RECOMMENDED IMMUNIZATION SCHEDULES FOR
CHILDREN NOT IMMUNIZED IN THE FIRST YEAR OF LIFE*

Recommended Time/Age	Immunizaton(s)†	Comments
Younger Than 7 Years
First Visit	DTaP, Hib, HBV, MMR	If indicated, tuberculin testing may be done at same visit. If child is 5y or oldeeer, Hib is not indicated in most circumstances
Interval After First Visit
1 mo (4wk)	DTaP, IPV, HBV, Var§	The second dose of IPV may be given if accelerated poliomyelitis immunization is necessary, such as for travelers to areas where polio is endemic.
2 mo	DTaP, Hib, IPV	Second dose of Hib is indicated only if the first dose was received when younger than 15 mo.
≥8 mo	DTaP, HBV, IPV	IPV and HBV are not given if the third dose was given earlier.
Age 4-6 y(at or before school entry)	DTaP, IPV, MMR¶	DTap is not necessary if the fourth dose was given after the fourth birthday; IPV is not necessary if the third dose was given after the fourth birthday.
Age 11-12y	Regular Immunization Schedule
7 - 12 Years
First Visit	HBV, MMR, dT, IPV
2 mo (8wk)	HBV, MMR, Var§, dT, IPV	IPV also may be given 1 mo after the first visit if accelerated poliomyelitis immunization is necessary.
8-14mo	HBV±, dT, IPV	IPV is not given if the third dose was given earlier.
Age 11-12y	Regular Immunization Schedule

* Table is not completely consistent with all package inserts. For products used, also consult manufacturer's package insert for instruction on storage, handling, dosage, and administration. Biologics prepared by different manufacturers may vay, and package inserts of the same manufacturer may change. Therefore, the physician should be aware of the contents of the current package insert. Vaccine abbreviations: HBV indicates hepatitis B virus; Var, varicella; DtaP, diptheria and tetanus toxoids and acellular pertussis; Hib, Haemophilus influenzae type b conjugate; IPV, inactivated poliovirus; MMR, live measels-mumps-rubella; dT adult tetanus toxoid (full dose) and diptheria toxoid (reduced dose), for children 7 years of age or oler, and adults.

NOTES:

† If all needed vaccines cannot be administered simultaneously, priority should be given to protecting the child against the diseases that pose the greatest immediate risk. In the U.S., these diseases for children younger than 2 years usually are measels and Haemophilus influenzae type b infection; for children older than 7 years, they are measels, mumps, and rubella. Before 13 years of age, immunity against hepatitis B and varicella should be ensured. DTaP, HBV,Hib, MMR, and Var can be given simultaneously at separate sites if failure of teh patient to return for future immunizations is a concern. For further information

§ Varicella vaccine can be administered to susceptible children any time after 12 months of age. Unimunnized children who lack a reliable history of varicella should be immunized before their 13th birthday.

¶ Minimal interval between doses of MMR is 1 month (4 wk).

± HBV may be given earlier in a 0-, 2-, and 4-month schedule.

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