Vaccine Recommendations for Infants and Children

For all children, decisions regarding vaccinations should be made in cooperation with a health-care provider who will review the traveller's medical history and itinerary. Each traveller should be up to date with their routine childhood vaccinations because many of the diseases prevented by these vaccines are rare or nonexistent in the United States but are still common in other parts of the world. The recommended childhood and adolescent immunisation schedule is depicted in Table 8-2. Table 8-3 depicts the catch-up schedule for children and adolescents who start their vaccination schedule late or who are >1 month behind. This table also describes the recommended minimal intervals between doses for children who need to be vaccinated on an accelerated schedule, which is sometimes required for international travel. Proof of yellow fever vaccination is required for entry into certain countries (see Yellow Fever Vaccine Requirements and Information on Malaria Risk and Prophylaxis, by Country). Recommendations for other vaccines and immunobiologics depend on the traveller's medical history and itinerary and do not alter the schedule for recommended childhood immunisations.

Modifying the Immunisation Schedule for Inadequately Immunised Infants and Younger Children before International Travel

Factors influencing recommendations for the age at which a vaccine is administered include the age-specific risks of the disease and its complications, the ability of people of a given age to respond to the vaccine, and the potential interference with the immune response by passively transferred maternal antibody. Vaccines are recommended for the youngest age group at risk for developing the disease whose members are known to develop an adequate antibody response to vaccination.

The routine immunisation recommendations and schedules for infants and children in the United States do not provide specific guidelines for infants and young children who will travel internationally before the age when specific vaccines and toxoids are routinely recommended. When deciding when to travel with a young infant or child, parents should be advised that the earliest opportunity to receive routine immunisations recommended in the United States (except for the dose of hepatitis B vaccine administered at birth) is at 6 weeks if an accelerated schedule is followed. Parents should also be aware of the youngest age at which vaccinations can be administered for diseases endemic at their destination. The following section provides additional guidance for active and passive immunisation of such infants and children. Additional information about all the diseases and vaccines mentioned below can be found in Chapter 4 (Prevention of Specific Infectious Diseases).

Routine Infant and Childhood Vaccinations

Hepatitis B Vaccine

Hepatitis B virus is a cause of acute and chronic hepatitis, cirrhosis, and hepatocellular carcinoma. There are 200 to 300 million chronic carriers worldwide. Infants and children who have not previously been vaccinated and who are travelling to areas with intermediate and high hepatitis B virus (HBV) endemicity are at risk if they are directly exposed to blood from the local population. Circumstances in which HBV transmission could occur in children include receipt of blood transfusions not screened for HBV surface antigen (HBsAg), exposure to unsterilized medical or dental equipment, or continuous close contact with local residents who have open skin lesions (impetigo, scabies, or scratched insect bites).

Hepatitis B vaccine is recommended for all infants, with the first dose administered soon after birth and before hospital discharge. Infants and children who will travel should receive the three doses of HBV vaccine before travelling. The interval between doses one and two should be 1-2 months. Between doses two and three, the interval should be a minimum of 2 months; the interval between doses one and three should be at least 4 months. The third dose should not be given before the infant is 6 months of age. Adolescents not previously vaccinated with hepatitis B vaccine should be vaccinated at 11-12 years of age. For adolescents, the usual schedule is two doses separated by at least 4 weeks, followed by a third dose 4-6 months after the second dose.

Diphtheria and Tetanus Toxoid and Pertussis Vaccine

Diphtheria, tetanus, and pertussis each occur worldwide and are endemic in countries with low immunisation levels. Infants and children leaving the United States should be immunised before travelling. Optimum protection against diphtheria, tetanus, and pertussis in the first year of life is achieved with at least three but preferably four doses of diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP), the first administered when the infant is 6-8 weeks of age and the next two at 4- to 8-week intervals. A fourth dose of DTaP should be administered 6-12 months after the third dose when the infant is 15-18 months of age. A fifth (booster) dose is recommended when the child is 4-6 years of age. The fifth dose is not necessary if the fourth dose in the primary series was given after the child's fourth birthday.

