• Clinical science

Immunization schedule

Abstract

Vaccinations are among the most effective measures of preventive medicine. Especially in infants and young children, they can prevent potentially harmful diseases and hospitalization. Almost no one currently living in the US has seen vaccine-preventable diseases first-hand because their frequency has been dramatically decreased by vaccination. However, they persist worldwide and vaccination programs are essential to prevent future outbreaks of diseases like pertussis, mumps, and measles. In the US, immunization guidelines are published and updated every year by the Centers for Disease Control and Prevention (CDC) and Advisory Committee on Immunization Practices (ACIP). The schedule is designed to protect children when they are most vulnerable and individuals at high-risk before they are exposed to possibly life-threatening diseases.

Furthermore, international travelers are at risk of exposure to vaccine-preventable diseases depending on the region visited and the activities planned. Travelers should therefore seek advice about potential immunizations before departure. At a pretravel consultation, the traveler's prior immunizations, health conditions, and likely exposure to diseases while traveling should be taken into account. Information on travel vaccinations may be found on the CDC and the WHO websites.

ACIP immunization schedule

Infants & Toddlers (age in months)

Toddlers

(age in years)

Childhood

(age in years)

Adolescence

(age in years)

Adult recommendations/protection
Birth 1 2 4 6 9 12 15 18 > 1.5 – < 2 2–3 4–6 7–10 11–12 13–15 16–18

Diphtheria and tetanus toxoids, acellular pertussis (DTaP)

1st dose; minimum age 6 weeks, exception: DTaP-inactivated poliovirus: 4 years 2nd dose 3rd dose Recommended age for catch-up immunization 4th dose Catch-up 5th dose Catch-up
  • Single booster dose of Tdap is recommended
  • In cases of catch-up immunization, the single booster dose of Tdap during adolescence should not be administered.
  • Booster doses of Td every 10 years
  • All pregnant women should receive a single dose of Tdap at 27–36 weeks of gestation regardless of the interval since the last Tdap or Td vaccination.
Rotavirus (RV)

1st dose orally, minimum age 6 weeks

2nd dose

3rd dose

Up to 3 years after completion of series
Hepatitis B (HepB) 1st dose (if infant > 2 kg) 2nd dose Recommended age for catch-up immunization 3rd dose Recommended age for catch-up immunization
  • For at least 20 years
  • Individuals who do not respond to a primary 3-dose hep B vaccine series (i.e., anti-HBs < 10mIU/mL) should complete a 2nd3-dose vaccine series
  • Nonresponders: individuals who have an anti-HBs < 10mIU/mL after 6 doses of hep B vaccine, for whom an acute or chronic HBV infection has been ruled out.
Hemophilus influenza type b (Hib)

1st dose, minimum age 6 weeks

2nd dose

3rd dose

Recommended age for catch-up immunization

3rd and

4th dose: booster dose

Recommended age for catch-up immunization Recommended for high-risk groups Duration of protection unknown; requires further investigation
Pneumococcal vaccines Pneumococcal conjugate (PCV13) 1st dose; minimum age 6 weeks 2nd dose 3rd dose Recommended age for catch-up immunization 4th dose

Recommended age for catch-up immunization

Recommended for high-risk groups
  • Not lifelong
  • For all adults age ≥ 65, PCV13 vaccine is recommended followed by the PPSV23 vaccine 12 months later.
  • For people age < 65 with certain high-risk conditions, sequential PCV13 and PPSV23 are also recommended.
Pneumococcal polysaccharide (PPSV23)

Recommended for high-risk groups, minimum age is 2 years

  • Not lifelong
  • Recommended for all adults ≥ 65 years (see above)
  • For people age < 65 with certain high-risk conditions, sequential PCV13 and PPSV23 are also recommended.
  • For adults age < 65 who are current smokers or have a chronic medical condition, PPSV23 vaccine alone is recommended.
Inactivated poliovirus (IPV) 1st dose, minimum age 6 weeks 2nd dose 3rd dose Recommended age for catch-up immunization 4th dose Recommended age for catch-up immunization (not routinely recommended for persons aged 18 and above) Probably lifelong after completion of series
Influenza (IIV, LIAV) Annual immunization (only IVV), 1 or 2 doses Annual immunization (IVV or LAIV); 1 or 2 doses (2–9 years), 1 dose (> 9 years) For 1 season; a yearly vaccine is recommended for all patients every flu season (Oct–April in northern hemisphere; May–
Hepatitis A (HepA) 2-dose series at 12–24 months (time between doses: 6–18 months) Recommended age for which catch-up is encouraged; recommended for high-risk groups For at least 25 years in adults and 14–20 years in children
Human papillomavirus (HPV) Recommended for high-risk
groups, minimum age 9 years
3-dose series Recommended age for catch-up immunization No evidence of weakened protection over time after completion of series
Meningococcal conjugate

