Practice Guidelines

Recommended Childhood and Adolescent Immunization Schedule, United States, 2003 and Update on Childhood Immunizations



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Am Fam Physician. 2003 Jan 1;67(1):188-198.

The 2003 Recommended Childhood and Adolescent Immunization Schedule (Figure 1) is similar to the 2002 schedule, except for four changes: a name change to reflect inclusion of adolescents, clarifications in the footnotes for hepatitis A and hepatitis B, encouragement for influenza vaccination of healthy children six to 23 months of age, and inclusion of a harmonized catch-up schedule for children who are behind in immunizations (Tables 1 and 2). The catch-up schedule offers specific guidance regarding the minimum time between doses as well as the number of doses for those who are behind schedule.

Among children zero to two years of age, influenza-related hospitalization rates range from about 186 to 1,038 per 100,000 for healthy children to 800 to 1,900 per 100,000 for those with high-risk conditions, depending on exact age.13 Izurieta and colleagues found rates of 144 to 187 per 100,000 children zero to 23 months of age.3,4 One study showed that healthy children six months to less than three years of age had rates of influenza-associated hospitalization as high or higher than rates among children three to 14 years of age with high-risk conditions.1,2 In one study,5 influenza was second only to respiratory syncytial virus in causing hospitalizations in persons with chronic underlying illness. Neuzil and colleagues1 found that for every 100 children, an annual average of six to 15 outpatient visits and three to nine courses of antibiotics are attributable to influenza. The illness attack rate is highest in children at 14 to 40 percent yearly, with attack rates typically higher than 30 percent in preschool-aged children.68

Influenza vaccine can cause local reactions such as soreness at the injection site. In young children not previously exposed to influenza vaccine, fever, malaise, and myalgia also can occur. Because inactivated influenza vaccines are not live, they cannot cause influenza. At the October 2002 Advisory Committee on Immunization Practices (ACIP) meeting, a study was presented from the Vaccine Safety Datalink that found that no serious reactions were associated with influenza vaccination among 251,600 children younger than 18 years, including 8,446 children six to 23 months of age, who received more than 438,000 doses of inactivated influenza vaccine.

Based on the hospitalization rates caused by influenza in young children, the high annual illness attack rate, and the safety of vaccination, the ACIP encourages vaccination of healthy children six through 23 months of age, beginning in the Fall of 2002.3 The Centers for Disease Control and Prevention's (CDC) Vaccine Information Statement on influenza has been updated to reflect this change (www.cdc.gov/nip/publications/VIS/default.htm). Before making a full recommendation to vaccinate all children six to 23 months of age annually (which is expected within the next two years), several issues need to be resolved, including parent and physician education, reimbursement, and efficient delivery mechanisms of influenza vaccine to young children.

Although vaccine shortages for tetanus, influenza, and varicella vaccines have resolved, shortages of conjugated pneumococcal vaccine continue. The ACIP recommends that children at highest risk (e.g., children with sickle cell disease) be vaccinated according to the normal schedule. During the shortage, the ACIP recommends that healthy infants and children younger than 24 months receive a decreased number of pneumococcal conjugate vaccine doses based on the age at which vaccination is begun and the estimated amount of vaccine available to the practice, as tabled at www.cdc.gov/mmwr/preview/mmwrhtml/mm5050a4.htm.

Recommended Childhood and Adolescent Immunization Schedule—United States, 2003

1. Hepatitis B vaccine (Hep B). All infants should receive the first dose of hepatitis B vaccine soon after birth and before hospital discharge; the first dose may also be given by age 2 months if the infant's mother is HBsAg-negative. Only monovalent hepatitis B vaccine can be used for the birth dose. Monovalent or combination vaccine containing Hep B may be used to complete the series. Four doses of vaccine may be administered when a birth dose is given. The second dose should be given at least 4 weeks after the first dose, except for combination vaccines, which cannot be administered before age 6 weeks. The third dose should be given at least 16 weeks after the first dose and at least 8 weeks after the second dose. The last dose in the vaccination series (third or fourth dose) should not be administered before age 6 months.

