Childhood Immunization Schedule (Birth to 6 Years)

VaccineDoses / ScheduleNotes
Hepatitis B (HepB)3-dose: birth, 1–2 mo, 6–18 mo1st dose within 24 hrs of birth
DTaP5-dose: 2, 4, 6, 15–18 mo, 4–6 yrDiphtheria, tetanus, pertussis
IPV (Polio)4-dose: 2, 4, 6–18 mo, 4–6 yrFinal dose at age 4 or older
Hib3–4 doses: 2, 4, (6 mo), 12–15 moHaemophilus influenzae type b
PCV15 or PCV204-dose: 2, 4, 6, 12–15 moPneumococcal conjugate
RV2–3 doses: 2, 4, (6 mo)Rotavirus; oral; series by 8 mo
MMR2-dose: 12–15 mo, 4–6 yrMeasles, mumps, rubella. Live vaccine.
Varicella (VAR)2-dose: 12–15 mo, 4–6 yrLive vaccine; avoid in immunocompromised
Hepatitis A (HepA)2-dose: 12–23 moSeparated by 6–18 months
InfluenzaAnnually starting at 6 months2 doses first year if naive (< 9 yr old)
COVID-19Per current CDC scheduleUpdated annually

School-Age and Adolescent Schedule (7–18 Years)

VaccineTimingNotes
Tdap11–12 yr (then Td/Tdap every 10 yr)Booster for DTaP; include in every pregnancy
HPV2-dose: 11–12 yr (if started before 15); 3-dose if 15+Up to age 26 routinely; shared decision 27–45 yr
MenACWY11–12 yr, booster at 16 yrMeningococcal; required for college
MenB16–23 yr (preferred 16–18)Shared decision; 2-dose series
InfluenzaAnnuallyIIV or LAIV (healthy non-pregnant)
COVID-19Per current scheduleUpdated annually

Adult Immunization Schedule

VaccineRecommendationKey Notes
InfluenzaAll adults annuallyHigh-dose or adjuvanted preferred for ≥ 65 yr
COVID-19All adults; updated annuallyFollow current CDC formulation
Tdap/TdTdap x1, then Td every 10 yrTdap in every pregnancy (27–36 wk)
RSVAdults ≥ 60 yr (shared decision); pregnancy 32–36 wkSingle dose; Abrysvo or mResvia
PCV15/PCV20All adults ≥ 65 yr; some high-risk younger adultsIf PCV15: follow with PPSV23
RZV (Shingrix)All adults ≥ 50 yr; 2-dose series 2–6 mo apartPreferred over ZVL; immunocompromised ≥ 19 yr
HepBAll adults < 60 yr unvaccinated; 60+ shared decision3-dose or 2-dose Heplisav-B
HepAUnvaccinated adults at riskTravel, liver disease, IVDU, MSM
MMRAdults born after 1957 without evidence of immunity1–2 doses; live vaccine — avoid in pregnancy/immunocompromised
Varicella2 doses if no prior disease or vaccinationLive vaccine; avoid in pregnancy
MenACWYHigh-risk groups, asplenia, travelBooster every 5 yr if ongoing risk
HPVThrough age 26 routinely; 27–45 shared decisionUp to 3 doses if ≥ 15 yr at series start

Vaccines in Special Populations

Pregnancy

  • Tdap: every pregnancy, 27–36 wk
  • Influenza: any trimester
  • COVID-19: recommended, any trimester
  • RSV (Abrysvo): 32–36 wk
  • Avoid all live vaccines (MMR, VAR, LAIV, ZVL)

Immunocompromised

  • Avoid all live vaccines
  • May need extra doses of inactivated vaccines
  • Shingrix (RZV) recommended ≥ 19 yr
  • PCV20 or PCV15 + PPSV23 recommended
  • Annual high-dose influenza preferred

Asplenia / Functional Asplenia

  • PCV20 + PPSV23 (or PCV15 + PPSV23)
  • MenACWY + MenB (2-dose series)
  • Hib vaccine (1 dose if not previously given)
  • Annual influenza

Travel

  • HepA and HepB for most destinations
  • Typhoid: food/water risk areas
  • Yellow fever: required in endemic regions
  • Meningococcal: sub-Saharan Africa, Hajj
  • Japanese encephalitis, rabies: per itinerary

Live vs. Inactivated Vaccines

Live Attenuated (Avoid in Immunocompromised / Pregnancy)

  • MMR (measles, mumps, rubella)
  • Varicella (VAR)
  • LAIV (intranasal influenza)
  • Yellow fever
  • Rotavirus (oral, infants)
  • Zoster live (ZVL — largely replaced by Shingrix)

Inactivated / Subunit / mRNA (Generally Safe in All)

  • IIV (injected influenza)
  • COVID-19 (mRNA, protein subunit)
  • Tdap, DTaP, IPV, Hib, PCV, HepB, HepA
  • Shingrix (RZV) — adjuvanted subunit
  • HPV (Gardasil 9)
  • MenACWY, MenB

Vaccine Contraindications and Precautions

True Contraindications (do not give)

Precautions (discuss risk/benefit)

NOT Contraindications

Vaccine Storage and Cold Chain

Key Exam Points