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2009 Adult Immunization Schedule
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Reproduced from the Centers for Disease Control and Prevention
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For a printer-friendly version of the Adult Immunization Schedules, download the pdf.
Report all clinically significant postvaccination reactions to the Vaccine Adverse Event Reporting System (VAERS). Reporting forms and instructions on filing a VAERS report are available at www.vaers.hhs.gov or by telephone, 800-822-7967. Information on how to file a Vaccine Injury Compensation Program claim is available at www.hrsa.gov/vaccinecompensation or by telephone, 800-338-2382. To file a claim for vaccine injury, contact the U.S. Court of Federal Claims, 717 Madison place, N.W., Washington, D.C. 20005; telephone: 202-357-6400.
Additional information about the vaccines in this schedule, extent of available data and contraindications for vaccination is also available at www.cdc.gov/vaccines or from the CDC-INFO Contact Center at 800-CDC-INFO (800-232-4636) in English and Spanish, 24 hours a day, 7 days a week. Use of trade names and commercial sources if for identification only and does not imply endorsement by the U.S. Department of Health and Human Services.
These schedules indicate the recommended age groups and medical indications for which administration of currently licensed vaccines is commonly indicated for adults ages 19 years and older, as of January 1, 2009. Licensed combination vaccines may be used whenever any components of the combination are indicated and when the vaccine's other components are not contraindicated. For detailed recommendations on all vaccines, including those used primarily for travelers or that are issued during the year, consult the manufacturers' package inserts and the complete statements from the Advisory Committee on Immunization Practices (www.cdc.gov/vaccines/pubs/acip-list.htm
1. Tetanus, diphtheria, and acellular pertussis (Td/Tdap) vaccination
Tdap should replace a single dose of Td for adults aged 19 through 64
years who have not received a dose of Tdap previously Adults with
uncertain or incomplete history of primary vaccination series with
tetanus and diphtheria toxoid–containing vaccines should begin or
complete a primary vaccination series. A primary series for adults is 3
doses of tetanus and diphtheria toxoid–containing vaccines; administer
the first 2 doses at least 4 weeks apart and the third dose 6–12 months
after the second. However, Tdap can substitute for any one of the doses
of Td in the 3-dose primary series.
The booster dose of
tetanus and diphtheria toxoid–containing vaccine should be administered
to adults who have completed a primary series and if the last
vaccination was received 10 or more years previously. Tdap or Td
vaccine may be used, as indicated.
If a woman is pregnant and
received the last Td vaccination 10 or more years previously,
administer Td during the second or third trimester. If the woman
received the last Td vaccination less than 10 years previously,
administer Tdap during the immediate postpartum period. A dose of Tdap
is recommended for postpartum women, close contacts of infants aged
less than 12 months, and all health-care personnel with direct patient
contact if they have not previously received Tdap.
An interval
as short as 2 years from the last Td is suggested; shorter intervals
can be used. Td may be deferred during pregnancy and Tdap substituted
in the immediate postpartum period, or Tdap may be administered instead
of Td to a pregnant woman after an informed discussion with the woman.
Consult the ACIP statement for recommendations for administering Td as prophylaxis in wound management.
2. Human papillomavirus (HPV) vaccination
HPV
vaccination is recommended for all females aged 11 through 26 years
(and may begin at age 9 years) who have not completed the vaccine
series. History of genital warts, abnormal Papanicolaou test, or
positive HPV DNA test is not evidence of prior infection with all
vaccine HPV types; HPV vaccination is recommended for persons with such
histories. Ideally, vaccine should be administered before potential
exposure to HPV through sexual activity; however, females who are
sexually active should still be vaccinated consistent with age-based
recommendations. Sexually active females who have not been infected
with any of the four HPV vaccine types receive the full benefit of the
vaccination. Vaccination is less beneficial for females who have
already been infected with one or more of the HPV vaccine types.
A
complete series consists of 3 doses. The second dose should be
administered 2 months after the first dose; the third dose should be
administered
6 months after the first dose.
