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Recommended vaccination for adults who meet age requirement, lack documentation of vaccination, or lack evidence of past infection

Recommended vaccination for adults with an additional risk factor or another indication

Precaution—vaccination might be indicated if benefit of protection outweighs risk of adverse reaction

Delay vaccination until after pregnancy if vaccine is indicated

Not recommended/ contraindicated —vaccine should not be administered

No recommendation/ Not applicable

adult conditions vaccine schedule

Vaccine	Pregnancy	Immuno-compromised (excluding HIV infection)	HIV infection CD4 count		Asplenia, complement deficiencies	End-stage renal disease; or on hemodialysis	Heart or lung disease, alcoholism1	Chronic liver disease	Diabetes	Health care personnel2	Men who have sex with men
			<200	≥200
IIV or RIV	1 dose annually
LAIV	NOT RECOMMENDED					PRECAUTION				1 dose annually
Tdap or Td	1 dose Tdap each pregnancy	1 dose Tdap, then Td or Tdap booster every 10 yrs
MMR	NOT RECOMMENDED			1 or 2 doses depending on indication
VAR	NOT RECOMMENDED			2 doses
RZV(preferred)	DELAY				2 doses at age ≥50 yrs
ZVL	NOT RECOMMENDED				1 dose at age ≥60 yrs
HPV	DELAY	3 doses through age 26 yrs			2 or 3 doses through age 26 yrs
PCV13		1					dose
PPSV23		1, 2,or 3 doses depending on age								and indication
HepA							2 or 3	doses	depending on vaccine
HepB							2 or 3	doses depending on vaccine
MenACWY	1 or 2 doses		depending on indication,			see notes for booster recommendations
MenB	PRECAUTION	2 or 3 doses			depending on	vaccine and indication, see notes for booster recommendations
Hib		3 doses HSCT3 recipients only			1	dose

Notes

Recommended Adult Immunization Schedule for ages 19 years or older, United States, 2020

For vaccine recommendations for persons age 0 through 18 years, see the Child and Adolescent Immunization Schedule.

Haemophilus influenzae type b vaccination

Special situations

• Anatomical or functional asplenia (including sickle cell disease): 1 dose if previously did not receive Hib; if elective splenectomy, 1 dose, preferably at least 14 days before splenectomy
• Hematopoietic stem cell transplant (HSCT): 3-dose series 4 weeks apart starting 6–12 months after successful transplant, regardless of Hib vaccination history

Hepatitis A vaccination

Routine vaccination

• Not at risk but want protection from hepatitis A (identification of risk factor not required): 2-dose series HepA (Havrix 6–12 months apart or Vaqta 6–18 months apart [minimum interval: 6 months]) or 3-dose series HepA-HepB (Twinrix at 0, 1, 6 months [minimum intervals: 4 weeks between doses 1 and 2, 5 months between doses 2 and 3])

Special situations

• At risk for hepatitis A virus infection: 2-dose series HepA or 3-dose series HepA-HepB as above
  • Chronic liver disease  (e.g., persons with hepatitis B, hepatitis C, cirrhosis, fatty liver disease, alcoholic liver disease, autoimmune hepatitis, alanine aminotransferase [ALT] or aspartate aminotransferase [AST] level greater than twice the upper limit of normal)
  • HIV infection
  • Men who have sex with men
  • Injection or noninjection drug use
  • Persons experiencing homelessness
  • Work with hepatitis A virus in research laboratory or with nonhuman primates with hepatitis A virus infection
  • Travel in countries with high or intermediate endemic hepatitis A
  • Close, personal contact with international adoptee (e.g., household or regular babysitting) in first 60 days after arrival from country with high or intermediate endemic hepatitis A (administer dose 1 as soon as adoption is planned, at least 2 weeks before adoptee’s arrival)
  • Pregnancy if at risk for infection or severe outcome from infection during pregnancy
  • Settings for exposure, including health care settings targeting services to injection or noninjection drug users or group homes and nonresidential day care facilities for developmentally disabled persons (individual risk factor screening not required)