Recommended for high-risk groups, minimum age 6 weeks for Hib-MenCY, 2 months for MenACWY-CRM and 9 months for MenACWY-D

1st dose
  • Booster dose at age 16 if first dose administered before 16th birthday
  • Catch-up immunization recommended for persons aged 13–18 years
Repeat every 5 years in high-risk groups
Meningococcal B
  • MenB vaccine series (2 or 3 doses depending on the brand) may be administered to adolescents and young adults aged 16–23 years to provide short-term protection against most strains of serogroup B meningococcal disease (clinical discretion); minimum age 10 years
  • Recommended for high-risk groups
Repeat every 5 years in high-risk groups
Measles, mumps, rubella (MMR)

Recommended for high-risk groups

(before traveling outside the US, 1st dose 6 to 11 months before departure; reimmunization with 1st dose at 12 to 15 months and 2nd dose 4 weeks later)

1st dose (minimum age for non-high-risk groups: 12 months) Recommended age for catch-up immunization 2nd dose Recommended age for catch-up immunization Probably lifelong
Varicella (VAR) 1st dose Recommended age for catch-up immunization 2nd dose Recommended age for catch-up immunization At least 10–20 years after completion of series
Last updated: September 20, 2016

References:[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]

Immunizations for travel

Below is only a selection of recommendations. Not included are immunizations recommended for the US. For details on recommendations regarding specific countries, further diseases, vaccinations or drugs, see the CDC Yellow Book.

Immunization Schedule Minimum age Risk areas Recommendation Other
Japanese encephalitis (JE)
  • 2 doses, 28 days apart
  • Should be completed at least one week before exposure
  • Booster if last dose ≥ 1 year ago
2 months Southeast Asia
  • Recommended for travelers or US citizens living in endemic areas during periods of JE transmission
  • There is currently no efficacy data available for the vaccine.
Yellow fever
  • 1 dose; at least 10 days before departure
9 months Africa, Central and South America
  • Recommended for all travelers or US citizens living in risk areas
  • Many African and South American countries require proof of vaccination from incoming travelers.
  • One dose provides lifelong protection.
Rabies
  • 3 doses: day 0, 7, and either 21 or 28 (depending on vaccine)
  • Provides protection within ∼ 2 weeks
none Rabies is endemic on all continents except Antarctica. However, several countries are considered rabies-free.
  • May be recommended for travelers visiting countries with a high occurrence of animal rabies and low availability of antirabies biologics (e.g., countries in Africa, South America, and Southeast Asia)
  • Depends also on planned activities (e.g., caving, wildlife work in rabies-epizootic areas)
  • After being bitten by a mammal (e.g., dog, cat, monkey) persons who have been previously vaccinated should get 2 more doses of rabies vaccine (days 0 and 3). Rabies immune globulin is not required.
Typhoid & paratyphoid Fever
  • Inactivated typhoid vaccine: 1 dose
    • At least 2 weeks before traveling
    • Booster dose every 2 years
  • Live typhoid vaccine: 4 doses; day 0, 3, 5, 7);
    • At least 1 week before traveling
    • Booster dose every 5 years
Common in most developing countries, especially in Southern Asia
  • Recommended for travelers with exposure to potentially contaminated foods and beverages
  • Persons with intimate exposure to a chronic carrier of Salmonella typhi
  • The vaccine can only prevent illness in about ¾ of cases.

Meningococcal Disease

  • Children at 2 months of age: MenACWY-CRM as a 4-dose series at 2, 4, 6, and 12 months of age
  • Children at 7–23 months of age: MenACWY-CRM or MenACWY-D as a 2-dose series
  • Travelers 2–56 years: 1 dose MenACWY-CRM or MenACWY-D
  • Travelers > 56 years: 1 dose of meningococcal polysaccharide vaccine (groups A, C, Y, W combined)
2 months Sub-Saharan Africa
  • A quadrivalent meningococcal conjugate vaccination (e.g., MenACWY-CRM or MenACWY-D; protects against serogroups A, C, W, and Y) is recommended for persons traveling or residing in hyperendemic or epidemic countries who are in close contact with natives.
  • Travelers aged ≥ 2 years going to Saudi Arabia on a pilgrimage to Mecca are required by the Saudi government to provide proof of vaccination with a quadrivalent meningococcal vaccine in the last 3 years. Documentation of 2 doses of a meningococcal vaccine against serogroup A is required for travelers aged 3 months to 2 years.

References:[20][21][22][23][24][25][26][27][28][29]