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Catch-up immunization schedule for children age 4 months through 6 years who start late or who are more than 1 month behind – United States, 2023

Catch-up immunization schedule for children age 4 months through 6 years who start late or who are more than 1 month behind – United States, 2023
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 (HepB)* Birth
  • 4 weeks
  • 8 weeks and at least 16 weeks after first dose
  • Minimum age for the final dose is 24 weeks
    
Rotavirus (RV) 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 (DTaP)Δ 6 weeks
  • 4 weeks
  • 4 weeks
  • 6 months
  • 6 months
Haemophilus influenzae type b (Hib)◊ 6 weeks
  • No further doses needed if first dose was administered at age 15 months or older
  • No further doses needed if previous dose was administered at age 15 months or older
  • 8 weeks (as final dose)
    • This dose is only necessary for children age 12 through 59 months who received 3 doses before the first birthday
  
  • 4 weeks if first dose was administered before the first birthday
  • 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 (as final dose) if first dose was administered at age 12 through 14 months
  • 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 first birthday, and second dose was administered at younger than 15 months;
    • or
    • If both doses were PedvaxHIB and were administered before the first birthday
Pneumococcal conjugate§ 6 weeks
  • No further doses needed for healthy children if first dose was administered at age 24 months or older
  • No further doses needed for healthy children if previous dose was administered at age 24 months or older
  • 8 weeks (as final dose)
    • This dose is only necessary for children age 12 through 59 months, regardless of risk, or age 60 through 71 months with any risk, who received 3 doses before age 12 months
  
  • 4 weeks if first dose was administered before the first birthday
  • 4 weeks if current age is younger than 12 months and previous dose was administered before age 7 months
  • 8 weeks (as final dose for healthy children) if first dose was administered at the first birthday or after
  • 8 weeks (as final dose for healthy children)
    • If previous dose was administered between 7 and 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
Inactivated poliovirus (IPV)¥ 6 weeks
  • 4 weeks
  • 4 weeks if current age is younger than 4 years
  • 6 months (minimum age 4 years for final dose)
  
  • 6 months (as final dose) if current age is 4 years or older
Measles, mumps, and rubella (MMR)‡ 12 months
  • 4 weeks
      
Varicella (VAR)† 12 months
  • 3 months
      
Hepatitis A (HepA)** 12 months
  • 6 months
      
Meningococcal serogroup A, C, W, Y (MenACWY)¶¶

MenACWY-CRM: 2 months

MenACWY-TT: 2 years
  • 8 weeks
  • Refer to footnote ¶¶
  • Refer to footnote ¶¶
  
The above table provides catch-up schedules and minimum intervals between doses for children whose vaccinations have been delayed. A vaccine series does not need to be restarted, regardless of the time that has elapsed between doses. Use this table in conjunction with its footnotes and related UpToDate content regarding the schedule of recommended childhood immunizations for children 0 through 6 years of age in the United States. This schedule is recommended by the Advisory Committee on Immunization Practices (ACIP) and approved by the Centers for Disease Control and Prevention, American Academy of Pediatrics, American Academy of Family Physicians, American College of Obstetricians and Gynecologists, American College of Nurse-Midwives, American Academy of Physician Associates, and National Association of Pediatric Nurse Practitioners.
  • 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.
  • 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, refer to ACIP's General Best Practice Guidelines for Immunizations.
  • For information about precautions and contraindications, refer to https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/contraindications.html.
  • Report clinically significant adverse events to the Vaccine Adverse Event Reporting System (VAERS) online at https://vaers.hhs.gov or by telephone, 800-822-7967.
  • For information regarding vaccination in the setting of a vaccine-preventable disease outbreak, contact your state or local health department.

anti-HBs: hepatitis B surface antibody; HBsAg: hepatitis B surface antigen; MenACWY-CRM: Menveo; MenACWY-D: Menactra; MenACWY-TT: MenQuadfi; mIU: milli-international units; MMWR: Morbidity and Mortality Weekly Report; PRP-T: polyribosylribitol phosphate conjugated to tetanus toxoid.

* Hepatitis B (HepB) vaccination
  • Unvaccinated children should complete a 3-dose series at 0, 1 to 2, and 6 months.
  • Special situations:
    • Revaccination is not generally recommended for persons with a normal immune status who were vaccinated as infants, children, adolescents, or adults.
    • Postvaccination serology testing and revaccination (if anti-HBs <10 mIU/mL) is recommended for certain populations, including:
      • Infants born to HBsAg-positive mothers.
      • Persons who are predialysis or on maintenance dialysis.
      • Other immunocompromised persons.
    • For detailed revaccination recommendations, refer to www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/hepb.html.

Rotavirus (RV) vaccination

  • Do not start the series on or after age 15 weeks, 0 days.
  • The maximum age for the final dose is 8 months, 0 days.
  • If any dose in the series is either RV5 (RotaTeq) or unknown, default to a 3-dose series.

Δ Diphtheria and tetanus toxoids, and acellular pertussis (DTaP) vaccination

  • Dose 5 is not necessary if dose 4 was administered at age 4 years or older and at least 6 months after dose 3.

