Immunization Schedule

(adapted from CDC recommendations for 1998)

Age Vaccine	Birth	1 mo	2 mos	4 mos	6 mos	12 mos	15 mos	18 mos	4-6 years	11-12 years	14-16 years

Hep B	Hep B #1
		Hep B #2			Hep B #3					Hep B
DPT			DTaP or DTP	DTaP or DTP	DTaP or DTP		DTaP or DTP		DTaP or DTP	Td
H. flu, b			Hib	Hib	Hib	Hib
Polio			Polio	Polio	Polio				Polio
MMR						MMR			MMR	MMR
Varicella						Var				Var

*Please note that the 1998 recommendations do not reflect the following recent changes:

1. Hep B vaccine: Concerns about mercury-containing preservatives have led to the recommendation that (except in certain instances such as maternal HepBSAg+), the vaccine should not be administered to patients under 6 months of age, or premature infants until 6 months of corrected age.

2. Polio vaccine: The incidence of polio vaccine-related paralysis outweighs the risk of wild-type polio in the US. Thus, it is recommended that everyone adopt the 4 IPV schedule unless there are specific reasons why this cannot be done.

3. Rotavirus vaccine: The rotavirus vaccine became available in 1999, and was initially administered at 2, 4 and 6 month visits. However, a question has been raised about a possible relationship to intussusception, and it is now held until after 6 months.

**Application Notes:**
Vaccine	Notes		Min.age first dose	Min.Interval dose 1 -2	Min.Interval dose 2-3	Min.Interval dose 3-4
Hepatitis	The first hepatitis vaccine is usually administered at birth, but occasionally is given at one month. If patients have not received all three doses by 11, complete the series during this year. The second dose cannot be given < a month after the first; the third dose must be given at least 2 months after the second dose, and 4 months after the first. Also refer to Neonatal Hepatitis.		birth	1 month	2 months	N/A
DTP	The acellular diptheria, tetanus, and pertussis vaccine is the preferred vaccine for every immunization, even if patients started with DTP. The 4th dose can be given as early as 12 months, as long as it has been at least 6 months since the 3rd dose. Td (tetanus and diptheria toxoids) are given at 11-12 years, as long as 5 years have elapsed since the last dose of DTP, DTaP, or Td. After that, Td boosters are recommended every 10 years. Also see tetanus considerations after injury.		6 weeks	4 weeks	4 weeks	6 months
Hib Conjugates	If the PRP-OMP conjugate vaccine is given, dose at 2 and 4 months, but omit 6 month dose. The final dose (*) should be given >12 months of age, and more than 2 months after previous dose.	HbOC PRP-T PRP-OMP	6 weeks 6 weeks 6 weeks	1 month 1 month 1 month	1 month 1 month *	* *
Polio	An oral live virus and an intramuscular inactivated polio vaccine are available; ACIP recommends 2 doses of IPV followed by 2 of OPV, but 4 of either IPV or OPV can be given. OPV should not be used with patients who are, or who are in contact with people who are, immunocompromised. If 3rd dose given after 4 th birthday, omit 4th dose.		6 weeks	4 weeks	4 weeks
MMR	The second MMR dose may be given any time, at least one month after the first dose, assuming that both are given after one year of age. The second dose should be received by no later than 12 years of age. The first dose may be given less than 1 year of age, in an outbreak area; if so, revaccinate at 12-15 months of age and administer additional dose at time of school entry.		12 months	1 month
Varicella	Vaccinate after one year of age; if 13 or older, requires two shots at least one month apart.		12 months	4 weeks

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Last modification: December 4, 1998