Pediatric Updates
Immunization Protects Children 2004 Immunization Schedule
From the American Academy of Pediatrics
Regular checkups at your pediatrician's office or local health clinic are an important way to keep children healthy.
By making sure that your child gets immunized on time, you can provide the best available defense against many dangerous childhood diseases. Immunizations protect children against:
All of these immunizations need to be given before children are 2 years old in order for them to be protected during their most vulnerable period. Are your child's immunizations
up-to-date?
The chart below includes immunization recommendations from the American Academy of Pediatrics. Remember to keep track of your child's immunizations -- it's the only way you can be sure
your child is up-to-date. Also, check with your pediatrician or health clinic at each visit to find out if your child needs any booster shots or if any new vaccines have been recommended since this
schedule was prepared.
If you don't have a pediatrician, call your local health department. Public health clinics usually have supplies of vaccine and may give shots free.
Recommended childhood and adolescent immunization schedule1. — United States, July-December 2004
- Indicates the recommended ages for routine administration of currently licensed childhood vaccines, as of April 1, 2004, for children through age 18 years. Any dose not given at the recommended age should be given at any subsequent visit when indicated and feasible.
Indicates age groups that warrant special effort to administer those vaccines not given previously. Additional vaccines may be licensed and recommended during the year. Licensed combination vaccines may be used whenever any components of the combination are indicated and the vaccine's other components are not contraindicated. Providers should consult the manufacturers' package inserts for detailed recommendations. Clinically significant adverse events that follow vaccination should be reported to the Vaccine Adverse Event Reporting System (VAERS). Guidance about how to obtain and complete a VAERS form is available online or by telephone, 1-800-822-7967.
- 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; 4 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 24 weeks.
Infants born to HBsAg-positive mothers should receive HepB 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 1-2 months. The last dose in the vaccination series should not be administered before age 24 weeks. These infants should be tested for HBsAg and anti-HBs at 9-15 months of age.
Infants born to mothers whose HBsAg status is unknown should receive the first dose of the HepB 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 1-2 months. The last dose in the vaccination series should not be administered before age 24 weeks
- Diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP). The fourth dose of DTaP may be administered at age 12 months provided that 6 months have
elapsed since the third dose and the child is unlikely to return at age 15-18 months. The final dose in the series should be given at age
4 years. Tetanus and diphtheria toxoids (Td) is recommended at age 11-12 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.
- Haemophilus influenzae type 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. The final dose in the series should be given at age 12 months.
- Measles, mumps, and rubella vaccine (MMR). The second dose of MMR is recommended routinely at age 4-6 years but may be administered during any visit, provided at least
4 weeks have elapsed since the first dose and both doses are administered beginning at or after age 12 months. Those who have not received the second dose previously should complete the schedule
by the visit at age 11-12 years.
- Varicella vaccine (VAR). 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 2 doses, given at least 4 weeks apart.
- Pneumococcal vaccine. The heptavalent pneumococcal conjugate vaccine (PCV) is recommended for all children aged 2-23 months. It is also recommended for certain children
aged 24-59 months. The final dose in the series should be given at age 12 months. Pneumococcal polysaccharide vaccine (PPV) is recommended in addition to PCV for certain high-risk groups. See MMWR 2000;49(No. RR-9):1-35.
- 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, and diabetes), health care workers, and other persons (including household members) in close contact with persons in groups of high-risk (see MMWR 2004;53[in press]) and can be administered to all others wishing to obtain immunity.In addition, healthy children aged
6-23 months and close contacts of health children aged 0-23 months are recommended to receive influenza vaccine, because children in this age group are at substantially increased risk of influenza-related hospitalizations. For healthy persons aged 5-49 years, the intranasally administered live, attenuated influenza vaccine (LAIV) is an acceptable alternative to the intramuscluar trivalent inactivated influenza vaccine (TIV). See MMWR 2003;52(No. RR-13):1-8. Children receiving TIV should be administered a dosage appropriate for their age (0.25 mL if 6-35 months or
0.5 mL if 3 years). Children aged
8 years who are receiving influenza vaccine for the first time should receive 2 doses (separated by
at least 4 weeks for TIV and at least 6 weeks for LAIV).
- 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 and MMWR. 1999;48(No. RR-12):1-37. 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.
Additional information about vaccines, including precautions and contraindications for vaccination and vaccine shortages is available at National Immunization Program
website or from the National Immunization Hotline, 800-232-2522 (English) or 800-232-0233 (Spanish).
Approved by the Advisory Committee on Immunization Practices, the American Academy of Pediatrics, and the American Academy of Family Physicians.
From Committee on Infectious Diseases: American Academy of Pediatrics, Recommended Childhood and Adolescent Immunization Schedule—United States, July-December 2004, Pediatrics 113(5): May 2004, 1448-insert
Additional Information
July 6, 2004
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