The Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) has released an updated version of the child and adolescent immunization schedule for ages 18 years and younger in the United States. 

Changes to the child and adolescent immunization schedule for 2021 include the following:

Haemophilus influenzae type b vaccination

  • Updated to indicate that no further doses of catch-up vaccination are needed if a dose was administered at age 15 months or older. 

Hepatitis B vaccination

  • For infants born to an HBsAg-negative mother and weighing less than 2000g: update clarifies when the vaccine can be administered.
    • Administer dose 1 at chronological age 1 month or hospital discharge (whichever is earlier and even if weight is still less than 2000g).

Human papillomavirus (HPV) vaccination

  • Updated to clarify that the dose series does not need to be restarted if the vaccination schedule is interrupted.

Influenza vaccination

  • Updated to reflect the recommendations for the 2020-21 influenza season.
  • The Special Situations section was updated regarding persons with egg allergy with symptoms other than hives:
    • If using an influenza vaccine other than Flublok or Flucelvax, the vaccine should be administered in a medical setting under supervision of a health care provider who can recognize and manage severe allergic reactions.
  • Additional information about severe allergic reactions:
    • All vaccination providers should be familiar with the office emergency plan and certified in cardiopulmonary resuscitation.
    • Previous severe allergic reaction to influenza vaccine is a contraindication to future receipt of any influenza vaccine.
  • The abbreviation for live attenuated influenza vaccine (LAIV) has been changed to LAIV4.
  • Additional circumstances for when LAIV4 should not be used:
    • Children less than 2 years of age.

Meningococcal serogroup A,C,W,Y vaccination

  • MenACWY-TT (MenQuadfi) has been added to the list of vaccines in the sections on routine vaccination, catch-up vaccination, and special situations.
  • Under Special Situations, information has been updated on the recommendations for the use of MenACWY-CRM (Menveo):
    • For infants who received dose 1 at age 3-6 months: administer a 3- or 4-dose series (dose 2 [and dose 3 if applicable] at least 8 weeks after previous dose until a dose is received at age 7 months or older, followed by an additional dose at least 12 weeks later and after age 12 months).

Tetanus, diphtheria, and pertussis (Tdap) vaccination; Diphtheria, tetanus, acellular pertussis (DTaP) vaccination

  • Under Special Situations, information has been added regarding the recommendation for the use of Tdap or DTaP vaccine in wound management.
  • For persons 7 years of age or older with history of 3 or more doses of tetanus-toxoid-containing vaccine:
    • For clean and minor wounds, administer Tdap or Td if more than 10 years since the last dose.
    • For all other wounds, administer Tdap or Td if more than 5 years since the last dose.
    • Tdap is preferred for persons age 11 years or older who have not previously received Tdap or whose Tdap history is unknown.
    • If a tetanus-toxoid-containing vaccine is indicated for a pregnant adolescent, Tdap should be used.

According to the CDC, fewer childhood vaccines have been administered due to a decline in outpatient pediatric visits resulting from the coronavirus disease 2019 (COVID-19) pandemic. The Agency is urging health care providers (HCPs) to work with families to bring children up to date with their vaccinations. Specifically HCPs should be identifying children who have missed well-child visits and/or recommended vaccination and contact them to schedule in person appointments.

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For additional guidance on the use of each vaccine appearing in the schedule, including precautions and contraindications, clinicians can view the respective ACIP vaccine recommendations at In addition, vaccine catch-up guidance can be found here.


Wodi AP, Ault K, Hunter P, et al. Advisory Committee on Immunization Practices recommended immunization schedule for children and adolescents aged 18 years or younger — United States, 2021. MMWR Morb Mortal Wkly Rep 2021;70:189-192. doi:

This article originally appeared on MPR