Recommended Immunization Catch-Up Schedule (4 Months-18 Years)

Catch-up Immunization Schedule for Children and Adolescents Who Start Late or Who Are More than 1 Month Behind

Recommendations for Ages 18 Years or Younger, United States, 2022

COVID-19 Vaccination

ACIP recommends use of COVID-19 vaccines for everyone ages 6 months and older. COVID-19 vaccine and other vaccines may be administered on the same day. See the COVID-19 Vaccine: Interim COVID-19 Immunization Schedule for additional information.

Using the schedule

To make vaccination recommendations, healthcare providers should:

  1. Determine needed vaccines based on age (Table 1)
  2. Determine appropriate intervals for catch-up, if needed (Table 2)
  3. Assess for medical conditions and other indications (Table 3)
  4. Review special situations (Vaccination Notes)
  5. Review contraindications and precautions to vaccination (Appendix)
More schedule resources

The tables below provide catch-up schedules and minimal intervals between doses for children based on age whose vaccinations have been delayed.

Table 1. By age
Table 2. Catch-up schedule
Table 3. By medical indications
Vaccination Notes
Appendix
Parent-friendly schedules

Children Age 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 B more info icon. Birth 4 weeks 8 weeks and at least 16 weeks after first dose.
Minimum age for the final dose is 24 weeks.
Rotavirus more info icon. 6 weeks Maximum age for first dose is 14 weeks, 6 days. 4 weeks 4 weeks
Maximum age for final dose is 8 months, 0 days.
Diphtheria, tetanus, and acellular pertussis more info icon. 6 weeks 4 weeks 4 weeks 6 months 6 months
Haemophilus influenzae type b more info icon. 6 weeks No further doses needed
if first dose was administered at age 15 months or older.
4 weeks
if first dose was administered before the 1st birthday.
8 weeks (as final dose)
if first dose was administered at age 12 through 14 months.
No further doses needed
if previous dose was administered at age 15 months or older.
4 weeks
If current age is younger than 12 months and first dose was administered at younger than age 7 months and at
least 1 previous dose was PRP-T (ActHib®, Pentacel®, Hiberix®), Vaxelis® or unknown
8 weeks and age 12 through 59 months (as final dose)
if current age is younger than 12 months and first dose was administered at age 7 through 11 months;
OR
if current age is 12 through 59 months and first dose was administered before the 1st birthday, and second dose was administered at younger than 15 months;
OR
if both doses were PedvaxHIB® and were administered before the 1st birthday
8 weeks (as final dose)This dose only necessary for children age 12 through
59 months who received 3 doses before the 1st birthday.
Pneumococcal conjugate more info icon. 6 weeks No further doses needed
for healthy children if first dose was administered at
age 24 months or older.
4 weeks

if first dose administered before the
1st birthday.
8 weeks (as final dose for healthy
children)

if first dose was administered at the
1st birthday or after.
No further doses needed
for healthy children if previous dose was administered at age 24 months or older.
4 weeks

if current age is younger than 12 months and previous dose given at <7 months old.
8 weeks (as final dose for healthy children)
if previous dose given between 7-11 months (wait until at least 12 months old);
OR
if current age is 12 months or older and at least 1 dose was administered before age 12 months.
8 weeks (as final dose)
This dose only necessary for children age 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 poliovirus more info icon. 6 weeks 4 weeks 4 weeks
if current age is <4 years.
6 months

(as final dose) if current age is 4 years or older.
6 months
(minimum age 4 years for final dose).
Measles, mumps, rubella more info icon. 12 months 4 weeks
Varicella more info icon. 12 months 3 months
Hepatitis A more info icon. 12 months 6 months
Meningococcal ACWY more info icon. 2 months MenACWY-CRM
9 months MenACWY-D
2 years MenACWY-TT
8 weeks See notes See notes

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Children and Adolescents Age 7 through 18 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
Meningococcal ACWY more info icon. Not Applicable (N/A) 8 weeks
Tetanus, diphtheria; tetanus, diphtheria, and acellular pertussis more info icon. 7 years 4 weeks 4 weeks
if first dose of DTaP/DT was administered before the 1st birthday.
6 months (as final dose)
if first dose of DTaP/DT or Tdap/Td was administered at or after the 1st birthday.
6 months
if first dose of DTaP/DT was administered before the 1st birthday.
Human papillomavirus more info icon. 9 years Routine dosing intervals are recommended.
Hepatitis A more info icon. N/A 6 months
Hepatitis B more info icon. N/A 4 weeks 8 weeks and at least 16 weeks after first dose.
Inactivated poliovirus more info icon. N/A 4 weeks 6 months
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.
A fourth dose of IPV is indicated if all previous doses were administered at <4 years or if the third dose was administered <6 months after the second dose.
Measles, mumps, rubella more info icon. N/A 4 weeks
Varicella more info icon. N/A 3 months if younger than age 13 years.

