James A. Haley Veterans' Hospital | VA Tampa Health Care | Veterans Affairs

2025 Vaccination Schedule: 0-18 Years Of Age

  1. Hepatitis B (HepB) vaccine. (Min age: birth)At birth:

• HBsAg-negative mother: administer 1 dose of monovalent HepB vaccine within 24hrs of birth for all medically stable infants ≥2000g. For infants <2000g, give 1 dose at chronological age 1 month or hospital discharge (whichever is earlier even if weight remains <2000g).

• HBsAg-positive mother: administer 1 dose of monovalent HepB vaccine and hepatitis B immune globulin (HBIG) within 12hrs of birth, regardless of birth weight. For infants <2000g, administer 3 more doses of vaccine (4 total) beginning at age 1 month. Test for HBsAg and antibody to HBsAg (anti-HBs) at age 9–12mos or 1–2mos after final dose if the series was delayed.

• Unknown HBsAg status: administer monovalent HepB vaccine within 12hrs of birth. For infants <2000g, add HBIG within 12hrs of birth, and 3 more doses of vaccine (4 total) beginning at age 1 month. For infants weighing ≥2000g, determine mother's HBsAg status as soon as possible and, if she is HBsAg-positive, also give HBIG as soon as possible but no later than age 1wk. If HBsAg-positive or status remains unknown, test for HBsAg and anti-HBs at age 9–12mos or 1–2mos after final dose if the series was delayed. Do not test before age 9mos.

   Doses after the birth dose:

• The 2nd dose should be administered at age 1–2mos and the 3rd dose at 6–18mos. Monovalent HepB vaccine should be used for doses administered before age 6wks.

• Infants who did not receive a birth dose should receive 3 doses of a HepB-containing vaccine as soon as feasible.

• The minimum interval is 4wks for the 1st and 2nd dose, 8wks for the 2nd and 3rd dose, and 16wks for the 1st and 3rd dose (if 4 doses, substitute 4th dose for 3rd dose in these calculations). The final (3rd or 4th) dose in the HepB vaccine series should be administered no earlier than age 24wks.

• Administration of a total of 4 doses of HepB vaccine is permitted when a combination vaccine containing HepB is administered after the birth dose.

• Revaccination may be recommended for: infants born to HBsAg-positive mothers, hemodialysis patients, or other immunocompromised persons.

• For catch-up vaccination recommendations, refer to the 2025 Catch-Up Vaccination Schedule: 4 Months–18 years chart.

  2. Rotavirus (RV) vaccine. (Min age: 6wks for both RV1 [Rotarix] and RV5 [RotaTeq])

• Administer a series of RV vaccine to all infants as follows:

1. If Rotarix is used, administer a 2-dose series at 2 and 4mos of age.

2. If RotaTeq is used, administer a 3-dose series at ages 2, 4, and 6mos.

3. If any dose in the series is either RotaTeq or unknown, default to 3-dose series.

  3. Diphtheria, tetanus, and acellular pertussis (DTaP) vaccine. (Min age: 6wks. Exception: DTaP-IPV [Kinrix, Quadracel]: 4yrs)

• Administer a 5-dose series of DTaP vaccine at ages 2, 4, 6, 15−18mos, and 4−6yrs. The 4th dose may be administered as early as age 12mos, provided at least 6mos have elapsed since the 3rd dose. If the 4th dose was inadvertently given as early as 12mos, it may be counted if given ≥4mos after the 3rd dose.

• 5th dose of DTaP vaccine is not needed if 4th dose was given at age ≥4yrs and ≥6mos after 3rd dose.

• For wound management in children age <7yrs with ≥3 doses of tetanus-toxoid-containing vaccine, administer DTaP for all wounds except clean and minor wounds if >5yrs since last dose of tetanus-toxoid-containing vaccine.

