What is the recommended vaccination schedule for a patient?

Adult Vaccination Schedule

All adults require ongoing vaccination throughout life based on age, health conditions, occupation, and lifestyle factors, with annual influenza vaccination recommended universally and age-specific vaccines administered according to the most recent ACIP guidelines. 1, 2

Universal Vaccinations for All Adults

• Influenza: Annual vaccination for all adults regardless of age, with high-dose or adjuvanted vaccines preferred for adults ≥65 years 2, 3
• Tdap/Td: One dose of Tdap if not previously received, then Td or Tdap booster every 10 years 2, 4, 3
• COVID-19: Follow current CDC recommendations for primary series and boosters (based on general medical knowledge and evolving guidelines)

Age-Specific Vaccination Recommendations

Ages 19-26 Years

• HPV: 2-3 dose series depending on age at initial vaccination; routine recommendation through age 26 2, 3
• MMR: 1-2 doses if born in 1957 or later without documentation of vaccination or evidence of immunity 2, 3
• Varicella: 2 doses if born in 1980 or later without evidence of immunity 2, 3
• Meningococcal B (MenB): 2-3 doses depending on vaccine, particularly for ages 19-23 years 3

Ages 27-49 Years

• HPV: Shared clinical decision-making for vaccination ages 27-45 years 2, 3
• Hepatitis A: 2-3 dose series for adults at risk 2, 3
• Hepatitis B: 2-3 dose series for adults at risk (Heplisav-B: 2 doses at least 4 weeks apart; Engerix-B or Recombivax HB: 3 doses at 0,1,6 months) 2, 3

Ages 50-64 Years

• Zoster (Shingles): 2 doses of recombinant zoster vaccine (RZV/Shingrix, preferred) given 2-6 months apart starting at age 50 2, 4, 3

Ages ≥65 Years

• Pneumococcal:
  • PCV13 based on shared clinical decision-making 2, 3
  • PPSV23 recommended for all adults ≥65 years 2, 3
  • Prevnar 20 (PCV20) administered as a single dose is an alternative option 5
• Zoster: 2 doses of RZV if not previously vaccinated 2, 3
• Influenza: High-dose or adjuvanted vaccines preferred 2

Special Population Recommendations

Pregnancy

• Tdap: One dose during each pregnancy, preferably at 27-36 weeks gestation, regardless of interval since prior Td or Tdap 1, 4, 3
• Influenza: Annual vaccination recommended during any trimester 3
• Live vaccines contraindicated: MMR, varicella, LAIV, zoster live vaccine 3

Healthcare Personnel

• MMR: 1-2 doses if born in 1957 or later 1, 4
• Varicella: 2 doses without evidence of immunity 1, 4
• Hepatitis B: Complete series if not previously vaccinated 1, 3
• Annual influenza: Inactivated vaccine preferred for those caring for severely immunocompromised patients 3
• Tdap: If not previously received 1

Immunocompromised Individuals

• Live vaccines generally contraindicated: MMR, varicella, LAIV, zoster live vaccine 2, 3
• Pneumococcal: Both PCV13 and PPSV23 recommended with specific timing 2, 3
• MenACWY: 2-dose primary series for adults with HIV 2
• Hepatitis B: May require higher doses or additional doses; special formulation (40 µg/mL Recombivax HB or 2 doses of 20 µg/mL Engerix-B) for hemodialysis patients 3
• Haemophilus influenzae type b (Hib): 3-dose series for hematopoietic stem cell transplant recipients starting 6-12 months post-transplant 3

Chronic Medical Conditions

Chronic liver disease (including hepatitis C, cirrhosis, fatty liver disease, alcoholic liver disease):

• Hepatitis A: 2-3 dose series 2, 3
• Hepatitis B: Complete series 2, 3

Chronic heart or lung disease, diabetes, alcoholism:

• Pneumococcal vaccination: PCV13 and PPSV23 based on age and specific conditions 2, 3
• Annual influenza vaccination 3

Asplenia or complement deficiencies:

• Pneumococcal: Both PCV13 and PPSV23 3
• MenACWY: 2-dose series with boosters 3
• MenB: 2-3 dose series 3
• Hib: 1 dose if not previously received, preferably ≥14 days before elective splenectomy 3

Risk-Based Vaccinations

Hepatitis A Indications

• Chronic liver disease 3
• Men who have sex with men 3
• Persons who use injection or non-injection drugs 3
• Persons with clotting factor disorders 3
• Travel to countries with high or intermediate hepatitis A endemicity 3
• Close personal contact with international adoptees from endemic countries 3

Hepatitis B Indications

• End-stage renal disease/hemodialysis 3
• HIV infection 3
• Chronic liver disease 2
• Healthcare personnel and public safety workers with blood exposure 3
• Sexually active persons not in mutually monogamous relationships 3
• Persons seeking STD evaluation or treatment 3
• Current or recent injection drug users 3
• Men who have sex with men 3
• Household contacts/sex partners of HBsAg-positive persons 3
• International travelers to endemic areas 3

Meningococcal Indications

• Anatomical or functional asplenia 3
• Persistent complement component deficiency 3
• HIV infection 2
• Eculizumab use 3
• Microbiologists routinely exposed to Neisseria meningitidis 3
• Travel to or residence in hyperendemic areas 3
• College students living in residence halls 3

Important Clinical Considerations

Vaccine Series Completion

• Vaccine series never need to be restarted regardless of time elapsed between doses 1, 4, 2
• Minimum intervals between doses must be respected, but longer intervals do not reduce final antibody response 1

Simultaneous Administration

• All indicated vaccines can and should be administered simultaneously at the same visit to improve completion rates 1, 4
• Do not mix different vaccines in the same syringe 5

Evidence of Immunity

For measles, mumps, rubella:

• Born before 1957 (except healthcare personnel and pregnant women) 3, 4
• Documentation of vaccination 3
• Laboratory evidence of immunity 3
• Provider-diagnosed disease is NOT acceptable evidence 3

For varicella:

• Documentation of 2 doses of vaccine at least 4 weeks apart 3
• U.S.-born before 1980 (except healthcare personnel and pregnant women) 3
• History of varicella or herpes zoster verified by healthcare provider 3
• Laboratory evidence of immunity 3

Common Pitfalls to Avoid

• Not checking vaccination history: Leads to missed opportunities for vaccination 4
• Assuming immunity without documentation: Always verify with records or laboratory evidence, especially for healthcare workers 4
• Overlooking Tdap in adults: Many adults have only received Td boosters and need one Tdap dose 4
• Delaying simultaneous vaccine administration: Multiple vaccines can safely be given at the same visit 1, 4
• Restarting vaccine series unnecessarily: Continue where left off regardless of time elapsed 1, 4, 2
• Missing pregnancy-related vaccinations: Tdap should be given during EACH pregnancy 1, 4
• Failing to consider occupation and travel: These factors significantly impact vaccination needs 4
• Using live vaccines in immunocompromised patients: Contraindicated and potentially dangerous 2, 3