HPV
vaccination is not specifically recommended for females with the
medical indications described in Figure 2, “Vaccines that might be
indicated for adults based on medical and other indications.” Because
HPV vaccine is not a live-virus vaccine, it may be administered to
persons with the medical indications described in Figure 2. However,
the immune response and vaccine efficacy might be less for persons with
the medical indications described in Figure 2 than in persons who do
not have the medical indications described or who are immunocompetent.
Health-care
personnel are not at increased risk because of occupational exposure,
and should be vaccinated consistent with age-based recommendations.
3. Varicella vaccination
All
adults without evidence of immunity to varicella should receive 2 doses
of single-antigen varicella vaccine if not previously vaccinated or the
second dose if they have received only one dose, unless they have a
medical contraindication.
Special consideration should be given
to those who 1) have close contact with persons at high risk for severe
disease (e.g., health-care personnel and family contacts of persons
with immunocompromising conditions) or 2) are at high risk for exposure
or transmission (e.g., teachers; child care employees; residents and
staff members of institutional settings, including correctional
institutions; college students; military personnel; adolescents and
adults living in households with children; nonpregnant women of
childbearing age; and international travelers).
Evidence of
immunity to varicella in adults includes any of the following: 1)
documentation of 2 doses of varicella vaccine at least 4 weeks apart;
2) U.S.-born before 1980 (although for health-care personnel and
pregnant women, birth before 1980 should not be considered evidence of
immunity); 3) history of varicella based on diagnosis or verification
of varicella by a health-care provider (for a patient reporting a
history of or presenting with an atypical case, a mild case, or both,
health-care providers should seek either an epidemiologic link to a
typical varicella case or to a laboratory-confirmed case or evidence of
laboratory confirmation, if it was performed at the time of acute
disease); 4) history of herpes zoster based on health-care provider
diagnosis or verification of herpes zoster by a health-care provider;
or 5) laboratory evidence of immunity or laboratory confirmation of
disease.
Pregnant women should be assessed for evidence of
varicella immunity. Women who do not have evidence of immunity should
receive the first dose of varicella vaccine upon completion or
termination of pregnancy and before discharge from the health-care
facility. The second dose should be administered 4–8 weeks after the
first dose.
4. Herpes zoster vaccination
A single dose of
zoster vaccine is recommended for adults aged 60 years and older
regardless of whether they report a prior episode of herpes zoster.
Persons with chronic medical conditions may be vaccinated unless their
condition constitutes a contraindication.
5. Measles, mumps, rubella (MMR) vaccination
Measles
component: Adults born before 1957 generally are considered immune to
measles. Adults born during or after 1957 should receive 1 or more
doses of MMR unless they have a medical contraindication, documentation
of 1 or more doses, history of measles based on health-care provider
diagnosis, or laboratory evidence of immunity.
A second dose
of MMR is recommended for adults who 1) have been recently exposed to
measles or are in an outbreak setting; 2) have been vaccinated
previously with killed measles vaccine; 3) have been vaccinated with an
unknown type of measles vaccine during 1963–1967; 4) are students in
postsecondary educational institutions; 5) work in a health-care
facility; or 6) plan to travel internationally.
Mumps
component: Adults born before 1957 generally are considered immune to
mumps. Adults born during or after 1957 should receive 1 dose of MMR
unless they have a medical contraindication, history of mumps based on
health-care provider diagnosis, or laboratory evidence of immunity.
A
second dose of MMR is recommended for adults who 1) live in a community
experiencing a mumps outbreak and are in an affected age group; 2) are
students in postsecondary educational institutions; 3) work in a
health-care facility; or 4) plan to travel internationally. For
unvaccinated health-care personnel born before 1957 who do not have
other evidence of mumps immunity, administering 1 dose on a routine
basis should be considered and administering a second dose during an
outbreak should be strongly considered.