  4. Haemophilus influenzae type b (Hib) conjugate vaccine. (Minimum age: 6wks for PRP‑T [ActHIB, Hiberix], PRP‑OMP [PedvaxHIB], DTaP‑IPV/Hib [Pentacel], DTaP-IPV-Hib-HepB [Vaxelis])

• Administer a 4-dose Hib vaccine series at 2, 4, and 6mos, then a booster dose at 12−15mos for ActHIB, Hiberix, Pentacel, or Vaxelis. Do not use Vaxelis as a booster dose; use a different Hib-containing vaccine. For PedvaxHIB, administer a 3-dose series at 2 and 4mos, then a booster dose at 12−15mos.

• Vaxelis and PedvaxHIB are preferred for the primary series over the other Hib vaccines for American Indian and Alaska Native infants.

• For catch-up vaccination recommendations, refer to the 2025 Catch-Up Vaccination Schedule: 4 Months−18 years chart.

• Persons with high-risk conditions: refer to the ACIP 2025 Immunization Schedule footnotes.

  5. Pneumococcal vaccines. (Min age: 6wks for PCV15 and PCV20, 2yrs for PPSV23)Routine vaccination with PCV:

• Administer a 4-dose series of PCV vaccine at ages 2, 4, 6mos and at age 12−15mos.

• Either PCV15 or PCV20 can be used for PCV vaccination. PCV20 is not indicated in healthy children if previously received 4 doses of PCV13 or PCV15 or another complete PCV series.

• Persons with high-risk conditions: refer to the ACIP 2025 Immunization Schedule footnotes.

  6. Inactivated poliovirus vaccine (IPV). (Min age: 6wks)

• Administer a 4-dose series of IPV at ages 2, 4, 6−18mos and 4−6yrs. The final dose in the series should be administered on or after the 4th birthday and at least 6mos after the previous dose.

• If ≥4 doses of IPV-containing combination vaccine are given before age 4yrs, an additional dose should be given on or after the 4th birthday and ≥6mos after the previous dose.

• If both trivalent OPV (tOPV) and IPV were given as part of a series, a total of 4 doses should be given to complete the series. Doses should be at least 4wks apart, with the final dose given on or after the 4th birthday and at least 6mos after the previous dose. If only OPV were given, and all doses given before 4yrs of age, 1 dose of IPV should be given at age ≥4yrs, at least 6mos after last OPV dose.

• Only tOPV counts toward the US vaccination requirements. Doses of OPV given before 4/1/2016 should be counted (unless noted as given during a campaign). Doses of OPV given on or after 4/1/2016 should not be counted.

• Unvaccinated or incompletely vaccinated adolescents age 18yrs should receive remaining IPV doses to complete a 3-dose primary series. Those who completed the primary series and remains at risk may receive one lifetime IPV booster.

  7. Influenza vaccines. (Min age: 6mos for inactivated influenza vaccine [IIV3], 2yrs for live attenuated influenza vaccine [LAIV3], 18yrs for recombinant influenza vaccine [RIV3])

• For the 2024–2025 season, administer 2 doses at least 4wks apart to children 6mos–8yrs who have not previously received ≥2 doses of influenza vaccine before July 1, 2024, or whose influenza vaccination history is unknown. Administer 1 dose if previously received ≥2 doses before July 1, 2024.

• Administer 1 dose for all children age ≥9yrs.

• Children with allergy to eggs can receive any influenza vaccine (egg-based and non-egg-based) appropriate for age and health status.

• Contraindications and precautions for influenza vaccines: refer to the ACIP 2025 Immunization Schedule footnotes or the product labeling.

  8. Measles, mumps, and rubella (MMR) vaccine. (Min age: 12mos)

• Administer a 2-dose series of MMR vaccine at ages 12−15mos and 4−6yrs.

• MMR or MMRV may be given. For the 1st dose in ages 12–47mos, a separate MMR and varicella vaccine is recommended, unless MMRV preferred. The maximum age for MMRV is 12yrs and the minimum interval between doses is 3mos.

• Administer 1 dose of MMR to infants aged 6−11mos before departure for international travel. These children should be revaccinated with 2 doses, the 1st at age 12−15mos (12mos for children in high-risk areas), and the 2nd dose ≥4wks later. Unvaccinated children ≥12mos should receive 2 doses ≥4wks apart before departure. Those previously vaccinated with 1 dose should receive the 2nd dose ≥4wks after the 1st dose.

