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2020 SCHEDULE: 0–18 YEARS OF AGE (Part 1 of 2) This schedule includes recommendations in effect as of February 1, 2020. 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 Rotavirus2 (RV) see 1st 2nd foot- RV1 (2-dose series); 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 1st 2nd foot- 3 or 4 type b4 (Hib) dose dose note dose 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) (IIV) OR 1 or 2 doses 1 dose only Annual Influenza7 (LAIV) vaccination (LAIV) Annual vaccination (LAIV) 1 or 2 doses 1 dose only , , see footnote 1st 2nd rubella8 (MMR) 8 dose dose st nd 9 1 2 Varicella (VAR) dose dose

10 see footnote 2 dose series (HepA) 10 see footnote 10 Meningococcal11 1st 2nd MenACWY-D ≥ 9mos; see footnote 11 dose dose MenACWY-CRM ≥ 2mos) Tetanus, , & acellular pertussis12 Tdap (Tdap: >–7yrs) Human papillomavirus13 see footnote (HPV) 13 see footnote 11 Meningococcal B11

Pneumococcal see footnote 5 polysaccharide5 (PPSV23) 1. Hepatitis B (HepB) vaccine. (Min age: birth) 2. (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 ≥2,000g. For infants <2000g, give 1 dose at chronological age 1. If RV1 is used, administer a 2-dose series at 2 and 4mos of age. 1 month or hospital discharge. 2. If RV5 is used, administer a 3-dose series at ages 2, 4, and 6mos. • HBsAg-positive mother: administer 1 dose of monovalent HepB 3. If any dose in series was RV5 or vaccine product is unknown vaccine and 0.5mL of hepatitis B immune globulin (HBIG) within for any dose in the series, a total of 3 doses of RV vaccine 12hrs of birth, regardless of birth weight. For infants <2000g, should be given. administer 3 more doses of vaccine (4 total) beginning at age 3. Diphtheria, tetanus, and acellular pertussis (DTaP) vaccine. 1 month. Test for HBsAg and antibody to HBsAg (anti-HBs) at age (Min age: 6wks. Exception: DTaP-IPV [Kinrix, Quadracel]: 4yrs) 9–12mos or 1–2mos after final dose if the series was delayed. • Administer a 5-dose series of DTaP vaccine at ages 2, 4, 6, • Unknown HBsAg status: administer monovalent HepB vaccine with- in 12hrs of birth, regardless of birth weight. For infants <2000g, add 15–18mos, and 4–6yrs. The 4th dose may be administered as 0.5mL of HBIG within 12hrs of birth, and 3 more doses of vaccine early as age 12mos, provided at least 6mos have elapsed since (4 total) beginning at age 1 month. Determine mother’s HBsAg the 3rd dose. If the 4th dose was inadvertently given as early as status as soon as possible and, if she is HBsAg-positive, also give 12mos, it may be counted if given ≥4mos after the 3rd dose. 0.5mL HBIG for infants weighing ≥2000g (no later than age 1wk). • 5th dose of DTaP vaccine is not needed if 4th dose was given at Doses after the birth dose: age ≥4yrs and ≥6mos after 3rd dose. • The 2nd dose should be administered at age 1–2mos and the 4. Haemophilus influenzae type b (Hib) . 3rd dose at 6–18mos. Monovalent HepB vaccine should be used (Minimum age: 6wks for PRP‑T [ACTHIB, DTaP‑IPV/Hib (Pentacel), for doses administered before age 6wks. Hiberix] and PRP‑OMP [PedvaxHIB]) • Infants who did not receive a birth dose should receive 3 doses • Administer a 4-dose series at 2, 4, 6, and 12–15mos of a HepB-containing vaccine as soon as feasible. for ActHIB, Hiberix, or Pentacel. For PedvaxHIB, administer a • The minimum interval is 4wks for the 1st and 2nd dose, 8wks for 3-dose series at 2, 4, and 12–15mos. the 2nd and 3rd dose, and 16wks for the 1st and 3rd dose • For catch-up vaccination recommendations, refer to the 2020 (if 4 doses, substitute 4th dose for 3rd dose in these calculations). Catch-Up Vaccination Schedule: 4 Months–18 years chart. The final (3rd or 4th) dose in the HepB vaccine series should be • Persons with high-risk conditions: refer to the ACIP 2020 administered no earlier than age 24wks. Immunization Schedule footnotes. • Administration of a total of 4 doses of HepB vaccine is permitted­ 5. Pneumococcal vaccines. (Min age: 6wks for PCV13, when