What vaccine should be given to a patient without an immunization record?

Vaccination Strategy for Adults Without Immunization Records

Adults without immunization records should be assumed unvaccinated and immediately receive all age-appropriate vaccines according to the current CDC immunization schedule, as administering vaccines to previously immunized individuals poses no additional risk. 1

Core Vaccination Approach

• Administer indicated vaccines immediately without waiting for records or serologic confirmation, prioritizing protection over theoretical concerns about redundant vaccination. 1
• The standard approach is to give vaccines rather than attempt serologic testing for most vaccines, as giving an extra dose to someone already immune is safe and avoids delays in protection. 1

Universal Vaccines for All Adults (Regardless of Age)

Tetanus-Diphtheria-Pertussis (Td/Tdap)

• Administer a complete 3-dose primary series if no documentation exists: first two doses at least 4 weeks apart, third dose 6-12 months after the second. 1

Influenza

• Give annual influenza vaccination regardless of age: standard-dose inactivated vaccine for adults 18-64 years, high-dose or adjuvanted formulations for those ≥65 years. 1

Hepatitis B

• Universal vaccination is recommended for all adults aged 19-59 years with either a 2-dose series of HEPLISAV-B at 0 and 1 month, or a 3-dose series of ENGERIX-B, Recombivax HB, or PreHevbrio at 0,1, and 6 months. 1

Age-Specific Vaccine Recommendations

Adults 19-49 Years

• MMR vaccine: Give 1-2 doses if born in 1957 or later without documentation of vaccination, physician-diagnosed disease, or laboratory immunity (2 doses required for healthcare workers and other high-risk adults). 1

Adults 50-64 Years

• Continue all core vaccines listed above. 1
• Pneumococcal vaccination if high-risk conditions are present. 1

Adults ≥65 Years

• Pneumococcal vaccines: Administer PCV15, PCV20, or PCV21 followed by PPSV23 based on specific sequencing guidelines. 1
• Recombinant zoster vaccine (Shingrix): Give 2-dose series at 0 and 2-6 months. 1

Additional Risk-Based Vaccines to Consider

Hepatitis A

• Give 2-dose series for men who have sex with men, injection drug users, individuals with chronic liver disease, travelers to endemic areas, and those with close contact with international adoptees. 1

Meningococcal (MCV4)

• Administer 2 doses 2 months apart for individuals with functional or anatomic asplenia, complement deficiencies, HIV infection, microbiologists, or travelers to endemic areas. 1

Critical Implementation Considerations

Immunocompromised Patients

• Complete all indicated vaccines at least 2 weeks before starting immunosuppressive therapy when possible. 1
• Give live vaccines at least 4 weeks before immunosuppression or defer until immune function recovers. 1
• Inactivated poliovirus vaccine (IPOL) should be used in all patients with immunodeficiency diseases when vaccination is indicated, though they may not develop full protective response. 2

Common Pitfalls to Avoid

• Never delay vaccination while attempting to locate old records—the risk of disease exposure outweighs any concern about redundant doses. 1
• Do not assume birth before 1957 confers immunity for healthcare workers, as documented immunity or vaccination is required. 3
• Avoid attempting to give separate mumps or rubella vaccines when MMR is indicated, as MMR is the vaccine of choice when recipients may be susceptible to more than one component. 3