Recommended Childhood and Adolescent Immunization Schedule: United States, 2021 - American ...
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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, 2021
COMMITTEE ON INFECTIOUS DISEASES
The 2021 recommended childhood and adolescent immunization
schedules have been approved by the Centers for Disease Control and
Prevention (CDC), American Academy of Pediatrics, American Academy of
Family Physicians, American College of Obstetricians and Gynecologists,
American College of Nurse-Midwives, American Academy of Physician Policy statements from the American Academy of Pediatrics benefit
Assistants, and National Association of Pediatric Nurse Practitioners. The from expertise and resources of liaisons and internal (AAP) and
external reviewers. However, policy statements from the American
schedules are revised annually to reflect current recommendations for the Academy of Pediatrics may not reflect the views of the liaisons or the
use of vaccines licensed by the US Food and Drug Administration. organizations or government agencies that they represent.
The 2021 childhood and adolescent immunization schedule has been The guidance in this statement does not indicate an exclusive course
of treatment or serve as a standard of medical care. Variations, taking
updated to ensure consistency between the format of the childhood and into account individual circumstances, may be appropriate.
adolescent and adult immunization schedules. Similar to last year, the All policy statements from the American Academy of Pediatrics
cover page includes a table with an alphabetical listing of vaccines, automatically expire 5 years after publication unless reaffirmed,
revised, or retired at or before that time.
approved abbreviations for each vaccine, and vaccine trade names.
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. conflict of interest statements with the American Academy of
Pediatrics. Any conflicts have been resolved through a process
Table 2 is the catch-up immunization schedule for persons 4 months to 18 approved by the Board of Directors. The American Academy of
Pediatrics has neither solicited nor accepted any commercial
years of age who start late or who are more than 1 month behind the involvement in the development of the content of this publication.
recommended age for vaccine administration. DOI: https://doi.org/10.1542/peds.2020-049775
Table 3 lists the vaccines that may be indicated for children and PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).
adolescents 18 years of age or younger on the basis of medical conditions.
Copyright © 2021 by the American Academy of Pediatrics
Similar to the 2021 schedule, the notes are presented in alphabetical FINANCIAL DISCLOSURE: The authors have indicated they have no
order. The following changes to individual footnotes have been made to financial relationships relevant to this article to disclose.
the 2021 schedule: FUNDING: No external funding.
• For influenza vaccines: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they
have no potential conflicts of interest to disclose.
○ Updated language about use of influenza vaccines in persons with an
egg allergy with symptoms other than hives: if using an influenza
vaccine other than Flublok or Flucelvax, administer in a medical To cite: COMMITTEE ON INFECTIOUS DISEASES. Recommended
Childhood and Adolescent Immunization Schedule: United
setting under the supervision of a health care provider who can
States, 2021. Pediatrics. 2021;147(3):e2020049775
recognize and manage severe allergic reactions.
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PEDIATRICS Volume 147, number 3, March 2021:e2020049775 FROM THE AMERICAN ACADEMY OF PEDIATRICS○ Added information regarding booster dose if it has been $1 color for delay until after
severe allergic reactions. year since completion of a MenB pregnancy has been replaced with
○ Updated information about use of primary series. A booster dose red, which indicates not
antiviral medications and interval of $6 months may be recommended and contraindicated;
administering quadrivalent live considered by public health an asterisk was also added to
attenuated influenza vaccine officials, depending on the indicate the HPV vaccine should be
(LAIV4): LAIV4 should not be specific outbreak, vaccination administered after pregnancy.
used if one received influenza strategy, and projected duration • Notes (Special Situations):
antiviral medications oseltamivir of elevated risk2 (ACIP Meeting, clarifying edits were made to the
or zanamivir within the previous June 26–27, 2019). notes to improve readability and
48 hours, peramivir within the • For tetanus toxoid, reduced the utility of the schedule for
previous 5 days, or baloxavir diphtheria toxoid, and acellular diphtheria and tetanus toxoids and
within the previous 17 days. pertussis vaccine (Tdap), ACIP acellular pertussis vaccination,
○ Added “Children younger than 2 recommendations have been Haemophilus influenzae type
years” to the situations in which updated to allow either the tetanus b vaccination, hepatitis A
LAIV4 should not be used1 and diphtheria toxoids vaccine or vaccination, hepatitis B vaccination,
(Advisory Committee on Tdap to be used for the decennial HPV vaccination, pneumococcal
Immunization Practices [ACIP] tetanus and diphtheria toxoids vaccination, and Tdap vaccination.
