Recommended Adult Immunization Schedule United States, October 2006September 2007

Recommended adult immunization schedule, by vaccine and age group

Vaccine

Age group (yrs)

1949 years

5064 years
1-dose Td booster every 10 yrs Substitute 1 dose of Tdap for Td

>65 years

Measles, mumps, rubella (MMR)3* Varicella4* Influenza5* Pneumococcal (polysaccharide)6,7 Hepatitis A8* Hepatitis B9* Meningococcal10

Recommended adult immunization schedule, by vaccine and medical and other indications
Congenital immunodeficiency; leukemia;11 lymphoma; generalized malignancy; cerebrospinal fluid leaks; therapy with alkylating agents, antimetabolites, radiation, or highdose, long-term corticosteroids

Indication

Vaccine

Pregnancy

Measles, mumps, rubella (MMR)3* Varicella4* Influenza5* Pneumococcal (polysaccharide)6,7 Hepatitis A8* Hepatitis B9* Meningococcal10
12 doses 2 doses (0, 612 mos, or 0, 618 mos) 3 doses (0, 12, 46 mos) 1 dose 1 dose 1 dose annually 2 doses (0, 48 wks)
1 dose annually

* Covered by the Vaccine Injury Compensation Program

These recommendations must be read along with the footnotes, which can be found on the next 2 pages of this schedule.
For all persons in this category who meet the age requirements and who lack evidence of immunity (e.g., lack documentation of vaccination or have no evidence of prior infection) Recommended if some other risk factor is present (e.g., on the basis of medical, occupational, lifestyle, or other indications) Contraindicated

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Tetanus, diphtheria, pertussis (Td/Tdap)1* Human papillomavirus (HPV)2*

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Tetanus, diphtheria, pertussis (Td/Tdap)1* Human papillomavirus (HPV)2*

1 or 2 doses 2 doses (0, 48 wks) 1 dose annually 12 doses 2 doses (0, 48 wks)

1 dose

1 dose annually 1 dose

2 doses (0, 612 mos, or 0, 618 mos) 3 doses (0, 12, 46 mos) 1 or more doses

Diabetes, heart disease, chronic pulmonary disease, chronic alcoholism

Asplenia 11 (including elective splenectomy and terminal complement component deficiencies)

Chronic liver disease, recipients of clotting factor concentrates

Kidney failure, end-stage renal disease, recipients of hemodialysis

Human immunodeficiency virus (HIV) infection 3,11

Health-care workers

1-dose Td booster every 10 yrs Substitute 1 dose of Tdap for Td

3 doses for women through age 26 years (0, 2, 6 mos) 1or 2 doses 2 doses 1 dose annually 12 doses 12 doses 2 doses (0, 612 mos, or 0, 618 mos) 3 doses (0, 12, 46 mos) 1 dose

