Child and Adolescent Immunization Schedule

Board takeaway

Use age, valid prior doses, medical risk, and contraindications together.

• Continue a delayed series without restarting valid doses.
• For dental care, the most useful decisions are coordinating catch-up, promoting HPV prevention, checking tetanus history after contaminated injury, and identifying patients whose immune status changes vaccine eligibility.

This is the AAP's 2026 schedule hosted by AAPD.

• Its age table, catch-up table, medical-risk table, notes, and addendum must be read together.
• Seasonal recommendations and product availability can change within the schedule year; the detailed entries below retain the season and product qualifications in this source.

Record review and catch-up

• Confirm vaccine/product, dose dates, age at each dose, immune status, pregnancy, allergies, prior reactions, travel, and outbreak exposure; identify the next valid dose and follow-up interval.
• Four weeks means 28 days; intervals of at least four months use calendar months.
• Doses up to four days early may count. Doses at least five days before a minimum age/interval do not count; repeat with the required minimum interval measured from the invalid dose.
• Apply every relevant medical-risk category; medical-risk conditions may overlap. Check current AAP guidance and prescribing information for complex cases.

Infant and childhood series

DTaP

• Primary doses at 2, 4, and 6 months; boosters at 15–18 months and 4–6 years.
• No fifth dose is needed if the fourth was given at age ≥4 years and ≥6 months after the third.
• A planned fourth dose can be given at ≥12 months if ≥6 months after the third.
• An inadvertent fourth dose at ≥12 months may count after ≥4 months.

Hib

• Product-dependent primary series, followed by a booster at 12–15 months.
• PedvaxHIB uses two primary doses; other listed products use three.
• Vaxelis is not a booster product.
• Vaxelis/PedvaxHIB are preferred for American Indian/Alaska Native infant primary vaccination.
• Healthy unvaccinated children 15–59 months need one dose; routine catch-up is not required at ≥60 months.

PCV15/PCV20

• 2, 4, 6, 12–15 months.
• Healthy children 2–4 years with an incomplete series need one PCV dose.
• A complete age-appropriate series does not justify extra PCV20 in a healthy child.

IPV

• 2, 4, 6–18 months, 4–6 years.
• Final dose at ≥4 years and ≥6 months after prior dose, even after combination-vaccine doses in infancy.
• Only trivalent OPV counts; source excludes OPV given on/after April 1, 2016.
• At age 18, incomplete primary series and increased exposure risk have separate completion/one-lifetime-booster pathways.

Rotavirus

• Rotarix at 2/4 months.
• RotaTeq at 2/4/6 months.
• Any RotaTeq or unknown product → three-dose series.
• First dose by 14 weeks 6 days.
• Final dose by 8 months 0 days.
• Minimum intervals four weeks.

HepA

• Two doses beginning 12–23 months, ≥6 months apart; catch-up through 18.
• Travel dose at 6–11 months does not replace the routine series.
• At ≥12 months, give first travel dose when travel is considered.

Hepatitis B: birth protection and follow-up

• Routine series: birth, 1–2 months, 6–18 months; final dose ≥24 weeks. Minimum intervals: first–second four weeks; second–final eight weeks; first–final 16 weeks. Combination products can yield four doses.
• HBsAg-negative mother: medically stable infant ≥2000 g → birth dose within 24 hours; < 2000 g → age one month or discharge, whichever first.
• HBsAg-positive mother: monovalent vaccine plus HBIG in separate limbs within 12 hours, regardless of weight. If < 2000 g, give three additional vaccine doses starting at one month.
• Unknown maternal status: give vaccine within 12 hours.
  • Infant < 2000 g: also give HBIG immediately and three additional vaccine doses.
  • Infant ≥2000 g, mother subsequently tests positive: give HBIG promptly, no later than day seven.
  • Other evidence of maternal HBV infection calls for the positive-mother pathway.
• Positive/remaining-unknown maternal status → infant HBsAg and anti-HBs at 9–12 months, or 1–2 months after delayed final dose; never before nine months.
• Routine revaccination unnecessary with normal immunity. Selected exposed infants, dialysis patients, and immunocompromised patients need serology/revaccination assessment when anti-HBs < 10 mIU/mL.
• Alternative catch-up: ages 11–15 may use two adult-formulation Recombivax HB doses ≥4 months apart; age 18 permits Heplisav-B or Twinrix schedules specified in the source.