Two doses of DTaP received at intervals at least 4 weeks apart can provide some protection; however, a single dose offers little protective benefit. Parents should be informed that infants and children who have not received at least three doses of DTaP might not be fully protected against pertussis. For infants and children <7 years of age, if an accelerated schedule is required to complete the series before travel, the schedule may be started as soon as the infant is 6 weeks of age, with the second and third doses given 4 weeks after each preceding dose. The fourth dose should not be given before the infant is 12 months of age and should be separated from the third dose by at least 6 months. The fifth (booster) dose should not be given before the child is 4 years of age.

Haemophilus influenzae Type b Conjugate Vaccine

Haemophilus influenzae type b (Hib) is an endemic disease worldwide that can cause fatal cases of meningitis, epiglottitis, and other invasive diseases. Infants and children should have optimal protection before travelling. Routine Hib vaccination beginning at 2 months of age is recommended for all U.S. children. The first dose may be given when an infant is as young as 6 weeks of age. Hib vaccine should never be given to an infant <6 weeks of age. A primary series consists of two or three doses (depending on the type of vaccine used) separated by 4-8 weeks. A booster dose is recommended when the infant is 12-15 months of age.

If Hib vaccination is started when the infant or child is 7 months of age, fewer doses may be required. If different brands of vaccine are administered, a total of three doses of Hib conjugate vaccine completes the primary series. After completion of the primary infant vaccination series, any of the licensed Hib conjugate vaccines may be used for the booster dose when the infant is 12-15 months of age.

If previously unvaccinated, infants <15 months of age should receive at least two vaccine doses before travel. An interval as short as 4 weeks between these two doses is acceptable. Unvaccinated infants and children 15-59 months of age should receive a single dose of Hib vaccine. Children >59 months of age do not need to be vaccinated unless a specific condition exists such as functional or anatomic asplenia, immunodeficiency, immunosuppression, or HIV infection.

Polio Vaccine

While polio has been eradicated in the United States, poliovirus continues to circulate in parts of Africa and Asia. In the United States, all infants and children should receive four doses of inactivated poliovirus vaccine (IPV) at 2, 4, and 6-18 months and 4-6 years of age. If accelerated protection is needed, the minimum interval between doses is 4 weeks, although the preferred interval between the second and third doses is 2 months. Infants and children who had initiated the poliovirus vaccination series with one or more doses of oral poliovirus vaccine (OPV) should receive IPV to complete the series.

Measles, Mumps, and Rubella Vaccine

Measles is an endemic disease in countries where measles immunisation levels are low, and the risk for contracting measles in many countries is greater than in the United States. Infants and children should be as well protected as possible against measles and should complete the immunisation series before travelling. While the risk for serious disease in infants from either mumps or rubella is low, these diseases do circulate in many parts of the world and vaccination is recommended.

In addition to the measles, mumps, and rubella vaccine (MMR), monovalent measles, monovalent mumps, monovalent rubella, and combinations of the components are available. However, the Advisory Committee on Immunisation Practices (ACIP) recommends that MMR be administered when any of the individual components is indicated.

According to the recommended childhood immunisation schedule (Table 8-2), a child should receive MMR at age 12 months and again at age 4-6 years. For children who are 12 months of age, the second dose of MMR may be given 28 days after the first dose.

Infants 6-11 months of age should receive a dose of MMR before departure. However, MMR given before age 12 months should not be counted as part of the series. Children who receive MMR before age 12 months will need two more doses of MMR, the first of which should be administered at age 12 months.

If MMR is unavailable, monovalent vaccines may be used. However, a child receiving monovalent vaccines will still need two doses of MMR beginning at age 12 months.

Varicella Vaccine

Varicella (chickenpox) is an endemic disease throughout the world. The varicella vaccine is recommended for all children 12 months of age.

A single dose of varicella vaccine is also recommended for all susceptible children by their 13th birthday. Efforts should be made to ensure varicella immunity by this age, because varicella disease can be more severe among older children and adults. Children >13 years of age need to receive two doses of varicella vaccine at least 4 weeks apart to optimise protection.

Vaccination is not necessary for children with a reliable history of chickenpox. When a prior history of chickenpox is unclear, the vaccine may be given.

