Adult Immunization Schedule

Recommendations for Ages 19 Years or Older, United States, 2022

COVID-19 Vaccination

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.

Using the schedule

To make vaccination recommendations, healthcare providers should:

  1. Determine needed vaccines based on age (Table 1)
  2. Assess for medical conditions and other indications (Table 2)
  3. Review special situations (Vaccination Notes)
  4. Review contraindications and precautions to vaccination (Appendix)
More schedule resources

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

adult vaccine schedule
Vaccine 19-26 years 27-49 years 50-64 years ≥65 years
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
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)
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.
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) more info icon.
2 or 3 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

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.

Haemophilus influenzae type b vaccination

Hepatitis A vaccination

Hepatitis B vaccination

Human papillomavirus vaccination

Influenza vaccination

Measles, mumps, and rubella vaccination

Meningococcal vaccination

Pneumococcal 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 and ACIP’s Recommendations for the Prevention and Control of 2021-22 seasonal influenza with Vaccines.

Vaccine

Contraindications1

Precautions2

Vaccine

Haemophilus influenzae type b (Hib)

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

Vaccine

Hepatitis A (HepA)

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

Vaccine

Hepatitis B (HepB)

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

Vaccine

Hepatitis A- Hepatitis B vaccine [HepA-HepB, (Twinrix®)]

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

Vaccine

Human papillomavirus (HPV)

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

Vaccine

Influenza, egg-based, inactivated injectable (IIV4)

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

Vaccine

Influenza, cell culture-based inactivated injectable
[(ccIIV4), Flucelvax® Quadrivalent]

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

Vaccine

Influenza, recombinant injectable
[(RIV4), Flublok® Quadrivalent]

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

Vaccine

Influenza, live attenuated [LAIV4, Flumist® Quadrivalent]

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

Vaccine

Measles, mumps, rubella (MMR)

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

Meningococcal ACWY (MenACWY)
[MenACWY-CRM (Menveo®); MenACWY-D (Menactra®); MenACWY-TT (MenQuadfi®)]

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

Vaccine

Meningococcal B (MenB)
[MenB-4C (Bexsero®); MenB-FHbp (Trumenba®)]

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

Vaccine

Pneumococcal conjugate (PCV15)

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

Vaccine

Pneumococcal conjugate (PCV20)

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

Vaccine

Pneumococcal polysaccharide (PPSV23)

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

Vaccine

Tetanus, diphtheria, and acellular pertussis (Tdap)

Tetanus, diphtheria (Td)

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

Vaccine

Varicella (VAR)

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

Vaccine

Zoster recombinant vaccine (RZV)

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
  • 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.
  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 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

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

Page last reviewed: February 17, 2022