2021 SCHEDULE: 0–18 YEARS OF AGE (Part 1 of 2) This schedule includes recommendations in effect as of February 1, 2021. Any dose not administered at the recommended age should be administered at a subsequent visit, when indicated and feasible. The use of a combination generally is preferred over separate injections of its equivalent component . Considerations should include provider assessment, patient preference, and the potential for adverse events. Consult full product labeling for detailed recommendations. Range of recommended Range of recommended ages Range of recommended ages Range of recommended ages for non-high-risk groups that ages for all children for catch-up for certain high-risk groups may receive vaccine, subject to clinical decision making

1 2 4 6 9 12 15 18 19–23 2–3 4–6 7–10 11–12 13–15 16 17–18 Vaccine Birth mo mos mos mos mos mos mos mos mos yrs yrs yrs yrs yrs yrs yrs st nd rd 1 1 2 3 (HepB) dose dose dose

2 see Rotavirus (RV) st nd foot- RV1 (2-dose series); 1 2 dose dose note RV5 (3-dose series) 2

Diphtheria, , & st nd rd th th acellular pertussis3 1 2 3 4 5 (DTaP: <7yrs) dose dose dose dose dose

see rd th st nd foot- 3 or 4 1 2 dose type b4 (Hib) dose dose note 4 see footnote 4 Pneumococcal 1st 2nd 3rd 4th conjugate5 (PCV13) dose dose dose dose Inactivated poliovirus6 1st 2nd 3rd 4th (IPV: <18yrs) dose dose dose dose

7 Annual vaccination (IIV) Annual vaccination (IIV) Influenza (IIV) OR 1 or 2 doses 1 dose only Annual Influenza7 (LAIV) vaccination (LAIV) Annual vaccination (LAIV) 1 or 2 doses 1 dose only Measles, mumps, see footnote 1st 2nd rubella8 (MMR) 8 dose dose st nd 9 1 2 Varicella (VAR) dose dose

10 see footnote 2 dose series Hepatitis A (HepA) 10 see footnote 10 Meningococcal11 (MenACWY-CRM ≥ 2mos; 1st 2nd MenACWY-D ≥ 9mos; see footnote 11 dose dose MenACWY-TT ≥2yrs) Tetanus, , & acellular pertussis12 Tdap (Tdap: >–7yrs)

