2018 Vaccination Schedule: Adults

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2018 Vaccination Schedule: Adults
2018 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 27−49yrs 50−64yrs ≥65yrs
Influenza1 1 dose annually
Tetanus, diphtheria, pertussis (Tdap or Td)2 1 dose Tdap, then Td booster every 10yrs
Measles, mumps, rubella (MMR)3 1 or 2 doses (if born in 1957 or later)      
Varicella (VAR)4 2 doses
Recombinant zoster (RZV)5 [preferred]   2 doses RZV (preferred)
or Zoster vaccine live (ZVL)5     or 1 dose ZVL
Human papillomavirus (HPV) Female6 2 or 3 doses  
Human papillomavirus (HPV) Male6 2 or 3 doses  
Pneumococcal 13-valent conjugate (PCV13)7   dose 
Pneumococcal polysaccharide (PPSV23)7 1 or 2 doses 1 dose
Hepatitis A8 2 or 3 doses
Hepatitis B9 3 doses
Meningococcal conjugate (MenACWY)10 1 or 2 doses, then booster every 5yrs if remains at risk
Meningococcal serogroup B (MenB)10 2 or 3 doses
Haemophilus influenzae type b (Hib)11 1 or 3 doses

 

  1. Influenza vaccination

• Give 1 dose of age-appropriate formulation of inactivated influenza vaccine (IIV) or recombinant influenza vaccine (RIV) annually.

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

• Live attenuated influenza vaccine (LAIV) is not recommended during the 2017−2018 influenza season.

 

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

• Persons who previously did not receive a dose of Tdap as an adult or child should receive 1 dose of Tdap vaccine, followed by Td booster every 10yrs.

• Give 1 dose of Tdap vaccine to pregnant women during each pregnancy (preferred during the early part of gestational weeks 27−36).

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

 

  3. Measles, mumps, rubella (MMR) vaccination

• Adults with no evidence of immunity to measles, mumps, or rubella should receive 1 dose of MMR vaccine.

• Evidence of immunity includes any of the following:

—Born before 1957 (except healthcare personnel)

—Documentation of receipt of MMR vaccine

—Lab evidence of immunity or disease (documentation of provider-diagnosed disease without lab confirmation is not considered evidence of immunity)

• Healthcare personnel born in 1957 or later should receive 2 doses of MMR at least 28 days apart for measles or mumps, or 1 dose for rubella. If born before 1957, consider MMR vaccination.

• Pregnant women and women of childbearing age with no evidence of immunity should receive 1 dose of MMR. Give vaccine after birth and before hospital discharge.

• Persons with HIV and CD4 count ≥200cells/μL for ≥6mos with no evidence of immunity should receive 2 doses at least 28 days apart.

• Students in postsecondary educational institutions, international travelers, and household contacts of immunocompromised persons should receive 2 doses at least 28 days apart (or 1 dose if previously received 1 MMR dose).

• Give 1 dose of MMR to persons who previously received ≤2 doses of mumps-containing vaccine and are identified by a public health authority to be at high risk during a mumps outbreak.

• MMR is contraindicated during pregnancy and in severe immunodeficiency.

 

  4. Varicella vaccination

• All adults without evidence of immunity to varicella should receive 2 doses of VAR vaccine 4–8wks apart. If previously received 1 dose of varicella-containing vaccine, give the 2nd dose at least 4wks after the 1st dose.

• Pregnant women should receive the first of the 2 doses or the 2nd dose after pregnancy and before hospital discharge.

• Persons with HIV and CD4 count ≥200cells/μL may receive 2 doses of VAR 3 months apart if clinically indicated.

• VAR is contraindicated during pregnancy and in severe immunodeficiency.

• 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. Zoster (recombinant zoster vaccine [RZV] and zoster vaccine live [ZVL]) vaccination

• Adults ≥50yrs regardless of past episode of herpes zoster or receipt of ZVL should receive 2 doses of RZV 2–6mos apart.

• Adults ≥60yrs should receive either RZV (preferred) or ZVL.

• Persons who previously received ZVL should receive 2 doses of RZV at least 2mos after ZVL.

• ZVL is contraindicated during pregnancy and in severe immunodeficiency.

 

  6. Human papilloma virus (HPV) vaccination

• Females through age 26yrs and males through age 21yrs should receive HPV vaccine. Males 22–26yrs may be vaccinated based on individual clinical decision.

• Give a 3-dose series at 0, 1–2, and 6mos to persons with no previous dose of HPV. The minimum interval should be 4wks between doses 1 and 2, 12wks between doses 2 and 3, and 5mos between doses 1 and 3; repeat doses if given too soon.

• If initiated vaccination at 9–14yrs and received 1 dose or 2 doses <5mos apart, give 1 dose. No additional dose is needed if initiated vaccination at 9–14yrs and received 2 doses at least 5mos apart.

• 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 poly-saccharide vaccine [PPSV23]) vaccination

• Immunocompetent adults ≥65yrs should receive 1 dose of PCV13, if not previously given, followed by 1 dose of PPSV23 at least 1yr after. If previously received PPSV23 but not PCV13, give PCV13 at least 1yr after.

• If both PCV13 and PPSV23 are indicated, give PCV13 first (do not give both vaccines during the same visit).

• Adults 19−64yrs with chronic heart disease (excluding hypertension), chronic lung or liver disease, alcoholism, diabetes, or cigarette smokers should receive 1 dose of PPSV23. At age ≥65yrs, give 1 dose of PCV13, if not previously given, and another dose of PPSV23 at least 1yr after PCV13 and at least 5yrs after PPSV23.