Infants born to HBsAg-positive mothers should receive hepatitis B vaccine and 0.5 mL hepatitis B immune globulin (HBIG) within 12 hours of birth at separate sites. The second dose is recommended at age 1 to 2 months. The last dose in the vaccination series should not be administered before age 6 months. These infants should be tested for HBsAg and anti-HBs at 9 to 15 months of age.

Infants born to mothers whose HBsAg status is unknown should receive the first dose of the hepatitis B vaccine series within 12 hours of birth. Maternal blood should be drawn as soon as possible to determine the mother's HBsAg status; if the HBsAg test is positive, the infant should receive HBIG as soon as possible (no later than age 1 week). The second dose is recommended at age 1 to 2 months. The last dose in the vaccination series should not be administered before age 6 months.

2. Diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP). The fourth dose of DTaP may be administered as early as age 12 months, provided 6 months have elapsed since the third dose and the child is unlikely to return at age 15 to 18 months.Tetanus and diphtheria toxoids (Td) is recommended at age 11 to 12 years if at least 5 years have elapsed since the last dose of tetanus and diphtheria toxoid-containing vaccine. Subsequent routine Td boosters are recommended every 10 years.

3.Haemophilus influenzaetype b (Hib) conjugate vaccine. Three Hib conjugate vaccines are licensed for infant use. If PRP-OMP (PedvaxHIB or ComVax [Merck]) is administered at ages 2 and 4 months, a dose at age 6 months is not required. DTaP/Hib combination products should not be used for primary immunization in infants at ages 2, 4, or 6 months, but can be used as boosters following any Hib vaccine.

4. Measles, mumps, and rubella vaccine (MMR). The second dose of MMR is recommended routinely at age 4 to 6 years but may be administered during any visit, provided at least 4 weeks have elapsed since the first dose and that both doses are administered beginning at or after age 12 months. Those who have not previously received the second dose should complete the schedule by the 11 to 12-year-old visit.

5. Varicella vaccine. Varicella vaccine is recommended at any visit at or after age 12 months for susceptible children (i.e., those who lack a reliable history of chickenpox). Susceptible persons aged 13 years should receive two doses, given at least 4 weeks apart.

6. Pneumococcal vaccine. The heptavalent pneumococcal conjugate vaccine (PCV) is recommended for all children aged 2 to 23 months. It is also recommended for certain children aged 24 to 59 months.Pneumococcal polysaccharide vaccine (PPV) is recommended in addition to PCV for certain high-risk groups. See MMWR 2000;49(RR-9):1–38.

7. Hepatitis A vaccine. Hepatitis A vaccine is recommended for children and adolescents in selected states and regions, and for certain high-risk groups; consult your local public health authority. Children and adolescents in these states, regions, and high-risk groups who have not been immunized against hepatitis A can begin the hepatitis A vaccination series during any visit. The two doses in the series should be administered at least 6 months apart. See MMWR 1999;48(RR-12):1–37.

8. Influenza vaccine. Influenza vaccine is recommended annually for children aged 6 months with certain risk factors (including but not limited to asthma, cardiac disease, sickle cell disease, HIV, diabetes, and household members of persons in groups of high risk; see MMWR 2002;51[RR-3];1–31), and can be administered to all others wishing to obtain immunity. In addition, healthy children aged 6 to 23 months are encouraged to receive influenza vaccine if feasible because children in this age group are at substantially increased risk for influenza-related hospitalizations. Children aged 12 years should receive vaccine in a dosage appropriate for their age (0.25 mL if aged 6 to 35 months or 0.5 mL if aged 3 years). Children aged 8 years who are receiving influenza vaccine for the first time should receive two doses separated by at least 4 weeks.

For additional information about vaccines, including precautions and contraindications for immunization and vaccine shortages, please visit the National Immunization Program Web site at www.cdc.gov/nip or call the National Immunization Information Hot-line at 800-232-2522 (English) or 800-232-0233 (Spanish).

Approved by the Advisory Committee on Immunization Practices (www.cdc.gov/nip/acip), the American Academy of Pediatrics (www.aap.org), and the American Academy of Family Physicians (www.aafp.org).