4 weeks
 if age 13 years or older.
Dengue more info icon. 9 years 6 months 6 months

Administer recommended vaccines if immunization history is incomplete or unknown. Do not restart or add doses to vaccine series for extended intervals between doses. When a vaccine is not administered at the recommended age, administer at a subsequent visit. The use of trade names is for identification purposes only and does not imply endorsement by the ACIP or CDC.

Notes

For vaccination recommendations for persons ages 19 years or older, see the Recommended Adult Immunization Schedule, 2022.

Additional information

  • Consult relevant ACIP statements for detailed recommendations.
  • For calculating intervals between doses, 4 weeks = 28 days. Intervals of ≥4 months are determined by calendar months.
  • Within a number range (e.g., 12–18), a dash (–) should be read as “through.”
  • Vaccine doses administered ≤4 days before the minimum age or interval are considered valid. Doses of any vaccine administered ≥5 days earlier than the minimum age or minimum interval should not be counted as valid 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 Table 3-1, Recommended and minimum ages and intervals between vaccine doses, in General Best Practice Guidelines for Immunization.
  • Information on travel vaccination requirements and recommendations is available at https://www.cdc.gov/travel/.
  • For vaccination of persons with immunodeficiencies, see Table 8-1, Vaccination of persons with primary and secondary immunodeficiencies, in General Best Practice Guidelines for Immunization, and Immunization in Special Clinical Circumstances (In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book: 2018 report of the Committee on Infectious Diseases. 31st ed. Itasca, IL: American Academy of Pediatrics, 2018:67–111).
  • For information about vaccination in the setting of a vaccine-preventable disease outbreak, contact your state or local health department.
  • The National Vaccine Injury Compensation Program (VICP) is a no-fault alternative to the traditional legal system for resolving vaccine injury claims. All routine child and adolescent vaccines are covered by VICP except for pneumococcal polysaccharide vaccine (PPSV23). For more information, see www.hrsa.gov/vaccinecompensation/index.html.
 

Dengue Vaccination

Diphtheria, tetanus, and pertussis (DTaP) vaccination
(minimum age: 6 weeks [4 years for Kinrix® or Quadracel®])

Haemophilus influenzae type b vaccination
(minimum age: 6 weeks)

Hepatitis A vaccination
(minimum age: 12 months for routine vaccination)

Hepatitis B vaccination
(minimum age: birth)

Human papillomavirus vaccination
(minimum age: 9 years)

Influenza vaccination
(minimum age: 6 months [IIV], 2 years [LAIV4], 18 years [recombinant influenza vaccine, RIV4])

Measles, mumps, and rubella vaccination
(minimum age: 12 months for routine vaccination)

Meningococcal serogroup A, C, W, Y vaccination (minimum age: 2 months [MenACWY-CRM, Menveo], 9 months [MenACWY-D, Menactra], 2 years [MenACWY-TT, MenQuadfi])

Meningococcal serogroup B vaccination
(minimum age: 10 years [MenB-4C, Bexsero®; MenB-FHbp, Trumenba®])

Pneumococcal vaccination
(minimum age: 6 weeks [PCV13], 2 years [PPSV23])

Poliovirus vaccination
(minimum age: 6 weeks)

Rotavirus vaccination
(minimum age: 6 weeks)

Tetanus, diphtheria, and pertussis (Tdap) vaccination
(minimum age: 11 years for routine vaccination, 7 years for catch-up vaccination)

Varicella vaccination
(minimum age: 12 months)

Appendix – Guide to Contraindications and Precautions to Commonly Used Vaccines

Adapted from Table 4-1 in Advisory Committee on Immunization Practices (ACIP) General Best Practice Guidelines for Immunization: Contraindication and Precautions and ACIP’s Recommendations for the Prevention and Control of 2021-22 seasonal influenza with Vaccines.

