Vaccination of Adolescents (Aged 10–18): Overview of Current Guidelines

Adolescence is a critically important period for immunization because, over time, protection from some childhood vaccines wanes, and the risk of contracting other infections increases as social interactions expand. Adolescent vaccination aims not only to protect the individual child but also to prevent the spread of dangerous diseases in the community.

This material presents current schedules for regular and catch-up immunizations for children aged 10 to 18, as well as guidelines for clinical exceptions.

Principles of adolescent vaccination

• To administer recommended vaccines if the vaccination schedule is incomplete or unknown.
• Do not restart the vaccine series or administer additional doses if the recommended intervals have been extended in the previous series.

Note on calculating intervals between vaccines

When determining vaccination timelines for adolescents, the following rules apply:

• Interval calculation: 1 month equals 4 weeks (28 days). Intervals of ≥4 months are calculated by calendar months.
• Permissible variation: doses administered up to ≤4 days before the minimum recommended age or interval are considered valid (counted).
• Invalid doses refer to doses of any vaccine given ≥5 days earlier than the minimum recommended age tare not counted; such doses must be administered again.
• Re-administration refers to the next dose after an invalid one, which should be given after a full recommended minimum interval.

Guidelines for adolescent vaccination (aged 10–18) against specific infectious diseases

Influenza

Routine vaccination

For individuals aged 18 and younger: annually 1 dose of any age-appropriate vaccine in season, provided there are no contraindications.

Exceptions

In cases of having close contacts (like caregivers do) with individuals with severe immunosuppression, if vaccination is conducted with live vaccines, the exposed person should avoid contact with vulnerable individuals for 7 days post-vaccination.

Note: egg allergy is not a contraindication for any influenza vaccine.

Human papillomavirus

Routine vaccination at 11-12 years; acceptable starting ages are from 9 years and also from 13 years and above if not previously vaccinated or if they have not completed the full vaccination course. An additional dose is not recommended if the vaccination was conducted with vaccines of any valency, observing minimum intervals.

Routine vaccination

Series of 2 or 3 doses depending on the age at the start of vaccination:

• Vaccination starts at 9-14 years: 2 doses with an interval of no less than 5 months.
• Vaccination starts at 9-14 years; if 1 dose or 2 doses with an interval of less than 5 months were given, then 1 additional dose.
• Vaccination starts at 9-14 years; if 2 doses were given with an interval of no less than 5 months, it means that vaccination is completed, and no additional dose is required.
• Vaccination starts at 15-18 years: 3 doses (minimum interval between the first and second doses is 4 weeks, between the second and third doses is 12 weeks, and between the first and third doses is 5 months).

Exceptions:

• Primary or secondary immunodeficiencies (reduced number and/or impaired differentiation of B-cells, full or partial defects of T-cells, HIV infection, malignant neoplasms, solid organ transplantation, autoimmune diseases, immunosuppressive therapy): a series of 3 doses, even for those starting vaccination at 9-14 years.

• Pregnancy. Pregnancy testing before vaccination is not required. Vaccination is not recommended until the pregnancy outcome. In the case of inadvertent vaccination during pregnancy, medical intervention is not required.

Meningococcal infection

MenB vaccines may be administered concurrently with MenACWY vaccines, preferably in different anatomical body areas. MenABCWY may be administered as an alternative to separate administration of MenACWY and MenB for healthy adolescents aged 16–23, as well as children aged ≥10 with increased risk of disease*.

MenACWY

Vaccines are interchangeable. Doses given before 10 years are not counted in the adolescent vaccination cycle.

Routine vaccination is conducted at 11–18 years: 1 dose + booster at 16 years (minimum interval between doses is 8 weeks). A booster is not required after 16 years if there is no increased risk of disease*.

