HPV4) at age 13 through 18 years if not previously vaccinated.
    • Use recommended routine dosing intervals (see above) for vaccine series catch-up.
  1. Meningococcal conjugate vaccines (Minimum age: 6 weeks for Hib-MenCY [MenHibrix], 9 months for MenACWY-D [Menactra], 2 months for MenACWY-CRM [Menveo])

    Routine vaccination:

    • Administer a single dose of Menactra or Menveo vaccine at age 11 through 12 years, with a booster dose at age 16 years.
    • Adolescents aged 11 through 18 years with HIV infection should receive a 2-dose primary series of Menactra or Menveo with at least 8 weeks between doses.
    • For children aged 2 months through 18 years with high-risk conditions, see below.

    Catch-up vaccination:

    • Administer Menactra or Menveo vaccine at age 13 through 18 years if not previously vaccinated.
    • If the first dose is administered at age 13 through 15 years, a booster dose should be administered at age 16 through 18 years with a minimum interval of at least 8 weeks between doses.
    • If the first dose is administered at age 16 years or older, a booster dose is not needed.
    • For other catch-up issues, see "Catch-up Immunization Schedule for Persons Aged 4 Months through 18 Years Who Start Late or Who Are More Than 1 Month Behind – United States, 2014."

    Vaccination of persons with high-risk conditions and other persons at increased risk of disease:

    • Children with anatomic or functional asplenia (including sickle cell disease):
      1. For children younger than 19 months of age, administer a 4-dose infant series of MenHibrix or Menveo at 2, 4, 6, and 12 through 15 months of age.
      2. For children aged 19 through 23 months who have not completed a series of MenHibrix or Menveo, administer 2 primary doses of Menveo at least 3 months apart.
      3. For children aged 24 months and older who have not received a complete series of MenHibrix or Menveo or Menactra, administer 2 primary doses of either Menactra or Menveo at least 2 months apart. If Menactra is administered to a child with asplenia (including sickle cell disease), do not administer Menactra until 2 years of age and at least 4 weeks after the completion of all PCV13 doses.
    • Children with persistent complement component deficiency:
      1. For children younger than 19 months of age, administer a 4-dose infant series of either MenHibrix or Menveo at 2, 4, 6, and 12 through 15 months of age.
      2. For children 7 through 23 months who have not initiated vaccination, two options exist depending on age and vaccine brand:
        1. For children who initiate vaccination with Menveo at 7 months through 23 months of age, a 2-dose series should be administered with the second dose after 12 months of age and at least 3 months after the first dose.
        2. For children who initiate vaccination with Menactra at 9 months through 23 months of age, a 2-dose series of Menactra should be administered at least 3 months apart.
        3. For children aged 24 months and older who have not received a complete series of MenHibrix, Menveo, or Menactra, administer 2 primary doses of either Menactra or Menveo at least 2 months apart.
    • For children who travel to or reside in countries in which meningococcal disease is hyperendemic or epidemic, including countries in the African meningitis belt or the Hajj, administer an age-appropriate formulation and series of Menactra or Menveo for protection against serogroups A and W meningococcal disease. Prior receipt of MenHibrix is not sufficient for children traveling to the meningitis belt or the Hajj because it does not contain serogroups A or W.
    • For children at risk during a community outbreak attributable to a vaccine serogroup, administer or complete an age- and formulation-appropriate series of MenHibrix, Menactra, or Menveo.
    • For booster doses among persons with high-risk conditions, refer to MMWR 2013; 62(RR02);1-22, available at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6202a1.htm External Web Site Policy.

    Catch-up recommendations for persons with high-risk conditions:

    1. If MenHibrix is administered to achieve protection against meningococcal disease, a complete age- appropriate series of MenHibrix should be administered.
    2. If the first dose of MenHibrix is given at or after 12 months of age, a total of 2 doses should be given at least 8 weeks apart to ensure protection against serogroups C and Y meningococcal disease.
    3. For children who initiate vaccination with Menveo at 7 months through 9 months of age, a 2-dose series should be administered with the second dose after 12 months of age and at least 3 months after the first dose.
    4. For other catch-up recommendations for these persons, refer to MMWR 2013; 62(RR02);1-22, available at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6202a1.htm. External Web Site Policy

    For complete information on use of meningococcal vaccines, including guidance related to vaccination of persons at increased risk of infection, see MMWR March 22, 2013; 62(RR02);1-22, available at http://www.cdc.gov/mmwr/pdf/rr/rr6202.pdf External Web Site Policy.

