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DOSE SHOULD BE GIVEN AT AGE:

First dose

2 months

Minimum age to start vaccination is 6 weeks.

Second dose

4 months

 DTaP and DT are given to children younger than 7 years of age, and Tdap and Td are given to older children and adults.

Third dose

6 months

DT does not contain pertussis, and is used as a substitute for DTaP for children who cannot tolerate pertussis vaccine.

Fourth dose

Between 15 and 18 months

 The fourth dose may be administered as early as age 12 months, provided at least 6 months have elapsed since the third dose.

DOSE SHOULD BE GIVEN AT AGE:

First dose

2 months

Second dose

6 to 8 weeks after first dose

Third dose

6 to 8 weeks after second dose

DOSE SHOULD BE GIVEN AT AGE:

First dose

2 months

Vaccine (Pentacel) is indicated for active immunization against diphtheria, tetanus, pertussis, poliomyelitis and invasive disease due to Haemophilus influenzae type b.

Second dose

4 months

Vaccine is approved for use as a four dose series in children 6 weeks through 4 years of age (prior to 5th birthday).

Third dose

6 months

Fourth dose

15 to 18 months
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DOSE SHOULD BE GIVEN AT AGE:

First dose

2 months

 Minimum age to start vaccine is 6 weeks.

Second dose

4 months

If PRP-OMP (PedvaxHIB or Comvax [HepB-Hib]) is administered at ages 2 and 4 months, a dose at age 6 months is not indicated.

Third dose

6 months

Hiberix should not be used for doses at ages 2, 4, or 6 months for the primary series but can be used as the final dose in children aged 12 months through 4 years.

Fourth dose

Between 12 and 15 months
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DOSE SHOULD BE GIVEN AT AGE:

First dose

19 years and older

Vaccinate persons with any of the following indications and any person seeking protection from hepatitis A virus (HAV) infection:

Behavioral: Men who have sex with men and persons who use injection drugs.

Occupational: Persons working with HAV-infected primates or with HAV in a research laboratory setting.

Medical: Persons with chronic liver disease and persons who receive clotting factor concentrates.

Other: Persons traveling to or working in countries that have high or intermediate endemicity of hepatitis A.

Second dose

6 to 18 months after first dose

Unvaccinated persons who anticipate close personal contact (e.g., household or regular babysitting) with an international adoptee during the first 60 days after arrival in the United States from a country with high or intermediate endemicity should be vaccinated. The first dose of the 2-dose hepatitis A vaccine series should be administered as soon as adoption is planned, ideally 2 or more weeks before the arrival of the adoptee.

Single-antigen vaccine formulations should be administered in a 2-dose schedule at either 0 and 6–12 months (Havrix), or 0 and 6–18 months (Vaqta). If the combined hepatitis A and hepatitis B vaccine (Twinrix) is used, administer 3 doses at 0, 1, and 6 months; alternatively, a 4-dose schedule may be used, administered on days 0, 7, and 21–30, followed by a booster dose at month 12.
DOSE SHOULD BE GIVEN AT AGE:
First dose 12 months+

Administer 2 doses at least 6 months apart.

Second dose

At least 6 months after first dose

HepA is recommended for children aged older than 23 months who live in areas where vaccination programs target older children, who are at increased risk for infection, or for whom immunity against hepatitis A is desired.

DOSE SHOULD BE GIVEN AT AGE:

First dose

Birth

Administer monovalent HepB to all newborns before 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.

Infants who did not receive a birth dose should receive 3 doses of HepB on a schedule of 0, 1, and 6 month.

Second dose

Between 1 month and 2 months

The second dose should be administered at age 1 or 2 months. Monovalent HepB should be used for doses administered before age 6 weeks.

Administration of 4 doses of HepB to infants is permissible when a combination vaccine containing HepB is administered after the birth dose.

Third dose

Between 6 months and 18 months

The final (3rd or 4th) dose in the HepB series should be administered no earlier than age 24 weeks.

DOSE SHOULD BE GIVEN AT AGE:

First Dose

19 years and older

Vaccinate persons with any of the following indications:

Sexually active persons who are not in a long-term, mutually monogamous relationship.

Persons seeking evaluation or treatment for a sexually transmitted disease (STD).

Current or recent injection-drug users; and men who have sex with men.

Healthcare personnel and public-safety workers who are exposed to blood or other potentially infectious body fluids.

Second Dose

1 month after first dose

Vaccinate persons with:

End-stage renal disease, patients receiving hemodialysis, persons with HIV infection, and persons with chronic liver disease.

