Last updated March 7, 2023

Adult Immunization Schedule 2023

Recommended Adult Immunization Schedule by Age Group, United Stated 2023

Recommended Adult Immunization Schedule by Medical Condition or Other Indication, United States, 2023

COVID-19 Vaccination

Routine Vaccination
Special Situations

Persons who are moderately or severely immunocompromised

For Janssen COVID-19 Vaccine recipients see COVID-19 schedule at www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us.html.

Note: Current COVID-19 schedule available at www.cdc.gov/vaccines/covid-19/downloads/COVID-19-immunization-schedule-ages-6months-older.pdf.
For more information on Emergency Use Authorization (EUA) indications for COVID-19 vaccines, please visit www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/covid-19-vaccines

See contraindications and precautions to COVID-19 vaccination.

Haemophilus influenzae type b vaccination

Special Situations
  • Anatomical or functional asplenia (including sickle cell disease): 1 dose if previously did not receive Hib; if elective splenectomy, 1 dose, preferably at least 14 days before splenectomy
  • Hematopoietic stem cell transplant (HSCT): 3-dose series 4 weeks apart starting 6–12 months after successful transplant, regardless of Hib vaccination history

Hepatitis A vaccination

Routine vaccination
  • Not at risk but want protection from hepatitis A
    (identification of risk factor not required): 2-dose series HepA (Havrix 6–12 months apart or Vaqta 6–18 months apart [minimum interval: 6 months]) or 3-dose series HepA-HepB (Twinrix at 0, 1, 6 months [minimum intervals: dose 1 to dose 2: 4 weeks / dose 2 to dose 3: 5 months])

Special Situations
  • At risk for hepatitis A virus infection: 2-dose series HepA or 3-dose series HepA-HepB as above
    • Chronic liver disease (e.g., persons with hepatitis B, hepatitis C, cirrhosis, fatty liver disease, alcoholic liver disease, autoimmune hepatitis, alanine aminotransferase [ALT] or aspartate aminotransferase [AST] level greater than twice the upper limit of normal)
    • HIV infection
    • Men who have sex with men
    • Injection or noninjection drug use
    • Persons experiencing homelessness
    • Work with hepatitis A virus in research laboratory or with nonhuman primates with hepatitis A virus infection
    • Travel in countries with high or intermediate endemic hepatitis A (HepA-HepB [Twinrix] may be administered on an accelerated schedule of 3 doses at 0, 7, and 21–30 days, followed by a booster dose at 12 months)
    • Close, personal contact with international adoptee (e.g., household or regular babysitting) in first 60 days after arrival from country with high or intermediate endemic hepatitis A (administer dose 1 as soon as adoption is planned, at least 2 weeks before adoptee’s arrival)
    • Pregnancy if at risk for infection or severe outcome from infection during pregnancy
    • Settings for exposure, including health care settings targeting services to injection or noninjection drug users or group homes and nonresidential day care facilities for developmentally disabled persons (individual risk factor screening not required)

Hepatitis B vaccination

Routine vaccination
  • Age 19 through 59 years: complete a 2- or 3- or 4-dose series
    • 2-dose series only applies when 2 doses of Heplisav-B* are used at least 4 weeks apart
    • 3-dose series Engerix-B, PreHevbrio*, or Recombivax HB at 0, 1, 6 months [minimum intervals: dose 1 to dose 2: 4 weeks / dose 2 to dose 3: 8 weeks / dose 1 to dose 3: 16 weeks])
    • 3-dose series HepA-HepB (Twinrix at 0, 1, 6 months [minimum intervals: dose 1 to dose 2: 4 weeks / dose 2 to dose 3: 5 months])
    • 4-dose series HepA-HepB (Twinrix) accelerated schedule of 3 doses at 0, 7, and 21–30 days, followed by a booster dose at 12 months
  • *Note: Heplisav-B and PreHevbrio are not recommended in pregnancy due to lack of safety data in pregnant persons.
  • Age 60 years or older with known risk factors for hepatitis B virus infection should complete a HepB vaccine series.
  • Age 60 years or older without known risk factors for hepatitis B virus infection may complete a HepB vaccine series.
    • Risk factors for hepatitis B virus infection include:
      • Chronic liver disease (e.g., persons with hepatitis C, cirrhosis, fatty liver disease, alcoholic liver disease, autoimmune hepatitis, alanine aminotransferase [ALT] or aspartate aminotransferase [AST] level greater than twice upper limit of normal)
      • HIV infection
      • Sexual exposure risk (e.g., sex partners of hepatitis B surface antigen [HBsAg]-positive persons; sexually active persons not in mutually monogamous relationships; persons seeking evaluation or treatment for a sexually transmitted infection; men who have sex with men)
      • Current or recent injection drug use
      • Percutaneous or mucosal risk for exposure to blood (e.g., household contacts of HBsAg-positive persons; residents and staff of facilities for developmentally disabled persons; health care and public safety personnel with reasonably anticipated risk for exposure to blood or blood-contaminated body fluids; persons on maintenance dialysis, including in-center or home hemodialysis and peritoneal dialysis, and persons who are predialysis; patients with diabetes)
      • Incarceration
      • Travel in countries with high or intermediate endemic hepatitis B


