As of 2026, vaccine recommendations in the U.S. are issued by multiple national bodies, including the CDC Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP) Committee on Infectious Diseases, and other professional medical organizations, such as the American Academy of Family Physicians (AAFP) and the American College of Obstetricians and Gynecologists (ACOG). Recommendations began to diverge after professional medical associations began to disagree with the recommendations of the new members of ACIP assembled by the Department of Health and Human Services to replace experienced committee members in June 2025.
Immunize.org provides access to all current recommendations from both ACIP and the professional medical organizations. To access the most current ACIP/CDC recommendations, visit ACIP Vaccine Recommendations and Guidelines (CDC), or visit Immunize.org for a searchable database of ACIP Vaccine Recommendations. AAP vaccine recommendations are published in the AAP Red Book, and are generally available on the AAP website. All current healthcare professional organization recommendations are also searchable and accessible from the Immunize.org website. Current immunization schedules published by groups including AAP and AAFP are posted at Immunize.org, as well.
Participants in the Vaccines for Children (VFC) federal entitlement program are required to follow CDC/ACIP recommendations when using VFC vaccines. Several states have issued guidance directing vaccination providers to continue to follow the AAP childhood immunization schedule. The choice of recommendation to follow may vary upon the state where the vaccination is given, insurance considerations, or the policy of the healthcare facility.
The original 2025 ACIP-recommended child and adolescent schedules were approved by the CDC (www.cdc.gov), American Academy of Pediatrics (www.aap.org), American Academy of Family Physicians (AAFP, www.aafp.org), American College of Obstetricians and Gynecologists (ACOG, www.acog.org), American College of Nurse-Midwives (www.midwife.org), American Academy of Physician Associates (AAPA, www.aapa.org), and National Association of Pediatric Nurse Practitioners (www.napnap.org).
The 2026 CDC childhood immunization schedule published originally on January 5, 2026, was developed within the Department of Health and Human Services (HHS) without external input. It is not endorsed by any healthcare professional organization.
The original 2025 ACIP-recommended adult schedules were approved by CDC and American College of Physicians (www.acponline.org), AAFP, ACOG, American College of Nurse-Midwives, AAPA, American Pharmacists Association (www.pharmacist.com), and Society for Healthcare Epidemiology of America (www.shea-online.org). At this time, the 2025 schedule continues to be the most current available CDC immunization schedule for adults.
You can download electronic versions of the schedules from CDC’s website at www.cdc.gov/vaccines/hcp/imz-schedules.
CDC schedules are available on the Immunize.org website at www.immunize.org/official-guidance/cdc/rec-schedules/. In addition, current recommended immunization schedules for children or adults published by healthcare professional organizations are available on Immunize.org at www.immunize.org/official-guidance/hpo/rec-schedules/.
There are several very easy to read pieces that can be downloaded from the Immunize.org website. This includes “Vaccinations for Infants and Children, Age 0–10 Years”, “When do children and teens need vaccinations?”, “Vaccinations for Preteens and Teens” and “You’re 16…We Recommend These Vaccines for You”. These handouts can be found at www.immunize.org/clinical/topic/parent-handouts/.
Immunize.org has developed several resources that can help patients identify what they may need. These include:
Translations of these handouts are also available in several languages. To access all of Immunize.org’s clinical resources available in languages other than English, visit www.immunize.org/translations/. All of these clinical resources can be found in the subsection of clinical resources that address adult immunization: www.immunize.org/clinical/topic/adult-vaccination/.
There is usually very close agreement between vaccine package inserts and ACIP statements. The Food and Drug Administration (FDA) must approve the package insert and requires documentation for all data and recommendations made in the insert. Occasionally, ACIP may use different data to formulate its recommendations, or try to add flexibility to its recommendations, which results in wording different that in the package insert. ACIP has sometimes made recommendations based on expert opinion and public health considerations. Traditionally, published recommendations of ACIP have been considered equally as authoritative as those on the package insert.
Vaccines must always be dispensed with a prescription or order from a physician or other healthcare provider authorized by the state to prescribe medications. However, there are situations where vaccines can be administered using a standing order or vaccine protocol that is not patient-specific. In these situations, a physician or other healthcare provider does not need to be physically present for the vaccine to be administered. Several studies have shown that the use of standing orders can improve vaccination rates, and ACIP recommends the use of standing orders programs in both outpatient and inpatient settings. A comprehensive set of standing orders for the routine vaccines given to children and adults can be found at www.immunize.org/clinical/topic/standing-orders-templates/.
No. Vaccines administered outside the U.S. generally can be accepted as valid if the schedule (i.e., minimum ages and intervals) is similar to that recommended in the U.S. However, with the exception of the influenza and pneumococcal polysaccharide vaccines, only written documentation should be accepted as evidence of previous vaccination. In general, if records cannot be located or will definitely not be available anywhere because of the patient’s circumstances, children without adequate documentation should be considered susceptible and should be started on the age-appropriate vaccination schedule. Serologic testing for immunity is an alternative to vaccination for certain antigens. More information is available in the relevant subsection of CDC’s General Best Practices for Immunization, available at www.cdc.gov/vaccines/hcp/imz-best-practices/special-situations.html#cdc_report_pub_study_section_7-persons-vaccinated-outside-the-united-states.