Pneumococcal Vaccine

Streptococcus pneumoniae causes substantial morbidity and mortality throughout the world each year. The vaccine is available in two forms: the pneumococcal conjugate vaccine (PCV7) and the pneumococcal polysaccharide vaccine (PPV23).

All infants should be vaccinated with PCV7. Infant vaccination provides the earliest protection and infants <23 months of age have the highest incidence of pneumococcal disease. The primary series for PCV7 includes three doses given at 2, 4, and 6 months of age with a fourth (booster) dose at 12-15 months of age (see Table 4-13). Children 24 months of age at high risk for the development of pneumococcal disease (with sickle cell disease, asplenia, HIV, chronic illness, or immunocompromising conditions) should receive a dose of PPV23 at least 2 months following their last dose of PCV7. If the child is 10 years of age, one revaccination with PPV23 should be considered 3-5 years after the first dose of PPV 23.

Unvaccinated children 7-11 months of age should receive two doses at least 4 weeks apart and a booster dose at age 12-15 months. Unvaccinated children 12-23 months of age should receive two doses at least 8 weeks apart. Previously unvaccinated healthy children 24-59 months of age should receive a single dose of PCV7. However, previously unvaccinated children 24-59 months of age at high risk for pneumococcal disease should receive two doses separated by at least 8 weeks. Children 24-59 months of age who are at increased risk for pneumococcal disease (as previously described) and who were previously vaccinated with PPV23 should receive two doses of PCV7 separated by at least 8 weeks. The PCV7 vaccine is not routinely recommended for children >59 months (5 years) of age.

Influenza Vaccine

Influenza vaccine can be used to reduce risk of influenza infection in transmission season (November-February in the Northern Hemisphere, April-September in the Southern Hemisphere, and throughout the year in the tropics). The vaccine is prepared in two forms: an intramuscular trivalent inactivated vaccine (TIV) and a live, attenuated, intranasal vaccine (LAIV).

All children 6-23 months of age should receive TIV annually. In addition, all children with risk factors for influenza (including but not limited to asthma, cardiac disease, sickle cell disease, HIV, and diabetes) should also receive TIV annually. In addition, all children who have close contact with healthy children <24 months of age or with persons at high risk should be vaccinated annually. For healthy children 5 years of age, LAIV is an acceptable alternative to TIV. (LAIV can be given to healthy persons 5-49 years of age).

Children receiving TIV should be administered an age-appropriate dose (0.25 mL for those 6-35 months of age and 0.5 mL for those 36 months of age). Children 8 years of age who are receiving influenza vaccine for the first time should receive two doses (separated by at least 4 weeks for TIV and at least 6 weeks for LAIV). Children 9 years of age should receive one injection of the 0.5-mL dose.

Hepatitis A Vaccine or Immune Globulin for Hepatitis A

Hepatitis A virus (HAV) is endemic in most parts of the world, and infants and children travelling to these areas are at increased risk for acquiring HAV infection. Although HAV is often not severe in infants and children <5 years of age, those infected efficiently transmit infection to other infants and children and to adults.

Children 2 years of age who will be travelling to areas where there is a high risk of HAV infection should be immunised. The HAV vaccine series consists of two doses at least 6 months apart. The first dose should be administered 4 weeks before travel to allow time for an adequate immune response to develop. The second dose is necessary for long-term protection.

The vaccine is not approved for children <2 years of age. Children <2 years of age and children who will be travelling less than 4 weeks after receipt of the first dose should be administered immune globulin (IG) (See Chapter 4, Hepatitis A section). The vaccine and IG can be administered at the same time at different anatomic sites.

IG interferes with the response to live injected vaccines (e.g., measles, mumps, rubella, and varicella vaccines). Administration of live vaccines should be delayed for at least 3 months after administration of IG. Moreover, IG should not be administered for 2 weeks after measles-, mumps-, and rubella-containing vaccines and for 3 weeks after vaccination with varicella vaccine. If IG is given during this time, the child should be revaccinated with the live vaccine at least 3 months after administration of IG. When travel plans do not allow adequate time for administration of live vaccines and IG before travel, the severity of the diseases and epidemiology of the diseases at destination points will help determine the most appropriate course of preparation.