View Large

Recommended Childhood and Adolescent Immunization Schedule—United States, 2003


1. Hepatitis B vaccine (Hep B). All infants should receive the first dose of hepatitis B vaccine soon after birth and before hospital discharge; the first dose may also be given by age 2 months if the infant's mother is HBsAg-negative. Only monovalent hepatitis B vaccine can be used for the birth dose. Monovalent or combination vaccine containing Hep B may be used to complete the series. Four doses of vaccine may be administered when a birth dose is given. The second dose should be given at least 4 weeks after the first dose, except for combination vaccines, which cannot be administered before age 6 weeks. The third dose should be given at least 16 weeks after the first dose and at least 8 weeks after the second dose. The last dose in the vaccination series (third or fourth dose) should not be administered before age 6 months.

Infants born to HBsAg-positive mothers should receive hepatitis B vaccine and 0.5 mL hepatitis B immune globulin (HBIG) within 12 hours of birth at separate sites. The second dose is recommended at age 1 to 2 months. The last dose in the vaccination series should not be administered before age 6 months. These infants should be tested for HBsAg and anti-HBs at 9 to 15 months of age.

Infants born to mothers whose HBsAg status is unknown should receive the first dose of the hepatitis B vaccine series within 12 hours of birth. Maternal blood should be drawn as soon as possible to determine the mother's HBsAg status; if the HBsAg test is positive, the infant should receive HBIG as soon as possible (no later than age 1 week). The second dose is recommended at age 1 to 2 months. The last dose in the vaccination series should not be administered before age 6 months.

2. Diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP). The fourth dose of DTaP may be administered as early as age 12 months, provided 6 months have elapsed since the third dose and the child is unlikely to return at age 15 to 18 months.Tetanus and diphtheria toxoids (Td) is recommended at age 11 to 12 years if at least 5 years have elapsed since the last dose of tetanus and diphtheria toxoid-containing vaccine. Subsequent routine Td boosters are recommended every 10 years.

3.Haemophilus influenzaetype b (Hib) conjugate vaccine. Three Hib conjugate vaccines are licensed for infant use. If PRP-OMP (PedvaxHIB or ComVax [Merck]) is administered at ages 2 and 4 months, a dose at age 6 months is not required. DTaP/Hib combination products should not be used for primary immunization in infants at ages 2, 4, or 6 months, but can be used as boosters following any Hib vaccine.

4. Measles, mumps, and rubella vaccine (MMR). The second dose of MMR is recommended routinely at age 4 to 6 years but may be administered during any visit, provided at least 4 weeks have elapsed since the first dose and that both doses are administered beginning at or after age 12 months. Those who have not previously received the second dose should complete the schedule by the 11 to 12-year-old visit.

5. Varicella vaccine. Varicella vaccine is recommended at any visit at or after age 12 months for susceptible children (i.e., those who lack a reliable history of chickenpox). Susceptible persons aged 13 years should receive two doses, given at least 4 weeks apart.

6. Pneumococcal vaccine. The heptavalent pneumococcal conjugate vaccine (PCV) is recommended for all children aged 2 to 23 months. It is also recommended for certain children aged 24 to 59 months.Pneumococcal polysaccharide vaccine (PPV) is recommended in addition to PCV for certain high-risk groups. See MMWR 2000;49(RR-9):1–38.

7. Hepatitis A vaccine. Hepatitis A vaccine is recommended for children and adolescents in selected states and regions, and for certain high-risk groups; consult your local public health authority. Children and adolescents in these states, regions, and high-risk groups who have not been immunized against hepatitis A can begin the hepatitis A vaccination series during any visit. The two doses in the series should be administered at least 6 months apart. See MMWR 1999;48(RR-12):1–37.

8. Influenza vaccine. Influenza vaccine is recommended annually for children aged 6 months with certain risk factors (including but not limited to asthma, cardiac disease, sickle cell disease, HIV, diabetes, and household members of persons in groups of high risk; see MMWR 2002;51[RR-3];1–31), and can be administered to all others wishing to obtain immunity. In addition, healthy children aged 6 to 23 months are encouraged to receive influenza vaccine if feasible because children in this age group are at substantially increased risk for influenza-related hospitalizations. Children aged 12 years should receive vaccine in a dosage appropriate for their age (0.25 mL if aged 6 to 35 months or 0.5 mL if aged 3 years). Children aged 8 years who are receiving influenza vaccine for the first time should receive two doses separated by at least 4 weeks.

