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Catch-up immunization schedule for children and adolescents age 7 through 18 years who start late or who are more than 1 month behind – United States, 2023

Catch-up immunization schedule for children and adolescents age 7 through 18 years who start late or who are more than 1 month behind – United States, 2023
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
  • 8 weeks
    
Tetanus, diphtheria (Td); tetanus, diphtheria, and acellular pertussis (Tdap) 7 years
  • 4 weeks
  • 4 weeks if first dose of DTaP/DT was administered before the first birthday
  • 6 months if first dose of DTaP/DT was administered before the first birthday
  • 6 months (as final dose) if first dose of DTaP/DT or Tdap/Td was administered at or after the first birthday
Human papillomavirus (HPV)Δ 9 years
  • Routine dosing intervals are recommended
Hepatitis A (HepA)◊ Not applicable
  • 6 months
    
Hepatitis B (HepB)§ Not applicable
  • 4 weeks
  • 8 weeks and at least 16 weeks after first dose
  
Inactivated poliovirus (IPV)¥ Not applicable
  • 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 (MMR)‡ Not applicable
  • 4 weeks
    
Varicella (VAR)† Not applicable
  • 3 months if younger than age 13 years
    
  • 4 weeks if age 13 years or older
Dengue** 9 years
  • 6 months
  • 6 months
  
The above table provides 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 this table in conjunction with its footnotes and related UpToDate content regarding the schedule of recommended childhood immunizations for children 7 through 18 years of age in the United States. This schedule is recommended by the Advisory Committee on Immunization Practices (ACIP) and approved by the Centers for Disease Control and Prevention, American Academy of Pediatrics, American Academy of Family Physicians, American College of Obstetricians and Gynecologists, American College of Nurse-Midwives, American Academy of Physician Associates, and National Association of Pediatric Nurse Practitioners.
  • 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.
  • 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, refer to ACIP's General Best Practice Guidelines for Immunization.
  • For information about precautions and contraindications, refer to https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/contraindications.html.
  • Report clinically significant adverse events to the Vaccine Adverse Event Reporting System (VAERS) online at https://vaers.hhs.gov or by telephone, 800-822-7967.
  • For information regarding vaccination in the setting of a vaccine-preventable disease outbreak, contact your state or local health department.

anti-HBs: hepatitis B surface antibody; DT: diphtheria and tetanus toxoids vaccine; DTaP: diphtheria and tetanus toxoids, and acellular pertussis vaccine; mIU: milli-international units; MMRV: combination measles, mumps, rubella, and varicella vaccine; MMWR: Morbidity and Mortality Weekly Report.

* Meningococcal serogroup A, C, W, Y (MenACWY) vaccination
  • Age 13 through 15 years: 1 dose now and booster at age 16 through 18 years (minimum interval 8 weeks).
  • Age 16 through 18 years: 1 dose.
  • For catch-up guidance for persons with high-risk conditions and other persons at increased risk of disease, refer to UpToDate content related to the routine immunization schedule, meningococcal vaccination, and immunization in the specific high-risk condition, and the ACIP recommendations. High-risk conditions and conditions that increase the risk of disease include anatomic or functional asplenia (including sickle cell disease); HIV infection; persistent complement component deficiency; complement inhibitor (eg, eculizumab, ravulizumab) use; travel to countries with hyperendemic or epidemic meningococcal disease, including countries in the African meningitis belt or during the Hajj (refer to wwwnc.cdc.gov/travel); first-year college students who live in residential housing (if not previously vaccinated at age 16 years or older); and military recruits.

Tetanus and diphtheria toxoids, and acellular pertussis (Tdap) vaccination

  • Adolescents age 13 through 18 years who have not received Tdap: 1 dose Tdap, then Td or Tdap booster every 10 years.
  • Persons age 7 through 18 years not fully vaccinated with DTaP: 1 dose Tdap as part of the catch-up series (preferably the first dose); if additional doses are needed, use Td or Tdap. Full vaccination with DTaP is defined by 5 valid doses of DTaP or 4 valid doses of DTaP if dose 4 was administered at age 4 years or older.
  • Tdap administered at 7 through 10 years:
    • Children age 7 through 9 years who receive Tdap should receive the routine Tdap dose at age 11 through 12 years.
    • Children age 10 years who receive Tdap do not need the routine Tdap dose at age 11 through 12 years.
  • DTaP inadvertently administered at or after age 7 years:
    • Children age 7 through 9 years: DTaP may count as part of catch-up series. Administer routine Tdap dose at age 11 through 12 years.
    • Children age 10 through 18 years: Count dose of DTaP as the adolescent Tdap booster.

