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POLICY STATEMENT Organizational Principles to Guide and Define the Child Health

Care System and/or Improve the Health of all Children

Recommended Childhood and


Adolescent Immunization Schedules:
United States, 2019
COMMITTEE ON INFECTIOUS DISEASES

The 2019 recommended childhood and adolescent immunization


schedules have been approved by the American Academy of Pediatrics
(AAP), the Advisory Committee on Immunization Practices and the
Centers for Disease Control and Prevention (CDC), the American Academy
of Family Physicians, and the American College of Obstetricians and
Gynecologists. The schedules are revised annually to reflect current
recommendations for the use of vaccines licensed by the US Food and
Drug Administration.
The 2019 childhood and adolescent immunization schedule has been
updated to ensure consistency between the format of the childhood and This document is copyrighted and is property of the American
Academy of Pediatrics and its Board of Directors. All authors have filed
adolescent and adult immunization schedules. Changes have been made to conflict of interest statements with the American Academy of
the cover page, including guidance for use of the schedule as well as a list Pediatrics. Any conflicts have been resolved through a process
approved by the Board of Directors. The American Academy of
of links to “Helpful information.” Similar to last year, the cover page Pediatrics has neither solicited nor accepted any commercial
includes a table with alphabetical listing of vaccines, approved involvement in the development of the content of this publication.

abbreviations for each vaccine, and vaccine trade names. Policy statements from the American Academy of Pediatrics benefit
from expertise and resources of liaisons and internal (AAP) and
Table 1 contains the recommended immunization schedule from birth external reviewers. However, policy statements from the American
Academy of Pediatrics may not reflect the views of the liaisons or the
through 18 years of age. The influenza row has been modified to reflect organizations or government agencies that they represent.
current CDC recommendations for use of LAIV in age-appropriate and
The guidance in this statement does not indicate an exclusive course
health status–appropriate children 24 months of age and older. A purple of treatment or serve as a standard of medical care. Variations, taking
bar has been added to the hepatitis A vaccine row, indicating into account individual circumstances, may be appropriate.
a recommendation for use of this vaccine among infants 6 through All policy statements from the American Academy of Pediatrics
11 months of age before departure to an international destination. A automatically expire 5 years after publication unless reaffirmed,
revised, or retired at or before that time.
purple bar has been added to the Tdap row, indicating vaccine use for
pregnant adolescents 13 through 18 years of age. DOI: https://doi.org/10.1542/peds.2019-0065

PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).


Table 2 is the catch-up immunization schedule for persons 4 months
through 18 years of age who start late or who are more than 1 month Copyright © 2019 by the American Academy of Pediatrics
behind the recommended age for vaccine administration. A change is
noted in relation to administration of Haemophilus influenzae type b and To cite: COMMITTEE ON INFECTIOUS DISEASES.
pneumococcal conjugate vaccines. The criteria under which no further Recommended Childhood and Adolescent Immunization
doses are needed are presented, followed by recommendations for those Schedules: United States, 2019. Pediatrics. 2019;143(3):
e20190065
in whom additional doses are indicated.