HPV and adolescent meningococcal protection

HPV

• AAP recommends starting at 9–12 years; catch-up through 18.
• Start before 15 → two doses 6–12 months apart, minimum five months.
• Start ≥15 → three doses at 0, 1–2, 6 months; minimum intervals four weeks, 12 weeks, and five months across first–last doses.
• Immunocompromise/HIV → three HPV doses even if starting before 15.
• Sexual abuse/assault history → start at nine.
• Completed valid series of any valency needs no extra dose.
• Defer during pregnancy; inadvertent administration needs no intervention, and pregnancy testing is unnecessary.

MenACWY

• 11–12 years and 16 years.
• First dose 13–15 → booster 16–18, ≥8 weeks later.
• First at 16–18 → one dose.
• Residential college entrants need a dose within five years, preferably at ≥16.
• Asplenia, HIV, complement deficiency/inhibitor use, travel, military service, and outbreaks modify MenACWY schedules/boosters.
• Infant series depends on starting age; liquid Menveo is not for children < 10.

MenB

• Shared decision-making at 16–23, preferably 16–18.
• Two doses ≥6 months apart.
• Rapid protection may use 0, 1–2, 6 months.
• High-risk asplenia/complement deficiency or inhibitor use → three-dose pathway and risk-based boosters.
• Use one brand throughout.

MenABCWY

• Age ≥10 when both ACWY and B are due the same day.
• Penbraya pairs with Trumenba, Penmenvy with Bexsero.
• These product families are not interchangeable.
• Combination boosters require ≥6 months from the previous dose.

MMR, varicella, and travel

• Both routine series: 12–15 months and 4–6 years. MMR catch-up minimum four weeks; varicella minimum three months below 13, four weeks at ≥13. Inadvertent varicella dose ≥4 weeks later may count.
• MMRV maximum age 12; minimum interval three months.
• AAP expresses no first-dose toddler preference between separate products and MMRV; counsel about rare febrile seizures 1–2 weeks after first MMRV.
• Second-dose MMRV generally preferred to reduce injections.
• International travel: MMR at 6–11 months, ideally ≥2 weeks before departure, followed by a new routine two-dose series.
• Older unvaccinated travelers need two doses ≥4 weeks apart; second ≥2 weeks before departure.
• Outbreak-related additional MMR requires public-health guidance.

Seasonal protection: influenza and COVID-19

Influenza

• Influenza: annually from six months.
  • In this source's 2025–2026 instructions, ages 6 months–8 years with < 2 prior doses before July 1, 2025, or unknown history need two doses ≥4 weeks apart; otherwise one.
  • Age ≥9 → one.
  • Egg allergy alone does not prevent age-appropriate vaccination.
• LAIV begins at two years; contraindications include pregnancy, immunocompromise, asplenia, age 2–4 asthma/recent wheezing, salicylates, cochlear implant/CSF leak, and recent specified influenza antivirals.
• Avoid LAIV for contacts of severely immunosuppressed patients in protected environments; inadvertent receipt → avoid contact seven days.
• Age-18 immunosuppressed solid-organ transplant recipients may receive high-dose/adjuvanted inactivated influenza vaccine; no preference over other appropriate injectable products.

COVID-19

• COVID-19: source recommends vaccination for all 6–23-month-olds; age 2–18 risk groups include severe-disease risk, congregate residence, never vaccinated, or high-risk household contacts.
  • Offer vaccination to other children whose families desire protection.
• Use latest available age/health-appropriate licensed product.
• Prior doses, age, product, and immune status determine completion.
• Immunocompromised pathways use expanded initial series and subsequent doses; additional doses are conditional on shared decision-making, ≥2 months after the last.
• Consult the actual dosing guide rather than extrapolating between products.

RSV, dengue, and mpox

RSV

• First RSV season: infant < 8 months → nirsevimab or clesrovimab if maternal vaccination absent/unknown or delivery < 14 days after vaccination.
  • Birth during season → within one week, ideally before discharge; otherwise shortly before/during season.
  • Maternal vaccine ≥14 days before delivery generally removes need, with rare discretionary exceptions.
• Second season, 8–19 months: nirsevimab for high-risk children: prematurity-related chronic lung disease requiring support in prior six months, severe immunocompromise, specified severe cystic-fibrosis disease or weight-for-length < 10th percentile, or American Indian/Alaska Native status.
  • Prior protection does not remove eligibility.
  • Cardiopulmonary bypass may require an additional antibody dose.
• Maternal Abrysvo: 32 weeks 0 days–36 weeks 6 days, September–January in most continental US settings, if never vaccinated in a prior pregnancy.
• Repeat pregnancy doses not recommended because data are lacking; protect the infant with antibody instead.
• Infant antibody season usually October–March; adjust to local epidemiology.

Dengue

• Source eligibility is age 9–16, endemic-area residence, and laboratory-confirmed prior infection.
• Three doses at 0/6/12 months.
• Not for travelers.
• Distribution ceased September 2025; stated shelf life ends September 2026—verify availability rather than proposing administration in October 2026.