Exceptions

• Dose at 13–15 years: booster at 16–18 years.
• A dose at 10 years is valid as the first dose, then a booster at 16 years.
• Adolescents with persistently increased disease risk* who received the last dose before 7 years should have the next dose in 3 years, then every 5 years while risk persists.
• Adolescents with persistently increased disease risk* who received the last dose at age 7 or older should have the next dose in 5 years, then every 5 years while risk persists.
• First-year students living in dormitories who are unvaccinated or partially vaccinated: 1 dose, if no booster at 16 years or if more than 5 years since previous vaccination.
• Routine splenectomy: 1 dose, preferably at least 14 days prior to surgery (doses administered within 14 days before surgery also count). If a dose cannot be administered before splenectomy, it should be given after surgery as soon as the patient’s condition stabilizes.

Explanations:

* Risk factors:

• Functional or anatomical asplenia;
• Persistent complement component deficiency or complement inhibitor therapy (eculizumab, ravulizumab, sumimlimab);
• HIV infection;
• Outbreak of disease caused by a serogroup included in the vaccine;
• Residents or travelers to countries endemic for meningococcal infection.

MenB

Vaccines from the same manufacturer should be used for the whole vaccination series, including booster doses. Re-vaccination is indicated for all individuals with increased disease risk** while the risk persists: the first re-vaccination 1 year after completing the primary series; subsequent re-vaccinations should be provided every 2-3 years.

Joint clinical decision-making

Healthy adolescents aged 16–18 should receive 2 doses with an interval of no less than 6 months (if the second dose is given earlier than 6 months, administer the third no less than 4 months after the second).

Exceptions

• Routine splenectomy: 1 dose, preferably at least 14 days prior to surgery (doses administered within 14 days before surgery also count). If a dose cannot be administered before splenectomy, it should be given after surgery as soon as the patient’s condition stabilizes.
• Age ≥10 years with increased risk of disease**: 3 doses in the series at 0, 1–2, and 6 months.

Explanations:

** Risk factors:

• Functional or anatomical asplenia;
• Persistent complement component deficiency or complement inhibitor therapy (eculizumab, ravulizumab, sumimlimab);
• Outbreak of type B meningococcal infection if more than 6 months have elapsed since the completion of the primary series.

Tetanus, diphtheria, pertussis

Routine vaccination

• All adolescents aged 11–12 years: 1 dose of Tdap*, then Td** or Tdap* every 10 years.
• The primary vaccination series is completed, and Tdap* was NOT administered at age 10 or older: 1 dose of Tdap*, then Td** or Tdap* every 10 years.
• No vaccination or incomplete primary vaccine series: administer remaining doses to complete the 3-dose primary series; the interval between the first and second doses should be no less than 4 weeks, and the third dose should be in 6–12 months (Tdap is preferred as the first dose and may replace any Td dose), then Td or Tdap every 10 years.

Exceptions

• Tdap* vaccination for any reason at age 10: Tdap* at 11–12 years is not required.
• If Td** is mistakenly administered instead of Tdap**, administer the missing Tdap* dose as soon as possible, even on the same day. There is no need to observe any minimum interval between Td** and Tdap* doses, except when these are given as part of an additional primary tetanus vaccination series.
• Pregnancy: 1 dose Tdap* in each pregnancy, preferably at 27–36 weeks gestation, but can be administered at any time during pregnancy.

Explanations:

* Tdap = diphtheria (with reduced antigen content) and tetanus toxoids adsorbed, combined with acellular pertussis component.

** Td = diphtheria (with reduced antigen content) and tetanus toxoid adsorbed.

Pneumococcal infection

Routine vaccination with conjugate vaccine (PCV) is not recommended for healthy children aged 60 months and older. Previously administered doses of PCV13 are valid.

Exceptions

Conditions that increase the risk of pneumococcal infection and warrant additional doses until age 18*.

Whenever possible, vaccination should be conducted at least two weeks prior to planned cochlear implantation and splenectomy.

Indications for use of polysaccharide vaccine (PPSV23) in children under 18: high-risk group for severe disease course due to specific ID or non-ID*, not vaccinated with PCV20.