Meeting, June 24, 2020). booster, tetanus prophylaxis for • A box within the notes section of
• For meningococcal serogroup A, C, wound management, and the immunization schedules was
W, and Y vaccines: additional required doses in the included that states, “COVID-19
catch-up immunization schedule, if Vaccination- ACIP recommends use
○ Added meningococcal groups A, a person has received at least 1 of COVID-19 vaccines within the
C, W, and Y polysaccharide Tdap dose3 (ACIP Meeting, October
tetanus toxoid conjugate vaccine scope of the Emergency Use
23–24, 2019). Authorization or Biologics License
(MenACWY-TT) as an option for
Application for the particular
preventing disease attributed to Other notable changes in the 2021 vaccine. Interim ACIP
the meningococcal serogroups A, child and adolescent immunization recommendations for use of
C, W, and Y. schedule include the following: COVID-19 vaccines can be found at
○ Added language for catch-up • Cover page: changed the www.cdc.gov/vaccines/hcp/acip-
vaccination for infants who abbreviation LAIV to LAIV4; added rec first page under
received 1 dose of meningococcal MenACWT-TT (MenQuadfi) to list “Additional Information.”
groups A, C, W, and Y of meningococcal ACWY; added
oligosaccharide diphtheria DTaP-IPV-Hib-HepB (Vaxelis) to list The 2021 version of Tables 1 through
CRM197 conjugate vaccine of combination vaccines. 3 and the notes are available on the
(MenACWY-CRM) at an age from American Academy of Pediatrics Web
• Table 1 (Recommended Child and
3 to 6 months2 (ACIP Meeting, site (https://redbook.solutions.aap.
Adolescent Immunization Schedule
June 26–27, 2019). org/SS/Immunization_Schedules.
by Age): changed the abbreviation
• For the meningococcal B vaccine for live attenuated influenza
asp and the CDC Web site (www.
(MenB): cdc.gov/vaccines/schedules/hcp/
vaccine (LAIV) to LAIV4. In the
child-adolescent.html). A parent-
○ For persons aged $10 years with hepatitis B vaccine row, arrows
friendly vaccine schedule for children
complement deficiency, were added to second dose.
and adolescents is available at www.
complement inhibitor use, or • Table 3 (Recommended Child and cdc.gov/vaccines/schedules/index.
asplenia or who are Adolescent Immunization Schedule html. An adult immunization schedule
microbiologists: MenB booster by Medical Condition): in the LAIV is published in February of each year
dose 1 year after completion of row, changed abbreviation to and is available at www.cdc.gov/
a MenB primary series, followed LAIV4. In the measles, mumps, and vaccines/schedules/hcp/adult.html.
by MenB booster doses every 2 to rubella (MMR) and varicella (VAR)
3 years thereafter, for as long as rows, pregnancy column, an Clinically significant adverse events
an increased risk remains. asterisk was added to indicate that follow immunization should be
○ For persons aged $10 years MMR and VAR vaccines should be reported to the Vaccine Adverse
determined by public health administered after pregnancy. In Event Reporting System. Guidance
officials to be at an increased risk the human papillomavirus (HPV) about how to obtain and complete
during an outbreak: One-time row, pregnancy column, the pink a Vaccine Adverse Event Reporting
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2 FROM THE AMERICAN ACADEMY OF PEDIATRICSSystem form can be obtained at www. EX OFFICIO
vaers.hhs.gov or by calling 800-822-
ABBREVIATIONS
David W. Kimberlin, MD, FAAP, Red Book
7967. Additional information can be Editor ACIP: Advisory Committee on Im-
found in the Red Book and at Red Elizabeth D. Barnett MD, FAAP, Red Book munization Practices
Book Online (http://aapredbook. Associate Editor CDC: Centers for Disease Control
Mark H. Sawyer, MD, FAAP, Red Book
aappublications.org Statements and Prevention
Associate Editor
from the ACIP and the CDC that Henry H. Bernstein, DO, MHCM, FAAP, Red HPV: human papillomavirus
contain detailed recommendations Book Online Associate Editor LAIV: live attenuated influenza
for individual vaccines, including H. Cody Meissner, MD, FAAP, Visual Red Book vaccine
recommendations for children with Associate Editor LAIV4: quadrivalent live attenu-
high-risk conditions, are available at ated influenza vaccine
www.cdc.gov/vaccines/hcp/acip- Tdap: tetanus toxoid, reduced
LIAISONS
recs/index.html Information on diphtheria toxoid, and acel-
new vaccine releases, vaccine Amanda C. Cohn, MD, FAAP – Centers for lular pertussis vaccine
Disease Control and Prevention
supplies, and interim Karen M. Farizo, MD – US Food and Drug
recommendations resulting from Administration
vaccine shortages and statements on Natasha B. Halasa, MD, MPH, FAAP –
REFERENCES
specific vaccines can be found at Pediatric Infectious Diseases Society
www.aapredbook.org/news/ David Kim, MD – US Department of Health 1. Grohskopf LA, Alyanak E, Broder KR, et al.