Household contacts and sex partners of persons with chronic HBV infection; clients and staff members of institutions for persons with developmental disabilities; and international travelers to countries with high or intermediate prevalence of chronic HBV infection.

Third Dose

At least 2 months after second dose

(At least 4 months after first dose)

If the combined hepatitis A and hepatitis B vaccine (Twinrix) is used, administer 3 doses at 0, 1, and 6 months; alternatively, a 4-dose Twinrix schedule, administered on days 0, 7, and 21 to 30, followed by a booster dose at month 12 may be used.

Adult patients receiving hemodialysis or with other immunocompromising conditions should receive 1 dose of 40 μg/mL (Recombivax HB) administered on a 3-dose schedule or 2 doses of 20 μg/mL (Engerix-B) administered simultaneously on a 4-dose schedule at 0,1,2, and 6 months.
DOSE SHOULD BE GIVEN AT AGE:
First dose Minimum 9 years
 Quadrivalent HPV vaccine (HPV4) or bivalent HPV vaccine (HPV2) is recommended for the prevention of cervical precancers and cancers in females.
Second dose 1 to 2 months after first dose HPV4 is recommended for prevention of cervical precancers, cancers, and genital warts in females.
Third dose 6 months after first dose
(24 weeks)		 HPV4 may be administered in a 3-dose series to males aged 9 through 18 years to reduce their likelihood of genital warts.

Administer the second dose 1 to 2 months after the first dose and the third dose 6 months after the first dose (at least 24 weeks after the first dose).

DOSE SHOULD BE GIVEN AT AGE:

First dose

2 months

Minimum age to start vaccine is 6 weeks.

Second dose

4 months

 If 4 or more doses are administered prior to age 4 years an additional dose should be administered at age 4 through 6 years.

Third dose

Between 6 and 18 months

The final dose in the series should be administered on or after the fourth birthday and at least 6 months following the previous dose.

Fourth dose

4 to 6 years

DOSE SHOULD BE GIVEN:

Yearly

(Starting at age 6 months)

For healthy children aged 2 years and older (i.e., those who do not have underlying medical conditions that predispose them to influenza complications), either LAIV or TIV may be used, except LAIV should not be given to children aged 2 through 4 years who have had wheezing in the past 12 months.

Administer 2 doses (separated by at least 4 weeks) to children aged 6 months through 8 years who are receiving seasonal influenza vaccine for the first time or who were vaccinated for the first time during the previous influenza season but only received 1 dose.

Children aged 6 months through 8 years who received no doses of monovalent 2009 H1N1 vaccine should receive 2 doses of 2010–2011 seasonal influenza vaccine.

For healthy nonpregnant persons aged 7 through 18 years (i.e., those who do not have underlying medical conditions that predispose them to influenza complications), either LAIV or TIV may be used.

DOSE SHOULD BE GIVEN AT AGE:

First dose

19 years and older

Adults born before 1957 generally are considered immune to measles and mumps. All adults born in 1957 or later should have documentation of 1 or more doses of MMR vaccine unless they have a medical contraindication to the vaccine, laboratory evidence of immunity to each of the three diseases, or documentation of provider-diagnosed measles or mumps disease. For rubella, documentation of provider-diagnosed disease is not considered acceptable evidence of immunity.

A second dose of MMR vaccine, administered a minimum of 28 days after the first dose, is recommended for adults who 1) have been recently exposed to measles or mumps or are in an outbreak setting; 2) are students in postsecondary educational institutions; 3) work in a healthcare facility; or 4) plan to travel internationally. Persons who received inactivated (killed) measles or mumps vaccine or measles or mumps vaccine of unknown type during 1963–1967 should be revaccinated with 2 doses of MMR vaccine.

Second dose

Minimum of 28 days after first dose

For women of childbearing age, regardless of birth year, rubella immunity should be determined. If there is no evidence of immunity, women who are not pregnant should be vaccinated. Pregnant women who do not have evidence of immunity should receive MMR vaccine upon completion or termination of pregnancy and before discharge from the healthcare facility.

For unvaccinated healthcare personnel born before 1957 who lack laboratory evidence of measles, mumps, and/or rubella immunity or laboratory confirmation of disease, healthcare facilities should 1) consider routinely vaccinating personnel with 2 doses of MMR vaccine at the appropriate interval (for measles and mumps) and 1 dose of MMR vaccine (for rubella), and 2) recommend 2 doses of MMR vaccine at the appropriate interval during an outbreak of measles or mumps, and 1 dose during an outbreak of rubella.

DOSE SHOULD BE GIVEN AT AGE:

First dose

Between 12 and 15 months

 Minimum age to start vaccine is 12 months.

