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

Adult Vaccination Recommendations

All adults should follow a comprehensive vaccination schedule based on age, health status, and risk factors to prevent vaccine-preventable diseases and their associated morbidity and mortality. 1

Age-Based Recommendations

• Annual influenza vaccination is recommended for all adults regardless of age or health status 1
• Tetanus and diphtheria (Td) booster should be administered every 10 years, with one dose of Tdap (tetanus, diphtheria, pertussis) substituting for one Td booster in adulthood 1
• Human Papillomavirus (HPV) vaccination is recommended as a 3-dose series for women through age 26 years 1
• Human Papillomavirus (HPV) vaccination is recommended as a 3-dose series for men through age 21 years 1
• Zoster (shingles) vaccination is recommended as a single dose for adults aged ≥60 years, regardless of previous history of herpes zoster 1
• Pneumococcal vaccination is recommended for adults 65 years or older: PCV13 (based on shared clinical decision-making) followed by PPSV23 at least 1 year later 1

Health Status-Based Recommendations

• Pneumococcal vaccination is strongly recommended for immunocompromised individuals 1
• Pneumococcal vaccination is recommended for adults with:
  • Chronic pulmonary disease (including asthma) 1
  • Chronic cardiovascular diseases 1
  • Diabetes mellitus 1
  • Chronic liver diseases 1
• Hepatitis B vaccination is recommended for:
  • Adults with end-stage renal disease, including patients receiving hemodialysis 1
  • Adults with HIV infection 1
  • Adults with chronic liver disease 1

Risk Factor-Based Recommendations

Occupational Risk Factors

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

Behavioral Risk Factors

• Hepatitis A vaccination is recommended for:
  • Men who have sex with men 1
  • Persons who use illegal drugs 1
• Hepatitis B vaccination is recommended for:
  • Sexually active persons not in long-term monogamous relationships 1
  • Current or recent injection drug users 1
  • Men who have sex with men 1

Travel-Related Risk Factors

• Hepatitis A vaccination is recommended for persons traveling to countries with high or intermediate endemicity of hepatitis A 1

Special Populations

Pregnant Women

• Tdap vaccination is recommended during each pregnancy, preferably between 27-36 weeks gestation 1
• Influenza vaccination is recommended for all pregnant women during influenza season 1

Asplenia

• Pneumococcal, meningococcal, and Haemophilus influenzae type b vaccines are recommended for individuals with asplenia 1

Specific Vaccine Administration Guidelines

Meningococcal Vaccine

• For individuals 10 through 55 years of age, a single dose of meningococcal conjugate vaccine is recommended 2
• A booster dose may be administered to individuals 15 through 55 years of age who remain at continued risk for meningococcal disease if at least 4 years have elapsed since a prior dose 2
• For children aged 2 through 5 years at continued high risk of meningococcal disease, a second dose may be administered 2 months after the first dose 2

Hepatitis B Vaccine

• The standard immunization regimen consists of 3 doses: initial dose, second dose 1 month later, and third dose 6 months after the first dose 3
• Adult dosage (>19 years) is 20 mcg/1.0 mL on a 0,1,6 month schedule 3
• Adult hemodialysis patients require a higher dose (40 mcg/2.0 mL) on a 0,1,2,6 month schedule 3
• For hemodialysis patients, annual antibody testing is recommended with booster doses when antibody levels decline below 10 mIU/mL 3

Challenges and Considerations

• Despite longstanding recommendations, adult vaccination coverage remains low and below Healthy People 2020 targets 4, 5
• Racial/ethnic disparities persist for all routinely recommended adult vaccines, with higher coverage generally observed among whites compared to other groups 5
• Adults without health insurance are significantly less likely to receive recommended vaccines 5
• Having a usual place for healthcare and regular physician contact is associated with higher vaccination rates 5
• Awareness of the need for vaccines among adults is low, and patients largely rely on healthcare provider recommendations 4

Strategies to Improve Vaccination Coverage

• Healthcare providers should assess vaccination status at every clinical encounter 4
• Providers should routinely recommend and offer needed vaccines to adult patients 5
• Implementation of reminder-recall systems and standing-order programs for vaccination can improve coverage 5
• Assessment of practice-level vaccination rates with feedback to staff members can help identify areas for improvement 5
• Special efforts should be made to reach adults without regular healthcare providers or insurance 5