Special Situations
  • Patients on dialysis: complete a 3- or 4-dose series
    • 3-dose series Recombivax HB at 0, 1, 6 months (note: use Dialysis Formulation 1 mL = 40 mcg)
    • 4-dose series Engerix-B at 0, 1, 2, and 6 months (note: use 2 mL dose instead of the normal adult dose of 1 mL)

Human papillomavirus vaccination

Routine vaccination
  • HPV vaccination recommended for all persons through age 26 years: 2- or 3-dose series depending on age at initial vaccination or condition:
    • Age 15 years or older at initial vaccination: 3-dose series at 0, 1–2 months, 6 months (minimum intervals: dose 1 to dose 2: 4 weeks / dose 2 to dose 3: 12 weeks / dose 1 to dose 3: 5 months; repeat dose if administered too soon)
    • Age 9–14 years at initial vaccination and received 1 dose or 2 doses less than 5 months apart: 1 additional dose
    • Age 9–14 years at initial vaccination and received 2 doses at least 5 months apart: HPV vaccination series complete, no additional dose needed
  • Interrupted schedules: If vaccination schedule is interrupted, the series does not need to be restarted
  • No additional dose recommended when any HPV vaccine series has been completed using the recommended dosing intervals.

Share decision making
  • Some adults age 27–45 years: Based on shared clinical decision-making, 2- or 3-dose series as above


Special Situations
  • Age ranges recommended above for routine and catch-up vaccination or shared clinical decision-making also apply in special situations
    • Immunocompromising conditions, including HIV infection: 3-dose series, even for those who initiate vaccination at age 9 through 14 years.
    • Pregnancy: Pregnancy testing is not needed before vaccination; HPV vaccination is not recommended until after pregnancy; no intervention needed if inadvertently vaccinated while pregnant.

Influenza vaccination

Routine vaccination
  • Age 19 years or older: 1 dose any influenza vaccine appropriate for age and health status annually
  • Age 65 years or older: Any one of quadrivalent high-dose inactivated influenza vaccine (HD-IIV4), quadrivalent recombinant influenza vaccine (RIV4), or quadrivalent adjuvanted inactivated influenza vaccine (aIIV4) is preferred. If none of these three vaccines is available, then any other age-appropriate influenza vaccine should be used.
  • For the 2022–2023 season, see www.cdc.gov/mmwr/volumes/71/rr/rr7101a1.htm
  • For the 2023–2024 season, see the 2023–2024 ACIP influenza vaccine recommendations.