a combination vaccine containing HepB is administered 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 2020 • Persons with high-risk conditions: refer to the ACIP 2020 Catch-Up Vaccination Schedule: 4 Months–18 years chart. Immunization Schedule footnotes. (continued) 2020 VACCINATION SCHEDULE: 0–18 YEARS OF AGE (Part 2 of 2) 6. Inactivated poliovirus vaccine (IPV). (Min age: 6wks) • MenACWY vaccination (Menactra, Menveo): • Administer a 4-dose series of IPV at ages 2, 4, 6–18mos and ——Administer a 2-dose series at 11–12yrs and 16yrs. 4–6yrs. The final dose in the series should be administered on or ——If Menactra is used, give either before or at the same time after the 4th birthday and at least 6mos after the previous dose. as DTaP. • If ≥4 doses of IPV-containing combination vaccine are given ——Administer 1 dose to 1st-year college students living in before age 4yrs, an additional dose should be given on or after residential housing (if not previously vaccinated at ≥16yrs) or the 4th birthday and ≥6mos after the previous dose. military recruits. • If both trivalent OPV (tOPV) and IPV were given as part of a series, ——Children who received MenACWY before age 10yrs may require a total of 4 doses should be given to complete the series. Doses booster doses due to ongoing increased meningococcal risk (see should be at least 4wks apart, with the final dose given on or after meningococcal MMWR publications). If booster doses not recom- the 4th birthday and at least 6mos after the previous dose. If only mended, administer routine vaccination at 11−12yrs and 16yrs. OPV were given, and all doses given before 4yrs of age, 1 dose of • MenB vaccination (Bexsero, Trumenba): IPV should be given at age ≥4yrs, at least 6mos after last OPV dose. ——Persons 16–23yrs (16–18yrs preferred) not at increased risk • Only tOPV counts toward the US vaccination requirements. may receive, based on shared clinical decision-making, 2 doses Doses of OPV given before 4/1/2016 should be counted (unless of Bexsero at least 1 month apart or 2 doses of Trumenba noted as given during a campaign). Doses of OPV given on or at least 6mos apart (if 2nd Trumenba dose given too soon, after 4/1/2016 should not be counted. administer a 3rd dose at least 4mos after the 2nd dose). • IPV is not routinely recommended for U.S. residents aged ≥18yrs. ——Children age ≥10yrs with high-risk conditions or during 7. Influenza vaccines. (Min age: 6mos for inactivated influenza an outbreak may require MenB booster doses (see ACIP vaccine [IIV], 2yrs for live attenuated [LAIV], recommendations). 18yrs for recombinant influenza vaccine [RIV]) ——The two MenB vaccines are not interchangeable. • For the 2019–2020 season, administer 1 dose of any influenza • Persons with high-risk conditions or those traveling to or living vaccine appropriate for age and health status annually to all in countries where meningococcal is hyperendemic or children beginning at age 6mos. epidemic: refer to the ACIP 2020 Immunization Schedule footnotes. • Administer 2 doses at least 4wks apart to children 6mos–8yrs who 12. Tetanus, diphtheria, and acellular pertussis (Tdap) vaccine. have not previously received ≥2 doses of influenza vaccine before (Min age: 11yrs for routine vaccination, 7yrs for catch-up) July 1, 2019, or whose influenza vaccination history is unknown. • Give 1 dose of Tdap vaccine to all adolescents aged 11–12yrs. • Contraindications and precautions for LAIV: refer to the ACIP • Tdap can be administered regardless of the interval since the 2020 Immunization Schedule footnotes or the product labeling. last tetanus and diphtheria -containing vaccine. 