Rubella component: 1
dose of MMR vaccine is recommended for women whose rubella vaccination
history is unreliable or who lack laboratory evidence of immunity. For
women of childbearing age, regardless of birth year, rubella immunity
should be determined and women should be counseled regarding congenital
rubella syndrome. Women who do not have evidence of immunity should
receive MMR vaccine upon completion or termination of pregnancy and
before discharge from the health-care facility.
6. Influenza vaccination
Medical
indications: Chronic disorders of the cardiovascular or pulmonary
systems, including asthma; chronic metabolic diseases, including
diabetes mellitus, renal or hepatic dysfunction, hemoglobinopathies, or
immunocompromising conditions (including immunocompromising conditions
caused by medications or human immunodeficiency virus [HIV]); any
condition that compromises respiratory function or the handling of
respiratory secretions or that can increase the risk of aspiration
(e.g., cognitive dysfunction, spinal cord injury, or seizure disorder
or other neuromuscular disorder); and pregnancy during the influenza
season. No data exist on the risk for severe or complicated influenza
disease among persons with asplenia; however, influenza is a risk
factor for secondary bacterial infections that can cause severe disease
among persons with asplenia.
Occupational indications: All
health-care personnel, including those employed by long-term care and
assisted-living facilities, and caregivers of children less than 5
years old.
Other indications: Residents of nursing homes and
other long-term care and assisted-living facilities; persons likely to
transmit influenza to persons at high risk (e.g., in-home household
contacts and caregivers of children aged less than 5 years old, persons
65 years old and older and persons of all ages with high-risk
condition[s]); and anyone who would like to decrease their risk of
getting influenza.
Healthy, nonpregnant adults aged less than
50 years without high-risk medical conditions who are not contacts of
severely immunocompromised persons in special care units can receive
either intranasally administered live, attenuated influenza vaccine
(FluMist®) or inactivated vaccine. Other persons should receive the
inactivated vaccine.
7. Pneumococcal polysaccharide (PPSV) vaccination
Medical
indications: Chronic lung disease (including asthma); chronic
cardiovascular diseases; diabetes mellitus; chronic liver diseases,
cirrhosis; chronic alcoholism, chronic renal failure or nephrotic
syndrome; functional or anatomic asplenia (e.g., sickle cell disease or
splenectomy [if elective splenectomy is planned, vaccinate at least 2
weeks before surgery]); immunocompromising conditions; and cochlear
implants and cerebrospinal fluid leaks. Vaccinate as close to HIV
diagnosis as possible.
Other indications: Residents of nursing homes or other long-term care
facilities and persons who smoke cigarettes. Routine use of PPSV is not
recommended for Alaska Native or American Indian persons younger than
65 years unless they have underlying medical conditions that are PPSV
indications. However, public health authorities may consider
recommending PPSV for Alaska Natives and American Indians aged 50
through 64 years who are living in areas in which the risk of invasive
pneumococcal disease is increased.
8. Revaccination with PPSV
One-time revaccination after 5 years is recommended for persons with
chronic renal failure or nephrotic syndrome; functional or anatomic
asplenia (e.g., sickle cell disease or splenectomy); and for persons
with immunocompromising conditions. For persons aged 65 years and
older, one-time revaccination if they were vaccinated 5 or more years
previously and were aged less than 65 years at the time of primary
vaccination.
9. Hepatitis A vaccination
Medical indications: Persons with chronic liver disease and persons who
receive clotting factor concentrates. Behavioral indications: Men who
have sex with men and persons who use illegal drugs. Occupational
indications: Persons working with hepatitis A virus (HAV)–infected
primates or with HAV in a research laboratory setting. Other
indications: Persons traveling to or working in countries that have
high
or intermediate endemicity of hepatitis A (a list of countries is
available at http://wwwn.cdc.gov/travel/contentdiseases.aspx) and any
person seeking protection from HAV infection.
Single-antigen vaccine formulations should be administered in a 2-dose
schedule at either 0 and 6–12 months (Havrix®), or 0 and 6–18 months
(Vaqta®). If the combined hepatitis A and hepatitis B vaccine
(Twinrix®) is used, administer 3 doses at 0, 1, and 6 months;
alternatively, a 4-dose schedule, administered on days 0, 7, and 21 to
30 followed by a booster dose at month 12 may be used.
