Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger, United States, 2024
Appendix
Vaccines and other
Immunizing Agents
Contraindicated or Not Recommended
1
Precautions
2
Dengue (DEN4CYD) • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
3
• Severe immunodeciency (e.g., hematologic and solid tumors, receipt of chemotherapy, congenital immunodeciency,
long-term immunosuppressive therapy or patients with HIV infection who are severely immunocompromised)
• Lack of laboratory conrmation of a previous Dengue infection
• Pregnancy
• HIV infection without evidence of severe immunosuppression
• Moderate or severe acute illness with or without fever
Diphtheria, tetanus, pertussis (DTaP) • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
3
• For DTaP only: Encephalopathy (e.g., coma, decreased level of consciousness, prolonged seizures) not attributable to
another identiable cause within 7 days of administration of previous dose of DTP or DTaP
• Guillain-Barré syndrome (GBS) within 6 weeks after previous dose of tetanus-toxoid–containing vaccine
• History of Arthus-type hypersensitivity reactions after a previous dose of diphtheria-toxoid–containing
or tetanus-toxoid–containing vaccine; defer vaccination until at least 10 years have elapsed since the last
tetanus-toxoid-containing vaccine
• For DTaP only: Progressive neurologic disorder, including infantile spasms, uncontrolled epilepsy,
progressive encephalopathy; defer DTaP until neurologic status claried and stabilized
• Moderate or severe acute illness with or without fever
Haemophilus inuenzae type b (Hib) • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
3
• Less than age 6 weeks
• Moderate or severe acute illness with or without fever
Hepatitis A (HepA) • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
3
including neomycin • Moderate or severe acute illness with or without fever
Hepatitis B (HepB) • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
3
including yeast
• Pregnancy: Heplisav-B and PreHevbrio are not recommended due to lack of safety data in pregnant persons. Use other hepatitis
B vaccines if HepB is indicated
4
.
• Moderate or severe acute illness with or without fever
Hepatitis A-Hepatitis B vaccine (HepA-HepB)
[Twinrix]
• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
3
including neomycin and
yeast
• Moderate or severe acute illness with or without fever
Human papillomavirus (HPV) • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
3
• Pregnancy: HPV vaccination not recommended.
• Moderate or severe acute illness with or without fever
Measles, mumps, rubella (MMR)
Measles, mumps, rubella, and varicella
(MMRV)
• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
3
• Severe immunodeciency (e.g., hematologic and solid tumors, receipt of chemotherapy, congenital immunodeciency,
long-term immunosuppressive therapy or patients with HIV infection who are severely immunocompromised)
• Pregnancy
• Family history of altered immunocompetence, unless veried clinically or by laboratory testing as immunocompetent
• Recent (≤11 months) receipt of antibody-containing blood product (specic interval depends on product)
• History of thrombocytopenia or thrombocytopenic purpura
• Need for tuberculin skin testing or interferon-gamma release assay (IGRA) testing
• Moderate or severe acute illness with or without fever
• For MMRV only: Personal or family (i.e., sibling or parent) history of seizures of any etiology
Meningococcal ACWY (MenACWY)
MenACWY-CRM [Menveo]
MenACWY-TT [MenQuad]
• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
3
• For Men ACWY-CRM only: severe allergic reaction to any diphtheria toxoid—or CRM197—containing vaccine
• For MenACWY-TT only: severe allergic reaction to a tetanus toxoid-containing vaccine
• For MenACWY-CRM only: Preterm birth if less than age 9 months
• Moderate or severe acute illness with or without fever
Meningococcal B (MenB)
MenB-4C [Bexsero]
MenB-FHbp [Trumenba]
• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
3
• Pregnancy
• For MenB-4C only: Latex sensitivity
• Moderate or severe acute illness with or without fever
Meningococcal ABCWY
(MenACWY-TT/MenB-FHbp) [Penbraya]
• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
3
• Severe allergic reaction to a tetanus toxoid-containing vaccine
• Moderate or severe acute illness, with or without fever
