Summary Of Recommendations For Adult Immunization
Summary of Recommendations for Adult Immunization
(Page 1 of 3)
Vaccine name
Contraindications and precautions
For whom vaccination is recommended
Schedule for vaccine administration
and route
(any vaccine can be given with another)
(mild illness is not a contraindication)
• Vaccinate all persons who want to reduce the risk of
• Give 1 dose every year in the fall or
Seasonal
Contraindications
becoming ill with influenza or spreading it to others.
Note: LAIV may not
winter.
Influenza
• Previous anaphylactic reaction to this vaccine,
• Special efforts should be made to vaccinate the follow-
be given to some of the
• Begin vaccination services as soon as
Trivalent
to any of its components, or to eggs.
ing persons because they are at higher risk for influenza
persons listed to the
vaccine is available and continue until
inactivated
• For LAIV only: age 50yrs and older; pregnancy;
complications: those who are ages 50yrs and older; have
left; see contraindica-
the supply is depleted.
influenza
chronic pulmonary (including asthma), cardio-
pulmonary (including asthma), cardiovascular (except
tions listed in far right
• Continue to give vaccine to unvacci-
vaccine
vascular (except hypertension), renal, hepatic,
hypertension), renal, hepatic, cognitive, neurologic/neu-
column.
nated adults throughout the influenza
(TIV)
neurological/neuromuscular, hematologic, or
romuscular, hematologic, or metabolic (including dia-
season (including when influenza
metabolic (including diabetes) disorders;
Give IM
betes) disorders; have immunosuppression (including that caused by medications or
activity is present in the community)
immunosuppression (including that caused by
HIV); will be pregnant during influenza season; residing in long-term care facilities.
and at other times when the risk of
medications or HIV).
Live
• Vaccinate adults, children, and teens who are household contacts, caregivers, or
influenza exists.
attenuated
Precautions
workplace contacts of the persons listed in bullet #2 above or of children age 0–59m.
• If 2 or more of the following live
influenza
• Moderate or severe acute illness.
• Vaccinate healthcare personnel.
virus vaccines are to be given—LAIV,
vaccine
• History of Guillain-Barré syndrome (GBS)
• Travelers to the tropics, to areas with current influenza activity, or on trips with
MMR, Var, Zos, and/or yellow fever
(LAIV)
within 6wks of previous influenza vaccination.
people from areas with current influenza activity (e.g., on organized tours ) should
vaccine—they should be given on the
Give
• For LAIV only: close contact with an immu-
consider vaccination.
same day. If they are not, space them
intranasally
nosuppressed person when the person requires
• Vaccinate students or other persons in institutional settings (e.g., dormitories, correc-
by at least 28d.
protective isolation.
tional facilities).
• Persons age 65yrs and older.
• Give 1 dose if unvaccinated or if pre-
Pneumococcal
Contraindication
• Persons who have chronic illness or other risk factors, including chronic cardiac or
vious vaccination history is unknown.
poly-
Previous anaphylactic reaction to this vaccine
pulmonary disease (including asthma), chronic liver disease, alcoholism, diabetes,
• Give a 1-time revaccination at least 5yrs
saccharide
or to any of its components.
CSF leaks, cigarette smoking, as well as people living in special environments or
after 1st dose to persons
(PPSV)
Precaution
social settings (including Alaska Natives and certain American Indian populations
- Age 65yrs and older if the 1st dose Moderate or severe acute illness.
Give IM or SC
age 50 through 64yrs if recommended by local public health authorities).
was given prior to age 65yrs
• Those at highest risk of fatal pneumococcal infection, including persons who
- At highest risk of fatal pneumococ-
- Have anatomic asplenia, functional asplenia, or sickle cell disease.
cal infection or rapid antibody loss
- Have an immunocompromising condition, including HIV infection, leukemia,
(see the 3rd bullet in the box to
lymphoma, Hodgkin’s disease, multiple myeloma, generalized malignancy,
left for listings of persons at
chronic renal failure, or nephrotic syndrome.
highest risk).
- Are receiving immunosuppressive chemotherapy (including corticosteroids).
- Have received an organ or bone marrow transplant.
- Are candidates for or recipients of cochlear implants.
• Persons age 60yrs and older.
Zoster (shingles)
• Give 1-time dose if unvaccinated,
Contraindications
(Zos)
regardless of previous history of herpes
• Previous anaphylactic reaction to any compo-
zoster (shingles) or chickenpox.
nent of zoster vaccine (e.g., gelatin & neomycin).
