Figure 1. Recommended Immunization Schedule For Adults Aged 19 Years or Older, by Vaccine and Age Group
Figure 1. Recommended Immunization Schedule For Adults Aged 19 Years or Older, by Vaccine and Age Group
Figure 1. Recommended Immunization Schedule For Adults Aged 19 Years or Older, by Vaccine and Age Group
Note: These recommendations must be read with the footnotes that follow
containing number of doses, intervals between doses, and other important information.
Figure 1. Recommended immunization schedule for adults aged 19 years or older, by vaccine and age group1
VACCINE
AGE GROUP
19-21 years
22-26 years
27-49 years
Influenza*,2
50-59 years
60-64 years
65 years
1 dose annually
Varicella
*,4
2 doses
3 doses
3 doses
Zoster6
1 dose
*,7
1 dose
1 dose
Hepatitis A
*,9
Hepatitis B*,10
Meningococcal 4-valent conjugate (MenACWY) or
polysaccharide (MPSV4)*,11
Meningococcal B (MenB)11
*,12
Report all clinically significant postvaccination reactions to the Vaccine Adverse Event Reporting System (VAERS). Reporting forms and instructions on filing a VAERS report are available
at www.vaers.hhs.gov or by telephone, 800-822-7967.
Information on how to file a Vaccine Injury Compensation Program claim is available at www.hrsa.gov/vaccinecompensation or by telephone, 800-338-2382. To file a claim for vaccine
injury, contact the U.S. Court of Federal Claims, 717 Madison Place, N.W., Washington, D.C. 20005; telephone, 202-357-6400.
Additional information about the vaccines in this schedule, extent of available data, and contraindications for vaccination is also available at
www.cdc.gov/vaccines or from the CDC-INFO Contact Center at 800-CDC-INFO (800-232-4636) in English and Spanish, 8:00 a.m. - 8:00 p.m. Eastern Time, Monday - Friday, excluding
holidays.
Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services.
The recommendations in this schedule were approved by the Centers for Disease Control and Preventions (CDC) Advisory Committee on Immunization Practices (ACIP), the American
Academy of Family Physicians (AAFP), the America College of Physicians (ACP), the American College of Obstetricians and Gynecologists (ACOG) and the American College of NurseMidwives (ACNM).
Figure 2. Vaccines that might be indicated for adults aged 19 years or older based on medical and other indications1
VACCINE
INDICATION
Pregnancy
Immunocompromising
conditions (excluding
HIV infection) 4,6,7,8,13
HIV infection
CD4+ count
(cells/L) 4,6,7,8,13
< 200
200
Men who
have sex
with men
(MSM)
Kidney failure,
end-stage renal
disease, on
hemodialysis
Heart disease,
chronic lung
disease, chronic
alcoholism
Chronic
liver
disease
Diabetes
Healthcare
personnel
1 dose annually
Influenza*,2
1 dose Tdap each
pregnancy
*,3
Varicella
*,4
2 doses
3 doses through age 26 yrs
3 doses through age 21 yrs
Contraindicated
1 dose
Contraindicated
*,8
Hepatitis A*,9
Hepatitis B*,10
3 doses
Meningococcal B (MenB)
11
*,12
3 doses post-HSCT
recipients only
Recommended for all persons who meet the age requirement, lack
documentation of vaccination, or lack evidence of past infection;
zoster vaccine is recommended regardless of past episode of zoster
1 dose
Recommended for persons with a risk
factor (medical, occupational, lifestyle, or
other indication)
No recommendation
Contraindicated
These schedules indicate the recommended age groups and medical indications for which administration of currently licensed vaccines is commonly recommended for adults
aged 19 years, as of February 2016. For all vaccines being recommended on the Adult Immunization Schedule: a vaccine series does not need to be restarted, regardless of the
time that has elapsed between doses. Licensed combination vaccines may be used whenever any components of the combination are indicated and when the vaccines other
components are not contraindicated. For detailed recommendations on all vaccines, including those used primarily for travelers or that are issued during the year, consult the
manufacturers package inserts and the complete statements from the Advisory Committee on Immunization Practices (www.cdc.gov/vaccines/hcp/acip-recs/index.html). Use
of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services.
FootnotesRecommended Immunization Schedule for Adults Aged 19 Years or Older: United States, 2016
1. Additional information
Additional guidance for the use of the vaccines described in this supplement is
available at www.cdc.gov/vaccines/hcp/acip-recs/index.html.
Information on vaccination recommendations when vaccination status is
unknown and other general immunization information can be found in the
General Recommendations on Immunization at
www.cdc.gov/mmwr/preview/mmwrhtml/rr6002a1.htm.
Information on travel vaccine requirements and recommendations (e.g., for
hepatitis A and B, meningococcal, and other vaccines) is available at
wwwnc.cdc.gov/travel/destinations/list.
Additional information and resources regarding vaccination of pregnant
women can be found at www.cdc.gov/vaccines/adults/rec-vac/pregnant.html.
2. Influenza vaccination
4. Varicella vaccination
All adults without evidence of immunity to varicella (as defined below) should
receive 2 doses of single-antigen varicella vaccine or a second dose if they have
received only 1 dose.
