Adult Immunization Schedule by Age

Recommendations for Ages 19 Years or Older, United States, 2024

Using the schedule

To make vaccination recommendations, healthcare providers should:

  1. Determine recommended vaccinations by age (Table 1)
  2. Assess need for additional recommended vaccinations by medical condition or other indication (Table 2)
  3. Review vaccine types, dosing frequencies and intervals, and considerations for special situations (Notes)
  4. Review contraindications and precautions for vaccine types (Appendix)
  5. Review new or updated ACIP guidance (Addendum)
The Immunization Schedule

Legend

Recommended vaccination for adults who meet age requirement, lack documentation of vaccination, or lack evidence of immunity

Recommended vaccination for adults with an additional risk factor or another indication

Recommended vaccination based on shared clinical decision-making

No recommendation/Not applicable

adult vaccine schedule
Vaccine 19-26 years 27-49 years 50-64 years ≥65 years
COVID-19 more info icon. 1 or more doses of updated (2023-2024 Formula) vaccine (See notes)
Influenza inactivated (IIV4) or
Influenza recombinant (RIV4) more info icon.
1 dose annually
more info icon.
Influenza live attenuated
(LAIV4) more info icon.
more info icon.
1 dose annually
Respiratory Syncytial Virus
(RSV) more info icon.
Seasonal administration during pregnancy. (See notes) ≥60 years
Tetanus, diphtheria, pertussis
(Tdap or Td) more info icon.
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) more info icon.
1 or 2 doses depending on indication
(if born in 1957 or later)
For healthcare personnel,
(See notes)
Varicella
(VAR) more info icon.
2 doses
(if born in 1980 or later)
2 doses
Zoster recombinant
(RZV) more info icon.
2 doses for immunocompromising conditions (See notes) 2 doses
Human papillomavirus
(HPV) more info icon.
2 or 3 doses depending on age at initial vaccination or condition 27 through 45 years
Pneumococcal
(PCV15, PCV20, PPSV23) more info icon.
See Notes
See Notes
Hepatitis A
(HepA) more info icon.
2, 3, or 4 doses depending on vaccine
Hepatitis B
(HepB) more info icon.
2, 3, or 4 doses depending on vaccine or condition
Meningococcal A, C, W, Y
(MenACWY) more info icon.
1 or 2 doses depending on indication, See notes for booster recommendations
Meningococcal B
(MenB) more info icon.
2 or 3 doses depending on vaccine and indication, See notes for booster recommendations
19 through 23 years
Haemophilus influenzae type b
(Hib) more info icon.
1 or 3 doses depending on indication
Mpox more info icon.
Assess need for additional recommended vaccinations by medical condition or other indication (Table 2)

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.

Additional information

  • For calculating intervals between doses, 4 weeks = 28 Intervals of ≥4 months are determined by calendar months.
  • Within a number range (e.g., 12–18), a dash (–) should be read as “through.”
  • Vaccine doses administered ≤4 days before the minimum age or interval are considered valid. Doses of any vaccine administered ≥5 days earlier than the minimum age or minimum interval should not be counted as valid and should be repeated. The repeat dose should be spaced after the invalid dose by the recommended minimum interval. For further details, see Table 3-2, Recommended and minimum ages and intervals between vaccine doses, in General Best Practice Guidelines for Immunization.
  • Information on travel vaccination requirements and recommendations is available at cdc.gov/travel/.
  • For vaccination of persons with immunodeficiencies, see Table 8-1, Vaccination of persons with primary and secondary immunodeficiencies, in General Best Practice Guidelines for Immunization.
  • For information about vaccination in the setting of a vaccine-preventable disease outbreak, contact your state or local health department.
  • The National Vaccine Injury Compensation Program (VICP) is a no-fault alternative to the traditional legal system for resolving vaccine injury claims. All vaccines included in the adult immunization schedule except PPSV23, RSV, RZV, Mpox, and COVID-19 vaccines are covered by the National Vaccine Injury Compensation Program (VICP). Mpox and COVID-19 vaccines are covered by the Countermeasures Injury Compensation Program (CICP). For more information, see www.hrsa.gov/vaccinecompensation or www.hrsa.gov/cicp.

COVID-19 vaccination

Haemophilus influenzae type b vaccination

Hepatitis A vaccination

Hepatitis B vaccination

Human papillomavirus vaccination

Influenza vaccination

Measles, mumps, and rubella vaccination

Meningococcal vaccination

Mpox vaccination

Pneumococcal vaccination

Poliovirus vaccination

Respiratory syncytial virus vaccination

Tetanus, diphtheria, and pertussis (Tdap) vaccination

Varicella vaccination

Zoster vaccination

 

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, Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2023–24 Influenza Season, Contraindications and Precautions for COVID-19 Vaccination, and Contraindications and Precautions for JYNNEOS Vaccination.