Special Situations
  • Egg allergy, hives only: any influenza vaccine appropriate for age and health status annually
  • Egg allergy–any symptom other than hives (e.g., angioedema, respiratory distress or required epinephrine or another emergency medical intervention): Any influenza vaccine appropriate for age and health status may be administered. If using egg-based IIV4 or LAIV4, administer in medical setting under supervision of health care provider who can recognize and manage severe allergic reactions.
  • Close contacts (e.g., caregivers, healthcare workers) of severely immunosuppressed persons who require a protected environment: these persons should not receive LAIV4. If LAIV4 is given, they should avoid contact with/caring for such immunosuppressed persons for 7 days after vaccination.
  • Severe allergic reaction (e.g., anaphylaxis) to a vaccine component or a previous dose of any influenza vaccine: see Appendix listing contraindications and precautions
  • History of Guillain-Barré syndrome within 6 weeks after previous dose of influenza vaccine: Generally, should not be vaccinated unless vaccination benefits outweigh risks for those at higher risk for severe complications from influenza

Measles, mumps, and rubella vaccination

Routine vaccination
  • No evidence of immunity to measles, mumps, or rubella: 1 dose
    • Evidence of immunity: Born before 1957 (health care personnel, see below), documentation of receipt of MMR vaccine, laboratory evidence of immunity or disease (diagnosis of disease without laboratory confirmation is not evidence of immunity)

Special Situations
  • Pregnancy with no evidence of immunity to rubella: MMR contraindicated during pregnancy; after pregnancy (before discharge from health care facility), 1 dose
  • Nonpregnant persons of childbearing age with no evidence of immunity to rubella: 1 dose
  • HIV infection with CD4 percentages ≥15% and CD4 count ≥200 cells/mm3 for at least 6 months and no evidence of immunity to measles, mumps, or rubella: 2-dose series at least 4 weeks apart; MMR contraindicated for HIV infection with CD4 percentage <15% or CD4 count <200 cells/mm3
  • Severe immunocompromising conditions: MMR contraindicated
  • Students in postsecondary educational institutions, international travelers, and household or close, personal contacts of immunocompromised persons with no evidence of immunity to measles, mumps, or rubella: 2-dose series at least 4 weeks apart if previously did not receive any doses of MMR or 1 dose if previously received 1 dose MMR
  • In mumps outbreak settings, for information about additional doses of MMR (including 3rd dose of MMR), see www.cdc.gov/mmwr/volumes/67/wr/mm6701a7. htm
  • Health care personnel:
    • Born before 1957 with no evidence of immunity to measles, mumps, or rubella: Consider 2-dose series at least 4 weeks apart for protection against measles or mumps or 1 dose for protection against rubella
    • Born in 1957 or later with no evidence of immunity to measles, mumps, or rubella: 2-dose series at least 4 weeks apart for protection against measles or mumps or at least 1 dose for protection against rubella

Meningococcal vaccination

Special Situations for MenACWY
  • Anatomical or functional asplenia (including sickle cell disease), HIV infection, persistent complement component deficiency, complement inhibitor (e.g., eculizumab, ravulizumab) use: 2-dose series MenACWY-D (Menactra, Menveo, or MenQuadfi) at least 8 weeks apart and revaccinate every 5 years if risk remains
  • Travel in countries with hyperendemic or epidemic meningococcal disease, or microbiologists routinely exposed to Neisseria meningitidis: 1 dose MenACWY (Menactra, Menveo, or MenQuadfi) and revaccinate every 5 years if risk remains
  • First-year college students who live in residential housing (if not previously vaccinated at age 16 years or older) or military recruits: 1 dose MenACWY (Menactra, Menveo, or MenQuadfi)
  • For MenACWY booster dose recommendations for groups listed under “Special situations” and in an outbreak setting (e.g., in community or organizational settings and among men who have sex with men) and additional meningococcal vaccination information, see www.cdc.gov/mmwr/volumes/69/rr/rr6909a1.htm

Shared clinical decision-making for MenB
  • Adolescents and young adults age 16–23 years (age 16–18 years preferred) not at increased risk for meningococcal disease: Based on shared clinical decision-making, 2-dose series MenB-4C (Bexsero) at least 1 month apart or 2-dose series MenB-FHbp (Trumenba) at 0, 6 months (if dose 2 was administered less than 6 months after dose 1, administer dose 3 at least 4 months after dose 2); MenB-4C and MenB-FHbp are not interchangeable (use same product for all doses in series)

