Recommended Immunization Catch-Up Schedule (4 Months-18 Years)
Catch-up Immunization Schedule for Children and Adolescents Who Start Late or Who Are More than 1 Month Behind
Recommendations for Ages 18 Years or Younger, United States, 2022
COVID-19 Vaccination
ACIP recommends use of COVID-19 vaccines for everyone ages 6 months and older. COVID-19 vaccine and other vaccines may be administered on the same day. See the COVID-19 Vaccine: Interim COVID-19 Immunization Schedule for additional information.
Using the schedule
To make vaccination recommendations, healthcare providers should:
- Determine needed vaccines based on age (Table 1)
- Determine appropriate intervals for catch-up, if needed (Table 2)
- Assess for medical conditions and other indications (Table 3)
- Review special situations (Vaccination Notes)
- Review contraindications and precautions to vaccination (Appendix)
More schedule resources
- Schedule changes and guidance single arrow icon
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The tables below provide catch-up schedules and minimal intervals between doses for children based on age whose vaccinations have been delayed.
Table 1. By age
Table 2. Catch-up schedule
Table 3. By medical indications
Vaccination Notes
Appendix
Parent-friendly schedules
Vaccine Catch-Up Guidance
CDC has developed catch-up guidance job aids to assist healthcare providers in interpreting Table 2 in the child and adolescent immunization schedule.
- Pneumococcal Conjugate Vaccine (PCV) Catch-Up Guidance for Children 4 Months through 4 Years of Age pdf icon[3 pages]
- Haemophilus influenzae type b-Containing Vaccines Catch-Up Guidance for Children 4 Months through 4 Years of Age
- Diphtheria-, Tetanus-, and Pertussis-Containing Vaccines Catch-Up Guidance for Children 4 Months through 6 Years of Age pdf icon[2 pages]
- Inactivated Polio Vaccine (IPV) pdf icon[2 pages]
- Tetanus-, Diphtheria-, and Pertussis-Containing Vaccines Catch-Up Guidance for Children 7 through 9 Years of Age pdf icon[2 pages]
- Tetanus-, Diphtheria-, and Pertussis-Containing Vaccines Catch-Up Guidance for Children 10 through 18 Years of Agepdf icon
Children Age 4 Months through 6 Years
| Vaccine | Minimum Age for Dose 1 | Minimum Interval Between Doses | |||
|---|---|---|---|---|---|
| Dose 1 to Dose 2 | Dose 2 to Dose 3 | Dose 3 to Dose 4 | Dose 4 to Dose 5 | ||
Hepatitis B  |
Birth | 4 weeks | 8 weeks and at least 16 weeks after first dose. Minimum age for the final dose is 24 weeks. |
||
| Rotavirus |
6 weeks Maximum age for first dose is 14 weeks, 6 days. | 4 weeks | 4 weeks Maximum age for final dose is 8 months, 0 days. |
||
| Diphtheria, tetanus, and acellular pertussis |
6 weeks | 4 weeks | 4 weeks | 6 months | 6 months |
| Haemophilus influenzae type b |
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. |
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 |
8 weeks (as final dose)This dose only necessary for children age 12 through 59 months who received 3 doses before the 1st birthday. |
|
| Pneumococcal conjugate |
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 administered before the 1st birthday. 8 weeks (as final dose for healthy children) if first dose was administered at the 1st birthday or after. |
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 given at <7 months old. 8 weeks (as final dose for healthy children) if previous dose given 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. |
8 weeks (as final dose) This dose only necessary for children age 12 through 59 months who received 3 doses before age 12 months or for children at high risk who received 3 doses at any age. |
|
| Inactivated poliovirus |
6 weeks | 4 weeks | 4 weeks if current age is <4 years. 6 months (as final dose) if current age is 4 years or older. |
6 months (minimum age 4 years for final dose). |
|
| Measles, mumps, rubella |
12 months | 4 weeks | |||
| Varicella |
12 months | 3 months | |||
| Hepatitis A |
12 months | 6 months | |||
| Meningococcal ACWY |
2 months MenACWY-CRM 9 months MenACWY-D 2 years MenACWY-TT |
8 weeks | See notes | See notes | |
Children and Adolescents Age 7 through 18 Years
| Vaccine | Minimum Age for Dose 1 | Minimum Interval Between Doses | |||
|---|---|---|---|---|---|
| Dose 1 to Dose 2 |
Dose 2 to Dose 3 |
Dose 3 to Dose 4 |
|||
| Meningococcal ACWY |
Not Applicable (N/A) | 8 weeks | |||
| Tetanus, diphtheria; tetanus, diphtheria, and acellular pertussis |
7 years | 4 weeks | 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. |
6 months if first dose of DTaP/DT was administered before the 1st birthday. |
|
| Human papillomavirus |
9 years | Routine dosing intervals are recommended. | |||
| Hepatitis A |
N/A | 6 months | |||
| Hepatitis B |
N/A | 4 weeks | 8 weeks and at least 16 weeks after first dose. | ||
| Inactivated poliovirus |
N/A | 4 weeks | 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. |