Hepatitis B vaccination

Routine vaccination

• Not at risk but want protection from hepatitis B (identification of risk factor not required): 2- or 3-dose series (2-dose series Heplisav-B at least 4 weeks apart [2-dose series HepB only applies when 2 doses of Heplisav-B are used at least 4 weeks apart] or 3-dose series Engerix-B or Recombivax HB at 0, 1, 6 months [minimum intervals: 4 weeks between doses 1 and 2, 8 weeks between doses 2 and 3, 16 weeks between doses 1 and 3]) or 3-dose series HepA-HepB (Twinrix at 0, 1, 6 months [minimum intervals: 4 weeks between doses 1 and 2, 5 months between doses 2 and 3])

Special situations

• At risk for hepatitis B virus infection: 2-dose (Heplisav-B) or 3-dose (Engerix-B, Recombivax HB) series or 3-dose series HepA-HepB (Twinrix) as above
  • Chronic liver disease (e.g., persons with hepatitis C, cirrhosis, fatty liver disease, alcoholic liver disease, autoimmune hepatitis, alanine aminotransferase [ALT] or aspartate aminotransferase [AST] level greater than twice upper limit of normal)
  • HIV infection
  • Sexual exposure risk (e.g., sex partners of hepatitis B surface antigen [HBsAg]-positive persons; sexually active persons not in mutually monogamous relationships; persons seeking evaluation or treatment for a sexually transmitted infection; men who have sex with men)
  • Current or recent injection drug use
  • Percutaneous or mucosal risk for exposure to blood (e.g., household contacts of HBsAg-positive persons; residents and staff of facilities for developmentally disabled persons; health care and public safety personnel with reasonably anticipated risk for exposure to blood or blood-contaminated body fluids; hemodialysis, peritoneal dialysis, home dialysis, and predialysis patients; persons with diabetes mellitus age younger than 60 years and, at discretion of treating clinician, those age 60 years or older)
  • Incarcerated persons
  • Travel in countries with high or intermediate endemic hepatitis B
  • Pregnancy if at risk for infection or severe outcome from infection during pregnancy. Heplisav-B not currently recommended due to lack of safety data in pregnant women

Human papillomavirus vaccination

Routine vaccination

• HPV vaccination recommended for all adults through age 26 years: 2- or 3-dose series depending on age at initial vaccination or condition:
  • Age 15 years or older at initial vaccination: 3-dose series at 0, 1–2, 6 months (minimum intervals: 4 weeks between doses 1 and 2/12 weeks between doses 2 and 3/5 months between doses 1 and 3; repeat dose if administered too soon)
  • Age 9 through 14 years at initial vaccination and received 1 dose or 2 doses less than 5 months apart: 1 dose
  • Age 9 through 14 years at initial vaccination and received 2 doses at least 5 months apart: HPV vaccination complete, no additional dose needed.
• If completed valid vaccination series with any HPV vaccine, no additional doses needed

Shared clinical decision-making

• Age 27 through 45 years based on shared clinical decision-making:
  • 2- or 3-dose series as above

Special situations

• Pregnancy through age 26 years: HPV vaccination not recommended until after pregnancy; no intervention needed if vaccinated while pregnant; pregnancy testing not needed before vaccination

Influenza vaccination

Routine vaccination

• Persons age 6 months or older: 1 dose any influenza vaccine appropriate for age and health status annually
• For additional guidance, see www.cdc.gov/flu/professionals/index.htm

Special situations

• Egg allergy, hives only: 1 dose any influenza vaccine appropriate for age and health status annually
• Egg allergy more severe than hives (e.g., angioedema, respiratory distress): 1 dose any influenza vaccine appropriate for age and health status annually in medical setting under supervision of health care provider who can recognize and manage severe allergic reactions
• LAIV should not be used in persons with the following conditions or situations:
  • History of severe allergic reaction to any vaccine component (excluding egg) or to a previous dose of any influenza vaccine
  • Immunocompromised due to any cause (including medications and HIV infection)
  • Anatomic or functional asplenia
  • Cochlear implant
  • Cerebrospinal fluid-oropharyngeal communication
  • Close contacts or caregivers of severely immunosuppressed persons who require a protected environment
  • Pregnancy
  • Received influenza antiviral medications within the previous 48 hours
• History of Guillain-Barré syndrome within 6 weeks of previous dose of influenza vaccine: Generally should not be vaccinated unless vaccination benefits outweigh risks for those at higher risk for severe complications from influenza

Measles, mumps, and rubella vaccination

Routine vaccination

• No evidence of immunity to measles, mumps, or rubella: 1 dose
  • Evidence of immunity: Born before 1957 (health care personnel, see below), documentation of receipt of MMR vaccine, laboratory, laboratory evidence of immunity or disease (diagnosis of disease without laboratory confirmation is not evidence of immunity)