Other Vaccines and Immune Globulin

Yellow Fever Vaccine

Yellow fever, a disease transmitted by mosquitoes, is endemic in certain areas of Africa and South America (Maps 4-12 and 4-13). Proof of yellow fever vaccination is required for entry into some countries (see Yellow Fever Vaccine Requirements and Information on Malaria Risk and Prophylaxis, by Country).

Infants are at high risk for developing encephalitis from yellow fever vaccine, a live virus vaccine. Vaccination of infants should be considered on an individual basis. Although the incidence of these adverse events has not been clearly defined, 14 of 18 reported cases of post-vaccination encephalitis were in infants <4 months old. One fatal case confirmed by viral isolation was in a 3-year-old child.

Travellers with infants <9 months of age should be strongly advised against travelling to areas within the yellow fever-endemic zone. The ACIP recommends that yellow fever vaccine never be given to infants <6 months of age. Infants 6-8 months of age should be vaccinated only if they must travel to areas of ongoing epidemic yellow fever and a high level of protection against mosquito bites is not possible. Infants and children >9 months of age can be vaccinated if they travel to countries within the yellow fever-endemic zone. Physicians considering vaccinating infants <9 months of age should contact the Division of Vector-Borne Infectious Diseases (970-221-6400) or the Division of Global Migration and Quarantine (404-498-1600) at CDC for advice.

Typhoid Vaccine

Typhoid fever is an acute, life-threatening febrile illness caused by the bacterium Salmonella enterica Typhi.

Two typhoid vaccines are available: a Vi capsular polysaccharide vaccine (ViCPS) administered intramuscularly and an oral, live, attenuated vaccine (Ty21a). Both vaccines induce a protective response in 50%-80% of recipients. The ViCPS vaccine can be administered to children 2 years of age, with a booster dose 2 years later if continued protection is needed. The Ty21a vaccine, which consists of a series of four capsules ingested every other day, can be administered to children 6 years of age. All the capsules should be taken at least 1 week before potential exposure. A booster series for Ty21a can be taken every 5 years.

Because neither vaccine is fully protective, preventing contamination of food and beverages remains extremely important.

Meningococcal Vaccine

Meningitis primarily affects children and adolescents, with high morbidity and mortality rates. Epidemics are recurrent in sub-Saharan Africa during the dry season (December through June), and CDC recommends travellers be vaccinated before travelling to this region during the dry season. Meningococcal vaccination is a requirement to enter Saudi Arabia when travelling to Mecca during the annual Hajj.

One meningococcal vaccine is licensed for use in the United States: the quadrivalent A, C, Y, and W-135 vaccine. The serogroup A polysaccharide in this vaccine induces an antibody response in some children as young as 3 months. Thus, vaccinating infants travelling to high-risk areas can provide some degree of protection. For children vaccinated at <4 years of age, revaccination in 2-3 years should be considered if they remain at high risk for infection. For children vaccinated at 4 years of age, revaccination should be considered in 3-5 years if they remain at high risk.

Japanese Encephalitis Vaccine

Primarily night-biting mosquitoes in rural areas of Asia and the Pacific Rim transmit Japanese encephalitis (JE). In temperate climates, their numbers are greatest from June through September; they are inactive during the winter. Most reported cases occur in children. Although most infections are asymptomatic, the mortality rate can be as high as 30%, and neurologic sequelae are reported in 50% of survivors. Serious neurologic sequelae occur more frequently in the very young. The risk to short-term travellers and those who confine their travel to urban centers is very low. Expatriates and travellers living for prolonged periods in rural areas where JE is endemic or epidemic are at greatest risk. Travellers with extensive unprotected outdoor, evening, and nighttime exposure in rural areas, such as might be experienced while bicycling, camping, or engaging in certain occupational activities, might be at high risk even if their trip is brief. The decision to vaccinate a child should take into consideration the itinerary, expected activities, and level of JE activity in the country.

JE vaccine is administered as a series of three injections on days 0, 7, and 30. A booster dose is administered at least 24 months later. Children 1-2 years of age receive 0.5 mL of vaccine per dose; those 3 years of age receive 1.0 mL of vaccine per dose. No data are available on vaccine efficacy for infants <1 year of age.

