CDC-Data-2025/other_reports/Vaccine Schedule 2025/CDC 0-18yrs Immunization Schedule 2025_djvu.txt

UNITED STATES 


Recommended Child and Adolescent Immunization Schedule 
for ages 18 years or younger 


Vaccines and Other Immunizing Agents in the Child and Adolescent Immunization Schedule* 


2025 


How to use the child and adolescent immunization 
Respiratory syncytial virus monoclonal antibody (Nirsevimab) RSV-mAb Beyfortus 
schedule 
COVID-19 vaccine IvCOV-mRNA Comirnaty/Pfizer-BioNTech 1 2 3 4 5 6 
COVID-19 Vaccine 
= Determine Determine Assess need Review Review Review new or 
ee ee recommended recommended for additional vaccine types, contraindications updated ACIP 
: vaccine byage __ interval forcatch- recommended _ frequencies, and precautions guidance 
1vCOV-aPS Novavax COVID-19 Vaccine (Table 1) up vaccination vaccines intervals, and for vaccine types (Addendum) 
: - (Table 2) by medical considerations (Appendix) 
Dengue vaccine DEN4CYD Dengvaxia condition or for special 
Diphtheria, tetanus, and acellular pertussis vaccine DTaP Daptacel other indication — situations 
Infanrix (Table 3) (Notes) 
Haemophilus influenzae type b vaccine Hib (PRP-T) ActHIB 
Hiberix 
Hib (PRP-OMP) —— PedvaxHIB Recommended by the Advisory Committee on Immunization Practices (www.cdc.gov/acip/index. 
Hepatitis A vaccine HepA Havrix html) and approved by the Centers for Disease Control and Prevention (www.cdc.gov), American 
Vaqta Academy of Pediatrics (www.aap.org), American Academy of Family Physicians (www.aafp.org), 
Hepatitis B vaccine HepB Engerix-B American College of Obstetricians and Gynecologists (www.acog.org), American College of Nurse- 
; = Recombivax HB Midwives (www.midwife.org), American Academy of Physician Associates (www.aapa.org), and 
Human papillomavirus vaccine nv Gardasil National Association of Pediatric Nurse Practitioners (www.napnap.org). 
Influenza vaccine (inactivated: egg-based) IIV3 Multiple 
Influenza vaccine (inactivated: cell-culture) ccllV3 Flucelvax Report 
Influenza vaccine (live, attenuated) LAIV3 FluMist * Suspected cases of reportable vaccine-preventable diseases or outbreaks to your state or local health 
Measles, mumps, and rubella vaccine MMR M-M-R II department 
Priorix az bos ‘ . 
ICT ts OeSTe TIE USC GON[SSIEW(CA NUN EIZET MenACWY-CRM  Menveo ° pens Gabe pete pes . the Vaccine Adverse Event Reporting System (VAERS) at 
MenACWY-TT MenQuadfi : ial 
Meningococcal serogroup B vaccine MenB-4C Bexsero Questions or comments 
MenB-FHbp Trumenba Contact www.cdc.gov/cdc-info or 800-CDC-INFO (800-232-4636), in English or Spanish, 8 a.m.-8 p.m. ET, 
Meningococcal serogroup A, B, C, W, Y vaccine MenACWY-TT/ Penbraya Monday through Friday, excluding holidays. 
MenB-FHbp 
nipexiogeine . . Mines siiinsss Download the CDC Vaccine Schedules app for providers at 
Pneumococcal conjugate vaccine PCV15 Vaxneuvance ‘ i 
PCV20 Previar20 ‘anja Www.cdc.gov/vaccines/hcp/imz-schedules/app.html 
Pneumococcal polysaccharide vaccine PPSV23 Pneumovax 23 
Poliovirus vaccine (inactivated) IPV Ipol Helpful information 
Respiratory syncytial virus vaccine RSV Abrysvo * Complete Advisory Committee on Immunization Practices (ACIP) recommendations: 
Rotavirus vaccine RV1 Rotarix www.cdc.gov/acip-recs/hcp/vaccine-specific/index.html 
RV5 RotaTeq ° ACIP Shared Clinical Decision-Making Recommendations: 
Tetanus, diphtheria, and acellular pertussis vaccine Tdap Adacel www.cdc.gov/acip/vaccine-recommendations/shared-clinical-decision-making.html 
Boostrix * General Best Practice Guidelines for Immunization (including contraindications and precautions): 
Tetanus and diphtheria vaccine Td Tenivac www.cdc.gov/vaccines/hcp/acip-recs/general-recs/index.html 
. . iiras ¢ Vaccine information statements: 
Varicella vaccine VAR Varivax 


Combination vaccines (use combination vaccines instead of separate injections when appropriate) 


Ps : hea : 
DTaP, hepatitis B, and inactivated poliovirus vaccine DTaP-HepB-IPV Pediarix neal forthe aaa as betaine rie Scan QR code 
DTaP i ‘ated DOloul ae PaWGhail 6 . DTaP-IPV/Hib p, | including case identification and outbreak response): for access to 

aP, inactivated poliovirus, and Haemophilus influenzae type b vaccine a /Hi entacel www.cdc.gov/surv-manual/php/ 
DTaP and inactivated poliovirus vaccine DTaP-IPV Kinrix ienab 
Quadracel 
DTaP, inactivated poliovirus, Haemophilus influenzae type b, and DTaP-IPV-Hib- Vaxelis 
hepatitis B vaccine HepB | | U.S. CENTERS FOR DISEASE 
Measles, mumps, rubella, and varicella vaccine MMRV ProQuad CONTROL AND PREVENTION 

*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. 


CS310020-E 


11/21/2024 


www.cdc.gov/vaccines/hcp/vis/index.html 


These recommendations must be read with the notes that follow. For those who fall behind or start late, provide catch-up vaccination at the earliest opportunity as indicated by the green bars. 
To determine minimum intervals between doses, see the catch-up schedule (Table 2). 


Respiratory syncytial virus 
(RSV-mAb [Nirsevimab]) 


Hepatitis B (HepB) 


Rotavirus (RV): RV1 (2-dose series), 
RV5 (3-dose series) 


Diphtheria, tetanus, acellular pertussis 
(DTaP <7 yrs) 


Haemophilus influenzae type b (Hib) 


Pneumococcal conjugate 
(PCV15, PCV20) 


Inactivated poliovirus (IPV) 


COVID-19 (1vCOV-mRNA, 1vCOV-aPS) 


Influenza (IIV3, ccllV3) 


Influenza (LAIV3) 


Measles, mumps, rubella (MMR) 


Varicella (VAR) 


Hepatitis A (HepA) 


Tetanus, diphtheria, acellular pertussis 
(Tdap =7 yrs) 


Human papillomavirus (HPV) 


Meningococcal (MenACWY-CRM =2 mos, 
MenACWY-TT =2years) 


Meningococcal B 
(MenB-4C, MenB-FHbp) 


Respiratory syncytial virus vaccine 
(RSV [Abrysvo]) 


Dengue (DEN4CYD: 9-16 yrs) 
Mpox 


Range of recommended ages 
for catch-up vaccination 


Range of recommended ages 
for all children 


1 dose (8 through 19 months), See Notes 


See Notes 


See Notes 


See Notes 


Recommended vaccination can 
begin in this age group 


Range of recommended ages 
for certain high-risk groups or 
populations 


See Notes 


Seasonal administration 
during pregnancy (See Notes) 


Seropositive in endemic 
dengue areas (See Notes) 


No Guidance/ 
Not Applicable 


Recommended vaccination based 
on shared clinical decision-making 


Page 2 


Table 2 


Recommended Catch-up Immunization Schedule for Children and Adolescents Who Start Late or Who Are More 
than 1 Month Behind, United States, 2025 


The table below 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 the section appropriate for the child’s age. Always use this table in conjunction with Table 1 and the Notes that follow. 


Vaccine 
Hepatitis B 


Rotavirus 


Diphtheria, tetanus, and 
acellular pertussis 


Haemophilus influenzae 
type b 


Pneumococcal conjugate 


Inactivated poliovirus 


Measles, mumps, rubella 
Varicella 

Hepatitis A 
Meningococcal ACWY 


Children and adolescents age 7 through 18 years 


Meningococcal ACWY 


Tetanus, diphtheria; 
tetanus, diphtheria, and 
acellular pertussis 


Human papillomavirus 


Hepatitis A 
Hepatitis B 
Inactivated poliovirus 


Measles, mumps, rubella 
Varicella 


Dengue 


Minimum Age for 


Borel Dose 1 to Dose 2 

Birth 4 weeks 

6 weeks 4 weeks 

Maximum age for first 

dose is 14 weeks, 6 days. 

6 weeks 4 weeks 

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. 

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 was administered before 
the 1st birthday 
8 weeks (as final dose for healthy 
children) 
if first dose was administered at the 
1st birthday or after 

6 weeks 4 weeks 

12 months 4 weeks 

12 months 3 months 

12 months 6 months 

2months MenACWY-CRM 8 weeks 

2 years MenACWY-TT 

Not applicable (N/A) 8 weeks 

7 years 4weeks 

9 years Routine dosing intervals are 
recommended. 