Special situations

• Pregnancy with no evidence of immunity to rubella: MMR contraindicated during pregnancy; after pregnancy (before discharge from health care facility), 1 dose
• Nonpregnant women of childbearing age with no evidence of immunity to rubella: 1 dose
• HIV infection with CD4 count ≥200 cells/μL for at least 6 months and no evidence of immunity to measles, mumps, or rubella: 2-dose series at least 4 weeks apart; MMR contraindicated in HIV infection with CD4 count <200 cells/μL
• Severe immunocompromising conditions: MMR contraindicated
• Students in postsecondary educational institutions, international travelers, and household or close, personal contacts of immunocompromised persons, with no evidence of immunity to measles, mumps, or rubella: 2-dose series at least 4 weeks apart if previously did not receive any MMR or 1 dose if previously received 1 dose MMR
• Health care personnel:
  • Born in 1957 or later with no evidence of immunity to measles, mumps, or rubella: 2-dose series at least 4 weeks apart for measles or mumps or at least 1 dose MMR for rubella
  • Born before 1957 with no evidence of immunity to measles, mumps, or rubella: Consider 2-dose series at least 4 weeks apart for measles or mumps or 1 dose for rubella

Meningococcal vaccination

Special situations for MenACWY

• Anatomical or functional asplenia (including sickle cell disease), HIV infection, persistent complement component deficiency, complement inhibitor (e.g., eculizumab, ravulizumab) use: 2-dose series MenACWY (Menactra, Menveo) at least 8 weeks apart and revaccinate every 5 years if risk remains
• Travel in countries with hyperendemic or epidemic meningococcal disease, microbiologists routinely exposed to Neisseria meningitidis: 1 dose MenACWY (Menactra, Menveo) and revaccinate every 5 years if risk remains
• First-year college students who live in residential housing (if not previously vaccinated at age 16 years or older) and military recruits: 1 dose MenACWY (Menactra, Menveo)

Shared clinical decision-making for MenB

• Adolescents and young adults age 16 through 23 years (age 16 through 18 years preferred) not at increased risk for meningococcal disease: Based on shared clinical decision-making, 2-dose series MenB-4C at least 1 month apart, or 2-dose series MenB-FHbp at 0, 6 months (if dose 2 was administered less than 6 months after dose 1, administer dose 3 at least 4 months after dose 2); MenB-4C and MenB-FHbp are not interchangeable (use same product for all doses in series)

Special situations for MenB

• Anatomical or functional asplenia (including sickle cell disease), persistent complement component deficiency, complement inhibitor (e.g., eculizumab, ravulizumab) use, microbiologists routinely exposed to Neisseria meningitidis: 2-dose primary series MenB-4C (Bexsero) at least 1 month apart, or 3-dose primary series MenB-FHbp (Trumenba) at 0, 1–2, 6 months (if dose 2 was administered at least 6 months after dose 1, dose 3 not needed); MenB-4C and MenB-FHbp are not interchangeable (use same product for all doses in series); 1 dose MenB booster 1 year after primary series and revaccinate every 2–3 years if risk remains
• Pregnancy: Delay MenB until after pregnancy unless at increased risk and vaccination benefits outweighs potential risks

Pneumococcal vaccination

Routine vaccination

• Age 65 years or older (immunocompetent):– see [New Pneumococcal Vaccine Recommendations for Adults Aged ≥65 Years Old]: 1 dose PPSV23
  • If PPSV23 was administered prior to age 65 years, adminster 1 dose PPSV23 at least 5 years after previous dose

Shared clinical decision-making

• Age 65 years and older (immunocompetent): 1 dose PCV13 based on shared clinical decision-making
  • If both PCV13 and PPSV23 are to be administered, PCV13 should be administered first
  • PCV13 and PPSV23 should be administered at least 1 year apart.
  • PCV13 and PPSV23 should not be administered during the same visit

Special situations see (New Pneumococcal Vaccine Recommendations for Adults Aged ≥65 Years Old)

