Adult Immunization Schedule
Recommendations for Ages 19 Years or Older, United States, 2022
ACIP recommends use of COVID-19 vaccines for everyone ages 6 months and older. COVID-19 vaccine and other vaccines may be administered on the same day. See the COVID-19 Vaccine: Interim COVID-19 Immunization Schedule for additional information.
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)
- Compliant version of the schedule single arrow icon
- Schedule changes and guidance single arrow icon
- Vaccines in the schedule single arrow icon
- Syndicate the schedules on your websitesingle arrow icon
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 | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
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) |
|||||||||||
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) |
1 dose PCV15 followed by PPSV23 OR 1 dose PCV20 |
||||||||||
Hepatitis A (HepA) ![]() |
2 or 3 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 2021-22 seasonal influenza with Vaccines.
Vaccine
Contraindications1
Precautions2
Contraindications1
- 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
Precautions2
- Moderate or severe acute illness with or without fever
Contraindications1
- Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 including neomycin
Precautions2
- Moderate or severe acute illness with or without fever
Contraindications1
- Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 including yeast
- For Heplisav-B only: Pregnancy
Precautions2
- Moderate or severe acute illness with or without fever
Contraindications1
- Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 including neomycin and yeast
Precautions2
- Moderate or severe acute illness with or without fever
Contraindications1
- Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
Precautions2
- Moderate or severe acute illness with or without fever
Contraindications1
- 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)
Precautions2
- 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
Contraindications1
- Severe allergic reaction (e.g., anaphylaxis) to any ccIIV of any valency, or to any component3 of ccIIV4
Precautions2
- 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
Contraindications1
- Severe allergic reaction (e.g., anaphylaxis) to any RIV of any valency, or to any component3 of RIV4
Precautions2
- 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
Contraindications1
- 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.
Precautions2
- 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
Contraindications1
- 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
Precautions2
- 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
Vaccine
Contraindications1
- 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
Precautions2
- Moderate or severe acute illness with or without fever
Contraindications1
- Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
Precautions2
- Pregnancy
- For MenB-4C only: Latex sensitivity
- Moderate or severe acute illness with or without fever
Contraindications1
- 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
Precautions2
- Moderate or severe acute illness with or without fever
Contraindications1
- 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
Precautions2
- Moderate or severe acute illness with or without fever
Contraindications1
- Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
Precautions2
- Moderate or severe acute illness with or without fever
Contraindications1
- 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
Precautions2
- 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
Contraindications1
- 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
Precautions2
- 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
- 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 vaccinesexternal icon.
Vaccines in the Adult Immunization Schedule*
Vaccine
Abbreviation(s)
Trade name(s)
Vaccine
Haemophilus influenzae type B vaccine
Abbreviation(s)
Hib
Trade name(s)
ActHIB®
Hiberix®
PedvaxHIB®
Vaccine
Hepatitis A vaccine
Abbreviation(s)
HepA
Trade name(s)
Havrix®
Vaqta®
Vaccine
Hepatitis A and hepatitis B vaccine
Abbreviation(s)
HepA-HepB
Trade name(s)
Twinrix®
Vaccine
Hepatitis B vaccine
Abbreviation(s)
HepB
Trade name(s)
Engerix-B®
Recombivax HB®
Heplisav-B®
Vaccine
Human papillomavirus vaccine
Abbreviation(s)
HPV Vaccine
Trade name(s)
Gardasil 9®
Vaccine
Influenza vaccine (inactivated)
Abbreviation(s)
IIV4
Trade name(s)
Many brands
Vaccine
Influenza vaccine (live, attenuated)
Abbreviation(s)
LAIV4
Trade name(s)
FluMist® Quadrivalent
Vaccine
Influenza vaccine (recombinant)
Abbreviation(s)
RIV4
Trade name(s)
Flublok® Quadrivalent
Vaccine
Measles, mumps, and rubella vaccine
Abbreviation(s)
MMR
Trade name(s)
M-M-R® II
Vaccine
Meningococcal serogroups A, C, W, Y vaccine
Abbreviation(s)
MenACWY-D
MenACWY-CRM
MenACWY-TT
Trade name(s)
Menactra®
Menveo®
MenQuadfi®
Vaccine
Meningococcal serogroup B vaccine
Abbreviation(s)
MenB-4C
MenB-FHbp
Trade name(s)
Bexsero®
Trumenba®
Vaccine
Pneumococcal 15-valent conjugate vaccine
Abbreviation(s)
PCV15
Trade name(s)
Vaxneuvance™
Vaccine
Pneumococcal 20-valent conjugate vaccine
Abbreviation(s)
PCV20
Trade name(s)
Prevnar 20™
Vaccine
Pneumococcal 23-valent polysaccharide vaccine
Abbreviation(s)
PPSV23
Trade name(s)
Pneumovax 23®
Vaccine
Tetanus and diphtheria toxoids
Abbreviation(s)
Td
Trade name(s)
Tenivac®
Tdvax™
Vaccine
Tetanus and diphtheria toxoids and acellular pertussis vaccine
Abbreviation(s)
Tdap
Trade name(s)
Adacel®
Boostrix®
Vaccine
Varicella vaccine
Abbreviation(s)
VAR
Trade name(s)
Varivax®
Vaccine
Zoster vaccine, recombinant
Abbreviation(s)
RZV
Trade name(s)
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 (ACPexternal icon), American Academy of Family Physicians (AAFPexternal icon), American College of Obstetricians and Gynecologists (ACOGexternal icon), American College of Nurse-Midwives (ACNMexternal icon), and American Academy of Physician Associates (AAPAexternal icon), and Society for Healthcare Epidemiology of America (SHEAexternal icon).
The comprehensive summary of the ACIP recommended changes made to the adult immunization schedule can be found in the February 18, 2022 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 Systemexternal icon or 800‑822‑7967
Injury Claims
All vaccines included in the adult immunization schedule except pneumococcal 23-valent polysaccharide (PPSV23) and zoster (RZV) vaccines are covered by the Vaccine Injury Compensation Program. Information on how to file a vaccine injury claim is available at www.hrsa.gov/vaccinecompensationexternal icon.
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