Recommended Immunization Schedule: Adults

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2016 Vaccination Schedule: Adults
2017 VACCINATION SCHEDULE: ADULTS
This schedule indicates the recommended age groups and medical indications for routine administration of currently licensed vaccines for persons ≥19yrs. Licensed combination vaccines may be used whenever any components of the combination are indicated and when the vaccine's other components are not contraindicated.

 

Recommended for all persons who meet the age requirement, lack documentation of vaccination, or lack evidence of past infection Recommended for persons with a risk factor (medical, occupational, lifestyle, or other indication)

 

Vaccine 19−21yrs 22−26yrs 27−59yrs 60−64yrs ≥65yrs
Influenza1 1 dose annually
Tetanus, diphtheria, pertussis (Td/Tdap)2 Substitute Tdap for Td once, then Td booster every 10yrs
Measles, mumps, rubella (MMR)3 1 or 2 doses    
Varicella (VAR)4 2 doses
Herpes Zoster (HZV)5   1 dose
Human papillomavirus (HPV) Female6 3 doses  
Human papillomavirus (HPV) Male6  3 d oses   
Pneumococcal 13-valent conjugate (PCV13)7  1 d ose 
Pneumococcal polysaccharide (PPSV23)7 1 or 2 doses 1 dose
Hepatitis A8 2 or 3 doses
Hepatitis B9 3 doses
Meningococcal 4-valent conjugate (MenACWY) or polysaccharide (MPSV4)10 1 or more doses
Meningococcal B (MenB)10 2 or 3 doses
Haemophilus influenzae type b (Hib)11 1 or 3 doses

  1. Influenza vaccination

• Annual vaccination against influenza is recommended for all persons ≥6mos without a contraindication. An age-appropriate formulation of inactivated influenza vaccine (IIV) or recombinant influenza vaccine (RIV; FluBlok) should be used.

• Pregnant women and persons with hives-only allergy to eggs should receive age-appropriate IIV. Persons with egg allergy other than hives (eg, angioedema, respiratory distress) may receive IIV in a medical setting under close supervision.

• RIV is an option for adults aged ≥18yrs with egg allergy of any severity.

• Intradermal IIV is an option for adults aged 18−64yrs.

• Adults aged ≥65yrs can receive the standard dose IIV or the high-dose or adjuvanted IIV (Fluzone High Dose).

• Live attenuated influenza vaccine (LAIV) is not recommended during the 2016−2017 influenza season.

  2. Tetanus, diphtheria, and acellular pertussis (Td/Tdap) vaccination

• Adults who have not received Tdap vaccine or for whom pertussis vaccine status is unknown should receive 1 dose of Tdap followed by Td booster every 10yrs. Tdap should be administered regardless of interval since the most recent tetanus or diphtheria-toxoid containing vaccine.

• Adults with an unknown or incomplete history of completing a 3 dose primary vaccination series with Td containing vaccines should complete a primary vaccination series including 1 Tdap dose.

• For unvaccinated adults, administer the 1st 2 doses at least 4wks apart and the 3rd dose 6−12mos after the 2nd.

• Administer 1 dose of Tdap vaccine to pregnant women during each pregnancy (preferred during the early part of gestational weeks 27−36), regardless of prior Tdap vaccination history.

• Refer to the ACIP statement for recommendations on Td/Tdap use as prophylaxis in wound management (see footnote 12).

  3. Measles, mumps, rubella (MMR) vaccination

• Adults born before 1957 generally are considered immune to measles and mumps. All adults born in 1957 or later should have documentation of 1 or more doses of MMR vaccine unless they have a medical contraindication to the vaccine, or lab evidence of immunity to each of the three diseases. Documentation of provider-diagnosed disease is not considered acceptable evidence of immunity for MMR.

Measles component:

• 2 doses of MMR vaccine, at least 28 days apart, is recommended for adults who

—are students in postsecondary educational institutions;

—work in a health-care facility; or

—plan to travel internationally.

• Persons who received inactivated (killed) measles vaccine or measles vaccine of unknown type from 1963–1967 should be revaccinated with 1 or 2 doses of MMR vaccine.

Mumps component:

• 2 doses of MMR vaccine, at least 28 days apart, is recommended for adults who

—are students in postsecondary educational institutions;

—work in a health-care facility; or

—plan to travel internationally.

• Persons vaccinated before 1979 with either killed mumps vaccine or mumps vaccine of unknown type who are at high risk for mumps infection (eg, persons who are working in a health-care facility) should be considered for revaccination with 2 doses of MMR vaccine at least 28 days apart.

