Catch-up Immunization Schedule for Children and Adolescents Aged 4 Months Through 18 Years Who Start Late

or Who Are More Than 1 Month Behind - United States · 2018

(for DTaP, IPV, Hep B, Hib, Measles, Mumps, Rubella, Pneumococcal, Varicella, TD, Tdap, Meningococcal ACWY)
Tables 1 and 2 provide catch-up schedules and minimum intervals between doses for children whose vaccinations have been delayed. A vaccine series
does not need to be restarted, regardless of the time that has elapsed between doses. Use the section appropriate for the child’s age. Always use these
tables in conjunction with the footnotes that follow.

Table 1. Catch-up Schedule for Children Age 4 Months Through 6 Years

Minimum Interval Between Doses
Vaccine Minimum Dose 1 to Dose 2 Dose 2 to Dose 3 Dose 3 to Dose 4 Dose 4 to
Age for Dose 5
Dose 1

Hepatitis B1 Birth 4 weeks 8 weeks and at least 16 weeks after

first dose; minimum age for the final
dose is 24 weeks
Diphtheria, Tetanus, 6 wks 4 weeks 4 weeks 6 months 6 months2
Pertussis2

Haemophilus 6 wks 4 weeks if first dose administered before the 4 weeks if current age is younger than 8 weeks (as final dose)
Influenzae type b3 1st birthday 12 months and first dose was This dose only
administered at younger than age 7 necessary for children
8 weeks (as final dose) if first dose months, and at least 1 previous dose aged 12 months through
administered at age 12 through 14 months was PRP-T (ActHiB, Pentacel, Hiberix) 59 months who received
or unknown. 3 doses before the 1st
No further doses needed if first dose birthday
administered at age 15 months or older 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
administered at younger than 15
months;
OR
• If both doses were PRP-OMP
(PedvaxHIB; Comvax) and were
administered before the 1st
birthday

No further doses needed if previous

dose administered at age 15 months or
older
Pneumococcal4 6 wks 4 weeks if first dose administered before the 4 weeks if current age is younger than 8 weeks (as final dose)
1st birthday 12 months and previous dose given at This dose only
less than 7 months old necessary for children
8 weeks (as final dose for healthy aged 12 months through
st
children) if first dose administered at the 1 8 weeks (as final dose for healthy 59 months who received
birthday or after children) 3 doses before age 12
• if previous dose given between 7 months or for high risk
No further doses needed for healthy through 11 months (wait until at children who receive 3
children if first dose administered at age 24 least 12 months old); doses at any age
months or older OR
• if current age is 12 months or older
and at least 1 dose was given
before age 12 months

No further doses needed for healthy

children if previous dose administered
at age 24 months or older
Inactivated 6 wks 4 weeks5 4 weeks5 If current age is < 4 years 4 6 months5 (minimum
Poliovirus5 weeks5 age 4 years for final
6 months (as final dose) if current age dose)
is 4 years or older
Measles, Mumps, 12 mos 4 weeks
Rubella6

Varicella7 12 mos 3 months

1
Hepatitis (Hep B) vaccine
• Unvaccinated persons should complete a 3-dose series at 0, 1-2, and 6 months.
2
Diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine
• The 5th dose of DTaP vaccine is not necessary if the 4th dose was administered at 4 years or older.
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3
Haemophilus influenzae type b conjugate (Hib) vaccine
• 1st dose at 7-11 months: Give 2nd dose at least 4 weeks later and 3rd (final) dose at 12-15 months or 8 weeks after 2nd dose (whichever is later).
• 1st dose at 12-14 months: Give 2nd (final) dose at least 8 weeks after 1st dose.
• 1st dose before 12 months and 2nd dose before 15 months: Give 3rd (final) dose 8 weeks after 2nd dose.
• 2 doses of PedvaxHib before 12 months: Give 3rd (final) dose at 12-59 months and at least 8 weeks after 2nd dose.
• Unvaccinated at 15-59 months: 1 dose.
4
Pneumococcal vaccines [Minimum age: 6 weeks for pneumococcal conjugate vaccine (PCV).
• 1 dose for healthy children aged 24-59 months with any incomplete PCV13 schedule.
5
Inactivated poliovirus (IPV) vaccine
• In the first 6 months of life, use minimum ages and intervals only for travel to a polio-endemic region or during an outbreak.
• If 4 or more doses were given before the 4th birthday, give 1 more dose at 4-6 years and at least 6 months after the previous dose.
• A 4th dose is not necessary if the 3rd dose was given on or after the 4th birthday and at least 6 months after the previous dose.
• If both OPV and IPV were administered as part of a series, a total of 4 doses should be administered, regardless of the child’s current age. If only OPV
was administered, and all doses were administered prior to 4 years of age, 1 dose of IPV should be administered at 4 years or older, at least 4 weeks
after the last OPV dose.
• Series Containing Oral Polio Vaccine (OPV), either mixed OPV-IPV or OPV only series:
• Total number of doses needed to complete the series is the same as that recommended for the U.S. IPV schedule.
• Only trivalent OPV (tOPV) counts toward the U.S. vaccination requirements.
6
Measles, mumps, and rubella (MMR) vaccine
• Unvaccinated children and adolescents: 2 doses at least 4 weeks apart.
7
Varicella Vaccine
• Ensure persons 7-18 years without evidence of immunity (see MMWR 2007; 56 [No. RR-4]; atwww.cdc.gov/mmwr/pdf/rr/rr5604.pdf) have 2 doses of
varicella vaccine.
• Ages 7-12: routine interval 3 months (minimum interval: 4 weeks).
• Ages 13 and older: minimum interval 4 weeks.