Vaccination should be emphasized for those who have close contact with
persons at high risk for severe disease (e.g., health care personnel and
family contacts of persons with immunocompromising conditions) or are at
high risk for exposure or transmission (e.g., teachers; child care employees;
residents and staff members of institutional settings, including correctional
institutions; college students; military personnel; adolescents and adults living
in households with children; nonpregnant women of childbearing age; and
international travelers).
Three HPV vaccines are licensed for use in females (bivalent HPV vaccine
[2vHPV], quadrivalent HPV vaccine [4vHPV], and 9-valent HPV vaccine [9vHPV])
and two HPV vaccines are licensed for use in males (4vHPV and 9vHPV).
For females, 2vHPV, 4vHPV, or 9vHPV is recommended in a 3-dose series for
routine vaccination at age 11 or 12 years and for those aged 13 through 26
years, if not previously vaccinated.
For males, 4vHPV or 9vHPV is recommended in a 3-dose series for routine
vaccination at age 11 or 12 years and for those aged 13 through 21 years, if not
previously vaccinated. Males aged 22 through 26 years may be vaccinated.
HPV vaccination is recommended for men who have sex with men through age
26 years who did not get any or all doses when they were younger.
Vaccination is recommended for immunocompromised persons (including
those with HIV infection) through age 26 years who did not get any or all doses
when they were younger.
A complete HPV vaccination series consists of 3 doses. The second dose should
be administered 48 weeks (minimum interval of 4 weeks) after the first dose;
the third dose should be administered 24 weeks after the first dose and 16
weeks after the second dose (minimum interval of 12 weeks).
HPV vaccines are not recommended for use in pregnant women. However,
pregnancy testing is not needed before vaccination. If a woman is found to
be pregnant after initiating the vaccination series, no intervention is needed;
the remainder of the 3-dose series should be delayed until completion or
termination of pregnancy.
6. Zoster vaccination
Adults born before 1957 are generally considered immune to measles and
mumps. All adults born in 1957 or later should have documentation of 1 or
more doses of MMR vaccine unless they have a medical contraindication to
the vaccine or laboratory evidence of immunity to each of the three diseases.
Documentation of provider-diagnosed disease is not considered acceptable
evidence of immunity for measles, mumps, or rubella.
Measles component:
A routine second dose of MMR vaccine, administered a minimum of 28 days
after the first dose, is recommended for adults who:
are students in postsecondary educational institutions,
work in a health care facility, or
plan to travel internationally.
Persons who received inactivated (killed) measles vaccine or measles vaccine
of unknown type during 19631967 should be revaccinated with 2 doses of
MMR vaccine.
Mumps component:
A routine second dose of MMR vaccine, administered a minimum of 28 days
after the first dose, is recommended for adults who:
are students in a postsecondary educational institution,
work in a health care facility, or
plan to travel internationally.
Persons vaccinated before 1979 with either killed mumps vaccine or mumps
vaccine of unknown type who are at high risk for mumps infection (e.g.,
persons who are working in a health care facility) should be considered for
revaccination with 2 doses of MMR vaccine.
Rubella component:
For women of childbearing age, regardless of birth year, rubella immunity
should be determined. If there is no evidence of immunity, women who are not
pregnant should be vaccinated. Pregnant women who do not have evidence
of immunity should receive MMR vaccine upon completion or termination of
pregnancy and before discharge from the health care facility.
Health care personnel born before 1957:
For unvaccinated health care personnel born before 1957 who lack laboratory
evidence of measles, mumps, and/or rubella immunity or laboratory
confirmation of disease, health care facilities should consider vaccinating
personnel with 2 doses of MMR vaccine at the appropriate interval for measles
and mumps or 1 dose of MMR vaccine for rubella.
8. Pneumococcal vaccination
General information
Adults are recommended to receive 1 dose of 13-valent pneumococcal
conjugate vaccine (PCV13) and 1, 2, or 3 doses (depending on
indication) of 23-valent pneumococcal polysaccharide vaccine (PPSV23).
PCV13 should be administered at least 1 year after PPSV23.
PPSV23 should be administered at least 1 year after PCV13, except
among adults with immunocompromising conditions, anatomical or
functional asplenia, cerebrospinal fluid leak, or cochlear implant, for
whom the interval should be at least 8 weeks; the interval between
PPSV23 doses should be at least 5 years.
No additional dose of PPSV23 is indicated for adults vaccinated with
PPSV23 at age 65 years.
When both PCV13 and PPSV23 are indicated, PCV13 should be
administered first; PCV13 and PPSV23 should not be administered
during the same visit.
When indicated, PCV13 and PPSV23 should be administered to adults
whose pneumococcal vaccination history is incomplete or unknown.