Second dose

4 to 6 years

 The second dose may be administered before age 4 years, provided at least 4 weeks have elapsed since the first dose.

DOSE SHOULD BE GIVEN AT AGE:

19 years and olders

A single dose of meningococcal vaccine is recommended for unvaccinated first-year college students living in dormitories; microbiologists routinely exposed to isolates of Neisseria meningitidis; military recruits; and persons who travel to or live in countries in which meningococcal disease is hyperendemic or epidemic (e.g., the “meningitis belt” of sub-Saharan Africa during the dry season [December through June]), particularly if their contact with local populations will be prolonged. Vaccination is required by the government of Saudi Arabia for all travelers to Mecca during the annual Hajj.

A 2-dose series of meningococcal conjugate vaccine is recommended for adults with anatomic or functional asplenia, or persistent complement component deficiencies. Adults with HIV infection who are vaccinated should also receive a routine 2-dose series. The 2 doses should be administered at 0 and 2 months.

Meningococcal conjugate vaccine, quadrivalent (MCV4) is preferred for adults with any of the preceding indications who are aged 55 years and younger; meningococcal polysaccharide vaccine (MPSV4) is preferred for adults aged 56 years and older. Revaccination with MCV4 every 5 years is recommended for adults previously vaccinated with MCV4 or MPSV4 who remain at increased risk for infection (e.g., adults with anatomic or functional asplenia, or persistent complement component deficiencies).
DOSE SHOULD BE GIVEN AT AGE:
First dose 2 years and older Administer 2 doses of MCV4 at least 8 weeks apart to children aged 2 through 10 years with persistent complement component deficiency and anatomic or functional asplenia, and 1 dose every 5 years thereafter.

Persons with human immunodeficiency virus (HIV) infection who are vaccinated with MCV4 should receive 2 doses at least 8 weeks apart.
Second dose At least 8 weeks after first dose Administer 1 dose of MCV4 to children aged 2 through 10 years who travel to countries with highly endemic or epidemic disease and during outbreaks caused by a vaccine serogroup.

Administer MCV4 to children at continued risk for meningococcal disease who were previously vaccinated with MCV4 or meningococcal polysaccharide vaccine after 3 years if the first dose was administered at age 2 through 6 years.
DOSE SHOULD BE GIVEN AT AGE:
11 years and up Administer MCV4 at age 11 through 12 years with a booster dose at age 16 years.

Administer 1 dose at age 13 through 18 years if not previously vaccinated. Persons who received their first dose at age 13 through 15 years should receive a booster dose at age 16 through 18 years.

Administer 1 dose to previously unvaccinated college freshmen living in a dormitory.

Administer 2 doses at least 8 weeks apart to children aged 2 through 10 years with persistent complement component deficiency and anatomic or functional asplenia, and 1 dose every 5 years thereafter.


Persons with HIV infection who are vaccinated with MCV4 should receive 2 doses at least 8 weeks apart.

Administer 1 dose of MCV4 to children aged 2 through 10 years who travel to countries with highly endemic or epidemic disease and during outbreaks caused by a vaccine serogroup.

Administer MCV4 to children at continued risk for meningococcal disease who were previously vaccinated with MCV4 or meningococcal polysaccharide vaccine after 3 years (if first dose administered at age 2 through 6 years) or after 5 years (if first dose administered at age 7 years or older)

DOSE SHOULD BE GIVEN AT AGE:

First dose

2 months

 PCV is recommended for all children aged younger than 5 years. Administer 1 dose of PCV to all healthy children aged 24 through 59 months who are not completely vaccinated for their age.

Second dose

4 months

A PCV series begun with 7-valent PCV (PCV7) should be completed with 13-valent PCV (PCV13). A single supplemental dose of PCV13 is recommended for all children aged 14 through 59 months who have received an age-appropriate series of PCV7.

Third dose

6 months

 A single supplemental dose of PCV13 is recommended for all children aged 60 through 71 months with underlying medical conditions who have received an age-appropriate series of PCV7. The supplemental dose of PCV13 should be administered at least 8 weeks after the previous dose of PCV7.

Fourth dose

12 to 15 months

 Administer PPSV at least 8 weeks after last dose of PCV to children aged 2 years or older with certain underlying medical conditions, including a cochlear implant.

DOSE SHOULD BE GIVEN AT AGE:

19 years and older

Vaccinate all persons with the following indications:

Chronic lung disease (including asthma); chronic cardiovascular diseases; diabetes mellitus; chronic liver diseases; cirrhosis; chronic alcoholism; functional or anatomic asplenia (e.g., sickle cell disease or splenectomy [if elective splenectomy is planned, vaccinate at least 2 weeks before surgery]); immunocompromising conditions (including chronic renal failure or nephrotic syndrome); and cochlear implants and cerebrospinal fluid leaks. Vaccinate as close to HIV diagnosis as possible.

