Vaccination Schedule

Vaccine(s):

Hepatitis B vaccine: A series of three doses (from 0-6 months of age) are given at age 0 (either in the hospital or first office visit), 1 month of age and 6 months (not sooner than 24 weeks) of age.

If the infant is born to a hepatitis B positive (HbsAg) mother, give HBIG within 12 hours of life and first dose of hepatitis B vaccine at separate sites (test for HBsAg & anti-HBs at nine months of age).

Determine mom's hepatitis B status as soon as possible and if mom is positive give HBIG (should be given less than one week of age). Infants born to positive Hepatitis B mothers should be tested for the disease (HBsAg) and antibody to HBsAg 1-2 months after the 3rd dose of vaccine (at the next well child visit at 9 months of age). When using combination vaccines it is permissible to give 4 doses of vaccine. Adults ages 18-59 with diabetes should be vaccinated.

Contraindication: allergy to Baker's yeast.

Vaccine(s)

Hepatitis B: The second dose should be administered 1 to 2 months after the first dose.

Contraindication: allergy to Baker's yeast.

Vaccines:

DTaP: Diphtheria, tetanus, and acellular pertussis vaccine; primary series of three doses at age 2, 4 and 6 months of life. Two boosters at 15-18 months (this fourth dose can be given as early as 12 months of age provided the third dose was given six months prior) and between 4-6 years of age. Contraindication: previous encephalopathy within 7 days of administered dose.

Hib: Haemophilus influenzae type b vaccine; conjugate vaccine given at 2, 4 and 6 months of age; if giving PRP-OMP or ComVax eliminate 6 month dose. Hibrerix should not be given as the primary doses at 2, 4 and 6 months of age. A booster is given between 12-15 months of age. Do not give on or after 5th birthday. Hiberix was recently approved to prevent invasive disease caused by Hib when administered as a booster dose in children 15 months to 4 years.

IPV: Inactivated poliovirus vaccine; Schedule is 2 and 4 months of age. Between 6 months and 18 months of age the child should receive a booster, and again between 4 and 6 years of age. An interval of at least 6 months between the next to the last dose and the last dose provides the best immunologic effect. If 4 doses of IPV are given before the 4th birthday an additional dose of IPV should be given on or after that birthday. Audio file

PCV: Pneumococcal conjugate vaccine. Recommended for all children younger than 5; given at 2, 4 and 6 months of life. Between 14 months and 59 months all infants who received PCV-7 should receive a single dose of PCV-13. PCV-13 was developed to replace PCV-7; going forward, all infants will receive PCV-13 instead of PCV-7. PCV-13 is indicated for the prevention of invasive disease and otitis media. Those with certain chronic medical conditions should receive PPSV vaccine.

Rota: Rotavirus vaccine; given at 2, 4 and 6 months of age. First dose must be given by 14 weeks, 6 days. The vaccine should not be initiated in infants who are 15 weeks,0 days of age. The maximum age at the final dose in the series is 8 months, 0 days. If using Rotarix for doses given at 2 and 4 months, a dose at six months is not indicated.

Vaccines:

DTaP: Diphtheria, tetanus, and acellular pertussis vaccine; second dose.

Contraindication: previous encephalopathy within 7 days of administered dose.

Hib: Haemophilus influenzae type b vaccine; conjugate vaccine; second dose.

IPV: Inactivated poliovirus vaccine; second dose.

PCV: Pneumococcal conjugate vaccine; second dose.

Rota: Rotavirus vaccine; second dose.

Vaccines:

DTaP: Diphtheria, tetanus, and acellular pertussis vaccine; third dose. Contraindication: previous encephalopathy within 7 days of administered dose.

Hib: Haemophilus influenzae type b vaccine; conjugate vaccine; third dose.

PCV: Pneumococcal conjugate vaccine; third dose.

Rota: Rotavirus vaccine; third dose

Seasonal influenza vaccine: Given at six months and annually. Flu vaccine should be given to all persons 6 months of age and older.

Those between the ages of 2 years and younger than 50 who are also healthy can receive Flumist (LAIV), but those between 2-4 years old with wheezing noted in the past 12 months should be given the trivalent inactivated influenza vaccine (TIV) intramuscularly.

