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Subsections
ACIP Adult Immunization Guidance

Immunizations

ACIP Adult Immunization Guidance

COVID-19 Vaccination Guidance 2023-2024

  • General Information
    • ACIP recommends 2024-2025 COVID-19 vaccines
      • As authorized or approved by FDA in persons ≥ 6 months of age
    • mRNA
      • Pfizer
        • Regardless of vaccination status
          • 0.3 mL IM x1; if previously vaccinated, admin ≥ 2 mth after last dose
      • Moderna
        • Regardless of vaccination status
          • 0.5 mL IM x1; if previously vaccinated, admin ≥ 2 mth after last dose
    • Protein subunit vaccine
      • Novavax
        • FDA authorized Novavax COVID-19 Vaccine, Adjuvanted (2024–2025 Formula)
          • Under EUA on August 30, 2024
    • COVID-19 Interim Considerations for use of COVID-19 Vaccines in USA (CDC)
  • Special Populations
    • Pfizer
      • Immunocompromised
        • Not previously vaccinated:
          • 0.3 mL IM x3; given at 3 wk interval between dose 1 and 2, THEN
          • Dose 3 given ≥ 4 wks later
        • Single previous Pfizer-BioNTech dose:
          • 0.3 mL IM x2; dose 1 given 3 wks after last dose, THEN
          • Dose 2 given ≥ 4 wks later
        • 2 previous Pfizer-BioNTech doses:
          • 0.3 mL IM x1; given ≥ 4 wks after last dose
        • ≥ 3 previous doses (any mRNA vaccine):
          • 0.3 mL IM x1; given ≥ 8 wks after last dose
        • ≥ 1 dose Novavax or Janssen (including in combo with any mRNA vaccine):
          • 0.3 mL IM x1; given ≥ 8 wks after last dose
        • Additional 0.3 mL dose may be admin ≥ 2 mth after completion of series
          • Subsequent doses may be admin at provider discretion
    • Moderna
      • Immunocompromised
        • Not previously vaccinated:
          • 0.5 mL IM x3; given at 4 wk interval
        • Single previous Moderna dose:
          • 0.5 mL IM x2; given at 4 wk interval (dose 1 given 4 wks after last dose)
        • 2 previous Moderna doses:
          • 0.5 mL IM x1; given 4 wks after last dose
        • ≥ 3 previous doses (any mRNA vaccine):
          • 0.5 mL IM x1; given 8 wks after last dose
        • ≥ 1 dose Novavax or Janssen (including in combo with any mRNA vaccine):
          • 0.5 mL IM x1; given 8 wks after last dose
        • Additional 0.5 mL dose may be admin ≥ 2 mth after completion of series
          • Subsequent doses may be admin at provider discretion
  • See COVID-19 Vaccines

Influenza Vaccination Guidance

Tetanus, Diphtheria, Pertussis (Td or Tdap) Vaccination Guidance

  • General information
    • Administer to adults who previously did not receive a dose of Tdap at or after age 11 years (routinely recommended at age 11–12 years): 1 dose of Tdap, followed by Td or Tdap every 10 years
    • ACIP recommends DTaP-IPV-Hib-HepB (Vaxelis®)
      • Should be included with PRP-OMP (PedvaxHIB®)
        • In the preferential recommendation for American Indian and Alaska Native infants
        • Based on the Haemophilus influenzae type b (Hib) component
  • Special populations
    • Pregnant women: Administer 1 dose of Tdap during each pregnancy, preferably in the early part of gestational weeks 27–36
    • If previously did not receive primary vaccination series for tetanus, diphtheria, and pertussis: 1 dose Tdap followed by 1 dose Td or Tdap at least 4 weeks later, and another dose Td 6-12 months after the last Td; Td or TDAP booster every 10 years thereafter
    • Information on the use of Tdap or Td as tetanus prophylaxis in wound management is available at: www.cdc.gov/mmwr/volumes/69/wr/mm6903a5.htm

