Immunisation from birth to 18 months: a schedule overview
This article is an informational overview only. Immunisation schedules vary by country, by individual health history, and by the most current guidance from your national health authority. Always follow the advice of your healthcare provider. The schedule discussed here uses the US CDC recommended immunisation schedule for children from birth to 18 months as a reference point, while noting where other countries differ. Source: cdc.gov/vaccines/schedules.
Cubby tracks vaccine schedules for the UK, US, UAE, and Germany in-app. This is a reminder and tracking tool, not a medical record, and does not replace your child's health record or your healthcare provider's advice.
Why immunisation schedules exist
A vaccine schedule is not arbitrary. Each recommended age is chosen based on two overlapping considerations: when a child becomes vulnerable, and when their immune system is ready to mount a protective response.
Babies are born with some protection borrowed from their mother. During pregnancy, maternal antibodies cross the placenta and provide passive immunity against several diseases. For some pathogens, this maternal protection is substantial; for others it is limited or short-lived. The immunity starts waning from birth and is largely gone within the first months of life. This creates a window of vulnerability that the early vaccine schedule is designed to close.
At the same time, the infant immune system is developing rapidly. Some vaccines work well in very young infants; others require a more mature immune response to generate lasting protection. The schedule sequences vaccines to match both the window of vulnerability and the immune system's readiness.
Timing also matters at a population level. Diseases like measles or whooping cough can spread rapidly through unvaccinated groups. When a high proportion of a population is vaccinated, transmission chains are broken, protecting even those who cannot be vaccinated for medical reasons, including newborns too young for certain vaccines. This community protection, often called herd immunity, is why on-time vaccination matters not just for the individual child but for the wider community.
Combination vaccines: fewer injections, same protection
Many of the vaccines on the schedule are combination products. Rather than giving six separate injections, a single combination vaccine can protect against multiple diseases in one shot. Examples include DTaP, which covers diphtheria, tetanus, and pertussis (whooping cough) in a single injection, and the Hib vaccine, which is often combined with other antigens.
Combination vaccines are rigorously tested for safety and effectiveness before approval. They do not overload the immune system. The immune system is exposed to thousands of antigens every day through normal environmental exposure, and the handful of additional antigens from a vaccination visit is well within its capacity to handle. The practical benefit is real: fewer visits, fewer injections, and less distress for both baby and caregiver.
Understanding the abbreviations
Vaccine abbreviations can be confusing. Here is a plain-language guide to the ones that appear in the schedule from birth to 18 months:
- DTaP: Diphtheria, Tetanus, and acellular Pertussis. Protects against three serious bacterial diseases. The "a" in DTaP stands for acellular, meaning it uses only specific parts of the pertussis bacterium rather than the whole cell, which makes it better tolerated than older whole-cell versions.
- IPV: Inactivated Poliovirus Vaccine. Protects against poliomyelitis. Given by injection in the schedule used in the US and many other countries.
- Hib: Haemophilus influenzae type b. Protects against a bacterium that can cause meningitis, pneumonia, and other serious infections in young children. Despite the name, it is not related to influenza.
- PCV13 or PCV15: Pneumococcal Conjugate Vaccine. Protects against strains of Streptococcus pneumoniae, which can cause pneumonia, meningitis, and ear infections. The number refers to how many strains are covered. PCV15 replaced PCV13 in the US schedule in 2023.
- HepB: Hepatitis B vaccine. Protects against hepatitis B virus infection, which can cause serious liver disease.
- HepA: Hepatitis A vaccine. Protects against hepatitis A virus infection, which causes acute liver illness.
- RV: Rotavirus vaccine. Given orally (not by injection). Rotavirus is the leading cause of severe diarrhoea in infants and young children worldwide.
- MMR: Measles, Mumps, and Rubella. A live attenuated vaccine given at 12 months and again in early childhood.
- Varicella: Chickenpox vaccine. Also a live attenuated vaccine, given alongside MMR from 12 months.
- Influenza: Flu vaccine. Recommended annually from six months of age.
The schedule from birth to 18 months
The following is a walkthrough of the CDC-recommended schedule. Your healthcare provider's specific recommendation may differ slightly based on your child's health history, the products available in your area, and updates to national guidance. Always confirm with your provider.