Interim clinical considerations for use of COVID-19 vaccines including contraindications and precautions

single arrow icon

Vaccine

Contraindications1

Precautions2

Dengue (DEN4CYD)

  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
  • Severe immunodeficiency (e.g., hematologic and solid tumors, receipt of chemotherapy, congenital immunodeficiency, long- term immunosuppressive therapy or patients with HIV infection who are severely immunocompromised)
  • Pregnancy
  • HIV infection without evidence of severe immunosuppression
  • Moderate or severe acute illness with or without fever
Diphtheria, tetanus, pertussis (DTaP)

Tetanus, diphtheria (DT)

  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
  • For DTaP only: Encephalopathy (e.g., coma, decreased level of consciousness, prolonged seizures) not attributable to another identifiable cause within 7 days of administration of previous dose of DTP or DTaP
  • Guillain-Barré syndrome (GBS) within 6 weeks after previous dose of tetanus-toxoid–containing vaccine
  • History of Arthus-type hypersensitivity reactions after a previous dose of diphtheria-toxoid— containing or tetanus-toxoid– containing vaccine; defer vaccination until at least 10 years have elapsed since the last tetanus-toxoid- containing vaccine
  • For DTaP only: Progressive neurologic disorder, including infantile spasms, uncontrolled epilepsy, progressive encephalopathy; defer DTaP until neurologic status clarified and stabilized
  • Moderate or severe acute illness with or without fever

Haemophilus influenzae type b (Hib)

  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
  • For Hiberix, ActHib, and PedvaxHIB only: History of severe allergic reaction to dry natural latex
  • Age <6 weeks
  • Moderate or severe acute illness with or without fever

Hepatitis A (HepA)

  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 including neomycin
  • Moderate or severe acute illness with or without fever

Hepatitis B (HepB)

  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 including yeast
  • For Heplisav-B only: Pregnancy
  • Moderate or severe acute illness with or without fever

Hepatitis A- Hepatitis B vaccine [HepA-HepB, (Twinrix®)]

  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 including neomycin and yeast
  • Moderate or severe acute illness with or without fever

Human papillomavirus (HPV)

  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
  • Moderate or severe acute illness with or without fever

Influenza, egg-based, inactivated injectable (IIV4)

  • Severe allergic reaction (e.g., anaphylaxis) after previous dose of any influenza vaccine (i.e., any egg-based IIV, ccIIV, RIV, or LAIV of any valency)
  • Severe allergic reaction (e.g., anaphylaxis) to any vaccine component3 (excluding egg)
  • Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any type of influenza vaccine
  • Persons with egg allergy with symptoms other than hives (e.g., angioedema, respiratory distress) or required epinephrine or another emergency medical intervention: Any influenza vaccine appropriate for age and health status may be administered. If using egg-based IIV4, administer in medical setting under supervision of healthcare provider who can recognize and manage severe allergic reactions
  • Moderate or severe acute illness with or without fever

Influenza, cell culture-based inactivated injectable
[(ccIIV4), Flucelvax® Quadrivalent]

  • Severe allergic reaction (e.g., anaphylaxis) to any ccIIV of any valency, or to any component3 of ccIIV4
  • Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any type of influenza vaccine
  • Persons with a history of severe allergic reaction (e.g., anaphylaxis) after a previous dose of any egg-based IIV, RIV, or LAIV of any valency. If using ccIV4, administer in medical setting under supervision of healthcare provider who can recognize and manage severe allergic reactions. May consult an allergist.
  • Moderate or severe acute illness with or without fever

Influenza, recombinant injectable
[(RIV4), Flublok® Quadrivalent]

  • Severe allergic reaction (e.g., anaphylaxis) to any RIV of any valency, or to any component3 of RIV4
  • Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any type of influenza vaccine
  • Persons with a history of severe allergic reaction (e.g., anaphylaxis) after a previous dose of any egg- based IIV, ccIIV, or LAIV of any valency. If using RIV4, administer in medical setting under supervision of healthcare provider who can recognize and manage severe allergic reactions. May consult an allergist.
  • Moderate or severe acute illness with or without fever

Influenza, live attenuated [LAIV4, Flumist® Quadrivalent]

