What vaccines are recommended for adults?

Recommended Adult Immunization Schedule

All adults should receive routine vaccinations according to the CDC's Advisory Committee on Immunization Practices (ACIP) recommendations, including annual influenza vaccination, tetanus-diphtheria boosters, and age-appropriate pneumococcal, zoster, and other vaccines based on risk factors. 1

Core Vaccinations for All Adults

Influenza Vaccine

• Annual vaccination recommended for all adults regardless of age 1
• Options include:
  • Inactivated influenza vaccine (IIV)
  • Recombinant influenza vaccine (RIV)
  • Live attenuated influenza vaccine (LAIV) for healthy, non-pregnant adults under 50 years
• Adults ≥65 years should preferably receive high-dose or adjuvanted formulation 2

Tetanus, Diphtheria, Pertussis (Td/Tdap)

• One-time dose of Tdap for all adults who have not previously received it 1
• Td or Tdap booster every 10 years thereafter 1
• Pregnant women: One dose of Tdap during each pregnancy, preferably between 27-36 weeks gestation 1
• Administration: Intramuscular injection in deltoid muscle 3

Age-Based Recommendations

Adults 19-26 years

• Human Papillomavirus (HPV): 2 or 3 doses depending on age at initial vaccination 1
• Measles, Mumps, Rubella (MMR): 1 or 2 doses for adults born in 1957 or later without evidence of immunity 1
• Varicella (VAR): 2 doses if born in 1980 or later without evidence of immunity 1

Adults 27-49 years

• HPV: Shared clinical decision-making for adults 27-45 years 1
• Hepatitis A and B: For those at risk (see risk factors below) 1

Adults 50-64 years

• Pneumococcal vaccine: Single dose of pneumococcal conjugate vaccine (PCV) for all adults ≥50 years 4
• Zoster recombinant vaccine (RZV): 2 doses at age ≥50 years 1, 2

Adults ≥65 years

• Pneumococcal vaccines:
  • PPSV23 (one dose) recommended for all adults ≥65 years 2
  • PCV13 recommended based on shared clinical decision-making for immunocompetent adults 2
  • If PCV13 is given, administer before PPSV23 with at least 1 year between doses 2
• Zoster recombinant vaccine (RZV): 2 doses preferred over zoster live vaccine (ZVL) 2

Risk-Based Recommendations

Hepatitis A Vaccine

• 2 or 3 doses for adults with:
  • Chronic liver disease 1
  • Men who have sex with men 1
  • Injection drug use 1
  • Travel to endemic countries 1

Hepatitis B Vaccine

• 3 doses for adults with:
  • Chronic liver disease 1
  • HIV infection 1
  • Sexual exposure risk 1
  • Healthcare workers 1
  • Diabetes (age 19-59 years; ≥60 years at provider discretion) 1
• Administration: Intramuscular injection 5

Meningococcal Vaccines

• MenACWY: 1 or 2 doses for adults with:
  • Anatomical or functional asplenia 1
  • Persistent complement component deficiency 1
  • Eculizumab use 2
  • HIV infection 1
• MenB: Consider for adults aged 19-23 years; recommended for those with specific risk factors 1

Haemophilus influenzae type b (Hib)

• 1 or 3 doses for adults with:
  • Anatomical or functional asplenia 1
  • Hematopoietic stem cell transplant 1

Special Populations

Pregnant Women

• Recommended: Influenza vaccine (inactivated), Tdap 1
• NOT recommended: MMR, Varicella, Zoster live vaccine 1
• Delay: HPV, Zoster recombinant vaccine 1

Immunocompromised Individuals

• Avoid live vaccines: MMR, Varicella, LAIV, Zoster live vaccine 1
• Recommended: Additional pneumococcal vaccination 1
• PCV13 strongly recommended for adults ≥65 years with immunocompromising conditions 2

Adults with Chronic Conditions

• Diabetes: Additional indication for hepatitis B, pneumococcal vaccines 1
• Chronic liver disease: Additional indication for hepatitis A and B, pneumococcal vaccines 1
• Heart or lung disease: Additional indication for pneumococcal vaccines 1
• End-stage renal disease: Additional indication for pneumococcal, hepatitis B vaccines 1

Common Pitfalls to Avoid

1. Inadequate pneumococcal vaccination: Failure to revaccinate with PPSV23 in patients who received it before age 65 2
2. Improper vaccine timing: PCV13 and PPSV23 should not be administered simultaneously 2
3. Missing high-risk indications: Smoking is an indication for pneumococcal vaccination 2
4. Overlooking Tdap: Adults should receive one lifetime dose of Tdap, regardless of when they received their last Td 1
5. Neglecting influenza vaccination: Annual vaccination is recommended for all adults 1

Vaccination Coverage Challenges

Despite recommendations, vaccination coverage among adults remains suboptimal:

• Pneumococcal vaccination coverage among adults ≥65 years and those with high-risk conditions remains below target levels 6
• Barriers to pneumococcal vaccination include lack of provider recommendation, low awareness, and misconceptions 7
• Age-based recommendations (such as for influenza) tend to achieve higher coverage rates than risk-based recommendations 8

By following these evidence-based recommendations, healthcare providers can help improve vaccination rates and reduce the burden of vaccine-preventable diseases among adults.