At birth
The first vaccine is given in the hospital shortly after birth: the first dose of hepatitis B (HepB). Hepatitis B can be transmitted from a mother to her baby during delivery. Vaccinating within 24 hours of birth, or even within 12 hours if the mother is known to be hepatitis B surface antigen positive, provides early protection before any exposure can occur. Babies born to mothers who are hepatitis B positive also receive hepatitis B immune globulin (HBIG) at birth for additional immediate protection.
At 2 months
The two-month visit is often the most vaccine-heavy appointment. The following are recommended:
- DTaP (first dose): diphtheria, tetanus, and pertussis
- IPV (first dose): polio
- Hib (first dose): Haemophilus influenzae type b
- PCV (first dose): pneumococcal disease
- Rotavirus (first dose): given orally
- HepB (second dose): hepatitis B
Pertussis (whooping cough) is especially dangerous in young infants, who can develop severe complications including pneumonia and prolonged coughing fits that interfere with breathing. This is why the pertussis vaccine is started early. Maternal vaccination with Tdap during pregnancy (a booster formulation) is also recommended to provide some passive protection to the newborn before they can be vaccinated.
At 4 months
The four-month visit continues the series started at two months:
- DTaP (second dose)
- IPV (second dose)
- Hib (second dose)
- PCV (second dose)
- Rotavirus (second dose)
Multiple doses are needed for most vaccines because a single dose in early infancy does not always generate a complete, long-lasting immune response. The series of doses trains the immune system progressively, with each dose building on the last.
At 6 months
At six months, the primary series for several vaccines is completed, and annual influenza vaccination begins:
- DTaP (third dose)
- IPV (third dose, or this may be given between 6 and 18 months depending on the product)
- Hib (third dose, product-dependent)
- PCV (third dose)
- Rotavirus (third dose, product-dependent: some rotavirus products require only two doses)
- HepB (third and final dose)
- Influenza (first dose): babies receiving flu vaccine for the first time need two doses given at least four weeks apart. From the following year, only one annual dose is needed.
At 12 months
The 12-month visit marks a shift in the schedule. Several vaccines that require a more mature immune response are introduced for the first time:
- MMR (first dose): measles, mumps, and rubella
- Varicella (first dose): chickenpox
- HepA (first dose): hepatitis A, given in two doses six months apart
- PCV (fourth and final dose)
- Hib (fourth and final dose, product-dependent)
MMR and varicella are live attenuated vaccines. They contain a weakened form of the live virus that can replicate briefly and stimulate a strong immune response without causing disease. Because they are live vaccines, they cannot be given to people with certain immune conditions without specialist advice.
The one-year mark also brings developmental check-ups that often occur alongside the vaccine visit. It is a busy appointment. Some families choose to space out vaccines if their healthcare provider agrees, but this leaves gaps in protection and is not recommended by most paediatric bodies.
At 15 to 18 months
The final routine vaccine appointments in the birth-to-18-months window include:
- DTaP (fourth dose): given between 15 and 18 months to boost protection going into toddlerhood
- HepA (second and final dose): completing the hepatitis A series
- Influenza: annually if in season
Summary table: birth to 18 months
| Age | Vaccines |
|---|---|
| Birth | HepB (1st dose) |
| 2 months | DTaP, IPV, Hib, PCV, Rotavirus, HepB (2nd dose) |
| 4 months | DTaP, IPV, Hib, PCV, Rotavirus |
| 6 months | DTaP, IPV, Hib, PCV, Rotavirus, HepB (3rd dose), Influenza (1st) |
| 12 months | MMR, Varicella, HepA (1st dose), PCV (4th), Hib (4th) |
| 15-18 months | DTaP (4th), HepA (2nd dose) |
This table is a simplified overview based on the CDC schedule. Product-specific differences and catch-up dosing are not shown. Always refer to your healthcare provider for your child's individual schedule.
Mild side effects: what is normal
It is normal and expected for babies to have some reaction after vaccination. Common mild side effects include:
- Redness, swelling, or tenderness at the injection site
- Low-grade fever (under 38.5 degrees Celsius / 101 degrees Fahrenheit)
- Fussiness or crying more than usual
- Increased sleepiness
- Reduced appetite for 24 to 48 hours
These responses indicate the immune system is activating. They typically resolve within one to two days. A cool, damp cloth on the injection site can help with local discomfort. Ask your provider before giving paracetamol or ibuprofen, as routine pre-medication before vaccination is generally not recommended.