10. Hepatitis B vaccination
Medical indications: Persons with end-stage renal disease, including
patients receiving hemodialysis; persons with HIV infection; and
persons with chronic liver disease.
Occupational indications: Health-care personnel and public-safety
workers who are exposed to blood or other potentially infectious body
fluids. Behavioral indications: Sexually active persons who are not in
a long-term, mutually monogamous relationship (e.g., persons with more
than 1 sex partner during the previous 6 months); persons seeking
evaluation or treatment for a sexually transmitted disease
(STD);current or recent injection-drug users; and men who have sex with
men.
Other indications: Household contacts and sex partners of persons with
chronic hepatitis B virus (HBV) infection; clients and staff members of
institutions for persons with developmental disabilities; international
travelers to countries with high or intermediate prevalence of chronic
HBV infection (a list of countries is available at
http://wwwn.cdc.gov/travel/contentdiseases.aspx); and any adult seeking
protection from HBV infection.
Hepatitis
B vaccination is recommended for all adults in the following settings:
STD treatment facilities; HIV testing and treatment facilities;
facilities providing drug-abuse treatment and prevention services;
health-care settings targeting services to injection-drug users or men
who have sex with men; correctional facilities; end-stage renal disease
programs and facilities for chronic hemodialysis patients; and
institutions and nonresidential daycare facilities for persons with
developmental disabilities.
If the combined hepatitis A and
hepatitis B vaccine (Twinrix®) is used, administer 3 doses at 0, 1, and
6 months; alternatively, a 4-dose schedule, administered on days 0, 7,
and 21 to 30 followed by a booster dose at month 12 may be used.
Special
formulation indications: For adult patients receiving hemodialysis or
with other immunocompromising conditions, 1 dose of 40 µg/mL
(Recombivax HB®) administered on a 3-dose schedule or 2 doses of 20
µg/mL (Engerix-B®) administered simultaneously on a 4-dose schedule at
0,1, 2 and 6 months.
11. Meningococcal vaccination
Medical
indications: Adults with anatomic or functional asplenia, or terminal
complement component deficiencies. Other indications: First-year
college students living in dormitories; microbiologists routinely
exposed to isolates of Neisseria meningitidis; military recruits; and
persons who travel to or live in countries in which meningococcal
disease is hyperendemic or epidemic (e.g., the “meningitis belt” of
sub-Saharan Africa during the dry season [December–June]), particularly
if their contact with local populations will be prolonged. Vaccination
is required by the government of Saudi Arabia for all travelers to
Mecca during the annual Hajj.
Meningococcal conjugate vaccine
(MCV) is preferred for adults with any of the preceding indications who
are aged 55 years or younger, although meningococcal polysaccharide
vaccine (MPSV) is an acceptable alternative. Revaccination with MCV
after 5 years might be indicated for adults previously vaccinated with
MPSV who remain at increased risk for infection (e.g., persons residing
in areas in which
disease is epidemic).
12. Selected conditions for which Haemophilus influenzae type b (Hib) vaccine may be used
Hib vaccine generally is not recommended for persons aged 5 years and
older. No efficacy data are available on which to base a recommendation
concerning use of Hib vaccine for older children and adults. However,
studies suggest good immunogenicity in patients who have sickle cell
disease, leukemia, or HIV infection or who have had a splenectomy;
administering 1 dose of vaccine
to these patients is not contraindicated.
13. Immunocompromising conditions
Inactivated vaccines
generally are acceptable (e.g., pneumococcal, meningococcal, and
influenza [trivalent inactivated influenza vaccine]) and live vaccines
generally are avoided in persons with immune deficiencies or
immunocompromising conditions. Information on specific conditions is
available at http://www.cdc.gov/vaccines/pubs/acip-list.htm.
Reproduced from the Centers for Disease Control and Prevention.
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