Give SC
• If 2 or more of the following live
• Primary cellular or acquired immunodeficiency.
virus vaccines are to be given—
• Pregnancy.
MMR, Zos, and/or yellow fever
Precaution
vaccine—they should be given on the
Moderate or severe acute illness.
same day. If they are not, space them
by at least 28d.
*This document was adapted from the recommendations of the Advisory Committee on Immunization Practices
tion (IAC) website at www.immunize.org/acip. This table is revised periodically. Visit IAC’s website at
(ACIP). To obtain copies of these recommendations, call the CDC-INFO Contact Center at (800) 232-4636;
www.immunize.org/adultrules to make sure you have the most current version.
visit CDC’s website at www.cdc.gov/vaccines/pubs/ACIP-list.htm; or visit the Immunization Action Coali-
Technical content reviewed by the Centers for Disease Control and Prevention, September 2009.
www.immunize.org/catg.d/p2011.pdf • Item #P2011 (9/09)
Immunization Action Coalition • 1573 Selby Avenue • Saint Paul, MN 55104 • (651) 647-9009 • www.immunize.org • www.vaccineinformation.org • admin@immunize.org
Summary of Recommendations for Adult Immunization (continued)
(Page 2 of 3)
Vaccine name
Schedule for vaccine administration
Contraindications and precautions
For whom vaccination is recommended
and route
(any vaccine can be given with another)
(mild illness is not a contraindication)
• All persons through age 18yrs.
• Give 3 doses on a 0, 1, 6m schedule.
Contraindication
Hepatitis B
• All adults wishing to be protected from hepatitis B virus infection.
(HepB)
• Alternative timing options for vaccination
Previous anaphylactic reaction to this vaccine
• High-risk persons, including household contacts and sex partners of HBsAg-posi-
include 0, 2, 4m and 0, 1, 4m.
or to any of its components.
Give IM
tive persons; injecting drug users; sexually active persons not in a long-term,
• There must be at least 4wks between doses Precaution
mutually monogamous relationship; men who have sex with men; persons with
#1 and #2, and at least 8wks between doses Moderate or severe acute illness.
Brands may
HIV; persons seeking evaluation or treatment for an STD; patients receiving
#2 and #3. Overall, there must be at least
be used
hemodialysis and patients with renal disease that may result in dialysis; healthcare
16wks between doses #1 and #3.
interchangeably.
personnel and public safety workers who are exposed to blood; clients and staff
• Schedule for those who have fallen
of institutions for the developmentally disabled; inmates of long-term correctional
behind: If the series is delayed between
facilities; and certain international travelers.
doses, DO NOT start the series over.
• Persons with chronic liver disease.
Continue from where you left off.
Note: Provide serologic screening for immigrants from endemic areas. If patient is
chronically infected, assure appropriate disease management. Screen sex partners
For Twinrix (hepatitis A and B combi-
and household members; give HepB at the same visit if not already vaccinated.
nation vaccine [GSK]) for patients age
18yrs and older only: give 3 doses on a
• All persons wishing to be protected from hepatitis A virus (HAV) infection.
0, 1, 6m schedule. There must be at least
Contraindication
Hepatitis A
• Persons who travel or work anywhere EXCEPT the U.S., Western Europe, New
4wks between doses #1 and #2, and at
Previous anaphylactic reaction to this vaccine
(HepA)
Zealand, Australia, Canada, and Japan.
least 5m between doses #2 and #3.
or to any of its components.
Give IM
• Persons with chronic liver disease; injecting and non-injecting drug users; men
An alternative schedule can also be used
Precautions
who have sex with men; people who receive clotting-factor concentrates; persons
at 0, 7d, 21–30d, and a booster at 12m.
• Moderate or severe acute illness.
Brands may
who work with HAV in experimental lab settings; food handlers when health au-
• Safety during pregnancy has not been deter-
be used
thorities or private employers determine vaccination to be appropriate.
• Give 2 doses.
mined, so benefits must be weighed against
interchangeably. • Persons who anticipate close personal contact with an international adoptee from
• The minimum interval between doses #1
potential risk.
a country of high or intermediate endemicity during the first 60 days following the
and #2 is 6m.
adoptee’s arrival in the U.S.
• If dose #2 is delayed, do not repeat dose
• Adults age 40yrs or younger with recent (within 2 wks) exposure to HAV. For
#1. Just give dose #2.
persons older than age 40yrs with recent (within 2 wks) exposure to HAV, immune
globulin is preferred over HepA vaccine.