Varicella Vaccination Guidance

  • General information
    • Administer to adults without evidence of immunity to varicella 2 dose series of varicella vaccine (VAR) 4–8 weeks apart if previously received no varicella-containing vaccine (if previously received 1 dose of varicella-containing vaccine, administer 1 dose of VAR at least 4 weeks after the first dose)
    • Evidence of immunity to varicella is defined by the following
      • U.S.-born before 1980 (except for pregnant women and health care personnel, see below)
      • Documentation of receipt of 2 doses of varicella or varicella-containing vaccine at least 4 weeks apart
      • Diagnosis or verification of a history of varicella or herpes zoster by a health care provider
      • Laboratory evidence of immunity or disease
  • Special populations
    • Pregnancy without evidence of varicella immunity
      • VAR is contraindicated for pregnant women and adults with severe immunodeficiency
      • Administer the first of the 2 doses or the second dose after pregnancy and before discharge from the healthcare facility (if previously received 1 dose of varicella-containing vaccine, administer 1 dose of VAR at least 4 weeks after the first dose) or administer 2 doses of VAR 4-8 weeks apart if previously received no varicella-containing vaccine (regardless of whether U.S.-born before 1980)
    • Health care personnel without evidence of immunity
      • Administer 1 dose VAR if previously received 1 dose varicella-containing vaccine, or 2-dose series VAR 4–8 weeks apart if previously did not receive any varicella-containing vaccine (regardless of whether U.S.-born before 1980)
    • Adults with HIV infection and CD4 cell count of ≥ 200 cells/μL with no evidence of immunity
      • May administer, based on an individual clinical decision, 2 doses of VAR 3 months apart
      • VAR contraindicated in HIV infection with CD4 count < 200 cells/μL or CD4 percentage < 15%

MMR, varicella, or zoster vaccines can be administered on the same day
If not administered on the same day, live vaccines should be separated by at least 28 days

Human Papillomavirus Vaccination Guidance

  • General information
    • Administer human papillomavirus (HPV) vaccine to all persons aged through age 26 years
      • 2- or 3-dose series depending on age at initial vaccination or condition
    • Age 15 years or older at initial vaccination
      • 3-dose series at 0, 1–2 months, 6 months (minimum intervals: dose 1 to dose 2: 4 weeks / dose 2 to dose 3: 12 weeks / dose 1 to dose 3: 5 months; repeat dose if administered too soon)
    • Age 9–14 years at initial vaccination and received 1 dose or 2 doses less than 5 months apart
      • 1 additional dose
    • Age 9–14 years at initial vaccination and received 2 doses at least 5 months apart
      • HPV vaccination series complete, no additional dose needed
    • Interrupted schedules
      • If vaccination schedule is interrupted, the series does not need to be restarted
    • No additional dose recommended when any HPV vaccine series has been completed using the recommended dosing intervals
  • Share decision making
    • Some adults age 27–45 years
      • Based on shared clinical decision-making, 2- or 3-dose series as above
  • Special populations
    • Adults with immunocompromising conditions (including HIV infection) through age 26 years
      • Administer 3-dose series, even for those who initiate vaccination at age 9 through 14 years
    • Pregnant women through age 26 years
      • HPV vaccination is not recommended during pregnancy
        • No intervention needed for women who inadvertently receive HPV vaccine while pregnant
      • Pregnancy testing is not needed before vaccination

Zoster Vaccination Guidance

  • General information
    • For adults aged ≥ 50 years, 2-dose series recombinant zoster vaccine (RZV, Shingrix) 2–6 months apart (minimum interval: 4 weeks; repeat dose if administered too soon) regardless of previous herpes zoster or previously received ZVL (administer RZV at least 2 months after ZVL)
    • Note
      • Serologic evidence of prior varicella is not necessary for zoster vaccination
        • If serologic evidence of varicella susceptibility becomes available, providers should follow ACIP guidelines for varicella vaccination first
        • RZV is not indicated for the prevention of varicella
          • There are limited data on the use of RZV in persons without a history of varicella or varicella vaccination
  • Special populations
    • Immunocompromising conditions (including persons with HIV regardless of CD4 count)
    • Pregnancy
      • There is currently no ACIP recommendation for RZV use in pregnancy
      • Consider delaying RZV until after pregnancy
    • Note
      • If there is no documented history of varicella, varicella vaccination, or herpes zoster, providers should refer to the clinical considerations for use of RZV in immunocompromised adults aged ≥ 19 years and the ACIP varicella vaccine recommendations for further guidance: https://www.cdc.gov/mmwr/volumes/71/wr/mm7103a2.htm

MMR, varicella, or zoster vaccines can be administered on the same day
If not administered on the same day, live vaccines should be separated by at least 28 days

