Adult Vaccination Guidelines
Universal Vaccinations for All Adults
All adults aged ≥18 years should receive annual influenza vaccination and COVID-19 vaccination, with specific enhanced formulations recommended for older adults. 1, 2, 3
Influenza Vaccination
- Annual influenza vaccination is recommended for all adults regardless of age or health status 1, 2, 3
- Adults aged ≥65 years should preferentially receive high-dose inactivated influenza vaccine, recombinant influenza vaccine, or adjuvanted inactivated influenza vaccine for enhanced protection 2, 3
- Pregnant women should receive influenza vaccination during any trimester of pregnancy 1
Tetanus, Diphtheria, and Pertussis (Td/Tdap)
- One dose of Tdap should replace one Td booster in adulthood, followed by Td or Tdap booster every 10 years 1, 3
- Either Td or Tdap can be used for decennial boosters and tetanus prophylaxis for wound management 3
- Tdap is specifically recommended during each pregnancy, preferably between 27-36 weeks gestation, regardless of interval since prior Td or Tdap vaccination 1, 3
- Adults with uncertain vaccination histories should complete a 3-dose primary series: first 2 doses at least 4 weeks apart, third dose 6-12 months after the second 4
COVID-19 Vaccination
- COVID-19 vaccination is recommended for all adults with a primary series (2-3 doses) plus boosters 2
- Moderately or severely immunocompromised individuals may require 3 doses for the primary series 2
- Co-administration with influenza vaccine is acceptable with no required waiting period 2
Age-Based Vaccination Recommendations
Adults 19-26 Years
Adults 27-45 Years
- HPV vaccination based on shared clinical decision-making for adults 27-45 years 3
Adults 27-49 Years
- Hepatitis A vaccination: 2-3 doses depending on vaccine for those at risk 3
- Hepatitis B vaccination: 2-3 doses depending on vaccine for those at risk 3
Adults 50-64 Years
- Recombinant zoster vaccine (RZV): 2 doses recommended 3
Adults ≥60 Years
- Zoster vaccination: 2 doses of recombinant zoster vaccine (RZV, preferred) for adults aged ≥50 years 1, 3
- Single dose of live zoster vaccine (ZVL) is an alternative but less preferred 3
Adults ≥65 Years
- Pneumococcal vaccination: PCV13 based on shared clinical decision-making, followed by PPSV23 at least 1 year later 1, 3
- PPSV23 is recommended for all adults ≥65 years 3
Adults Born in 1957 or Later
- MMR vaccination: 1-2 doses depending on indication for adults lacking documentation of vaccination or evidence of immunity 3
Adults Born in 1980 or Later
- Varicella vaccination: 2 doses for adults without evidence of immunity 3
Medical Condition-Based Recommendations
Immunocompromised Individuals
- Pneumococcal vaccination is strongly recommended with both PCV13 and PPSV23 1, 3
- Live vaccines (MMR, varicella, live attenuated influenza vaccine, live zoster vaccine) are generally contraindicated 3
- 2-dose primary series of MenACWY for adults with HIV 3
- Hepatitis B vaccination recommended for adults with HIV infection 1
Chronic Medical Conditions
Chronic Pulmonary Disease (including asthma):
Chronic Cardiovascular Disease:
Diabetes Mellitus:
- Pneumococcal vaccination recommended 1, 3
- Hepatitis B vaccination recommended for all susceptible diabetics ≤60 years of age 5
Chronic Liver Disease:
- Pneumococcal vaccination recommended 1, 3
- Hepatitis B vaccination recommended, including for hepatitis C infection, cirrhosis, fatty liver disease, alcoholic liver disease, autoimmune hepatitis, and elevated liver enzymes 1, 3
End-Stage Renal Disease/Hemodialysis:
- Hepatitis B vaccination recommended with special high-dose formulation (40 µg/mL Recombivax HB or 2 doses of 20 µg/mL Engerix-B administered simultaneously) 1
Asplenia or Complement Deficiencies:
- Pneumococcal, meningococcal, and Haemophilus influenzae type b vaccines recommended 1
Risk Factor-Based Recommendations
Healthcare Personnel and Occupational Exposure
- Hepatitis B vaccination for healthcare personnel and public safety workers exposed to blood 1
- Hepatitis A vaccination for persons working with hepatitis A virus in laboratory settings 1
- Meningococcal vaccination for microbiologists routinely exposed to Neisseria meningitidis 1
Behavioral Risk Factors
- Hepatitis A vaccination for men who have sex with men 1
- Hepatitis A vaccination for persons who use illegal drugs 1
- Hepatitis B vaccination for sexually active persons not in long-term monogamous relationships 1
- Hepatitis B vaccination for current or recent injection drug users 1
- Hepatitis B vaccination for men who have sex with men 1
Travel
- Hepatitis A vaccination for persons traveling to countries with high or intermediate endemicity 1
Respiratory Syncytial Virus (RSV) Vaccination
- Single lifetime dose of RSV vaccine recommended for adults aged ≥75 years 6
- RSV vaccine recommended for adults aged 60-74 years at increased risk for severe RSV disease 6
Key Implementation Considerations
Vaccine Series Continuity
- Vaccine series do not need to be restarted regardless of time elapsed between doses 3
Special Formulations
- A 2-dose hepatitis B vaccine series (Heplisav-B) can be administered at least 4 weeks apart for adults ≥18 years 3
Common Pitfalls to Avoid
- Do not delay Tdap in pregnancy due to recent Td vaccination; Tdap should be given during each pregnancy 1, 3
- Do not assume adults born before 1980 are immune to varicella if they are healthcare personnel or pregnant women 4
- Do not use live vaccines in immunocompromised patients 3
- Do not restart vaccine series if doses are delayed; continue where left off 3
Coverage Gaps
Current vaccination coverage remains suboptimal: as of November 2024, only 34.7% of adults reported receiving influenza vaccine and 17.9% reported receiving COVID-19 vaccine for the 2024-25 season 6. Coverage is lowest among younger adults and those without health insurance 6.