For additional information about vaccines, including precautions and contraindications for immunization and vaccine shortages, please visit the National Immunization Program Web site at www.cdc.gov/nip or call the National Immunization Information Hot-line at 800-232-2522 (English) or 800-232-0233 (Spanish).

Approved by the Advisory Committee on Immunization Practices (www.cdc.gov/nip/acip), the American Academy of Pediatrics (www.aap.org), and the American Academy of Family Physicians (www.aafp.org).

Recommended Childhood and Adolescent Immunization Schedule—United States, 2003


1. Hepatitis B vaccine (Hep B). All infants should receive the first dose of hepatitis B vaccine soon after birth and before hospital discharge; the first dose may also be given by age 2 months if the infant's mother is HBsAg-negative. Only monovalent hepatitis B vaccine can be used for the birth dose. Monovalent or combination vaccine containing Hep B may be used to complete the series. Four doses of vaccine may be administered when a birth dose is given. The second dose should be given at least 4 weeks after the first dose, except for combination vaccines, which cannot be administered before age 6 weeks. The third dose should be given at least 16 weeks after the first dose and at least 8 weeks after the second dose. The last dose in the vaccination series (third or fourth dose) should not be administered before age 6 months.

Infants born to HBsAg-positive mothers should receive hepatitis B vaccine and 0.5 mL hepatitis B immune globulin (HBIG) within 12 hours of birth at separate sites. The second dose is recommended at age 1 to 2 months. The last dose in the vaccination series should not be administered before age 6 months. These infants should be tested for HBsAg and anti-HBs at 9 to 15 months of age.

Infants born to mothers whose HBsAg status is unknown should receive the first dose of the hepatitis B vaccine series within 12 hours of birth. Maternal blood should be drawn as soon as possible to determine the mother's HBsAg status; if the HBsAg test is positive, the infant should receive HBIG as soon as possible (no later than age 1 week). The second dose is recommended at age 1 to 2 months. The last dose in the vaccination series should not be administered before age 6 months.

2. Diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP). The fourth dose of DTaP may be administered as early as age 12 months, provided 6 months have elapsed since the third dose and the child is unlikely to return at age 15 to 18 months.Tetanus and diphtheria toxoids (Td) is recommended at age 11 to 12 years if at least 5 years have elapsed since the last dose of tetanus and diphtheria toxoid-containing vaccine. Subsequent routine Td boosters are recommended every 10 years.

3.Haemophilus influenzaetype b (Hib) conjugate vaccine. Three Hib conjugate vaccines are licensed for infant use. If PRP-OMP (PedvaxHIB or ComVax [Merck]) is administered at ages 2 and 4 months, a dose at age 6 months is not required. DTaP/Hib combination products should not be used for primary immunization in infants at ages 2, 4, or 6 months, but can be used as boosters following any Hib vaccine.

4. Measles, mumps, and rubella vaccine (MMR). The second dose of MMR is recommended routinely at age 4 to 6 years but may be administered during any visit, provided at least 4 weeks have elapsed since the first dose and that both doses are administered beginning at or after age 12 months. Those who have not previously received the second dose should complete the schedule by the 11 to 12-year-old visit.

5. Varicella vaccine. Varicella vaccine is recommended at any visit at or after age 12 months for susceptible children (i.e., those who lack a reliable history of chickenpox). Susceptible persons aged 13 years should receive two doses, given at least 4 weeks apart.

6. Pneumococcal vaccine. The heptavalent pneumococcal conjugate vaccine (PCV) is recommended for all children aged 2 to 23 months. It is also recommended for certain children aged 24 to 59 months.Pneumococcal polysaccharide vaccine (PPV) is recommended in addition to PCV for certain high-risk groups. See MMWR 2000;49(RR-9):1–38.

7. Hepatitis A vaccine. Hepatitis A vaccine is recommended for children and adolescents in selected states and regions, and for certain high-risk groups; consult your local public health authority. Children and adolescents in these states, regions, and high-risk groups who have not been immunized against hepatitis A can begin the hepatitis A vaccination series during any visit. The two doses in the series should be administered at least 6 months apart. See MMWR 1999;48(RR-12):1–37.

