Vaccinations in Adults
The Centers for Disease Control and Prevention’s (CDC’s) Advisory Committee on Immunization Practices (ACIP) annually reviews the recommended adult immunization schedule to ensure that the schedule reflects current recommendations for the licensed vaccine. Vaccines are recommended for adults on the basis of their age, prior vaccinations, health conditions, lifestyle, occupation, and travel. [1]
Vaccines recommended for routine immunization are discussed below. Note that the following vaccines also may be recommended for additional age groups depending on risk factors.
For the CDC’s current specific vaccination recommendations by vaccine and age group, recommendations based on medical and other indications, and contraindications and precautions, please refer to the CDC’s Adult Immunization Schedules. [1]
Influenza - 1 dose annually
Various influenza vaccines have been approved that are directed toward patients with egg allergy (eg, Flucelvax, Flublok) and for elderly adults to provide a stronger immune response (eg, Fluzone High-Dose, Fluad).
Adults with a history of egg allergy who have only hives after exposure to egg should receive age-appropriate inactivated influenza (IIV) or recombinant influenza vaccine (RIV). Adults with a history of egg allergy with symptoms other than hives (eg, angioedema, respiratory distress, lightheadedness, recurrent emesis, or who required epinephrine or other emergency intervention) may receive age-appropriate IIV or RIV. The selected vaccine should be administered in an inpatient or outpatient medical setting and supervised by a healthcare provider who is able to recognize and manage severe allergic conditions. [2]
The ACIP recommends return of intranasal flu vaccine in the United States for the 2018-2019 season
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Influenza virus vaccine quadrivalent, intranasal age range: 2-49 years
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The ACIP recommended return of the intranasal flu vaccine in the United States for the 2018-2019 season based on positive results from a US study in children aged 2 years to younger than 4 years that evaluated the shedding and antibody responses of the H1N1 strain in the live attenuated influenza vaccine (LAIV). The study showed that the new 2017-2018 H1N1 LAIV postpandemic strain (A/Slovenia) performed significantly better than the 2015-2016 H1N1 LAIV postpandemic strain (A/Bolivia), which was associated with lower effectiveness and was not recommended during the prior two seasons. [3]
Tetanus, diphtheria, pertussis - Every 10 years
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Tetanus and reduced diphtheria toxoids/acellular pertussis vaccine (Tdap; Boostrix, Adacel)
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Boostrix: Substitute 1-time dose of Tdap for Td booster
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Adacel: Administer first Tdap dose 5 years or more after the last dose of DTaP series or Td vaccination; a second dose may be administered 8 years or more after the first Tdap dose
Varicella - 2 doses for adults without evidence of immunity
Measles, mumps, rubella (MMR) - One or two doses should be documented for adults born after 1957 [1]
Adults aged 19-59 years: 0.5 mL SC; administer a second dose 28 days later for high-risk adults
Adults aged 50 years or older: 0.5 mL SC; administer one dose only
Additional dose during mumps outbreak: During an outbreak, persons identified as being at increased risk who have received two or fewer 2 doses of mumps virus–containing vaccine or have unknown vaccination status should receive one dose [1, 6]
Human papillomavirus 9-valent (HPV) - 3 doses for adolescents and adults aged 15-45 years if immunization series was not completed during childhood (ie, aged 9-14 years) [7]
Zoster - Two doses of recombinant zoster vaccine (RZV) (preferred) or one dose of zoster vaccine live (ZVL)
Administer two doses of RZV (Shingrix) 2-6 months apart to adults aged 50 years or older regardless of past episode of herpes zoster or receipt of ZVL (Zostavax)
Administer two doses of RZV 2-6 months apart to adults who previously received ZVL at least 2 months after ZVL
For adults aged 60 years or older, administer either RZV or ZVL (RZV is preferred)
Pneumococcal
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PLUS
Immunocompetent adults aged 65 years or older should receive 13-valent pneumococcal conjugate vaccine (PCV13) followed by 23-valent pneumococcal polysaccharide vaccine (PPSV23) at least 1 year after PCV13. An additional 1 or 2 doses of PPSV23 may be indicated for certain individuals (eg, chronic heart disease, immunocompromising conditions, anatomical or functional asplenia, cerebrospinal fluid leak, cochlear implant).
If PPSV23 has previously been administered, PCV13 should be administered at least 1 year after PPSV23. When two or more doses of PPSV23 are indicated, the interval between PPSV23 doses should be at least 5 years.
No additional doses of PPSV23 are indicated for adults who received PPSV23 at age 65 years or older. When indicated, PCV13 and PPSV23 should be administered to adults whose pneumococcal vaccination history is incomplete or unknown. [1]
Additional vaccines that may be recommended in adults depending on risk factors and vaccination history
Haemophilus influenza type b (Hib)
Meningococcal
Hepatitis A and B