• Age 19 through 64 years with chronic medical conditions (chronic heart [excluding hypertension], lung, or liver disease, diabetes), alcoholism, or cigarette smoking: 1 dose PPSV23
• Age 19 years or older with immunocompromising conditions (congenital or acquired immunodeficiency [including B- and T-lymphocyte deficiency, complement deficiencies, phagocytic disorders, HIV infection], chronic renal failure, nephrotic syndrome, leukemia, lymphoma, Hodgkin disease, generalized malignancy, iatrogenic immunosuppression [e.g., drug or radiation therapy], solid organ transplant, multiple myeloma) or anatomical or functional asplenia (including sickle cell disease and other hemoglobinopathies): 1 dose PCV13 followed by 1 dose PPSV23 at least 8 weeks later, then another dose PPSV23 at least 5 years after previous PPSV23; at age 65 years or older, administer 1 dose PPSV23 at least 5 years after most recent PPSV23 (note: only 1 dose PPSV23 recommended at age 65 years or older)
• Age 19 years or older with cerebrospinal fluid leak or cochlear implant: 1 dose PCV13 followed by 1 dose PPSV23 at least 8 weeks later; at age 65 years or older, administer another dose PPSV23 at least 5 years after PPSV23 (note: only 1 dose PPSV23 recommended at age 65 years or older)

Tetanus, diphtheria, and pertussis vaccination

Routine vaccination

• Previously did not receive Tdap at or after age 11 years: 1 dose Tdap, then Td or Tdap every 10 years

Special situations

• Previously did not receive primary vaccination series for tetanus, diphtheria, or pertussis: At least 1 dose Tdap followed by 1 dose Td or Tdap at least 4 weeks after Tdap and another dose Td or Tdap 6–12 months after last Td or Tdap (Tdap can be substituted for any Td dose, but preferred as first dose); Td or Tdap every 10 years thereafter
• Pregnancy: 1 dose Tdap during each pregnancy, preferably in early part of gestational weeks 27–36
• For information on use of Td or Tdap as tetanus prophylaxis in wound management, see Prevention of Pertussis, Tetanus, and Diphtheria with Vaccines in the United States: Recommendations of the Advisory Committee on Immunization Practices (ACIP).

Varicella vaccination

Routine vaccination

• No evidence of immunity to varicella: 2-dose series 4–8 weeks apart if previously did not receive varicella-containing vaccine (VAR or MMRV [measles-mumps-rubella-varicella vaccine] for children); if previously received 1 dose varicella-containing vaccine, 1 dose at least 4 weeks after first dose
  • Evidence of immunity: U.S.-born before 1980 (except for pregnant women and health care personnel [see below]), documentation of 2 doses varicella-containing vaccine at least 4 weeks apart, diagnosis or verification of history of varicella or herpes zoster by a health care provider, laboratory evidence of immunity or disease

Special situations

• Pregnancy with no evidence of immunity to varicella: VAR contraindicated during pregnancy; after pregnancy (before discharge from health care facility), 1 dose if previously received 1 dose varicella-containing vaccine or dose 1 of 2-dose series (dose 2: 4–8 weeks later) if previously did not receive any varicella-containing vaccine, regardless of whether U.S.-born before 1980
• Health care personnel with no evidence of immunity to varicella: 1 dose if previously received 1 dose varicella-containing vaccine; 2‑dose series 4–8 weeks apart if previously did not receive any varicella-containing vaccine, regardless of whether U.S.-born before 1980
• HIV infection with CD4 count ≥200 cells/μL with no evidence of immunity: Vaccination may be considered (2 doses, administered 3 months apart); VAR contraindicated in HIV infection with CD4 count <200 cells/μL
• Severe immunocompromising conditions: VAR contraindicated

Zoster vaccination

Routine vaccination

• Age 50 years or older: 2-dose series RZV (Shingrix) 2–6 months apart (minimum interval: 4 weeks; repeat dose if administered too soon) regardless of previous herpes zoster or history of ZVL (Zostavax) vaccination (administer RZV at least 2 months after ZVL)
• Age 60 years or older: 2-dose series RZV 2–6 months apart (minimum interval: 4 weeks; repeat if administered too soon) or 1 dose ZVL if not previously vaccinated. RZV preferred over ZVL (if previously received ZVL, administer RZV at least 2 months after ZVL)

Special situations

• Pregnancy: ZVL contraindicated; consider delaying RZV until after pregnancy if RZV is otherwise indicated
• Severe immunocompromising conditions (including HIV infection with CD4 count <200 cells/μL): ZVL contraindicated; recommended use of RZV under review

Vaccines in the Adult Immunization Schedule