2019 Vaccination Schedule: Adults
2019 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 inactivated (IIV) or recombinant (RIV)1 1 dose annually
or Influenza live attenuated (LAIV)1 or 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 (if born in 1980 or later)    
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 A (HepA)8 2 or 3 doses
Hepatitis B (HepB)9 2 or 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), recombinant influenza vaccine (RIV), or live attenuated influenza vaccine (LAIV) annually.

• Persons with hives-only allergy to eggs should receive age-appropriate IIV, RIV, or LAIV. If allergy more severe than hives, administer in a medical setting under supervision of healthcare provider.

• LAIV is not recommended in persons with immunocompromising conditions (including HIV), asplenia, cerebrospinal fluid leak, cochlear implant, pregnant women, close contacts/caregivers of severely immunocompromised persons, use of influenza antivirals in previous 48hrs.

 

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

• Persons who previously did not receive a dose of Tdap at ≥11yrs should receive 1 dose of Tdap vaccine, followed by Td booster every 10yrs.

• Persons who previously did not receive primary series for tetanus, diphtheria, and pertussis should receive 1 dose of Tdap vaccine, followed by Td at least 4wks after, and another Td dose 6–12mos after last Td (Tdap can be substituted for any Td dose); Td booster every 10yrs thereafter.

• 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).

• 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 without evidence of immunity should receive the first of 2 doses (4–8wks apart) or the 2nd dose, if previously received 1 dose, after pregnancy and before hospital discharge.

• HCP without evidence of immunity should receive 2 doses 4–8wks apart or the 2nd dose if previously received 1 dose.

• 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

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

— lab evidence of immunity or 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 (repeat dose if given <4wks apart).

• Adults ≥60yrs should receive either 2 doses of RZV (preferred) or 1 dose of ZVL if not previously vaccinated.

• 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.

• If initiated vaccination at ≥15yrs, give a 3-dose series at 0, 1–2, and 6mos; the 1st and 2nd doses should be at least 4wks apart, the 2nd and 3rd doses at least 12wks apart, and the 1st and 3rd doses at least 5mos apart; 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 polysaccharide 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 PCV13 and at least 5yrs after last PPSV23 dose. If previously received PPSV23 but not PCV13, give PCV13 at least 1yr after PPSV23.

• 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.

• Adults ≥19yrs with immunocompromising conditions (eg, complement deficiencies, phagocytic disorders, HIV, chronic renal failure, nephrotic syndrome, malignancy, solid organ transplant, multiple myeloma) or anatomical or functional asplenia (including sickle cell disease) 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 previous PPSV23 dose. At age ≥65yrs, give another dose of PPSV23 at least 5yrs after the last PPSV23 dose (only 1 dose PPSV23 recommended at age ≥65yrs).

• 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. At age ≥65yrs, give another dose of PPSV23 at least 5yrs after the last PPSV23 dose (only 1 dose PPSV23 recommended at age ≥65yrs).

 

  8. Hepatitis A vaccination

• Vaccinate any person seeking protection from hepatitis A virus (HAV) infection with either a 2-dose series of the single antigen HepA vaccine or a 3-dose series of the HepA-HepB vaccine combination.

• Vaccinate with a 2-dose series HepA vaccine to persons with any of the following indications:

— chronic liver disease or clotting factor disorders;

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

— homelessness;

— work with HAV in research lab or nonhuman primates with HAV infection;

— travel to countries with high or intermediate endemicity of hepatitis A;

— close personal contact with international adoptee (eg, household, regular babysitting) in 1st 60 days after arrival from country with high or intermediate endemic hepatitis A (give 1st dose as soon as adoption is planned, at least 2wks before adoptee’s arrival)

• Give 2 doses of the single-antigen vaccine at either 0 and 6–12mos (Havrix), or 0 and 6–18mos (Vaqta); doses should be at least 6mos apart. If the combined HepA and HepB 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:

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

— HIV-infection;

— 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);

— current or recent injection drug use;

— percutaneous or mucosal risk for blood exposure (eg, household contacts of HBsAg-positive persons, residents/staff of facilities for persons with developmental disabilities, HCPs and public safety workers who are exposed to blood or blood-contaminated body fluids, dialysis patients, patients <60yrs with diabetes [≥60yrs at the discretion of the treating clinician]);

— incarcerated;

— travel to countries with high or intermediate hepatitis B endemicity

— Give a 2-dose series with Heplisav-B at least 4wks apart (2-dose series HepB only applies when 2 doses of Heplisav-B are used) or a 3-dose series with either Engerix-B, Recombivax HB or Twinrix. 3-dose series with single-antigen HepB vaccines (Engerix-B, Recombivax HB) are given 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 HepA and HepB 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 and persons traveling in countries where meningococcal ­disease is hyperendemic or epidemic should receive 1 dose of MenACWY; revaccinate every 5yrs if risk remains

— first-year college students in residential housing (if not received vaccine at ≥16yrs) and military recruits should receive 1 dose of MenACWY.

• 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 (if 2nd dose given too soon, give 3rd dose at least 4mos after 2nd dose).

— adults with anatomic or functional asplenia, persistent complement component deficiency, on eculizumab therapy, 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 (3rd dose is not needed if 2nd dose was given at least 6mos after 1st dose)

— delay MenB until after pregnancy unless at increased risk and benefit outweighs potential risks.

— 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.

• 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

• For 2018–2019 season, any licensed age-appropriate influenza vaccine may be used. The schedule was updated to include LAIV as an option for adults through age 49yrs, except those with immunocompromised conditions, asplenia, cerebrospinal fluid leak, cochlear implant, pregnancy, close contact with or are caregivers of severely immunocompromised persons in a protected environment, and receipt of influenza antivirals in the previous 48hrs.

• Heplisav-B is added as a 2-dose regimen given at least 4wks apart. It can be used as a substitute in a 3-dose series with a different HepB vaccine, but a valid 2-dose series requires 2 doses of Heplisav-B.

• Homelessness is addded as an indication for routine HepA vaccination. A 2-dose series of single-antigen HepA vaccine or a 3-dose series of HepA-HepB combination vaccine may be used.

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 Adult Immunization Schedule for Ages 19 Years or Older, United States, 2019. https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html.

(Rev. 2/2019)

This article originally appeared on MPR