Measles, Mumps, Rubella (MMR) Vaccination Guidance

  • General information
    • Administer 1 dose of measles, mumps, and rubella vaccine (MMR) to adults with no evidence of immunity to measles, mumps, or rubella
    • Evidence of immunity is defined by the following
      • Born before 1957 (except for healthcare personnel, see below)
      • Documentation of receipt of MMR
      • Laboratory evidence of immunity or disease
    • Diagnosis of disease without laboratory confirmation is not considered evidence of immunity
  • Special populations
    • Pregnant women and nonpregnant women of childbearing age with no evidence of immunity to rubella
      • MMR contraindicated during pregnancy
      • Administer 1 dose of MMR (if pregnant, administer MMR after pregnancy and before discharge from health care facility)
    • HIV infection with CD4 percentages ≥ 15% and CD4 cell count ≥ 200 cells/μL for at least 6 months and no evidence of immunity to measles, mumps, or rubella
      • Administer 2 doses of MMR at least 4 weeks apart
      • MMR contraindicated for HIV infection with CD4 percentage < 15% or CD4 count < 200 cells/μL
    • Severe immunocompromising conditions
      • MMR contraindicated
    • Students in postsecondary educational institutions, international travelers, and household contacts of immunocompromised persons with no evidence of immunity to measles, mumps, or rubella
      • Administer 2 doses of MMR at least 4 weeks apart if previously did not receive any MMR or
      • Administer 1 dose of MMR if previously administered 1 dose of MMR
    • Health care personnel born in 1957 or later with no evidence of immunity
      • Administer 2 doses of MMR at least 4 weeks apart for measles or mumps, or 1 dose of MMR for rubella
      • If born before 1957, consider 2-dose series MMR at least 4 weeks apart for measles or mumps, or 1 dose MMR for rubella

MMR, varicella, or zoster vaccines can be administered on the same day
If not administered on the same day, live vaccines should be separated by at least 28 days

Pneumococcal Vaccination Guidance

  • General information
    • Age 65 years or older who have
      • Not previously received a dose of PCV13, PCV15 or PCV20 or whose previous vaccination history is unknown
        • 1 dose PCV15 or 1 dose PCV20
          • If PCV15 used
            • Followed w/ a dose of PPSV23 given at least 1 year after the PCV15 dose
            • A minimum interval of 8 weeks between PCV15 and PPSV23 can be considered for adults w/ an immunocompromising condition (e.g., cochlear implant, or CSF fluid leak to minimize the risk of invasive pneumococcal disease caused by serotypes unique to PPSV23 in these vulnerable groups
      • Previously received only PCV7
        • Follow recommendation above
      • Previously received only PCV13
        • 1 dose PCV15 or 1 dose PCV20 at least 1 year after the PPSV23 dose
        • If PCV 15 is used, it need not be followed by another dose PPSV23
      • Previously received both PCV13 and PPSV23 but NO PPSV23 was received at age 65 years or older
      • Previously received both PCV13 and PPSV23, AND PPSV23 was received at age 65 years or older
        • Based on shared clinical decision-making, 1 dose of PCV20 at least 5 years after the last pneumococcal vaccine dose
    • PCV21 an option for adults aged ≥ 19 years
      • Who currently have a recommendation to receive a dose of PCV
      • Recommendation was adopted by the CDC on June 27, 2024
    • For guidance on determining which pneumococcal vaccines a patient needs and when
  • Special populations
    • Adults 19-64 years of age with certain chronic medical conditions/other risk factors
      • Alcoholism
      • Cerebrospinal fluid leak
      • Chronic heart disease
        • Congestive heart failure
        • Cardiomyopathies
      • Chronic liver disease
      • Chronic lung disease
        • Chronic obstructive pulmonary disease
        • Emphysema
        • Asthma
      • Chronic renal failure
      • Cigarette smoking
      • Cochlear implant
      • Congenital or acquired asplenia
      • Congenital or acquired immunodeficiency
      • B- (humoral) or T-lymphocyte deficiency
      • Complement deficiency
        • Particularly C1, C2, C3, or C4 deficiency
      • Phagocytic disorder,
        • Excluding chronic granulomatous disease
      • Diabetes mellitus
      • Generalized malignancy
      • HIV infection
      • Hodgkin disease
      • Iatrogenic immunosuppression
        • Long-term systemic corticosteroids
        • Radiation therapy
      • Leukemia
      • Lymphoma
      • Multiple myeloma
      • Nephrotic syndrome
      • Sickle cell disease or other hemoglobinopathies
      • Solid organ transplant
    • Previously received only PPSV23
      • 1 dose PCV15 OR 1 dose PCV20 at least 1 year after the PPSV23 dose
      • If PCV15 is used, it need not be followed by another dose of PPSV23
    • Previously received both PCV13 and PPSV23 but have not completed the recommended series

