What vaccinations are recommended for adults based on age, health status, and other risk factors?

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Adult Vaccination Recommendations

Adult vaccination recommendations should be tailored based on age, health status, and specific risk factors to prevent vaccine-preventable diseases that cause significant morbidity and mortality. 1

Age-Based Recommendations

All Adults

  • Annual influenza vaccination is recommended for all adults regardless of age or health status 1
  • Tetanus and diphtheria (Td) booster every 10 years, with one dose of Tdap (tetanus, diphtheria, pertussis) substituting for one Td booster in adulthood 1

Adults 19-26 years

  • Human Papillomavirus (HPV) vaccination:
    • Women through age 26 years: 3-dose series 1
    • Men through age 21 years: 3-dose series 1
    • Men who have sex with men: recommended through age 26 years 1

Adults 60 years and older

  • Zoster (shingles) vaccination: 1 dose recommended for adults aged ≥60 years, regardless of previous history of herpes zoster 1
  • Pneumococcal vaccination:
    • Age 65 years or older: PCV13 (based on shared clinical decision-making) followed by PPSV23 at least 1 year later 1
    • These vaccines should not be administered during the same visit 1

Health Status-Based Recommendations

Immunocompromised Individuals

  • Pneumococcal vaccination is strongly recommended 1
  • Live vaccines (MMR, varicella, zoster, live influenza) are contraindicated 1
  • Additional doses of certain vaccines may be recommended 1

Chronic Medical Conditions

  • Pneumococcal vaccination is recommended for adults with:

    • Chronic pulmonary disease (including asthma)
    • Chronic cardiovascular diseases
    • Diabetes mellitus
    • Chronic liver diseases
    • Chronic alcoholism
    • Chronic renal failure or nephrotic syndrome
    • Functional or anatomic asplenia
    • Immunosuppressive conditions
    • Cochlear implants and cerebrospinal fluid leaks 1

  • Hepatitis B vaccination is recommended for adults with:

    • End-stage renal disease, including patients receiving hemodialysis
    • HIV infection
    • Chronic liver disease 1, 2
    • For hemodialysis patients: 40 mcg (2 × 20 mcg) dose at 0,1,2, and 6 months with annual antibody testing 2

Risk Factor-Based Recommendations

Occupational Risk

  • Hepatitis B vaccination for healthcare personnel and public safety workers exposed to blood 1, 2
  • Hepatitis A vaccination for persons working with hepatitis A virus in laboratory settings 1
  • Meningococcal vaccination for microbiologists routinely exposed to Neisseria meningitidis 1, 3

Behavioral Risk

  • Hepatitis A vaccination for:

    • Men who have sex with men
    • Persons who use illegal drugs 1

  • Hepatitis B vaccination for:

    • Sexually active persons not in long-term monogamous relationships
    • Current or recent injection drug users
    • Men who have sex with men 1

Travel Risk

  • Hepatitis A vaccination for persons traveling to countries with high or intermediate endemicity of hepatitis A 1
  • Meningococcal vaccination may be recommended for certain international travelers 3

Special Considerations

Pregnancy

  • Tdap is recommended during each pregnancy, preferably between 27-36 weeks gestation 1
  • Influenza vaccination is recommended for all pregnant women during influenza season 1
  • Varicella, MMR, and zoster vaccines are contraindicated during pregnancy 1

Asplenia

  • Pneumococcal, meningococcal, and Haemophilus influenzae type b vaccines are recommended 1
  • For meningococcal vaccination in asplenia: 2-dose primary series MenB (Bexsero) at least 1 month apart; or 3-dose primary series MenB-FHbp (Trumenba) at 0,1-2,6 months 1, 3

Common Pitfalls and Barriers to Adult Vaccination

  • Low awareness: Adult vaccination rates remain well below Healthy People 2020 targets 4, 5
  • Racial/ethnic disparities persist for all routinely recommended adult vaccines 4, 6
  • Lack of health insurance significantly decreases likelihood of vaccination 6
  • Lack of usual place for healthcare reduces vaccination rates 6

Strategies to Improve Adult Vaccination Rates

  • Healthcare providers should assess vaccination status at every clinical encounter 4, 5
  • Implement reminder-recall systems and standing-order programs for vaccination 6
  • Assess practice-level vaccination rates with feedback to staff members 6
  • Target interventions to populations with lowest vaccination rates, including those without regular healthcare providers or insurance 6

Adult vaccination is a critical component of preventive healthcare that requires a systematic approach based on age, health status, and risk factors to reduce the burden of vaccine-preventable diseases.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

5
Research

Noninfluenza vaccination coverage among adults - United States, 2011.

MMWR. Morbidity and mortality weekly report, 2013

6
Research

Surveillance of Vaccination Coverage Among Adult Populations - United States, 2014.

Morbidity and mortality weekly report. Surveillance summaries (Washington, D.C. : 2002), 2016

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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.

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