Recommended Childhood Immunization Schedule
United States, January - December 1999
Vaccines1 are listed under routinely recommended ages. Bars indicate range of recommended ages for immunization. Any dose not given at the recommended age should be given as a "catch-up" immunization at any subsequent visit when indicated and feasible. Ovals indicate vaccines to be given if previously recommended doses were missed or given earlier than the recommended minimum age.
Approved by the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP)
1 This schedule indicates the recommended ages for routine administration
of currently licensed childhood vaccines as of 11/1/99. 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 its other components are not
contraindicated. Providers should consult the manufacturers' package
inserts for detailed recommendations.
2 Infants born to HBsAg-negative mothers should receive the 1st dose
of hepatitis B (Hep B) vaccine by age 2 months. The 2nd dose should be
at least 1 month after the 1st dose. The 3rd dose should be administered at least 4 months
after the 1st dose and at least 2 months after the 2nd
dose, but not before 6 months of age for infants.
Infants born to HBsAg-positive mothers should receive hepatitis B
vaccine and 0.5 mL hepatitis B immune globulin (HBIG) within 12 hours
of birth at separate sites. The 2nd dose is recommended at 1 month of age
and the 3rd dose at 6 months of age.
Infants born to mothers whose HBsAg status is unknown should
receive hepatitis B vaccine within 12 hours of birth. Maternal blood
should be drawn at the time of delivery to determine the mother's HBsAg
status; if the HBsAg test is positive, the infant should receive HBIG as
soon as possible (no later than 1 week of age).
All children and adolescents (through 18 years of age) who have not
been immunized against hepatitis B may begin the series during any visit.
Special efforts should be made to immunize children who were born in or
whose parents were born in areas of the world with moderate or high
endemicity of hepatitis B virus infection.
3 The 4th dose of DTaP (diphtheria and tetanus toxoids and
acellular pertussis vaccine) may be administered as early as 12 months of age,
provided 6 months have elapsed since the 3rd dose and the child is
unlikely to return at age 15 to 18 months. Td (tetanus and diphtheria
toxoids) is recommended at 11 to 12 years of age if at least 5 years have
elapsed since the last dose of DTP, DTaP, or DT. Subsequent routine Td
boosters are recommended every 10 years.
4 Three Haemophilus influenzae type b (Hib) conjugate vaccines are
licensed for infant use. If PRP-OMP (PedvaxHIB or ComVax [Merck]) is
administered at 2 and 4 months of age, a dose at 6 months is not required.
Because clinical studies in infants have demonstrated that using
some combination products may induce a lower immune response to the Hib
vaccine component, DTaP/Hib combination products should not be used
for primary immunization in infants at 2, 4, or 6 months of age unless
FDA-approved for these ages.
5 To eliminate the risk of vaccine-associated paralytic polio (VAPP), an
all-IPV schedule is now recommended for routine childhood polio
vaccination in the United States. All children should receive four doses
of IPV at 2 months, 4 months, 6 to 18 months, and 4 to 6 years. OPV (if
available) may be used only for the following special circumstances:
- Mass vaccination campaigns to control outbreaks of paralytic polio.
- Unvaccinated children who will be traveling in <4 weeks to areas
where polio is endemic or epidemic.
- Children of parents who do not accept the recommended number of
vaccine injections. These children may receive OPV only for the third
or fourth dose or both; in this situation, health care professionals
should administer OPV only after discussing the risk for VAPP with parents or
caregivers.
- During the transition to an all-IPV schedule,
recommendations for the use of remaining OPV supplies in
physicians' offices and clinics have been issued by the
American Academy of Pediatrics (see Pediatrics, December 1999).
6 The 2nd dose of measles, mumps, and rubella (MMR) vaccine is
recommended routinely at 4 to 6 years of age but may be administered
during any visit, provided at least 4 weeks have elapsed since receipt of
the 1st dose and that both doses are administered beginning at or after 12
months of age. Those who have not previously received the second dose
should complete the schedule by the 11- to 12-year-old visit.
7 Varicella (Var) vaccine is recommended at any visit on or after the first
birthday for susceptible children, i.e., those who lack a reliable history of
chickenpox (as judged by a health care professional) and who have not
been immunized. Susceptible persons 13 years of age or older should
receive 2 doses, given at least 4 weeks apart.
8 Hepatitis A (Hep A) is shaded to indicate its recommended use in
selected states and/or regions; consult your local public health authority.
(Also see MMWR Morb. Mortal Wkly Rep. Oct. 01, 1999;48(RR-12); 1-37).
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