    Clinical Algorithm(s)

    None provided

    Evidence Supporting the Recommendations

    Type of Evidence Supporting the Recommendations

    The type of evidence supporting the recommendations is not specifically stated.

    Benefits/Harms of Implementing the Guideline Recommendations

    Potential Benefits
    • Age-appropriate administration of vaccines to children and adolescents
    • Decline in vaccine-preventable diseases among children and adolescents
    Potential Harms
    • Clinically significant adverse events that follow immunization should be reported to the Vaccine Adverse Event Reporting System (VAERS) at http://www.vaers.hhs.gov External Web Site Policy or by telephone, 800-822-7967.
    • For contraindications and precautions to use of a vaccine, vaccination providers should consult the relevant Advisory Committee on Immunization Practices (ACIP) statement available online at http://www.cdc.gov/vaccines/pubs/acip-list.htm External Web Site Policy.

    Contraindications

    Contraindications
    • Live, attenuated influenza vaccine (LAIV) should not be administered to some persons, including 1) children with asthma, 2) children 2 through 4 years who had wheezing in the past 12 months, or 3) those who have any other underlying medical conditions that predispose them to influenza complications.
    • Clinically significant adverse events that follow immunization should be reported to the Vaccine Adverse Event Reporting System (VAERS) at http://www.vaers.hhs.gov External Web Site Policy or by telephone, 800-822-7967.
    • For contraindications and precautions to use of a vaccine, vaccination providers should consult the relevant Advisory Committee on Immunization Practices (ACIP) statement available online at http://www.cdc.gov/vaccines/pubs/acip-list.htm External Web Site Policy.

    Qualifying Statements

    Qualifying Statements

    Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services.

    Implementation of the Guideline

    Description of Implementation Strategy

    An implementation strategy was not provided.

    Implementation Tools
    Chart Documentation/Checklists/Forms
    Foreign Language Translations
    Patient Resources
    Pocket Guide/Reference Cards
    Resources
    For information about availability, see the Availability of Companion Documents and Patient Resources fields below.

    Institute of Medicine (IOM) National Healthcare Quality Report Categories

    IOM Care Need
    Staying Healthy
    IOM Domain
    Effectiveness
    Patient-centeredness

    Identifying Information and Availability

    Bibliographic Source(s)
    Centers for Disease Control and Prevention (CDC). Advisory committee on immunization practices recommended immunization schedules for persons aged 0 through 18 years - United States, 2014. MMWR Morb Mortal Wkly Rep. 2014 Feb 7;63(5):108-9. PubMed External Web Site Policy
    Adaptation

    Not applicable: The guideline was not adapted from another source.

    Date Released
    2004 Apr 30 (revised 2014 Feb 7)
    Guideline Developer(s)
    Centers for Disease Control and Prevention - Federal Government Agency [U.S.]
    Source(s) of Funding

    United States Government

    Guideline Committee

    Advisory Committee on Immunization Practices (ACIP)

    ACIP Childhood/Adolescent Immunization Work Group

    Composition of Group That Authored the Guideline

    Author: Iyabode Akinsanya-Beysolow, MD, Atlanta, Georgia

    Advisory Committee on Immunization Practices (ACIP) Members: Jonathan Temte, MD, PhD (Chair), University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Larry Pickering, MD (Executive Secretary), National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia; Nancy Bennett, MD, University of Rochester School of Medicine and Dentistry, Rochester, New York; Joseph Bocchini, Jr., MD, Louisiana State University Health Sciences Center, Shreveport, Louisiana; Douglas Campos-Outcalt, MD, University of Arizona College of Medicine, Phoenix, Arizona; Tamera Coyne-Beasley, MD, University of North Carolina, Chapel Hill, North Carolina; Jeffrey Duchin, MD, University of Washington, Seattle, Washington; Kathleen Harriman, PhD, California Department of Public Health, Richmond, CA; Lee Harrison, MD, University of Pittsburgh, Pittsburgh, Pennsylvania; Renée Jenkins, MD, Howard University School of Medicine, District of Columbia; Ruth Karron, MD, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Allison Kempe, MD, MPH, University of Colorado School of Medicine, Denver, CO; Cynthia Pelligrini, Public Policy and Government Affairs, March of Dimes, Washington, DC; Arthur L. Reingold, M.D., University of California, Berkeley, CA; Lorry Rubin, MD, Steven and Alexandra Cohen Children's Medical Center of New York, North Shore-Long Island Jewish Health System, Hew Hyde Park, NY; Marietta Vásquez, MD, Yale University School of Medicine, New Haven, CT