Administer two doses 4 weeks apart to those ages 6 months to 8 years old receiving seasonal flu vaccine for the first time. Children ages 6 months to 3 years should receive 0.25 mL and children ages 3 to 8 years old should receive 0.5 mL. Children on long-term aspirin therapy should receive TIV.

Adults older than age 50 years should be given the inactivated form of the vaccine (TIV) and adults age 65 and older can receive the standard vaccine or the high-dose (Fluzone) influenza vaccine. Egg allergy is no longer a contraindication for flu vaccine. Those with an egg allergy should receive the inactivated form of the vaccine.

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Vaccines

6-18 months:
Hepatitis B: Third dose; IPV booster

12-15 months:
Hib: Third dose.

MMR: Measles, mumps and rubella vaccine is given in two doses. The first vaccine is given at or after the first birthday (12-15 months) and again between 4-6 years of age (if not on schedule the second dose should be given before the 12th birthday). The second dose can be given before the 4th birthday provided there is 4 weeks between the first and second dose. Two doses result in 99% immunity.

PCV: Third dose.

Varicella (chickenpox) vaccine: Vaccine is administered in two doses; the first between 12-15 months of age and the second dose between 4-6 years of age. If given off schedule it is recommended to have at least three months between the first and second dose, but if the second dose was administered at least 4 weeks after the first dose it can be accepted as valid. Adults without evidence of immunity should receive two doses. Pregnant women who do not have immunity should be vaccinated after the delivery or termination of the pregnancy.

12-23 months:
Hepatitis A: Vaccine should be given at 1 year of age and again six months later. Older children/adults (older than 23 months of age) desiring the vaccine should also be vaccinated.

15-18 months:
DTaP: Third dose.

Vaccines:

DTAP: Booster.

MMR: Second vaccine given between 4-6 years of age (if not on schedule the second dose should be given before the 12th birthday). The second dose can be given before the 4th birthday provided there is 4 weeks between the first and second dose.

IPV: Booster.

Varicella: Second dose.

Vaccines:

HPV: Human Papillomavirus vaccine (either HPV2 or HPV4) should be administered between ages 11 or 12 for females with catch up scheduled from ages 11-26 years. Give HPV4 (Gardacil) to males ages 11-21 to protect them from genital warts.

This vaccine is given in three doses, the second dose given 1 to 2 months after the first dose and the third dose given 6 months after the first dose. If the schedule is interrupted the vaccine series does not have to be restarted. Ideally, the same vaccine (either HPV2 or HPV4) should be used in the series. Syncope (fainting) has been reported to occur after vaccination; to avoid severe injury observe patients for 15 minutes in the office after they are vaccinated.

Tdap: Tetanus, diphtheria, and pertussis booster One dose between 10-64 years of age (should take the place of one Td vaccine for older individuals).

Children coming of age should get their one Tdap between ages 10-18 years old. Adults should be given one Tdap in place of a Td vaccine up to the age of 65. Those age 65 and older who have not previously received Tdap and who have close contact with infants aged less than 12 months old should also receive a Tdap vaccine. Pregnant mothers should be given Tdap after 20 weeks gestation.

Td booster is given every ten years (to follow ten years after the Tdap dose)

MCV: Two doses of MCV4 at age 11-12 years with a booster at age 16 years. Administer one dose to previously unvaccinated college freshmen living in a dormitory. Administer two doses at least 8 weeks apart to children ages 2-10 years with persistent complement component deficiency and anatomic or functional asplenia, and one dose every 5 years thereafter.

Vaccines

Zoster: Vaccine in a single dose should be given to those aged 50 and older regardless of whether they report previous episodes of herpes zoster.

PPSV: Vaccine given also as a one-time revaccination after 5 years for persons 19-64 with chronic renal failure or nephrotic syndrome; functional or anatomic asplenia (e.g., sickle cell disease or splenectomy); and for persons with immunocompromising conditions.

All adults 19 years and older with a history of asthma or who smoke cigarettes should receive a dose of PPSV. Available data do not support asthma or smoking as an indication for PPSV immunization among people younger than 19.

For those 65 or older, one-time revaccination is recommended if they were vaccinated 5 or more years previously and were aged less than 65 years at the time of primary vaccination.