Footnotes 1. Tetanus, diphtheria, and acellular pertussis (Td/Tdap) vaccination. workers born before 1957 who do not have other evidence of mumps immunity, Adults with uncertain histories of a complete primary vaccination series with consider giving 1 dose on a routine basis and strongly consider giving a second diphtheria and tetanus toxoidcontaining vaccines should begin or complete a dose during an outbreak. Rubella component: administer 1 dose of MMR primary vaccination series. A primary series for adults is 3 doses; administer vaccine to women whose rubella vaccination history is unreliable or who lack the first 2 doses at least 4 weeks apart and the third dose 612 months after laboratory evidence of immunity. For women of childbearing age, regardless the second. Administer a booster dose to adults who have completed a primary of birth year, routinely determine rubella immunity and counsel women regarding series and if the last vaccination was received $10 years previously. Tdap or congenital rubella syndrome. Do not vaccinate women who are pregnant or tetanus and diphtheria (Td) vaccine may be used; Tdap should replace a who might become pregnant within 4 weeks of receiving vaccine. Women single dose of Td for adults aged <65 years who have not previously received who do not have evidence of immunity should receive MMR vaccine upon a dose of Tdap (either in the primary series, as a booster, or for wound completion or termination of pregnancy and before discharge from the healthmanagement). Only one of two Tdap products (Adacel [sanofi pasteur, care facility. Swiftwater, Pennsylvania]) is licensed for use in adults. If the person is pregnant 4. Varicella vaccination. All adults without evidence of immunity to varicella and received the last Td vaccination >10 years previously, administer Td during should receive 2 doses of varicella vaccine. Special consideration should be the second or third trimester; if the person received the last Td vaccination in given to those who 1) have close contact with persons at high risk for severe <10 years, administer Tdap during the immediate postpartum period. A onedisease (e.g., health-care workers and family contacts of immunocompromised time administration of 1-dose of Tdap with an interval as short as 2 years from persons) or 2) are at high risk for exposure or transmission (e.g., teachers of a previous Td vaccination is recommended for postpartum women, close young children; child care employees; residents and staff members of contacts of infants aged <12 months, and all health-care workers with direct institutional settings, including correctional institutions; college students; military patient contact. In certain situations, Td can be deferred during pregnancy personnel; adolescents and adults living in households with children; nonand Tdap substituted in the immediate postpartum period, or Tdap can be pregnant women of childbearing age; and international travelers). Evidence of given instead of Td to a pregnant woman after an informed discussion with the immunity to varicella in adults includes any of the following: 1) documentation woman (see http://www.cdc.gov/nip/publications/acip-list.htm). Consult the of 2 doses of varicella vaccine at least 4 weeks apart; 2) U.S.born before ACIP statement for recommendations for administering Td as prophylaxis in 1980 (although for health-care workers and pregnant women, birth before wound management (http://www.cdc.gov/mmwr/preview/mmwrhtml/ 1980 should not be considered evidence of immunity); 3) history of varicella 00041645.htm). based on diagnosis or verification of varicella by a health-care provider (for a 2. Human Papillomavirus (HPV) vaccination. HPV vaccination is patient reporting a history of or presenting with an atypical case, a mild case, recommended for all women aged <26 years who have not completed the or both, health-care providers should seek either an epidemiologic link with a typical varicella case or evidence of laboratory confirmation, if it was performed vaccine series. Ideally, vaccine should be administered before potential at the time of acute disease); 4) history of herpes zoster based on health-care exposure to HPV through sexual activity; however, women who are sexually provider diagnosis; or 5) laboratory evidence of immunity or laboratory active should still be vaccinated. Sexually active women who have not been confirmation of disease. Do not vaccinate women who are pregnant or might infected with any of the HPV vaccine types receive the full benefit of the become pregnant within 4 weeks of receiving the vaccine. Assess pregnant vaccination. Vaccination is less beneficial for women who have already been women for evidence of varicella immunity. Women who do not have evidence infected with one or more of the four HPV vaccine types. A complete series of immunity should receive dose 1 of varicella vaccine upon completion or consists of 3 doses. The second dose should be administered 2 months after termination of pregnancy and before discharge from the health-care facility. the first dose; the third dose should be administered 6 months after the first Dose 2 should be administered 48 weeks after dose 1. dose. Vaccination is not recommended during pregnancy. If a woman is found to be pregnant after initiating the vaccination series, the remainder of the 35. Influenza vaccination: Medical indications: chronic disorders of the dose regimen should be delayed until after completion of the pregnancy. cardiovascular or pulmonary systems, including asthma; chronic metabolic 3. Measles, Mumps, Rubella (MMR) vaccination. Measles component: diseases, including diabetes mellitus, renal dysfunction, hemoglobinopathies, adults born before 1957 can be considered immune to measles. Adults born or immunosuppression (including immunosuppression caused by medications or HIV); any condition that compromises respiratory function or the handling of during or after 1957 should receive $1 dose of MMR unless they have a respiratory secretions or that can increase the risk of aspiration (e.g., cognitive medical contraindication, documentation of $1 dose, history of measles based dysfunction, spinal cord injury, or seizure disorder or other neuromuscular on health-care provider diagnosis, or laboratory evidence of immunity. A second disorder); and pregnancy during the influenza season. No data exist on the dose of MMR is recommended for adults who 1) have been recently exposed risk for severe or complicated influenza disease among persons with asplenia; to measles or in an outbreak setting; 2) were previously vaccinated with killed however, influenza is a risk factor for secondary bacterial infections that can measles vaccine; 3) have been vaccinated with an unknown type of measles cause severe disease among persons with asplenia. Occupational indications: vaccine during 19631967; 4) are students in postsecondary educational health-care workers and employees of long-termcare and assisted living institutions; 5) work in a health-care facility, or 6) plan to travel internationally. facilities. Other indications: residents of nursing homes and other long-term Withhold MMR or other measles-containing vaccines from HIV-infected persons care and assisted living facilities; persons likely to transmit influenza to persons with severe immunosuppression. Mumps component: adults born before 1957 at high risk (i.e., in-home household contacts and caregivers of children aged can generally be considered immune to mumps. Adults born during or after 059 months, or persons of all ages with high-risk conditions); and anyone 1957 should receive 1 dose of MMR unless they have a medical who would like to be vaccinated. Healthy, nonpregnant persons aged 549 contraindication, history of mumps based on health-care provider diagnosis, years without high-risk medical conditions who are not contacts of severely or laboratory evidence of immunity. A second dose of MMR is recommended immunocompromised persons in special care units can receive either for adults who 1) are in an age group that is affected during a mumps outbreak; intranasally administered influenza vaccine (FluMist) or inactivated vaccine. 2) are students in postsecondary educational institutions; 3) work in a healthcare facility; or 4) plan to travel internationally. For unvaccinated health-care Other persons should receive the inactivated vaccine.

