Few interventions match the impact of pediatric immunizations in protecting children from preventable diseases. The CDC’s recommended vaccination schedule is crucial for public health, shielding against once-serious threats to young lives. Yet, navigating this pediatric immunization schedule can be challenging, especially for children with delayed immunizations or underlying health issues.
This article explores recommended routine and non-routine pediatric immunizations. It covers vaccine schedules, safety considerations, and the diseases these preventive measures target. From infancy to adolescence, understanding these recommendations improves patient care and supports community health efforts.
Related: Pediatric Immunizations: The Schedule and Beyond
Recommended routine pediatric immunizations
The CDC offers guidelines for routine immunizations, but the schedule can be intricate for children with delayed shots or medical conditions. Here are the routine immunization recommendations for children and details about the diseases these vaccines protect against.
Birth to 2 months
- Hepatitis B (HepB): The first dose of the HepB vaccine should ideally be given within 12-24 hours of birth. This vaccine prevents hepatitis B, a severe liver infection. Infants who miss this vaccination at birth can receive it at any age. Low birth weight infants may receive the vaccine at one month or upon hospital discharge.
- RSV-mab: Not a vaccine, this antibody shot helps protect infants from respiratory syncytial virus (RSV). Pregnant women are advised to get the RSV vaccine during their third trimester if their baby is due during the RSV season (fall and winter). This immunization protects the newborn from severe RSV disease. Most infants born to vaccinated mothers won’t need the antibody shot. If required, it’s given during or just before the RSV season.
1-2 months
- Hepatitis B (HepB): To ensure continued protection, the second dose of the HepB vaccine should be given 1-2 months after the first dose.
2 months
- Diphtheria, yetanus, and acellular Pertussis (DTaP): This vaccine protects against three potentially deadly bacterial diseases: Diphtheria, tetanus, and pertussis (whooping cough).
- Haemophilus influenzae Type B (Hib): Hib vaccination prevents severe infections caused by Haemophilus influenzae Type B, including meningitis and pneumonia.
- Inactivated poliovirus (IPV): The IPV vaccine protects against poliomyelitis, which can cause paralysis and death.
- Pneumococcal conjugate vaccine (PCV): This vaccine prevents infections caused by Streptococcus pneumoniae, such as pneumonia, meningitis, and bloodstream infections.
- Rotavirus (R.V.): The R.V. vaccine protects against rotavirus, a leading cause of severe diarrhea in infants and young children.
4 months
- Diphtheria, tetanus, and acellular pertussis (DTaP): A second dose of DTaP is administered to continue protection against these diseases.
- Haemophilus Influenzae Type B (Hib): A second dose of Hib ensures sustained protection against Haemophilus influenzae Type B.
- Inactivated poliovirus (IPV): The second dose of IPV maintains immunity against poliovirus.
- Pneumococcal conjugate vaccine (PCV): A second dose of PCV is given to protect against pneumococcal infections.
- Rotavirus (R.V.): Depending on the brand, a second dose of the R.V. vaccine may be administered to protect against rotavirus.
6 months
- Diphtheria, tetanus, and acellular pertussis (DTaP): The third dose of DTaP continues to provide protection.
- Haemophilus influenzae type B (Hib): Depending on the brand, a third dose of Hib may be necessary.
- Pneumococcal conjugate vaccine (PCV): The third dose of PCV is given for ongoing protection.
- Rotavirus (R.V.): Depending on the brand, a third dose of the R.V. vaccine may be needed.
6 months and annually
- Influenza (flu): Children six months and older are advised to receive the flu vaccine annually. For children under nine years receiving the vaccine for the first time or who received only one dose before July 2023, the vaccine is given in two separate doses at least a month apart. Children older than nine or those who have received at least two doses previously require only one dose.
6-18 months
- Hepatitis B (HepB): The third dose of HepB is administered to ensure long-term protection.
- Inactivated poliovirus (IPV): The third dose of IPV is given to maintain immunity against poliovirus.
12-15 months
- Haemophilus influenzae type B (Hib): The final dose of Hib completes the series.
- Measles, mumps, and rubella (MMR): The MMR vaccine protects against measles, mumps, and rubella. It is sometimes given in combination with the varicella vaccine as MMRV.
- Pneumococcal conjugate vaccine (PCV): The final dose of PCV ensures ongoing protection.
- Varicella (Chickenpox): The varicella vaccine protects against chickenpox.
