What is the recommended immunization schedule for adults?

Adult Immunization Schedule Recommendations

The recommended adult immunization schedule includes annual influenza vaccination for all adults, Tdap/Td boosters every 10 years, age-appropriate pneumococcal vaccination for adults ≥65 years, zoster vaccination for adults ≥50 years, and additional vaccines based on age, medical conditions, and risk factors. 1

Core Adult Vaccinations by Age Group

For All Adults (19+ years)

• Influenza: Annual vaccination with inactivated (IIV) or recombinant (RIV) vaccine 2
  • Note: Live attenuated influenza vaccine (LAIV) should not be used in adults with certain medical conditions 2
• Tetanus, diphtheria, pertussis: One-time Tdap dose for those who haven't received it, then Td or Tdap booster every 10 years 2

Adults 19-26 years

• Human papillomavirus (HPV): 2-3 doses depending on age at initial vaccination 2
  • If vaccination started before age 15 and received 2 doses at least 5 months apart, no additional doses needed 2
  • Otherwise, complete 3-dose series (0,1-2, and 6 months) 2
• Measles, mumps, rubella (MMR): 1-2 doses for adults born in 1957 or later without evidence of immunity 2
• Varicella: 2 doses for adults born in 1980 or later without evidence of immunity 2

Adults 27-49 years

• HPV: Shared clinical decision-making for adults 27-45 years 1
• Hepatitis A and B: 2-3 doses depending on vaccine and risk factors 2
• Meningococcal vaccines: Based on risk factors 2

Adults 50-64 years

• Zoster recombinant (RZV): 2 doses for adults ≥50 years 2
• Pneumococcal: For adults with certain medical conditions 1

Adults 65+ years

• Pneumococcal: All adults ≥65 years should receive pneumococcal polysaccharide vaccine (PPSV23) 2
  • Pneumococcal conjugate vaccine (PCV13) based on shared clinical decision-making 1
  • Consider PCV13 for those in nursing homes, areas with low pediatric PCV13 uptake, travelers to regions without pediatric PCV13 programs, or those with chronic conditions 2

Vaccinations for Special Populations

Pregnant Women

• Tdap: One dose during each pregnancy, preferably between 27-36 weeks gestation 1
• Influenza: Annual inactivated vaccine recommended 1
• Avoid live vaccines: MMR, Varicella, and live Zoster vaccines are contraindicated 1

Adults with Chronic Medical Conditions

• Pneumococcal: Recommended for adults with:
  • Chronic heart, lung, or liver disease
  • Diabetes
  • Alcoholism
  • Smoking history
  • Multiple chronic conditions 2
• Hepatitis B: Recommended for adults with chronic liver disease, including hepatitis C infection, cirrhosis, fatty liver disease, alcoholic liver disease, autoimmune hepatitis, and elevated liver enzymes 2

Immunocompromised Adults

• Meningococcal: Adults with HIV infection should receive a 2-dose primary series of MenACWY 2
• Avoid live vaccines: MMR, Varicella, and live Zoster vaccines are contraindicated 1
• Additional pneumococcal protection may be needed 1

Common Vaccination Errors to Avoid

1. Overlooking Tdap: All adults should receive one lifetime dose of Tdap, regardless of when they received their last Td 1
2. Neglecting annual influenza vaccination 1
3. Failure to revaccinate with PPSV23 in patients who received it before age 65 1
4. Co-administration errors: PCV13 and PPSV23 should not be administered simultaneously 1
5. Missing high-risk indications for additional vaccines, such as smoking being an indication for pneumococcal vaccination 1

Recent Updates to Vaccination Recommendations

• As of 2024, the Advisory Committee on Immunization Practices (ACIP) has expanded pneumococcal conjugate vaccine recommendations to include all adults aged ≥50 years 3
• The ACIP now recommends either 20-valent PCV (PCV20) alone or 15-valent PCV (PCV15) in series with PPSV23 for adults aged ≥65 years and adults 19-64 years with certain risk factors 4
• Post-COVID-19 pandemic, there has been increased focus on adult immunization globally, though disparities exist across income groups 5

Practical Approach to Adult Vaccination

1. Assess by age: Determine recommended vaccinations based on age group
2. Evaluate medical conditions: Identify additional recommended vaccines based on health status
3. Review vaccination history: Check for missing or incomplete vaccinations
4. Consider special circumstances: Pregnancy, immunocompromised status, travel plans

For specific guidance on vaccination schedules and special situations, healthcare providers should consult the CDC's Advisory Committee on Immunization Practices (ACIP) recommendations or use the CDC Vaccine Schedules App 2.