Refer to this CDC web page for current information on the vaccination of U.S.-bound refugees and V-93 applicants: www.cdc.gov/immigrant-refugee-health/hcp/panel-physicians/vaccination.html.
ACIP recommendations are used to decide which vaccines are age-appropriate for the general immigrant population. Refer to the CDC table of vaccines required for immigrant visa applicants by age: www.cdc.gov/immigrant-refugee-health/media/pdfs/Vaccine-Requirements-According-to-Applicant-Age-panel-physicians-p.pdf.
Children adopted from outside the U.S. and political refugees are recommended to receive age-appropriate vaccination, with catch-up vaccination as appropriate. More information is available in the “Special Situations” section of CDC’s General Best Practices for Immunization, available at www.cdc.gov/vaccines/hcp/imz-best-practices/special-situations.html#cdc_report_pub_study_section_7-persons-vaccinated-outside-the-united-states. People entering the U.S. as visitors are not required to provide proof of vaccination regardless of the length of stay.
People working in healthcare settings are recommended to be vaccinated against influenza, hepatitis B, measles, mumps, rubella, varicella, and pertussis. As of September 3, 2025, recommendations for COVID-19 vaccination differ between CDC, which no longer has a specific occupational recommendation, and other healthcare professional organizations. The Society for Healthcare Epidemiology of America (SHEA) continues to support COVID-19 vaccination of all healthcare personnel. Adults are generally assumed to have been vaccinated against polio in childhood; any adult known or strongly suspected of being unvaccinated against polio should be vaccinated. For measles, mumps, rubella, and varicella, serologic evidence of immunity is an acceptable substitute for documentation of vaccination. In addition, microbiologists working in a laboratory should receive vaccination against meningococcal ACWY and meningococcal serogroup B disease. In rare cases, some laboratory personnel should also receive a single polio vaccine booster and typhoid vaccines. For more information, refer to a current recommended adult immunization schedule or the 2011 ACIP recommendations for immunization of healthcare personnel, www.cdc.gov/mmwr/pdf/rr/rr6007.pdf.
You can get this information from CDC’s Travel Health website at wwwnc.cdc.gov/travel/. CDC also publishes Health Information for International Travel (a.k.a. the “Yellow Book”) as a reference for those who advise international travelers of health risks. The “Yellow Book” is written primarily for healthcare providers, although others might find it useful. The contents of the book are available on the CDC Travel Health website. The book can also be ordered in print form. See the “Yellow Book” at http://www.cdc.gov/yellow-book/index.html
For Immunize.org’s curated list of resources for travel vaccination, see www.immunize.org/vaccines/travel-vaccines/.
Infants who will travel outside the United States should be up to date for all routinely recommended vaccines. One dose of MMR is recommended for infants age 6 through 11 months before international travel. This dose does not count toward the two doses needed to complete the childhood schedule. Infants 6 through 11 months of age traveling to an area at risk for hepatitis A exposure also should receive a dose of hepatitis A vaccine. This dose does not count toward the two doses needed to complete a childhood vaccination series for long-term protection. Infants younger than age 12 months traveling to a hepatitis A endemic area are not recommended to receive immune globulin for prevention of hepatitis A because immune globulin could interfere with the response to MMR. Varicella vaccine is not recommended before age 12 months, even for travelers. For other vaccine recommendations for travelers, consult the CDC travel website at wwwnc.cdc.gov/travel/.
Due to the variety of causes and consequences of altered immunocompetence, and limited studies of vaccination with these conditions, vaccination recommendations for primary and secondary immunodeficiencies are generally based upon expert opinion.
CDC’s “General Best Practices for Immunization” includes a subsection for vaccine recommendations for people with altered immunocompetence here: www.cdc.gov/vaccines/hcp/imz-best-practices/altered-immunocompetence.html. For a summary of specific vaccine recommendations for people with different types of primary and secondary immunodeficiencies, refer to Table 8-1 at that site.
People who do not have a functioning spleen or who have had a splenectomy are at increased risk for infection with encapsulated bacteria, especially Pneumococcus, Neisseria meningitidis, and Haemophilus influenzae type b (Hib).
In addition to receiving routine vaccinations, children and adults without a functioning spleen who are age 2 years and older need additional pneumococcal vaccinations, with specific recommendations dependent on an individual’s age and specific pneumococcal vaccination history. Refer to current immunization schedules, Immunize.org’s standing orders templates for pneumococcal vaccination, or CDC’s PneumoRecs VaxAdvisor Mobile App.