N/A 6 months 

N/A 4 weeks 

N/A 4 weeks 

N/A 4 weeks 

N/A 3 months if younger than age 13 years. 
4 weeks if age 13 years or older 

9 years 6 months 


Children age 4 months through 6 years 
Minimum Interval Between Doses 
Dose 2 to Dose 3 
8 weeks and at least 16 weeks after first dose 
minimum age for the final dose is 24 weeks 


4 weeks 
maximum age for final dose is 8 months, 0 days 


4 weeks 


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 


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 was administered at <7 months old 
8 weeks (as final dose for healthy children) 

if previous dose was administered 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 


4 weeks 

if current age is <4 years 

6 months (as final dose) 

if current age is 4 years or older 


See Notes 


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 


8 weeks and at least 16 weeks after first dose 


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. 


6 months 


Dose 3 to Dose 4 Dose 4 to Dose 5 


6 months 

A fifth dose is not necessary 

if the fourth dose was 
administered at age 4 years or 
older and at least 6 months 
after dose 3 


6 months 


8 weeks (as final dose) 

This dose only necessary 

for children age 12 through 

59 months who received 3 doses 
before the 1st birthday. 


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. 


6 months (minimum age 4 years 
for final dose) 


See Notes 


6 months 

if first dose of DTaP/DT was 
administered before the 1st 
birthday 


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. 


Page 3 


aF-]e)(-"eM Recommended Child and Adolescent Immunization Schedule by Medical Indication, United States, 2025 


Always use this table in conjunction with Table 1 and the Notes that follow. Medical conditions are often not mutually exclusive. If multiple conditions are present, refer to guidance in all relevant 
columns. See Notes for medical conditions not listed. 


HIV infection CD4 Asplenia or 
Vaccine percentage and count? persistent Kidney failure, 
and other Immunocompromised CSF leak or complement End-stage 
immunizing (excluding HIV <15%or | =>15% and cochlear component Heart disease or renal disease Chronic liver 
agents Pregnancy infection) <200/mm? | =200/mm? implant deficiencies chronic lung disease or on dialysis disease Diabetes 


RSV-mAb 1 dose depending on maternal 1 dose depending on maternal 


2nd RSV season 2nd RSV season for chronic 
(nirsevimab) RSV vaccination status (See Notes) lung disease (See Notes) RSV vaccination status (See Notes) 


Hepatitis B 


Rotavirus 


DTaP 


DTaP/Td. 
oe Tdap: 1 dose each pregnancy 


Hib See Notes See Notes 


Pneumococcal 


IPV 


Influenza Solid organ transplant: 
inactivated 18yrs (See Notes) 


LAIV3 
MMR 
VAR 


Hepatitis A 


HPV 3-dose series (See Notes) 


MenB 
RSV (Abrysvo) Seasonal administration 
¥ (See Notes) 
Dengue 
Mpox See Notes 
Recommended for all age- Not recommended for all children, Recommended for all age-eligible Precaution: Might be Contraindicated or not No Guidance/ 
eligible children who lack but recommended for some children, and additional doses may be indicated if benefit of recommended Not Applicable 
documentation of a complete children based on increased risk for necessary based on medical condition protection outweighs *Vaccinate after pregnancy, 
vaccination series or severe outcomes from disease or other indications. See Notes. risk of adverse reaction if indicated 


a. For additional information regarding HIV laboratory parameters and use of live vaccines, see the General Best Practice Guidelines for Immunization, 
“Altered Immunocompetence,’ at www.cdc.gov/vaccines/hcp/acip-recs/general-recs/immunocompetence.html and Table 4-1 (footnote J) at b. Severe Combined Immunodeficiency 
www.cdc.gov/vaccines/hcp/acip-recs/general-recs/contraindications.html. 


c. LAIV3 contraindicated for children 2-4 years of age with 
asthma or wheezing during the preceding 12 months 


Page 4 


| Notes | Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger, United States, 2025 


For vaccination recommendations for persons ages 
19 years or older, see the Recommended 
Adult Immunization Schedule, 2025. 


Additional information 


¢ For calculating intervals between doses, 4 weeks = 28 days. 
Intervals of >4 months are determined by calendar months. 


e 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 3-2, Recommended and minimum ages and 
intervals between vaccine doses, in General Best Practice 
Guidelines for Immunization at www.cdc.gov/vaccines/hcp/ 
acip-recs/general-recs/timing.html. 


¢ Information on travel vaccination requirements and 
recommendations is available at 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 at www.cdc.gov/vaccines/hcp/acip-recs/ 
general-recs/immunocompetence.html, and Immunization in 
Special Clinical Circumstances (In: Kimberlin DW, Barnett ED, 
Lynfield Ruth, Sawyer MH, eds. Red Book: 2021-2024 Report 
of the Committee on Infectious Diseases. 32nd ed. Itasca, IL: 
American Academy of Pediatrics; 2021:72-86). 


¢ 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 vaccines included in 
the child and adolescent vaccine schedule are covered by 
VICP except dengue, PPSV23, RSV, Mpox and COVID-19 
vaccines. Mpox and COVID-19 vaccines are covered by the 
Countermeasures Injury Compensation Program (CICP). For 
more information, see www.hrsa.gov/vaccinecompensation 
or www.hrsa.gov/cicp. 


COVID-19 vaccination 


(minimum age: 6 months [Moderna and Pfizer-BioNTech COVID-19 vaccines], 12 years [Novavax COVID-19 Vaccine]) 


Routine vaccination 
Age 6 months-4 years 


All vaccine doses should be from the same manufacturer. 
¢ Unvaccinated: 

-2 doses 2024-25 Moderna at 0, 4-8 weeks 

-3 doses 2024-25 Pfizer-BioNTech at 0, 3-8, and at least 
8 weeks after dose 2 

¢ Incomplete initial vaccination series before 2024-25 
vaccine with: 

- 1 dose Moderna: complete initial series with 1 dose 
2024-25 Moderna 4-8 weeks after most recent dose 

-1 dose Pfizer-BioNTech: complete initial series with 2 doses 
2024-25 Pfizer-BioNTech 8 weeks apart (administer dose 1 
3-8 weeks after most recent dose). 

- 2 doses Pfizer-BioNTech: complete initial series with 1 dose 
2024-25 Pfizer-BioNTech at least 8 weeks after the most 
recent dose. 

¢ Completed initial vaccination series before 2024-25 
vaccine with: 

-2 or more doses Moderna: 1 dose 2024-25 Moderna at 
least 8 weeks after the most recent dose. 

-3 or more doses Pfizer-BioNTech: 1 dose 2024-25 Pfizer- 
BioNTech at least 8 weeks after the most recent dose. 


Age 5-11 years 

¢ Unvaccinated: 1 dose 2024-25 Moderna or Pfizer-BioNTech 

¢ Previously vaccinated before 2024-25 vaccine with 1 or 
more doses Moderna or Pfizer-BioNTech: 1 dose 2024-25 
Moderna or Pfizer-BioNTech at least 8 weeks after the most 
recent dose. 


Age 12-18 years 
¢ Unvaccinated: 
- 1 dose 2024-25 Moderna or Pfizer-BioNTech 
-2 doses 2024-25 Novavax at 0, 3-8 weeks 
¢ Previously vaccinated before 2024-25 vaccine with: 

- 1 or more doses Moderna or Pfizer-BioNTech: 1 dose 
2024-25 Moderna or Novavax or Pfizer-BioNTech at least 
8 weeks after the most recent dose. 

- 1 dose Novavax: 1 dose 2024—25 Novavax 3-8 weeks after 
most recent dose. If more than 8 weeks after most recent 
dose, administer 1 dose 2024-25 Moderna or Novavax or 
Pfizer-BioNTech. 

-2 or more doses Novavax: 1 dose 2024—25 Moderna or 
Novavax or Pfizer-BioNTech at least 8 weeks after the most 
recent dose. 


Special situation 
Persons who are moderately or severely immunocompromised. 


Age 6 months-4 years 


Use vaccine from the same manufacturer for all doses (initial 
vaccination series and additional doses*). 


¢ Unvaccinated: 

-4 doses (3-dose initial series 2024-25 Moderna at 0, 
4 weeks, and at least 4 weeks after dose 2, followed by 
1 dose 2024-25 Moderna 6 months later [minimum interval 
2 months]).May administer additional doses.* 

-4 doses (3-dose initial series 2024-25 Pfizer-BioNTech 
at 0, 3 weeks, and at least 8 weeks after dose 2, followed by 
1 dose 2024-25 Pfizer-BioNTech 6 months later [minimum 
interval 2 months]). May administer additional doses.* 


¢ Incomplete initial 3-dose vaccination series before 
2024-25 vaccine: 


- Previous vaccination with Moderna 


- 1 dose Moderna: complete initial series with 2 doses 
2024-25 Moderna at least 4 weeks apart (administer dose 1 
4 weeks after most recent dose), followed by 1 dose 2024- 
25 Moderna 6 months later (minimum interval 2 months). 
May administer additional doses of Moderna.* 

-2 doses Moderna: complete initial series with 1 dose 
2024-25 Moderna at least 4 weeks after most recent dose, 
followed by 1 dose 2024-25 Moderna 6 months later 
(minimum interval 2 months). May administer additional 
doses of Moderna.* 

- Previous vaccination with Pfizer-BioNTech 


-1 dose Pfizer-BioNTech: complete initial series with 
2 doses 2024-25 Pfizer-BioNTech at least 8 weeks apart 
(administer dose 1 3 weeks after most recent dose), 
followed by 1 dose 2024-25 Pfizer-BioNTech 6 months later 
(minimum interval 2 months). May administer additional 
doses of Pfizer-BioNTech.* 

- 2 doses Pfizer-BioNTech: complete initial series with 
1 dose 2024-25 Pfizer-BioNTech at least 8 weeks after 
most recent dose, followed by 1 dose 2024-25 Pfizer- 
BioNTech 6 months later (minimum interval 2 months). May 
administer additional doses of Pfizer-BioNTech.* 


Page 5 


| Notes | Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger, United States, 2025 


COVID-19 vaccination - continued 


¢ Completed initial 3-dose vaccination series before 

2024-25 vaccine with: 

-3 or more doses Moderna: 2 doses 2024-25 Moderna 
6 months apart (minimum interval 2 months). Administer 
dose 1 at least 8 weeks after the most recent dose. May 
administer additional doses of Moderna.* 

-3 or more doses Pfizer-BioNTech: 2 doses 2024-25 Pfizer- 
BioNTech 6 months apart (minimum interval 2 months). 
Administer dose 1 at least 8 weeks after the most recent 
dose. May administer additional doses of Pfizer-BioNTech.* 


Age 5-11 years 


Use vaccine from the same manufacturer for all doses in the initial 


vaccination series. 