    ACIP Childhood/Adolescent Immunization Work Group Members: Renée Jenkins, MD (Chair), District of Columbia (ACIP); Allison Kempe, MD, Aurora, Colorado (ACIP); Cynthia Pellegrini, Washington, DC (ACIP); H. Cody Meissner, MD, Boston, Massachusetts; Amy B. Middleman, Oklahoma City, Oklahoma; Susan Lett, MD, Boston, Massachusetts; Diane Peterson, Saint Paul, Minnesota; Chris Barry, MMSc, Raleigh, North Carolina; Everett Schlamm, MD, Verona, New Jersey; Katie Brewer, MSN, Silver Spring, Maryland; Patricia Stinchfield, MPH, Saint Paul, Minnesota; Rosemary Spence, MA, Denver, Colorado; William L. Atkinson, MD, Harrisonville, Missouri; Meredith Loveless, MD, Louisville, Kentucky

    Work Group Contributors (CDC): Andrew Kroger, MD, Atlanta, Georgia; Charles Wolfe, Atlanta, Georgia; Donna Weaver, MN, Atlanta, Georgia; JoEllen Wolicki, Atlanta, Georgia; Melissa Barnett, MS, Atlanta, Georgia; Jennifer Hamborsky, MPH, Atlanta, Georgia

    Financial Disclosures/Conflicts of Interest

    Given the substantial financial implications that Advisory Committee on Immunization Practices (ACIP) recommendations may have for the public and private sectors, as well as for vaccine manufacturers, candidates who are nominated for ACIP membership undergo careful screening for potential conflicts of interest before their names are submitted for final consideration. To ensure integrity of the ACIP, all nominees are reviewed by the ACIP Steering Committee. Stringent measures are taken to assure that there is not only technical compliance with ethics statutes and regulations regarding financial conflicts but also that more general concerns regarding potential for appearance of a conflict of interest are addressed or avoided altogether through both pre- and post-appointment considerations. People with specific vaccine-related interests at the time of application are not considered for appointment to the Committee. Examples of such interests include direct employment of the candidate or an immediate family member by a vaccine manufacturer or its parent company, serving on a board of a vaccine manufacturer, and holding a patent on a vaccine or related product. Potential ACIP members are asked before submission of their names for final selection to recuse themselves during the term of membership from activities that are, or could be construed as, conflicts of interest. These activities include provision of advisory or consulting services to a vaccine manufacturer or its parent company and acceptance of honoraria or travel reimbursement from a vaccine manufacturer. Once accepted for membership, ACIP members are required every year to file confidential financial reports with the Office of Government Ethics and to disclose publicly all vaccine-related interests and work, including participation in clinical trials, at each meeting. If, despite all these safeguards, a conflict exists, limited waivers allow members to participate in committee discussions with the condition that they are prohibited from voting on matters involving the specific or competing vaccine manufacturers. A member who develops an important conflict of interest during the 4-year term will be required to resign from the ACIP.

    Screening for conflicts of interest is rigorous and balances the possibility of bias caused by a conflict with the need for vaccine and immunization expertise, including cross-cutting knowledge and experience in the various components of the immunization field. Some data important to the committee can be obtained only through working relationships with vaccine manufacturers. Representatives of vaccine manufacturers may present data on vaccine immunogenicity, effectiveness, and safety to ACIP work groups and at meetings of the full ACIP, but they are not permitted to serve as members of work groups, or have any input into ACIP deliberations.

    Source: Smith JC, Snider DE, Pickering LK; Advisory Committee on Immunization Practices. Immunization policy development in the United States: the role of the Advisory Committee on Immunization Practices. Ann Intern Med. 2009 Jan 6;150(1):45-9.

    Guideline Status

    This is the current release of the guideline.

    This guideline updates a previous version: Centers for Disease Control and Prevention. Advisory Committee on Immunization Practices (ACIP) recommended immunization schedule for persons aged 0 through 18 years -- United States, 2013. MMWR Morb Mortal Wkly Rep. 2013 Feb 1;62(Suppl 1):2-8.

    Guideline Availability

    Electronic copies: Available from the Centers for Disease Control and Prevention (CDC) Web site External Web Site Policy.

    Print copies: Available from the Centers for Disease Control and Prevention, MMWR, Atlanta, GA 30333. Additional copies can be purchased from the Superintendent of Documents, U.S. Government Printing Office, Washington, DC 20402-9325; (202) 783-3238.