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. | |
| Measles, mumps, rubella |
N/A | 4 weeks | |||
| Varicella |
N/A | 3 months if younger than age 13 years. 4 weeks if age 13 years or older. |
|||
| Dengue |
9 years | 6 months | 6 months | ||
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.
Notes
For vaccination recommendations for persons ages 19 years or older, see the Recommended Adult Immunization Schedule, 2022.
Additional information
- Consult relevant ACIP statements for detailed recommendations.
- For calculating intervals between doses, 4 weeks = 28 days. Intervals of ≥4 months are determined by calendar months.
- 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 3-1, Recommended and minimum ages and intervals between vaccine doses, in General Best Practice Guidelines for Immunization.
- Information on travel vaccination requirements and recommendations is available at https://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, and Immunization in Special Clinical Circumstances (In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book: 2018 report of the Committee on Infectious Diseases. 31st ed. Itasca, IL: American Academy of Pediatrics, 2018:67–111).
- 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 routine child and adolescent vaccines are covered by VICP except for pneumococcal polysaccharide vaccine (PPSV23). For more information, see www.hrsa.gov/vaccinecompensation/index.html.
Diphtheria, tetanus, and pertussis (DTaP) vaccination
(minimum age: 6 weeks [4 years for Kinrix® or Quadracel®])
Influenza vaccination
(minimum age: 6 months [IIV], 2 years [LAIV4], 18 years [recombinant influenza vaccine, RIV4])
Meningococcal serogroup A, C, W, Y vaccination (minimum age: 2 months [MenACWY-CRM, Menveo], 9 months [MenACWY-D, Menactra], 2 years [MenACWY-TT, MenQuadfi])
Meningococcal serogroup B vaccination
(minimum age: 10 years [MenB-4C, Bexsero®; MenB-FHbp, Trumenba®])
Tetanus, diphtheria, and pertussis (Tdap) vaccination
(minimum age: 11 years for routine vaccination, 7 years for catch-up vaccination)
Appendix – 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 and ACIP’s Recommendations for the Prevention and Control of 2021-22 seasonal influenza with Vaccines.
Interim clinical considerations for use of COVID-19 vaccines including contraindications and precautions
Vaccine
Contraindications1
Precautions2
- Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
- 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
- HIV infection without evidence of severe immunosuppression
- Moderate or severe acute illness with or without fever
- Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
- For DTaP only: Encephalopathy (e.g., coma, decreased level of consciousness, prolonged seizures) not attributable to another identifiable cause within 7 days of administration of previous dose of DTP or DTaP
- 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
- Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
- For Hiberix, ActHib, and PedvaxHIB only: History of severe allergic reaction to dry natural latex
- Age <6 weeks
- Moderate or severe acute illness with or without fever
- Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 including neomycin
- Moderate or severe acute illness with or without fever
- Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 including yeast
- For Heplisav-B only: Pregnancy
- Moderate or severe acute illness with or without fever
- Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 including neomycin and yeast
- Moderate or severe acute illness with or without fever
- Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
- Moderate or severe acute illness with or without fever
- Severe allergic reaction (e.g., anaphylaxis) after previous dose of any influenza vaccine (i.e., any egg-based IIV, ccIIV, RIV, or LAIV of any valency)
- Severe allergic reaction (e.g., anaphylaxis) to any vaccine component3 (excluding egg)
- Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any type of influenza vaccine
- Persons with egg allergy with symptoms other than hives (e.g., angioedema, respiratory distress) or required epinephrine or another emergency medical intervention: Any influenza vaccine appropriate for age and health status may be administered. If using egg-based IIV4, administer in medical setting under supervision of healthcare provider who can recognize and manage severe allergic reactions
- Moderate or severe acute illness with or without fever
- Severe allergic reaction (e.g., anaphylaxis) to any ccIIV of any valency, or to any component3 of ccIIV4
- Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any type of influenza vaccine
- 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 ccIV4, administer in medical setting under supervision of healthcare provider who can recognize and manage severe allergic reactions. May consult an allergist.
