Vaccination Schedule for 4-Year-Olds

Core Vaccines

• The American Academy of Pediatrics recommends administering the fifth dose of DTaP vaccine, the fourth dose of IPV, the second dose of MMR vaccine, and the second dose of varicella vaccine at age 4-6 years 1
• Administer the final (fifth) dose of DTaP at age 4-6 years, completing the childhood series, with vaccine effectiveness of 98.1% within the first year after administration 1, 2, 3, 4, 5
• Give the fourth and final dose of IPV at age 4-6 years, completing the childhood polio vaccination series 1, 6, 7, 8
• Administer the second dose of MMR at age 4-6 years, with all children achieving seroprotective antibody levels for measles, mumps, and rubella after this second dose 1, 2, 3, 7, 5
• Give the second dose of varicella vaccine at age 4-6 years, with this dose significantly boosting immunity against chickenpox 1, 2, 3, 9

Practical Administration Considerations

• DTaP-IPV combination vaccines (Kinrix or Quadracel) are preferred to reduce the number of injections from four to three, with comparable safety and immunogenicity to separately administered vaccines 6, 7, 10, 8, 5
• All four vaccines (DTaP, IPV, MMR, and varicella) can and should be administered during the same visit, without interfering with immune responses to any of the vaccine antigens 7, 10

Additional Vaccine to Consider

• Annual influenza vaccination is recommended for all children aged 6 months and older, with children under 9 years who have received fewer than two lifetime doses of influenza vaccine needing two doses given at least 4 weeks apart 1, 2, 3

Important Clinical Caveats

• Whenever feasible, use the same manufacturer's DTaP vaccine throughout the series, but vaccination should never be delayed if the previous manufacturer is unknown or unavailable 6, 7, 8
• The final DTaP dose should not be given before age 4 years, while these vaccines can be given as early as age 4 years if the child is unlikely to return for a later visit 1, 2, 3