Mpox

• At-risk age-18 patients → two Jynneos doses 28 days apart.
• Assess recent STI, multiple partners, relevant venues/events, partners' risk, and anticipated exposure.
• Pregnancy data are limited; source permits vaccination with listed risk factors despite no general pregnancy recommendation.

Medical risk and safety decisions

• Hib: asplenia/HIV/immune deficiencies and chemotherapy may need extra doses.
  • Repeat doses given during or within 14 days before therapy ≥3 months after completion.
  • HCT → three doses four weeks apart, starting 6–12 months after successful transplant.
  • Elective splenectomy: indicated dose preferably ≥14 days beforehand.
• Pneumococcus: CSF leak/cochlear implant, chronic organ disease, diabetes, dialysis, asplenia, and immunocompromise require history-specific PCV/PPSV23 assessment.
  • PCV20 often completes protection; some PPSV23 pathways in immunocompromised patients require another PCV20/PPSV23 ≥5 years later.
  • Give indicated PCV15 before PPSV23, ≥8 weeks apart, not together.
  • Pregnancy recommendations absent because data are limited.
• Tdap:
  • 11–12 years; catch-up from seven.
  • Tdap at 7–9 still requires adolescent booster; at ten it does not.
  • Each pregnancy: preferably early in weeks 27–36.
• Wounds with ≥3 prior tetanus doses: age ≥7, booster if >10 years for clean/minor or >5 years for other wounds; < 7, source specifies DTaP for other wounds if >5 years.
• This passage does not supply the complete unknown/< 3-dose wound algorithm.

Contraindication or precaution

• Contraindication → do not give; precaution → usually defer, but weigh protection against reaction risk. Anaphylaxis is product/component-specific; moderate/severe acute illness is a precaution.
• Live MMR/varicella contraindicated in pregnancy/severe immunodeficiency; MMRV contraindicated with any HIV infection. Blood products, antiviral therapy, seizure history, and immune-family history require specific review.
• Rotavirus contraindicated with SCID/intussusception.
• Unexplained encephalopathy within seven days of pertussis vaccine contraindicates that component; Td may replace remaining DTaP in affected children < 7.
• Neurologic instability, recent vaccine-associated GBS, and Arthus reactions need appendix review.
• COVID-associated myocarditis/pericarditis within three weeks and MIS-C/MIS-A are precautions. Vaccine allergy assessment must distinguish influenza products and exclude egg allergy alone.

Reporting and documentation

• Record dose validity, unresolved history, contraindication/precaution, counseling, medical referral, and next due date.
• Report suspected reportable disease/outbreak to local/state health authorities; significant vaccine adverse events to VAERS. RSV antibody events → MedWatch; if coadministered with other products, VAERS.
• Source identifies VICP/CICP resources; do not assume every listed product has identical compensation coverage.

Common board traps

Answer aloud

How should you address incomplete vaccine records in a 12-year-old?

Verify valid prior doses and coordinate risk-appropriate catch-up with the medical team without restarting valid series.

• Review product, dose dates, minimum ages/intervals, immune status, pregnancy, and contraindications.
• Include HPV, Tdap, MenACWY, and seasonal protection as applicable.
• Missing paperwork does not prove no vaccination; document the next valid dose and follow-up.

Does a healthy child starting HPV at 14 need three doses?

Usually no: initiation before 15 uses two doses, routinely 6–12 months apart with a minimum five-month interval.

• Three-dose minimum intervals: four weeks between doses 1–2, 12 weeks between 2–3, and five months between 1–3.
• AAP recommends starting at 9–12 years; defer vaccination during pregnancy.

Does maternal RSV vaccination in a previous pregnancy protect this infant?

It does not replace the current infant-protection pathway; assess infant age, season, maternal status, and risk.

• Repeat maternal doses are not recommended in this source because data are lacking; protect the infant with the indicated antibody instead.
• First season, under eight months: nirsevimab or clesrovimab when maternal vaccination is absent/unknown or birth occurred less than 14 days after vaccination.
• Second season, 8–19 months: selected high-risk children receive nirsevimab, not clesrovimab.

How does the 2026 AAP schedule guide tetanus review after a dental injury?

Review wound type, age, valid dose history, and time since the last tetanus-containing vaccine with the medical team.

• At age seven or older with at least three prior doses, the source lists a booster after more than ten years for clean/minor wounds or more than five years for other wounds.
• Under seven, it specifies DTaP for other wounds after more than five years.
• This passage does not provide the complete unknown/fewer-than-three-dose wound algorithm; do not infer that no intervention is needed.