1. PCV20 unavailable: PPSV23 no less than 8 weeks after completing PCV vaccination.
2. Developed IDs, vaccinated with PPSV23: PCV20 or a second dose of PPSV23 in 5 years.

Explanations:

* Immunodeficiencies (IDs):

• Kidney disease and dialysis;
• Kidney disease with nephrotic syndrome;
• Functional or anatomical asplenia;
• Congenital or acquired immunodeficiency, including deficiency of B- (humoral) or T-cells; complement system deficiency, especially C1, C2, C3, and C4 deficiency; and phagocytosis disorders (excluding chronic granulomatous disease);
• Immunosuppressive therapy or radiation therapy (including treatment of Hodgkin’s disease, acute leukemia, lymphoma, malignant neoplasms);
• Solid organ transplantation;
• HIV infection;
• Sickle cell anemia or other hemoglobinopathies.

Non-immunodeficiencies (non-IDs):

• Cerebrospinal fluid leak;
• Chronic heart diseases (especially cyanotic congenital heart defects and heart failure);
• Chronic kidney disease (except those specified in the immunodeficiency list below);
• Chronic liver disease;
• Chronic lung diseases (including moderate persistent or severe persistent asthma);
• Diabetes mellitus;
• Cochlear implant.

Catch-up vaccination

Haemophilus influenzae type b

Routine vaccination is not recommended for healthy adolescents, even if not previously vaccinated.

Exceptions

• Anatomical or functional asplenia (including sickle cell anemia): 1 dose if not previously vaccinated.
• Routine splenectomy: 1 dose, preferably at least 14 days prior to surgery (doses administered within 14 days before surgery also count). If a dose cannot be administered before splenectomy, it should be given after surgery as soon as the patient’s condition stabilizes.
• Hematopoietic stem cell transplantation (HSCT): 3 doses at 4-week intervals, starting 6-12 months after HSCT regardless of prior vaccination history.

Poliomyelitis

If adolescents are unvaccinated or not fully vaccinated: 2 doses of inactivated vaccine with a minimum interval of 4 weeks, with a third dose after a minimum interval of 6 months.

Hepatitis A

If an adolescent under the age of 18 is unvaccinated, 2 doses of vaccine with a minimum interval of 6 months; if vaccinated once, 1 dose.

Measles, mumps, rubella

Routine vaccination

1. No evidence of immunity to measles, mumps, or rubella*: 2 doses at an interval of at least 4 weeks.
2. Previously vaccinated with 1 dose: 1 dose.

Explanations:

Pregnancy testing before vaccination is not required. Vaccination is contraindicated during pregnancy. In the case of inadvertent vaccination during pregnancy, medical intervention is not required.

* Evidence of immunity: having medical records confirming vaccination, laboratory evidence of immunity or disease (a disease diagnosis without laboratory confirmation is not proof of immunity).

Varicella

Routine vaccination

If there is no evidence of immunity to varicella*: 2 doses at 4-8 week intervals, if unvaccinated; if vaccinated once, 1 dose.

Exceptions

For HIV-infected patients with CD4 ≥15% and CD4 ≥200 cells/mm3lacking evidence of immunity to varicella: 2 doses at a 3-month interval.

Combined vaccine against measles, mumps, rubella and varicella (MMRV): Priorix-Tetra (GSK) or ProQuad (Merck, for children aged <13).

Explanations:

Pregnancy testing before vaccination is not required. Vaccination is contraindicated during pregnancy. In the case of inadvertent vaccination during pregnancy, medical intervention is not required.

* Evidence of immunity: having medical records confirming vaccination with 2 doses at not less than 4-week intervals, a case of varicella or herpes zoster; or laboratory evidence of immunity to the varicella virus.

Hepatitis B

If an adolescent is unvaccinated, a series of 3 doses with a schedule of 0, 1, and 6 months (minimum interval between first and second doses is 4 weeks, between second and third doses is 8 weeks, between first and third doses is 16 weeks).