¢ Unvaccinated: 

-4 doses (3-dose initial series 2024-25 Moderna at 0, 
4 weeks, and at least 4 weeks after dose 2, followed by 
1 dose 2024-25 Moderna or Pfizer-BioNTech 6 months later 
[minimum interval 2 months]). May administer additional 
doses.* 

-4 doses (3-dose initial series 2024-25 Pfizer-BioNTech 
at 0, 3 weeks, and at least 4 weeks after dose 2, followed by 
1 dose 2024-25 Moderna or Pfizer-BioNTech 6 months later 
[minimum interval 2 months]). May administer additional 
doses.* 


¢ Incomplete initial 3-dose vaccination series before 
2024-25 vaccine: 
- Previous vaccination with Moderna 

- 1 dose Moderna: complete initial series with 2 doses 
2024-25 Moderna at least 4 weeks apart (administer dose 
1 4 weeks after most recent dose), followed by 1 dose 
2024-25 Moderna or Pfizer-BioNTech 6 months later 
(minimum interval 2 months). May administer additional 
doses of Moderna or Pfizer-BioNTech.* 

-2 doses Moderna: complete initial series with 1 dose 
2024-25 Moderna at least 4 weeks after most recent 
dose, followed by 1 dose 2024-25 Moderna or Pfizer- 
BioNTech 6 months later (minimum interval 2 months). 
May administer additional doses of Moderna or Pfizer- 
BioNTech.* 


- Previous vaccination with Pfizer-BioNTech 

- 1 dose Pfizer-BioNTech: complete initial series with 
2 doses 2024-25 Pfizer-BioNTech at least 4 weeks 
apart (administer dose 1 3 weeks after most recent 
dose), followed by 1 dose 2024-25 Moderna or Pfizer- 
BioNTech 6 months later (minimum interval 2 months). 
May administer additional doses of Moderna or Pfizer- 
BioNTech.* 

- 2 doses Pfizer-BioNTech: complete initial series with 
1 dose 2024-25 Pfizer-BioNTech at least 4 weeks after 
most recent dose, followed by 1 dose 2024-25 Moderna 
or Pfizer-BioNTech 6 months later (minimum interval 
2 months). May administer additional doses of Moderna or 
Pfizer-BioNTech.* 


¢ Completed initial 3-dose vaccination series before 


2024-25 vaccine with: 

-3 or more doses Moderna or 3 or more doses Pfizer- 
BioNTech: 2 doses 2024-25 Moderna or Pfizer-BioNTech 
6 months apart (minimum interval 2 months). Administer 
dose 1 at least 8 weeks after the most recent dose. May 
administer additional doses of Moderna or Pfizer-BioNTech.* 


Age 12-18 years 


Use vaccine from the same manufacturer for all doses in the initial 
vaccination series. 


¢ Unvaccinated: 


-4 doses (3-dose initial series Moderna at 0, 4 weeks, and 
at least 4 weeks after dose 2, followed by 1 dose 2024-25 
Moderna or Novavax or Pfizer-BioNTech 6 months later 
[minimum interval 2 months]). May administer additional 
doses of Moderna or Novavax or Pfizer-BioNTech.* 

-4 doses (3-dose initial series Pfizer-BioNTech at 0, 3 weeks, 
and at least 4 weeks after dose 2, followed by 1 dose 2024- 
25 Moderna or Novavax or Pfizer-BioNTech 6 months later 
[minimum interval 2 months]). May administer additional 
doses of Moderna or Novavax or Pfizer-BioNTech.* 

-3 doses (2-dose initial series Novavax at 0, 3 weeks, 
followed by 1 dose Moderna or Novavax or Pfizer-BioNTech 
6 months later [minimum interval 2 months]). May 
administer additional doses of Moderna or Novavax or 
Pfizer-BioNTech.* 


¢ Incomplete initial vaccination series before 2024-25 
vaccine: 


- Previous vaccination with Moderna 

- 1 dose Moderna: complete initial series with 2 doses 
2024-25 Moderna at least 4 weeks apart (administer dose 1 
4 weeks after most recent dose), followed by 1 dose 2024- 
25 Moderna or Novavax or Pfizer-BioNTech 6 months later 
(minimum interval 2 months). May administer additional 
doses of Moderna or Novavax or Pfizer-BioNTech.* 

-2 doses Moderna: complete initial series with 1 dose 
2024-25 Moderna at least 4 weeks after most recent dose, 
followed by 1 dose 2024-25 Moderna or Novavax or Pfizer- 
BioNTech 6 months later (minimum interval 2 months). 
May administer additional doses of Moderna or Novavax or 
Pfizer-BioNTech.* 

- Previous vaccination with Pfizer-BioNTech 

-1 dose Pfizer-BioNTech: complete initial series with 
2 doses 2024-25 Pfizer-BioNTech at least 4 weeks apart 
(administer dose 1 3 weeks after most recent dose), 
followed by 1 dose 2024-25 Moderna or Novavax or Pfizer- 
BioNTech 6 months later (minimum interval 2 months). 
May administer additional doses of Moderna or Novavax or 
Pfizer-BioNTech.* 

- 2 doses Pfizer-BioNTech: complete initial series with 
1 dose 2024-25 Pfizer-BioNTech at least 4 weeks after 
most recent dose, followed by 1 dose 2024-25 Moderna 
or Novavax or Pfizer-BioNTech 6 months later (minimum 
interval 2 months). May administer additional doses of 
Moderna or Novavax or Pfizer-BioNTech.* 

- Previous vaccination with Novavax 

- 1 dose Novavax: complete initial series with 1 dose 
2024-25 Novavax at least 3 weeks after most recent dose, 
followed by 1 dose 2024-25 Moderna or Novavax or Pfizer- 
BioNTech 6 months later (minimum interval 2 months). 
May administer additional doses of Moderna or Novavax or 
Pfizer-BioNTech.* 


Page 6 


| Notes | Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger, United States, 2025 


COVID-19 vaccination - continued Dengue vaccination 


¢ Completed initial 3-dose vaccination series before 

2024-25 vaccine with: 

-3 or more doses Moderna or 3 or more doses Pfizer- 
BioNTech: 2 doses 2024-25 Moderna or Novavax or Pfizer- 
BioNTech 6 months apart (minimum interval 2 months). 
Administer dose 1 at least 8 weeks after the most recent 
dose. May administer additional doses of Moderna or 
Novavax or Pfizer-BioNTech.* 


-2 or more doses Novavax: 2 doses 2024-25 Moderna or 
Novavax or Pfizer-BioNTech 6 months apart (minimum 
interval 2 months). Administer dose 1 at least 8 weeks after 
the most recent dose. May administer additional doses of 
Moderna or Novavax or Pfizer-BioNTech.* 


*Additional doses of 2024-25 COVID-19 vaccine for 
moderately or severely immunocompromised: based on 
shared clinical decision-making and administered at least 

2 months after the most recent dose (see Table 2 at www. 
cdc.gov/vaccines/covid-19/clinical-considerations/interim- 
considerations-us.html#table-02.). For description of moderate 
and severe immunocompromising conditions and treatment, 
see www.cdc.gov/vaccines/covid-19/clinical-considerations/ 
interim-considerations-us.html#immunocompromising- 
conditions-treatment. 


Unvaccinated persons have never received any COVID-19 
vaccine doses. There is no preferential recommendation for 
the use of one COVID-19 vaccine over another when more 
than one recommended age-appropriate vaccine is available. 
Administer an age-appropriate COVID-19 vaccine product for 
each dose. 


For information about transition from age 4 years to age 

5 years or age 11 years to age 12 years during COVID-19 
vaccination series, see Tables 1 and 2 at www.cdc.gov/vaccines/ 
covid-19/clinical-considerations/interim-considerations-us. 
html. 


For information about interchangeability of COVID-19 vaccines, 
see www.cdc.gov/vaccines/covid-19/clinical-considerations/ 
interim-considerations-us.html#Interchangeability. 


Current COVID-19 schedule and dosage formulation available 
at www.cdc.gov/covidschedule. For more information on 
Emergency Use Authorization (EUA) indications for COVID-19 
vaccines, see www.fda.gov/emergency-preparedness-and- 
response/coronavirus-disease-201 9-covid-19/covid-19- 
vaccines. 


(minimum age: 9 years) 


Routine vaccination 

¢ Age 9-16 years living in areas with endemic dengue AND 
have laboratory confirmation of previous dengue infection 
- 3-dose series administered at 0, 6, and 12 months 

e Endemic areas include Puerto Rico, American Samoa, US 
Virgin Islands, Federated States of Micronesia, Republic of 
Marshall Islands, and the Republic of Palau. For updated 
guidance on dengue endemic areas and pre-vaccination 
laboratory testing see www.cdc.gov/mmwr/volumes/70/rr/ 
rr7006a1.htm?s_cid=rr7006a1_w and www.cdc.gov/dengue/ 
index.html 

¢ Dengue vaccine should not be administered to children 
traveling to or visiting endemic dengue areas. 