Footnotes 6. Pneumococcal polysaccharide vaccination. Medical indications: chronic disorders of the pulmonary system (excluding asthma); cardiovascular diseases; diabetes mellitus; chronic liver diseases, including liver disease as a result of alcohol abuse (e.g.,cirrhosis); chronic renal failure or nephrotic syndrome; functional or anatomic asplenia (e.g., sickle cell disease or splenectomy [if elective splenectomy is planned, vaccinate at least 2 weeks before surgery]); immunosuppressive conditions (e.g., congenital immunodeficiency, HIV infection [vaccinate as close to diagnosis as possible when CD4 cell counts are highest], leukemia, lymphoma, multiple myeloma, Hodgkin disease, generalized malignancy, organ or bone marrow transplantation); chemotherapy with alkylating agents, antimetabolites, or highdose, long-term corticosteroids; and cochlear implants. Other indications: Alaska Natives and certain American Indian populations and residents of nursing homes or other long-termcare facilities. 7. Revaccination with pneumococcal polysaccharide vaccine. One-time revaccination after 5 years for persons with chronic renal failure or nephrotic syndrome; functional or anatomic asplenia (e.g., sickle cell disease or splenectomy); immunosuppressive conditions (e.g., congenital immunodeficiency, HIV infection, leukemia, lymphoma, multiple myeloma, Hodgkin disease, generalized malignancy, or organ or bone marrow transplantation); or chemotherapy with alkylating agents, antimetabolites, or high-dose, longterm corticosteroids. For persons aged $65 years, one-time revaccination if they were vaccinated $5 years previously and were aged <65 years at the time of primary vaccination. 8. Hepatitis A vaccination. Medical indications: persons with chronic liver disease and persons who receive clotting factor concentrates. Behavioral indications: men who have sex with men and persons who use illegal drugs. Occupational indications: persons working with hepatitis A virus (HAV)infected primates or with HAV in a research laboratory setting. Other indications: persons traveling to or working in countries that have high or intermediate endemicity of hepatitis A (a list of countries is available at http://www.cdc.gov/travel/ diseases.htm) and any person who would like to obtain immunity. Current vaccines should be administered in a 2-dose schedule at either 0 and 612 months, or 0 and 618 months. If the combined hepatitis A and hepatitis B vaccine is used, administer 3 doses at 0, 1, and 6 months . 9. Hepatitis B vaccination. Medical indications: Persons with end-stage renal disease, including patients receiving hemodialysis; persons seeking evaluation or treatment for a sexually transmitted disease (STD); persons with HIV infection; persons with chronic liver disease; and persons who receive clotting factor concentrates. Occupational indications: health-care workers and publicsafety workers who are exposed to blood or other potentially infectious body fluids. Behavioral indications: sexually active persons who are not in a longterm, mutually monogamous relationship (i.e., persons with >1 sex partner during the previous 6 months); current or recent injection-drug users; and men who have sex with men. Other indications: household contacts and sex partners of persons with chronic hepatitis B virus (HBV) infection; clients and staff members of institutions for persons with developmental disabilities; all clients of STD clinics; international travelers to countries with high or intermediate prevalence of chronic HBV infection (a list of countries is available at http:// www.cdc.gov/travel/diseases.htm); and any adult seeking protection from HBV infection. Settings where hepatitis B vaccination is recommended for all adults: STD treatment facilities; HIV testing and treatment facilities; facilities providing drug-abuse treatment and prevention services; health-care settings providing services for injection-drug users or men who have sex with men; correctional facilities; end-stage renal disease programs and facilities for chronic hemodialysis patients; and institutions and nonresidential daycare facilities for persons with developmental disabilities. Special formulation indications: for adult patients receiving hemodialysis and other immunocompromised adults, 1 dose of 40 Fg/mL (Recombivax HB) or 2 doses of 20 Fg/mL (Engerix-B). 10. Meningococcal vaccination. Medical indications: adults with anatomic or functional asplenia, or terminal complement component deficiencies. Other indications: first-year college students living in dormitories; microbiologists who are routinely exposed to isolates of Neisseria meningitidis; military recruits; and persons who travel to or live in countries in which meningococcal disease is hyperendemic or epidemic (e.g., the meningitis belt of Sub-Saharan Africa during the dry season [DecemberJune]), particularly if contact with local populations will be prolonged. Vaccination is required by the government of Saudi Arabia for all travelers to Mecca during the annual Hajj. Meningococcal conjugate vaccine is preferred for adults with any of the preceeding indications who are aged #55 years, although meningococcal polysaccharide vaccine (MPSV4) is an acceptable alternative. Revaccination after 5 years might be indicated for adults previously vaccinated with MPSV4 who remain at high risk for infection (e.g., persons residing in areas in which disease is epidemic). 11. Selected conditions for which Haemophilus influenzae type b (Hib) vaccination may be used. Hib conjugate vaccines are licensed for children aged 6 weeks71 months. No efficacy data are available on which to base a recommendation concerning use of Hib vaccine for older children and adults with the chronic conditions associated with an increased risk for Hib disease. However, studies suggest good immunogenicity in patients who have sickle cell disease, leukemia, or HIV infection or have had splenectomies; administering vaccine to these patients is not contraindicated.

