Which vaccines are adjuvanted?

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Last updated: October 20, 2026 • View editorial policy

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Adjuvanted Vaccines Currently Available in the United States

Several vaccines containing nonaluminum adjuvants are licensed in the United States, including Shingrix (AS01B adjuvant), Fluad/Fluad Quadrivalent (MF59 adjuvant), Heplisav-B (CpG oligodeoxynucleotide adjuvant), and Arexvy (AS01E adjuvant). 1, 2

Specific Adjuvanted Vaccines by Disease

Herpes Zoster (Shingles)

  • Shingrix (recombinant zoster subunit vaccine)
    • Contains AS01B adjuvant
    • Licensed for adults ≥50 years
    • Two-dose series 1, 2

Influenza

  • Fluad/Fluad Quadrivalent (adjuvanted inactivated influenza vaccine)
    • Contains MF59 adjuvant (oil-in-water emulsion)
    • Licensed for adults ≥65 years
    • Annual administration 1, 2, 3

Hepatitis B

  • Heplisav-B (recombinant hepatitis B surface antigen vaccine)
    • Contains cytosine phosphoguanine (CpG) 1018 oligodeoxynucleotide adjuvant
    • Licensed for adults ≥18 years
    • Two-dose series (at least 4 weeks apart) 1, 2, 4
    • Not recommended during pregnancy due to lack of safety data 4

Respiratory Syncytial Virus (RSV)

  • Arexvy (RSV vaccine)
    • Contains AS01E adjuvant
    • Licensed for older adults 2

Important Clinical Considerations

Coadministration Guidance

When administering adjuvanted vaccines with other vaccines:

  • Administer at separate anatomic sites when giving concomitantly 1, 2
  • Consider using nonadjuvanted alternatives when two nonaluminum adjuvant-containing vaccines need simultaneous administration, though vaccination should not be delayed if specific products are unavailable 1, 2
  • If administering vaccines more likely to cause injection site reactions (HD-IIV3, aIIV3), give in different limbs when possible 2

Safety Profile

Limited data exist on simultaneous administration of multiple nonaluminum adjuvant-containing vaccines. However, coadministration of Shingrix with nonadjuvanted influenza vaccine showed no decreased immunogenicity or safety concerns, with most reactogenicity symptoms resolving within 4 days 1, 2

Aluminum-Based Adjuvants

Note that traditional aluminum salt adjuvants (aluminum hydroxide, aluminum phosphate) are present in many other vaccines but are distinct from the newer nonaluminum adjuvants discussed above. The guidelines specifically highlight these newer adjuvant systems as requiring special consideration for coadministration 1, 2

References

4
Guideline

recommended adult immunization schedule, united states, 2019.

Annals of Internal Medicine, 2019

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.