Table 2. Catch-up Schedule for Children and Adolescents Age 7 Through 18 Years
Vaccine Minimum Age Dose 1 to Dose 2 Dose 2 to Dose 3 Dose 3 to
for Dose1 Dose 4
Meningococcal1 6 weeks 8 weeks

Tetanus, Diphtheria / 7 yrs2 4 weeks 4 weeks if first dose of DTaP/DT 6 months if

Tetanus, Diphtheria, administered before the 1st birthday first dose of
Pertussis2 6 months (as final dose) if first dose of DTaP/DT
DTaP/DT or Tdap/Td administered at or administered
after the 1st birthday before the 1st
birthday
Hepatitis B3 Not 4 weeks 8 weeks and at least 16 weeks after first
Applicable dose
(N/A)
Inactivated Poliovirus4 N/A 4 weeks 6 months4 6 months4
A fourth dose is not necessary if the third A fourth dose of
dose was administered at age 4 years or IPV is indicated
older and at least 6 months after the if all previous
previous dose. doses were
administered at
<4 years or if
the third dose
was
administered <
6 months after
the second
dose.

Measles, Mumps, Rubella5 N/A 4 weeks

Varicella6 N/A 3 months if younger than age 13
years
4 weeks if age 13 years or older

1
Meningococcal vaccines
• Age 13-15 years: 1 dose now and booster at age 16-18 years. Minimum interval 8 weeks.
• Age 16-18 years: 1 dose.
2
Tetanus and diphtheria toxoids vaccine (Td) and tetanus and diphtheria toxoids and acellular pertussis (Tdap) vaccine
• Adolescents 13–18 who have not received Tdap: 1 dose, followed by a Td booster every 10 years.
• Persons aged 7–18 years not fully immunized with DTaP: 1 dose of Tdap as part of the catch-up series (preferably the first dose). If additional doses
are needed, use Td.
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• Children 7–10 years who receive Tdap inadvertently or as part of the catch-up series may receive the routine Tdap dose at 11–12 years.
• DTaP inadvertently given after the 7th birthday: Child 7–10: DTaP may count as part of catch-up series. Routine Tdap dose at 11-12 may be given.
• Adolescent 11–18: Count dose of DTaP as the adolescent Tdap booster.
3
Hepatitis B (HepB) vaccine
• Unvaccinated persons should complete a 3-dose series at 0, 1-2, and 6 months.
• Adolescents 11–15 years of age may use an alternative 2-dose schedule, with at least 4 months between doses (adult formulation Recombivax HB
only).
4
Inactivated poliovirus (IPV) vaccine
• If 4 or more doses were given before the 4th birthday, give 1 more dose at age 4–6 years and at least 6 months after the previous dose.
• A 4th dose is not necessary if the 3rd dose was given on or after the 4th birthday and at least 6 months after the previous dose.
• IPV is not routinely recommended for U.S. residents 18 years or older.
• If both OPV and IPV were administered as part of a series, a total of 4 doses should be administered, regardless of the child’s current age. If only OPV
was administered, and all doses were administered prior to 4 years of age, 1 dose of IPV should be administered at 4 years or older, at least 4 weeks
after the last OPV dose.
• Series Containing Oral Polio Vaccine (OPV), either mixed OPV-IPV or OPV only series:
• Total number of doses needed to complete the series is the same as that recommended for the U.S. IPV schedule.
• Only trivalent OPV (tOPV) counts toward the U.S. vaccination requirements.
5
Measles, mumps, and rubella (MMR) vaccine
• Unvaccinated children and adolescents: 2 doses at least 4 weeks apart.
6
Varicella (VAR) vaccine
• varicella vaccine.
• Ages 7-12: routine interval 3 months (minimum interval: 4 weeks).
• Ages 13 and older: minimum interval 4 weeks.

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