Diphtheria, tetanus, and pertussis (DTaP) 


vaccination (minimum age: 6 weeks [4 years 
for Kinrix or Quadracel]) 


Routine vaccination 
¢ 5-dose series (3-dose primary series at age 2, 4, and 6 months, 
followed by booster doses at ages 15-18 months and 
4-6 years) 
- Prospectively: Dose 4 may be administered as early as age 
12 months if at least 6 months have elapsed since dose 3. 
- Retrospectively: A 4th dose that was inadvertently 
administered as early as age 12 months may be counted if at 
least 4 months have elapsed since dose 3. 


Catch-up 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. 

¢ For other catch-up guidance, see Table 2. 


Special situations 

¢ Children younger than age 7 years with a contraindication 
specific to the pertussis component of DTaP: May 
administer Td for all recommended remaining doses in place 
of DTaP. Encephalopathy within 7 days of vaccination when 
not attributable to another identifiable cause is the only 
contraindication specific to the pertussis component of DTaP. 
For additional information, see www.cdc.gov/pertussis/hcp/ 
vaccine-recommendations/td-offlabel.html. 

¢ Wound management in children younger than age 7 
years with history of 3 or more doses of tetanus-toxoid- 
containing vaccine: For all wounds except clean and minor 
wounds, administer DTaP if more than 5 years since last 
dose of tetanus-toxoid-containing vaccine. For detailed 
information, see www.cdc.gov/mmwr/volumes/67/rr/ 
rr6702a1.htm. 


Haemophilus influenzae type b vaccination 


(minimum age: 6 weeks) 


Routine vaccination 
¢ ActHIB, Hiberix, Pentacel, or Vaxelis: 4-dose series 
(3-dose primary series at age 2, 4, and 6 months, followed by 
a booster dose* at age 12-15 months) 
- *Vaxelis is not recommended for use as a booster dose. A 
different Hib-containing vaccine should be used for the 
booster dose. 


¢ PedvaxHIB: 3-dose series (2-dose primary series at age 2 and 
4 months, followed by a booster dose at age 12-15 months) 


¢ American Indian and Alaska Native infants: Vaxelis and 
PedvaxHIB preferred over other Hib vaccines for the primary 
series. 


Catch-up vaccination 

¢ Dose 1 at age 7-11 months: Administer dose 2 at least 
4 weeks later and dose 3 (final dose) at age12—15 months or 
8 weeks after dose 2 (whichever is later). 


¢ Dose 1 at age 12-14 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) at least 
8 weeks after dose 2. 


¢ 2 doses of PedvaxHIB before age 12 months: Administer 
dose 3 (final dose) at age12-59 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 15-59 months: Administer 1 dose. 


¢ Previously unvaccinated children age 60 months or 
older who are not considered high risk: Catch-up 
vaccination not required. 


For other catch-up guidance, see Table 2. Vaxelis can be used 
for catch-up vaccination in children younger than age 5 years. 
Follow the catch-up schedule even if Vaxelis is used for one 
or more doses. For detailed information on use of Vaxelis see 
www.cdc.gov/mmwr/volumes/69/wr/mm6905a5.htm. 


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| Notes | Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger, United States, 2025 


Haemophilus influenzae type b vaccination 
- continued 


Special situations 
¢ Chemotherapy or radiation treatment: 
Age 12-59 months 
- Unvaccinated or only 1 dose before age 12 months: 2 doses, 
8 weeks apart 
-2 or more doses before age 12 months: 1 dose at least 
8 weeks after previous dose 
Doses administered within 14 days of starting therapy or during 
therapy should be repeated at least 3 months after therapy 
completion. 


¢ Hematopoietic stem cell transplant (HSCT): 
- 3-dose series 4 weeks apart starting 6 to 12 months after 
successful transplant, regardless of Hib vaccination history 


¢ Anatomic or functional asplenia (including sickle 
cell disease): 
Age 12-59 months 


- Unvaccinated or only 1 dose before age 12 months: 2 doses, 
8 weeks apart 


-2 or more doses before age 12 months: 1 dose at least 
8 weeks after previous dose 


Unvaccinated* persons age 5 years or older 
- 1 dose 


¢ Elective splenectomy: 
Unvaccinated* persons age 15 months or older 


- 1 dose (preferably at least 14 days before procedure) 
¢ HIV infection: 
Age 12-59 months 


- Unvaccinated or only 1 dose before age 12 months: 2 doses, 
8 weeks apart 


-2 or more doses before age 12 months: 1 dose at least 
8 weeks after previous dose 


Unvaccinated* persons age 5-18 years 
-1 dose 


¢ Immunoglobulin deficiency, early component 
complement deficiency, or early component complement 
inhibitor use: 
Age 12-59 months 
- Unvaccinated or only 1 dose before age 12 months: 
2 doses, 8 weeks apart 
-2 or more doses before age 12 months: 
1 dose at least 8 weeks after previous dose 


*Unvaccinated = Less than routine series (through age 
14 months) or no doses (age 15 months or older) 


Hepatitis A vaccination 


(minimum age: 12 months for routine vaccination) 


Routine vaccination 


¢ 2-dose series (minimum interval: 6 months) at age 12- 
23 months 


Catch-up vaccination 


e Unvaccinated persons through age 18 years should 
complete a 2-dose series (minimum interval: 6 months). 


e Persons who previously received 1 dose at age 12 months or 
older should receive dose 2 at least 6 months after dose 1. 


e Adolescents age 18 years or older may receive HepA-HepB 
(Twinrix) as a 3-dose series (0, 1, and 6 months) or 4-dose 
series (3 doses at 0, 7, and 21-30 days, followed by a booster 
dose at 12 months). 


International travel 
¢ Persons traveling to or working in countries with high or 
intermediate endemic hepatitis A (www.cdc.gov/travel/): 

- Infants age 6-11 months: 1 dose before departure; 
revaccinate with 2 doses (separated by at least 6 months) 
between age 12-23 months. 

- Unvaccinated age 12 months or older: Administer dose 
1 as soon as travel is considered. 


Hepatitis B vaccination 
(minimum age: birth) 


Routine vaccination 
¢ Mother is HBsAg-negative 
- 3-dose series at age 0, 1-2, 6-18 months (use monovalent 
HepB vaccine for doses administered before age 
6 weeks) 
- Birth weight =2,000 grams: 1 dose within 24 hours of birth 
if medically stable 
- Birth weight <2,000 grams: 1 dose at chronological age 
1 month or hospital discharge (whichever is earlier and 
even if weight is still <2,000 grams) 
- Infants who did not receive a birth dose should begin 
the series as soon as possible (see Table 2 for minimum 
intervals). 
- Administration of 4 doses is permitted when a combination 
vaccine containing HepB is used after the birth dose. 
- Minimum intervals (see Table 2): when 4 doses 
are administered, substitute “dose 4” for “dose 3” 
in these calculations. 
- Final (3rd or 4th) dose: age 6-18 months 
(minimum age 24 weeks) 


e Mother is HBsAg-positive 

- Birth dose (monovalent HepB vaccine only): administer 
HepB vaccine and hepatitis B immune globulin (HBIG) 
in separate limbs within 12 hours of birth, regardless 
of birth weight. 

- Birth weight <2000 grams: administer 3 additional doses 
of HepB vaccine beginning at age 1 month (total of 4 doses). 

- Final (3rd or 4th) dose: administer at age 6 months 
(minimum age 24 weeks). 

- Test for HBsAg and anti-HBs at age 9-12 months. If HepB 
series is delayed, test 1-2 months after final dose. Do not 
test before age 9 months. 


Page 8 


| Notes | Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger, United States, 2025 


Hepatitis B vaccination - continued 


e Mother is HBsAg-unknown 
If other evidence suggestive of maternal hepatitis B infection 
exists (e.g., presence of HBV DNA, HBeAg-positive, or mother 
known to have chronic hepatitis B infection), manage infant 
as if mother is HBsAg-positive. 
- Birth dose (monovalent HepB vaccine only): 

- Birth weight =2,000 grams: administer HepB vaccine 
within 12 hours of birth. Determine mother’s HBsAg status 
as soon as possible. If mother is determined to be HBsAg- 
positive, administer HBIG as soon as possible (in separate 
limb), but no later than 7 days of age. 

- Birth weight <2,000 grams: administer HepB vaccine 
and HBIG (in separate limbs) within 12 hours of birth. 
Administer 3 additional doses of HepB vaccine beginning 
at age 1 month (total of 4 doses). 

- Final (3rd or 4th) dose: administer at age 6 months 

(minimum age 24 weeks). 

- If mother is determined to be HBsAg-positive or if status 
remains unknown, test for HBsAg and anti-HBs at age 

9-12 months. If HepB series is delayed, test 1-2 months 

after final dose. Do not test before age 9 months. 


Catch-up vaccination 

e Unvaccinated persons should complete a 3-dose series at 
0, 1-2, 6 months. See Table 2 for minimum intervals. 

e Adolescents age 11-15 years may use an alternative 2-dose 
schedule with at least 4 months between doses (adult 
formulation Recombivax HB only). 

e Adolescents age 18 years may receive: 

- Heplisav-B: 2-dose series at least 4 weeks apart 

- PreHevbrio*: 3-dose series at 0, 1, and 6 months 

- HepA-HepB (Twinrix): 3-dose series (0, 1, and 6 months) or 
4-dose series (3 doses at 0, 7, and 21-30 days, followed by a 
booster dose at 12 months). 