Hepatitis A Vaccination Guidance

  • General information
    • Not at risk but want protection from hepatitis A
      • 2-dose series of single-antigen hepatitis A vaccine HepA
        • Havrix 6–12 months apart or
        • Vaqta 6–18 months apart; minimum interval: 6 months
          OR
      • 3-dose series of combined hepatitis A and hepatitis B vaccine (Twinrix) at 0, 1, and 6 months
        • Minimum intervals:
          • 4 weeks between the first and second doses
          • 5 months between second and third doses
  • Special populations
    • At risk for hepatitis A virus infection
      • 2-dose series HepA or 3-dose series HepA-HepB as above
      • Administer HepA or HepA-HepB to adults with the following indications:
        • Persons experiencing homelessness
        • Travel to or work in countries with high or intermediate hepatitis A endemicity
        • Men who have sex with men
        • Injection or non-injection drug use
        • Work with hepatitis A virus in a research laboratory or with nonhuman primates infected with hepatitis A virus
        • Clotting factor disorders
        • Chronic liver disease
        • Close, personal contact with an international adoptee (e.g., household, or regular babysitting) during the first 60 days after arrival in the United States from a country with high or intermediate endemicity (administer the first dose as soon as the adoption is planned)
        • Healthy adults through age 40 years who have recently been exposed to hepatitis A virus; adults older than age 40 years may receive HepA if hepatitis A immunoglobulin cannot be obtained
    • Information about hepatitis A vaccine recommendations is available at: https://www.cdc.gov/mmwr/volumes/68/wr/mm6806a6.htm

Hepatitis B Vaccination Guidance

  • General information
    • Age 19 through 59 years: complete a 2- or 3- or 4-dose series
    • Not at risk but wants protection from hepatitis B
      • 2-dose series HepB (2-dose series Heplisav-B at least 4 weeks apart [2-dose series HepB only applies when 2 doses of Heplisav-B are used at least 4 weeks apart] or
      • 3-dose series Engerix-B, PreHevbrio or Recombivax HB at 0, 1, 6 months [minimum intervals: 4 weeks between doses 1 and 2, 8 weeks between doses 2 and 3, 16 weeks between doses 1 and 3]) or
      • 3-dose series HepA-HepB (Twinrix at 0, 1, 6 months [minimum intervals: 4 weeks between doses 1 and 2, 5 months between doses 2 and 3])
      • 4-dose series HepA-HepB (Twinrix) accelerated schedule of 3 doses at 0, 7, and 21–30 days, followed by a booster dose at 12 months
    • Note
      • Heplisav-B and PreHevbrio are not recommended in pregnancy due to lack of safety data in pregnant persons
    • Age 60 years or older w/ known risk factors for HBV infection should complete a HepB vaccine series
    • Age 60 years or older without known risk factors for HBV infection may complete a HepB vaccine series
      • See below for risk factors
  • Special populations
    • At risk for hepatitis B virus infection
      • 2-dose (Heplisav-B) or 3-dose (Engerix-B, Recombivax HB) series HepB, or 3-dose series HepA-HepB as above
      • Administer HepB or HepA-HepB to adults with the following indications:
        • Age ≥ 60 or older and at risk for hep B infection
        • Chronic liver disease, such as:
          • Hepatitis C infection
          • Cirrhosis
          • Fatty liver disease
          • Alcoholic liver disease
          • Autoimmune hepatitis
          • Alanine aminotransferase (ALT) or aspartate aminotransferase (AST) level greater than twice the upper limit of normal
        • HIV infection
        • Percutaneous or mucosal risk of exposure to blood, for example:
          • Household contacts of HBsAg-positive persons
          • Adults younger than age 60 years with diabetes mellitus or aged 60 years or older with diabetes mellitus based on individual clinical decision
          • Adults in predialysis care or receiving hemodialysis or peritoneal dialysis
          • Recent or current injection drug users
          • Health care and public safety workers at risk for exposure to blood or blood-contaminated body fluids
        • Sexual exposure risk, such as:
          • Sex partners of HBsAg-positive persons
          • Sexually active persons not in a mutually monogamous relationship; persons seeking evaluation or treatment for a sexually transmitted infection
          • Men who have sex with men (MSM)
        • Receive care in settings where a high proportion of adults have risks for hepatitis B infection, including:
          • Facilities providing sexually transmitted disease treatment
          • Drug-abuse treatment and prevention services
          • Hemodialysis and end-stage renal disease programs
          • Institutions for developmentally disabled persons
          • Health care settings targeting services to injection drug users or MSM
          • HIV testing and treatment facilities
          • Correctional facilities
        • Travel in countries with high or intermediate hepatitis B endemicity
    • Patients on dialysis: complete a 3- or 4-dose series
      • 3-dose series Recombivax HB at 0, 1, 6 months (note: use Dialysis Formulation 1 mL = 40 mcg)
      • 4-dose series Engerix-B at 0, 1, 2, and 6 months (note: use 2 mL dose instead of the normal adult dose of 1 mL)
    • Pregnancy
      • Heplisav-B not recommended
        • Lack of safety data in pregnant women

