Pediatric vaccine schedule

CDC childhood immunization schedule, contraindications, and special-situation vaccines.

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◆Routine schedule (memorize the ages)

•Birth: HepB #1
•2 mo: HepB #2, DTaP #1, Hib #1, IPV #1, PCV13 #1, RV #1
•4 mo: DTaP #2, Hib #2, IPV #2, PCV13 #2, RV #2
•6 mo: HepB #3, DTaP #3, Hib #3 (if PRP-T), PCV13 #3, RV #3 (if rotateq), influenza (annual after 6 mo)
•12–15 mo: MMR #1, varicella #1, HepA #1, PCV13 booster, Hib booster
•15–18 mo: DTaP #4
•4–6 yr: DTaP #5, IPV #4, MMR #2, varicella #2
•11–12 yr: Tdap, HPV (2-dose if started before 15, 3-dose if 15+), meningococcal #1
•16 yr: meningococcal #2, MenB optional shared decision-making

•ABSOLUTE: anaphylaxis to prior dose or vaccine component
•Live vaccines (MMR, varicella, rotavirus, yellow fever, BCG): contraindicated in pregnancy + severe immunocompromise (CD4 <200 for MMR/VZV)
•Egg allergy: most flu vaccines safe; carefully observe — only severe hx contraindicates older formulations
•Intussusception history → no rotavirus
•Severe combined immunodeficiency (SCID) → no live vaccines
•Live vaccines OK in HIV with CD4 >200 (MMR, varicella)
•Mild illness (URI, low fever) is NOT a contraindication

•Pregnancy: Tdap every pregnancy (27–36 weeks) + flu seasonal; NEVER live vaccines
•Asplenia (anatomic or functional like SCD): pneumococcal (PCV13 + PPSV23), Hib, meningococcal — encapsulated organisms
•Immigrants/refugees: catch-up schedule based on age
•HCWs: HepB series, MMR, Tdap, annual flu, COVID, varicella
•Travelers: yellow fever (live — avoid in pregnant/immunocompromised), typhoid, HepA, Japanese encephalitis depending on destination

•Rabies: vaccine series + RIG (if not previously vaccinated) for high-risk bite/exposure
•Tetanus: TIG + vaccine if dirty wound + no recent booster (or unknown)
•HepB: vaccine + HBIG within 24 hr of high-risk exposure (NB to HepB+ mom, needle stick from HepB+ source)
•Measles: vaccine within 72 hr OR IG within 6 days for susceptible contacts
•Varicella: VariZIG for immunocompromised, neonates born to mom with active VZV, or VZ-negative pregnant women

Live (avoid in pregnancy + immunocompromise)	Killed/inactivated/subunit
MMR	DTaP, Tdap, Td
Varicella	Hib
Rotavirus	HepB, HepA
Influenza (LAIV nasal)	Influenza (IIV injectable)
Yellow fever, BCG, oral typhoid	HPV, PCV13, PPSV23, meningococcal

◆Pregnancy: Tdap every pregnancy at 27–36 wks (passive immunity to newborn for pertussis)
◆Anatomic/functional asplenia → vaccinate for encapsulated organisms (Pneumo, Hib, Meningo)
◆Egg allergy ≠ contraindication to flu vaccine in most cases
◆HepB at birth is the ONLY routine birth vaccine in US
◆Catch-up immunization: minimum intervals between doses — never start over
◆Live virus vaccines: separate by ≥28 days if not given on same day (otherwise immune interference)

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