Immunization schedules
Recommended schedule for active immunization of normal infants and childrena  in the United States

Recom-	Immunization(s)c	Comments
mended
	ageb

	Birth	HBVd
	1-2 mo	HBVd
	2 mo	DTP, Hibe, OPV	DTP and OPV can be initiated as early as 4 weeks after birth
				in areas of high endemicity or during outbreaks
	4 mo	DTP, Hibe, OPV	2-mo interval (minimum of 6 weeks) recommended for OPV
	6 mo	DTP, (Hibe)	
	6-18 mo	HBVd, OPV
	12-15 mo	Hibe, MMR	MMR should be given at 12 mo of age in high-risk areas.  If
			 	indicated, tuberculin testing may be done at the same visit
	15-18 mo	DTaP  or DTP	The 4th dose of diphtheria-tetanus-periussis vaccine should be
				given 6-12 mo after the third dose of DTP and may be given
				as early as 12 mo of age, provided that the interval between
				doses 3 and 4 is at least 6 mo and DTP is given.  DTaP is not
				currently licensed for use in children younger than 15 mo
	 4-6 yr	DTaP or DTP, OPV	DTaP or DTP and OPV should be given at or before school entry.
				DTP or DTaP should not be given at or after the 7th birthday
	11-12 yr	MMR	MMR should be given at entry to middle school or junior high
				school unless 2 doses were given after the 1st birthday
	14-16 yr	Td	Repeat every 10 yr throughout life

aTable is not completely consistent with all package inserts.  For products used, also consult manufacurer’s package insert for instructions for storage, handling, dosage, and administration.  Biologies prepared by different manufacturers may vary, and package inserts of the same manufacturer may change from time to time.  Therefore, the physician should be aware of the contents of the current package insert.
bThese recommended ages should not he construed as absolute. For example, 2 months can be 6 to 10 weeks. However, MMR usually should not he given to children younger than 12 months. If measles vaccination is indicated, monovalent measles vaccine is recommended, and MMR should he given subsequently, at 12-15 months.
cVaccine abbreviations; HBV = Hepatitis B virus vaccine; DTP = diphtheria and tetanus toxoids and pertussis vaccine; DTaP = diphtheria and tetanus toxoids and aœllular pertussis vaccine; Hib = Haemophilus influenzae type b conjugate vaccine; OPV = oral poliovirus vaccine (containing attenuated poliovirus types 1, 2, and 3); MMR = live measles, mumps, and rubella viruses vaccine; Td = adult tetanus toxoid (full dose) and diphtheria toxoid (reduced dose), for children  >7 y and adults.
dAn acceptable alternative to minimize the number of visits for immunizing infants of HBsAg-negative mothers is to administer dose 1 at 0-2 mo, dose 2 at 4 mo, and dose 3 at 6 to 18 mo.
e(Hib: dose 3 of Hib is not indicated if the product for doses 1 and 2 was PedvaxHiB [PRP-OMP], available from Merck & Co., West Point, PA).
From American Academy of Pediatrics.  In Peter G, ed: 1994 Redbook; Report of the committee on infectious diseases, ed 23, Elk Grove Village, IL, 1994, American Academy of Pediatrics, p 23.

Recommended immunization schedules for children not immunized in the first year of life

	Recom-	Immunization(s)a,b	Comments
	mended
	time/age
	Younger than 7 years
	First Visit	DTP, Hib, HBV,	If indicated, tuberculin testing may be done at same visit.
		  MMR, OPV	If child is 5 y of age or older, Hib is not indicated
	Interval
after first visit:
	1 mo	DTP, HBV	OPV may be given if accelerated poliomyelitis vaccination is
				necessary, such as for travelers to areas where polio is endemic
	2 mo	DTP, Hib, OPV	Second dose of Hib is indicated only in children whose first dose
				was received when younger than 15 mo
	28 mo	DTP or DTaPc,	OPV is not given if the third dose was given earlier
		  OPV
	4-6 y	DTP or DTaPc,	DTP or DTaP is not necessary if the fourth dose was given after
	 (at or before	  OPV		the fourth birthday; OPV is not necessary if the third dose was
	 school entry)		given after the fourth birthday
	11-12 y	MMH	At entry to middle school or junior high school
	10 y later	Td	Repeat every 10 yr throughout life

	7 years and olderd,e
	First Visit	HDVf, OPV, MMR,	
		  Td
	Interval
after first visit:
	2 mo	HBVf, OPV, Td	OPV may also be given 1 mo after the first visit if accelerated
				poliomyelitis vaccination is necessary
	8-14 mo	HBVf, OPV, Td	OPV is not given if the third dose was given earlier
	11-12 y	MMH	At entry to middle school or junior high school
	10 y later	Td	Repeat every 10 yr throughout life

a Abbreviations for vaccines are explained in the footnotes above.  If all needed vaccines cannot be administered simultaneously, priority should be given to protecting the child against those diseases that pose the greatest immediate risk.  In the US, these diseases for children younger than 2 y usually are measles and Haemophilus influenzae type b infection; for children older than 7 y, they are measles, mumps, and rubella (MMR).
b DTP or DTaP, HBV, Hib, MMR, and OPV can be given simultaneously at separate sites if failure of the patient to return for future immunizations is a concern.
c DTaP is not currently licensed for use in children younger than 15 mo of age and is not recommended for primary immunization (ie, first 3 doses) at any age.
d If person is 18 y or older, routine poliovirus vaccination is not indicated in the US.
e Minimal interval between doses of MMR is 1 mo.
f  Priority should be given to hepatitis B immunization of adolescents.

From American Academy of Pediatrics.  In Peter G, ed: 1994 Redbook; Report of the committee on infectious diseases, ed 23, Elk Grove Village, IL, 1994, American Academy of Pediatrics, p 23.