- Moderate or severe acute illness with or without fever
- Severe allergic reaction (e.g., anaphylaxis) to any RIV of any valency, or to any component3 of RIV4
- Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any type of influenza vaccine
- Persons with a history of severe allergic reaction (e.g., anaphylaxis) after a previous dose of any egg- based IIV, ccIIV, or LAIV of any valency. If using RIV4, administer in medical setting under supervision of healthcare provider who can recognize and manage severe allergic reactions. May consult an allergist.
- Moderate or severe acute illness with or without fever
- Severe allergic reaction (e.g., anaphylaxis) after previous dose of any influenza vaccine (i.e., any egg-based IIV, ccIIV, RIV, or LAIV of any valency)
- Severe allergic reaction (e.g., anaphylaxis) to any vaccine component3 (excluding egg)
- Children age 2 – 4 years with a history of asthma or wheezing
- Anatomic or functional asplenia
- Immunocompromised due to any cause including medications and HIV infection
- Close contacts or caregivers of severely immunosuppressed persons who require a protected environment
- Pregnancy
- Cochlear implant
- 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.
- Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any type of influenza vaccine
- Asthma in persons aged 5 years old or older
- Persons with egg allergy with symptoms other than hives (e.g., angioedema, respiratory distress) or required epinephrine or another emergency medical intervention: Any influenza vaccine appropriate for age and health status may be administered. If using LAIV4 (which is egg based), administer in medical setting under supervision of healthcare provider who can recognize and manage severe allergic reactions. May consult an allergist.
- Persons with underlying medical conditions (other than those listed under contraindications) that might predispose to complications after wild-type influenza virus infection [e.g., chronic pulmonary, cardiovascular (except isolated hypertension), renal, hepatic, neurologic, hematologic, or metabolic disorders (including diabetes mellitus)]
- Moderate or severe acute illness with or without fever
- Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
- 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
- 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
- Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
- For MenACWY-D and Men ACWY-CRM only: severe allergic reaction to any diphtheria toxoid– or CRM197–containing vaccine
- For MenACWY-TT only: severe allergic reaction to a tetanus toxoid-containing vaccine
- For MenACWY-CRM only: Preterm birth if less than age 9 months
- Moderate or severe acute illness with or without fever
- Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
- Pregnancy
- For MenB-4C only: Latex sensitivity
- Moderate or severe acute illness with or without fever
- Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
- Severe allergic reaction (e.g., anaphylaxis) to any diphtheria-toxoid– containing vaccine or its component3
- Moderate or severe acute illness with or without fever
- Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
- Moderate or severe acute illness with or without fever
- Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
- Pregnancy
- Moderate or severe acute illness with or without fever
- Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
- Severe combined immunodeficiency (SCID)
- History of intussusception
- Altered immunocompetence other than SCID
- Chronic gastrointestinal disease
- RV1 only: Spina bifida or bladder exstrophy
- Moderate or severe acute illness with or without fever
- Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
- For Tdap only: Encephalopathy (e.g., coma, 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
- Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
- 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
- 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
- When a contraindication is present, a vaccine should NOT be administered. Kroger A, Bahta L, Hunter P. ACIP General Best Practice Guidelines for Immunization.
- 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.
- 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 vaccinesexternal icon.