Special Situations for MenB
  • Anatomical or functional asplenia (including sickle cell disease), persistent complement component deficiency, complement inhibitor (e.g., eculizumab, ravulizumab) use, or microbiologists routinely exposed to Neisseria meningitidis: 2-dose primary series MenB-4C (Bexsero) at least 1 month apart or 3-dose primary series MenB-FHbp (Trumenba) at 0, 1–2, 6 months (if dose 2 was administered at least 6 months after dose 1, dose 3 not needed; if dose 3 is administered earlier than 4 months after dose 2, a fourth dose should be administered at least 4 months after dose 3); MenB-4C and MenB-FHbp are not interchangeable (use same product for all doses in series); 1 dose MenB booster 1 year after primary series and revaccinate every 2–3 years if risk remains
  • Pregnancy: Delay MenB until after pregnancy unless at increased risk and vaccination benefits outweigh potential risks
  • For MenB booster dose recommendations for groups listed under “Special situations” and in an outbreak setting (e.g., in community or organizational settings and among men who have sex with men) and additional meningococcal vaccination information, see www.cdc.gov/mmwr/volumes/69/rr/rr6909a1.htm
  • Note: MenB vaccines may be administered simultaneously with MenACWY vaccines if indicated, but at a different anatomic site, if feasible.

Pneumococcal vaccination

Routine vaccination
  • Age 65 years or older who have:
    • Not previously received a dose of PCV13, PCV15, or PCV20 or whose previous vaccination history is unknown: 1 dose PCV15 OR 1 dose PCV20. If PCV15 is used, this should be followed by 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 of invasive pneumococcal disease caused by serotypes unique to PPSV23 in these vulnerable groups.
    • Previously received only PCV7: follow the recommendation above.
    • Previously received only PCV13: 1 dose PCV20 at least 1 year after the PCV13 dose OR complete the recommended PPSV23 series as described here: www.cdc.gov/vaccines/vpd/pneumo/downloads/pneumo-vaccine-timing.pdf
    • Previously received only PPSV23: 1 dose PCV15 OR 1 dose PCV20 at least 1 year after the PPSV23 dose. If PCV15 is used, it need not be followed by another dose of PPSV23.
    • Previously received both PCV13 and PPSV23 but NO PPSV23 was received at age 65 years or older: 1 dose PCV20 at least 5 years after their last pneumococcal vaccine dose OR complete the recommended PPSV23 series as described here: www.cdc.gov/vaccines/vpd/pneumo/downloads/pneumo-vaccine-timing.pdf
    • Previously received both PCV13 and PPSV23, AND PPSV23 was received at age 65 years or older: Based on shared clinical decision-making, 1 dose of PCV20 at least 5 years after the last pneumococcal vaccine dose.
    • For guidance on determining which pneumococcal vaccines a patient needs and when, please refer to the mobile app which can be downloaded here: www.cdc.gov/vaccines/vpd/pneumo/hcp/pneumoapp.html

Special Situations
  • Age 19–64 years with certain underlying medical conditions or other risk factors** who have
    • Not previously received a PCV13, PCV15, or PCV20 or whose previous vaccination history is unknown: 1 dose PCV15 OR 1 dose PCV20. If PCV15 is used, this should be followed by 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
    • Previously received only PCV7: follow the recommendation above
    • Previously received only PCV13: 1 dose PCV20 at least 1 year after the PCV13 dose OR complete the recommended PPSV23 series as described here:
      www.cdc.gov/vaccines/vpd/pneumo/downloads/pneumo-vaccine-timing.pdf
    • Previously received only PPSV23: 1 dose PCV15 OR 1 dose PCV20 at least 1 year after the PPSV23 dose. If PCV15 is used, it need not be followed by another dose of PPSV23
    • Previously received both PCV13 and PPSV23 but have not completed the recommended series: 1 dose PCV20 at least 5 years after their last pneumococcal vaccine dose OR complete the recommended PPSV23 series as described here:
      www.cdc.gov/vaccines/vpd/pneumo/downloads/pneumo-vaccine-timing.pdf
  • For guidance on determining which pneumococcal vaccines a patient needs and when, please refer to the mobile app which can be downloaded here: www.cdc.gov/vaccines/vpd/pneumo/hcp/pneumoapp.html
*Note: Immunocompromising conditions include chronic renal failure, nephrotic syndrome, immunodeficiency, iatrogenic immunosuppression, generalized malignancy, human immunodeficiency virus, Hodgkin disease, leukemia, lymphoma, multiple myeloma, solid organ transplants, congenital or acquired asplenia, sickle cell disease, or other hemoglobinopathies.