    Availability of Companion Documents

    The following are available:

    • CDC. New framework (GRADE) for development of evidence-based recommendations by the Advisory Committee on Immunization Practices. MMWR. 2012;61(18):327-327. Electronic copies: Available from the Centers for Disease Control and Prevention (CDC) Web site External Web Site Policy.
    • Ahmed F, Temte JL, Campos-Outcalt D, Schünemann HJ; ACIP Evidence Based Recommendations Work Group (EBRWG). Methods for developing evidence-based recommendations by the Advisory Committee on Immunization Practices (ACIP) of the U.S. Centers for Disease Control and Prevention (CDC). Vaccine. 2011 Nov 15;29(49):9171-6. Epub 2011 Aug 11. Electronic copies: Available to subscribers at the Vaccine Web site External Web Site Policy.
    • Smith JC, Snider DE, Pickering LK; Advisory Committee on Immunization Practices. Immunization policy development in the United States: the role of the Advisory Committee on Immunization Practices. Ann Intern Med. 2009 Jan 6;150(1):45-9. Electronic copies: Available from the Annals of Internal Medicine Web site External Web Site Policy.

    The following are also available:

    • 2014 child & adolescent immunization schedules (birth-18 years and "catch-up" schedule). Electronic copies: Available in Portable Document Format (PDF) in English and Spanish, as well as a variety of formats including pocket-size, from the CDC Web site External Web Site Policy.
    • Advisory Committee on Immunization Practices (ACIP) recommendation statements for specific vaccines are available in PDF from the CDC Web site External Web Site Policy.

    A variety of resources for healthcare providers, including vaccine record forms; information on vaccine storage, handling, and administration; and immunization education and training are available from the CDC Web site External Web Site Policy. Flyers and brochures for practice/patients are also available from the CDC Web site External Web Site Policy.

    Patient Resources

    The following are available:

    • Parents' guide to childhood immunizations. Centers for Disease Control and Prevention (CDC); 2012 Mar. 64 p. Electronic copies: Available in Portable Document Format (PDF) from the Centers for Disease Control and Prevention (CDC) Web site External Web Site Policy.
    • Vaccine Information Statements (VISs) for individual vaccines are available in PDF in a variety of languages from the CDC Web site External Web Site Policy.

    Various tools for parents, adolescents, and teens, including parent-friendly immunization schedule formats in English and Spanish and a personalized immunization schedule tool and catch-up scheduler are available from the CDC Web site External Web Site Policy. Flyers and brochures are also available from the CDC Web site External Web Site Policy.

    Additional resources and information for parents are provided at the For Parents: Vaccines for Your Children External Web Site Policy page of the CDC Web site.

    Please note: This patient information is intended to provide health professionals with information to share with their patients to help them better understand their health and their diagnosed disorders. By providing access to this patient information, it is not the intention of NGC to provide specific medical advice for particular patients. Rather we urge patients and their representatives to review this material and then to consult with a licensed health professional for evaluation of treatment options suitable for them as well as for diagnosis and answers to their personal medical questions. This patient information has been derived and prepared from a guideline for health care professionals included on NGC by the authors or publishers of that original guideline. The patient information is not reviewed by NGC to establish whether or not it accurately reflects the original guideline's content.

    NGC Status

    This NGC summary was completed by ECRI on February 25, 2004. This summary was updated by ECRI on October 20, 2004 after the Centers for Disease Control and Prevention (CDC) issued interim recommendations in response to the shortage of influenza vaccine. This summary was updated again by ECRI on January 27, 2005, and on January 19, 2006. This summary was updated by ECRI on October 25, 2006 following the updated FDA advisory on Menactra (Meningococcal Conjugate Vaccine). This summary was updated again by ECRI on January 26, 2007. This summary was updated by ECRI on February 19, 2007 following the FDA advisory on Rotavirus, Live, Oral, Pentavalent vaccine (RotaTeq). This summary was updated by ECRI Institute on July 9, 2007 following the FDA advisory on RotaTeq (Rotavirus, Live, Oral, Pentavalent) vaccine. This NGC summary was updated by ECRI Institute on April 13, 2009. This summary was updated by ECRI Institute on April 1, 2010 following the U.S. Food and Drug Administration advisory on Rotarix Vaccine. This summary was revised by ECRI Institute on June 3, 2010 following the updated U.S. Food and Drug Administration advisory on Rotarix Vaccine. This summary was updated by ECRI Institute on October 5, 2010. This summary was updated by ECRI Institute on November 12, 2010 following the U.S. Food and Drug Administration (FDA) advisory on Afluria (influenza virus vaccine). This summary was updated by ECRI Institute on March 29, 2011. This NGC summary was updated by ECRI Institute on July 6, 2012. This NGC summary was updated by ECRI Institute on March 7, 2013. This NGC summary was updated by ECRI Institute on March 25, 2014.

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