  9. Varicella (VAR) vaccine. (Min age: 12mos)

• Administer a 2-dose series of VAR vaccine at ages 12−15mos and 4−6yrs. The 2nd dose may be administered as early as 3mos after the 1st dose. If the 2nd dose was given at least 4wks after the 1st dose, it can be accepted as valid.

• VAR or MMRV may be administered. For the 1st dose in ages 12–47mos, a separate MMR and varicella vaccine is recommended, unless MMRV preferred. The maximum age for MMRV is 12yrs.

10. Hepatitis A (HepA) vaccine. (Min age: 12mos)

• Initiate the 2-dose HepA vaccine series, separated by ≥6mos beginning at age 12–23mos.

• Administer 1 dose of HepA vaccine to infants aged 6–11mos before departure to countries with high or intermediate HepA endemicity; revaccinate with 2 doses, ≥6mos apart, between age 12–23mos. Unvaccinated children aged ≥12mos should receive 1 dose as soon as travel is considered.

• For catch-up vaccination recommendations, refer to the 2025 Catch-Up Vaccination Schedule: 4 Months–18 years chart.

11. Meningococcal vaccines. (Min age: 2mos for MenACWY-CRM [Menveo], 2yrs for MenACWY-TT [MenQuadfi], 10yrs for serogroup B meningococcal [MenB] vaccines: MenB-4C [Bexsero] and MenB-FHbp [Trumenba], 10yrs for MenACWY-TT/MenB-FHbp [Penbraya])

• MenACWY vaccination (Menveo, MenQuadfi): 

— Administer a 2-dose series at 11−12yrs and 16yrs.

— Administer 1 dose to 1st-year college students living in residential housing (if not previously vaccinated at ≥16yrs) or military recruits.

— Children who received MenACWY before age 10yrs and for whom boosters are recommended due to ongoing increased meningococcal risk should follow the booster schedule for persons at increased risk. If boosters are not recommended, administer routine vaccination at 11−12yrs and 16yrs.

— Menveo is available in 2 formulations (lyophilized and liquid). The liquid formulation should not be used before age 10yrs.

• MenB vaccination (Bexsero, Trumenba):

— Persons 16−23yrs (16−18yrs preferred) not at increased risk may receive, based on shared clinical decision-making, 2 doses ≥6mos apart (if 2nd dose given too soon, give 3rd dose ≥4mos after the 2nd dose).

— Bexsero and Trumenba are not interchangeable; use the same product for all doses in a series.

• MenACWY and MenB vaccines may be given simultaneously but at different anatomic sites, if feasible.

• Children age ≥10yrs may receive 1 dose of Penbraya as an alternative to separate administration of MenACWY and MenB when both vaccines would be given on the same clinic day.

— Children not at increased risk: if Penbraya is used for 1st dose of MenB, Trumenba should be given for 2nd dose.

— Children at increased risk: Penbraya may be used for additional MenACWY and MenB doses (including booster). The interval between Penbraya doses is ≥6mos.

• Persons with high-risk conditions or those traveling to or living in countries where meningococcal disease is hyperendemic or epidemic: refer to the ACIP 2025 Immunization Schedule footnotes.

• Additional information on MenACWY and MenB booster doses in special situations is available at https://www.Cdc.Gov/mmwr/volumes/69/rr/rr6909a1.Htm.

12. Tetanus, diphtheria, and acellular pertussis (Tdap) vaccine. (Min age: 11yrs for routine vaccination, 7yrs for catch-up)

• Give 1 dose of Tdap (adolescent booster) at age 11–12yrs.

• Tdap can be administered regardless of the interval since the last tetanus and diphtheria toxoid-containing vaccine.

• Administer 1 dose of Tdap vaccine to pregnant adolescents during each pregnancy (preferably during the early part of gestational weeks 27–36).

• For catch-up vaccination recommendations, refer to the 2025 Catch-Up Vaccination Schedule: 4 Months−18 years chart.