Special situations 
e Revaccination is generally not recommended for persons 
with a normal immune status who were vaccinated as infants, 
children, adolescents, or adults. 
¢ Post-vaccination serology testing and revaccination 
(if anti-HBs <10mlU/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, see www.cdc. 
gov/mmwr/volumes/67/rr/rr6701a1.htm. 
*Note: PreHevbrio is not recommended in pregnancy due to 
lack of safety data in pregnant persons. 


Human papillomavirus vaccination 


(minimum age: 9 years) 


Routine and catch-up vaccination 


e HPV vaccination routinely recommended at age 11-12 years 


(can start at age 9 years) and catch-up HPV vaccination 


recommended for all persons through age 18 years if not 


adequately vaccinated. 


e 2- or 3-dose series depending on age at initial vaccination: 


- Age 9-14 years at initial vaccination: 2-dose series at 0, 
6-12 months (minimum interval: 5 months; repeat dose if 


administered too soon) 


- Age 15 years or older at initial vaccination: 3-dose series 
at 0, 1-2 months, 6 months (minimum intervals: dose 1 to 
dose 2 = 4 weeks; dose 2 to dose 3 = 12 weeks; dose 1 to 
dose 3 = 5 months; repeat dose if administered too soon) 


¢ No additional dose recommended when any HPV 
vaccine series of any valency has been completed using 
recommended dosing intervals. 


Special situations 

¢ Immunocompromising conditions, including HIV 
infection: 3-dose series, even for those who initiate 
vaccination at age 9 through 14 years. 


¢ History of sexual abuse or assault: Start at age 9 years 


¢ Pregnancy: Pregnancy testing not needed before 
vaccination; HPV vaccination not recommended until 
after pregnancy; no intervention needed if vaccinated 
while pregnant 


Influenza vaccination 


(minimum age: 6 months [IIV3], 2 years [LAIV3],18 
years [recombinant influenza vaccine, RIV3]) 


Routine vaccination 
e Use any influenza vaccine appropriate for age and health 
status annually: 
- Age 6 months-8 years who have received fewer than 
2 influenza vaccine doses before July 1, 2024, or whose 
influenza vaccination history is unknown: 2 doses, separated 
by at least 4 weeks. Administer dose 2 even if the child turns 
9 years between receipt of dose 1 and dose 2. 
- Age 6 months-8 years who have received at least 
2 influenza vaccine doses before July 1, 2024: 1 dose. 
- Age 9 years or older: 1 dose 
- Age 18 years solid organ transplant recipients receiving 
immunosuppressive medications: high-dose inactivated 
(HD-IIV3) and adjuvanted inactivated (allV3) influenza 
vaccines are acceptable options. No preference over other 
age-appropriate IIV3 or RIV3. 


e For the 2024-25 season, see www.cdc.gov/mmwr/ 
volumes/73/rr/rr7305a1.htm. 


¢ For the 2025-26 season, see the 2025-26 ACIP influenza 
vaccine recommendations. 


Special situations 

* Close contacts (e.g., household contacts) of severely 
immunosuppressed persons who require a protected 
environment: should not receive LAIV3. If LAIV3 is 
given, they should avoid contact with, or caring for such 
immunosuppressed persons for 7 days after vaccination. 


Note: Persons with an egg allergy can receive any influenza 
vaccine (egg-based or non-egg based) appropriate for age and 
health status. 


Page 9 


| Notes | Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger, United States, 2025 


Measles, mumps, and rubella vaccination 


(minimum age: 12 months for routine vaccination) 


Routine vaccination 
e 2-dose series at age 12-15 months, age 4-6 years 


¢ MMR or MMRV* may be administered 


Note: For dose 1 in children age 12-47 months, it is 
recommended to administer MMR and varicella vaccines 
separately. MMRV* may be used if parents or caregivers express 
a preference. 


Catch-up vaccination 

¢ Unvaccinated children and adolescents: 2-dose series at 
least 4 weeks apart* 

¢ The maximum age for use of MMRV* is 12 years. 


Special situations 
¢ International travel 
- Infants age 6-11 months: 1 dose before departure; 
revaccinate with 2-dose series at age 12-15 months 
(12 months for children in high-risk areas) and dose 2 as 
early as 4 weeks later.* 
- Children age 12 months or older: 
- Unvaccinated: 2-dose series (separated by at least 
4 weeks*) before departure 
- Previously received 1 dose: administer dose 2 at least 
4 weeks after dose 1* 
¢ ln mumps outbreak settings, for information about additional 
doses of MMR (including 3rd dose of MMR), see www.cdc. 
gov/mmwr/volumes/67/wr/mm6701a7.htm 
*Note: If MMRV is used, the minimum interval between MMRV 
doses is 3 months. 


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


10 years [MenACWY-TT/MenB-FHbp, Penbraya]) 


Routine vaccination 
* 2-dose series at age 11-12 years; 16 years 


Catch-up vaccination 


e Age 13-15 years: 1 dose now and booster at age 16-18 years 
(minimum interval: 8 weeks) 


¢ Age 16-18 years: 1 dose 


Special situations 

Anatomic or functional asplenia (including sickle cell 
disease), HIV infection, persistent complement 
component deficiency, complement inhibitor 

(e.g., eculizumab, ravulizumab) use: 


¢ Menveo* 

-Dose 1 at age 2 months: 4-dose series (additional 3 doses 
at age 4, 6, and 12 months) 

-Dose 1 at age 3-6 months: 3- or 4-dose series (dose 2 
[and dose 3 if applicable] at least 8 weeks after previous 
dose until a dose is received at age 7 months or older, 
followed by an additional dose at least 12 weeks later 
and after age 12 months) 

-Dose 1 at age 7-23 months: 2-dose series (dose 2 at least 
12 weeks after dose 1 and after age 12 months) 

-Dose 1 at age 24 months or older: 2-dose series 
at least 8 weeks apart 


¢ MenQuadfi 


-Dose 1 at age 24 months or older: 2-dose series at least 
8 weeks apart 


Travel to countries with hyperendemic or epidemic 
meningococcal disease, including countries in the African 
meningitis belt or during the Hajj (www.cdc.gov/travel/): 


¢ Children younger than age 24 months: 
- Menveo* (age 2-23 months) 

- Dose 1 at age 2 months: 4-dose series (additional 3 doses at 
age 4, 6, and 12 months) 

- Dose 1 at age 3-6 months: 3- or 4-dose series (dose 2 
[and dose 3 if applicable] at least 8 weeks after previous 
dose until a dose is received at age 7 months or older, 
followed by an additional dose at least 12 weeks later 
and after age 12 months) 

- Dose 1 at age 7-23 months: 2-dose series (dose 2 at least 
12 weeks after dose 1 and after age 12 months) 


¢ Children age 2 years or older: 1 dose Menveo* 
or MenQuadfi 


First-year college students who live in residential housing 
(if not previously vaccinated at age 16 years or older) or 
military recruits: 1 dose Menveo* or MenQuadfi 


Adolescent vaccination of children who received MenACWY 
prior to age 10 years: 


¢ Children for whom boosters are recommended because 
of an ongoing increased risk of meningococcal disease 
(e.g., those with complement component deficiency, HIV, 
or asplenia): Follow the booster schedule for persons at 
increased risk. 


¢ Children for whom boosters are not recommended 
(e.g., a healthy child who received a single dose for travel 
to a country where meningococcal disease is endemic): 
Administer MenACWY according to the recommended 
adolescent schedule with dose 1 at age 11-12 years and 
dose 2 at age 16 years. 


*Menveo has two formulations: lyophilized and liquid. The liquid 
formulation should not be used before age 10 years. See www. 
cdc.gov/vaccines/vpd/mening/downloads/menveo-single-vial- 
presentation.pdf. 


Note: For MenACWY booster dose recommendations for 
groups listed under “Special situations” and in an outbreak 
setting and additional meningococcal vaccination information, 
see www.cdc.gov/mmwr/volumes/69/rr/rr6909a1.htm. 


Children age 10 years or older may receive a single dose 
of Penbraya as an alternative to separate administration of 
MenACWY and MenB when both vaccines would be given 
on the same clinic day (see “Meningococcal serogroup B 
vaccination” section below for more information). 


Page 10 


| Notes | Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger, United States, 2025 


Meningococcal serogroup B vaccination 
(minimum age: 10 years [MenB-4C, Bexsero; MenB- 


FHbp, Trumenba; MenACWY-TT/MenB-FHbp, 
Penbraya)]) 


Shared clinical decision-making 
¢ Adolescents not at increased risk age 16-23 years 

(preferred age 16-18 years)* based on shared clinical 

decision-making. 

- Bexsero or Trumenba (use same brand for all doses): 
2-dose series at least 6 months apart (if dose 2 is 
administered earlier than 6 months, administer dose 3 
at least 4 months after dose 2) 


*To optimize rapid protection (e.g., for students starting college 
in less than 6 months), a 3-dose series (0, 1-2, 6 months) may be 
administered. 