8. Measles, mumps, and (MMR) vaccine. • Administer 1 dose of Tdap vaccine to pregnant adolescents (Min age: 12mos) during each pregnancy (preferably during the early part of • Administer a 2-dose series of MMR vaccine at ages 12–15mos gestational weeks 27−36). and 4–6yrs. The 2nd dose may be given as early as 4wks after • For catch-up vaccination recommendations, refer to the 2020 the 1st dose. Catch-Up Vaccination Schedule: 4 Months–18 years chart. • Administer 1 dose of MMR to infants aged 6–11mos before 13. Human papillomavirus (HPV) vaccines. departure from the U.S. for international travel. These children (Minimum age: 9yrs for 9vHPV [ 9]) should be revaccinated with 2 doses, the 1st at age 12–15mos • Adolescents age 11–12yrs (can start at age 9yrs) and through (12mos for children in high-risk areas), and the 2nd dose at 18yrs (if not previously adequately vaccinated) should receive least 4wks later. Unvaccinated children ≥12mos should receive 2 HPV vaccine series. Number of doses is dependent on age at doses at least 4 wks apart before departure. initial vaccination: 9. Varicella (VAR) vaccine. (Min age: 12mos) ——Initiated at age 9–14yrs: administer a 2-dose series at 0, • Administer a 2-dose series of VAR vaccine at ages 12–15mos 6–12mos. The minimum interval between doses is 5mos; and 4–6yrs. The 2nd dose may be administered as early as 3mos repeat dose if given too soon. after the 1st dose. If the 2nd dose was given at least 4wks after ——Initiated at age ≥15yrs: administer a 3-dose series at 0, 1–2, the 1st dose, it can be accepted as valid. and 6mos. The 1st and 2nd dose should be at least 4wks apart, the 2nd and 3rd dose at least 12wks apart, and the 1st and 10. Hepatitis A (HepA) vaccine. (Min age: 12mos) 3rd dose at least 5mos apart; repeat dose if given too soon. • Initiate the 2-dose HepA vaccine series, separated by ≥6mos beginning at age 12mos. • No additional doses are needed for persons who have completed a valid series with any HPV vaccine. • Unvaccinated children through 18yrs should complete 2 doses ≥6mos apart. Children who previously received 1 dose at • Administer HPV vaccine beginning at age 9yrs to children with age ≥12mos should receive 2nd dose ≥6mos after 1st dose. any history of sexual abuse or assault. Adolescents aged ≥18yrs may receive a 3- or 4-dose series of • Immunocompromised children should receive a 3-dose series at the combined HepA and HepB vaccine (Twinrix). 0, 1–2, and 6mos, regardless of age at vaccine initiation. • Administer 1 dose of HepA vaccine to infants aged 6–11mos • HPV vaccination is not recommended for pregnancy. However, before departure to countries with high or intermediate HepA pregnancy testing is not needed before vaccination. If found to endemicity; revaccinate with 2 doses, ≥6mos apart, between age be pregnant after initiating the vaccination series, no interven- 12–23mos. Unvaccinated children aged ≥12mos should receive tion is needed; the remainder of the series should be delayed 1 dose as soon as travel is considered. until completion of pregnancy. 11. Meningococcal vaccines. (Min age: 9mos for MenACWY-D NOTE: Refer to the ACIP 2020 Recommended Child and [Menactra], 2mos for MenACWY-CRM [Menveo], 10yrs for Adolescent Immunization Schedule for Ages 18 Years or serogroup B meningococcal [MenB] vaccines: MenB-4C Younger footnotes for of persons with high [Bexsero] and MenB-FHbp [Trumenba]) risk conditions. CHANGES IN THE SCHEDULE SINCE LAST RELEASE • The HepA footnote has been revised to include that all previously booster doses in persons ≥10yrs old with high risk conditions has unvaccinated children aged 2−18yrs should receive catch-up also been added to the footnote. vaccination and complete a 2-dose series. • The poliovirus vaccine footnote has been revised to include • The HepB footnote has been updated to include populations for detailed information regarding which OPV doses may count toward whom revaccination may be recommended. vaccination requirements. • Vaccination guidance has been added for children who received • The DTaP footnote has been updated to clarify the necessity of the MenACWY vaccine before age 10yrs. Recommendation for MenB 5th dose. 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, 2020. https://www.cdc.gov/vaccines/ schedules/hcp/imz/child-adolescent.html. Accessed April 3, 2020. (Rev. 4/2020)