• For wound management in children age ≥7yrs with ≥3 doses of tetanus-toxoid-containing vaccine, administer Tdap or Td for clean and minor wounds if >10yrs since last dose of tetanus-toxoid-containing vaccine. For all other wounds, administer Tdap or Td if >5yrs since last dose of tetanus vaccine. Tdap is preferred for age ≥11yrs with no or unknown history of Tdap vaccination, or in pregnancy.

13. Human papillomavirus (HPV) vaccines. (Min age: 9yrs for 9vHPV [Gardasil 9])

• Adolescents age 11−12yrs (can start at age 9yrs) and through 18yrs (if not previously adequately vaccinated) should receive HPV vaccine series. Number of doses is dependent on age at initial vaccination:

— Initiated at age 9−14yrs: administer a 2-dose series at 0, 6–12mos. The minimum interval between doses is 5mos; repeat dose if given too soon.

— Initiated at age ≥15yrs: administer a 3-dose series at 0, 1−2, and 6mos. The 1st and 2nd dose should be at least 4wks apart, the 2nd and 3rd dose at least 12wks apart, and the 1st and 3rd dose at least 5mos apart; repeat dose if given too soon.

• No additional doses are needed for persons who have completed a valid series with any HPV vaccine.

• Administer HPV vaccine beginning at age 9yrs to children with any history of sexual abuse or assault.

• Immunocompromised children should receive a 3-dose series at 0, 1−2, and 6mos, regardless of age at vaccine initiation.

• HPV vaccination is not recommended until after pregnancy. However, pregnancy testing is not needed before vaccination. If found to be pregnant after initiating the vaccination series, no intervention is needed; the remainder of the series should be delayed until completion of pregnancy.

14. Dengue vaccine (Min age: 9yrs for DEN4CYD [Dengvaxia])

• Give 3 doses at 0, 6, 12mos in persons age 9−16yrs who live in dengue endemic areas and have laboratory-confirmed previous dengue infection.

• Children traveling to or visiting dengue endemic areas should not be vaccinated.

15. Covid-19 vaccines (Min age: 6mos for Moderna and Pfizer-BioNTech vaccines; 12yrs for Novavax vaccine)

• ACIP recommends use of COVID-19 vaccines for everyone ages ≥6mos.

• Unvaccinated children and those previously vaccinated before 2024–2025 vaccine (Moderna, Pfizer-BioNTech, Novavax) should receive age-appropriate dose(s) of the 2024–2025 formulation.

• There is no preferential recommendation for the use of one COVID-19 vaccine over another when more than one age-appropriate vaccine is available.

• All vaccine doses in the series should be from the same manufacturer.

• For a list of currently available COVID-19 vaccines and other recommendations for COVID-19 vaccination including dosing for immunocompromised adults, see https://www.Cdc.Gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.Html.

16. Respiratory syncytial virus (RSV vaccine, RSV-mAb). (Min age: birth for nirsevimab [Beyfortus])

• Either maternal RSV vaccination with Abrysvo or infant immunization with nirsevimab is recommended to prevent RSV lower respiratory tract infection in infants.

• RSV immunization (nirsevimab [Beyfortus]):

— Give 1 dose of nirsevimab to infants born to mothers who are unvaccinated, with unknown vaccination status, vaccinated in previous pregnancy, or recently vaccinated less than 14 days prior to delivery. Nirsevimab is not needed but can be considered in rare circumstances if the mother received RSV vaccine at least 14 days before delivery.

— Timing of administration:

❭ Infants born October-March: give within 1 week of birth

❭ Infants born April-September: give shortly before start of RSV season (optimally October-November)

— Nirsevimab can be given to children who are eligible to receive palivizumab. If previously received nirsevimab, palivizumab should not be given for the same RSV season.

• RSV vaccination (Abrysvo):

— Give 1 dose of RSV vaccine Abrysvo to pregnant persons at 32wks 0 days through 36wks 6 days gestation from September through January, regardless of previous RSV infection.

— There is currently no recommendation for RSV vaccination in subsequent pregnancies. Infants born to mothers who received Abrysvo during a previous pregnancy should receive nirsevimab.