**Note: Underlying medical conditions or other risk factors include alcoholism, chronic heart/liver/lung disease, chronic renal failure, cigarette smoking, cochlear implant, congenital or acquired asplenia, CSF leak, diabetes mellitus, generalized malignancy, HIV, Hodgkin disease, immunodeficiency, iatrogenic immunosuppression, leukemia, lymphoma, multiple myeloma, nephrotic syndrome, solid organ transplants, or sickle cell disease, or other hemoglobinopathies.

Polio vaccination

Routine poliovirus vaccination of adults residing in the United States is not necessary

Special situations

  • Adults at increased risk of exposure to poliovirus with:
    • No evidence of a complete polio vaccination series (i.e., at least 3 doses): administer remaining doses (1, 2, or 3 doses) to complete a 3-dose series
    • Evidence of completed polio vaccination series (i.e., at least 3 doses): may administer one lifetime IPV booster

For detailed information, see: www.cdc.gov/vaccines/vpd/polio/hcp/recommendations.html


Tetanus, diphtheria, and pertussis (Tdap) vaccination

Routine vaccination
  • Previously did not receive Tdap at or after age 11 years: 1 dose Tdap, then Td or Tdap every 10 years

Special Situations
  • Previously did not receive primary vaccination series for tetanus, diphtheria, or pertussis: 1 dose Tdap followed by 1 dose Td or Tdap at least 4 weeks later, and a third dose of Td or Tdap 6–12 months later (Tdap can be substituted for any Td dose, but preferred as first dose), Td or Tdap every 10 years thereafter
  • Pregnancy: 1 dose Tdap during each pregnancy, preferably in early part of gestational weeks 27–36
  • Wound management: Persons with 3 or more doses of tetanus-toxoid-containing vaccine: For clean and minor wounds, administer Tdap or Td if more than 10 years since last dose of tetanus-toxoid-containing vaccine; for all other wounds, administer Tdap or Td if more than 5 years since last dose of tetanus-toxoid-containing vaccine. Tdap is preferred for persons who have not previously received Tdap or whose Tdap history is unknown. If a tetanus-toxoid-containing vaccine is indicated for a pregnant woman, use Tdap. For detailed information, see www.cdc.gov/mmwr/volumes/69/wr/mm6903a5.htm

Varicella vaccination

Routine vaccination
  • No evidence of immunity to varicella: 2-dose series 4–8 weeks apart if previously did not receive varicella-containing vaccine (VAR or MMRV [measles-mumps-rubella-varicella vaccine] for children); if previously received 1 dose varicella-containing vaccine, 1 dose at least 4 weeks after first dose
    • Evidence of immunity: U.S.-born before 1980 (except for pregnant persons and health care personnel [see below]), documentation of 2 doses varicella-containing vaccine at least 4 weeks apart, diagnosis or verification of history of varicella or herpes zoster by a health care provider, laboratory evidence of immunity or disease

Special Situations
  • Pregnancy with no evidence of immunity to varicella: VAR contraindicated during pregnancy; after pregnancy (before discharge from health care facility), 1 dose if previously received 1 dose varicella-containing vaccine or dose 1 of 2-dose series (dose 2: 4–8 weeks later) if previously did not receive any varicella-containing vaccine, regardless of whether U.S.-born before 1980
  • Health care personnel with no evidence of immunity to varicella: 1 dose if previously received 1 dose varicella-containing vaccine; 2-dose series 4–8 weeks apart if previously did not receive any varicella-containing vaccine, regardless of whether U.S.-born before 1980
  • HIV infection with CD4 percentages ≥15% and CD4 count ≥200 cells/mm3 with no evidence of immunity: Vaccination may be considered (2 doses 3 months apart); VAR contraindicated for HIV infection with CD4 percentage <15% or CD4 count <200 cells/mm3
  • Severe immunocompromising conditions: VAR contraindicated

Zoster vaccination

Routine vaccination
  • Age 50 years or older*: 2-dose series recombinant zoster vaccine (RZV, Shingrix) 2–6 months apart (minimum interval: 4 weeks; repeat dose if administered too soon), regardless of previous herpes zoster or history of zoster vaccine live (ZVL, Zostavax) vaccination.
  • *Note: Serologic evidence of prior varicella is not necessary for zoster vaccination. However, if serologic evidence of varicella susceptibility becomes available, providers should follow ACIP guidelines for varicella vaccination first. RZV is not indicated for the prevention of varicella, and there are limited data on the use of RZV in persons without a history of varicella or varicella vaccination.