8. Influenza vaccine. Influenza vaccine is recommended annually for children aged 6 months with certain risk factors (including but not limited to asthma, cardiac disease, sickle cell disease, HIV, diabetes, and household members of persons in groups of high risk; see MMWR 2002;51[RR-3];1–31), and can be administered to all others wishing to obtain immunity. In addition, healthy children aged 6 to 23 months are encouraged to receive influenza vaccine if feasible because children in this age group are at substantially increased risk for influenza-related hospitalizations. Children aged 12 years should receive vaccine in a dosage appropriate for their age (0.25 mL if aged 6 to 35 months or 0.5 mL if aged 3 years). Children aged 8 years who are receiving influenza vaccine for the first time should receive two doses separated by at least 4 weeks.

For additional information about vaccines, including precautions and contraindications for immunization and vaccine shortages, please visit the National Immunization Program Web site at www.cdc.gov/nip or call the National Immunization Information Hot-line at 800-232-2522 (English) or 800-232-0233 (Spanish).

Approved by the Advisory Committee on Immunization Practices (www.cdc.gov/nip/acip), the American Academy of Pediatrics (www.aap.org), and the American Academy of Family Physicians (www.aafp.org).

TABLE 1

Catch-up Schedule for Children Four Months Through Six Years of Age

Minimum interval between doses
Dose one (minimum age) Dose one to dose two Dose two to dose three Dose three to dose four Dose four to dose five

DTaP (6 weeks)

4 weeks

4 weeks

6 months

6 months*

IPV (6 weeks)

4 weeks

4 weeks

4 weeks†

Hep B‡ (birth)

4 weeks

8 weeks (and 16 weeks after first dose)

MMR (12 months)

4 weeks§

Varicella (12 months)

Hib‖ (6 weeks)

4 weeks: if first dose givenat age <12 months

4 weeks¶: if current age <12 months

8 weeks (as final dose): this dose only necessary for children aged 12 months to 5 years who received three doses before age 12 months

8 weeks (as final dose): if first dose given at age 12 to 14 months

8 weeks (as final dose)¶: if current age ≥12 months and second dose given at age <15 months

No further doses needed: if first dose given at age≥15 months

No further doses needed: if previous dose given at age ≥15 months

PCV# (6 weeks)

4 weeks: if first dose given at age <12 months and current age <24 months

4 weeks: if current age <12 months

8 weeks (as final dose): this dose only necessary for children aged 12 months to five years who received three doses before age 12 months

8 weeks (as final dose): if first dose given at age ≥12 months or current age 24 to 59 months

8 weeks (as final dose): if current age ≥12 months

No further doses needed: for healthy children if previous dose given at age ≥24 months

No further doses needed: for healthy children if first dose given at age ≥24 months


*—DTaP: The fifth dose is not necessary if the fourth dose was given after the fourth birthday.

†—IPV: For children who received an all-IPV or all-OPV series, a fourth dose is not necessary if third dose was given at age 4 years.

If OPV and IPV were given as part of a series, a total of four doses should be given, regardless of the child's current age.

‡—Hep B: All children and adolescents who have not been immunized against hepatitis B should begin the hepatitis B vaccination series during any visit. Providers should make special efforts to immunize children who were born in, or whose parents were born in, areas of the world where hepatitis B virus infection is moderately or highly endemic.

§—MMR: The second dose of MMR is recommended routinely at age 4 to 6 years, but may be given earlier if desired.

‖—Hib: Vaccine is not generally recommended for children aged 5 years.

¶—Hib: If current age < 12 months and the first two doses were PRP-OMP (PedvaxHIB or ComVax), the third (and final) dose should be given at age 12 to 15 months and at least 8 weeks after the second dose.

#—PCV: Vaccine is not generally recommended for children aged 5 years.

note:Report adverse reactions to vaccine through the federal Vaccine Adverse Event Reporting System. For information on reporting reactions following vaccines, please visit www.vaers.hhs.gov or call the 24-hour national toll-free information line 800-822-7967. Report suspected cases of vaccine-preventable diseases to your state or local health department.

