Immunization Schedules for Children in the US

African American nurse giving patient injection
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Immunization schedules are designed to protect infants and children before they have been exposed to potentially life-threatening diseases and when they are most vulnerable to them. The recommended schedule depends on the type of vaccine, the disease the vaccine is designed for, and the age of the child at which the vaccine can be 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.

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 get:

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

Kids can also get fewer shots if combination vaccines are used, such as:

  • Pediarix, a combination of DTaP, polio, and the hepatitis B vaccine
  • ProQuad, a combination of MMR and varicella vaccines
  • Pentacel, a combination of DTaP, polio, and Hib vaccines
  • Kinrix or Quadracel, a combination of DTaP and polio vaccines

Further vaccines are recommended for 11 to 12 years old:

More Vaccines Than in the Past

By the time they start kindergarten, most kids will get multiple doses of 10 vaccines to protect them against 14 vaccine-preventable infections. Why is that better than the immunization schedules from the 1980s when kids only got 10 doses of three vaccines (1983) or 11 doses of four vaccines (1989)?

While they got fewer shots back then, the more important statistic is the much higher numbers of many infections that are now preventable with vaccines that people (mainly kids) got each year in the years before a routine vaccine was given for protection, such as:

  • Pneumonia, meningitis, and blood infections from the Streptococcus pneumoniae bacteria: 63,067 cases and 6,500 deaths
  • Meningitis, epiglottitis, and other serious infections from the Haemophilus influenzae type b (Hib) bacteria: 20,000 cases and 1,000 deaths
  • Hepatitis A: 117,333 cases, 6,863 hospitalizations, and 137 deaths
  • Hepatitis B: 66,232 cases, 7,348 hospitalizations, and 237 deaths
  • Rotavirus gastroenteritis: 3 million cases, 70 hospitalizations, and 20 to 60 deaths
  • Chickenpox: just over 4 million cases, 10,000 hospitalizations, and 100 deaths

The HPV vaccine may greatly reduce the number of cancers of the cervix, vagina, vulva, penis, anus, rectum, and oropharynx. The CDC estimates the number of these HPV-linked cancers at 34,800 per year.

Vaccination Schedules in Europe

Some people like to point out that other countries have immunization schedules with fewer vaccines. However, that information may be outdated and it overstates the differences. Many European countries have added chickenpox and Streptococcus pneumoniae vaccines to their schedules. They had already matched the rest of the U.S. vaccine program other than for hepatitis vaccines and rotavirus.

Sweden now recommends vaccination to cover the same diseases as in the U.S., adding hepatitis B coverage. Kids in Finland routinely get vaccinations for the same diseases as those in the U.S. with the exception of hepatitis B and hepatitis A vaccines. However, these are available for children in high-risk groups. Iceland has added the Streptococcus pneumoniae vaccine to their routine immunization schedule, but they do not routinely vaccinate for rotavirus.

Now, the main difference is that these countries have targeted vaccination for high-risk chidren for hepatitis A and B, while the U.S. recommends universal vaccination.

This makes sense, since:

  • Hepatitis A is not endemic in most countries in Europe
  • Hepatitis B is often found in very well-defined risk groups in many countries in Europe

Some countries in Europe are still studying the risk versus benefit analysis of routinely using the rotavirus vaccine.

The big takeaway from these other countries is not that they use fewer shots; it is what a good job they do in vaccinating their kids. In Finland, vaccination coverage statistics show that 98 to 99% of children are vaccinated.

Around the world, many countries have immunization schedules that are nearly identical to the CDC immunization schedule. Since 2007, infants in Australia, for example, have gotten vaccinations against nine diseases 2 months of age, just like in the United States.

Risks of Alternative Immunization Schedules

The recommended vaccine schedule is based on when a child is most likely to be exposed to a disease and when a child's immune system is mature enough to respond to the vaccine. This ensures that the child is protected at the time they become at risk of these diseases.

Altering this schedule means that the child is at risk when they could be protected. Also, because many vaccines need multiple doses to be fully effective, the child is less protected if they delay starting the schedule or miss or delay doses. To stay on top of an altered schedule requires a parent to be extremely diligent, as healthcare providers may not send the same reminders they might for the standard schedule.

As well, an altered schedule means more time spent in the waiting room at the pediatrician, which is a chance for the unprotected child to be exposed to these contagious diseases from other children seeking care.

Alternative vaccination schedules are untested and unproven. They may leave your child at risk for preventable diseases that can be deadly.

Alternative immunization schedules that some people continue to promote include:

  • User-friendly vaccination schedule: This vaccination schedule, which delayed vaccination until after age 2 years, is not possible to follow as it recommended individual thimerasol-free vaccines rather DTaP, and the individual vaccines are not available. The author now recommends no vaccines at all and promotes many beliefs at odds with medical science.
  • Dr. Bob's alternative vaccine schedule: Spaces out vaccines so that infants don't get more than two at a time, but they have to get monthly shots instead, delays hepatitis A and hepatitis B vaccine until kids are older, and recommends individual measles, mumps, and rubella shots instead of the combination MMR vaccine.

An article by Dr. Paul Offit, chief of the Division of Infectious Diseases at Children's Hospital of Philadelphia in Pediatrics in 2009 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, your unimmunized child will not be as much 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 built to ensure your child is protected as much as possible. The recommended schedule prevents diseases that in the past resulted in large numbers of children being sick, disabled, paralyzed, or dead. 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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Article Sources
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  3. Centers for Disease Control and Prevention. How many cancers are linked with HPV per year? Updated August 2, 2019.

  4. The Public Health Agency of Sweden. Vaccination programmes.

  5. Finnish Institute of Health and Welfare. Vaccination programme for children and adolescents. Updated September 19, 2018.

  6. Directorate of Health. National childhood vaccination programme in Iceland as of January 2020.

  7. University of Helsinki. Nearly all Finnish chil­dren are vac­cin­ated – thanks to the child wel­fare clinic sys­tem. March 14, 2018.

  8. Australian Government Department of Health. National immunisation program schedule. Updated March 19, 2020.

  9. DonaldMiller.com. Some recent comments on vaccines. March, 2011.

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

  11. 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.