This schedule indicates the recommended age groups and medical indications for routine administration of currently licensed vaccines for persons aged $19 years, as of October 1, 2006. Licensed combination vaccines may be used whenever any components of the combination are indicated and when the vaccines other components are not contraindicated. For detailed recommendations on all vaccines, including those used primarily for travelers or that are issued during the year, consult the manufacturers package inserts and the complete statements from the Advisory Committee on Immunization Practices (http://www.cdc.gov/nip/publications/acip-list.htm). Report all clinically significant postvaccination reactions to the Vaccine Adverse Event Reporting System (VAERS). Reporting forms and instructions on filing a VAERS report are available at http://www.vaers.hhs.gov or by telephone, 800-822-7967. Information on how to file a Vaccine Injury Compensation Program claim is available at http://www.hrsa.gov/vaccinecompensation or by telephone, 800-338-2382.To file a claim for vaccine injury, contact the U.S. Court of Federal Claims, 717 Madison Place, N.W., Washington, D.C. 20005; telephone, 202-357-6400. Additional information about the vaccines in this schedule and contraindications for vaccination is also available at http://www.cdc.gov/nip or from the CDC-INFO Contact Center at 800-CDC-INFO (800-232-4636) in English and Spanish, 24 hours a day, 7 days a week.

Approved by the Advisory Committee on Immunization Practices, the American College of Obstetricians and Gynecologists, and the American Academy of Family Physicians