| Vaccine Name and Route | For Whom Vaccination Is Recommended | Schedule for Vaccine Administration* | Contraindications and Precautions† |
|---|---|---|---|
| Influenza TIV (give IM) LAIV (give intranasally) | • Vaccination is recommended for all adults. (This includes healthy adults aged 19–49 years without risk factors.) • LAIV is only approved for healthy nonpregnant people aged 2–49 years. • Adults aged 18-64 years may be given any intramuscular TIV product or, alternatively, the intradermal TIV product (Fluzone Intradermal). • Adults ages 65 years and older may be given standard-dose TIV or, alternatively, the high-dose TIV (Fluzone High-Dose). Note: LAIV may not be given to some adults; see contraindications and precautions listed in far right column. | • Give 1 dose every year in the fall or winter. Begin vaccination services as soon as vaccine is available and continue until the supply is depleted. • Continue to give vaccine to unvaccinated adults throughout the influenza season (including when influenza activity is present in the community) and at other times when the risk of influenza exists. • If 2 or more of the following live virus vaccines are to be given—LAIV, MMR, varicella, or yellow fever—they should be given on the same day; otherwise space them apart by at least 28 days. | Contraindications: • Previous anaphylactic reaction to this vaccine or to any of its components. Egg allergy is no longer a contraindication for TIV. • For LAIV only: pregnancy; chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, neurological/neuromuscular, hematologic, or metabolic (including diabetes) disorders; immunosuppression (including that caused by meds or HIV) Precautions: • Moderate or severe acute illness. • History of Guillain-Barré syndrome within 6 weeks after previous influenza vaccination. • For LAIV only: close contact with an immunosuppressed person when the person requires protective isolation or receipt of specific antivirals (ie., zanamivir or oseltamivir) 48 hours before vaccination. Avoid use of these antiviral drugs for 14 days after vaccination. |
| Human papillomavirus HPV2 (Cervarix; give IM) HPV4 (Gardasil; give IM) | HPV2 or HPV4: • All previously unvaccinated women through age 26 years HPV4 only: • All previously unvaccinated men through the age of 21 years and previously unvaccinated men 22-26 years who are immunocompromised, who test positive for HIV infection, or who have sex with men Note: any man may receive the HPV4 through age 26 if desired | • Give 3 doses on a 0, 2, and 6 month schedule. • There must be at least 4 weeks between doses 1 and 2 and at least 12 weeks between doses 2 and 3. Overall, there must be at least 24 weeks between doses 1 and 3. If possible, use the same vaccine product for all 3 doses. | Contraindication: • Previous anaphylactic reaction to this vaccine or to any of its components. Precautions: • Moderate or severe acute illness. • Data on vaccination in pregnancy are limited. Vaccination should be delayed until after completion of the pregnancy. |
| Pneumococcal polysaccharide (PSV23; give IM or SC) | See Table 1 | See Table 1 | Contraindication: Previous anaphylactic reaction to this vaccine or to any of its components. Precaution: Moderate or severe acute illness. |
| Td, Tdap (give IM) | • All adults who lack written documentation of a primary series of at least 3 doses of tetanus and diphtheria toxoid vaccine. • A booster dose of tetanus- and diphtheria toxoid–containing vaccine may be needed for wound management as early as 5 years after last dose; consult ACIP recommendations‡ • During pregnancy, when indicated, give Td or Tdap in second or third trimester. If not administered during pregnancy, give Tdap in immediate postpartum period. For Tdap only: • Adults <65 years who have not already received Tdap. • Adults of any age, including adults ≥65 years in contact with infants <12 months (eg, parents, grandparents, childcare providers) who have not received a dose of Tdap should be prioritized for vaccination. • Health care personnel of all ages. • Adults aged ≥65 years without a risk indicator (eg, not in contact with an infant) may also be vaccinated. | • For people who are unvaccinated or behind, complete the primary Td series (spaced at 0, 1- to 2-month, 6- to 12-month intervals); substitute a one-time dose of Tdap for one of the doses in the