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The recommended immunization schedules for persons aged 0--18 years and the catch-up immunization schedule for 2008 have been approved by the Advisory Committee on Immunization Practices, the American Academy of Pediatrics, and the American Academy of Family Physicians.
Changes listed here are outlined in MMWR with figures, etc.
- The pneumococcal conjugate vaccine (PCV or Prevnar) footnote reflects updated recommendations for incompletely vaccinated children aged 24–59 months, including those with underlying medical conditions.
- Recommendations for use of the live attenuated influenza vaccine (Flumist) now include healthy children as young as 2 years. LAIV should not be administered to children younger than 5 years with recurrent wheezing. Children aged under 9 years who are receiving influenza vaccine for the first time or who were vaccinated for the first time last season, but only received 1 dose, should have 2 doses of vaccine, at least 4 weeks apart. Other updates are included.
- For meningococcal vaccines, changes affect certain children aged 2–10 years. Vaccinating with meningococcal conjugate vaccine (MCV4 or Menactra) is preferred to meningococcal polysaccharide vaccine (MPSV4) for children at increased risk for meningococcal disease, including children who are traveling to or residents of countries in which the disease is hyperendemic or epidemic, children who have terminal complement component deficiencies, and children who have anatomic or functional asplenia. The catch-up schedule for youths aged 13–18 years has been
updated. MPSV4 is an acceptable alternative for short-term (i.e., 3–5 years) protection against meningococcal disease for persons aged 2–18 years.
- The tetanus and diphtheria toxoids/tetanus and diphtheria toxoids and acellular pertussis vaccine (Td/Tdap) catch-up schedule for persons aged 7–18 years who received their first dose before age 12 months now indicates that these youths should receive 4 doses, with at least 4 weeks (not 8 weeks) between doses 2 and 3.
- The catch-up bars for hepatitis B and Haemophilus influenzae type b conjugate vaccine have been deleted on the routine schedule for persons aged 0–6 years. The figure title refers users to the catch-up schedule (Table) for patients who fall behind or start late with vaccinations.
This schedule indicates the recommended ages for routine administration of currently licensed childhood vaccines, as of January 1, 2008, for children through age 18 years. Any dose not given at the recommended age should be given at any subsequent visit when indicated and feasible. Indicates age groups that warrant special effort to administer those vaccines not previously given. Additional vaccines may be licensed and recommended during the year. Licensed combination vaccines may be used whenever any components of the combination are indicated and the vaccine's other components are not contraindicated. Providers should consult the manufacturers' package inserts for detailed recommendations. Clinically significant adverse events that follow immunization should be reported to the Vaccine Adverse Event Reporting System (VAERS). Guidance about how to obtain and complete a VAERS form can be found on the Internet: http://www.vaers.org/ or by calling 1-800-822-7967.
1. Hepatitis B (HepB) vaccine. (Minimum age: birth) At birth: Administer monovalent HepB to all newborns prior to hospital discharge. If mother is hepatitis B surface antigen (HBsAg) positive, administer HepB and 0.5 mL of hepatitis B immune globulin (HBIG) within 12 hours of birth. If mother's HBsAg status is unknown, administer HepB within 12 hours of birth. Determine the HBsAg status as soon as possible and if HBsAg positive, administer HBIG (no later than age 1 week). If mother is HBsAg negative, the birth dose can be delayed, in rare cases, with a provider's order and a copy of the mother's negative HBsAg laboratory report in the infant's medical record. After the birth dose: 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 no earlier than age 24 weeks. Infants born to HBsAg-positive mothers should be tested for HBsAg and antibody to HBsAg after completion of at least 3 doses of a licensed HepB series, at age 9-18 months (generally at the next well-child visit). 4-month dose: It is permissible to administer 4 doses of HepB when combination vaccines are administered after the birth dose. If monovalent HepB is used for doses after the birth dose, a dose at age 4 months is not needed.
2. Rotavirus vaccine (Rota). (Minimum age: 6 weeks) Administer the first dose at age 6–12 weeks. Do not start the series later than age 12 weeks. Administer the final dose in the series by age 32 weeks. Do not administer any dose later than age 32 weeks. Data on safety and efficacy outside of these age ranges are insufficient.
3. Diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine. (Minimum age: 6 weeks) If PRP-OMP (PedvaxHIB ® or ComVax ® [Merck]) is administered at ages 2 and 4 months, a dose at age 6 months is not required. TriHIBit ® (DTaP/Hib) combination products should not be used for primary immunization but can be used as boosters following any Hib vaccine in children age 12 months or older.
4. 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 immunization in infants at ages 2, 4 or 6 months but can be used as boosters after any Hib vaccine. The final dose in the series should be administered at age ≥12 months.
5. Pneumococcal vaccine (Prevnar). (Minimum age: 6 weeks for pneumococcal conjugate vaccine [PCV]; 2 years for pneumococcal polysaccharide vaccine [PPV]) Administer one dose of PCV to all healthy children aged 24–59 months having any incomplete schedule. Administer PPV to children aged 2 years and older with underlying medical conditions.
6. Influenza vaccine. (Minimum age: 6 months for trivalent inactivated influenza vaccine [TIV or flu shot]; 2 years for live, attenuated influenza vaccine [LAIV or Flumist]) Administer annually to children aged 6–59 months and to all eligible close contacts of children aged 0–59 months. Administer annually to children 5 years of age and older with certain risk factors, to other persons (including household members) in close contact with persons in groups at higher risk, and to any child whose parents request vaccination. For healthy persons (those who do not have underlying medical conditions that predispose them to influenza complications) ages 2–49 years, either LAIV or TIV may be used. Children receiving TIV should receive 0.25 mL if age 6–35 months or 0.5 mL if age 3 years or older. Administer 2 doses (separated by 4 weeks or longer) to children younger than 9 years who are receiving influenza vaccine for the first time or who were vaccinated for the first time last season but only received one dose.
7. Measles, mumps, and rubella vaccine (MMR). (Minimum age: 12 months) Administer the second dose of MMR at age 4–6 years. MMR may be administered before age 4–6 years, provided 4 weeks or more have elapsed since the first dose.
8. Varicella vaccine. (Minimum age: 12 months) Administer second dose at age 4–6 years; may be administered 3 months or more after first dose. Do not repeat second dose if administered 28 days or more after first dose.
9. Hepatitis A vaccine. (Minimum age: 12 months) Administer to all children aged 1 year (i.e., aged 12–23 months). Administer the 2 doses in the series at least 6 months apart. Children not fully vaccinated by age 2 years can be vaccinated at subsequent visits. HepA is recommended for certain other groups of children, including in areas where vaccination programs target older children.
10. Meningococcal vaccine. (Minimum age: 2 years for meningococcal conjugate vaccine (MCV4 or Menactra) and for meningococcal polysaccharide vaccine (MPSV4)) Administer MCV4 to children aged 2–10 years with terminal complement deficiencies or anatomic or functional asplenia and certain other high-risk groups. MPSV4 is also acceptable. Administer MCV4 to persons who received MPSV4 3 or more years previously and remain at increased risk for meningococcal disease.
For additional information about vaccines, including precautions and contraindications for immunization and vaccine shortages, please visit the National Immunization Program Web site at www.cdc.gov/nip/or call the National Immunization Information Hotline at 800-232-2522 (English) or 800-232-0233 (Spanish).
Approved by the Advisory Committee on Immunization Practices (www.cd.gov/nip/acip), the American Academy of Pediatrics (www.aap.org), and the American Academy of Family Physicians (www.aafp.org).
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