Every year, the CDC prints out a recommended vaccine schedule for children and adults, complete with a full page of footnotes and explanations (see the links in the previous answer). However, this recommended schedule contains a number of acceptable variations. While the individual vaccines on the schedule are fixed, the number of booster doses is different in certain circumstances, and the timing of administration of the vaccines can vary by several months.
One factor in this variability depends on which brand of vaccine is being used. For example, with one brand of HiB vaccine, the six-month booster dose is necessary, but with another brand, the booster dose is not required.
Another variable factor in the vaccine schedule is that some vaccines have a specific recommended age for administration, but other vaccines have a recommended range of ages for when the vaccine should be given. For example, the first and second doses of the polio vaccine are recommended to be given at two and four months of age, respectively, while the third dose can be given at any time between six and eighteen months.
Finally, the availability of combination vaccines, where multiple vaccines are combined in one syringe, might affect the schedule. If hepatitis B was given separately, then the three doses could be given at birth, at one or two months, and at six months. However, hepatitis B is part of a combination vaccine along with polio and DTaP, both of which are recommended at four months of age. If you choose this combination vaccine at four months, you may be giving your child an extra dose of hepatitis B vaccine (which does not appear to be harmful). If you choose to avoid the extra dose of hepatitis B vaccine, you have to give polio and DTaP separately, which means two needles for your baby instead of just one needle with the combination vaccine.
With all this in mind, we am presenting the recommended vaccine schedule as given in our office during the fall of 2008. You will see that we give a hepatitis B dose at the four-month checkup, mainly because we feel that fewer needles is more important than avoiding the extra dose of hepatitis B. Other offices might choose a slightly different schedule, but as long as they are following the basic CDC recommendations, they will all be equally acceptable.
Recommended Vaccine Schedule for Children
Birth: Hepatitis B
2 months: HiB, DTaP, pneumococcal, rotavirus, polio, hepatitis B
4 months: HiB, DTaP, pneumococcal, rotavirus, polio, hepatitis B
6 months: HiB, DTaP, pneumococcal, rotavirus, polio, hepatitis B, flu*
Every October: Flu*
12 months: MMR, chickenpox, hepatitis
A, pneumococcal, HiB**
18 months: DTaP, hepatitis A
4 to 6 years: DTaP, polio, MMR, chickenpox
11 to 12 years: Meningitis, human papillo-
mavirus (HPV)***, Tdap
* The flu vaccine is recommended at the six-month well-child checkup, if that visit falls during flu season (October through March), and every subsequent October for all children over the age of six months. The recommendation has recently been extended to administer the flu vaccine to all children under age eighteen. The flu vaccine can be given either as an injection (over age six months) or as a nasal spray (over age two years). In general, the first year children receive the vaccine, they should receive two doses a month apart.
**There is a shortage of the HiB vaccine in 2008. This has led to a temporary recommendation of not giving the HiB booster if a child has received the primary HiB series. When the shortage is relieved, we will start giving the vaccine at the twelve-month well-child checkup again and will also offer catchup doses to those children who did not receive the twelve-month dose.
***The HPV vaccine is for women only and is given in a series of three doses.
In addition to this schedule, there are some additional recommendations for certain high-risk children. For example, the meningitis vaccine can be given as early as age two years if a child is at higher risk of developing that illness, such as a child with sickle cell disease. And if a child has a cochlear implant and is at high risk of pneumococcal disease, he or she can receive a different brand of the pneumococcal vaccine after age two, in addition to the pneumococcal vaccine given to infants.
The vaccine schedule for adults can be broken into two categories: vaccine by age and vaccine by risk. While some vaccines are fixed at certain ages, other vaccines are recommended only for certain highrisk situations. In addition, if adults did not receive certain vaccines as children, such as the MMR or chickenpox vaccines, they should be given catch-up doses as adults.
Recommended Vaccine Schedule for Adults
Age 9 to 26: HPV (women only, series of 3 doses)
Age 50+: Annual flu vaccine every October
Age 60: Shingles vaccine once
Age 65: Pneumococcal vaccine once
Every 10 years: Td (but replace Td with Tdap once if younger than age
For adults, the following vaccines are recommended in certain high-risk situations: flu, pneumococcal, hepatitis A, hepatitis B, and meningitis. Notice that the flu and pneumococcal vaccines are repeated in both the high-risk-group list and the vaccine-by-age list. This is because both of these vaccines are recommended not only when a person reaches a certain age but also at a younger age with certain medical conditions.