What is the recommended adult vaccination schedule?

Recommended Adult Immunization Schedule

The Advisory Committee on Immunization Practices (ACIP) recommends a comprehensive adult vaccination schedule that includes annual influenza vaccination for all adults, Tdap/Td boosters every 10 years, pneumococcal vaccines for adults ≥65 years, and specific vaccines based on age, health conditions, and risk factors. 1

Core Vaccinations for All Adults

• Influenza: Annual vaccination for all adults, with high-dose or adjuvanted vaccines preferred for adults ≥65 years 1, 2
• Tetanus, Diphtheria, Pertussis (Td/Tdap): One dose of Tdap, followed by Td or Tdap booster every 10 years; either Td or Tdap can be used for decennial boosters 1
• Measles, Mumps, Rubella (MMR): 1-2 doses for adults born in 1957 or later who lack documentation of vaccination or evidence of immunity 1
• Varicella (Chickenpox): 2 doses for adults born in 1980 or later without evidence of immunity 1

Age-Specific Recommendations

Adults 19-26 years:

• Human Papillomavirus (HPV): 2-3 dose series depending on age at initial vaccination 1
  • Women through age 26 years and men through age 21 years should receive a 3-dose series if not previously vaccinated 1
  • Those who initiated HPV series before age 15 years and received 2 doses at least 5 months apart are considered adequately vaccinated 1

Adults 27-49 years:

• Hepatitis A: 2-3 doses depending on vaccine for those at risk 1
• Hepatitis B: 2-3 doses depending on vaccine for those at risk 1
• HPV: Shared clinical decision-making for adults 27-45 years 1

Adults 50-64 years:

• Zoster (Shingles): 2 doses of recombinant zoster vaccine (RZV, preferred) 1

Adults ≥65 years:

• Pneumococcal:
  • PCV13 (conjugate) based on shared clinical decision-making for immunocompetent adults 1
  • PPSV23 (polysaccharide) recommended for all adults in this age group 1
• Zoster: 2 doses of RZV (preferred) or 1 dose of ZVL 1

Special Population Recommendations

Immunocompromised Individuals:

• Pneumococcal: Both PCV13 and PPSV23 recommended 1
• Meningococcal: 2-dose primary series of MenACWY for adults with HIV 1
• Live vaccines (MMR, VAR, LAIV, ZVL): Generally contraindicated 1

Chronic Medical Conditions:

• 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 1
• Pneumococcal: Recommended for adults with chronic heart, lung, or liver disease, diabetes, or alcoholism 1

Pregnant Women:

• Tdap: One dose during each pregnancy, preferably between 27-36 weeks gestation 1
• Influenza: Recommended during any trimester of pregnancy 1
• Live vaccines (MMR, VAR, LAIV, ZVL): Contraindicated during pregnancy 1

Recent Updates to Vaccination Recommendations

• As of 2020, PCV13 is recommended based on shared clinical decision-making for adults ≥65 years who do not have an immunocompromising condition 1
• Either Td or Tdap can now be used for decennial boosters and tetanus prophylaxis for wound management 1
• For the 2018-2019 influenza season, LAIV was reintroduced as an option for adults through age 49 years without contraindications 1
• A new hepatitis B vaccine (Heplisav-B) can be administered in a 2-dose series at least 4 weeks apart for adults ≥18 years 1

Common Pitfalls in Adult Vaccination

• Missed opportunities: Healthcare providers should assess vaccination status at every clinical encounter 3
• Incomplete series: Vaccine series do not need to be restarted regardless of the time elapsed between doses 1
• Undervaccination of high-risk groups: Despite recommendations, vaccination coverage remains below Healthy People 2020 targets, particularly among adults with chronic conditions 3, 4
• Racial/ethnic disparities: Persistent gaps in vaccination coverage exist across racial and ethnic groups 3

Remember that these recommendations are updated annually by the ACIP, and clinicians should refer to the most current guidelines for the latest information on adult immunizations 1.