COVID-19 vaccination recommendations have changed. See the latest recommendations.
Adult Immunization Schedule by Age
To make vaccination recommendations, healthcare providers should:
- Determine needed vaccines based on age (Table 1)
- Assess for medical conditions and other indications (Table 2)
- Review special situations (Vaccination Notes)
- Review contraindications and precautions to vaccination (Appendix)
Legend
Recommended vaccination for adults who meet age requirement, lack documentation of vaccination, or lack evidence of past infection
Recommended vaccination for adults with an additional risk factor or another indication
Recommended vaccination based on shared clinical decision-making
No recommendation/Not applicable
Vaccine | 19-26 years | 27-49 years | 50-64 years | ≥65 years | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
COVID-19 ![]() |
2- or 3- dose primary series and booster (see notes) | |||||||||||
Influenza inactivated (IIV4) or Influenza recombinant (RIV4) ![]() |
1 dose annually | |||||||||||
![]() Influenza live attenuated (LAIV4) ![]() |
![]() 1 dose annually |
|||||||||||
Tetanus, diphtheria, pertussis (Tdap or Td) ![]() |
1 dose Tdap each pregnancy; 1 dose Td/Tdap for wound management (see notes) | |||||||||||
1 dose Tdap, then Td or Tdap booster every 10 years | ||||||||||||
Measles, mumps, rubella (MMR) ![]() |
1 or 2 doses depending on indication (if born in 1957 or later) |
For healthcare personnel, (see notes) |
||||||||||
Varicella (VAR) ![]() |
2 doses (if born in 1980 or later) |
2 doses | ||||||||||
Zoster recombinant (RZV) ![]() |
2 doses for immunocompromising conditions (see notes) | 2 doses | ||||||||||
Human papillomavirus (HPV) ![]() |
2 or 3 doses depending on age at initial vaccination or condition | 27 through 45 years | ||||||||||
Pneumococcal (PCV15, PCV20, PPSV23) ![]() |
1 dose PCV15 followed by PPSV23 OR 1 dose PCV20 (see notes) |
See Notes | ||||||||||
See Notes | ||||||||||||
Hepatitis A (HepA) ![]() |
2, 3, or 4 doses depending on vaccine | |||||||||||
Hepatitis B (HepB) ![]() |
2, 3, or 4 doses depending on vaccine or condition | |||||||||||
Meningococcal A, C, W, Y (MenACWY) ![]() |
1 or 2 doses depending on indication, see notes for booster recommendations | |||||||||||
Meningococcal B (MenB) ![]() |
2 or 3 doses depending on vaccine and indication, see notes for booster recommendations | |||||||||||
19 through 23 years | ||||||||||||
Haemophilus influenzae type b (Hib) ![]() |
1 or 3 doses depending on indication |
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.
Notes
For vaccine recommendations for persons 18 years of age or younger, see the Recommended Child and Adolescent Immunization Schedule.
Appendix - Guide to Contraindications and Precautions to Commonly Used Vaccines
Adapted from Table 4-1 in Advisory Committee on Immunization Practices (ACIP) General Best Practice Guidelines for Immunization: Contraindication and Precautions and ACIP’s Recommendations for the Prevention and Control of 2022-23 seasonal influenza with Vaccines.
For COVID-19 vaccine contraindications and precautions see www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us.html#contraindications
Vaccine
Vaccine
Contraindicated or Not Recommended1
Contraindicated or Not Recommended1
Precautions2
Precautions2
- 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)
- 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
- Moderate or severe acute illness with or without fever
- 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
- Severe allergic reaction (e.g., anaphylaxis) to any ccIIV of any valency, or to any component3 of ccIIV4
- Severe allergic reaction (e.g., anaphylaxis) to any ccIIV of any valency, or to any component3 of ccIIV4
- Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any type of influenza vaccine
- 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 health care provider who can recognize and manage severe allergic reactions. May consult an allergist.
- Moderate or severe acute illness with or without fever
- Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any type of influenza vaccine
- 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 health care provider who can recognize and manage severe allergic reactions. May consult an allergist.
- Moderate or severe acute illness with or without fever
- Severe allergic reaction (e.g., anaphylaxis) to any RIV of any valency, or to any component3 of RIV4
- Severe allergic reaction (e.g., anaphylaxis) to any RIV of any valency, or to any component3 of RIV4
- Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any type of influenza vaccine
- 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 health care provider who can recognize and manage severe allergic reactions. May consult an allergist.
- Moderate or severe acute illness with or without fever
- Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any type of influenza vaccine
- 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 health care provider who can recognize and manage severe allergic reactions. May consult an allergist.
- Moderate or severe acute illness with or without fever
- 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)
- Anatomic or functional asplenia
- Immunocompromised due to any cause including, but not limited to, 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.
- 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)
- Anatomic or functional asplenia
- Immunocompromised due to any cause including, but not limited to, 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 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
- Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any type of influenza vaccine
- Asthma in persons aged 5 years 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
- 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
- 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
- Moderate or severe acute illness with or without fever
- Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 including neomycin
- 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
- Moderate or severe acute illness with or without fever
- Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 including yeast
- Pregnancy: Heplisav-B and PreHevbrio are not recommended due to lack of safety data in pregnant persons.
