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

Adult Vaccination Recommendations

All adults should receive annual influenza vaccination and COVID-19 vaccination, with Td/Tdap boosters every 10 years, and additional vaccines based on age, medical conditions, and risk factors as outlined below. 1, 2

Universal Vaccinations for All Adults

• Influenza vaccine annually for all adults ≥18 years, regardless of age or health status 1, 2

  • Adults ≥65 years should preferentially receive high-dose inactivated, recombinant, or adjuvanted formulations for enhanced protection 2
  • Pregnant women should receive influenza vaccination during any trimester 2

• COVID-19 vaccination with primary series (2-3 doses) plus boosters for all adults 2

  • Moderately or severely immunocompromised individuals may require 3 doses for primary series 2
  • Can be co-administered with influenza vaccine without waiting period 2

• Tetanus-diphtheria-pertussis (Td/Tdap) with one dose of Tdap replacing one Td booster in adulthood, followed by Td or Tdap every 10 years 1, 2

  • Adults with uncertain vaccination history should complete 3-dose primary series: first 2 doses ≥4 weeks apart, third dose 6-12 months after second 2
  • Tdap during each pregnancy between 27-36 weeks gestation, regardless of interval since prior Td/Tdap 1, 2

Age-Based Vaccination Schedule

Ages 19-26 Years

• HPV vaccination: 2-3 dose series depending on age at initial vaccination 2
  • Women through age 26 years: 3-dose series 1
  • Men through age 21 years: 3-dose series 1

Ages 27-45 Years

• HPV vaccination based on shared clinical decision-making 2

Ages 50-64 Years

• Recombinant zoster vaccine (RZV): 2 doses 2

Ages ≥60 Years

• Zoster (shingles) vaccination: 2 doses of RZV (preferred), regardless of previous herpes zoster history 1, 2

Ages ≥65 Years

• Pneumococcal vaccination: PCV13 (based on shared clinical decision-making) followed by PPSV23 at least 1 year later 1, 2
  • PPSV23 recommended for all adults ≥65 years 2

Medical Condition-Based Recommendations

Immunocompromised Individuals

• Pneumococcal vaccination strongly recommended with both PCV13 and PPSV23 1, 2
• 2-dose primary series of MenACWY 2
• Hepatitis B vaccination 1, 2
• Live vaccines contraindicated (MMR, varicella, live attenuated influenza vaccine, live zoster vaccine) 2

Chronic Pulmonary Disease (Including Asthma)

• Pneumococcal vaccination 1, 2

Chronic Cardiovascular Disease

• Pneumococcal vaccination 1, 2

Diabetes Mellitus

• Pneumococcal vaccination 1, 2

Chronic Liver Disease

• Pneumococcal vaccination 1, 2
• Hepatitis B vaccination (including hepatitis C, cirrhosis, fatty liver disease, alcoholic liver disease, autoimmune hepatitis, elevated liver enzymes) 1, 2

End-Stage Renal Disease/Hemodialysis

• Hepatitis B vaccination with special high-dose formulation (40 µg/mL Recombivax HB or 2 doses of 20 µg/mL Engerix-B administered simultaneously) 1, 2, 3
  • For hemodialysis patients: 40 mg (2 × 20 mg) on 0,1,2,6 months schedule 3
  • Annual antibody testing recommended; give booster when antibody levels decline below 10 mIU/mL 3

HIV Infection

• Hepatitis B vaccination 1, 2
• 2-dose primary series of MenACWY 2

Asplenia or Complement Deficiencies

• Pneumococcal, meningococcal, and Haemophilus influenzae type b vaccines 1, 2

Risk Factor-Based Recommendations

Healthcare Personnel and Public Safety Workers

• Hepatitis B vaccination for those exposed to blood 1, 2

Laboratory Workers

• Hepatitis A vaccination for those working with hepatitis A virus 1, 2
• Meningococcal vaccination for microbiologists routinely exposed to Neisseria meningitidis 1, 2, 4

Men Who Have Sex with Men

• Hepatitis A vaccination 1, 2
• Hepatitis B vaccination 1, 2

Substance Use

• Hepatitis A vaccination for persons who use illegal drugs 1, 2
• Hepatitis B vaccination for current or recent injection drug users 1, 2

Sexual Risk Factors

• Hepatitis B vaccination for sexually active persons not in long-term monogamous relationships 1, 2

International Travel

• Hepatitis A vaccination for persons traveling to countries with high or intermediate endemicity 1, 2

Critical Implementation Considerations

• Vaccine series do not need to be restarted regardless of time elapsed between doses; continue where left off 2
• Do not delay Tdap in pregnancy due to recent Td vaccination; give during each pregnancy 2
• Do not assume adults born before 1980 are immune to varicella if they are healthcare personnel or pregnant women 2
• 2-dose hepatitis B vaccine series (Heplisav-B) can be administered at least 4 weeks apart for adults ≥18 years 2
• Administer vaccines immediately after reconstitution for products requiring reconstitution 4

Common Pitfalls to Avoid

The most significant barrier to adult vaccination is missed opportunities during clinical encounters—even among adults with health insurance and ≥10 physician contacts per year, 18.2%-85.6% remain unvaccinated for recommended vaccines 5. Healthcare providers must assess vaccination status, recommend, and offer vaccines at every clinical encounter 6, 7. Racial/ethnic disparities persist across all vaccines, with generally lower coverage among non-white populations 6, 7, 5. Adults without health insurance or a usual place for healthcare consistently report lower vaccination rates 5.