General Best Practice Guidelines for Immunization: Timing and Spacing of Immunobiologics
Abbreviations: DEN4CYD = dengue vaccine; DTaP = diphtheria and tetanus toxoids and acellular pertussis; HepA =
hepatitis A; HepB = hepatitis B; Hib = Haemophilus influenzae type b; HPV = human papillomavirus; IPV =
inactivated poliovirus; LAIV = live, attenuated influenza vaccine; MenACWY = quadrivalent meningococcal conjugate
vaccine; MenB = serogroup B meningococcal vaccine; MenB-4C = Bexsero; MenB-FHbp = Trumenba; MMR =
measles, mumps, and rubella; MMRV
= measles, mumps, rubella, and varicella; MPSV4 = quadrivalent meningococcal polysaccharide vaccine; PCV13 =
pneumococcal conjugate vaccine; PPSV23= pneumococcal polysaccharide vaccine; PRP-OMP = polyribosylribitol
phosphate-meningococcal outer membrane protein conjugate; RZV = recombinant zoster vaccine; Td = tetanus and
diphtheria toxoids; Tdap = tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis.
(a)
Combination vaccines are available. Use of licensed combination vaccines is generally preferred to separate
injections of their equivalent component vaccines. When administering combination vaccines, the minimum age for
administration is the oldest age for any of the individual components. The minimum interval between doses is equal to
the greatest interval of any of the individual components.
(b)
Information on travel vaccines, including typhoid, Japanese encephalitis, and yellow fever, is available at
https://www.cdc.gov/travel.
Information on other vaccines that are licensed in the United States but not distributed,
including anthrax and smallpox, is available at http://emergency.cdc.gov/bioterrorism/ .
(c)
“Months” refers to calendar months.
(d)
Within a number range, a hyphen (-) should be read as “through.”
(e)
Combination vaccines containing the hepatitis B component are available (see Table 3-3). These vaccines should not
be administered to infants aged <6 weeks because of the other vaccine components (i.e., Hib, DTaP, HepA, and IPV).
(f)
The minimum recommended age for DTaP-4 is 15 months, with a recommended 6 months from DTaP-3 (the
recommended interval between DTaP-3 and DTaP-4 is 6 months). However, DTaP4 need not be repeated if given on
or after 12 months of age and at least 4 months after DTaP-3. The 4-day grace period can be applied when validating
past doses and can be applied to the minimum age of 12 months and the minimum interval of 4 months between
DTaP-3 and DTaP-4. The 4-day grace period can be used when planning doses ahead of time, but should be applied to
the minimum age of 15 months and the minimum interval between DTaP-3 and DTaP-4 of 6 months.
(g)
If a fourth dose of DTaP is given on or after the fourth birthday, a fifth dose is not needed if the interval between the
third dose and fourth dose is at least 6 months.
(h)
Adjuvanted Hepatitis B vaccine (HepB-CgG) can be administered to adults 18 years old and older on a two dose
schedule, the first and second dose separated by 4 weeks.
(i)
HepB-3 should be administered at least 8 weeks after HepB-2 and at least 16 weeks after HepB-1 and should not be
administered before age 24 weeks.
(j)
For Hib and PCV13, children receiving the first dose of vaccine at age ≥7 months require fewer doses to complete the
series.
(k)
If PRP-OMP (Pedvax-Hib, Merck Vaccine Division) was administered at ages 2 and 4 months, a dose at age 6
months is not necessary. The final dose has a minimum age of 12 months.
(l)
A two-dose schedule of HPV vaccine is recommended for most persons beginning the series between 9 through 14
years of age. See HPV vaccine-specific recommendations for details.
www.cdc.gov/mmwr/volumes/65/wr/pdfs/mm6549a5.pdf
(m)
If a patient is eligible for a 2-dose HPV series, and the second dose is given less than four weeks after the first dose,
it is an invalid dose. Administer another dose 6-12 months after the first dose. If the second dose is given less than five
months after the first dose, but more than four weeks after the first dose, the next dose should be administered at least
12 weeks after the second dose, and at least 6-12 months after the first dose. The 4-day grace period may be used. If
the third dose was administered before December 16, 2016, and was administered 12 weeks after the 2nd dose, and 16
weeks after the first dose, it is a valid dose. The 4-day grace period may be used. If the third dose was administered on
or after December 16, 2016, and was administered 12 weeks after the 2nd dose and 5 months after the first dose, it is a
valid dose. The 4-day grace period may be used.
(n)
The minimum age for HPV-3 is based on the baseline minimum age for the first dose (i.e., 9 years) and the
minimum interval of 5 months between the first and third dose. If the third dose was administered before December
16, 2016, and was administered 12 weeks after the 2nd dose, and 16 weeks after the first dose, it is a valid dose. The 4-
day grace period may be used. If the third dose was administered on or after December 16, 2016, and was
administered.
(o)
One dose of influenza vaccine per season is recommended for most persons. To determine which children younger
than 9 years should receive 2 doses in a single season, please see influenza vaccine-specific recommendations (82). If a
dose of LAIV is administered to a child 6 months to 2 years of age in error, the dose does not need to be repeated.