JE vaccine is associated with local reactions and mild systemic side effects (fever, headache, myalgias, and malaise). Serious allergic reactions, including anaphylaxis, have occurred up to 1 week after immunisation. Children receiving the vaccine series should be observed for 30 minutes after immunisation. Moreover, the series should be completed at least 10 days before departure, and during that time, vaccine recipients should be remain in areas with access to medical care.

Rabies Vaccine

Rabies is an acute, fatal encephalomyelitis usually transmitted by the bite of an infected mammal. Rabies occurs throughout the world and is endemic in most countries. As with other vaccines, the decision to vaccinate will depend on the itinerary and expected activities during international travel. Children should always be instructed to avoid contact with unfamiliar animals because those animals could be infected with rabies.

Three rabies vaccines are licensed for use in the United States. Each may be administered to infants and children. All the rabies vaccines, when used in a preexposure regimen, are given as a series of injections on days 0, 7, and 21 or 28 days. Even if a child has completed the pre-exposure prophylaxis, any mammal bite warrants immediate medical evaluation to determine the need for postexposure immunisation.

Bibliography

Centers for Disease Control and Prevention. Preventing pneumococcal disease among infants and young children: recommendations of the Advisory Committee on Immunisation Practices (ACIP). MMWR Morbid Mortal Wkly Rep 2000;49 (No. RR-9):1-35.
Centers for Disease Control and Prevention. Prevention and control of meningococcal disease and Meningococcal disease and college students: recommendations of the Advisory Committee on Immunisation Practices (ACIP). MMWR Morbid Mortal Wkly Rep 2000;49 (No. RR-7):1-22.
Centers for Disease Control and Prevention. Prevention and control of influenza: recommendations of the Advisory Committee on Immunisation Practices (ACIP). MMWR Morbid Mortal Wkly Rep 2004;53 (No. RR-6):1-40.
Epidemiology and prevention of vaccine-preventable diseases. Seventh edition. Eds. William Atkinson, Charles Wolfe. Washington: Public Health Foundation; 2003.
Mackell SM. Vaccinations for the paediatric traveller. Clin Infect Dis 2003; 37:1508-16.

Table 8-2. Recommended childhood and adolescent immunisation schedule — United States, 2006.

Click on the image below to enlarge
Table 8-2. Recommended childhood and adolescent immunisation schedule — United States, 2006.

1 Hepatitis B (HepB) vaccine. AT BIRTH: All newborns should receive monovalent HepB soon after birth and before hospital discharge. Infants born to mothers who are HBsAg-positive should receive HepB and 0.5 mL of hepatitis B immune globulin (HBIG) within 12 hours of birth. Infants born to mothers whose HBsAg status is unknown should receive HepB within 12 hours of birth. The mother should have blood drawn as soon as possible to determine her HBsAg status; if HBsAg-positive, the infant should receive HBIG as soon as possible (no later than age 1 week). For infants born to HBsAg-negative mothers, the birth dose can be delayed in rare circumstances but only if a physician’s order to withhold the vaccine and a copy of the mother’s original HBsAg-negative laboratory report are documented in the infant’s medical record. FOLLOWING THE BIRTHDOSE: The HepB series should be completed with either monovalent HepB or a combination vaccine containing HepB. The second dose should be administered at age 1–2 months. The final dose should be administered at age ≥24 weeks. It is permissible to administer 4 doses of HepB (e.g., when combination vaccines are given after the birth dose); however, if monovalent HepB is used, a dose at age 4 months is not needed. Infants born to HBsAg-positive mothers should be tested for HBsAg and antibody to HBsAg after completion of the HepB series, at age 9–18 months (generally at the next well-child visit after completion of the vaccine series).