13 see Human papillomavirus footnote (HPV) 13 see footnote 11 Meningococcal B11

Pneumococcal polysaccharide5 (PPSV23) see footnote 5 1. Hepatitis B (HepB) vaccine. (Min age: birth) 2. Rotavirus (RV) vaccine. (Min age: 6wks for both RV1 [Rotarix] At birth: and RV5 [RotaTeq]) • HBsAg-negative mother: administer 1 dose of monovalent HepB • Administer a series of RV vaccine to all infants as follows: vaccine within 24hrs of birth for all medically stable infants 1. If RV1 is used, administer a 2-dose series at 2 and 4mos of age. ≥2000g. For infants <2000g, give 1 dose at chronological age 1 2. If RV5 is used, administer a 3-dose series at ages 2, 4, and 6mos. month or hospital discharge (whichever is earlier even if weight 3. If any dose in series was RV5 or vaccine product is unknown remains <2000g). for any dose in the series, a total of 3 doses of RV vaccine • HBsAg-positive mother: administer 1 dose of monovalent HepB should be given. vaccine and 0.5mL of hepatitis B immune globulin (HBIG) within 3. Diphtheria, tetanus, and acellular pertussis (DTaP) vaccine. 12hrs of birth, regardless of birth weight. For infants <2000g, (Min age: 6wks. Exception: DTaP-IPV [Kinrix, Quadracel]: 4yrs) administer 3 more doses of vaccine (4 total) beginning at age • Administer a 5-dose series of DTaP vaccine at ages 2, 4, 6, 1 month. Test for HBsAg and to HBsAg (anti-HBs) at age 15–18mos, and 4–6yrs. The 4th dose may be administered as 9–12mos or 1–2mos after final dose if the series was delayed. early as age 12mos, provided at least 6mos have elapsed since • Unknown HBsAg status: administer monovalent HepB vaccine with- the 3rd dose. If the 4th dose was inadvertently given as early as in 12hrs of birth, regardless of birth weight. For infants <2000g, add 12mos, it may be counted if given ≥4mos after the 3rd dose. 0.5mL of HBIG within 12hrs of birth, and 3 more doses of vaccine • 5th dose of DTaP vaccine is not needed if 4th dose was given at (4 total) beginning at age 1 month. Determine mother’s HBsAg age ≥4yrs and ≥6mos after 3rd dose. status as soon as possible and, if she is HBsAg-positive, also give • For wound management in children age <7yrs with ≥3 doses 0.5mL HBIG for infants weighing ≥2000g (no later than age 1wk). of tetanus--containing vaccine, administer DTaP for all Doses after the birth dose: wounds except clean and minor wounds if >5yrs since last dose • The 2nd dose should be administered at age 1–2mos and the of tetanus-toxoid-containing vaccine. 3rd dose at 6–18mos. Monovalent HepB vaccine should be used 4. Haemophilus influenzae type b (Hib) . for doses administered before age 6wks. (Minimum age: 6wks for PRP‑T [ACTHIB, DTaP‑IPV/Hib (Pentacel), • Infants who did not receive a birth dose should receive 3 doses Hiberix] and PRP‑OMP [PedvaxHIB]) of a HepB-containing vaccine as soon as feasible. • Administer a 4-dose series at 2, 4, 6, and 12–15mos • The minimum interval is 4wks for the 1st and 2nd dose, 8wks for for ActHIB, Hiberix, or Pentacel. For PedvaxHIB, administer a the 2nd and 3rd dose, and 16wks for the 1st and 3rd dose 3-dose series at 2, 4, and 12–15mos. (if 4 doses, substitute 4th dose for 3rd dose in these calculations). • For catch-up vaccination recommendations, refer to the 2021 The final (3rd or 4th) dose in the HepB vaccine series should be Catch-Up : 4 Months–18 years chart. administered no earlier than age 24wks. • Persons with high-risk conditions: refer to the ACIP 2021 • Administration of a total of 4 doses of HepB vaccine is permitted­ Immunization Schedule footnotes. when a combination vaccine containing HepB is administered 5. Pneumococcal vaccines. (Min age: 6wks for PCV13, after the birth dose. 2yrs for PPSV23) • Revaccination may be recommended for: infants born to HBsAg- Routine vaccination with PCV13: positive mothers, hemodialysis patients, or other immunocompro- • Administer a 4-dose series of PCV13 vaccine at ages 2, 4, 6mos mised persons. and at age 12–15mos. • For catch-up vaccination recommendations, refer to the 2021 • Persons with high-risk conditions: refer to the ACIP 2021 Catch-Up Vaccination Schedule: 4 Months–18 years chart. Immunization Schedule footnotes. (continued) 2021 VACCINATION SCHEDULE: 0–18 YEARS OF AGE (Part 2 of 2) 6. Inactivated poliovirus vaccine (IPV). (Min age: 6wks) — Administer 1 dose to 1st-year college students living in residential • Administer a 4-dose series of IPV at ages 2, 4, 6–18mos and housing (if not previously vaccinated at ≥16yrs) or military recruits. 