◊ Haemophilus influenzae type b (Hib) vaccination

  • Dose 1 at age 7 through 11 months: Administer dose 2 at least 4 weeks later and dose 3 (final dose) at age 12 through 15 months or 8 weeks after dose 2 (whichever is later).
  • Dose 1 at age 12 through 14 months: Administer dose 2 (final dose) at least 8 weeks after dose 1.
  • Dose 1 before age 12 months and dose 2 before age 15 months: Administer dose 3 (final dose) 8 weeks after dose 2.
  • 2 doses of PedvaxHIB before age 12 months: Administer dose 3 (final dose) at 12 through 59 months and at least 8 weeks after dose 2.
  • 1 dose administered at age 15 months or older: No further doses needed.
  • Unvaccinated at age 15 through 59 months: Administer 1 dose. Unvaccinated is defined by less than the routine series (through age 14 months) or no doses (age 15 months or older).
  • Previously unvaccinated children age 60 months or older who are not considered high risk do not require catch-up vaccination.
  • DTaP-IPV-Hib-HepB (Vaxelis) can be used for catch-up vaccination in children less than age 5 years. Follow the catch-up schedule even if DTaP-IPV-Hib-HepB is used for one or more doses. For detailed information on use of DTaP-IPV-Hib-HepB refer to MMWR Morb Mortal Wkly Rep 2020; 69:136.
  • Special situations:
    • Refer to UpToDate content related to the routine immunization schedule, Hib vaccination, and immunization in the specific high-risk group, and the ACIP recommendations. High-risk conditions and special situations include chemotherapy or radiation treatment, hematopoietic cell transplant, anatomic or functional asplenia (including sickle cell disease), elective splenectomy, HIV infection, immunoglobulin deficiency, and early complement component deficiency.

§ Pneumococcal conjugate (PCV13, PCV15, or PCV20) vaccination

  • Healthy children age 24 through 59 months with any incomplete PCV series: 1 dose PCV15 or PCV20. An incomplete series is defined as not having received all doses in either the recommended series or an age-appropriate catch-up series. Refer to the ACIP recommendations for details.
  • Special situations:
    • High-risk conditions: Refer to separate UpToDate content and the ACIP recommendations for information on pneumococcal vaccination in children with high-risk conditions. High-risk conditions include functional or anatomic asplenia (eg, sickle cell disease and other hemoglobinopathies, congenital or acquired asplenia or splenic dysfunction); congenital or acquired immunodeficiencies; HIV infection; nephrotic syndrome; chronic kidney disease; on maintenance dialysis; malignant neoplasms, leukemias, lymphomas, Hodgkin disease, multiple myeloma, and other diseases treated with chemotherapy and/or radiation therapy; iatrogenic immunosuppression (eg, solid organ transplantation, long-term systemic glucocorticoids, tumor necrosis alpha inhibitors [eg, etanercept, infliximab], radiation therapy); cerebrospinal fluid leak; cochlear implant; chronic heart disease (particularly cyanotic congenital heart disease, cardiac failure, and cardiomyopathy); chronic lung disease (including moderate-to-severe persistent asthma); diabetes mellitus; and chronic liver disease.
    • Children with high-risk conditions should receive at least one dose of PCV20 or they should receive the polysaccharide vaccine (PPSV23).

¥ Inactivated poliovirus (IPV) vaccination

  • In the first 6 months of life, use minimum ages and intervals only for travel to a polio-endemic region or during an outbreak.
  • 4 or more doses of IPV can be administered before the fourth birthday when a combination vaccine containing IPV is used. However, a dose is still recommended after the fourth birthday and at least 6 months after the previous dose.
  • Series containing oral polio vaccine (OPV), either mixed OPV-IPV or OPV-only series:
    • Total number of doses needed to complete the series is the same as that recommended for the United States IPV schedule. Refer to MMWR Morb Mortal Wkly Rep 2017; 66:23.
    • Only trivalent OPV (tOPV) counts toward the United States vaccination requirements.
      • Doses of OPV administered before April 1, 2016, should be counted (unless specifically noted as administered during a campaign).
      • Doses of OPV administered on or after April 1, 2016, should not be counted.
      • For guidance to assess doses documented as "OPV," refer to MMWR Morb Mortal Wkly Rep 2017; 66:180.

‡ Measles, mumps, and rubella (MMR) vaccination

  • Unvaccinated children: 2-dose series at least 4 weeks apart.

† Varicella (VAR) vaccination

  • The minimum interval between the 2 doses is 3 months.

** Hepatitis A (HepA) vaccination

  • Unvaccinated children should complete a 2-dose series (minimum interval: 6 months).
  • Persons who previously received 1 dose at age 12 months or older should receive dose 2 at least 6 months after dose 1.

¶¶ Meningococcal serogroup A, C, W, Y (MenACWY) vaccination

  • Special situations:
    • Refer to UpToDate content related to the routine immunization schedule, meningococcal vaccination, and immunization in the specific high-risk condition, and the ACIP recommendations. High-risk conditions and conditions that increase the risk of disease include anatomic or functional asplenia (including sickle cell disease), HIV infection, persistent complement component deficiency, complement inhibitor (eg, eculizumab, ravulizumab) use, and travel to countries with hyperendemic or epidemic meningococcal disease, including countries in the African meningitis belt or during the Hajj (refer to wwwnc.cdc.gov/travel).
    • MenACWY-CRM (Menveo) has two formulations: lyophilized and liquid. The liquid formulation should not be used before age 10 years.
Adapted from: Centers for Disease Control and Prevention. Immunization schedules. Available at: www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html (Accessed on February 17, 2023).
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