Recommended Childhood and Adolescent Immunization Schedule: United States, 2025: Policy Statement

The 2025 recommended childhood and adolescent immunization schedules have been approved by the Centers for Disease Control and Prevention (CDC), American Academy of Pediatrics (AAP), American Academy of Family Physicians, American College of Obstetricians and Gynecologists, American College of Nurse-Midwives, American Academy of Physician Associates, and National Association of Pediatric Nurse Practitioners. The schedules are revised annually to reflect current recommendations for the use of vaccines licensed by the US Food and Drug Administration.The cover page includes a table with an alphabetical listing of vaccines and other immunizing agents, approved abbreviations for each agent, and trade names.Table 1 contains the recommended immunization schedule from birth to 18 years of age.Table 2 is the catch-up immunization schedule for persons 4 months to 18 years of age who start late or who are more than 1 month behind the recommended age for vaccine administration.Table 3 lists the vaccines and other immunizing agents that may be indicated for children and adolescents 18 years of age or younger on the basis of medical conditions.The Notes provide additional information and are presented in alphabetical order of the vaccine or other immunizing agent.The Appendix provides conditions when vaccines and other immunizing agents are contraindicated or not recommended or when precautions should be considered.The Addendum summarizes new and updated Advisory Committee on Immunization Practices (ACIP) that occur after the 2025 immunization schedules are published.The following changes have been made to the 2025 schedule:The table listing immunization names and abbreviations includes the following changes:◦ All influenza vaccines were changed from quadrivalent to trivalent.◦ Influenza vaccine (inactivated, cell-culture), ccIIV3, was added.TABLE 1. Recommended Child and Adolescent Immunization Schedule by Age Polio: “IPV <18 years” was deleted from the vaccine column. For the age 18 years column, the previously gray bar was changed to green to reflect the recommendation for catch-up vaccination if vaccination is incomplete.COVID-19: The text has been updated to “1 or more doses of the 2024-25 vaccine,” with detailed guidance in the Notes.1Influenza: All influenza vaccines were changed from quadrivalent to trivalent. The overlaying text was changed to “1 dose annually” or “1 or 2 doses annually” to harmonize with the adult schedule. Cell-culture inactivated influenza vaccine, ccIIV3, was added as an option.Dengue: The previously yellow bar was changed to purple to reflect that the dengue vaccine is recommended only for certain high-risk groups within the age group.Legend text for the table colors were updated as follows: ◦ Purple legend has changed from “Range of recommended ages for certain high-risk groups” to “Range of recommended ages for certain high-risk groups or populations.”◦ Gray legend has changed from “No recommendation/Not applicable” to “No Guidance/Not Applicable” to harmonize with Table 3.TABLE 2. Recommended Catch-up Immunization Schedule for Persons 4 Months to 18 Years of Age No updates were made to Table 2.TABLE 3. Recommended Schedule by Medical Indication COVID-19: For the Immunocompromised and HIV infection with CD4 <15% or <200 mm3 columns, the previously yellow bar was changed to brown to reflect that additional doses may be needed.Influenza (inactivated): “Solid organ transplant: 18 years” overlaying text was added to the Immunocompromised column, with additional guidance in the Notes.COVID-19: This section has been updated with new recommendations for the 2024-25 COVID-19 vaccination recommendations including the recommendation for additional doses in persons who are moderately or severely immunocompromised.DTaP: Language was added to reflect Td may be administered in children age <7 years with a contraindication specific to the pertussis component of DTaP.Hib:◦ Preferential use of Vaxelis and PedvaxHIB for primary doses in American Indian and Alaska Native infants was added.2◦ The special situation of “Immunoglobulin deficiency, early component complement deficiency” was updated to “Immunoglobulin deficiency, early component complement deficiency, or early component complement inhibitor use.”Hepatitis B: Heplisav B was removed from the list of vaccine products that cannot be used during pregnancy.Influenza:◦ All influenza vaccines were changed from quadrivalent to trivalent.