Related: A Review of Measles, Mumps, and Rubella for Pharmacists and Pharmacy Technicians, 2nd Edition
12-23 months
- Hepatitis A (HepA): The HepA vaccine is given as two shots at least six months apart to protect against hepatitis A.
15-18 months
- Diphtheria, tetanus, and acellular pertussis (DTaP): The fourth dose of DTaP helps maintain immunity.
4-6 years
- Diphtheria, tetanus, and acellular pertussis (DTaP): The fifth and final dose of DTaP.
- Measles, mumps, and rubella (MMR): The second dose of MMR boosts immunity.
- Inactivated poliovirus (IPV): The fourth dose of IPV ensures continued protection.
- Varicella (Chickenpox): The second dose of the varicella vaccine helps maintain immunity.
9-16 years
- Dengue vaccine: Providers give this vaccine in three doses to children who have previously had dengue fever and live in areas where it is expected, such as Puerto Rico, American Samoa, and the U.S. Virgin Islands.
11-12 years
- Human papillomavirus (HPV): A patient gets the HPV vaccine in two shots over 6-12 months. Providers can be administer it to patients as young as age nine. Teens and young adults aged 15-26 and those with weak immune systems receive three shots over six months. Effective for both boys and girls, the vaccine helps prevent genital warts and certain types of cancer.
- Tetanus, diphtheria, and pertussis booster (Tdap): Healthcare providers recommend the Tdap booster for each pregnant woman.
- Meningococcal vaccine (MenACWY): The MenACWY vaccine protects against meningococcal bacteria types A, C, W, and Y. Experts recommend a booster dose at age 16.
16-18 years
- Meningococcal vaccine (MenB): The MenB vaccine protects against meningococcal bacterium type B. Teens and young adults aged 16-23 can receive the MenB vaccine in two doses, with the preferred age being 16-18. This vaccine is essential for college students at a higher infection risk.
Additional vaccines for young adults
However, traveling to an endemic area may necessitate administering vaccines to children earlier than usual. For guidance, visit the CDC Traveler’s website or speak with your healthcare provider.
Non-routine pediatric immunizations for special population
Immunization is crucial for maintaining public health. The approach to vaccinations requires careful consideration for special populations, such as those with compromised immune systems. These groups include preterm and low-birth-weight infants, pregnant women, patients with primary immunodeficiencies, transplant recipients, and children with chronic conditions like HIV or cancer.
Specific recommended pediatric immunizations for special populations
Use inactivated vaccines, safe for immunocompromised individuals, whenever possible. These vaccines include those for influenza and certain bacterial infections like pneumococcal disease. Live vaccines, however, pose risks. Healthcare providers should generally avoid these in severely immunocompromised patients due to the potential for disease.
For patients with conditions like asplenia or HIV, additional vaccines beyond routine immunizations may be necessary. These can mitigate higher risks of certain infections. Influenza vaccination, administered annually, is particularly emphasized to protect against seasonal flu outbreaks.
Non-routine pediatric immunizations for travelers
Traveling internationally with children requires careful planning, especially regarding immunizations. Each country has specific health risks, so certain vaccines may be essential to protect your child. Below are the non-routine pediatric immunizations recommendations for travelers. For a comprehensive list, consult your doctor or visit the CDC’s travelers’ health website.
Dengue vaccine
Dengue, a mosquito-borne illness, can cause severe illness, especially in children. The Advisory Committee on Immunization Practices (ACIP) approved the live attenuated dengue virus vaccine, Dengvaxia, in June 2021 for children aged 9–16 years with confirmed past dengue infection.
This vaccine is vital for residents of dengue-endemic areas like American Samoa, Puerto Rico, and the U.S. Virgin Islands. Regulatory agencies have not approved this for travelers from non-endemic regions. The vaccination involves three doses given six months apart, with prior dengue infection testing essential to avoid severe illness in those without previous exposure.
Japanese encephalitis vaccine
Japanese encephalitis (J.E.) is another mosquito-borne disease prevalent in most of Asia and parts of the western Pacific. While the risk is low for short-term travelers confined to urban areas, it increases for those spending a month or more in endemic regions.
Providers recommend the inactivated Vero cell culture-derived J.E. vaccine (IXIARO) for travelers aged two months and older. The primary series consists of two doses administered 28 days apart. Experts recommend a booster dose for travelers who received their primary J.E. vaccine series over a year before potential exposure.