• Adults ≥19yrs with immunodeficiency disorders, HIV, anatomical or functional asplenia (including sickle cell disease), or chronic renal failure and nephrotic syndrome should receive 1 dose of PCV13 followed by 1 dose of PPSV23 at least 8wks after, and a 2nd dose of PPSV23 at least 5yrs after the first PPSV23 dose. If the most recent PPSV23 dose was given before age 65yrs, at age ≥65yrs, give another dose of PPSV23 at least 5yrs after the last PPSV23 dose.

• Adults ≥19yrs with cerebrospinal fluid leak or cochlear implant should receive 1 dose of PCV13 followed by 1 dose of PPSV23 at least 8wks after. If the PPSV23 dose was given before age 65yrs, at age ≥65yrs, give another dose of PPSV23 at least 5yrs after the last PPSV23 dose.

 

  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 or clotting factor disorders

—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).

—Healthy adults through age 40yrs who have recently been exposed to HAV. Adults ≥40yrs may receive vaccine if hepatitis A immunoglobulin cannot be obtained.

• Single-antigen vaccine formulations should be given as a 2-dose series at either 0 and 6–12mos (Havrix), or 0 and 6–18mos (Vaqta); doses should be at least 6mos apart. If the combined hepatitis A and hepatitis B vaccine (Twinrix) is used, administer 3 doses at 0, 1, and 6mos; the 1st and 2nd doses should be at least 4wks apart, and the 2nd and 3rd doses at least 5mos apart.

 

  9. Hepatitis B vaccination

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

—persons with chronic liver disease (eg, HCV infection, cirrhosis, fatty or alcoholic liver disease, autoimmune hepatitis, ALT/AST >2xULN);

—HIV-infected individuals;

—persons with percutaneous or mucosal risk of blood exposure (eg, household contacts of HBsAg-positive persons, patients <60yrs with diabetes [≥60yrs at the discretion of the treating clinician], adults receiving dialysis, injection drug users, HCPs and public safety workers who are exposed to blood or blood-contaminated body fluids);

—persons with sexual exposure risk (eg, sex partners of HBsAg-positive persons, sexually active persons who are not in a mutually monogamous relationship, persons seeking evaluation or treatment for an STD, men who have sex with men);

—adults receiving care in settings at high risk for HBV infection (eg, STD treatment facilities, drug-abuse treatment and prevention services, ESRD and dialysis centers, institutions for persons with developmental disabilities, health-care settings targeting services to injection-drug users or men who have sex with men, HIV testing and treatment facilities, correctional facilities);

—travel to countries with high or intermediate hepatitis B endemicity

• Single-antigen vaccine formulations (Engerix-B, Recombivax HB) should be given as a 3-dose series at 0, 1 and 6mos; the 1st and 2nd doses should be at least 4wks apart, and the 2nd and 3rd doses at least 8wks apart. If the combined hepatitis A and hepatitis B vaccine (Twinrix) is used, administer 3 doses at 0, 1, and 6mos; the 1st and 2nd doses should be at least 4wks apart, and the 2nd and 3rd doses at least 5mos apart.

 

10. Meningococcal (Serogroups A, C, W, and Y [MenACWY] or serogroup B [MenB]) vaccination

• MenACWY vaccination (Menactra, Menveo):

—Adults with anatomical or functional asplenia, HIV, persistent complement component deficiency, or on eculizumab therapy should receive 2 doses of MenACWY at least 8wks apart. Revaccinate with 1 dose every 5yrs if risk remains.

—Microbiologists routinely exposed to N. meningitidis, military recruits, first-year college students in residential housing (if not received vaccine at ≥16yrs), adults traveling to or living in countries where meningococcal disease is hyperendemic or epidemic, or persons at risk during an outbreak should receive 1 dose of MenACWY. Revaccinate with 1 dose every 5yrs if risk remains.

• MenB vaccination (Bexsero, Trumenba):

—Young adults 16–23yrs (16–18yrs preferred) not at increased risk may receive 2 doses of Bexsero at least 1 month apart or 2 doses of Trumenba at least 6mos apart.

—Adults with anatomic or functional asplenia, persistent complement component deficiency, on eculizumab therapy, persons at risk during an outbreak, or microbiologists routinely exposed to N. meningitidis should receive 2 doses of Bexsero at least 1 month apart or 3 doses of Trumenba at 0, 1–2, and 6mos.

—The two MenB vaccines are not interchangeable.

 

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 Tdap or Td 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

Tetanus, diphtheria, and acellular pertussis vaccine

The text “Td/Tdap” has been replaced by “Tdap or Td” and the bar was updated to indicate 1 dose of Tdap followed by Td booster every 10yrs.

Measles, mumps, rubella (MMR) vaccine

The footnotes were updated to include the recommended 1 dose of MMR to adults who previously received ≤2 doses of mumps-containing vaccine and are considered high risk during an outbreak.

Zoster vaccine

The schedule bars and footnotes were updated to include recommendations for the new recombinant zoster vaccine (RZV). The term herpes zoster vaccine (HZV) has been replaced by zoster vaccine live (ZVL). Rows for both RZV (preferred) and ZVL were added to the schedule table.

Human papilloma virus (HPV) vaccine

The schedule series for HPV vaccination has been updated to include 2 or 3 doses depending on age at initiation.

Meningococcal vaccine

The schedule bars and footnotes have been revised to include a change in dosing for MenACWY vaccination (1 or 2 doses, then booster every 5yrs if risk remains). MPSV4 (4-valent meningococcal polysaccharide vaccine) is no longer available and has been removed from the adult immunization schedule.

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, 2018. https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html

(Rev. 3/2018)

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