All asplenic people should receive a primary series of at least 2 doses of meningococcal ACWY vaccine (MenACWY) with periodic booster doses as recommended to sustain protection. See the MenACWY recommendation table at www.immunize.org/catg.d/p2018.pdf for details. Asplenic people age 10 years and older should also receive a 3-dose series of meningococcal serogroup B vaccine (MenB) with an initial booster dose one year after completion of the primary series and subsequent booster doses every 2–3 years thereafter. Pentavalent MenABCWY vaccines (Penbraya, Pfizer; Penmenvy, GSK) are also an option when MenACWY and MenB are due at the same visit. The minimum interval between pentavalent products is 6 months.
Two doses of Hib vaccine should be given to unimmunized children 12–59 months of age (defined as a child who received zero or 1 dose before 12 months of age). A single dose of Hib vaccine should be administered to unimmunized people age 5 years or older (in this case, “unimmunized” is defined as those who have not received at least 1 dose of Hib vaccine after 14 months of age).
Pneumococcal conjugate vaccine (PCV), Haemophilus influenzae type b (Hib) vaccine, MenACWY, and meningococcal B vaccine should be given at least 14 days before a scheduled splenectomy, if possible. This is done so the patient is protected from these diseases before the spleen is removed; however, doses given during the 14 days before surgery also can be counted as valid. If the doses cannot be given prior to the splenectomy, they should be given as soon as the patient’s condition has stabilized after surgery. If PCV20 or PCV21 is given, pneumococcal polysaccharide vaccine (PPSV23) is not needed; if PCV15 is given, administer a dose of PPSV23 at least 8 weeks after the dose of PCV15 if the patient is age 2 years or older.
Since the patient is asplenic, the second dose of the primary series of MenACWY should be given at least 8 weeks after the first dose. He will need a dose of MenACWY every 5 years for the rest of his life. The 3-dose series of MenB (whether Trumenba [Pfizer] or Bexsero [GSK]) should be completed. The first booster dose of MenB will be due one year after completion of the primary series and subsequent booster doses are recommended every 2–3 years for the rest of his life. The same MenB vaccine manufacturer should be used for all doses in the series, including booster doses.
People who receive MenB vaccine have an option to receive the corresponding pentavalent MenABCWY when both MenACWY and MenB vaccines are due at the same visit, as long as the appropriate brand and dose interval is used. Pentavalent Penbraya (Pfizer) can be given to patients with a history of receiving Trumenba; pentavalent Penmenvy (GSK) is for patients who previously received Bexsero.
Since the patient has already received one dose of PCV20, in accordance with pneumococcal vaccination recommendations for immunocompromised adults younger than age 50, no further doses are needed. Based on the patient’s age, only one dose of Hib vaccine is recommended, so no further doses are needed. The patient should receive influenza vaccine annually.
Preterm infants should be vaccinated at the same chronological age and according to the same schedule as full-term infants, regardless of birth weight, with the exception of the birth dose of hepatitis B vaccine. Infants weighing less than 2 kg (4.4 lb) whose mothers’ HBsAg status is either positive or unknown should receive HBIG (hepatitis B immune globulin) and hepatitis B vaccine within 12 hours of birth. This dose of hepatitis B vaccine should not be counted as a valid first dose in the series, and it should be repeated at age 1 month. If the preterm infant’s mother’s HBsAg status is negative, the infant’s first dose of hepatitis B vaccine should be withheld until the infant is chronologically 1 month of age or is ready to be discharged from the hospital, whichever occurs first.
CDC now classifies HepB as a shared clinical decision-making vaccine for infants born to test-negative mothers; however, the American Academy of Pediatrics continues to recommend routine infant immunization to protect newborns as soon as feasible from unrecognized exposures and lifelong chronic hepatitis B virus infection. For more information on timing, see the Vaccination of Preterm Infants subsection of the Special Situations section of CDC’s “General Best Practices for Immunization”, available at www.cdc.gov/vaccines/hcp/imz-best-practices/special-situations.html#cdc_report_pub_study_section_4-vaccination-of-preterm-infants.
This question has arisen more frequently since the introduction of the RSV preventive antibody, nirsevimab (Beyfortus, Sanofi), which has an injection volume of 1 mL for infants younger than age 8 months who weigh 5 kg or more at the time of immunization. High-risk children entering their second RSV season require a Beyfortus dose volume of 2 mL. Beyfortus is often administered at a routine visit when other infant immunizations are due.
There is no specific guidance to not exceed 1 mL in one muscle. In fact, there is no clear standard of practice and reference texts vary in guidance. Facilities or health systems may have medication policies/procedures that outline guidance for their staff. Professional judgement is needed when administering intramuscular medications or immunizations to people, including children, because muscle size varies from person to person.
CDC immunization education experts suggest a range of volume, depending upon the muscle injected. For the deltoid, the typical volume injected is 0.5 mL (maximum: 2 mL). For the vastus lateralis (the thigh): the typical volume that may be injected is 1–4 mL (maximum: 5 mL). Infants and toddlers fall at the lower end of these ranges, whereas adolescents and adults generally fall on the higher end of the range.
If more than 1 mL of volume needs to be injected into the thigh, that can be done while staying well within the acceptable range. Use of combination vaccines, when indicated and available, can decrease injection volume.