2 Diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine. The fourth dose of DTaP may be administered as early as age 12 months, provided 6 months have elapsed since the third dose and the child is unlikely to return at age 15-18 months. The final dose in the series should be given at age ≥4 years. Tetanus and diphtheria toxoids and acellular pertussis vaccine (Tdap – adolescent preparation) is recommended at age 11–12 years for those who have completed the recommended childhood DTP/DTaP vaccination series and have not received a Td booster dose. Adolescents 13–18 years who missed the 11–12-year Td/Tdap booster dose should also receive a single dose of Tdap if they have completed the recommended childhood DTP/DTaP vaccination series. Subsequent tetanus and diphtheria toxoids (Td) are recommended every 10 years.

3 Haemophilus influenzae type b (Hib) conjugate vaccine. Three Hib conjugate vaccines are licensed for infant use. If PRP-OMP (PedvaxHIB® or ComVax® [Merck]) is administered at ages 2 and 4 months, a dose at age 6 months is not required. DTaP/Hib combination products should not be used for primary immunisation in infants at ages 2, 4 or 6 months but can be used as boosters following any Hib vaccine. The final dose in the series should be administered at age 12 months.

4 Measles, mumps, and rubella vaccine (MMR). The second dose of MMR is recommended routinely at age 4-6 years but may be administered during any visit, provided at least 4 weeks have elapsed since the first dose and both doses are administered beginning at or after age 12 months. Those who have not previously received the second dose should complete the schedule by age 11-12 years.

5 Varicella vaccine. Varicella vaccine is recommended at any visit at or after age 12 months for susceptible children (i.e., those who lack a reliable history of chickenpox). Susceptible persons aged 13 years should receive 2 doses administered at least 4 weeks apart.

6 Meningococcal vaccine (MCV4). Meningococcal conjugate vaccine (MCV4) should be given to all children at the 11–12 year old visit as well as to unvaccinated adolescents at high school entry (15 years of age). Other adolescents who wish to decrease their risk for meningococcal disease may also be vaccinated. All college freshmen living in dormitories should also be vaccinated, preferably with MCV4, although meningococcal polysaccharide vaccine (MPSV4) is an acceptable alternative. Vaccination against invasive meningococcal disease is recommended for children and adolescents aged ≥2 years with terminal complement deficiencies or anatomic or functional asplenia and certain other high risk groups (see MMWR 2005;54 [RR-7]:1-21); use MPSV4 for children aged 2–10 years and MCV4 for older children, although MPSV4 is an acceptable alternative.

7 Pneumococcal vaccine. The heptavalent pneumococcal conjugate vaccine (PCV) is recommended for all children aged 2-23 months and for certain children aged 24-59 months. The final dose in the series should be given at age 12 months. Pneumococcal polysaccharide vaccine (PPV) is recommended in addition to PCV for certain high-risk groups. See MMWR 2000;49(RR-9):1-35.

8 Influenza vaccine. Influenza vaccine is recommended annually for children aged 6 months with certain risk factors (including, but not limited to, asthma, cardiac disease, sickle cell disease, human immunodeficiency virus [HIV], diabetes, and conditions that can compromise respiratory function or handling of respiratory secretions or that can increase the risk for aspiration), healthcare workers, and other persons (including household members) in close contact with persons in groups at high risk (see MMWR 2005;54[RR-8]:1-55). In addition, healthy children aged 6-23 months and close contacts of healthy children aged 0-5 months are recommended to receive influenza vaccine, because children in this age group are at substantially increased risk for influenza-related hospitalizations. For healthy persons aged 5-49 years, the intranasally administered live, attenuated influenza vaccine (LAIV) is an acceptable alternative to the intramuscular trivalent inactivated influenza vaccine (TIV). See MMWR 2005;54(RR-8):1-55. Children receiving TIV should be administered a dosage appropriate for their age (0.25mL if 6-35 months or 0.5mL if 3 years). Children aged 8 years who are receiving influenza vaccine for the first time should receive 2 doses (separated by at least 4 weeks for TIV and at least 6 weeks for LAIV).

9 Hepatitis A vaccine (HepA). HepA is recommended for all children at 1 year of age (i.e.,12–23 months). The 2 doses in the series should be administered at least 6 months apart. States, counties, and communities with existing HepA vaccination programs for children 2–18 years of age are encouraged to maintain these programs. In these areas, new efforts focused on routine vaccination of 1-year-old children should enhance, not replace, ongoing programs directed at a broader population of children. HepA is also recommended for certain high risk groups (see MMWR 1999; 48[RR-12]1-37).