Special Situations
  • Pregnancy: There is currently no ACIP recommendation for RZV use in pregnancy. Consider delaying RZV until after pregnancy.
  • Immunocompromising conditions (including persons with HIV regardless of CD4 count)**: 2-dose series recombinant zoster vaccine (RZV, Shingrix) 2–6 months apart (minimum interval: 4 weeks; repeat dose if administered too soon). For detailed information, see www.cdc.gov/shingles/vaccination/immunocompromised-adults.html
  • **Note: If there is no documented history of varicella, varicella vaccination, or herpes zoster, providers should refer to the clinical considerations for use of RZV in immunocompromised adults aged ≥19 years and the ACIP varicella vaccine recommendations for further guidance: www.cdc.gov/mmwr/volumes/71/wr/mm7103a2.htm

Guide to Contraindications and Precautions to Commonly Used Vaccines

Vaccine Contraindications Precautions
Haemophilus influenzae type b (Hib) Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
For Hiberix, ActHib, and PedvaxHIB only: History of severe allergic reaction to dry natural latex
Moderate or severe acute illness with or without fever
Hepatitis A (HepA) Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 including neomycin Moderate or severe acute illness with or without fever
Hepatitis B (HepB) Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 including yeast
For Heplisav-B only: Pregnancy
Moderate or severe acute illness with or without fever
Hepatitis A- Hepatitis B vaccine [HepA-HepB, (Twinrix®)] Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 including neomycin and yeast Moderate or severe acute illness with or without fever
Human papillomavirus (HPV) Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 Moderate or severe acute illness with or without fever
Influenza, egg-based, inactivated injectable (IIV4) Severe allergic reaction (e.g., anaphylaxis) after previous dose of any influenza vaccine (i.e., any egg-based IIV, ccIIV, RIV, or LAIV of any valency)
Severe allergic reaction (e.g., anaphylaxis) to any vaccine component3 (excluding egg)
Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any type of influenza vaccine
Persons with egg allergy with symptoms other than hives (e.g., angioedema, respiratory distress) or required epinephrine or another emergency medical intervention: Any influenza vaccine appropriate for age and health status may be administered. If using IIV4 or LAIV4, administer in medical setting under supervision of healthcare provider who can recognize and manage severe allergic reactions
Moderate or severe acute illness with or without fever
Influenza, cell culture-based inactivated injectable
[(ccIIV4), Flucelvax® Quadrivalent]
Severe allergic reaction (e.g., anaphylaxis) to any ccIIV of any valency, or to any component3 of ccIIV4 Persons with a history of severe allergic reaction (e.g., anaphylaxis) after a previous dose of any egg-based IIV, RIV, or LAIV of any valency. If using ccIV4, administer in medical setting under supervision of healthcare provider who can recognize and manage severe allergic reactions. May consult an allergist.
Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any type of influenza vaccine
Moderate or severe acute illness with or without fever
Influenza, recombinant injectable
[(RIV4), Flublok® Quadrivalent]
Severe allergic reaction (e.g., anaphylaxis) to any RIV of any valency, or to any component3 of RIV4 Persons with a history of severe allergic reaction (e.g., anaphylaxis) after a previous dose of any egg- based IIV, ccIIV, or LAIV of any valency. If using RIV4, administer in medical setting under supervision of healthcare provider who can recognize and manage severe allergic reactions. May consult an allergist.
Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any type of influenza vaccine
Moderate or severe acute illness with or without fever
Influenza, live attenuated [LAIV4, Flumist® Quadrivalent] Severe allergic reaction (e.g., anaphylaxis) after previous dose of any influenza vaccine (i.e., any egg-based IIV, ccIIV, RIV, or LAIV of any valency)
Severe allergic reaction (e.g., anaphylaxis) to any vaccine component3 (excluding egg)
Adults age 50 years or older
Anatomic or functional asplenia
Immunocompromised due to any cause including medications and HIV infection
Close contacts or caregivers of severely immunosuppressed persons who require a protected environment
Pregnancy
Cochlear implant
Active communication between the cerebrospinal fluid (CSF) and the oropharynx, nasopharynx, nose, ear or any other cranial CSF leak
Received influenza antiviral medications oseltamivir or zanamivir within the previous 48 hours, peramivir within the previous 5 days, or baloxavir within the previous 17 days.
Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any type of influenza vaccine
Asthma in persons aged 5 years old or older