and Human Services Office of Infectious Prevention and control of seasonal
vaccstatus.shtml. Disease and HIV/AIDS Policy influenza with vaccines:
Eduardo López Medina, MD, MSc – Sociedad recommendations of the Advisory
COMMITTEE ON INFECTIOUS DISEASES, Latinoamericana de Infectologia Pediatrica
Committee on Immunization Practices -
Scot B. Moore, MD, FAAP – Committee on
2020–2021 United States, 2020–21 influenza season.
Practice Ambulatory Medicine
Yvonne A. Maldonado, MD, FAAP, Lakshmi Panagiotakopoulos, MD, MPH, FAAP MMWR Recomm Rep. 2020;69(8):1–24
Chairperson – Centers for Disease Control and Prevention 2. Mbaeyi SA, Bozio CH, Duffy J, et al.
Sean T. O’Leary, MD, MPH, FAAP, Vice Laura Sauvé, MD, FCPS – Canadian Paediatric Meningococcal vaccination:
Chairperson Society recommendations of the Advisory
Ritu Banerjee, MD, PhD, FAAP Neil S. Silverman, MD – American College of
James D. Campbell, MD, MS, FAAP
Committee on Immunization Practices,
Obstetricians and Gynecologists
United States, 2020. MMWR Recomm
Mary T. Caserta, MD, FAAP Jeffrey R. Starke, MD, FAAP – American
Jeffrey S. Gerber, MD, PhD, FAAP Thoracic Society Rep. 2020;69(9):1–41
Athena P. Kourtis, MD, PhD, MPH, FAAP James J. Stevermer, MD, MSPH, FAAFP – 3. Havers FP, Moro PL, Hunter P, Hariri S,
Ruth Lynfield, MD, FAAP American Academy of Family Physicians Bernstein H. Use of tetanus toxoid,
Flor M. Munoz, MD, MSc, FAAP Kay M. Tomashek, MD, MPH, DTM – National reduced diphtheria toxoid, and
Dawn Nolt, MD, MPH, FAAP Institutes of Health
Adam Ratner, MD, FAAP
acellular pertussis vaccines: updated
Samir S. Shah, MD, MSCE, FAAP recommendations of the Advisory
William J. Steinbach, MD, FAAP Committee on Immunization Practices
Kenneth M. Zangwill, MD, FAAP STAFF — United States, 2019. MMWR Morb
Theoklis E. Zaoutis, MD, MSCE, FAAP Jennifer M. Frantz, MPH Mortal Wkly Rep. 2020;69(3):77–83
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PEDIATRICS Volume 147, number 3, March 2021 3Recommended Childhood and Adolescent Immunization Schedule: United
States, 2021
COMMITTEE ON INFECTIOUS DISEASES
Pediatrics originally published online February 12, 2021;
Updated Information & including high resolution figures, can be found at:
Services http://pediatrics.aappublications.org/content/early/2021/02/11/peds.2
020-049775
References This article cites 3 articles, 0 of which you can access for free at:
http://pediatrics.aappublications.org/content/early/2021/02/11/peds.2
020-049775#BIBL
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Downloaded from www.aappublications.org/news by guest on February 12, 2021Recommended Childhood and Adolescent Immunization Schedule: United
States, 2021
COMMITTEE ON INFECTIOUS DISEASES
Pediatrics originally published online February 12, 2021;
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/early/2021/02/11/peds.2020-049775
Pediatrics is the official journal of the American Academy of Pediatrics. A monthly publication, it
has been published continuously since 1948. Pediatrics is owned, published, and trademarked by
the American Academy of Pediatrics, 345 Park Avenue, Itasca, Illinois, 60143. Copyright © 2021
by the American Academy of Pediatrics. All rights reserved. Print ISSN: 1073-0397.
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