What Changed in the 2023 U.S. Immunization Schedule for Children and Teens

About the schedule

Each year the Advisory Committee on Immunization Practices (ACIP) approves a recommended immunization schedule for children and adolescents 18 and younger, summarizing its vaccine recommendations. The 2023 schedule was approved in October 2022 and endorsed by CDC, the American Academy of Pediatrics, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, the American College of Nurse-Midwives, the American Academy of Physician Associates and the National Association of Pediatric Nurse Practitioners.

ACIP bases each recommendation on in-depth review of the disease's epidemiology and impact, vaccine efficacy, effectiveness and safety, quality of evidence, feasibility and economics. Providers should use the schedule's tables, notes and appendix together. The schedule is updated every year; for the one in force now, see CDC's immunization schedules page and the ACIP recommendations.

The main changes for 2023

New or updated recommendations for influenza, pneumococcal conjugate, MMR and COVID-19 vaccines, and clarified guidance for dengue, hepatitis A and B, HPV, meningococcal (MenACWY and MenB), polio and varicella vaccines.

Cover page

• Added COVID-19 vaccines, PCV15 (15-valent pneumococcal conjugate vaccine) and a newly licensed MMR vaccine, Priorix, to the list of vaccines and trade names.

Table 1 — routine schedule

• COVID-19: a new row, shaded for ages 6 months to 18 years: "2- or 3-dose primary series and booster."
• Pneumococcal conjugate: PCV15 added.
• Polio (IPV): "See Notes" added at ages 17–18, for guidance on 18-year-olds.

Table 2 — catch-up schedule

• Pneumococcal conjugate: clarifies when a fourth dose is needed — only for children 12–59 months regardless of risk, or 60–71 months with any risk condition, who received three doses before 12 months.

Table 3 — by medical condition

• COVID-19: a new row, with "See Notes" for HIV infection and other immunocompromise.

Vaccine notes

Language was aligned with the adult schedule wherever possible.

• Injury compensation: now mentions the Countermeasures Injury Compensation Program for COVID-19 vaccines.
• COVID-19: a new section — primary series for most people, and for those moderately or severely immunocompromised, with links to current booster guidance, Janssen recipients, preexposure prophylaxis and Emergency Use Authorizations.
• Dengue: not to be given to children traveling to or visiting areas where dengue is common.
• Hepatitis B: highlights guidance for infants whose mothers tested positive for hepatitis B surface antigen or whose status is unknown; adds Heplisav-B and PreHevbrio for catch-up at age 18.
• Influenza: updated for 2022–23; live attenuated flu vaccine should not go to close contacts of severely immunosuppressed people who need a protected environment; guidance for egg allergy beyond hives moved into the notes.
• MMR: additional doses in a mumps outbreak.
• MenACWY: the new one-vial Menveo is not for children under 10.
• MenB (Trumenba): if the second dose comes 6 months or more after the first, no third dose is needed; if the third comes less than 4 months after the second, give a fourth at least 4 months after the third.
• Pneumococcal: PCV15 added throughout; PCV13 and PCV15 are interchangeable; link to CDC's pneumococcal vaccine app.
• Polio: a new section on IPV for 18-year-olds at higher risk of exposure.

Appendix — contraindications and precautions

• Column renamed "Contraindicated or not recommended."
• Influenza: egg-allergy guidance moved to the notes.
• Dengue: no laboratory confirmation of prior dengue infection is a contraindication.
• Hepatitis B: Heplisav-B and PreHevbrio are not recommended in pregnancy — use other hepatitis B vaccines — with pregnancy registry information for inadvertent exposure.
• HPV: not recommended during pregnancy.
• MMR: MMRV added; a personal or family history of seizures is a precaution for MMRV.
• Varicella: review the MMR/MMRV precautions if MMRV is used.

All vaccines in the child schedule except DTaP, rotavirus and PCV13 also appear in the adult schedule, and the two share harmonized notes.

Sources

Based on A. Patricia Wodi, Neil Murthy, Veronica McNally, Sybil Cineas and Kevin Ault, "Advisory Committee on Immunization Practices Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger — United States, 2023," Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention, by authors from CDC, the Franny Strong Foundation, Brown University and Western Michigan University; published by CDC.