Persons with underlying medical conditions (other than those listed under contraindications) that might predispose to complications after wild-type influenza virus infection [e.g., chronic pulmonary, cardiovascular (except isolated hypertension), renal, hepatic, neurologic, hematologic, or metabolic disorders (including diabetes mellitus)]
Moderate or severe acute illness with or without fever
Measles, mumps, rubella (MMR) Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
Severe immunodeficiency (e.g., hematologic and solid tumors, receipt of chemotherapy, congenital immunodeficiency, long-term immunosuppressive therapy or patients with HIV infection who are severely immunocompromised)
Pregnancy
Family history of altered immunocompetence, unless verified clinically or by laboratory testing as immunocompetent
Recent (≤11 months) receipt of antibody-containing blood product (specific interval depends on product)
History of thrombocytopenia or thrombocytopenic purpura
Need for tuberculin skin testing or interferon-gamma release assay (IGRA) testing
Moderate or severe acute illness with or without fever
Meningococcal ACWY (MenACWY)
[MenACWY-CRM (Menveo®); MenACWY-D (Menactra®); MenACWY-TT (MenQuadfi®)]
Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
For MenACWY-D and Men ACWY-CRM only: severe allergic reaction to any diphtheria toxoid– or CRM197–containing vaccine
For MenACWY-TT only: severe allergic reaction to a tetanus toxoid-containing vaccine
Moderate or severe acute illness with or without fever
Meningococcal B (MenB)
[MenB-4C (Bexsero®); MenB-FHbp (Trumenba®)]
Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 Pregnancy
For MenB-4C only: Latex sensitivity
Moderate or severe acute illness with or without fever
Pneumococcal conjugate (PCV15)
Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
Severe allergic reaction (e.g., anaphylaxis) to any diphtheria-toxoid–containing vaccine or to its vaccine component3
Moderate or severe acute illness with or without fever
Pneumococcal conjugate (PCV20)
Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
Severe allergic reaction (e.g., anaphylaxis) to any diphtheria-toxoid– containing vaccine or to its vaccine component3
Moderate or severe acute illness with or without fever
Pneumococcal polysaccharide (PPSV23) Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 Moderate or severe acute illness with or without fever
Tetanus, diphtheria, and acellular pertussis (Tdap)
Tetanus, diphtheria (Td)
Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
For Tdap only: Encephalopathy (e.g., coma, decreased level of consciousness, prolonged seizures), not attributable to another identifiable cause, within 7 days of administration of previous dose of DTP, DTaP, or Tdap
Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of tetanus-toxoid–containing vaccine
History of Arthus-type hypersensitivity reactions after a previous dose of diphtheria-toxoid— containing or tetanus-toxoid– containing vaccine; defer vaccination until at least 10 years have elapsed since the last tetanus-toxoid– containing vaccine
Moderate or severe acute illness with or without fever
For Tdap only: Progressive or unstable neurological disorder, uncontrolled seizures, or progressive encephalopathy until a treatment regimen has been established and the condition has stabilized
Varicella (VAR) Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
Severe immunodeficiency (e.g., hematologic and solid tumors, receipt of chemotherapy, congenital immunodeficiency, long- term immunosuppressive therapy or patients with HIV infection who are severely immunocompromised)
Pregnancy
Family history of altered immunocompetence, unless verified clinically or by laboratory testing as immunocompetent
Recent (≤11 months) receipt of antibody-containing blood product (specific interval depends on product)
Receipt of specific antiviral drugs (acyclovir, famciclovir, or valacyclovir) 24 hours before vaccination (avoid use of these antiviral drugs for 14 days after vaccination)
Use of aspirin or aspirin-containing products
Moderate or severe acute illness with or without fever
Zoster recombinant vaccine (RZV) Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 Moderate or severe acute illness with or without fever
Current herpes zoster infection
1. When a contraindication is present, a vaccine should NOT be administered. Kroger A, Bahta L, Hunter P. ACIP General Best Practice Guidelines for Immunization.
2. When a precaution is present, vaccination should generally be deferred but might be indicated if the benefit of protection from the vaccine outweighs the risk for an adverse reaction. Kroger A, Bahta L, Hunter P. ACIP General Best Practice Guidelines for Immunization.
3. Vaccination providers should check FDA-approved prescribing information for the most complete and updated information, including contraindications, warnings, and precautions. See Package inserts for U.S.-licensed vaccinesexternal icon.