COVID-19 and Flu Vaccines

adult vaccine schedule appendix
Vaccine Contraindicated or Not Recommended1 Precautions2
COVID-19 mRNA vaccines
[Pfizer-BioNTech, Moderna]
  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a component of an mRNA COVID-19 vaccine4
  • Diagnosed non-severe allergy (e.g., urticaria beyond the injection site) to a component of an mRNA COVID-19 vaccine4; or non-severe, immediate (onset less than 4 hours) allergic reaction after administration of a previous dose of an mRNA COVID-19 vaccine
  • Myocarditis or pericarditis within 3 weeks after a dose of any COVID-19 vaccine
  • Multisystem inflammatory syndrome in children (MIS-C) or multisystem inflammatory syndrome in adults (MIS-A)
  • Moderate or severe acute illness, with or without fever
COVID-19 protein subunit vaccine
[Novavax]
  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a component of a Novavax COVID-19 vaccine4
  • Diagnosed non-severe allergy (e.g., urticaria beyond the injection site) to a component of Novavax COVID-19 vaccine4; or non-severe, immediate (onset less than 4 hours) allergic reaction after administration of a previous dose of a Novavax COVID-19 vaccine
  • Myocarditis or pericarditis within 3 weeks after a dose of any COVID-19 vaccine
  • Multisystem inflammatory syndrome in children (MIS-C) or multisystem inflammatory syndrome in adults (MIS-A)
  • 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
  • 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
  • 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
Influenza, recombinant injectable (RIV4)
[Flublok Quadrivalent]
  • 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
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)
  • 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
  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 vaccines.
  4. See package inserts and FDA EUA fact sheets for a full list of vaccine ingredients. mRNA COVID-19 vaccines contain polyethylene glycol (PEG).

Other Vaccines

adult vaccine schedule appendix
Vaccine Contraindicated or Not Recommended1 Precautions2
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
  • 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
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
  • Pregnancy: HPV vaccination not recommended
  • 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-TT) [MenQuadfi]
  • 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
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
Meningococcal ABCWY
(MenACWY-TT/MenB-FHbp) [Penbraya]
  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
  • Severe allergic reaction to a tetanus toxoid-containing vaccine
  • Moderate or severe acute illness, with or without fever
Mpox [Jynneos]
  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
  • Moderate or severe acute illness, with or without fever
Pneumococcal conjugate (PCV15, 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
Poliovirus vaccine, inactivated (IPV)
  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
  • Pregnancy
  • Moderate or severe acute illness with or without fever
Respiratory syncytial virus vaccine (RSV)
  • Severe allergic reaction (e.g., anaphylaxis) to a vaccine component
  • 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. www.cdc.gov/vaccines/hcp/acip-recs/general-recs/contraindications.html
  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. www.cdc.gov/vaccines/hcp/acip-recs/general-recs/contraindications.html
  3. Vaccination providers should check FDA-approved prescribing information for the most complete and updated information, including contraindications, warnings, and precautions. Package inserts for U.S.-licensed vaccines are available at www.fda.gov/vaccines-blood-biologics/approved-products/vaccines-licensed-use-united-states.
  4. 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.
 

Addendum – Adult Recommended Immunization Schedule for ages 19 years or older, United States, 2024

In addition to the recommendations presented in the previous sections of this immunization schedule, ACIP has approved the following recommendations by majority vote since October 26, 2023. The following recommendations have been adopted by the CDC Director and are now official. Links are provided if these recommendations have been published in Morbidity and Mortality Weekly Report (MMWR).

Vaccines

Vaccines

Vaccines

Recommendations

Recommendations

Recommendations

Effective Date of
Recommendation*

Effective Date of Recommendation*

Effective Date of
Recommendation*

No new vaccines or vaccine recommendations to report

Vaccines

No new vaccines or vaccine recommendations to report

Recommendations
Effective Date of Recommendation*

*The effective date is the date when the CDC director adopted the recommendation and when the ACIP recommendation became official.

 

Vaccines in the Adult Immunization Schedule*

adult vaccine schedule
Vaccine Abbreviation(s) Trade name(s)
COVID-19 vaccine 1vCOV-mRNA Comirnaty®/Pfizer- BioNTech COVID-19 Vaccine
Spikevax®/Moderna 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®
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-CRM Menveo®
MenACWY-TT MenQuadfi®
Meningococcal serogroup B vaccine MenB-4C Bexsero®
MenB-FHbp Trumenba®
Meningococcal serogroup A, B, C, W, Y vaccine MenACWY-TT/MenB-FHbp Penbraya
Mpox vaccine Mpox Jynneos®
Pneumococcal conjugate vaccine PCV15 Vaxneuvance
PCV20 Prevnar 20
Pneumococcal polysaccharide vaccine PPSV23 Pneumovax 23®
Poliovirus vaccine IPV Ipol®
Respiratory syncytial virus vaccine RSV Arexvy®
Abrysvo
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 child and adolescent immunization schedule will be published in an upcoming MMWR in early 2024.

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

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.

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