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 Schedule:
United States, 2020
COMMITTEE ON INFECTIOUS DISEASES

The 2020 recommended childhood and adolescent immunization

schedules have been approved by the American Academy of Pediatrics, the
Advisory Committee on Immunization Practices of 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 Policy statements from the American Academy of Pediatrics benefit
the use of vaccines licensed by the US Food and Drug Administration. from expertise and resources of liaisons and internal (AAP) and
external reviewers. However, policy statements from the American
The 2020 childhood and adolescent immunization schedule has been Academy of Pediatrics may not reflect the views of the liaisons or the
organizations or government agencies that they represent.
updated to ensure consistency between the format of the childhood and
The guidance in this statement does not indicate an exclusive course
adolescent and adult immunization schedules. Similar to last year, the of treatment or serve as a standard of medical care. Variations, taking
cover page includes a table with an alphabetical list of vaccines, approved into account individual circumstances, may be appropriate.
abbreviations for each vaccine, and vaccine trade names. The American All policy statements from the American Academy of Pediatrics
College of Nurse-Midwives has been added to the list of approving automatically expire 5 years after publication unless reaffirmed,
revised, or retired at or before that time.
organizations.
This document is copyrighted and is property of the American
Table 1 contains the recommended immunization schedule from birth to Academy of Pediatrics and its Board of Directors. All authors have filed
18 years of age. The row for hepatitis A vaccine has been changed to conflict of interest statements with the American Academy of
Pediatrics. Any conflicts have been resolved through a process
a solid green bar from age 2 to 18 years to reflect routine catch-up approved by the Board of Directors. The American Academy of
vaccination for all children through 18 years of age. The row for Pediatrics has neither solicited nor accepted any commercial
involvement in the development of the content of this publication.
meningococcal serogroups A, C, W, Y vaccine (MenACWY) was moved
DOI: https://doi.org/10.1542/peds.2019-3995
down in the table to appear just above the row for meningococcal
serogroup B vaccine. For the label legend, the blue box legend definition, Copyright © 2020 by the American Academy of Pediatrics
which formerly said, “Range of recommended ages for non-high-risk FINANCIAL DISCLOSURE: The authors have indicated no financial
groups that may receive vaccine, subject to individual clinical decision- relationships relevant to this article to disclose.

making” was changed to “Recommended based on shared clinical decision- FUNDING: No external funding.
making,” with an asterisk for human papillomavirus vaccine at ages 9 and POTENTIAL CONFLICT OF INTEREST: The author has indicated he has no
10 years (“*can be used in this age group”). The gray box label for “no potential conflicts of interest to disclose.
recommendation” was updated to include “not applicable.”
Table 2 is the catch-up immunization schedule for persons 4 months to To cite: COMMITTEE ON INFECTIOUS DISEASES. Recommended
Childhood and Adolescent Immunization Schedule: United
18 years of age who start late or who are more than 1 month behind the
States, 2020. Pediatrics. 2020;145(3):e20193995
recommended age for vaccine administration. The only change to table 2

