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]

COVID-19

Bivalent mRNA vaccines (bivalent Moderna, bivalent Pfizer)

Recommended for initial immunization and for additional doses in certain populations

Monovalent vaccine, adjuvanted (Novavax) in limited situations

Adults who have completed primary vaccination using any COVID-19 vaccine and have not received any previous booster dose(s) may receive a monovalent Novavax booster dose at least 6 months after completion of the primary series if they are unable (ie, contraindicated or not available) or unwilling to receive an mRNA vaccine and otherwise would not receive a booster dose

Influenza

1 dose annually

Various influenza vaccines have been approved that are directed toward patients with egg allergy (eg, Flucelvax, Flublok)^[2]and for elderly adults to provide a stronger immune response (eg, Fluzone High-Dose, Fluad).^[3]

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]

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 (M-M-R II, Priorix)

One or 2 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 2 or fewer doses of mumps virus–containing vaccine or have unknown vaccination status should receive 1 dose ^{[1, 4]}
Measles mumps and rubella vaccine, live

Human papillomavirus 9-valent (HPV)

The following are recommendations for the HPV 9-valent vaccine:

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) ^[5]
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)

ACIP recommendations ^{[1, 6]}:
Administer 2 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)
Adults younger than 50 years with immunocompromising conditions should receive 2 doses
Zoster vaccine recombinant

Pneumococcal vaccines

The following are recommendations for pneumococcal vaccines:

Aged 50 years and older: 1 dose PCV15 or 1 dose PCV20 ^[7]
If PCV15 is administered, follow with a dose of PPSV23 given at least 1 year after the PCV15 dose
A minimum interval of 8 weeks between PCV15 and PPSV23 can be considered for adults with an immunocompromising condition, cochlear implant, or cerebrospinal fluid leak to minimize the risk for invasive pneumococcal disease caused by serotypes unique to PPSV23 in these vulnerable groups
Adults aged 19-64: ACIP guidelines recommend use for adults with immunocompromising conditions, cerebrospinal fluid leak, or cochlear implant. ^[7]
Pneumococcal vaccine 20-valent (PCV20) once, OR
Pneumococcal vaccine 15-valent (PCV14) once plus Pneumococcal vaccine polyvalent (PPSV23) administered 1 year after PCV15

Additional vaccines that may be recommended in adults depending on risk factors and vaccination history

Polio (IPV)

Routine poliovirus vaccination of adults residing in the United States is not necessary.^[8]

Adults at increased risk for exposure to poliovirus with ^[8]

Polio vaccine inactivated
No evidence of completed polio vaccination series (ie, at least 3 doses): Administer remaining doses (1, 2, or 3 doses) to complete a 3-dose series
Evidence of completed polio vaccination series (ie, at least 3 doses): May administer 1 lifetime IPV booster

Haemophilus influenza type B (Hib)