What other vaccinations are recommended?

Recommended Adult Vaccinations

All adults require a core set of routine vaccinations regardless of specific risk factors, including annual influenza vaccine, tetanus-diphtheria-pertussis (Tdap/Td) boosters, and age-appropriate vaccines such as pneumococcal, HPV, and zoster vaccines. 1

Universal Vaccinations for All Adults

Influenza Vaccination

• Annual influenza vaccination is recommended for all adults aged ≥19 years, regardless of health status or risk factors 2, 1
• Choose between inactivated influenza vaccine (IIV), recombinant influenza vaccine (RIV), or live attenuated influenza vaccine (LAIV) based on age and health status 2
• Adults aged 18-49 years without high-risk conditions can receive any age-appropriate formulation 2
• Adults aged ≥50 years should receive IIV or RIV (not LAIV) 2

Tetanus, Diphtheria, and Pertussis (Tdap/Td)

• One dose of Tdap should be administered to all adults who have not previously received it, followed by Td booster every 10 years 2, 1
• Adults with unknown or incomplete vaccination history should complete a 3-dose primary series including one Tdap dose 2
• Pregnant women should receive Tdap during each pregnancy, preferably between 27-36 weeks gestation, regardless of prior vaccination timing 2, 1

Age-Based Vaccinations

Human Papillomavirus (HPV)

• Women through age 26 years should receive a 3-dose HPV vaccine series 1
• Men through age 21 years should receive a 3-dose HPV vaccine series 1

Zoster (Shingles)

• Adults aged ≥60 years should receive one dose of zoster vaccine, regardless of previous herpes zoster history 1

Pneumococcal Vaccination

• Adults aged ≥65 years should receive PCV13 (based on shared clinical decision-making) followed by PPSV23 at least 1 year later 1

Medical Condition-Based Vaccinations

Pneumococcal Vaccine (for adults <65 years)

• Strongly recommended for immunocompromised individuals 1
• Chronic pulmonary disease including asthma 1
• Chronic cardiovascular disease 1
• Diabetes mellitus 1
• Chronic liver disease including cirrhosis 1, 3
• Chronic renal failure or nephrotic syndrome 2
• Functional or anatomic asplenia 2
• Cochlear implants or cerebrospinal fluid leaks 2
• Administer both PCV13 and PPSV23 in sequence, with PCV13 first followed by PPSV23 at least 8 weeks later 3

Hepatitis B Vaccination

• End-stage renal disease including hemodialysis patients 1
• HIV infection 1
• Chronic liver disease 1, 3
• Healthcare personnel and public safety workers exposed to blood 1
• Sexually active persons not in long-term monogamous relationships 2, 1
• Current or recent injection drug users 1
• Men who have sex with men 1
• The 2-dose Heplisav-B vaccine (given ≥4 weeks apart) is an alternative to traditional 3-dose series for adults ≥18 years, though pregnant women should not receive Heplisav-B due to lack of safety data 2

Hepatitis A Vaccination

• Chronic liver disease including cirrhosis (2-dose series) 2, 3
• Men who have sex with men 2, 1
• Persons who use injection or noninjection drugs 2, 1
• Persons working with hepatitis A virus in laboratory settings 2, 1
• Travelers to countries with high or intermediate hepatitis A endemicity 2, 1
• Persons experiencing homelessness should receive routine hepatitis A vaccination 2
• Administer as 2-dose series of single-antigen vaccine or 3-dose series of combination hepatitis A and B vaccine (Twinrix) 2

Meningococcal Vaccination

• Microbiologists routinely exposed to Neisseria meningitidis 1
• Persons with anatomic or functional asplenia 2

Special Populations

Pregnant Women

• Tdap during each pregnancy (27-36 weeks gestation preferred) 2, 1
• Annual influenza vaccination during influenza season 1
• Avoid Heplisav-B hepatitis B vaccine due to lack of safety data 2
• Avoid LAIV (use IIV instead) 2

Healthcare Personnel

• Annual influenza vaccination 2
• Hepatitis B vaccination 1
• Healthcare workers caring for severely immunocompromised persons should receive IIV or RIV rather than LAIV 2

Important Caveats

Contraindications to Influenza Vaccine

• Severe allergic reaction to any vaccine component 2
• History of Guillain-Barré syndrome within 6 weeks of previous influenza vaccination is a precaution (not absolute contraindication) 2

LAIV-Specific Contraindications

• Pregnancy 2
• Immunocompromised persons 2
• Close contacts or caregivers of severely immunocompromised persons 2
• Persons who received influenza antiviral medications in previous 48 hours 2
• Cerebrospinal fluid leak or cochlear implant 2

Revaccination Considerations

• Pneumococcal revaccination after 5 years for persons with chronic renal failure, nephrotic syndrome, functional or anatomic asplenia, or immunosuppressive conditions 2, 3
• For persons aged ≥65 years, one-time pneumococcal revaccination if previously vaccinated ≥5 years ago when aged <65 years 2