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PEDIATRICS Volume 145, number 3, March 2020:e20193995 FROM THE AMERICAN ACADEMY OF PEDIATRICS
was that “ACWY” was added to catch-up vaccination through specifically noted as administered
“Meningococcal” in relevant rows to 18 years of age. during a campaign). Doses of OPV
clarify that these recommendations  Hepatitis B vaccine administered on or after April 1,
apply to MenACWY only and not 2016, should not be counted.
○ A “Special Situations” section
meningococcal serogroup B vaccine.
was added containing  MenACWY
Table 3 lists the vaccines that may be recommendations for ○ Guidance was added regarding
indicated for children and revaccination and a link to the adolescent revaccination for
adolescents 18 years of age or Advisory Committee on children who received the
younger on the basis of medical Immunization Practices hepatitis vaccine before age 10 years.
conditions. All boxes in the hepatitis A B recommendations. The new
Adolescent vaccination of
vaccine row were changed to yellow language states “revaccination is
children who received MenACWY
to denote that it is a routine not generally recommended for
before age 10 years:
vaccination for all children, including persons with a normal immune
those with medical indications. The status who were vaccinated as n “Children in whom boosters
pregnancy box in the MenACWY row infants, children, adolescents or are not recommended due to
has been changed to yellow because adults. Revaccination may be an ongoing increased risk of
pregnancy is not considered an recommended for certain meningococcal disease (eg,
indication to withhold routine populations, including infants a healthy child who traveled to
adolescent vaccination. The red box in born to HBsAg-positive [hepatitis a country where
the label legend has been updated to B surface antigen–positive] meningococcal disease is
“Not recommended/Contraindicated— mothers, hemodialysis patients, endemic): administer
vaccine should not be administered” or other immunocompromised MenACWY according to the
(from “Contraindicated or use not persons.” recommended adolescent
recommended—vaccine should not be  Influenza vaccines schedule with dose 1 at age
administered because of risk for 11–12 years and dose 2 at age
○ The routine recommendations
serious adverse reaction”). The gray 16 years.”
box label for “no recommendation” was section was reformatted to more
clearly outline circumstances n “Children in whom boosters
updated to include “not applicable.”
under which 1 or 2 doses of are recommended due to an
Similar to the 2019 schedule, the influenza vaccine are ongoing increased risk of
notes are presented in alphabetical recommended. meningococcal disease (eg,
order. The following changes to ○ The situations under which live those with complement
individual footnotes have been made attenuated influenza vaccine deficiency, HIV, or asplenia):
to the 2020 schedule: (LAIV) should not be used was follow the booster schedule
 Diphtheria-tetanus-acellular reformatted to a bulleted list for persons at increased
pertussis (DTaP) vaccine instead of a paragraph. risk.”
○ A clarification was added to the
 Poliovirus vaccine  Meningococcal serogroup B
○ The note was moved to the
catch-up recommendation that vaccines
dose 5 is not necessary if dose 4 appropriate place alphabetically ○ The heading that formerly read,
was administered at age 4 years (from “I” to “P”).
“Clinical Discretion” was changed
or older and was administered at ○ The title was changed from to “Shared Clinical Decision-
least 6 months after dose 3. “Inactivated poliovirus Making.”
 Haemophilus influenzae type vaccination” to “Poliovirus ○ A reference link was provided to
b vaccine vaccination,” and information
booster dose guidance to mirror
○
was added regarding which doses
A bullet was added to clarify that similar language in the
of trivalent oral poliovirus
catch-up vaccination is not MenACWY note.
vaccine (OPV) may be counted as
recommended for children
valid, now reading, “Only  Tetanus toxoid, reduced diphtheria
5 years and older who are not at toxoid, and acellular pertussis,
trivalent OPV (tOPV) counts
high risk. adsorbed (Tdap) vaccine
toward the US vaccination
 Hepatitis A vaccine requirements. Doses of OPV ○ Tdap was added as an option for
○ A note was added to reflect the administered before April 1, booster doses and remaining
recommendation for routine 2016, should be counted (unless doses of the catch-up series.