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PEDIATRICS Volume 143, number 3, March 2019:e20190065 FROM THE AMERICAN ACADEMY OF PEDIATRICS
Table 3 lists the vaccines that may be • Polio vaccine is published in February of each year
indicated for children and • A bullet has been added re- and is available at www.cdc.gov/
adolescents 18 years of age or garding the use of combination vaccines/schedules/hcp/adult.html.
younger on the basis of medical vaccines that contain IPV. This Clinically significant adverse events
conditions. A pink color has been bullet mirrors similar in- that follow immunization should be
added to the pregnancy column in the formation presented in the hep- reported to the Vaccine Adverse Event
HPV row, indicating the need for atitis B vaccine note. Reporting System. Guidance about
a delay in vaccination for pregnant
adolescents. The influenza vaccine • Influenza vaccines how to obtain and complete a Vaccine
Adverse Event Reporting System form
row has been modified to separate • LAIV has been added where
can be obtained at www.vaers.hhs.gov
LAIV from IIV and to include appropriate.
or by calling 800-822-7967. Additional
contraindications and precautions • A “special situations” section has information can be found in the Red
for LAIV. been added with information re- Book and at Red Book Online (http://
A bullet directing providers to their garding vaccination of persons aapredbook.aappublications.org/).
state or local health departments for with a history of egg allergy and Statements from the Advisory
information regarding vaccination in information regarding when not Committee on Immunization Practices
the setting of a vaccine-preventable to use LAIV. and the CDC that contain detailed
disease outbreak has been added to • MMR and meningococcal vaccines recommendations for individual
the "Additional Information" section • Language regarding use of the vaccines, including recommendations
of the notes. MMR vaccine in the setting of for children with high-risk conditions,
a mumps outbreak and Men- are available at www.cdc.gov/
This year, the notes are presented in
ACWY and MenB vaccine use in vaccines/hcp/acip-recs/index.html.
alphabetical order. The following
the setting of meningococcal Information on new vaccine releases,
changes to individual footnotes have
outbreaks has been removed, and vaccine supplies, and interim
been made:
providers are now directed to recommendations resulting from
• Hepatitis A vaccine vaccine shortages and statements on
local health departments for in-
• Information regarding the use of formation regarding vaccination specific vaccines can be found at www.
combined HepA-HepB (Twinrix) during an outbreak (see “Addi- aapredbook.org/news/vaccstatus.
vaccine in persons 18 years of tional Information” section). shtml.
age or older has been added. • Tdap vaccine
• A section for international travel COMMITTEE ON INFECTIOUS DISEASES,
• The catch-up vaccination section 2018–2019
has been added with recommen-
has been updated to indicate that
dation for vaccination of those 6 Yvonne A. Maldonado, MD, FAAP,
those who received a dose of Tdap Chairperson
through 11 months of age and
or DTaP at 7 through 10 years of Theoklis E. Zaoutis, MD, MSCE, FAAP, Vice
unvaccinated persons 12 months
age inadvertently or as part of the Chairperson
of age or older. Ritu Banerjee, MD, PhD, FAAP
catch-up schedule should receive
• Homelessness has been added as the routine dose of Tdap at 11 Elizabeth D. Barnett, MD, FAAP
an indication for vaccination. James D. Campbell, MD, MS, FAAP
through 12 years of age. Jeffrey S. Gerber, MD, PhD, FAAP
• Hepatitis B vaccine • A link to information regarding Athena P. Kourtis, MD, PhD, MPH, FAAP
• The word “all” has been added to the use of Tdap/Td for wound Ruth Lynfield, MD, FAAP
Flor M. Munoz, MD, MSc, FAAP
the vaccine recommendation for prophylaxis has been added.
Dawn Nolt, MD, MPH, FAAP
the birth dose for medically sta- The 2019 version of tables 1 through Ann-Christine Nyquist, MD, MSPH, FAAP
ble infants ($2000 g) born to 3 and the notes are available on the Sean T. O’Leary, MD, MPH, FAAP
hepatitis B surface antigen- Mark H. Sawyer, MD, FAAP
American Academy of Pediatrics Web
William J. Steinbach, MD, FAAP
negative mothers. This was site (https://redbook.solutions.aap. Tina Q. Tan, MD, FAAP
added to emphasize the recom- org/SS/Immunization_Schedules.
mendation for this population. aspx) and the CDC Web site (www.
• Information regarding the use of cdc.gov/vaccines/schedules/hcp/ EX OFFICIO
CPG–adjuvanted HepB (Heplisav- child-adolescent.html). A parent- David W. Kimberlin, MD, FAAP – Red Book
Editor
B) vaccine and combination friendly vaccine schedule for children
Henry H. Bernstein, DO, MHCM, FAAP – Red
Twinrix vaccine in persons and adolescents is available at www. Book Online Associate Editor
18 years or older has cdc.gov/vaccines/schedules/index. H. Cody Meissner, MD, FAAP – Visual Red
been added. html. An adult immunization schedule Book Associate Editor

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2 FROM THE AMERICAN ACADEMY OF PEDIATRICS
LIAISONS Nicole Le Saux, MD, FRCP(C) – Canadian STAFF
Paediatric Society
Jennifer M. Frantz, MPH
Amanda C. Cohn, MD, FAAP – Centers for Scot B. Moore, MD, FAAP – Committee on
Disease Control and Prevention Practice Ambulatory Medicine
Jamie Deseda-Tous, MD – Sociedad Neil S. Silverman, MD – American College of
Latinoamericana de Infectologia Pediatrica Obstetricians and Gynecologists ABBREVIATIONS
Karen M. Farizo, MD – US Food and Drug Jeffrey R. Starke, MD, FAAP – American AAP: American Academy of
Administration Thoracic Society
Pediatrics
Marc Fischer, MD, FAAP – Centers for Disease James J. Stevermer, MD, MSPH, FAAFP –
Control and Prevention American Academy of Family Physicians CDC: Centers for Disease Control
Natasha B. Halasa, MD, MPH, FAAP – Kay M. Tomashek, MD, MPH, DTM – National and Prevention
Pediatric Infectious Diseases Society Institutes of Health

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PEDIATRICS Volume 143, number 3, March 2019 3
Recommended Childhood and Adolescent Immunization Schedules: United
States, 2019
COMMITTEE ON INFECTIOUS DISEASES
Pediatrics originally published online February 5, 2019;

Updated Information & including high resolution figures, can be found at:
Services http://pediatrics.aappublications.org/content/early/2019/02/01/peds.2
019-0065
Subspecialty Collections This article, along with others on similar topics, appears in the
following collection(s):
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ous_diseases
Infectious Disease
http://www.aappublications.org/cgi/collection/infectious_diseases_su
b
Vaccine/Immunization
http://www.aappublications.org/cgi/collection/vaccine:immunization
_sub
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Recommended Childhood and Adolescent Immunization Schedules: United
States, 2019
COMMITTEE ON INFECTIOUS DISEASES
Pediatrics originally published online February 5, 2019;

The online version of this article, along with updated information and services, is
located on the World Wide Web at:
http://pediatrics.aappublications.org/content/early/2019/02/01/peds.2019-0065

Pediatrics is the official journal of the American Academy of Pediatrics. A monthly publication, it
has been published continuously since 1948. Pediatrics is owned, published, and trademarked by
the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois,
60007. Copyright © 2019 by the American Academy of Pediatrics. All rights reserved. Print
ISSN: 1073-0397.

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