• All adults who lack written documentation of a primary series consisting of at least
• For persons who are unvaccinated or
Contraindications
Td, Tdap
3 doses of tetanus- and diphtheria-toxoid-containing vaccine.
behind, complete the primary series with
• Previous anaphylactic reaction to this vaccine
(Tetanus,
• A booster dose of tetanus- and diphtheria-toxoid-containing vaccine may be
Td (spaced at 0, 1–2m, 6–12m intervals).
or to any of its components.
diphtheria,
needed for wound management as early as 5yrs after receiving a previous dose, so
One-time dose of Tdap may be used for
• For Tdap only, history of encephalopathy
pertussis)
consult ACIP recommendations.*
any dose if younger than age 65yrs.
within 7d following DTP/DTaP.
Give IM
• Using tetanus toxoid (TT) instead of Td or Tdap is not recommended.
• Give Td booster every 10yrs after the pri-
Precautions
• In pregnancy, when indicated, give Td or Tdap in 2nd or 3rd trimester. If not admin-
mary series has been completed. For adults • Moderate or severe acute illness.
istered during pregnancy, give Tdap in immediate postpartum period.
younger than age 65yrs, a 1-time dose of
• GBS within 6wks of receiving a previous dose
For Tdap only:
Tdap is recommended to replace the next Td.
of tetanus-toxoid-containing vaccine.
• All adults younger than age 65yrs who have not already received Tdap.
• Intervals of 2yrs or less between Td and
• Unstable neurologic condition.
• Adults in contact with infants younger than age 12m (e.g., parents, grandparents
Tdap may be used.
• History of Arthus reaction following a previ-
younger than age 65yrs, childcare providers, healthcare personnel) who have not
Note: The two Tdap products are licensed
ous dose of tetanus- and/or diphtheria-toxoid-
received a dose of Tdap should be prioritized for vaccination.
for different age groups: Adacel (sanofi) for
containing vaccine, including MCV4.
• Healthcare personnel who work in hospitals or ambulatory care settings and have
use in persons age 11–64yrs and Boostrix
Note: Tdap may be given to pregnant women at
direct patient contact and who have not received Tdap.
(GSK) for use in persons age 10–64yrs.
the provider’s discretion.
• Not routinely recommended for U.S. residents age 18yrs and older.
• Refer to ACIP recommendations* regarding Contraindication
Polio
Note: Adults living in the U.S. who never received or completed a primary series of
unique situations, schedules, and
Previous anaphylactic or neurologic reaction to
(IPV)
polio vaccine need not be vaccinated unless they intend to travel to areas where ex-
dosing information.
this vaccine or to any of its components.
Give IM or SC
posure to wild-type virus is likely. Previously vaccinated adults can receive 1 booster
Precautions
dose if traveling to polio endemic areas or to areas where the risk of exposure is high.
• Moderate or severe acute illness.
• Pregnancy.
Summary of Recommendations for Adult Immunization (continued)
(Page 3 of 3)
Vaccine name
For whom vaccination is recommended
Schedule for vaccine administration
Contraindications and precautions
and route
(any vaccine can be given with another)
(mild illness is not a contraindication)
Varicella
• All adults without evidence of immunity.
• Give 2 doses.
Contraindications
(Var)
Note: Evidence of immunity is defined as written documen-
• Dose #2 is given 4–8wks after dose #1.
• Previous anaphylactic reaction to this vaccine or to any of its components.
(Chickenpox)
tation of 2 doses of varicella vaccine; a history of varicella
• If dose #2 is delayed, do not repeat
• Pregnancy or possibility of pregnancy within 4wks.
disease or herpes zoster (shingles) based on healthcare-
dose #1. Just give dose #2.
• Persons on high-dose immunosuppressive therapy or who are immuno-
Give SC
provider diagnosis; laboratory evidence of immunity; and/or
• If 2 or more of the following live
compromised because of malignancy and primary or acquired cellular
birth in the U.S. before 1980, with the exceptions that fol-
virus vaccines are to be given—LAIV,
immunodeficiency, including HIV/AIDS (although vaccination may be
low. Healthcare personnel (HCP) and pregnant women born
MMR, Var, Zos, and/or yellow fever
considered if CD4+ T-lymphocyte counts are greater than or equal to 200
in the U.S. before 1980 who do not meet any of the criteria
vaccine—they should be given on the
cells/µL. See MMWR 2007;56,RR-4).
above should be tested. If they are not immune, give the 1st
same day. If they are not, space them
Precautions
dose of varicella vaccine immediately (HCP) or postpartum
by at least 28d.