Rubella component:

• Pregnant women who do not have evidence of immunity should receive 1 dose of MMR vaccine upon completion or termination of pregnancy and before discharge from the healthcare facility. Non-pregnant women of childbearing age without evidence of immunity should receive 1 dose of MMR vaccine.

Health-care personnel born before 1957:

• For unvaccinated HCPs born before 1957 who lack lab evidence of measles, mumps, and/or rubella immunity or lab confirmation of disease, health care facilities should consider routinely vaccinating personnel with 2 doses of MMR vaccine at least 28 days apart for measles and mumps or 1 dose of MMR vaccine for rubella.

  4. Varicella vaccination

• All adults without evidence of immunity to varicella should receive 2 doses of single-antigen varicella vaccine 4−8wks apart, or a 2nd dose if they have received only 1 dose.

• Special consideration for vaccination should be given to those who

—have close contact with persons at high risk for severe disease (eg, HCPs and family contacts of persons with immunocompromising conditions) or

—are at high risk for exposure or transmission (eg, teachers; child care employees; residents and staff members of institutional settings, including correctional institutions; college students; military personnel; adolescents and adults living in households with children; nonpregnant women of childbearing age; and international travelers).

• Pregnant women should be assessed for evidence of varicella immunity. Women who do not have evidence of immunity should receive the 1st dose of varicella vaccine upon completion or termination of pregnancy and before discharge from the healthcare facility. The 2nd dose should be administered 4–8wks after the 1st dose.

• Evidence of immunity to varicella in adults includes any of the following:

—documentation of 2 doses of varicella vaccine at least 4wks apart;

—U.S.-born before 1980, except HCPs and pregnant women

—history of varicella or herpes zoster disease based on diagnosis or verification of varicella or herpes zoster by a HCP; or

—lab evidence of immunity or lab confirmation of disease.

  5. Herpes zoster (HZV) vaccination

• Adults ≥60yrs should receive 1 dose of HZV regardless of whether they report a prior episode of herpes zoster.

• Persons ≥60yrs with chronic medical conditions may be vaccinated unless their condition constitutes a contraindication, such as pregnancy or severe immunodeficiency.

  6. Human papilloma virus (HPV) vaccination

• Females through age 26yrs and males through age 21yrs who have not received any HPV vaccine should receive a 3-dose series at 0, 1−2, and 6mos. If HPV vaccination series initiated before age 15yrs and received 2 doses ≥5mos apart, no additional dose needed; if only 1 dose received or 2 doses <5mos apart, 1 additional dose should be given.

• Males 22−26yrs may be vaccinated with the same dosing schedule.

• HPV vaccination is recommended for men who have sex with men (MSM) and for immunocompromised persons (including those with HIV infection) through age 26yrs who have not received any HPV vaccine.

• Not recommended for use in pregnant women. However, pregnancy testing is not needed before vaccination. If a woman is found to be pregnant after initiating the vaccination series, no intervention is needed; the remainder of the 3 dose series should be delayed until completion of or termination of pregnancy.

  7. Pneumococcal (13-valent pneumococcal conjugate vaccine [PCV13] and 23-valent pneumococcal polysaccharide vaccine [PPSV23]) vaccination

• General information

—Only 1 dose of PCV13 and 1, 2, or 3 doses of PPSV23 is recommended depending on indication.

—When indicated, PCV13 and PPSV23 should be administered to adults whose pneumococcal vaccination history is incomplete or unknown.

—When both PCV13 and PPSV23 are indicated, PCV13 should be administered first; PCV13 and PPSV23 should not be administered during the same visit.

—If previously vaccinated with PPSV23, PCV13 should be administered at least 1yr after PPSV23.

—No additional dose of PPSV23 is indicated for adults vaccinated with PPSV23 at or after age 65yrs.

• Adults aged ≥65yrs who are immunocompetent:

—Administer PCV13 followed by PPSV23 at least 1yr later.

• Adults aged 19−64yrs with immunocompromising conditions or anatomical or functional asplenia:

—Administer PCV13 and 1 dose of PPSV23 at least 8wks after PCV13; a 2nd dose of PPSV23 should be given at least 5yrs after the 1st dose.

—If most recent dose of PPSV23 was given at <65yrs, at age ≥65yrs, administer another dose of PPSV23 at least 8wks after PCV13 and at least 5yrs after the last dose of PPSV23.

• Adults aged 19−64yrs with cerebrospinal fluid leaks or cochlear implants:

—Administer PCV13 followed by PPSV23 at least 8wks after PCV13.