Δ Human papillomavirus (HPV) vaccination

  • HPV vaccination routinely recommended at age 11 through 12 years (can start at age 9 years) and catch-up HPV vaccination recommended for all persons through age 18 years if not adequately vaccinated.
  • 2- or 3-dose series depending on age at initial vaccination:
    • Age 9 through 14 years at initial vaccination: 2-dose series at 0 and 6 to 12 months (minimum interval: 5 months; repeat dose if administered too soon).
    • Age 15 years or older at initial vaccination: 3-dose series at 0, 1 to 2, and 6 months (minimum intervals: dose 1 to dose 2: 4 weeks; dose 2 to dose 3: 12 weeks; dose 1 to dose 3: 5 months; repeat dose if administered too soon).
  • Interrupted schedules: If vaccination schedule is interrupted, the series does not need to be restarted.
  • No additional dose recommended after completing series with recommended dosing intervals using any HPV vaccine.
  • Special situations:
    • Immunocompromising conditions, including HIV infection: 3-dose series, even for those who initiate vaccination at age 9 through 14 years.
    • History of sexual abuse or assault: Start at age 9 years.
    • Pregnancy: Pregnancy testing not needed before vaccination; HPV vaccination not recommended until after pregnancy; no intervention needed if vaccinated while pregnant.

◊ Hepatitis A (HepA) vaccination

  • Unvaccinated persons through age 18 years should complete a 2-dose series (minimum interval: 6 months).
  • Persons who previously received 1 dose at age 12 months or older should receive dose 2 at least 6 months after dose 1.
  • Adolescents age 18 years or older may receive the combined HepA and HepB vaccine, Twinrix, as a 3-dose series (0, 1, and 6 months) or a 4-dose series (3 doses at 0, 7, and 21 to 30 days, followed by a booster dose at 12 months).

§ Hepatitis B (HepB) vaccination

  • Unvaccinated persons should complete a 3-dose series at 0, 1 to 2, and 6 months.
  • Adolescents age 11 through 15 years of age may use an alternative 2-dose schedule, with at least 4 months between doses (adult formulation Recombivax HB only).
  • Adolescents age 18 years or older may receive:
    • Heplisav-B: 2-dose series at least 4 weeks apart.
    • PreHevbrio: 3-dose series at 0, 1, and 6 months.
    • Combined HepA and HepB vaccine, Twinrix: 3-dose series (0, 1, and 6 months) or 4-dose series (3 doses at 0, 7, and 21 to 30 days, followed by a booster dose at 12 months).
  • Special situations:
    • Postvaccination serology testing and revaccination (if anti-HBs <10 mIU/mL) is recommended for certain populations, including:
      • Persons who are predialysis or on maintenance dialysis.
      • Other immunocompromised persons.
    • For detailed revaccination recommendations, refer to www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/hepb.html.
  • NOTE: Heplisav-B and PreHevbrio are not recommended in pregnancy due to lack of safety data in pregnant persons.

¥ Inactivated poliovirus (IPV) vaccination

  • IPV vaccine is not routinely recommended for United States residents age 18 years or older.
  • 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 United States IPV schedule. Refer to MMWR Morb Mortal Wkly Rep 2017; 66:23.
    • Only trivalent OPV (tOPV) counts toward the United States vaccination requirements.
      • Doses of OPV administered before April 1, 2016, should be counted (unless specifically noted as administered during a campaign).
      • Doses of OPV administered on or after April 1, 2016, should not be counted.
      • For guidance to assess doses documented as "OPV," refer to MMWR Morb Mortal Wkly Rep 2017; 66:180.

‡ Measles, mumps, and rubella (MMR) vaccination

  • Unvaccinated children and adolescents: 2-dose series at least 4 weeks apart.
  • The maximum age for MMRV is 12 years.
  • Minimum interval between MMRV doses: 3 months.

† Varicella (VAR) vaccination

  • Ensure persons age 7 through 18 years without evidence of immunity (refer to MMWR Recomm Rep 2007; 56(RR04):1) have a 2-dose series:
    • Age 7 through 12 years: Routine interval: 3 months (a dose inadvertently administered after at least four weeks may be counted as valid).
    • Age 13 years and older: Routine interval: 4 through 8 weeks (minimum interval: 4 weeks).
    • The maximum age for use of MMRV is 12 years.

** Dengue vaccination

  • Age 9 through 16 years living in dengue endemic areas and have laboratory confirmation of previous dengue infection: 3-dose series administered at 0, 6, and 12 months.
  • Endemic areas include Puerto Rico, American Samoa, United States Virgin Islands, Federated States of Micronesia, Republic of Marshall Islands, and the Republic of Palau. For updated guidance on dengue endemic areas and prevaccination laboratory testing refer to MMWR Recomm Rep 2021; 70(6):1 and www.cdc.gov/dengue/vaccine/hcp/index.html.
  • Dengue vaccine should not be administered to children traveling to or visiting endemic dengue areas.
Adapted from: Centers for Disease Control and Prevention. Immunization schedules. Available at: https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html (Accessed on November 29, 2023).
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