For additional information on shared clinical decision-making 
for MenB, see www.cdc.gov/vaccines/hcp/admin/downloads/ 
isd-job-aid-scdm-mening-b-shared-clinical-decision-making.pdf 
Special situations 
Anatomic or functional asplenia (including sickle cell 
disease), persistent complement component deficiency, 
complement inhibitor (e.g., eculizumab, ravulizumab) use. 
- Bexsero or Trumenba (use same brand for all doses 
including booster doses) 3-dose series at 0, 1-2, 6 months 
(if dose 2 was administered at least 6 months after dose 1, 
dose 3 not needed; if dose 3 is administered earlier than 
4 months after dose 2, a 4th dose should be administered at 
least 4 months after dose 3) 


For MenB booster dose recommendations for groups listed 
under “Special situations” and in an outbreak setting and 
additional meningococcal vaccination information, see 
www.cdc.gov/mmwr/volumes/69/rr/rr6909a1.htm. 


Note: MenB vaccines may be administered simultaneously 
with MenACWY vaccines if indicated, but at a different 
anatomic site, if feasible. 


Children age 10 years or older may receive a dose of Penbraya 
(MenACWY-TT/MenB-FHbp) as an alternative to separate 
administration of MenACWY and MenB when both vaccines 
would be given on the same clinic day. For age-eligible 
children not at increased risk, if Penbraya is used for dose 1 
MenB, MenB-FHbp (Trumenba) should be administered for 
dose 2 MenB. For age-eligible children at increased risk of 
meningococcal disease, Penbraya may be used for additional 
MenACWY and MenB doses (including booster doses) if both 
would be given on the same clinic day and at least 6 months 
have elapsed since most recent Penbraya dose. 


Mpox vaccination 


(minimum age: 18 years [Jynneos]) 


Special situations 

¢ Age 18 years and at risk for mpox infection: complete 
2-dose series, 28 days apart. 
Risk factors for mpox infection include: 


- Persons who are gay, bisexual, and other MSM, transgender 
or nonbinary people who in the past 6 months have had: 


- A new diagnosis of at least 1 sexually transmitted disease 
- More than 1 sex partner 
- Sex at a commercial sex venue 
- Sex in association with a large public event in a geographic 
area where mpox transmission is occurring 

- Persons who are sexual partners of the persons described 
above 

- Persons who anticipate experiencing any of the situations 
described above 


¢ Pregnancy: There is currently no ACIP recommendation 
for Jynneos use in pregnancy due to lack of safety data in 
pregnant persons. Pregnant persons with any risk factor 
described above may receive Jynneos. 


For detailed information, see www.cdc.gov/mpox/hcp/vaccine- 
considerations/vaccination-overview.html 


Pneumococcal vaccination 
(minimum age: 6 weeks [PCV15], [PCV 20]; 2 years 


[PPSV23]) 


Routine vaccination with PCV 
e 4-dose series at 2, 4,6, 12-15 months 


Catch-up vaccination with PCV 

¢ Healthy children ages 2-4 years with any incomplete* 
PCV series: 1 dose PCV 

¢ For other catch-up guidance, see Table 2. 

Note: For children without risk conditions, PCV20 is not 


indicated if they have received 4 doses of PCV13 or PCV15 or 
another age appropriate complete PCV series. 


Special situations 

Children and adolescents with cerebrospinal fluid leak; 
chronic heart disease; chronic kidney disease (excluding 
maintenance dialysis and nephrotic syndrome); chronic 
liver disease; chronic lung disease (including moderate 
persistent or severe persistent asthma); cochlear implant; 
or diabetes mellitus: 


Age 2-5 years 
e Any incomplete* PCV series with: 
-3 PCV doses: 1 dose PCV (at least 8 weeks after the most 
recent PCV dose) 
- Less than 3 PCV doses: 2 doses PCV (at least 8 weeks after the 
most recent dose and administered at least 8 weeks apart) 
¢ Completed recommended PCV series but have not received 
PPSV23. 
- Previously received at least 1 dose of PCV20: no further PCV or 
PPSV23 doses needed 
- Not previously received PCV20: administer 1 dose PCV20 or 
1 dose PPSV23 administer at least 8 weeks after the most 
recent PCV dose. 


Page 11 


| Notes | Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger, United States, 2025 


Pneumococcal vaccination - continued 


Age 6-18 years 

Not previously received any dose of PCV13, PCV15, or PCV20: 
administer 1 dose of PCV15 or PCV20. If PCV15 is used and no 
previous receipt of PPSV23, administer 1 dose of PPSV23 at 
least 8 weeks after the PCV15 dose.** 


° Received PCV before age 6 years but have not received 
PPSV23 
- Previously received at least 1 dose of PCV20: no further PCV 
or PPSV23 doses needed 
- Not previously received PCV20: 1 dose PCV20 or 1 dose 
PPSV23 administer at least 8 weeks after the most recent 
PCV dose. 


¢ Received PCV13 only at or after age 6 years: administer 1 dose 
PCV20 or 1 dose PPSV23 at least 8 weeks after the most recent 
PCV13 dose. 


¢ Received 1 dose PCV13 and 1 dose PPSV23 at or after age 
6 years: no further doses of any PCV or PPSV23 indicated. 


Children and adolescents on maintenance dialysis, or 
with immunocompromising conditions such as nephrotic 
syndrome; congenital or acquired asplenia or splenic 
dysfunction; congenital or acquired immunodeficiencies; 
diseases and conditions treated with immunosuppressive 
drugs or radiation therapy, including malignant 
neoplasms, leukemias, lymphomas, Hodgkin disease, and 
solid organ transplant; HIV infection; or sickle cell disease 
or other hemoglobinopathies: 


Age 2-5 years 
e Any incomplete* PCV series: 
-3 PCV doses: 1 dose PCV (at least 8 weeks after the most 
recent PCV dose) 
- Less than 3 PCV doses: 2 doses PCV (at least 8 weeks after the 
most recent dose and administered at least 8 weeks apart) 
¢ Completed recommended PCV series but have not received 
PPSV23 
- Previously received at least 1 dose of PCV20: no further PCV 
or PPSV23 doses needed 
- Not previously received PCV20: administer 1 dose PCV20 or 
1 dose PPSV23 at least 8 weeks after the most recent PCV 
dose. If PPSV23 is used, administer 1 dose of PCV20 or dose 
2 PPSV23 at least 5 years after dose 1 PPSV23. 


Age 6-18 years 

¢ Not previously received any dose of PCV13, PCV15, or PCV20: 
administer 1 dose of PCV15 or 1 dose of PCV20. If PCV15 is 
used and no previous receipt of PPSV23, administer 1 dose of 
PPSV23 at least 8 weeks after the PCV15 dose.** 


¢ Received PCV before age 6 years but have not received 

PPSV23 

- Previously received at least 1 dose of PCV20: no additional 
dose of PCV or PPSV23 

- Not previously received PCV20: administer 1 dose PCV20 or 
1 dose PPSV23 at least 8 weeks after the most recent PCV 
dose. If PPSV23 is used, administer either PCV20 or dose 2 
PPSV23 at least 5 years after dose 1 PPSV23. 


¢ Received PCV13 only at or after age 6 years: administer 1 dose 
PCV20 or 1 dose PPSV23 at least 8 weeks after the most recent 
PCV13 dose. If PPSV23 is used, administer 1 dose of PCV20 or 
dose 2 PPSV23 at least 5 years after dose 1 PPSV23. 


¢ Received 1 dose PCV13 and 1 dose PPSV23 at or after age 
6 years: administer 1 dose PCV20 or 1 dose PPSV23 at least 
8 weeks after the most recent PCV13 dose and at least 5 years 
after dose 1 PPSV23. 


Pregnancy: no recommendation for PCV or PPSV23 due to 
limited data. Summary of existing data on pneumococcal 
vaccination during pregnancy can be found at www.cdc.gov/ 
mmwr/volumes/72/rr/rr7203a1.htm 


For guidance on determining which pneumococcal vaccines a 
patient needs and when, please refer to the mobile app, which 
can be downloaded here: wcms-wp.cdc.gov/pneumococcal/ 
hcp/vaccine-recommendations/app.html 


*Incomplete series = Not having received all doses in either the 
recommended series or an age-appropriate catch-up series. 
See Table 2 in ACIP pneumococcal recommendations at 
stacks.cdc.gov/view/cdc/133252 


**When both PCV15 and PPSV23 are indicated, administer 
all doses of PCV15 first. PCV15 and PPSV23 should not be 
administered during the same visit. 


Poliovirus vaccination 


(minimum age: 6 weeks) 


Routine vaccination 

e 4-dose series at ages 2, 4, 6-18 months, 4-6 years; administer 
the final dose on or after age 4 years and at least 6 months 
after the previous dose. 


¢ 4 or more doses of IPV can be administered before age 4 years 
when a combination vaccine containing IPV is used. However, 
a dose is still recommended on or after age 4 years and at 
least 6 months after the previous dose. 


Catch-up 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. 


e Adolescents age 18 years known or suspected to be 
unvaccinated or incompletely vaccinated: administer 
remaining doses (1, 2, or 3 IPV doses) to complete a 3-dose 
primary series.* Unless there are specific reasons to believe 
they were not vaccinated, most persons aged 18 years or 
older born and raised in the United States can assume they 
were vaccinated against polio as children. 

Series containing oral poliovirus 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 U.S. IPV schedule. See 
www.cdc.gov/mmwr/volumes/66/wr/mm6601a6.htm?s_%20 
cid=mm6601a6_w. 

¢ Only trivalent OPV (tOPV) counts toward the 
U.S. 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,’ see 
www.cdc.gov/mmwr/volumes/66/wr/mm6606a7.htm?s_ 
cid=mm6606a7_w. 

¢ For other catch-up guidance, see Table 2. 