◦ The section was updated with recommendations for use of the 2024-25 influenza vaccines3 including use of aIIV3 or HD-IIV3 in solid organ recipients age 18 years.MMR: The section on international travel includes a new note to recommend that children age ≥12 months vaccinated with 1 dose should get a second dose at least 4 weeks after the first if they are going to travel internationally.MenB: Routine vaccination and Special situations sections were updated with the revised dosing schedule for Bexsero as a 2-dose series at 0 and 6 months for healthy persons aged 16-23 years based on shared decision-making or a 3-dose series at 0, 1–2, and 6 months for persons aged ≥10 years at increased risk for serogroup B meningococcal disease.4Pneumococcal: A bullet was added for use during pregnancy, “no recommendation for PCV or PPSV23 due to limited data. A summary of existing data on pneumococcal vaccination during pregnancy can be found at https://www.cdc.gov/mmwr/volumes/72/rr/rr7203a1.htm.”RSV-mAb:◦ For infants born in October through March, the ideal timing of nirsevimab administration was added, “Administer 1 dose nirsevimab within 1 week of birth—ideally during the birth hospitalization.”◦ Updated notes clarify the optimal timing for administering nirsevimab as October through November or within 1 week of birth.◦ The routine vaccination section was revised to include infants born to persons who received RSV vaccine in previous pregnancies.RSV vaccination (maternal): A bullet point was added for clarification, “Infants born to pregnant persons who received RSV vaccine during a previous pregnancy should receive nirsevimab.”Influenza: All influenza vaccines were changed from quadrivalent to trivalent.Hepatitis B: Heplisav B was removed from the list of vaccine products that cannot be used during pregnancy.MMR/MMRV: Contraindication for use of MMRV in HIV infected persons was added.Varicella: Language to review contraindications for MMR/MMRV if using MMRV was added.Footnote: The weblink for the Heplisav-B pregnancy registry was deleted because it is no longer available.The 2025 version of Tables 1 through 3, notes, appendix, and addendum, originally published in November 2024 and endorsed by the American Academy of Pediatrics, are available on the American Academy of Pediatrics website (https://publications.aap.org/redbook/pages/Immunization-Schedules). A parent-friendly vaccine schedule for children and adolescents is available at https://www.healthychildren.org/English/safety-prevention/immunizations/Pages/Recommended-Immunization-Schedules.aspxClinically significant adverse events that follow immunization should be reported to the Vaccine Adverse Event Reporting System. Guidance about how to obtain and complete a Vaccine Adverse Event Reporting System form can be obtained at www.vaers.hhs.gov or by calling 800-822-7967. Additional information can be found in the Red Book and at Red Book Online (https://publications.aap.org/redbook). Statements from the ACIP and the CDC that contain detailed recommendations for individual vaccines, including recommendations for children with high-risk conditions, are available at https://www.cdc.gov/acip/vaccine-recommendations/index.html. Information on new vaccine releases, vaccine supplies, and interim recommendations resulting from vaccine shortages and statements on specific vaccines can be found at https://publications.aap.org/redbook/resources/15449/.Sean T. O’Leary, MD, MPH, FAAP, ChairpersonJames D. Campbell, MD, MS, FAAP, Vice ChairpersonMonica I. Ardura, DO, MSCS, FAAPKristina A. Bryant, MD, FAAP, Red Book Online Associate EditorMary T. Caserta, MD, FAAPClaudia Espinosa, MD, MSc, FAAPRobert W. Frenck, Jr, MD, FAAPC. Mary Healy, MDChandy C. John, MD, MS, FAAPAaron Milstone, MD, MHS, FAAPAngela L. Myers, MD, MPH, FAAPPia S. Pannaraj, MD, MPH, FAAPAdam J. Ratner, MD, MPH, FAAP, Red Book Associate EditorJosé R. Romero, MD, FAAPMatthew Zahn, MD, FAAPDavid W. Kimberlin, MD, FAAP, Red Book EditorRitu Banerjee, MD, PhD, FAAP, Red Book Associate EditorElizabeth D. Barnett MD, FAAP, Red Book Associate EditorRuth Lynfield, MD, FAAP, Red Book Associate EditorAmina Ahmed, MD, FAAP – American Thoracic SocietyMichelle Barton-Forbes, MD – Canadian Paediatric SocietyCristina Cardemil, MD, MPH, FAAP – National Institutes of HealthLisa M. Kafer, MD, FAAP – AAP Committee on Practice Ambulatory MedicineLucia Lee, MD – US Food and Drug AdministrationDenee Moore, MD – American Academy of Family PhysiciansChinedu Okeke, MD, MPH, MPA – HHS Office of Infectious Disease and HIV/AIDS PolicyManisha Patel, MD, MS, MBA – Centers for Disease Control and PreventionChris Prestel, MD – Centers for Disease Control and PreventionJennifer Thompson, MD – American College of Obstetricians and GynecologistsJuan Pablo Torres, MD, PhD – Sociedad Latinoamericana de Infectología PediátricaMelinda Wharton, MD, MPH – Centers for Disease Control and PreventionCharles R. Woods, Jr, MD, MS, FAAP – Pediatric Infectious Diseases SocietyGillian Gibbs, MPH

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