Vaccines in the Adult Immunization Schedule*

Vaccine
Abbreviation(s)
Trade name(s)
COVID-19 Vaccine
1vCOV-mRNA
Pfizer- BioNTech COVID-19 Vaccine
SPIKEVAX®/Moderna COVID-19 Vaccine
COVID-19 Vaccine
2vCOV-mRNA
Pfizer-BioNTech COVID-19 Vaccine, Bivalent
Moderna COVID-19 Vaccine, Bivalent
COVID-19 Vaccine
1vCOV-aPS
Novavax COVID-19 Vaccine
Haemophilus influenzae type B vaccine
Hib
ActHIB®
Hiberix®
PedvaxHIB®
Hepatitis A vaccine
HepA
Havrix®
Vaqta®
Hepatitis A and hepatitis B vaccine
HepA-HepB
Twinrix®
Hepatitis B vaccine
HepB
Engerix-B®
Recombivax HB®
Heplisav-B®
PreHevbrio®
Human papillomavirus vaccine
HPV Vaccine
Gardasil 9®
Influenza vaccine (inactivated)
IIV4
Many brands
Influenza vaccine (live, attenuated)
LAIV4
FluMist® Quadrivalent
Influenza vaccine (recombinant)
RIV4
Flublok® Quadrivalent
Measles, mumps, and rubella vaccine
MMR
M-M-R® II
Meningococcal serogroups A, C, W, Y vaccine MenACWY-D
MenACWY-CRM
MenACWY-TT
Menactra®
Menveo®
MenQuadfi®
Meningococcal serogroup B vaccine MenB-4C
MenB-FHbp
Bexsero®
Trumenba®
Pneumococcal 15-valent conjugate vaccine
PCV15
Vaxneuvance™
Pneumococcal 20-valent conjugate vaccine
PCV20
Prevnar 20™
Pneumococcal 23-valent polysaccharide vaccine
PPSV23
Pneumovax 23®
Tetanus and diphtheria toxoids
Td
Tenivac®
Tdvax™
Tetanus and diphtheria toxoids and acellular pertussis vaccine
Tdap
Adacel®
Boostrix®
Varicella vaccine
VAR
Varivax®
Zoster vaccine, recombinant
RZV
Shingrix
Poliovirus vaccine
IPV
IPOL
*Administer recommended vaccines if vaccination history is incomplete or unknown. Do not restart or add doses to vaccine series if there are extended intervals between doses. The use of trade names is for identification purposes only and does not imply endorsement by the ACIP or CDC.

Recommendation Grading

Disclaimer

Overview

Title

Recommended Adult Immunization Schedule: United States, 2023

Authoring Organization

Publication Month/Year

February 9, 2023

Document Type

Guideline

Country of Publication

US

Target Patient Population

Adults ages 19 Years or Older

Target Provider Population

Family medicine providers, OBGYNs, pharmacists and other allied providers

Inclusion Criteria

Male, Female, Adult, Older adult

Health Care Settings

Ambulatory, Long term care

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Management, Prevention

Diseases/Conditions (MeSH)

D007114 - Immunization, D007115 - Immunization Schedule

Keywords

vaccination, immunization, immunizations, shingles