Rabies vaccine
Rabies, a form of acute viral encephalitis, is almost always fatal once symptoms appear. Children traveling to regions where rabies is common, deficient- and middle-income countries with free-roaming dogs, are at increased risk. In June 2021, ACIP updated the preexposure prophylaxis for children to a two-dose schedule administered on day 0 and day 7, reducing the burden and cost compared to the previous three-dose schedule. Postexposure prophylaxis, involving human rabies immune globulin (RIG) and a series of four vaccine doses, is necessary for unvaccinated children potentially exposed to rabies.
Tick-borne encephalitis vaccine
Tick-borne encephalitis (TBE) is prevalent in Asia and Europe, with infection resulting from tick bites during outdoor activities. The FDA approved a TBE vaccine in August 2021 for individuals aged one year and older.
The primary vaccination involves three doses, with the second dose given one to three months after the first and the third dose five to twelve months after the second. Providers recommend a booster dose for ongoing exposure three years after the primary series.
Typhoid vaccine
Typhoid fever, caused by Salmonella enterica serotype Typhi, poses a significant risk in areas with poor sanitation. Two vaccines are available: the Vi capsular polysaccharide vaccine (ViCPS), administered intramuscularly for children aged two years and older, and the oral live attenuated vaccine (Ty21a) for children six years and older.
The ViCPS vaccine requires a booster dose every two years. The Ty21a vaccine consists of four capsules taken every other day, with a booster series recommended every five years.
Yellow fever vaccine
Yellow fever, transmitted by mosquitoes, is endemic to certain parts of Africa and South America. Vaccination is essential for entering some countries and protecting against the disease. Vaccinate children nine months and older before traveling to these regions.
Infants under nine months are at higher risk of developing encephalitis from the vaccine. ACIP advises against administering the vaccine to infants under six months and recommends it for infants aged six to eight months only if travel to high-risk areas is unavoidable.
Understanding vaccine contraindications
Contraindications refer to specific conditions or factors in recipients that increase the risk of a severe adverse reaction to a vaccine. These conditions necessitate withholding a vaccine to avoid harm. While most contraindications are temporary, which means vaccinations can often be administered later, healthcare providers should recognize and adhere to these guidelines to ensure patient safety.
One notable example is the contraindication for the Measles, Mumps, and Rubella (MMR) vaccine in severely immunocompromised individuals. Such individuals should not receive live vaccines like MMR due to the increased risk of severe adverse reactions. Similarly, pregnant women should not receive live, attenuated virus vaccines because of the theoretical risk to the fetus (4).
Specific vaccine contraindications
Healthcare providers should develop a comprehensive understanding of contraindications for various vaccines. The following are some specific examples:
- Dengue vaccine: Use in persons with laboratory confirmation of previous dengue infection and who reside in endemic areas. Severe allergic reactions, severe immunodeficiency, and pregnancy are contraindications
- D.T., Td, DTaP: Severe allergic reactions, encephalopathy within seven days of a previous dose, and certain neurological disorders are contraindications for these vaccines. Additionally, a history of Arthus-type hypersensitivity reactions requires deferral of vaccination for at least ten years.
- Hepatitis A and B vaccines: Severe allergic reactions to previous doses or components of the vaccines are contraindications. For Hepatitis B, hypersensitivity to yeast is also a contraindication.
- HPV vaccine: Severe allergic reactions, including those to yeast, contraindicate the use of the HPV vaccine.
- Influenza vaccines (IIV, LAIV): Severe allergic reactions to previous doses or components, Guillain-Barré syndrome within six weeks of a previous dose, and certain medical conditions like asthma in specific age groups are contraindications. Live attenuated influenza vaccine (LAIV) has additional contraindications, including pregnancy and certain antiviral medications within specified time frames.
- MMR and varicella vaccines: Severe allergic reactions, severe immunodeficiency, and pregnancy are contraindications for these vaccines. Additionally, recent receipt of antibody-containing blood products and use of specific antiviral drugs are precautions.
Reporting clinically significant adverse events
Despite rigorous testing and monitoring, vaccines can occasionally cause adverse events. Reporting these events is crucial for ongoing safety surveillance and ensuring public trust in vaccination programs. Clinically significant adverse events are those that lead to hospitalization, disability, congenital anomalies, or death.
Healthcare providers play a pivotal role in identifying and reporting adverse events. The Vaccine Adverse Event Reporting System (VAERS) in the United States is a critical tool for collecting and analyzing data on vaccine-related adverse events. Timely and accurate reporting helps identify potential safety concerns, leading to a better understanding and managing vaccine risks.
