Table 3: Catch-up Immunization Schedule (United States 2009)

Catch-up Immunization Schedule for Persons Aged 4 Months-18 Years Who Start Late or Who Are More Than 1 Month Behind

The table below 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 the table appropriate for the child's age.

Catch-up Schedule for Persons Aged 4 Months-6 Years

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	Dose 4 to Dose 5
Hepatitis B1	Birth	4 weeks	8 weeks (and 16 weeks after first dose)
Rotavirus2	6 weeks	4 weeks	4 weeks
Diphtheria, Tetanus, Pertussis3	6 weeks	4 weeks	4 weeks	6 months	6 months3
Haemophilus influenzae type b4	6 weeks	4 weeks if first dose administered at younger than 12 months of age 8 weeks (as final dose) if first dose administered at age 12-14 months No further doses needed if first dose administered at 15 months of age or older	4 weeks4 if current age is younger than 12 months 8 weeks (as final dose)4 if current age is 12 months or older and second dose administered at younger than 15 months of age No further doses needed if previous dose administered at age 15 months or older	8 weeks (as final dose) This dose only necessary for children aged 12 months-5 years who received 3 doses before age 12 months
Pneumococcal5	6 weeks	4 weeks if first dose administered at younger than 12 months of age 8 weeks (as final dose) if first dose administered at age12 months or older or current age 24-59 months No further doses needed for healthy children if first dose administered at age 24 months or older	4 weeks if current age is younger than 12 months 8 weeks (as final dose) if current age is 12 months or older No further doses needed for healthy children if previous dose administered at age 24 months or older	8 weeks (as final dose) This dose only necessary for children aged 12 months-5 years who received 3 doses before age 12 months
Inactivated Poliovirus6	6 weeks	4 weeks	4 weeks	4 weeks6
Measles, Mumps, Rubella7	12 months	4 weeks
Varicella8	12 months	3 months
Hepatitis A9	12 months	6 months

Catch-up Schedule for Persons Aged 7-18 Years

Vaccine	Minimum Age for Dose 1	Minimum Interval Between Doses
		Dose 1 to Dose 2	Dose 2 to Dose 3	Dose 4 to Dose 5
Tetanus, Diphtheria/ Tetanus, Diphtheria, Pertussis10	7 years10	4 weeks	4 weeks if first dose administered at younger than 12 months of age 6 months if first dose administered at age 12 months or older	6 months if first dose administered at younger than 12 months of age
Human Papillomavirus11	9 years	4 weeks	12 weeks (and 24 weeks after the first dose)
Hepatitis A9	12 months	6 months
Hepatitis B1	Birth	4 weeks	8 weeks (and 16 weeks after first dose)
Inactivated Poliovirus6	6 weeks	4 weeks	4 weeks	4 weeks6
Measles, Mumps, Rubella7	12 months	4 weeks
Varicella8	12 months	4 weeks if first dose administered at age 13 years or older 3 months if first dose administered at younger than 13 years of age

Footnotes

1. Hepatitis B vaccine (HepB).

• Administer the 3-dose series to those not previously vaccinated.
• A 2-dose series (separated by at least 4 months) of adult formulation Recombivax HB® is licensed for children aged 11 through 15 years.

2. Rotavirus vaccine (RV).

• The maximum age for the first dose is 14 weeks 6 days. Vaccination should not be initiated for infants aged 15 weeks or older (i.e., 15 weeks 0 days or older).
• Administer the final dose in the series by age 8 months 0 days.
• If Rotarix® was administered for the first and second doses, a third dose is not indicated.

3. Diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP).

• The fifth dose is not necessary if the fourth dose was administered at age 4 years or older.

4. Haemophilus influenzae type b conjugate vaccine (Hib).

• Hib vaccine is not generally recommended for persons aged 5 years or older. No efficacy data are available on which to base a recommendation concerning use of Hib vaccine for older children and adults. However, studies suggest good immunogenicity in persons who have sickle cell disease, leukemia, or HIV infection, or who have had a splenectomy; administering 1 dose of Hib vaccine to these persons is not contraindicated.
• If the first 2 doses were PRP-OMP (PedvaxHIB® or Comvax®), and administered at age 11 months or younger, the third (and final) dose should be administered at age 12 through 15 months and at least 8 weeks after the second dose.
• If the first dose was administered at age 7 through 11 months, administer 2 doses separated by 4 weeks and a final dose at age 12 through 15 months.

5. Pneumococcal vaccine.

• Administer 1 dose of pneumococcal conjugate vaccine (PCV) to all healthy children aged 24 through 59 months who have not received at least 1 dose of PCV on or after age 12 months.
• For children aged 24 through 59 months with underlying medical conditions, administer 1 dose of PCV if 3 doses were received previously or administer 2 doses of PCV at least 8 weeks apart if fewer than 3 doses were received previously.
• Administer pneumococcal polysaccharide vaccine (PPSV) to children aged 2 years or older with certain underlying medical conditions (see MMWR 2000;49[No. RR-9]), including a cochlear implant, at least 8 weeks after the last dose of PCV.

6. Inactivated poliovirus vaccine (IPV).

• For children who received an all-IPV or all-oral poliovirus (OPV) series, a fourth dose is not necessary if the third dose was administered at age 4 years or older.
• If both OPV and IPV were administered as part of a series, a total of 4 doses should be administered, regardless of the child’s current age.

7. Measles, mumps, and rubella vaccine (MMR).

• Administer the second dose at age 4 through 6 years. However, the second dose may be administered before age 4, provided at least 28 days have elapsed since the first dose. If not previously vaccinated, administer 2 doses with at least 28 days between doses.

8. Varicella vaccine.

• Administer the second dose at age 4 through 6 years. However, the second dose may be administered before age 4, provided at least 3 months have elapsed since the first dose.
• For persons aged 12 months through 12 years, the minimum interval between doses is 3 months. However, if the second dose was administered at least 28 days after the first dose, it can be accepted as valid.
• For persons aged 13 years and older, the minimum interval between doses is 28 days.

9. Hepatitis A vaccine (HepA).

• HepA is recommended for children older than 1 year who live in areas where vaccination programs target older children or who are at increased risk of infection. See MMWR 2006;55(No. RR-7).

10. Tetanus and diphtheria toxoids vaccine (Td) and tetanus and diphtheria toxoids and acellular pertussis vaccine (Tdap).

• Doses of DTaP are counted as part of the Td/Tdap series.
• Tdap should be substituted for a single dose of Td in the catch-up series or as a booster for children aged 10 through 18 years; use Td for other doses.

11. Human papillomavirus vaccine (HPV).

• Administer the series to females at age 13 through 18 years if not previously vaccinated.
• Use recommended routine dosing intervals for series catch-up (i.e., the second and third doses should be administered at 2 and 6 months after the first dose). However, the minimum interval between the first and second doses is 4 weeks. The minimum interval between the second and third doses is 12 weeks, and the third dose should be given at least 24 weeks after the first dose.

Information about reporting reactions after immunization is available online at http://www.vaers.hhs.gov or by telephone, 800-822-7967. Suspected cases of vaccine-preventable diseases should be reported to the state or local health department. Additional information, including precautions and contraindications for immunization, is available from the National Center for Immunization and Respiratory Diseases at http://www.cdc.gov/vaccines or telephone, 800-CDC-INFO (800-232-4636).

Department of Health and Human Services, Centers for Disease Control and Prevention, Safer Healthier People.

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