  • Severe allergic reaction (e.g., anaphylaxis) after previous dose of any influenza vaccine (i.e., any egg-based IIV, ccIIV, RIV, or LAIV of any valency)
  • Severe allergic reaction (e.g., anaphylaxis) to any vaccine component3 (excluding egg)
  • Children age 2 – 4 years with a history of asthma or wheezing
  • Anatomic or functional asplenia
  • Immunocompromised due to any cause including medications and HIV infection
  • Close contacts or caregivers of severely immunosuppressed persons who require a protected environment
  • Pregnancy
  • Cochlear implant
  • Active communication between the cerebrospinal fluid (CSF) and the oropharynx, nasopharynx, nose, ear or any other cranial CSF leak
  • Children and adolescents receiving aspirin or salicylate-containing medications
  • Received influenza antiviral medications oseltamivir or zanamivir within the previous 48 hours, peramivir within the previous 5 days, or baloxavir within the previous 17 days.
  • Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any type of influenza vaccine
  • Asthma in persons aged 5 years old or older
  • Persons with egg allergy with symptoms other than hives (e.g., angioedema, respiratory distress) or required epinephrine or another emergency medical intervention: Any influenza vaccine appropriate for age and health status may be administered. If using LAIV4 (which is egg based), administer in medical setting under supervision of healthcare provider who can recognize and manage severe allergic reactions. May consult an allergist.
  • Persons with underlying medical conditions (other than those listed under contraindications) that might predispose to complications after wild-type influenza virus infection [e.g., chronic pulmonary, cardiovascular (except isolated hypertension), renal, hepatic, neurologic, hematologic, or metabolic disorders (including diabetes mellitus)]
  • Moderate or severe acute illness with or without fever

Measles, mumps, rubella (MMR)

  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
  • Severe immunodeficiency (e.g., hematologic and solid tumors, receipt of chemotherapy, congenital immunodeficiency, long-term immunosuppressive therapy or patients with HIV infection who are severely immunocompromised)
  • Pregnancy
  • Family history of altered immunocompetence, unless verified clinically or by laboratory testing as immunocompetent
  • Recent (≤11 months) receipt of antibody-containing blood product (specific interval depends on product)
  • History of thrombocytopenia or thrombocytopenic purpura
  • Need for tuberculin skin testing or interferon-gamma release assay (IGRA) testing
  • Moderate or severe acute illness with or without fever

Meningococcal ACWY (MenACWY)
[MenACWY-CRM (Menveo®); MenACWY-D (Menactra®); MenACWY-TT (MenQuadfi®)]

  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
  • For MenACWY-D and Men ACWY-CRM only: severe allergic reaction to any diphtheria toxoid– or CRM197–containing vaccine
  • For MenACWY-TT only: severe allergic reaction to a tetanus toxoid-containing vaccine
  • For MenACWY-CRM only: Preterm birth if less than age 9 months
  • Moderate or severe acute illness with or without fever

Meningococcal B (MenB)
[MenB-4C (Bexsero®); MenB-FHbp (Trumenba®)]

  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
  • Pregnancy
  • For MenB-4C only: Latex sensitivity
  • Moderate or severe acute illness with or without fever

Pneumococcal conjugate (PCV13)

  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
  • Severe allergic reaction (e.g., anaphylaxis) to any diphtheria-toxoid– containing vaccine or its component3
  • Moderate or severe acute illness with or without fever

Pneumococcal polysaccharide (PPSV23)

  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
  • Moderate or severe acute illness with or without fever

Poliovirus vaccine, inactivated (IPV)

  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
  • Pregnancy
  • Moderate or severe acute illness with or without fever

Rotavirus (RV) [RV1 (Rotarix®), RV5 (RotaTeq®)]

  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
  • Severe combined immunodeficiency (SCID)
  • History of intussusception
  • Altered immunocompetence other than SCID
  • Chronic gastrointestinal disease
  • RV1 only: Spina bifida or bladder exstrophy
  • Moderate or severe acute illness with or without fever
Tetanus, diphtheria, and acellular pertussis (Tdap)

Tetanus, diphtheria (Td)

  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
  • For Tdap only: Encephalopathy (e.g., coma, decreased level of consciousness, prolonged seizures) not attributable to another identifiable cause within 7 days of administration of previous dose of DTP, DTaP, or Tdap
  • Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of tetanus-toxoid–containing vaccine
  • History of Arthus-type hypersensitivity reactions after a previous dose of diphtheria-toxoid— containing or tetanus-toxoid– containing vaccine; defer vaccination until at least 10 years have elapsed since the last tetanus-toxoid– containing vaccine
  • For Tdap only: Progressive or unstable neurological disorder, uncontrolled seizures, or progressive encephalopathy until a treatment regimen has been established and the condition has stabilized
  • Moderate or severe acute illness with or without fever

Varicella (VAR)