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2 FROM THE AMERICAN ACADEMY OF PEDIATRICS
 ○ Guidance also was added for a Vaccine Adverse Event Reporting H. Cody Meissner, MD, FAAP – Visual Red
DTaP and Tdap doses received at System form can be obtained at www. Book Associate Editor
7 to 10 years of age. vaers.hhs.gov or by calling 800-822-
n “Tdap administered at 7–10 7967. Additional information can be LIAISONS
years: found in the Red Book and at Red
Amanda C. Cohn, MD, FAAP, Centers for
Book Online (http://aapredbook. Disease Control and Prevention
♦ Children age 7–9 years who aappublications.org/). Statements David Kim, MD, HHS, Office of Infectious
receive Tdap should receive from the ACIP and the CDC that Disease and HIV/AIDS Policy
the routine Tdap dose at age contain detailed recommendations Karen M. Farizo, MD, US Food and Drug
11–12 years. for individual vaccines, including Administration
Marc Fischer, MD, FAAP, Centers for Disease
♦ Children age 10 years who recommendations for children with Control and Prevention
receive Tdap do not need to high-risk conditions, are available Natasha B. Halasa, MD, MPH, FAAP, Pediatric
receive the routine Tdap at www.cdc.gov/vaccines/hcp/ Infectious Diseases Society
dose at age 11–12 years. acip-recs/index.html. Information on Nicole Le Saux, MD, FRCP(C), Canadian
Paediatric Society
n DTaP inadvertently new vaccine releases, vaccine supplies,
Eduardo Lopez, MD, Sociedad
administered after the seventh and interim recommendations Latinoamericana de Infectologia Pediatrica
birthday: resulting from vaccine shortages Scot B. Moore, MD, FAAP, Committee on
and statements on specific vaccines Practice Ambulatory Medicine
♦ Children age 7–9 years: DTaP Neil S. Silverman, MD, American College of
can be found at www.aapredbook.
may count as part of catch- Obstetricians and Gynecologists
org/news/vaccstatus.shtml.
up series. Administer routine Jeffrey R. Starke, MD, FAAP, American
Tdap dose at age Thoracic Society
11–12 years. James J. Stevermer, MD, MSPH, FAAFP,
COMMITTEE ON INFECTIOUS DISEASES, American Academy of Family Physicians
♦ Children age 10–18 years: 2019–2020 Kay M. Tomashek, MD, MPH, DTM, National
Count dose of DTaP as the Yvonne A. Maldonado, MD, FAAP, Institutes of Health
adolescent Tdap booster.” Chairperson
Theoklis E. Zaoutis, MD, MSCE, FAAP, Vice
The 2020 version of tables 1 through Chairperson
3 and the notes are available on the Ritu Banerjee, MD, PhD, FAAP STAFF
American Academy of Pediatrics Web Elizabeth D. Barnett, MD, FAAP
James D. Campbell, MD, MS, FAAP Jennifer M. Frantz, MPH
site (https://redbook.solutions.aap.
org/SS/Immunization_Schedules. Mary T. Caserta, MD, FAAP
Jeffrey S. Gerber, MD, PhD, FAAP
aspx) and the CDC Web site (www. Athena P. Kourtis, MD, PhD, MPH, FAAP
cdc.gov/vaccines/schedules/hcp/ Ruth Lynfield, MD, FAAP ABBREVIATIONS
child-adolescent.html). A parent- Flor M. Munoz, MD, MSc, FAAP
CDC: Centers for Disease Control
friendly vaccine schedule for children Dawn Nolt, MD, MPH, FAAP
Ann-Christine Nyquist, MD, MSPH, FAAP and Prevention
and adolescents is available at www.
Sean T. O’Leary, MD, MPH, FAAP DTaP: diphtheria-tetanus-acellular
cdc.gov/vaccines/schedules/index. William J. Steinbach, MD, FAAP pertussis
html. An adult immunization schedule Ken Zangwill, MD, FAAP MenACWY: meningococcal
is published in February of each year
serogroups A, C, W, Y
and is available at www.cdc.gov/
vaccine
vaccines/schedules/hcp/adult.html. EX OFFICIO
OPV: oral poliovirus vaccine
Clinically significant adverse events David W. Kimberlin, MD, FAAP – Red Book Tdap: tetanus toxoid, reduced
that follow immunization should be Editor
diphtheria toxoid, and
Mark H. Sawyer, MD, FAAP – Red Book
reported to the Vaccine Adverse Associate Editor acellular pertussis,
Event Reporting System. Guidance Henry H. Bernstein, DO, MHCM, FAAP – Red adsorbed
about how to obtain and complete Book Online Associate Editor

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PEDIATRICS Volume 145, number 3, March 2020 3
 Recommended Childhood and Adolescent Immunization Schedule: United
States, 2020
COMMITTEE ON INFECTIOUS DISEASES
Pediatrics 2020;145;
DOI: 10.1542/peds.2019-3995 originally published online February 4, 2020;

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 Recommended Childhood and Adolescent Immunization Schedule: United
States, 2020
COMMITTEE ON INFECTIOUS DISEASES
Pediatrics 2020;145;
DOI: 10.1542/peds.2019-3995 originally published online February 4, 2020;

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/145/3/e20193995

Pediatrics is the official journal of the American Academy of Pediatrics. A monthly publication, it
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