TABLE 1   Catch-up Schedule for Children Four Months Through Six Years of Age

View Table

TABLE 1

Catch-up Schedule for Children Four Months Through Six Years of Age

Minimum interval between doses
Dose one (minimum age) Dose one to dose two Dose two to dose three Dose three to dose four Dose four to dose five

DTaP (6 weeks)

4 weeks

4 weeks

6 months

6 months*

IPV (6 weeks)

4 weeks

4 weeks

4 weeks†

Hep B‡ (birth)

4 weeks

8 weeks (and 16 weeks after first dose)

MMR (12 months)

4 weeks§

Varicella (12 months)

Hib‖ (6 weeks)

4 weeks: if first dose givenat age <12 months

4 weeks¶: if current age <12 months

8 weeks (as final dose): this dose only necessary for children aged 12 months to 5 years who received three doses before age 12 months

8 weeks (as final dose): if first dose given at age 12 to 14 months

8 weeks (as final dose)¶: if current age ≥12 months and second dose given at age <15 months

No further doses needed: if first dose given at age≥15 months

No further doses needed: if previous dose given at age ≥15 months

PCV# (6 weeks)

4 weeks: if first dose given at age <12 months and current age <24 months

4 weeks: if current age <12 months

8 weeks (as final dose): this dose only necessary for children aged 12 months to five years who received three doses before age 12 months

8 weeks (as final dose): if first dose given at age ≥12 months or current age 24 to 59 months

8 weeks (as final dose): if current age ≥12 months

No further doses needed: for healthy children if previous dose given at age ≥24 months

No further doses needed: for healthy children if first dose given at age ≥24 months


*—DTaP: The fifth dose is not necessary if the fourth dose was given after the fourth birthday.

†—IPV: For children who received an all-IPV or all-OPV series, a fourth dose is not necessary if third dose was given at age 4 years.

If OPV and IPV were given as part of a series, a total of four doses should be given, regardless of the child's current age.

‡—Hep B: All children and adolescents who have not been immunized against hepatitis B should begin the hepatitis B vaccination series during any visit. Providers should make special efforts to immunize children who were born in, or whose parents were born in, areas of the world where hepatitis B virus infection is moderately or highly endemic.

§—MMR: The second dose of MMR is recommended routinely at age 4 to 6 years, but may be given earlier if desired.

‖—Hib: Vaccine is not generally recommended for children aged 5 years.

¶—Hib: If current age < 12 months and the first two doses were PRP-OMP (PedvaxHIB or ComVax), the third (and final) dose should be given at age 12 to 15 months and at least 8 weeks after the second dose.

#—PCV: Vaccine is not generally recommended for children aged 5 years.

note:Report adverse reactions to vaccine through the federal Vaccine Adverse Event Reporting System. For information on reporting reactions following vaccines, please visit www.vaers.hhs.gov or call the 24-hour national toll-free information line 800-822-7967. Report suspected cases of vaccine-preventable diseases to your state or local health department.

Smallpox vaccination is not recommended for children in a pre-exposure situation because of the risk of adverse reactions. Studies from the 1960s reveal a death rate of one per 1 million primary vaccinations; rates of adverse reactions are highest among persons younger than five years. Adverse reactions include generalized vaccinia, inadvertent inoculation to other places on the body, eczema vaccinia that typically occurs among persons with a history of eczema, progressive vaccinia in persons with impaired T-cell function, postvaccine encephalitis (typically among infants and the elderly), transmission of vaccine virus to others, and death.

Useful Web sites for current information include www.immunizationed.org, which is a site developed by family physician educators and has free Palm OS and CE applications of the childhood and adult immunization schedules, www.immunize.org, http://www.aafp.org/patient-care/clinical-recommendations/all/immunizations.html, which contains the American Academy of Family Physicians' clinical policies on immunization, www.cdc.gov/nip, and www.immunizationinfo.org.

TABLE 2

Catch-up Schedule for Children Seven Through 18 Years of Age

Minimum interval between doses
Dose one to dose two Dose two to dose three Dose three to booster dose

Td: 4 weeks

Td: 6 months

Td*:

6 months: if first dose given at age <12 months and current age <11 years

5 years: if first dose given at age ≥12 months and third dose given at age <7 years and current age ≥11 years

10 years: if third dose given at age ≥7 years

IPV†: 4 weeks

IPV†: 4 weeks

IPV†

Hep B: 4 weeks

Hep B: 8 weeks (and 16 weeks after first dose)

MMR: 4 weeks

Varicella‡: 4 weeks


*—Td: For children 7 to 10 years of age, the interval between the third and booster dose is determined by the age when the first dose was given. For adolescents 11 to 18 years of age, the interval is determined by the age when the third dose was given.