Exceptions

1. Not fully vaccinated. If the schedule is interrupted after the first dose, the second dose should be given as soon as possible with a minimum interval of 8 weeks between the second and third doses. If only the third dose is delayed, it should be administered as soon as possible.
2. Two-dose regimen (Recombivax HB, 1.0 ml). Ages 11–15, 2 doses at 4–6 month intervals. If vaccination is not completed by the age of 16, 2 additional doses of another vaccine should be administered.

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Additional recommendations

COVID-19

The Nuvaxovid vaccine (Sanofi-Novavax) for the 2025–2026 season is an option for any adolescent aged 12 and older.

Vaccination schedule for the 2025–2026 season (using all doses of Nuvaxovid):

1. Age of 12–18 without moderate or severe immunodeficiency. 1 dose no less than 8 weeks after the last dose received in the previous season.
2. Age of 12 and older, moderate or severe immunodeficiency*.

• Previously unvaccinated: 2 doses at intervals of at least 3 weeks, the third dose with a minimum interval of 2 months after the second dose.
• Previously received the primary course of any COVID-19 vaccine (2 doses of the Novavax subunit protein vaccine or 3 doses of an mRNA vaccine): the first dose no less than 8 weeks after the last vaccination in the previous season, the second dose after a minimum interval of 2 months.

Vaccination is recommended for all children over 6 months of age with moderate or severe immunodeficiency* and at increased risk of severe course of COVID-19** based on joint clinical decision-making with age-appropriate vaccines updated for the current year**. No preference if several vaccines are available.

• Unvaccinated: primary course of 3 doses + 1 dose after 6 months.
• Started but not completed by 2025–2026 series of 3 doses***: complete the course of 3 doses + 1 dose after 6 months.
• If a course of 3 doses was completed, 2 doses at 6-month intervals.

Explanations:

* Moderate or severe immunodeficiency:

• Therapy for solid tumors and hematological malignancies.
• Hematological malignancies (chronic lymphocytic leukemia, non-Hodgkin’s lymphoma, multiple myeloma, acute leukemia).
• Solid organ or hematopoietic stem cell transplantation and immunosuppressive therapy.
• Primary immunodeficiency (common variable immunodeficiency, severe combined immunodeficiency, DiGeorge syndrome, Wiskott-Aldrich syndrome).
• HIV infection with <200 cells/mm3, AIDS-defining illness in medical history without immune restoration or with clinical manifestations of HIV infection, HIV infection without ART.
• Immunosuppressive therapy.

** Associated conditions and increased risk of severe course of COVID-19

*** Vaccination history against COVID-19 includes all doses of a COVID-19 vaccine from any manufacturer received before the commencement of COVID-19 vaccine sales in 2025–2026.

Respiratory syncytial virus

Routine vaccination

• Pregnancy from 32 weeks 0 days to 36 weeks 6 days of gestation from September to January (RSV season)*: 1 dose of Abrysvo. Administer the vaccine regardless of previous RSV infection. Vaccination is not recommended for all other pregnant women. No data on whether additional doses are needed in subsequent pregnancies.
• Should not be administered on the 37th week of pregnancy and later, as well as less than 2 weeks before the delivery. If gestational age meets the criteria, but there is a likelihood of delivery within 2 weeks, it is advisable to postpone vaccination and plan immunization of the newborn with monoclonal antibodies against RSV.

Explanations:

* Follow recommendations for vaccination timing considering RSV seasonality in your region.

Dengue fever

Routine vaccination at the age of 9–16 with laboratory-confirmed prior infection, residing in dengue-endemic areas: 3 doses of Dengvaxia with a schedule of 0, 6, and 12 months (significant protection is achieved after the first dose).

Summary table of vaccination precautions and contraindications

Explanations:

* Contraindication for all vaccines: severe allergic reaction (anaphylaxis) to a previous dose or to vaccine components. Vaccines SHOULD NOT be administered if contraindications are present.

** Precautions: moderate or severe acute illness with normal or elevated body temperature. Vaccination should generally be postponed if precautions are present but may be indicated if the vaccination benefit outweighs potential risks.