Mpox [Jynneos] • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
3
• Moderate or severe acute illness, with or without fever
Pneumococcal conjugate (PCV) • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
3
• Severe allergic reaction (e.g., anaphylaxis) to any diphtheria-toxoid-containing vaccine or its component
3
• Moderate or severe acute illness with or without fever
Pneumococcal polysaccharide (PPSV23) • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
3
• Moderate or severe acute illness with or without fever
Poliovirus vaccine, inactivated (IPV) • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
3
• Pregnancy
• Moderate or severe acute illness with or without fever
RSV monoclonal antibody (RSV-mAb) • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
5
• Moderate or severe acute illness with or without fever
Respiratory syncytial virus vaccine (RSV) • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
3
• Moderate or severe acute illness with or without fever
Rotavirus (RV)
RV1 [Rotarix]
RV5 [RotaTeq]
• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
3
• Severe combined immunodeciency (SCID)
• History of intussusception
• Altered immunocompetence other than SCID
• Chronic gastrointestinal disease
• RV1 only: Spina bida or bladder exstrophy
• Moderate or severe acute illness with or without fever
Tetanus, diphtheria, and acellular pertussis
(Tdap)
Tetanus, diphtheria (Td)
• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
3
• For Tdap only: Encephalopathy (e.g., coma, decreased level of consciousness, prolonged seizures) not attributable to
another identiable cause within 7 days of administration of previous dose of DTP, DTaP, or Tdap
• Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of tetanus-toxoid–containing vaccine
• History of Arthus-type hypersensitivity reactions after a previous dose of diphtheria-toxoid–containing
or tetanus-toxoid–containing vaccine; defer vaccination until at least 10 years have elapsed since the last
tetanus-toxoid–containing vaccine
• For Tdap only: Progressive or unstable neurological disorder, uncontrolled seizures, or progressive
encephalopathy until a treatment regimen has been established and the condition has stabilized
• Moderate or severe acute illness with or without fever
Varicella (VAR) • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
3
• Severe immunodeciency (e.g., hematologic and solid tumors, receipt of chemotherapy, congenital immunodeciency,
long-term immunosuppressive therapy or patients with HIV infection who are severely immunocompromised)
• Pregnancy
• Family history of altered immunocompetence, unless veried clinically or by laboratory testing as immunocompetent
• Recent (≤11 months) receipt of antibody-containing blood product (specic interval depends on product)
• Receipt of specic antiviral drugs (acyclovir, famciclovir, or valacyclovir) 24 hours before vaccination (avoid
use of these antiviral drugs for 14 days after vaccination)
• Use of aspirin or aspirin-containing products
• Moderate or severe acute illness with or without fever
• If using MMRV, see MMR/MMRV for additional precautions
1. When a contraindication is present, a vaccine should NOT be administered. Kroger A, Bahta L, Hunter P. ACIP General Best Practice Guidelines for Immunization. www.cdc.gov/vaccines/hcp/acip-recs/general-recs/contraindications.html
2. When a precaution is present, vaccination should generally be deferred but might be indicated if the benet of protection from the vaccine outweighs the risk for an adverse reaction. Kroger A, Bahta L, Hunter P. ACIP General Best Practice Guidelines for
Immunization. www.cdc.gov/vaccines/hcp/acip-recs/general-recs/contraindications.html
3. Vaccination providers should check FDA-approved prescribing information for the most complete and updated information, including contraindications, warnings, and precautions. Package inserts for U.S.-licensed vaccines are available at
www.fda.gov/vaccines-blood-biologics/approved-products/vaccines-licensed-use-united-states.
4. For information on the pregnancy exposure registries for persons who were inadvertently vaccinated with Heplisav-B or PreHevbrio while pregnant, please visit heplisavbpregnancyregistry.com or www.prehevbrio.com/#safety.
5. Full prescribing information for BEYFORTUS (nirsevimab-alip) www.accessdata.fda.gov/drugsatfda_docs/label/2023/761328s000lbl.pdf