• US jurisdictions with differing RSV seasonality should follow guidance from public health authorities or regional medical centers on timing of administration.

17. Mpox vaccine (Min age: 18yrs for Jynneos)

• Give 2 doses 4wks apart, to persons age 18yrs and at risk for mpox infection.

February 2025: Notable Drug Approvals

Drug Pharmacologic Class Indication More Information Allergic Disorders Odactra (Dermatophagoides farinae and Dermatophagoides pteronyssinus) Allergen extract Treatment of house dust mite-induced allergic rhinitis, with or without conjunctivitis, in pediatric patients aged 5 to 11 years. Odactra Approved for Younger Patients With House Dust Mite-Induced Allergic Rhinitis Immunization Penmenvy (meningococcal Groups A, B, C, W, and Y vaccine) Meningococcal vaccine For active immunization to prevent invasive disease caused by Neisseria meningitidis serogroups A, B, C, W, and Y in individuals 10 through 25 years of age. Pentavalent Meningococcal Vaccine Penmenvy Gets FDA Approval Vimkunya (chikungunya vaccine, recombinant) Vaccine containing purified virus-like particles consisting of CHIKV capsid protein For the prevention of disease caused by chikungunya virus in individuals 12 years of age and older. FDA Approves Vimkunya to Protect Against Chikungunya Virus Infectious Diseases Emblaveo (aztreonam and avibactam) Monobactam antibiotic and β-lactamase inhibitor In combination with metronidazole, for patients 18 years and older who have limited or no alternative options for the treatment of complicated intra-abdominal infections, including those caused by the following susceptible Gram-negative microorganisms: Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca, Enterobacter cloacae complex, Citrobacter freundii complex and Serratia marcescens. Emblaveo Approved for Intra-Abdominal Infections in Patients With Limited Options Metabolic Disorders Ctexli (chenodiol)

Bile acid

Treatment of cerebrotendinous xanthomatosis. FDA Approves Ctexli for Cerebrotendinous Xanthomatosis Neurologic Disorders Gomekli (mirdametinib)

Mitogen-activated protein kinase kinases 1 and 2 inhibitor

Treatment of adult and pediatric patients aged 2 years and older with neurofibromatosis type 1 who have symptomatic plexiform neurofibromas not amenable to complete resection. Gomekli Approved for NF1-Associated Plexiform Neurofibromas Onapgo (apomorphine hydrochloride)

Non-ergoline dopamine agonist

Treatment of motor fluctuations ("off" episodes) in adults with advanced Parkinson disease Apomorphine Infusion Device Onapgo Approved for Parkinson Disease Obstetrics and Gynecology Miudella (copper intrauterine system)

Copper containing intrauterine system

For the prevention of pregnancy in females of reproductive potential for up to 3 years. New Copper IUD Miudella Approved for Pregnancy Prevention Oncology Adcetris (brentuximab vedotin)

CD30-directed antibody-drug conjugate

In combination with lenalidomide and a rituximab product for adult patients with relapsed or refractory large B-cell lymphoma, including diffuse large B-cell lymphoma (DLBCL) not otherwise specified, DLBCL arising from indolent lymphoma, or high-grade B-cell lymphoma, after 2 or more lines of systemic therapy who are ineligible for autologous hematopoietic stem cell transplantation or chimeric antigen receptor T-cell therapy. Adcetris Combo Regimen Approved for R/R Large B-Cell Lymphoma Romvimza (vimseltinib)

Kinase inhibitor that inhibits colony-stimulating factor 1 receptor

Treatment of adult patients with symptomatic tenosynovial giant cell tumor for which surgical resection will potentially cause worsening functional limitation or severe morbidity.. Romvimza Approved for Symptomatic Tenosynovial Giant Cell Tumor Ophthalmic Disorders Susvimo (ranibizumab injection)

Vascular endothelial growth factor inhibitor

Treatment of patients with diabetic macular edema  who have previously responded to at least 2 intravitreal injections of a vascular endothelial growth factor inhibitor medication. Susvimo Approval Expanded to Include Diabetic Macular Edema

Pentavalent MenABCWY Vaccine Elicits Broad Protection In Young Adults, Adolescents

An investigational pentavalent meningococcal vaccine (MenABCWY) was found to be noninferior to the CRM197-glycoconjugate vaccine (MenACWY-CRM) for protection against invasive meningococcal disease (IMD) among MenACWY-primed adolescents and young adults. These findings were published in Clinical Infectious Diseases.

