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

Influenza virus vaccine quadrivalent may also be an option, intranasal age range: 2-49 years
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]
AIV4 was not recommended during the 2017-2018 or 2016-2017 influenza seasons because it was poorly effective against circulating strains of influenza in the United States. ^{[4, 5]}

Tetanus, diphtheria, pertussis - Every 10 years

Tetanus and reduced diphtheria toxoids/acellular pertussis vaccine (Tdap; Boostrix, Adacel)
Regardless of the interval since receiving their last tetanus or diphtheria toxoid-containing vaccine, persons aged 19 years or older who have never received a dose of Tdap should receive 1 dose of Tdap.
To ensure continued protection against tetanus and diphtheria, booster doses of either Td or Tdap should be administered every 10 years throughout life.^[1]
Diphtheria and tetanus toxoids (Td)

Varicella - 2 doses for adults without evidence of immunity

Varicella virus vaccine live

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]}

Measles mumps and rubella vaccine, live

Human papillomavirus 9-valent (HPV)

Adolescents and adults aged 15-26 years: 2-3 doses (depending on vaccination history) if immunization series was not completed during childhood (ie, age 9-14 years) ^[7]
Adults aged 27-45 years: Need for vaccination based on shared decision making between patient and clinician
Human papillomavirus vaccine, nonavalent

Zoster - Two doses of recombinant zoster vaccine (RZV) (preferred) or one dose of zoster vaccine live (ZVL)

ACIP recommendations^{[1, 8]}:

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 vaccines

PPSV23

All patients aged 65 years or older: ACIP recommends routine vaccination with 1 dose of PPSV23.

If PPSV23 was administered before age 65 years, administer 1 dose of PPSV23 at least 5 years after previous dose.

Immunocompromised adults aged 19 years or older: ACIP guidelines recommend use for adults with immunocompromising conditions, cerebrospinal fluid leak, or cochlear implant.

Pneumococcal vaccine polyvalent (PPSV23)

PCV13

PCV13 is no longer recommended for routine vaccination in immunocompetent adults.

Immunocompromised adults aged 19 years or older: ACIP guidelines recommend use for adults with immunocompromising conditions, cerebrospinal fluid leak, or cochlear implant.

Immunocompetent adults aged 65 years or older: Need for vaccination based on shared decision making between patient and clinician (ie, no longer routinely recommended for all adults ≥65 years).