Special situations 

¢ Adolescents aged 18 years at increased risk of exposure to 
poliovirus and completed primary series*: may administer 
one lifetime IPV booster 

*Note: Complete primary series consist of at least 3 doses of IPV 

or trivalent oral poliovirus vaccine (tOPV) in any combination. 


For detailed information, see: www.cdc.gov/vaccines/vpd/ 
polio/hcp/recommendations.html 


Page 12 


| Notes | Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger, United States, 2025 


Respiratory syncytial virus immunization 


(minimum age: birth [Nirsevimab, RSV-mAb, Beyfortus]) 


Routine immunization 
¢ Infants born October - March in most of the continental 

United States* 

- Mother did not receive RSV vaccine or mother’s RSV 
vaccination status is unknown or mother received 
RSV vaccine in previous pregnancy: administer 1 dose 
nirsevimab within 1 week of birth—ideally during the birth 
hospitalization. 

- Mother received RSV vaccine less than 14 days prior to 
delivery: administer 1 dose nirsevimab within 1 week of 
birth—ideally during the birth hospitalization. 

- Mother received RSV vaccine at least 14 days prior to 
delivery: nirsevimab not needed but can be considered in 
rare circumstances at the discretion of healthcare providers 
(see www.cdc.gov/vaccines/vpd/rsv/hcp/child-faqs.html) 


¢ Infants born April-September in most of the continental 
United States* 
- Mother did not receive RSV vaccine or mother’s RSV 
vaccination status is unknown or mother received 
RSV vaccine in previous pregnancy: administer 1 dose 
nirsevimab shortly before start of RSV season.* 
- Mother received RSV vaccine less than 14 days prior to 


delivery: administer 1 dose nirsevimab shortly before start of 


RSV season.* 

- Mother received RSV vaccine at least 14 days prior to 
delivery: nirsevimab not needed but can be considered in 
rare circumstances at the discretion of healthcare providers 
(see www.cdc.gov/vaccines/vpd/rsv/hcp/child-faqs.html) 


Infants with prolonged birth hospitalization** (e.g., for 
prematurity) discharged October through March should be 
immunized shortly before or promptly after discharge. 


Special situations 

¢ Ages 8-19 months with chronic lung disease of 
prematurity requiring medical support (e.g., 
chronic corticosteroid therapy, diuretic therapy, or 
supplemental oxygen) any time during the 6-month 
period before the start of the second RSV season; severe 
immunocompromise; cystic fibrosis with either weight 
for length <10th percentile or manifestation of severe 
lung disease (e.g., previous hospitalization for pulmonary 
exacerbation in the first year of life or abnormalities on 
chest imaging that persist when stable)**: 
- 1 dose nirsevimab shortly before start of second RSV 

season* 


e Ages 8-19 months who are American Indian or 
Alaska Native: 1 dose nirsevimab shortly before start of 
second RSV season* 


¢ Age-eligible and undergoing cardiac surgery with 
cardiopulmonary bypass**: 1 additional dose of nirsevimab 
after surgery. See www.accessdata.fda.gov/drugsatfda_docs/ 
label/2023/761328s000Ibl.pdf 


*Note: While the timing of the onset and duration of 

RSV season may vary, administration of nirsevimab is 
recommended October through March in most of the 
continental United States (optimally October through 
November or within 1 week of birth). Providers in jurisdictions 
with RSV seasonality that differs from most of the continental 
United States (e.g., Alaska, jurisdiction with tropical climate) 
should follow guidance from public health authorities (e.g., 
CDC, health departments) or regional medical centers on 
timing of administration based on local RSV seasonality. 


**Note: Nirsevimab can be administered to children who are 
eligible to receive palivizumab. Children who have received 
nirsevimab should not receive palivizumab for the same RSV 
season. 


For further guidance, see www.cdc.gov/mmwr/volumes/72/ 
wr/mm7234a4.htm and www.cdc.gov/vaccines/vpd/rsv/hcp/ 
child-faqs.html 


Respiratory syncytial virus vaccination 


(RSV [Abrysvo]) 


Routine vaccination 

¢ Pregnant at 32 weeks 0 days through 36 weeks and 6 days 
gestation from September through January in most of the 
continental United States*: 1 dose Abrysvo. Administer RSV 
vaccine regardless of previous RSV infection. 

- Either maternal RSV vaccination with Abrysvo or infant 
immunization with nirsevimab (RSV monoclonal antibody) is 
recommended to prevent severe respiratory syncytial virus 
disease in infants. 


¢ All other pregnant persons: RSV vaccine not recommended 


e Subsequent pregnancies: additional doses not 
recommended. No data are available to inform whether 
additional doses are needed in subsequent pregnancies. 
Infants born to pregnant persons who received RSV vaccine 
during a previous pregnancy should receive nirsevimab. 


*Note: Providers in jurisdictions with RSV seasonality that 
differs from most of the continental United States (e.g., Alaska, 
jurisdictions with tropical climate) should follow guidance from 
public health authorities (e.g., CDC, health departments) or 
regional medical centers on timing of administration based on 
local RSV seasonality. 


Rotavirus vaccination 


(minimum age: 6 weeks) 


Routine vaccination 
¢ Rotarix: 2-dose series at age 2 and 4 months 


¢ RotaTeq: 3-dose series at age 2, 4, and 6 months 


¢ If any dose in the series is either RotaTeq or unknown, default 
to 3-dose series. 


Catch-up 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. 
¢ For other catch-up guidance, see Table 2. 


Page 13 


| Notes | Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger, United States, 2025 


Tetanus, diphtheria, and pertussis (Tdap) 


vaccination (minimum age: 11 years for routine 
vaccination, 7 years for catch-up vaccination) 


Routine vaccination 
e Age 11-12 years: 1 dose Tdap (adolescent booster) 


¢ Pregnancy: 1 dose Tdap during each pregnancy, preferably in 
early part of gestational weeks 27-36 


Note: Tdap may be administered regardless of the interval 
since the last tetanus- and diphtheria-toxoid-containing 
vaccine. 


Catch-up vaccination 


e Age 13-18 years who have not received Tdap: 
1 dose Tdap (adolescent booster) 


¢ Age 7-18 years not fully vaccinated* with DTaP: 1 dose 
Tdap as part of the catch-up series (preferably the first dose); 
if additional doses are needed, use Td or Tdap. 


¢ Tdap administered at age 7-10 years: 
- Age 7-9 years who receive Tdap should receive the 
adolescent Tdap booster dose at age 11-12 years 
- Age 10 years who receive Tdap do not need the adolescent 
Tdap booster dose at age 11-12 years 


¢ DTaP inadvertently administered on or after age 7 years: 
- Age 7-9 years: DTaP may count as part of catch-up series. 
Administer adolescent Tdap booster dose at age 11-12 years. 
- Age 10-18 years: Count dose of DTaP as the adolescent 
Tdap booster dose. 


¢ For other catch-up guidance, see Table 2. 


Special situations 

¢ Wound management in persons age 7 years or older with 
history of 3 or more doses of tetanus-toxoid-containing 
vaccine: For clean and minor wounds, administer Tdap or 
Td if more than 10 years since last dose of tetanus-toxoid- 
containing vaccine; for all other wounds, administer Tdap 
or Td if more than 5 years since last dose of tetanus-toxoid- 
containing vaccine. Tdap is preferred for persons age 11 years 
or older who have not previously received Tdap or whose 
Tdap history is unknown. If a tetanus-toxoid-containing 
vaccine is indicated for a pregnant adolescent, use Tdap. 


¢ For detailed information, see www.cdc.gov/mmwr/ 
volumes/69/wr/mm6903a5.htm. 


*Fully vaccinated = 5 valid doses of DTaP or 4 valid doses of 
DTaP if dose 4 was administered at age 4 years or older 


Varicella vaccination 


(minimum age: 12 months) 


Routine vaccination 
e 2-dose series at age 12-15 months, 4-6 years 
¢ VAR or MMRV may be administered* 


¢ Dose 2 may be administered as early as 3 months after dose 1 
(a dose inadvertently administered after at least 4 weeks may 
be counted as valid). 


*Note: For dose 1 in children age 12-47 months, it is 
recommended to administer MMR and varicella vaccines 
separately. MMRV may be used if parents or caregivers express 
a preference. 


Catch-up vaccination 
¢ Ensure persons age 7-18 years without evidence of immunity 

(see MMWR at www.cdc.gov/mmwr/pdf/rr/rr5604.pdf) have a 

2-dose series: 

- Age 7-12 years: Routine interval: 3 months (a dose 
inadvertently administered after at least 4 weeks may be 
counted as valid) 

- Age 13 years and older: Routine interval: 4-8 weeks 
(minimum interval: 4 weeks) 

- The maximum age for use of MMRV is 12 years. 