The investigational MenABCWY vaccine is a combination of MenACWY-CRM and 4CMenB. In a phase 3, randomized, clinical study (ClinicalTrials.Gov Identifier: NCT04707391), researchers evaluated immune responses elicited by MenABCWY for protection against IMD among a cohort of healthy adolescents and young adults primed with MenACWY.

The study was conducted across 65 sites in Argentina, Australia, Canada, and the United States between 2021 and 2023. Healthy individuals (N=1250) aged 15 to 25 years who had received a MenACWY vaccine at least 4 years prior to study enrollment were randomly assigned 1:1 to receive 2 doses of MenABCWY at 0 and 6 months and placebo at month 7 (n=626) or MenACWY-CRM at month 0 and 4CMenB at months 6 and 7 (n=624). The primary study objective was to show noninferior immune responses against serogroups A, C, W, and Y between the groups, particularly with MenABCWY administered as a booster for the MenACWY component. Reactogenicity and safety were also assessed.

Among patients in the MenABCWY and MenACWY cohorts, 54.8% and 52.1% were girls or women, 71.9% and 70.7% were aged 15 to 17 years, and 75.7% and 74.8% were White, respectively.

"

These findings provide further supporting evidence for the development of the MenABCWY vaccine for broad protection against IMD.

At month 1, there were no significant differences in the rates of MenABCWY vs MenACWY recipients who achieved a 4-fold or greater increase in human serum bactericidal antibody (hSBA) titers against serogroups A (mean difference [MD], -2.5%; 95% CI, -5.6 to 0.5), C (MD, -0.1%; 95% CI, -2.8 to 2.9), W (MD, 0.4%; 95% CI, -2.4 to 3.3), and Y (MD, -0.8%; 95% CI, -3.6% to 2.1%). Similar trends were observed between the groups at month 7.

At baseline, the rate of patients with hSBA titers at or above the lower limit of quantification (LLOQ) in both the MenABCWY and MenACWY groups were lowest for serogroup A (27.7% and 28.8%, respectively) and highest for serogroup C (57.7% and 56.2%, respectively). The percentage of patients with hSBA titers at or above the LLOQ for serogroups A, C, W, and Y increased 1 month following vaccination, with rates of 99.5% to 100% observed after 2 MenABCWY doses, 97.9% to 98.9% observed after 1 MenABCWY dose, and 96.8% to 99.0% observed after 1 MenACWY-CRM dose.

In the MenABCWY group, the rate of patients who achieved hSBA titers at or above the LLOQ by month 7 was 88.5% for factor H binding protein (fHbp), 95.8% for Neisseria adhesin A (NadA), 96.3% for neisserial heparin-binding antigen (NHBA), and 75.6% for Porin A (PorA). Moreover, the rate of MenACBWY recipients who experienced a 4-fold rise from baseline in hSBA titers was highest for NadA (90.1%), followed by fHbp (68.1%), NHBA (64.6%), and PorA (45.7%) indicator strains.

Overall, 84.5% and 70.9% of MenABCWY recipients experienced solicited adverse events (AEs) following receipt of the first and second vaccine doses, respectively. Patients in the MenACWY arm reported similar rates of solicited AEs after each vaccine dose. Pain at the injection site was the most common site-specific AE and fatigue and headache were the most common solicited systemic AEs in both groups. Most AEs were of mild to moderate severity, and the mean duration of solicited AEs was fewer than 4 days across both groups.

These findings may have limited generalizability due to the lack of broad racial and ethnic diversity among the study population.

According to the researchers, "These findings provide further supporting evidence for the development of the MenABCWY vaccine for broad protection against IMD."

Disclosure: This research was supported by GlaxoSmithKline, and multiple study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

This article originally appeared on Vaccine Advisor

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