Immunization Schedules for Children in the United States

African American nurse giving patient injection
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Immunization schedules are designed to protect infants and children from potentially life-threatening diseases before they have been exposed to them and while they are most vulnerable to infection. The recommended schedule depends on the type of vaccine, the disease the vaccine is designed for, and the age at which it's most beneficial. Alternative schedules are not recommended as they can leave children at risk. While vaccination schedules may vary from country to country, they have become more uniform.

By the time they start kindergarten, most kids will get multiple doses of 10 vaccines to protect them against 14 vaccine-preventable infections.

Vaccination Schedule for Children

The immunization schedule recommended for kids by the Centers for Disease Control and Prevention (CDC), American Academy of Pediatrics, American Academy of Family Physicians, and Advisory Committee on Immunization Practices, states that by the time children in the United States start kindergarten, they should have had:

  • Hepatitis B vaccine (HepB): Three-dose series at birth, 1 to 2 months, and 6 to 18 months.
  • Rotavirus vaccine (RV): Either oral Rotarix (two-dose series at 2 months and 4 months) or oral RotaTeq (three-dose series at 2, 4, and 6 months).
  • Diphtheria, tetanus, and pertussis vaccine (DTaP): Five-dose series at 2, 4, 6, 15 to 18 months, and 4 to 6 years.
  • Haemophilus influenzae type b vaccine (Hib): Choice of three-dose or four-dose series: ActHIB, Hiberix, or Pentacel at 2, 4, 6, and 12 to 15 months or PedvaxHIB at 2, 4, and 12 to 15 months.
  • Pneumococcal vaccine (PCV13): Four-dose series at 2, 4, 6, and 12 to 15 months of the Prevnar 13 vaccine. Children with high-risk heart or lung conditions also receive Pneumovax 23 (PPSV23) at age 2.
  • Polio vaccine (IPV): Four-dose series at 2, 4, 6 to 18 months, and 4 to 6 years.
  • Measles, mumps, rubella vaccine (MMR): Two-dose series at 12 to 15 months and 4 to 6 years.
  • Varicella (chickenpox) vaccine (VAR): Two-dose series at 12 to 15 months and 4 to 6 years.
  • Hepatitis A vaccine (HepA): Two-dose series at 12 months and 18 to 23 months.
  • Influenza vaccine (IIV): Yearly beginning at 6 months, with two doses separated by at least four weeks for children between 6 months to 8 years if they have had fewer than two previous vaccine doses, and only one dose if they have had two previous influenza vaccine doses. Also available as a nasal spray (LAIV) for children who are 2 or older.

Further vaccines are recommended for 11 to 12 years old:

Combination Vaccines

Single vaccines that protect against several diseases at once can reduce the total number of shots a child receives. Combination vaccines include:

  • Pediarix, a combination of DTaP, polio, and the hepatitis B vaccine, given as as a three-dose series at 2, 4, and 6 months.
  • ProQuad, a combination of MMR and varicella vaccines, which can be given at 12 months to 12 years. However, it's preferable to use ProQuad only as the second dose in the series for these vaccines at age 4 to 6 years, following the initial vaccine as the first dose.
  • Pentacel, a combination of DTaP, polio, and Hib vaccines, given at 2, 4, 6, and 12 to 15 months.
  • Kinrix or Quadracel, a combination of DTaP and polio vaccines, given at age 4 to 6 to replace the fifth dose of DTaP and the fourth dose of polio vaccine.

Health authorities are concerned children may miss immunizations due to the disruptions surrounding the COVID-19 pandemic. It is important parents and guardians make sure children do not miss or delay immunizations.

Alternative Schedules

Alternative immunization schedules grew out of concerns of parents about the number of vaccinations children receive before age 2 as well as the safety of receiving multiple vaccines at one time. They sought to space out immunizations to address these issues, but are not highly regarded by most pediatricians and other health care providers and experts. Nonetheless, two such alternatives continue to be promoted:

  • User-friendly vaccination schedule: Delays vaccinations until after age 2 and rather than DTap, recommends individual thimerasol-free vaccines for diphtheria, tetanus, and pertussis—vaccines that are not available. What's more, the author now recommends no vaccines at all and promotes many beliefs at odds with medical science.
  • Dr. Bob's alternative vaccine schedule: Developed by pediatrician Robert Sears, M.D., this schedule paces vaccines so that infants get no more than two at a time, meaning they will need monthly shots. It also delays the hepatitis A and hepatitis B vaccine until children are older, and recommends individual measles, mumps, and rubella shots rather than the combination MMR vaccine.

The recommended vaccine schedule is based on when a child is most likely to be exposed to a disease and when their immune system is mature enough to respond to the vaccine. Altering this schedule can put a child at risk just when they could and should be protected. Also, because many vaccines are fully effective only if given in multiple doses, a child is less protected if they delay starting the schedule or miss or delay doses.

What's more, to stay on top of an altered schedule requires a parent to be extremely diligent, as pediatricians who do not support alternative schedules may not send the same reminders they might for the standard schedule. An altered schedule means more time spent in the waiting room at the pediatrician's office as well, increasing a child's chance of exposure to contagious diseases before they have complete protection.

In an article in Pediatrics, Dr. Paul Offit, chief of the Division of Infectious Diseases at Children's Hospital of Philadelphia, discusses the numerous failings of the logic of Dr. Bob's alternative schedule. One especially problematic piece of logic is that as long as other parents immunize their children on schedule, a non-immunized child won't be at risk. However, there have been outbreaks of these diseases in U.S. states once too many parents made the same decision.

A Word From Verywell

Vaccine schedules are designed to ensure a child is protected from preventable contagious diseases to the highest degree possible. The recommended schedule prevents diseases that in the past resulted in large numbers of children being sick, disabled, paralyzed, or losing their lives. Living in a society where vaccination rates are high and the vaccine schedules are followed helps protect all children. Formerly-rare diseases can circulate and produce outbreaks when vaccination rates are low, placing unvaccinated children at risk.

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  1. Centers for Disease Control and Prevention. Immunization schedules. Table 1. Recommended child and adolescent immunization schedule for ages 18 years or younger, United States, 2020. Updated February 3, 2020.

  2. Seattle Children's Hospital. Most parents avoid alternative vaccination schedules. Updated October 4, 2011.

  3. Offit PA, Moser CA. The problem with Dr Bob's alternative vaccine schedulePediatrics. 2009;123(1):e164‐e169. doi:10.1542/peds.2008-2189

  4. Zipprich J, Winter K, Hacker J, et al. Measles outbreak--California, December 2014-February 2015. 2015;64(7):196]. MMWR Morb Mortal Wkly Rep. 2015;64(6):153‐154.