Page 14 


Appendix Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger, United States, 2025 


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, Prevention and Control of Seasonal Influenza with Vaccines: 
Recommendations of the Advisory Committee on Immunization Practices—United States, 2024-25 Influenza Season | MMWR (cdc.gov), and Contraindications and Precautions for COVID-19 Vaccination 


Vaccines and other 


I a Contraindicated or Not Recommended’ Precautions” 

mmunizing Agents 

COVID-19 mRNA vaccines + Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a component of + Diagnosed non-severe allergy (e.g., urticaria beyond the injection site) to a 
[Pfizer-BioNTech, Moderna] an mRNA COVID-19 vaccine? component of an mRNA COVID-19 vaccine’; or non-severe, immediate (onset 


less than 4 hours) allergic reaction after administration of a previous dose of 
an mRNA COVID-19 vaccine 

+ Myocarditis or pericarditis within 3 weeks after a dose of any COVID-19 vaccine 

+ Multisystem inflammatory syndrome in children (MIS-C) or multisystem 
inflammatory syndrome in adults (MIS-A) 

+ Moderate or severe acute illness, with or without fever 


COVID-19 protein subunit + Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a component of + Diagnosed non-severe allergy (e.g., urticaria beyond the injection site) toa 
vaccine a Novavax COVID-19 vaccine? component of Novavax COVID-19 vaccine?; or non-severe, immediate (onset 
[Novavax] less than 4 hours) allergic reaction after administration of a previous dose of 


a Novavax COVID-19 vaccine 
+ Myocarditis or pericarditis within 3 weeks after a dose of any COVID-19 vaccine 
+ Multisystem inflammatory syndrome in children (MIS-C) or multisystem 
inflammatory syndrome in adults (MIS-A) 
+ Moderate or severe acute illness, with or without fever 


Influenza, egg-based, + Severe allergic reaction (e.g., anaphylaxis) after previous dose of any influenza vaccine + Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any 
inactivated injectable (IIV3) (i.e., any egg-based IIV, ccllV, RIV, or LAIV of any valency) type of influenza vaccine 

+ Severe allergic reaction (e.g., anaphylaxis) to any vaccine component? (excluding egg) + Moderate or severe acute illness with or without fever 
Influenza, cell culture-based + Severe allergic reaction (e.g., anaphylaxis) to any ccllV of any valency, or to any component? of ccllV3 + Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any 
inactivated injectable (ccllV3) type of influenza vaccine 
[Flucelvax] + 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 ccllV3, administer in 
medical setting under supervision of health care provider who can recognize and 
manage severe allergic reactions. May consult an allergist. 

+ Moderate or severe acute illness with or without fever 


Influenza, recombinant + Severe allergic reaction (e.g., anaphylaxis) to any RIV of any valency, or to any component? of RIV3 + Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any 
injectable (RIV3) type of influenza vaccine 
[Flublok] + Persons with a history of severe allergic reaction (e.g., anaphylaxis) after a previous 


dose of any egg-based IIV, ccllV, or LAIV of any valency. If using RIV3, administer in 
medical setting under supervision of health care 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 + Severe allergic reaction (e.g., anaphylaxis) after previous dose of any influenza vaccine + Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any 
(LAIV3) (i.e., any egg-based IV, ccllV, RIV, or LAIV of any valency) type of influenza vaccine 
[Flumist] + Severe allergic reaction (e.g., anaphylaxis) to any vaccine component? (excluding egg) - Asthma in persons age 5 years old or older 
+ Children age 2-4 years with a history of asthma or wheezing + Persons with underlying medical conditions other than those listed under 
+ Anatomic or functional asplenia contraindications that might predispose to complications after wild-type 
+ Immunocompromised due to any cause including, but not limited to, medications and HIV infection influenza virus infection, e.g., chronic pulmonary, cardiovascular (except isolated 
+ Close contacts or caregivers of severely immunosuppressed persons who require a protected environment hypertension), renal, hepatic, neurologic, hematologic, or metabolic disorders 
- Pregnancy (including diabetes mellitus) 
+ Cochlear implant + Moderate or severe acute illness with or without fever 


+ 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 


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. See package inserts and FDA EUA fact sheets for a full list of vaccine ingredients. mRNA COVID-19 vaccines contain polyethylene glycol (PEG). 

4. 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 vaccines. 


Page 15 


Appendix 


Vaccines and other 
Immunizing Agents 


Dengue (DEN4CYD) 


Diphtheria, tetanus, pertussis (DTaP) 


raindicated or Not Recommended! 


+ Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component? 

+ 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) 

+ Lack of laboratory confirmation of a previous dengue infection 


+ Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component? 
+ Encephalopathy (e.g., coma, decreased level of consciousness, prolonged seizures) not attributable to another 


identifiable cause within 7 days of admin 


istration of previous dose of DTP or DTaP 


Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger, United States, 2025 


Precautions” 


+ Pregnancy 
+ HlV infection without evidence of severe immunosuppression 
+ Moderate or severe acute illness with or without fever 


+ 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: 
+ Younger than age 6 weeks 


after a previous dose or to a vaccine component? 


+ 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 component? including neomycin 


+ Moderate or severe acute illness with or without fever 


Hepatitis B (HepB) 


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


+ Severe allergic reaction (e.g., anaphylaxis: 
+ Pregnancy: PreHevbrio is not recommend 
HepB is indicated* 


+ Severe allergic reaction 
yeast 


‘e.g., anaphylaxis) 


after a previous dose or to a vaccine component? including yeast 
led due to lack of safety data in pregnant persons. Use other hepatitis B vaccines if 


after a previous dose or to a vaccine component? including neomycin and 


+ Moderate or severe acute illness with or without fever 


+ 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 component? 


+ Pregnancy: HPV vaccination not recommended. 


+ Moderate or severe acute illness with or without fever 


Measles, mumps, rubella (MMR) 
Measles, mumps, rubella, and varicella 
(MMRV) 


+ Severe allergic reaction (e.g., anaphylaxis 


after a previous dose or to a vaccine component? 


+ 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 


+ For MMRV only: HIV infection of any seve' 


rity 


+ 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 

+ For MMRV only: Personal or family (i.e., sibling or parent) history of seizures of any etiology 

+ If using MMRV, see Varicella/MMRV for additional precautions 


Meningococcal ACWY (MenACWY) 
MenACWY-CRM [Menveo] 
MenACWY-TT [MenQuadfi] 


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


+ Severe allergic reaction (e.g., anaphylaxis: 
+ For Men ACWY-CRM only: severe allergic 


after a previous dose or to a vaccine component? 
reaction to any diphtheria toxoid— or CRM197—containing vaccine 


+ For MenACWY-TT only: severe allergic reaction to a tetanus toxoid-containing vaccine 


+ Severe allergic reaction (e.g., anaphylaxis 


after a previous dose or to a vaccine component? 


+ For MenACWY-CRM only: Preterm birth if younger than age 9 months 
+ Moderate or severe acute illness with or without fever 


+ Pregnancy 
+ For MenB-4C only: Latex sensitivity 
+ Moderate or severe acute illness with or without fever 


Meningococcal ABCWY 
(MenACWY-TT/MenB-FHbp) [Penbraya] 


+ Severe allergic reaction (e.g., anaphylaxis: 
+ Severe allergic reaction to a tetanus toxoi 


after a previous dose or to a vaccine component? 
d-containing vaccine 


+ Moderate or severe acute illness, with or without fever 


Mpox UJynneos] 


+ Severe allergic reaction (e.g., anaphylaxis 


after a previous dose or to a vaccine component? 


+ Moderate or severe acute illness, with or without fever 


Pneumococcal conjugate (PCV) 


+ Severe allergic reaction 
+ Severe allergic reaction 


e.g., anaphylaxis 
e.g., anaphylaxis 


after a previous dose or to a vaccine component? 
to any diphtheria-toxoid-containing vaccine or its component? 


+ 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 component? 


+ 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 component? 


+ Pregnancy 
+ Moderate or severe acute illness with or without fever 


RSV monoclonal antibody (RSV-mAb) 


+ Severe allergic reaction (e.g., anaphylaxis 


after a previous dose or to a vaccine component? 


+ Moderate or severe acute illness with or without fever 


Respiratory syncytial virus vaccine (RSV) 


+ Severe allergic reaction (e.g., anaphylaxis: 


after a previous dose or to a vaccine component? 


+ Moderate or severe acute illness with or without fever 


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


+ Severe allergic reaction (e.g., anaphylaxis 
+ Severe combined immunodeficiency (SC 
+ History of intussusception 


after a previous dose or to a vaccine component? 
ID) 


+ 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: 
+ For Tdap only: Encephalopathy (e.g., com: 


after a previous dose or to a vaccine component? 
a, 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) 
Measles, mumps, rubella, and varicella 
(MMRV) 


+ Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component? 
+ 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 


+ For MMRV only: HIV infection of any seve 


rity 


+ 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 

+ If using MMRV, see MMR/MMRV for additional precautions 


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. www.cdc.gov/vaccines/hcp/acip-recs/general-recs/contraindications.html. 

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. www.cdc.gov/vaccines/hcp/acip-recs/general-recs/contraindications.html. 

3. Vaccination providers should check FDA-approved prescribing information for the most complete and updated information, including contraindications, warnings, and precautions. Package inserts for U.S.-licensed vaccines are available at 
www.fda.gov/vaccines-blood-biologics/approved-products/vaccines-licensed-use-united-states. 

4. For information on the pregnancy exposure registry for persons who were inadvertently vaccinated with PreHevbrio while pregnant, please visit www.prehevbrio.com/#safety. 

5. Full prescribing information for BEYFORTUS (nirsevimab-alip) www.accessdata.fda.gov/drugsatfda_docs/label/2023/761328sO000IbI.pdf. 


Page 16 


MYolel-yale(¥laaM Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger, United States, 2025 


In addition to the recommendations presented in the previous sections of this immunization schedule, ACIP has approved the following recommendations by majority vote since October 24, 2024. The following 
recommendations have been adopted by the CDC Director and are now official. Links are provided if these recommendations have been published in Morbidity and Mortality Weekly Report (MMWR). 


Vaccines Recommendations Effective Date of Recommendation* 


No new vaccines or vaccine recommendations to report 


*The effective date is the date when the CDC director adopted the recommendation and when the ACIP recommendation became official. Page 17