National Immunization Schedule (NIS) Vaccination Recommendations
The National Immunization Schedule recommends specific vaccines based on age, health conditions, and risk factors, with all adults needing annual influenza vaccination, Tdap/Td boosters every 10 years, and age-specific vaccines like pneumococcal, zoster, and HPV vaccines to reduce morbidity and mortality from vaccine-preventable diseases. 1
Adult Vaccination Schedule by Age Group
All Adults (19+ years)
- Influenza: 1 dose annually 1
- Tetanus, diphtheria, pertussis: 1 dose Tdap, then Td or Tdap booster every 10 years 1
- Hepatitis A & B: 2-3 doses depending on vaccine and risk factors 1
Adults 19-26 years
- HPV (Human papillomavirus):
Adults 27-49 years
- MMR (Measles, Mumps, Rubella): 1-2 doses if born in 1957 or later and no evidence of immunity 1
- Varicella: 2 doses if born in 1980 or later and no evidence of immunity 1
Adults 50-64 years
- Zoster recombinant (RZV): 2 doses at age ≥50 years 1
Adults 65+ years
- Pneumococcal vaccines:
- Zoster recombinant (RZV): 2 doses (preferred) or Zoster live (ZVL): 1 dose 1
Special Populations and Conditions
Immunocompromised Persons
- Pneumococcal vaccines: Additional doses may be recommended 1
- MMR: Contraindicated in severe immunodeficiency 1
- Varicella: Contraindicated 1
- HPV: 3 doses through age 26 years 1
Pregnancy
- Influenza: Recommended annually 1
- Tdap: 1 dose during each pregnancy 1
- HPV: Not recommended until after pregnancy 1
- MMR & Varicella: Contraindicated during pregnancy 1
- MenB: Delay unless at increased risk 1
Anatomical or Functional Asplenia
- Meningococcal vaccines:
- Hib: 1 dose if previously did not receive Hib 1
Chronic Medical Conditions
- Pneumococcal vaccines: Recommended for those with chronic heart, lung, liver disease, diabetes, or alcoholism 1
- Hepatitis A: Recommended for chronic liver disease 1
- Hepatitis B: Recommended for diabetes, chronic liver disease, HIV infection, end-stage renal disease 1
Travel and Occupational Recommendations
International Travelers
- Hepatitis A: 2-dose series for travel to countries with high or intermediate endemic hepatitis A 1
- Hepatitis B: 2-3 dose series for travel to countries with high or intermediate prevalence of chronic HBV infection 1
- MenACWY: 1 dose for travel to countries with hyperendemic or epidemic meningococcal disease 1
Healthcare Personnel
- Influenza: Annual vaccination 1
- Hepatitis B: 3-dose series 1
- MMR: 2 doses if born in 1957 or later with no evidence of immunity 1
Important Implementation Considerations
- Documentation: Maintain complete vaccination records to avoid unnecessary revaccination 1
- Missed opportunities: Despite healthcare access, 20-87% of adults with health insurance and frequent physician contact remain unvaccinated for recommended vaccines 2
- Disparities: Vaccination coverage is generally lower among non-White adults compared to non-Hispanic White adults 2
Common Pitfalls to Avoid
- Delaying vaccination: Adult vaccination rates remain well below Healthy People 2020 targets 3
- Improper scheduling: Administering vaccines out of sequence can affect efficacy 4
- Missing high-risk groups: Special populations often need modified schedules or additional vaccines 1
- Overlooking boosters: Many adults require booster doses to maintain immunity 1
- Neglecting to verify immunity: For MMR and varicella, documentation of immunity is important before vaccination 1
The NIS vaccination schedule is designed to optimize protection against vaccine-preventable diseases throughout life, reducing morbidity and mortality while improving quality of life for adults of all ages.