—If most recent PPSV23 dose was given at <65yrs, at age ≥65yrs, administer another dose of PPSV23 at least 8wks after PCV13 and at least 5yrs after the last dose of PPSV23.

• Adults aged 19−64yrs with chronic heart disease (including CHF and cardiomyopathies, excluding hypertension), chronic lung disease (including COPD, emphysema, and asthma), chronic liver disease (including ­cirrhosis), alcoholism, diabetes mellitus, or who smoke cigarettes:

—Administer PPSV23. At age ≥65yrs, administer PCV13 and another dose of PPSV23 at least 1yr after PCV13 and at least 5yrs after the last dose of PPSV23.

• Immunocompromising conditions that are indications for pneumococcal vaccination are: Congenital or acquired immunodeficiency (including B- or T lymphocyte deficiency, complement deficiencies, and phagocytic disorders excluding chronic granulomatous disease), HIV infection, chronic renal failure, nephrotic syndrome, leukemia, lymphoma, Hodgkin disease, generalized malignancy, multiple myeloma, solid organ transplant, and iatrogenic immunosuppression (including long-term systemic corticosteroids and radiation therapy).

• Anatomical or functional asplenia that are indications for pneumococcal vaccination are: Sickle cell disease and other hemoglobinopathies, congenital or acquired asplenia, splenic dysfunction, and splenectomy. Administer pneumococcal vaccines at least 2wks before immunosuppressive therapy or an elective splenectomy, and as soon as possible to adults who are newly diagnosed with HIV infection.

  8. Hepatitis A vaccination

• Vaccinate any person seeking protection from hepatitis A virus (HAV) infection and persons with any of the following indications:

—men who have sex with men and persons who use injection or non-injection illicit drugs;

—persons working with HAV-infected primates or with HAV in a research lab;

—persons with chronic liver disease and persons who receive clotting factor concentrates;

—persons traveling to or working in countries that have high or intermediate endemicity of hepatitis A; and

—unvaccinated persons who anticipate close personal contact (eg, household or regular babysitting) with an international adoptee during the 1st 60 days after arrival in the U.S. from a country with high or intermediate endemicity. (See footnote 12 for more information on travel recommendations).

• Single-antigen vaccine formulations should be administered in a 2-dose schedule at either 0 and 6–12mos (Havrix), or 0 and 6–18mos (Vaqta). If the combined hepatitis A and hepatitis B vaccine (Twinrix) is used, administer 3 doses at 0, 1, and 6mos.

  9. Hepatitis B vaccination

• Vaccinate any person seeking protection from hepatitis B virus (HBV) infection and persons with any of the following indications:

—sexually active persons who are not in a long-term, mutually monogamous relationship (eg, persons with >1 sex partner during the previous 6mos); persons seeking evaluation or treatment for an STD; current or recent injection-drug users; and men who have sex with men;

—HCPs and public-safety workers who are exposed to blood or other potentially infectious body fluids;

—persons with diabetes <60yrs; persons with diabetes who are ≥60yrs at the discretion of the treating clinician;

—persons with ESRD, including patients receiving hemodialysis; persons with HIV infection; and persons with chronic liver disease;

—pregnant women who are at risk for HBV infection;

—household contacts and sex partners of hepatitis B surface antigen-positive persons; international travelers to countries with high or intermediate prevalence of chronic HBV infection; and

—all adults in the following settings: STD treatment facilities; HIV testing and treatment facilities; facilities providing drug-abuse treatment and prevention services; health-care settings targeting services to injection-drug users or men who have sex with men; correctional facilities; ESRD programs and facilities for chronic hemodialysis patients; and institutions and nonresidential daycare facilities for persons with developmental disabilities.

• Single-antigen vaccine formulations (Engerix-B, Recombivax HB) should be administered in a 3 dose schedule at 0, 1 and 6mos. If the combined hepatitis A and hepatitis B vaccine (Twinrix) is used, administer 3 doses at 0, 1, and 6mos.

• Adult patients receiving hemodialysis should receive a 3-dose series of 40µg Recombivax HB at 0, 1, and 6mos or a 4-dose series of 40µg Engerix B at 0, 1, 2, and 6mos.

10. Meningococcal vaccination

• Administer 2 doses of meningococcal conjugate vaccine (MenACWY [Menactra, Menveo]) at least 2mos apart to adults of all ages with anatomical or functional asplenia, persistent complement component deficiencies, or HIV patients not previously vaccinated. If an HIV infected person previously received 1 dose of MenACWY, a 2nd dose should be administered at least 2mos after the 1st dose.