Use other hepatitis B vaccines if HepB is indicated4
- Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 including yeast
- Pregnancy: Heplisav-B and PreHevbrio are not recommended due to lack of safety data in pregnant persons.
Use other hepatitis B vaccines if HepB is indicated4
- Moderate or severe acute illness with or without fever
- Moderate or severe acute illness with or without fever
- Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 including neomycin and yeast
- 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
- Moderate or severe acute illness with or without fever
- Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
- Pregnancy: HPV vaccination not recommended
- Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
- Pregnancy: HPV vaccination not recommended
- Moderate or severe acute illness with or without fever
- Moderate or severe acute illness with or without fever
- 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
- 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
- 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
- Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
- For MenACWY-D and MenACWY-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
- Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
- For MenACWY-D and MenACWY-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
- Moderate or severe acute illness with or without fever
- Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
- 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
- Pregnancy
- For MenB-4C only: Latex sensitivity
- Moderate or severe acute illness with or without fever
- 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
- 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
- Moderate or severe acute illness with or without fever
- Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
- Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
- Moderate or severe acute illness with or without fever
- Moderate or severe acute illness with or without fever
- Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
- Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
- Moderate or severe acute illness with or without fever
- Moderate or severe acute illness with or without fever
- 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
- 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
- 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
- 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
- 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
- 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
- Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
- 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
- Moderate or severe acute illness with or without fever
- Current herpes zoster infection
- When a contraindication is present, a vaccine should NOT be administered. Kroger A, Bahta L, Hunter P. ACIP General Best Practice Guidelines for Immunization.
- 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.
- 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 vaccines.
- For information on the pregnancy exposure registries for persons who were inadvertently vaccinated with Heplisav-B or PreHevbrio while pregnant, please visit heplisavbpregnancyregistry.com/ or www.prehevbrio.com/#safety.
Vaccines in the Adult Immunization Schedule*
Vaccine | Abbreviation(s) | Trade name(s) |
---|---|---|
COVID-19 vaccine | 1vCOV-mRNA | Comirnaty®/Pfizer- BioNTech COVID-19 Vaccine |
SPIKEVAX®/Moderna COVID-19 Vaccine | ||
2vCOV-mRNA | Pfizer-BioNTech COVID-19 Vaccine, Bivalent | |
Moderna COVID-19 Vaccine, Bivalent | ||
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® Heplisav-B® PreHevbrio® Recombivax HB® |
Human papillomavirus vaccine | HPV | 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® Priorix® |
Meningococcal serogroups A, C, W, Y vaccine | MenACWY-D | Menactra® |
MenACWY-CRM | Menveo® | |
MenACWY-TT | MenQuadfi® | |
Meningococcal serogroup B vaccine | MenB-4C | Bexsero® |
MenB-FHbp | Trumenba® | |
Pneumococcal conjugate vaccine | PCV15 | Vaxneuvance™ |
PCV20 | Prevnar 20™ | |
Pneumococcal polysaccharide vaccine | PPSV23 | Pneumovax 23® |
Poliovirus vaccine | IPV | IPOL® |
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 |
*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.
This schedule is recommended by the Advisory Committee on Immunization Practices (ACIP) and approved by the Centers for Disease
Control and Prevention (CDC), American College of Physicians (ACP), American Academy of Family Physicians (AAFP), American College of Obstetricians and Gynecologists (ACOG), American College of Nurse-Midwives (ACNM), American Academy of Physician Associates (AAPA), American Pharmacists Association (APhA), and Society for Healthcare Epidemiology of America (SHEA).
The comprehensive summary of the ACIP recommended changes made to the adult immunization schedule can be found in the February 10, 2023 MMWR.
Report
- Suspected cases of reportable vaccine-preventable diseases or outbreaks to the local or state health department
- Clinically significant postvaccination reactions to the Vaccine Adverse Event Reporting System or 800‑822‑7967
Injury Claims
All vaccines included in the adult immunization schedule except PPSV23, RZV, and COVID-19 vaccines are covered by the National Vaccine Injury Compensation Program (VICP). COVID-19 vaccines that are authorized or approved by the FDA are covered by the Countermeasures Injury Compensation Program (CICP). For more information, see www.hrsa.gov/vaccinecompensation or www.hrsa.gov/cicp.
Questions or comments
Contact www.cdc.gov/cdc-info or 800-CDC-INFO (800-232-4636), in English or Spanish, 8 a.m.–8 p.m. ET, Monday through Friday, excluding holidays.
Helpful information
- Complete Advisory Committee on Immunization Practices (ACIP) recommendations
- General Best Practice Guidelines for Immunization
(including contraindications and precautions) - Vaccine Information Statements
- Manual for the Surveillance of Vaccine-Preventable Diseases
(including case identification and outbreak response) - Travel vaccine recommendations
- Recommended Child and Adolescent Immunization Schedule, United States
- ACIP Shared Clinical Decision-Making Recommendations