Hepatitis B vaccine (Hep B). All infants should receive the
first dose of hepatitis B vaccine soon after birth and before hospital
discharge; the first dose may also be given by age 2 months if the infant's
mother is HBsAg-negative. Only monovalent hepatitis B vaccine can be used for
the birth dose. Monovalent or combination vaccine containing Hep B may be used
to complete the series; four doses of vaccine may be administered if
combination vaccine is used. The second dose should be given at least 4 weeks
after the first dose, except for Hib-containing vaccine, which cannot be
administered before age 6 weeks. The third dose should be given at least 16
weeks after the first dose and at least 8 weeks after the second dose. The last
dose in the vaccination series (third or fourth dose) should not be
administered before age 6 months.
Infants born to HBsAg-positive mothers
should receive hepatitis B vaccine and 0.5 mL hepatitis B immune globulin
(HBIG) within 12 hours of birth at separate sites. The second dose is
recommended at age 1-2 months and the vaccination series should be completed
(third or fourth dose) at age 6 months.
Infants born to mothers whose HBsAg status
is unknown should receive the first dose of the hepatitis B vaccine series
within 12 hours of birth. Maternal blood should be drawn at the time of
delivery to determine the mother's HBsAg status; if the HBsAg test is positive,
the infant should receive HBIG as soon as possible (no later than age 1 week).
Diphtheria and tetanus toxoids and acellular
pertussis vaccine (DTaP).The fourth dose of DTaP may be administered as
early as age 12 months, provided 6 months have elapsed since the third dose and
the child is unlikely to return at age 15-18 months. Tetanus and diphtheria
toxoids (Td) is recommended at age 11-12 years if at least 5 years have
elapsed since the last dose of tetanus and diphtheria toxoid-containing
vaccine. Subsequent routine Td boosters are recommended every 10 years.
Haemophilus influenzae type b (Hib)
conjugate vaccine. Three Hib conjugate vaccines are licensed for infant
use. If PRP-OMP (PedvaxHIB® or ComVax® [Merck]) is administered at ages
2 and 4 months, a dose at age 6 months is not required. DTaP/ Hib combination
products should not be used for primary immunization in infants at age 2, 4 or
6 months, but can be used as boosters following any Hib vaccine.
Inactivated poliovirus vaccine (IPV). An all-IPV schedule is
recommended for routine childhood poliovirus vaccination in the United States.
All children should receive four doses of IPV at age 2 months, 4 months, 6-18
months, and 4-6 years.
Measles, mumps, and rubella vaccine
(MMR). The second dose of MMR is recommended routinely at age 4-6 years but
may be administered during any visit, provided at least 4 weeks have elapsed
since the first dose and that both doses are administered beginning at or after
age 12 months. Those who have not previously received the second dose should
complete the schedule by the visit at age 11-12 years.
Varicella vaccine. Varicella vaccine is
recommended at any visit at or after age 12 months for susceptible children
(i.e., those who lack a reliable history of chickenpox). Susceptible persons
aged >13 years should receive two doses, given at least 4 weeks
Pneumococcal vaccine. The heptavalent
pneumococcal conjugate vaccine (PCV) is recommended for all children
aged 2-23 months and for certain children aged 24-59 months. Pneumococcal
polysaccharide vaccine (PPV) is recommended in addition to PCV for certain
high-risk groups. See MMWR 2000; 49( RR-9); 1-37.
Hepatitis A vaccine. Hepatitis A vaccine
is recommended for use in selected states and regions, and for certain
high-risk groups; consult your local public health authority. See MMWR
1999; 48( RR-12); 1-37.
Influenza vaccine. Influenza vaccine is
recommended annually for children age > 6 months with certain risk
factors (including but not limited to asthma, cardiac disease, sickle cell
disease, HIV and diabetes; see MMWR 2001; 50( RR-4); 1-44), and can be
administered to all others wishing to obtain immunity. Children aged
<12 years should receive vaccine in a dosage appropriate for their
age (0. 25 mL if age 6- 35 months or 0. 5 mL if aged >3 years).
Children aged < 8 years who are receiving influenza vaccine for the
first time should receive two doses separated by at least 4 weeks.
Additional information about vaccines, vaccine
supply, and contraindications for immunization, is available at
www.cdc.gov/nip or at the National
Immunization Hotline, 800- 232- 2522 (English) or 800- 232- 0233