Other: Residents of nursing homes or long-term care facilities and persons who smoke cigarettes. Routine use of PPSV is not recommended for American Indians/Alaska Natives or persons aged less than 65 years unless they have underlying medical conditions that are PPSV indications. However, public health authorities may consider recommending PPSV for American Indians/Alaska Natives and persons aged 50 through 64 years who are living in areas where the risk for invasive pneumococcal disease is increased.

(In certain cases a second dose may be needed)

One-time revaccination after 5 years is recommended for persons aged 19 through 64 years with chronic renal failure or nephrotic syndrome; functional or anatomic asplenia (e.g., sickle cell disease or splenectomy); and for persons with immunocompromising conditions. For persons aged 65 years and older, one-time revaccination is recommended if they were vaccinated 5 or more years previously and were aged less than 65 years at the time of primary vaccination.

DOSE SHOULD BE GIVEN AT AGE:

First dose

6 to 14 Weeks

 Administer the first dose at age 6 through 14 weeks (maximum age: 14 weeks 6 days). Vaccination should not be initiated for infants aged 15 weeks 0 days or older.

Second dose

4 months

 If Rotarix is administered at ages 2 and 4 months, a dose at 6 months is not indicated.

Third dose

6 months

 The maximum age for the final dose in the series is 8 months 0 days.
DOSE SHOULD BE GIVEN AT AGE:
First dose Between 11 and 18 years The minimum age for Boostrix is 10 years and 11 years for Adacel.

Persons aged 11 through 18 years who have not received Tdap should receive a dose followed by Td booster doses every 10 years thereafter.

Persons aged 7 through 10 years who are not fully immunized against pertussis (including those never vaccinated or with unknown pertussis vaccination status) should receive a single dose of Tdap. Refer to the catch-up schedule if additional doses of tetanus and diphtheria toxoid–containing vaccine are needed.

Tdap can be administered regardless of the interval since the last tetanus and diphtheria toxoid–containing vaccine.

DOSE SHOULD BE GIVEN AT AGE:

First dose

12 to 15 months

 The second dose may be administered before age 4 years, provided at least 3 months have elapsed since the first dose.

Second dose

4 to 6 years

 For children aged 12 months through 12 years the recommended minimum interval between doses is 3 months. However, if the second dose was administered at least 4 weeks after the first dose, it can be accepted as valid.

DOSE SHOULD BE GIVEN AT AGE:

First dose

19 years and up

All adults without evidence of immunity to varicella should receive 2 doses of single-antigen varicella vaccine if not previously vaccinated or a second dose if they have received only 1 dose, unless they have a medical contraindication. Special consideration should be given to those who 1) have close contact with persons at high risk for severe disease (e.g., healthcare personnel and family contacts of persons with immunocompromising conditions or 2) are at high risk for exposure or transmission (e.g., teachers; child-care employees; residents and staff members of institutional settings, including correctional institutions; college students; military personnel; adolescents and adults living in households with children; no pregnant women of childbearing age; and international travelers).

Pregnant women should be assessed for evidence of varicella immunity. Women who do not have evidence of immunity should receive the first dose of varicella vaccine upon completion or termination of pregnancy and before discharge from the healthcare facility. The second dose should be administered 4–8 weeks after the first dose.

Second dose

At least 4 weeks after first dose

 Evidence of immunity to varicella in adults includes any of the following: 1) documentation of 2 doses of varicella vaccine at least 4 weeks apart; 2) U.S.-born before 1980 (although for healthcare personnel and pregnant women, birth before 1980 should not be considered evidence of immunity); 3) history of varicella based on diagnosis or verification of vermicelli by a healthcare provider (for a patient reporting a history of or having an atypical case, a mild case, or both, healthcare providers should seek either an epidemiologic link with a typicalvaricella case or to a laboratory-confirmed case or evidence of laboratory confirmation, if it was performed at the time of acute disease); 4) history of herpes zoster based on diagnosis or verification of herpes zoster by a healthcare provider; or 5) laboratory evidence of immunity or laboratory confirmation of disease.

DOSE SHOULD BE GIVEN AT AGE:

60 years and older

A single dose of zoster vaccine is recommended for adults aged 60 years and older regardless of whether they report a previous episode of herpes zoster. Persons with chronic medical conditions may be vaccinated unless their condition constitutes a contraindication.

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