  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
  • Severe immunodeficiency (e.g., hematologic and solid tumors, receipt of chemotherapy, congenital immunodeficiency, long- term immunosuppressive therapy or patients with HIV infection who are severely immunocompromised)
  • Pregnancy
  • Family history of altered immunocompetence, unless verified clinically or by laboratory testing as immunocompetent
  • Recent (≤11 months) receipt of antibody-containing blood product (specific interval depends on product)
  • Receipt of specific antiviral drugs (acyclovir, famciclovir, or valacyclovir) 24 hours before vaccination (avoid use of these antiviral drugs for 14 days after vaccination)
  • Use of aspirin or aspirin-containing products
  • Moderate or severe acute illness with or without fever
  1. When a contraindication is present, a vaccine should NOT be administered. Kroger A, Bahta L, Hunter P. ACIP General Best Practice Guidelines for Immunization.
  2. When a precaution is present, vaccination should generally be deferred but might be indicated if the benefit of protection from the vaccine outweighs the risk for an adverse reaction. Kroger A, Bahta L, Hunter P. ACIP General Best Practice Guidelines for Immunization.
  3. Vaccination providers should check FDA-approved prescribing information for the most complete and updated information, including contraindications, warnings, and precautions. See Package inserts for U.S.-licensed vaccinesexternal icon.

Vaccines in the Child and Adolescent Immunization Schedule

Vaccine

Abbreviation(s)

Trade name(s)

Dengue vaccine

DEN4CYD

Dengvaxia®

Diphtheria, tetanus, and acellular pertussis vaccine

DTaP

Daptacel®
Infanrix®

Diphtheria, tetanus vaccine

DT

No Trade Name

Haemophilus influenzae type B vaccine

Hib (PRP-T)
Hib (PRP-OMP)

ActHIB®
Hiberix®
PedvaxHIB®

Hepatitis A vaccine

HepA

Havrix®
Vaqta®

Hepatitis B vaccine

HepB

Engerix-B®
Recombivax HB®

Human papillomavirus vaccine

HPV

Gardasil 9®

Influenza vaccine (inactivated)

IIV4

Multiple

Influenza vaccine (live, attenuated)

LAIV4

FluMist® Quadrivalent

Measles, mumps, and rubella vaccine

MMR

M-M-R® II

Meningococcal serogroups A, C, W, Y vaccine

MenACWY-D
MenACWY-CRM
MenACWY-TT

Menactra®
Menveo®
MenQuadfi®

Meningococcal serogroup B vaccine

MenB-4C
MenB-FHbp

Bexsero®
Trumenba®

Pneumococcal 13-valent conjugate vaccine

PCV13

Prevnar 13®

Pneumococcal 23-valent polysaccharide vaccine

PPSV23

Pneumovax® 23

Poliovirus vaccine (inactivated)

IPV

IPOL®

Rotavirus vaccine

RV1
RV5

Rotarix®
RotaTeq®

Tetanus, diphtheria, and acellular pertussis vaccine

Tdap

Adacel®
Boostrix®

Tetanus and diphtheria vaccine

Td

Tenivac®
TDvax™

Varicella vaccine

VAR

Varivax®

Combination Vaccines

(Use combination vaccines instead of separate injections when appropriate)

Vaccine

Abbreviation(s)

Trade name(s)

DTaP, hepatitis B, and inactivated poliovirus vaccine

DTaP-HepB-IPV

Pediarix®

DTaP, inactivated poliovirus, and Haemophilus influenzae type B vaccine

DTaP-IPV/Hib

Pentacel®

DTaP and inactivated poliovirus vaccine

DTaP-IPV

Kinrix®
Quadracel®

DTaP, inactivated poliovirus, Haemophilus influenzae type b, and hepatitis B vaccine

DTaP-IPV-Hib-HepB

Vaxelis®

Measles, mumps, rubella, and varicella vaccines

MMRV

ProQuad®

This schedule is recommended by the Advisory Committee on Immunization Practices (ACIP) and approved by the Centers for Disease Control and Prevention (CDC), American Academy of Pediatrics (AAPexternal icon), American Academy of Family Physicians (AAFPexternal icon)), American College of Obstetricians and Gynecologists (ACOGexternal icon), American College of Nurse-Midwives (ACNMexternal icon), American Academy of Physician Associates (AAPAexternal icon), and National Association of Pediatric Nurse Practitioners (NAPNAPexternal icon).

The comprehensive summary of the ACIP recommended changes made to the child and adolescent immunization schedule can be found in the February 18, 2022 MMWR.

 

Report

  • Suspected cases of reportable vaccine-preventable diseases or outbreaks to your state or local health department
  • Clinically significant adverse events to the Vaccine Adverse Event Reporting System (VAERS) at www.vaers.hhs.govexternal icon or (800-822-7967)

Questions or comments
Contact www.cdc.gov/cdc-info or 800-CDC-INFO (800-232-4636), in English or Spanish, 8 a.m.–8 p.m. ET, Monday through Friday, excluding holidays.

Helpful information

 

 

Page last reviewed: February 17, 2022

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