2003 Immunization Chart

Content provided by the Faculty of the Harvard Medical School

2003 Immunization Chart

This schedule indicates the recommended ages for routine administration of currently licensed childhood vaccines, as of Dec. 1, 2002, for children through age 18 years. Any dose not given at the recommended age should be given at any subsequent visit when indicated and feasible. Green indicates age groups that warrant special effort to administer those vaccines not previously given. Additional vaccines may be licensed and recommended during the year. Licensed combination vaccines may be used whenever any components of the combination are indicated and the vaccine's other components are not contraindicated. Providers should consult the manufacturers' package inserts for detailed recommendations.

Approved by the Advisory Committee on Immunization Practices, the American Academy of Pediatrics, and the American Academy of Family Physicians.

1. Hepatitis B vaccine (HepB). All infants should receive the first dose ofhepatitis B vaccine soon after birth and before hospital discharge; the first dosemay also be given by age 2 months if the infant's mother is HBsAg-negative.Only monovalent HepB can be used for the birth dose. Monovalent orcombination vaccine containing HepB may be used to complete the series.Four doses of vaccine may be administered when a birth dose is given. Thesecond dose should be given at least 4 weeks after the first dose, except forcombination vaccines which cannot be administered before age 6 weeks. Thethird dose should be given at least 16 weeks after the first dose and at least 8weeks after the second dose. The last dose in the vaccination series (third orfourth dose) should not be administered before age 6 months.

Infants born to HBsAg-positive mothers should receive HepB and 0.5 mLHepatitis B Immune Globulin (HBIG) within 12 hours of birth at separate sites.The second dose is recommended at age 1-2 months. The last dose in thevaccination series should not be administered before age 6 months. Theseinfants should be tested for HBsAg and anti-HBs at 9-15 months of age.Infants born to mothers whose HBsAg status is unknown should receivethe first dose of the HepB series within 12 hours of birth. Maternal blood shouldbe drawn as soon as possible to determine the mother's HBsAg status; if theHBsAg test is positive, the infant should receive HBIG as soon as possible (nolater than age 1 week). The second dose is recommended at age 1-2 months.The last dose in the vaccination series should not be administered beforeage 6 months.

2. Diphtheria and tetanus toxoids and acellular pertussisvaccine (DTaP). The fourth dose of DTaP may be administered as early asage 12 months, provided 6 months have elapsed since the third dose and thechild is unlikely to return at age 15-18 months. Tetanus and diphtheriatoxoids (Td) is recommended at age 11-12 years if at least 5 years haveelapsed since the last dose of tetanus and diphtheria toxoid-containingvaccine. Subsequent routine Td boosters are recommended every 10 years.

3. Haemophilus influenzae type b (Hib) conjugate vaccine. ThreeHib conjugate vaccines are licensed for infant use. If PRP-OMP (PedvaxHIBor ComVax [Merck]) is administered at ages 2 and 4 months, a dose at age 6months is not required. DTaP/Hib combination products should not be used forprimary immunization in infants at ages 2, 4 or 6 months, but can be used asboosters following any Hib vaccine.

4. Measles, mumps, and rubella vaccine (MMR). The second dose ofMMR is recommended routinely at age 4-6 years but may be administeredduring any visit, provided at least 4 weeks have elapsed since the first dose andthat both doses are administered beginning at or after age 12 months. Thosewho have not previously received the second dose should complete theschedule by the 11-12 year old visit.

5. Varicella vaccine. Varicella vaccine is recommended at any visit at orafter age 12 months for susceptible children, i.e. those who lack a reliablehistory of chickenpox. Susceptible persons aged 13 years or older should receive twodoses, given at least 4 weeks apart.

6. Pneumococcal vaccine. The heptavalent pneumococcal conjugatevaccine (PCV) is recommended for all children age 2-23 months. It is alsorecommended for certain children age 24-59 months. Pneumococcalpolysaccharide vaccine (PPV) is recommended in addition to PCV for certainhigh-risk groups.

7. Hepatitis A vaccine. Hepatitis A vaccine is recommended for childrenand adolescents in selected states and regions, and for certain high-risk groups;consult your local public health authority. Children and adolescents in thesestates, regions, and high risk groups who have not been immunized againsthepatitis A can begin the hepatitis A vaccination series during any visit. The twodoses in the series should be administered at least 6 months apart.

8. Influenza vaccine. Influenza vaccine is recommended annually forchildren age 6 months or older with certain risk factors (including but not limited toasthma, cardiac disease, sickle cell disease, HIV, diabetes, and householdmembers of persons in groups at high risk; and can be administered to all others wishing to obtain immunity. In addition,healthy children age 6-23 months are encouraged to receive influenza vaccine iffeasible because children in this age group are at substantially increased risk forinfluenza-related hospitalizations. Children aged 12 years or younger should receivevaccine in a dosage appropriate for their age (0.25 mL if age 6-35 months or 0.5mL if aged 3 years or older). Children aged 8 years or younger who are receiving influenzavaccine for the first time should receive two doses separated by at least4 weeks.

For additional information about vaccines, including precautions and contradictions for immunization, please visit the National Immunization Program Web site or call the National Immunization Hotline at (800) 232-2522 (English) or (800) 232-0233 (Spanish).

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Last updated:	April 04, 2006