Meningococcal Vaccination Guidance

  • Serogroups A, C, W, and Y meningococcal vaccine (MenACWY)
    • All 11- to 12-year-old adolescents should receive a MenACWY vaccine
    • Since protection wanes, CDC recommends a MenACWY booster dose at age 16 years
    • Special populations
      • Routine and booster vaccination of persons aged ≥ 2 months at increased risk for meningococcal disease
        • Dosing schedule varies by age and indication
        • Interval for booster doses varies by age at time of previous vaccination:
          • Persons with certain medical conditions including anatomic or functional asplenia, complement component deficiencies (e.g., C3, C5–C9, properdin, factor H, or factor D), complement inhibitor (e.g., eculizumab [Soliris] or ravulizumab [Ultomiris]) use, or HIV infection
          • Microbiologists with routine exposure to Neisseria meningitidis isolates
          • Persons at increased risk during an outbreak (e.g., in community or organizational settings, and among men who have sex with men)
          • Persons who travel to or live in countries where meningococcal disease is hyperendemic or epidemic
          • Unvaccinated or undervaccinated first-year college students living in residence halls
          • Military recruits
    • Additional meningococcal vaccination information
  • Shared clinical decision-making for MenB
    • Adolescents and young adults age 16–23 years (age 16–18 years preferred) not at increased risk for meningococcal disease
      • Based on shared clinical decision-making, 2-dose series MenB-4C (Bexsero) at least 1 month apart or 2-dose series MenB-FHbp (Trumenba) at 0, 6 months (if dose 2 was administered less than 6 months after dose 1, administer dose 3 at least 4 months after dose 2)
      • MenB-4C and MenB-FHbp are not interchangeable (use same product for all doses in series)
  • Serogroup B meningococcal vaccine (MenB)
    • Routine and booster vaccination of persons aged ≥ 10 years at increased risk for meningococcal disease
    • Vaccination of adolescents and young adults aged 16–23 years with a 2-dose MenB series
      • On the basis of shared clinical decision-making
      • Preferred age for MenB vaccination is 16–18 years
    • Special populations
      • Persons with certain medical conditions, such as
        • Anatomic or functional asplenia
        • Complement component deficiencies
        • Complement inhibitor use
      • Microbiologists with routine exposure to N. meningitidis isolates
      • Persons at increased risk during an outbreak
        • In community or organizational settings
        • Among men who have sex with men

Haemophilus influenzae type b (Hib) Vaccination Guidance

  • Special populations
    • Anatomical or functional asplenia (including sickle cell disease)
      • 1 dose if previously did not receive Hib
      • If elective splenectomy, 1 dose, preferably at least 14 days before splenectomy
    • Hematopoietic stem cell transplant (HSCT)
      • 3-dose series 4 weeks apart starting 6–12 months after successful transplant
        • Regardless of Hib vaccination history

RSV Vaccination Guidance

  • General information
    • ACIP recommends adults ≥ 75 years
      • Receive a single dose of RSV vaccine
    • ACIP recommends adults 60–74 years and who are at increased risk of severe RSV disease
      • Receive a single dose of RSV vaccine

Chikungunya Vaccination Guidance

  • General information
    • ACIP recommends chikungunya vaccine for persons aged ≥ 18 years
      • Traveling to a country or territory where there is a chikungunya outbreak
  • Special populations
    • Following persons traveling to a country or territory without an outbreak but with evidence of chikungunya virus transmission among humans < 5 years
      • Persons aged > 65 years, particularly those with underlying medical conditions, who are likely to have at least moderate exposure to mosquitoes
      • Persons staying for a cumulative period of ≥ 6 months
    • Laboratory workers with potential for exposure to chikungunya virus

References

  1. Centers for Disease Control and Prevention (CDC). Advisory Committee on Immunization Practices (ACIP): ACIP Recommendations. Available at: https://www.cdc.gov/vaccines/acip/recommendations.html. [Accessed September 2024]

Contributor(s)

  1. Pacheco, Caleb S., MD
  2. Hernandez, James, DO
  3. Cherian, Geo, MD
  4. Singh, Ajaydeep, MD

Updated/Reviewed: September 2024