†—IPV: Vaccine is not generally recommended for persons aged 18 years.

‡—Varicella: Give two-dose series to all susceptible adolescents aged 13 years.

note:Report adverse reactions to vaccines through the federal Vaccine Adverse Event Reporting System. For information on reporting reactions following vaccines, please visit www.vaers.hhs.gov or call the 24-hour national toll-free information line 800-822-7967. Report suspected cases of vaccine-preventable diseases to your state or local health department.

TABLE 2   Catch-up Schedule for Children Seven Through 18 Years of Age

View Table

TABLE 2

Catch-up Schedule for Children Seven Through 18 Years of Age

Minimum interval between doses
Dose one to dose two Dose two to dose three Dose three to booster dose

Td: 4 weeks

Td: 6 months

Td*:

6 months: if first dose given at age <12 months and current age <11 years

5 years: if first dose given at age ≥12 months and third dose given at age <7 years and current age ≥11 years

10 years: if third dose given at age ≥7 years

IPV†: 4 weeks

IPV†: 4 weeks

IPV†

Hep B: 4 weeks

Hep B: 8 weeks (and 16 weeks after first dose)

MMR: 4 weeks

Varicella‡: 4 weeks


*—Td: For children 7 to 10 years of age, the interval between the third and booster dose is determined by the age when the first dose was given. For adolescents 11 to 18 years of age, the interval is determined by the age when the third dose was given.

†—IPV: Vaccine is not generally recommended for persons aged 18 years.

‡—Varicella: Give two-dose series to all susceptible adolescents aged 13 years.

note:Report adverse reactions to vaccines through the federal Vaccine Adverse Event Reporting System. For information on reporting reactions following vaccines, please visit www.vaers.hhs.gov or call the 24-hour national toll-free information line 800-822-7967. Report suspected cases of vaccine-preventable diseases to your state or local health department.

The Author

Dr. Zimmerman is an associate professor in the Department of Family Medicine and Clinical Epidemiology at the University of Pittsburgh School of Medicine with a secondary appointment in the Department of Behavioral and Community Health Sciences. He is a voting member of the Advisory Committee on Immunization Practices.

Address correspondence to Richard K. Zimmerman, M.D., M.P.H., Department of Family Medicine, University of Pittsburgh, 3518 Fifth Ave., Pittsburgh, PA 15261 (e-mail: zimmer@pitt.edu).

REFERENCES

1. Neuzil KM, Mellen BG, Wright PF, Mitchel EF Jr, Griffin MR. The effect of influenza on hospitalizations, outpatient visits, and courses of antibiotics in children. N Engl J Med. 2000;342:225–31.

2. Neuzil KM, Wright PF, Mitchel EF Jr, Griffin MR. The burden of influenza illness in children with asthma and other chronic medical conditions. J Pediatr. 2000;137:856–64.

3. Bridges CB, Fukuda K, Uyeki TM, Cox NJ, Singleton JA. Prevention and control of influenza. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2002;51:(RR-3)1–31.

4. Izurieta HS, Thompson WW, Kramarz P, Shay DK, Davis RL, DeStefano F, et al. Influenza and the rates of hospitalization for respiratory disease among infants and young children. N Engl J Med. 2000;342:232–9.

5. Glezen WP, Greenberg SB, Atmar RL, Piedra PA, Couch RB. Impact of respiratory virus infections on persons with chronic underlying conditions. JAMA. 2000;283:499–505.

6. Sullivan KM, Monto AS, Longini IM Jr. Estimates of the U.S. health impact of influenza. Am J Public Health. 1993;83:1712–6.

7. Glezen WP. Considerations of the risk of influenza in children and indications for prophylaxis. Rev Infect Dis. 1980;2:408–20.

8. Glezen WP, Taber LH, Frank AL, Gruber WC, Piedra PA. Influenza virus infections in infants. Pediatr Infect Dis J. 1997;16:1065–8.



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