Adults aged 65 years (immunocompetent) who:
have not received PCV13 or PPSV23: administer PCV13 followed by
PPSV23 at least 1 year after PCV13.
have not received PCV13 but have received a dose of PPSV23 at age 65
years: administer PCV13 at least 1 year after PPSV23.
have not received PCV13 but have received 1 or more doses of PPSV23
at age <65 years: administer PCV13 at least 1 year after the most recent
dose of PPSV23. Administer a dose of PPSV23 at least 1 year after PCV13
and at least 5 years after the most recent dose of PPSV23.
have received PCV13 but not PPSV23 at age <65 years: administer
PPSV23 at least 1 year after PCV13.
have received PCV13 and 1 or more doses of PPSV23 at age <65 years:
administer PPSV23 at least 1 year after PCV13 and at least 5 years after
the most recent dose of PPSV23.
Adults aged 19 years with immunocompromising conditions or anatomical or
functional asplenia (defined below) who:
have not received PCV13 or PPSV23: administer PCV13 followed by
PPSV23 at least 8 weeks after PCV13. Administer a second dose of
PPSV23 at least 5 years after the first dose of PPSV23.
have not received PCV13 but have received 1 dose of PPSV23:
administer PCV13 at least 1 year after the PPSV23. Administer a second
dose of PPSV23 at least 8 weeks after PCV13 and at least 5 years after
the first dose of PPSV23.
Vaccinate any person seeking protection from hepatitis B virus (HBV) infection
and persons with any of the following indications:
sexually active persons who are not in a long-term, mutually
monogamous relationship (e.g., persons with more than 1 sex partner
during the previous 6 months); persons seeking evaluation or treatment
for a sexually transmitted disease (STD); current or recent injection drug
users; and men who have sex with men;
health care personnel and public safety workers who are potentially
exposed to blood or other infectious body fluids;
persons who are aged <60 years with diabetes as soon as feasible
after diagnosis; persons with diabetes who are aged 60 years at the
discretion of the treating clinician based on the likelihood of acquiring
HBV infection, including the risk posed by an increased need for assisted
blood glucose monitoring in long-term care facilities, the likelihood of
experiencing chronic sequelae if infected with HBV, and the likelihood
of immune response to vaccination;
persons with end-stage renal disease (including patients receiving
hemodialysis), persons with HIV infection, and persons with chronic
liver disease;
household contacts and sex partners of hepatitis B surface antigen
positive persons, clients and staff members of institutions for persons
with developmental disabilities, and international travelers to regions
with high or intermediate levels of endemic HBV infection (see footnote
1); and
all adults in the following settings: STD treatment facilities, HIV testing
and treatment facilities, facilities providing drug abuse treatment and
prevention services, health care settings targeting services to injection
drug users or men who have sex with men, correctional facilities,
end-stage renal disease programs and facilities for chronic hemodialysis
patients, and institutions and nonresidential day care facilities for
persons with developmental disabilities.
Administer missing doses to complete a 3-dose series of hepatitis B vaccine to
those persons not vaccinated or not completely vaccinated. The second dose
should be administered at least 1 month after the first dose; the third dose
should be administered at least 2 months after the second dose (and at least 4
months after the first dose). If the combined hepatitis A and hepatitis B vaccine
(Twinrix) is used, give 3 doses at 0, 1, and 6 months; alternatively, a 4-dose
Twinrix schedule may be used, administered on days 0, 7, and 2130, followed
by a booster dose at 12 months.
Adult patients receiving hemodialysis or with other immunocompromising
conditions should receive 1 dose of 40 mcg/mL (Recombivax HB) administered
on a 3-dose schedule at 0, 1, and 6 months or 2 doses of 20 mcg/mL (Engerix-B)
administered simultaneously on a 4-dose schedule at 0, 1, 2, and 6 months.
General information
Serogroup A, C, W, and Y meningococcal vaccine is available as a
conjugate (MenACWY [Menactra, Menveo]) or a polysaccharide (MPSV4
[Menomune]) vaccine.
Serogroup B meningococcal (MenB) vaccine is available as a 2-dose
series of MenB-4C vaccine (Bexsero) administered at least 1 month apart
or a 3-dose series of MenB-FHbp (Trumenba) vaccine administered at
0, 2, and 6 months; the two MenB vaccines are not interchangeable, i.e.,
the same MenB vaccine product must be used for all doses.
MenACWY vaccine is preferred for adults with serogroup A, C, W, and
Y meningococcal vaccine indications who are aged 55 years, and
for adults aged 56 years: 1) who were vaccinated previously with
MenACWY vaccine and are recommended for revaccination or 2) for
9. Hepatitis A vaccination
Vaccinate any person seeking protection from hepatitis A virus (HAV) infection
and persons with any of the following indications:
men who have sex with men;
persons who use injection or noninjection illicit drugs;
persons working with HAV-infected primates or with HAV in a research
laboratory setting;
persons with chronic liver disease and persons who receive clotting
factor concentrates;
persons traveling to or working in countries that have high or
intermediate endemicity of hepatitis A (see footnote 1); and
unvaccinated persons who anticipate close personal contact (e.g.,
household or regular babysitting) with an international adoptee during
the first 60 days after arrival in the United States from a country with
high or intermediate endemicity of hepatitis A (see footnote 1). The first
dose of the 2-dose hepatitis A vaccine series should be administered as
soon as adoption is planned, ideally 2 or more weeks before the arrival
of the adoptee.