series, preferably the first. • Give Td booster every 10 years after the primary series has been completed. • Tdap should be given regardless of interval since previous Td. | Contraindications: • Previous anaphylactic reaction to this vaccine or to any of its components. • For Tdap only, history of encephalopathy not attributable to an identifiable cause, within 7 days after DTP/DTaP. Precautions: • Moderate or severe acute illness. • Guillain-Barré syndrome within 6 weeks after previous dose of tetanus toxoid–containing vaccine. • For Tdap only, progressive or unstable neurologic disorder, uncontrolled seizures, or progressive neuropathy until a treatment regimen has been established and the condition has stabilized. • History of arthus reaction after a prior dose of tetanus- or diphtheria toxoid–containing vaccine; defer vaccination until at least 10 years have elapsed since the last tetanus toxoid–containing vaccine. |
| Zoster (shingles; give SC) | • People aged ≥60 years Note: Zoster is FDA-approved for persons 50 years and older, but is not CDC recommended for this age group and therefore may not be covered by some insurers for persons aged 50–59 years | • Give one-time dose if unvaccinated, regardless of previous history of herpes zoster (shingles) or chickenpox. • If 2 or more of the following live virus vaccines are to be given—MMR, zoster, or yellow fever—they should be given on the same day. If they are not, space them by at least 28 days. | Contraindications: • Previous anaphylactic reaction to this vaccine or to any of its components • Primary cellular or acquired immunodeficiency • Pregnancy Precautions: • Moderate or severe acute illness. • Receipt of specific antivirals (ie, acyclovir, famciclovir, or valacyclovir) 24 hours before vaccination, if possible; delay resumption of these antiviral drugs for 14 days after vaccination. |
| Meningococcal Meningococcal conjugate vaccines (MCV4; give IM) Menactra, Menveo Meningococcal polysaccharide vaccine (MPSV4; give SC) | For people through age 18 years, consult “Summary of Recommendations for Child/Teen Immunization” at www.immunize.org/catg.d/p2010.pdf. • People with anatomic or functional asplenia or persistent complement component deficiency. • People who travel to or reside in countries in which meningococcal disease is hyperendemic or epidemic (eg, the “meningitis belt” of Sub-Saharan Africa). • Microbiologists routinely exposed to isolates of Neisseria meningitidis • First-year college students through age 21 years who live in residence halls (see fifth bullet in the column to the right for details). | • Give 2 initial doses of MCV4 2 months apart to adults ≤55 years with risk factors listed in first bullet in column to left or to adults with HIV in this age group. • Give one initial dose to all other adults with risk factors (see second through fourth bullets in column to left). • Give booster doses every 5 years to adults with continuing risk (see the first through third bullets in column to left). • MCV4 is preferred over MPSV4 for people ≤55 years old unless contraindicated; use MPSV4 only if age ≥56 years • For first-year college students aged 19-21 years living in residence halls, give one dose if unvaccinated plus booster dose if most recent dose was given when <16 years. | Contraindication: • Previous anaphylactic reaction to this vaccine or to any of its components Precaution: • Moderate or severe acute illness |
| Hepatitis A | Refer to the Summary of Recommendations for Adult Immunization table at the Immunization Action Coalition (IAC) website at www.immunize.org/adultrules | ||
| Hepatitis B | |||
| MMR | |||
| Varicella | |||
| Polio | |||
↵* Any vaccine can be given with another.
↵† Mild illness is not a contraindication.
Adapted with permission from Summary of Recommendations for Adult Immunization, Immunization Action Coalition, St. Paul, MN (2011). The original table is adapted from the recommendations of the Advisory Committee on Immunization Practices (ACIP) and is updated regularly at www.immunize.org/adultrules.
CDC, Centers for Disease Control and Prevention; FDA, US Food and Drug Administration; IM, intramuscularly; LAIV, live attenuated influenza vaccine; MMR, measles–mumps–rubella; SC, subcutaneously; Td, tetanus–diptheria; Tdap, tetanus, diphtheria, acellular pertussis; TIV, trivalent inactivated influenza vaccine.