4–6yrs. The final dose in the series should be administered on or — Children who received MenACWY before age 10yrs may require after the 4th birthday and at least 6mos after the previous dose. booster doses due to ongoing increased meningococcal risk (see • If ≥4 doses of IPV-containing combination vaccine are given meningococcal MMWR publications). If booster doses not recom- before age 4yrs, an additional dose should be given on or after mended, administer routine vaccination at 11−12yrs and 16yrs. the 4th birthday and ≥6mos after the previous dose. • MenB vaccination (Bexsero, Trumenba): • If both trivalent OPV (tOPV) and IPV were given as part of a series, — Persons 16–23yrs (16–18yrs preferred) not at increased risk a total of 4 doses should be given to complete the series. Doses may receive, based on shared clinical decision-making, 2 doses should be at least 4wks apart, with the final dose given on or after of Bexsero at least 1 month apart or 2 doses of Trumenba the 4th birthday and at least 6mos after the previous dose. If only at least 6mos apart (if 2nd Trumenba dose given too soon, OPV were given, and all doses given before 4yrs of age, 1 dose of administer a 3rd dose at least 4mos after the 2nd dose). IPV should be given at age ≥4yrs, at least 6mos after last OPV dose. — The two MenB vaccines are not interchangeable. • Only tOPV counts toward the US vaccination requirements. • Persons with high-risk conditions or those traveling to or living Doses of OPV given before 4/1/2016 should be counted (unless in countries where meningococcal disease is hyperendemic or noted as given during a campaign). Doses of OPV given on or epidemic: refer to the ACIP 2021 Immunization Schedule footnotes. after 4/1/2016 should not be counted. • Additional information on MenACWY and MenB booster doses • IPV is not routinely recommended for U.S. residents aged ≥18yrs. in special situations is available at https://www.cdc.gov/mmwr/ 7. Influenza vaccines. (Min age: 6mos for inactivated influenza volumes/69/rr/rr6909a1.htm. vaccine [IIV], 2yrs for live attenuated [LAIV], 12. Tetanus, diphtheria, and acellular pertussis (Tdap) vaccine. 18yrs for recombinant influenza vaccine [RIV]) (Min age: 11yrs for routine vaccination, 7yrs for catch-up) • For the 2020–2021 season, administer 2 doses at least 4wks • Give 1 dose of Tdap vaccine to all adolescents aged 11–12yrs. apart to children 6mos–8yrs who have not previously received • Tdap can be administered regardless of the interval since the ≥2 doses of influenza vaccine before July 1, 2020, or whose last tetanus and diphtheria toxoid-containing vaccine. influenza vaccination history is unknown. Administer 1 dose if • Administer 1 dose of Tdap vaccine to pregnant adolescents previously received ≥2 doses before July 1, 2020. during each (preferably during the early part of • Administer 1 dose for all children age ≥9yrs. gestational weeks 27−36). • Children with hives-only allergy to eggs should receive any age and • For catch-up vaccination recommendations, refer to the 2021 health status-appropriate influenza vaccine. For allergy other than Catch-Up Vaccination Schedule: 4 Months–18 years chart. hives (eg, angioedema, respiratory distress), give in a medical setting • For wound management in children age ≥7yrs with ≥3 doses of under supervision of healthcare provider if using a vaccine other ­tetanus-toxoid-containing vaccine, administer Tdap or Td for clean than RIV4 or ccIIV4. Children with a previous severe allergic reaction and minor wounds if >10yrs since last dose of tetanus-toxoid-con- to any influenza vaccine is contraindicated for future vaccination. taining vaccine. For all other wounds, administer Tdap or Td if >5yrs • Contraindications and precautions for LAIV: refer to the ACIP since last dose of . Tdap is preferred for age ≥11yrs 2021 Immunization Schedule footnotes or the product labeling. with no or unknown history of Tdap vaccination, or in pregnancy. 8. Measles, mumps, and rubella (MMR) vaccine. (Min age: 12mos) 13. Human papillomavirus (HPV) vaccines. • Administer a 2-dose series of MMR vaccine at ages 12–15mos (Min age: 9yrs for 9vHPV [ 9]) and 4–6yrs. The 2nd dose may be given as early as 4wks after • Adolescents age 11–12yrs (can start at age 9yrs) and through 18yrs the 1st dose. (if not previously adequately vaccinated) should receive HPV vaccine • Administer 1 dose of MMR to infants aged 6–11mos before series. Number of doses is dependent on age at initial vaccination: departure from the U.S. for international travel. These children — Initiated at age 9–14yrs: administer a 2-dose series at 0, should be revaccinated with 2 doses, the 1st at age 12–15mos 6–12mos. The minimum interval between doses is 5mos; (12mos for children in high-risk areas), and the 2nd dose at least repeat dose if given too soon. 4wks later. Unvaccinated children ≥12mos should receive — Initiated at age ≥15yrs: administer a 3-dose series at 0, 1–2, 2 doses at least 4 wks apart before departure. and 6mos. The 1st and 2nd dose should be at least 4wks apart, 9. Varicella (VAR) vaccine. (Min age: 12mos) the 2nd and 3rd dose at least 12wks apart, and the 1st and • Administer a 2-dose series of VAR vaccine at ages 12–15mos 3rd dose at least 5mos apart; repeat dose if given too soon. and 4–6yrs. The 2nd dose may be administered as early as 3mos • Series does not need to be restarted if vaccination schedule is after the 1st dose. If the 2nd dose was given at least 4wks after interrupted. the 1st dose, it can be accepted as valid. • No additional doses are needed for persons who have completed a valid series with any HPV vaccine. 