• Moderate or severe acute illness.
and before hospital discharge (pregnant women). Give the
• May use as postexposure prophylaxis
• If blood, plasma, and/or immune globulin (IG or VZIG) were given in
2nd dose 4–8 wks later. Routine post-vaccination serologic
if given within 5d.
past 11m, see ACIP statement General Recommendations on Immuniza-
testing is not recommended.
tion* regarding time to wait before vaccinating.
Meningo-
• All persons age 11 through 18yrs.
• Give 1 dose.
Contraindication
coccal
• College freshmen living in a dormitory.
• If previous vaccine was MCV4 or MPSV4, Previous anaphylactic or neurologic reaction to this vaccine or to any of its
Conjugate vaccine • Persons with anatomic or functional asplenia or with a
revaccinate after 5yrs if risk continues.
components, including diphtheria toxoid (for MCV4).
(MCV4)
persistent complement component deficiency.
• MCV4 is preferred over MPSV4 for
Precautions
Give IM
• Persons who travel to or reside in countries in which
persons age 55yrs and younger; use
• Moderate or severe acute illness.
meningococcal disease is hyperendemic or epidemic
MPSV4 ONLY if there is a permanent
• For MCV4 only, history of Guillain-Barré syndrome (GBS).
Polysaccharide
(e.g., the “meningitis belt” of Sub-Saharan Africa).
contraindication/precaution to MCV4.
vaccine
• Microbiologists routinely exposed to isolates of N. menin-
• If the only risk factor is living in a
(MPSV4)
gitidis.
campus dormitory, there is no need to
Give SC
give a 2nd dose.
• Persons born in 1957 or later (especially those born outside • Give 1 or 2 doses (see criteria in 1st
Contraindications
MMR
the U.S.) should receive at least 1 dose of MMR if there is
and 2nd bullets in box to left).
• Previous anaphylactic reaction to this vaccine or to any of its components.
(Measles,
no laboratory evidence of immunity or documentation of a
• If dose #2 is recommended, give it no
• Pregnancy or possibility of pregnancy within 4wks.
mumps,
dose given on or after the first birthday.
sooner than 4wks after dose #1.
• Severe immunodeficiency (e.g., hematologic and solid tumors; receiving
rubella)
• Persons in high-risk groups, such as healthcare personnel
• If a pregnant woman is found to be
chemotherapy; congenital immunodeficiency; long-term immunosuppres-
Give SC
(paid, unpaid, or volunteer), students entering college and
rubella susceptible, give 1 dose of
sive therapy; or severely symptomatic HIV.) Note: HIV infection is NOT a
other post–high school educational institutions, and interna-
MMR postpartum.
contraindication to MMR for those who are not severely immunocompromised
tional travelers, should receive a total of 2 doses.
• If 2 or more of the following live
(i.e., CD4+ T-lymphocyte counts are greater than or equal to 200 cells/µL).
• Persons born before 1957 are usually considered immune,
virus vaccines are to be given—LAIV, Precautions
but evidence of immunity (serology or history of 2 doses of
MMR, Var, Zos, and/or yellow fever
• Moderate or severe acute illness.
MMR) should be considered for healthcare personnel.
vaccine—they should be given on the
• If blood, plasma, and/or immune globulin were given in past 11m, see
• Women of childbearing age who do not have acceptable
same day. If they are not, space them
ACIP statement General Recommendations on Immunization* regarding
evidence of rubella immunity or vaccination.
by at least 28d.
time to wait before vaccinating.
Note: Routine post-vaccination serologic testing is not
• Within 72hrs of measles exposure, give • History of thrombocytopenia or thrombocytopenic purpura.
recommended.
1 dose as postexposure prophylaxis to
susceptible adults.
Note: If TST (tuberculosis skin test) and MMR are both needed but not
given on same day, delay TST for 4–6wks after MMR.
Human
• All previously unvaccinated women through age 26yrs.
• Give 3 doses on a 0, 2, 6m schedule.
Contraindication
papillomavirus
• There must be at least 4wks between
Previous anaphylactic reaction to this vaccine or to any of its components.
(HPV)
doses #1 and #2 and at least 12wks
Precautions
between doses #2 and #3. Overall,
• Moderate or severe acute illness.
Give IM
there must be at least 24wks between
• Data on vaccination in pregnancy are limited. Vaccination should be
doses #1 and #3.
delayed until after completion of the pregnancy.