When to seek medical advice after vaccination
Most post-vaccine reactions are mild and self-limiting. Call your doctor or seek medical attention if your baby:
- Has a high fever (above 39 degrees Celsius / 102 degrees Fahrenheit) that does not come down
- Cries inconsolably for more than three hours
- Becomes very pale, limp, or difficult to rouse
- Develops hives, facial swelling, or difficulty breathing within the first 15 to 30 minutes after vaccination (signs of a rare allergic reaction)
- Has a seizure
Serious adverse events after vaccination are rare. Vaccine providers are trained to manage immediate allergic reactions, which is one reason they observe your baby for a short period after some vaccines.
Catch-up schedules for late starters
If your baby misses one or more vaccine doses, do not worry that the protection is lost entirely. Catch-up schedules allow children to resume vaccination without restarting any completed series from the beginning. The specific catch-up path depends on which vaccines were missed, the child's age, and the minimum intervals required between doses.
The CDC and WHO both publish catch-up schedule guidance. Your healthcare provider can review your child's vaccine record and recommend the appropriate next steps. The main message is to catch up as promptly as possible, because every day without vaccination represents a day without protection for a child and a contribution to reduced community immunity.
Addressing questions and hesitancy
Many parents have questions or concerns about the vaccine schedule. This is understandable. Vaccinating your baby involves injections, and it is natural to want to understand what you are giving and why.
Common questions include concerns about the number of vaccines given at once, ingredient lists, and historical studies that have since been retracted or debunked. The scientific consensus, supported by data from billions of vaccine doses administered globally over decades, is that the benefits of the recommended schedule substantially outweigh the risks for the vast majority of children.
If you have specific concerns, the best approach is to raise them with your paediatrician or family doctor before the appointment. Come with your questions written down. Ask for explanations, not just reassurance. A good provider will take your questions seriously and give you evidence-based answers. The WHO also publishes accessible resources addressing common concerns about vaccine safety at who.int/immunization.
Choosing to delay or decline vaccines without a medical reason does carry real risk. Some diseases that vaccines prevent, including pertussis and measles, have seen resurgences in communities with lower vaccination rates. The risks of the diseases are, for most healthy children, substantially higher than the risks of the vaccines.
Tracking vaccines with Cubby
Keeping track of which vaccines your baby has received, and which are coming up, can be challenging across the first 18 months. Cubby's in-app vaccine tracker supports the UK, US, UAE, and German immunisation schedules. You can log completed vaccines, see what is due next, and set reminders before upcoming appointments. This is a personal tracking and reminder tool, not a medical record. Always keep your child's official immunisation record (the physical record card or digital record provided by your healthcare authority) up to date, and bring it to every appointment.
Frequently asked questions
Why does my baby need so many vaccines in the first two months?
The two-month visit is often the most vaccine-heavy appointment because maternal antibodies passed to the baby before birth begin to wane in the first weeks of life. Vaccinating early closes the window of vulnerability before the baby's immune system has fully learned to defend itself. Combination vaccines mean fewer injections than the number of diseases covered.
What side effects are normal after vaccination?
Mild side effects are common and expected. These include soreness or redness at the injection site, a low-grade fever, fussiness, and sleepiness for 24 to 48 hours after vaccination. These responses show the immune system is working. Give paracetamol only if your doctor advises it, as routine pre-medication before vaccination is not recommended.
My baby missed a scheduled vaccine. Do we have to start the series over?
No. Catch-up schedules allow babies who miss doses to get back on track without restarting from the beginning. The number and timing of catch-up doses depends on the specific vaccine and the child's age. Your healthcare provider or the CDC catch-up schedule at cdc.gov/vaccines/schedules can guide this. Delaying vaccines does leave a gap in protection, so catching up promptly is important.
Are the vaccines on the schedule safe to give together?
Yes. Combination vaccines and co-administration of multiple vaccines at the same visit are studied extensively before approval. The immune system is capable of responding to many antigens at once. Decades of data show that giving vaccines together does not overwhelm the immune system and significantly reduces the number of clinic visits required.