10. Hepatitis A (HepA) vaccine. (Min age: 12mos) • Administer HPV vaccine beginning at age 9yrs to children with • Initiate the 2-dose HepA vaccine series, separated by ≥6mos any history of sexual abuse or assault. beginning at age 12mos. • Immunocompromised children should receive a 3-dose series at • Unvaccinated children through 18yrs should complete 2 doses 0, 1–2, and 6mos, regardless of age at vaccine initiation. ≥6mos apart. Children who previously received 1 dose at • HPV vaccination is not recommended for pregnancy. However, age ≥12mos should receive 2nd dose ≥6mos after 1st dose. pregnancy testing is not needed before vaccination. If found to Adolescents aged ≥18yrs may receive a 3- or 4-dose series of be pregnant after initiating the vaccination series, no interven- the combined HepA and HepB vaccine (Twinrix). tion is needed; the remainder of the series should be delayed • Administer 1 dose of HepA vaccine to infants aged 6–11mos until completion of pregnancy. before departure to countries with high or intermediate HepA endemicity; revaccinate with 2 doses, ≥6mos apart, between age 14. Covid-19 vaccines (Min age: 16yrs for BNT162b2; 12–23mos. Unvaccinated children aged ≥12mos should receive 18yrs for mRNA-1273 and Ad.26.COV2.S) 1 dose as soon as travel is considered. • Under Emergency Use Authorization for persons aged ≥16yrs • Pfizer-BioNTech vaccine (BNT162b2): give 2 doses, 21 days apart 11. Meningococcal vaccines. (Min age: 2mos for MenACWY-CRM • Moderna vaccine (mRNA-1273): give 2 doses, 28 days apart [Menveo], 9mos for MenACWY-D [Menactra], 2yrs for MenACWY- • Janssen (J&J) vaccine (Ad.26.COV2.S): give 1 dose only TT [MenQuadfi], 10yrs for serogroup B meningococcal [MenB] vaccines: MenB-4C [Bexsero] and MenB-FHbp [Trumenba]) NOTE: Refer to the ACIP 2021 Recommended Child and • MenACWY vaccination (Menactra, Menveo): Adolescent Immunization Schedule for Ages 18 Years or — Administer a 2-dose series at 11–12yrs and 16yrs. Younger footnotes for of persons with high — If Menactra is used, give either before or at the same time as DTaP. risk conditions. CHANGES IN THE SCHEDULE SINCE LAST RELEASE • The DTaP and Tdap notes have been revised to include recom­ men­ ­ • The influenza note has been updated for egg-allergic persons with dations­ for use in wound management. symptoms other than hives and for LAIV4 use. • Text has been added in the HepB note to clarify the recom­ men­ da­ tion­ • Text has been added in the meningococcal note for MenQuadfi use for infants weighing <2000g at birth with HBsAg-negative mothers. and for Menveo use in infants who received dose 1 at age 3−6mos. • The HPV note has been revised to include recommendations for • A text box has been added to include recommendations for interrupted schedules. Covid-19 vaccination. REFERENCES For information on individual vaccines, please see product monographs at www.eMPR.com, contact company for full labeling, or call the National Immunization Hotline at (800) 232-4636. Source: Advisory Committee on Immunization Practices (ACIP). Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger, United States, 2021. https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html. Accessed March 10, 2021. Oliver S, Gargano J, Marin M, et al. The Advisory Committee on Immunization Practices’ Interim Recommendation for Use of Moderna COVID-19 Vaccine — United States, December 2020. MMWR Morb Mortal Wkly Rep. 2021;69:1653-1656. DOI: http://dx.doi.org/10.15585/mmwr.mm695152e1. Oliver S, Gargano J, Marin M, et al. The Advisory Committee on Immunization Practices’ Interim Recommendation for Use of Pfizer-BioNTech COVID-19 Vaccine — United States, December 2020. MMWR Morb Mortal Wkly Rep. 2020;69:1922-1924. DOI: http://dx.doi.org/10.15585/mmwr.mm6950e2. Oliver SE, Gargano JW, Scobie H, et al. The Advisory Committee on Immunization Practices’ Interim Recommendation for Use of Janssen COVID-19 Vaccine — United States, February 2021. MMWR Morb Mortal Wkly Rep. 2021;70:329–332. DOI: http://dx.doi.org/10.15585/mmwr.mm7009e4. (Rev. 3/2021)