Vaccines in the Child and Adolescent Immunization Schedule
Vaccine
Abbreviation(s)
Trade name(s)
Dengue vaccine
DEN4CYD
Dengvaxia®
Diphtheria, tetanus, and acellular pertussis vaccine
DTaP
Daptacel®
Infanrix®
Diphtheria, tetanus vaccine
DT
No Trade Name
Haemophilus influenzae type B vaccine
Hib (PRP-T)
Hib (PRP-OMP)
ActHIB®
Hiberix®
PedvaxHIB®
Hepatitis A vaccine
HepA
Havrix®
Vaqta®
Hepatitis B vaccine
HepB
Engerix-B®
Recombivax HB®
Human papillomavirus vaccine
HPV
Gardasil 9®
Influenza vaccine (inactivated)
IIV4
Multiple
Influenza vaccine (live, attenuated)
LAIV4
FluMist® Quadrivalent
Measles, mumps, and rubella vaccine
MMR
M-M-R® II
Meningococcal serogroups A, C, W, Y vaccine
MenACWY-D
MenACWY-CRM
MenACWY-TT
Menactra®
Menveo®
MenQuadfi®
Meningococcal serogroup B vaccine
MenB-4C
MenB-FHbp
Bexsero®
Trumenba®
Pneumococcal 13-valent conjugate vaccine
PCV13
Prevnar 13®
Pneumococcal 23-valent polysaccharide vaccine
PPSV23
Pneumovax® 23
Poliovirus vaccine (inactivated)
IPV
IPOL®
Rotavirus vaccine
RV1
RV5
Rotarix®
RotaTeq®
Tetanus, diphtheria, and acellular pertussis vaccine
Tdap
Adacel®
Boostrix®
Tetanus and diphtheria vaccine
Td
Tenivac®
TDvax™
Varicella vaccine
VAR
Varivax®
Combination Vaccines
(Use combination vaccines instead of separate injections when appropriate)
Vaccine
Abbreviation(s)
Trade name(s)
DTaP, hepatitis B, and inactivated poliovirus vaccine
DTaP-HepB-IPV
Pediarix®
DTaP, inactivated poliovirus, and Haemophilus influenzae type B vaccine
DTaP-IPV/Hib
Pentacel®
DTaP and inactivated poliovirus vaccine
DTaP-IPV
Kinrix®
Quadracel®
DTaP, inactivated poliovirus, Haemophilus influenzae type b, and hepatitis B vaccine
DTaP-IPV-Hib-HepB
Vaxelis®
Measles, mumps, rubella, and varicella vaccines
MMRV
ProQuad®
This schedule is recommended by the Advisory Committee on Immunization Practices (ACIP) and approved by the Centers for Disease Control and Prevention (CDC), American Academy of Pediatrics (AAPexternal icon), American Academy of Family Physicians (AAFPexternal icon)), American College of Obstetricians and Gynecologists (ACOGexternal icon), American College of Nurse-Midwives (ACNMexternal icon), American Academy of Physician Associates (AAPAexternal icon), and National Association of Pediatric Nurse Practitioners (NAPNAPexternal icon).
The comprehensive summary of the ACIP recommended changes made to the child and adolescent immunization schedule can be found in the February 18, 2022 MMWR.
Report
- Suspected cases of reportable vaccine-preventable diseases or outbreaks to your state or local health department
- Clinically significant adverse events to the Vaccine Adverse Event Reporting System (VAERS) at www.vaers.hhs.govexternal icon or (800-822-7967)
Questions or comments
Contact www.cdc.gov/cdc-info or 800-CDC-INFO (800-232-4636), in English or Spanish, 8 a.m.–8 p.m. ET, Monday through Friday, excluding holidays.
Helpful information
- Complete Advisory Committee on Immunization Practices (ACIP) recommendations
- General Best Practice Guidelines for Immunization
- Vaccine information statements
- Outbreak information (including case identification and outbreak response), see Manual for the Surveillance of Vaccine-Preventable Diseases
- ACIP Shared Clinical Decision-Making Recommendations
Page last reviewed: February 17, 2022