Immunization Schedule, Adult

  • Influenza vaccine.

  • All adults should be immunized every year.

  • All adults, including pregnant women and people with hives-only allergy to eggs can receive the inactivated influenza (IIV) vaccine.

  • Adults aged 18–49 years can receive the recombinant influenza (RIV) vaccine. The RIV vaccine does not contain any egg protein.

  • Adults aged 65 years or older can receive the standard-dose IIV or the high-dose IIV.

  • Tetanus, diphtheria, and acellular pertussis (Td, Tdap) vaccine.

  • Pregnant women should receive 1 dose of Tdap vaccine during each pregnancy. The dose should be obtained regardless of the length of time since the last dose. Immunization is preferred during the 27th to 36th week of gestation.

  • An adult who has not previously received Tdap or who does not know his or her vaccine status should receive 1 dose of Tdap. This initial dose should be followed by tetanus and diphtheria toxoids (Td) booster doses every 10 years.

  • Adults with an unknown or incomplete history of completing a 3-dose immunization series with Td-containing vaccines should begin or complete a primary immunization series including a Tdap dose.

  • Adults should receive a Td booster every 10 years.

  • Varicella vaccine.

  • An adult without evidence of immunity to varicella should receive 2 doses or a second dose if he or she has previously received 1 dose.

  • Pregnant females who do not have evidence of immunity should receive the first dose after pregnancy. This first dose should be obtained before leaving the health care facility. The second dose should be obtained 4–8 weeks after the first dose.

  • Human papillomavirus (HPV) vaccine.

  • Females aged 13–26 years who have not received the vaccine previously should obtain the 3-dose series.

  • The vaccine is not recommended for use in pregnant females. However, pregnancy testing is not needed before receiving a dose. If a female is found to be pregnant after receiving a dose, no treatment is needed. In that case, the remaining doses should be delayed until after the pregnancy.

  • Males aged 13–21 years who have not received the vaccine previously should receive the 3-dose series. Males aged 22–26 years may be immunized.

  • Immunization is recommended through the age of 26 years for any male who has sex with males and did not get any or all doses earlier.

  • Immunization is recommended for any person with an immunocompromised condition through the age of 26 years if he or she did not get any or all doses earlier.

  • During the 3-dose series, the second dose should be obtained 4–8 weeks after the first dose. The third dose should be obtained 24 weeks after the first dose and 16 weeks after the second dose.

  • Zoster vaccine.

  • One dose is recommended for adults aged 60 years or older unless certain conditions are present.

  • Measles, mumps, and rubella (MMR) vaccine.

  • Adults born before 1957 generally are considered immune to measles and mumps.

  • Adults born in 1957 or later should have 1 or more doses of MMR vaccine unless there is a contraindication to the vaccine or there is laboratory evidence of immunity to each of the three diseases.

  • A routine second dose of MMR vaccine should be obtained at least 28 days after the first dose for students attending postsecondary schools, health care workers, or international travelers.

  • People who received inactivated measles vaccine or an unknown type of measles vaccine during 1963–1967 should receive 2 doses of MMR vaccine.

  • People who received inactivated mumps vaccine or an unknown type of mumps vaccine before 1979 and are at high risk for mumps infection should consider immunization with 2 doses of MMR vaccine.

  • For females of childbearing age, rubella immunity should be determined. If there is no evidence of immunity, females who are not pregnant should be vaccinated. If there is no evidence of immunity, females who are pregnant should delay immunization until after pregnancy.

  • Unvaccinated health care workers born before 1957 who lack laboratory evidence of measles, mumps, or rubella immunity or laboratory confirmation of disease should consider measles and mumps immunization with 2 doses of MMR vaccine or rubella immunization with 1 dose of MMR vaccine.

  • Pneumococcal 13-valent conjugate (PCV13) vaccine.

  • When indicated, a person who is uncertain of his or her immunization history and has no record of immunization should receive the PCV13 vaccine.

  • An adult aged 19 years or older who has certain medical conditions and has not been previously immunized should receive 1 dose of PCV13 vaccine. This PCV13 should be followed with a dose of pneumococcal polysaccharide (PPSV23) vaccine. The PPSV23 vaccine dose should be obtained at least 8 weeks after the dose of PCV13 vaccine.

  • An adult aged 19 years or older who has certain medical conditions and previously received 1 or more doses of PPSV23 vaccine should receive 1 dose of PCV13. The PCV13 vaccine dose should be obtained 1 or more years after the last PPSV23 vaccine dose.

  • Pneumococcal polysaccharide (PPSV23) vaccine.

  • When PCV13 is also indicated, PCV13 should be obtained first.

  • All adults aged 65 years and older should be immunized.

  • An adult younger than age 65 years who has certain medical conditions should be immunized.

  • Any person who resides in a nursing home or long-term care facility should be immunized.

  • An adult smoker should be immunized.

  • People with an immunocompromised condition and certain other conditions should receive both PCV13 and PPSV23 vaccines.

  • People with human immunodeficiency virus (HIV) infection should be immunized as soon as possible after diagnosis.

  • Immunization during chemotherapy or radiation therapy should be avoided.

  • Routine use of PPSV23 vaccine is not recommended for American Indians, Alaska Natives, or people younger than 65 years unless there are medical conditions that require PPSV23 vaccine.

  • When indicated, people who have unknown immunization and have no record of immunization should receive PPSV23 vaccine.

  • One-time revaccination 5 years after the first dose of PPSV23 is recommended for people aged 19–64 years who have chronic kidney failure, nephrotic syndrome, asplenia, or immunocompromised conditions.

  • People who received 1–2 doses of PPSV23 before age 65 years should receive another dose of PPSV23 vaccine at age 65 years or later if at least 5 years have passed since the previous dose.

  • Doses of PPSV23 are not needed for people immunized with PPSV23 at or after age 65 years.

  • Meningococcal vaccine.

  • Adults with asplenia or persistent complement component deficiencies should receive 2 doses of quadrivalent meningococcal conjugate (MenACWY-D) vaccine. The doses should be obtained at least 2 months apart.

  • Microbiologists working with certain meningococcal bacteria, military recruits, people at risk during an outbreak, and people who travel to or live in countries with a high rate of meningitis should be immunized.

  • A first-year college student up through age 21 years who is living in a residence hall should receive a dose if he or she did not receive a dose on or after his or her 16th birthday.

  • Adults who have certain high-risk conditions should receive one or more doses of vaccine.

  • Hepatitis A vaccine.

  • Adults who wish to be protected from this disease, have certain high-risk conditions, work with hepatitis A-infected animals, work in hepatitis A research labs, or travel to or work in countries with a high rate of hepatitis A should be immunized.

  • Adults who were previously unvaccinated and who anticipate close contact with an international adoptee during the first 60 days after arrival in the United States from a country with a high rate of hepatitis A should be immunized.

  • Hepatitis B vaccine.

  • Adults who wish to be protected from this disease, have certain high-risk conditions, may be exposed to blood or other infectious body fluids, are household contacts or sex partners of hepatitis B positive people, are clients or workers in certain care facilities, or travel to or work in countries with a high rate of hepatitis B should be immunized.

  • Haemophilus influenzae type b (Hib) vaccine.

  • A previously unvaccinated person with asplenia or sickle cell disease or having a scheduled splenectomy should receive 1 dose of Hib vaccine.

  • Regardless of previous immunization, a recipient of a hematopoietic stem cell transplant should receive a 3-dose series 6–12 months after his or her successful transplant.

  • Hib vaccine is not recommended for adults with HIV infection.