• Administer 1 dose of MenACWY vaccine to microbiologists routinely exposed to isolates of Neisseria meningitidis, military recruits, persons at risk during an outbreak attributable to a vaccine serogroup, and persons who travel to or live in countries in which meningococcal disease is hyperendemic or epidemic.

• First-year college students up through age 21yrs who are living in residence halls should be vaccinated with 1 dose of MenACWY vaccine if they have not received a dose on or after their 16th birthday.

• MenACWY is preferred for adults with any of the preceding indications who are ≤55yrs as well as for adults ≥56yrs:

—were vaccinated previously with MenACWY and are recommended for revaccination, or

—for whom multiple doses are anticipated.

• Meningococcal polysaccharide vaccine (MPSV4 [Menomune]) is preferred for adults ≥56yrs who have not received MenACWY previously and who require a single dose only.

• Revaccination with MenACWY every 5yrs is recommended for adults previously vaccinated with MenACWY or MPSV4 who remain at increased risk for infection (eg, adults with anatomic or functional asplenia, persistent complement component deficiencies, or HIV, microbiologists, travelers, military recruits).

• Serogroup B meningococcal (MenB [Bexsero, Trumenba]) vaccine is recommended for routine use in adults who are at increased risk for serogroup B meningococcal disease (eg, adults with anatomic/functional asplenia or persistent complement component deficiencies, microbiologists, persons at risk during an outbreak). Healthy young adults aged 16−23yrs (preferred 16−18yrs) may be vaccinated for short-term protection. MenB vaccination is not routinely recommended for HIV patients or travelers.

• The two MenB vaccines are not interchangeable. Bexsero is a 2-dose series administered at least 1mo apart and Trumenba is a 3-dose series administered at 0, 1−2, and 6mos.

11Haemophilus influenzae type b (Hib) vaccination

• 1 dose of Hib vaccine should be administered to persons with functional or anatomic asplenia, sickle cell disease or are undergoing elective splenectomy if they have not previously received Hib vaccine. Hib should be administered ≥14 days before splenectomy.

• Recipients of a hematopoietic stem cell transplant should be vaccinated with a 3-dose regimen 6–12mos after a successful transplant, regardless of vaccination history; at least 4wks should separate doses.

• Hib vaccine is not recommended for adults with HIV infection since their risk for Hib infection is low.

12. Additional information

• Immunocompromising conditions: Inactivated vaccines generally are acceptable (eg, pneumococcal, meningococcal, and inactivated influenza vaccine), and live vaccines generally are avoided in persons with immune deficiencies or immunocompromising conditions. Information on specific conditions is available at https://www.cdc.gov/vaccines/schedules/hcp/imz/adult-conditions.html.

• ACIP recommendations on Td/Tdap use available at www.cdc.gov/mmwr/preview/mmwrhtml/rr5517a1.htm.

• Information on travel vaccine requirements and recommendations (eg, for hepatitis A and B, meningococcal, and other vaccines) available at http://wwwnc.cdc.gov/travel/destinations/list.

CHANGES IN THE SCHEDULE SINCE LAST RELEASE

Influenza vaccine

LAIV has been removed from the schedule for the 2016−2017 influenza season. The use of IIV and RIV has been updated for adults with hives-only allergy to eggs and adults with egg allergy other than hives (eg, angioedema, respiratory distress).

Hepatitis B (HBV) vaccine

The administration of a HepB vaccine series for adults with chronic liver disease (eg, HCV infection, cirrhosis, fatty liver disease, alcoholic liver) was updated.

Human papilloma virus (HPV) vaccine

The use of HPV vaccine for adult females and males has been updated. Additional dosing information has been added in the footnote for patients who initiated vaccination before aged 15yrs.

Meningococcal vaccine

The meningococcal vaccine footnote has been updated to reflect a change in MenACWY dosing schedule for HIV patients, depending on previous vaccination status. The use of MenB vaccines in adults with anatomic/functional asplenia, persistent complement component deficiencies, or HIV, microbiologists, persons at risk during an outbreak, and healthy young adults has also been updated.

REFERENCES

For information on individual vaccines, please see product monographs at www.eMPR.com, contact company for full labeling, or call the National Immunization Hotline at (800) 232-4636.

Source: Advisory Committee on Immunization Practices (ACIP). Recommended Immunization Schedule for Adults Aged 19 Years or Older, by Vaccine and Age Group — United States, 2017. https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html

(Rev. 3/2017)

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