Table 8-3. Recommended childhood immunisation schedule — United States, 2006. For children and adolescents who start late or who are >1 month behind

The tables below give catch-up schedules and minimum intervals between doses for children who have delayed immunisations. There is no need to restart a vaccine series regardless of the time that has elapsed between doses. Use the chart appropriate for the child’s age.

Catch-up schedule for children aged 4 months through 6 years:

Vaccine	Minimum Age for Dose 1	Minimum Interval Between Doses
Vaccine	Minimum Age for Dose 1	Dose 1 to Dose 2	Dose 2 to Dose 3	Dose 3 to Dose 4	Dose 4 to Dose 5
Diphtheria, Tetanus, Pertussis	6 weeks	4 weeks	4 weeks	6 months	6 months1
Inactivated Poliovirus	6 weeks	4 weeks	4 weeks	4 weeks2
Hepatitis B3	Birth	4 weeks	8 weeks (and 16 weeks after first dose)
Measles, Mumps, Rubella	12 months	4 weeks4
Varicella	12 months
Haemophilus influenzae tybe b5	6 weeks	4 weeks if first dose given at age <12 months 8 weeks (as final dose) if first dose given at age 12-14 months No further doses needed if first dose given at age 15 months	4 weeks6 if current age <12 months 8 weeks (as final dose)6 if current age 12 months and second dose given at age <15 months No further doses needed if previous dose given at age 15 months	8 weeks (as final dose) This dose only necessary for children aged 12 months-5 years who received 3 doses before age 12 months
Pneumococcal7	6 weeks	4 weeks if first dose given at age <12 months and current age <24 months 8 weeks (as final dose) if first dose given at age 12 months or current age 24-59 months No further doses needed for healthy children if first dose given at age 24 months	4 weeks if current age <12 months 8 weeks (as final dose) if current age 12 months No further doses needed for healthy children if previous dose given at age 24 months	8 weeks (as final dose) This dose only necessary for children aged 12 months-5 years who received 3 doses before age 12 months

Catch-up schedule for children aged 7 years through 18 years:

Vaccine	Minimum Interval Between Doses
Vaccine	Dose 1 to Dose 2	Dose 2 to Dose 3	Dose 3 to Booster Dose
Tetanus, Diphtheria	4 weeks	6 months	6 months8 if first dose given at age <12 months and current age <11 years; otherwise 5 years
Inactivated Poliovirus9	4 weeks	4 weeks	IPV2,9
Hepatitis B	4 weeks	8 weeks (and 16 weeks after first dose)
Measles, Mumps, Rubella	4 weeks
Varicella9	4 weeks

1 DTaP. The fifth dose is not necessary if the fourth dose was given after the fourth birthday.

2 IPV. For children who received an all-IPV or all-oral poliovirus (OPV) series, a fourth dose is not necessary if third dose was administered at age 4 years. If both OPV and IPV were given as part of a series, a total of 4 doses should be given, regardless of the child's current age.

3 HepB. Administer the 3-dose series to all children and adolescents <19 years of age if they were not previously vaccinated.

4 MMR. The second dose of MMR is recommended routinely at age 4-6 years but may be administered earlier if desired.

5 Hib. Vaccine is not generally recommended for children aged 5 years.

6 Hib. If current age <12 months and the first 2 doses were PRP-OMP (PedvaxHIB® or ComVax® [Merck]), the third (and final) dose should be administered at age 12-15 months and at least 8 weeks after the second dose.

7 PCV. Vaccine is not generally recommended for children aged 5 years.

8 Td. Adolescent tetanus, diphtheria, and pertussis vaccine (Tdap) may be substituted for any dose in a primary catch-up series or as a booster if age appropriate for Tdap. A fiveyear interval from the last Td dose is encouraged when Tdap is used as a booster dose. See ACIP recommendations for further information.

9 IPV. Vaccine is not generally recommended for persons aged 18 years.

10 Varicella. Administer the 2-dose series to all susceptible adolescents aged 13 years.

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