Adult Immunization Schedule Notes

• Anatomical or functional asplenia (including sickle cell disease): 1 dose if previously did not receive Hib vaccine.
  • 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.

• Any person who is not fully vaccinated and requests vaccination (identification of risk factor not required): complete 2–dose series HepA (Havrix 6–12 months apart or Vaqta 6–18 months apart [minimum interval:6 months]) or 3–dose series HepA–HepB (Twinrix at 0, 1, 6 months [minimum intervals: dose 1 to dose 2 = 4 weeks; dose 2 to dose 3 = 5 months])

• Any person who is not fully vaccinated and who is at risk for hepatitis A virus infection or severe disease from hepatitis A virus infection: complete 2–dose series HepA or 3–dose series HepA–HepB as above. Risk factors include:
  • Chronic liver disease including persons with hepatitis B, hepatitis C, 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
  • Men who have sex with men
  • Injection or noninjection drug use
  • Persons experiencing homelessness
  • Work with hepatitis A virus in research laboratory or with nonhuman primates with hepatitis A virus infection
  • Travel in countries with high or intermediate endemic hepatitis A: HepA–HepB (Twinrix) may be administered on an accelerated schedule of 3 doses at 0, 7, and 21–30 days, followed by a booster dose at 12 months
  • Close, personal contact with international adoptee (e.g., household or regular babysitting) in first 60 days after arrival from country with high or intermediate endemic hepatitis A: dose 1 as soon as adoption is planned; preferably at least 2 weeks before adoptee’s arrival.
  • Pregnancy if at risk for infection or severe outcome from infection during pregnancy
  • Settings for exposure, including health care settings serving persons who use injection or noninjection drug, or group homes and nonresidential day care facilities for developmentally disabled persons (individual risk factor screening not required)

• Age 19 through 59 years: complete a 2- or 3- or 4-dose series
  • 2-dose series only applies when 2 doses of Heplisav-B are used at least 4 weeks apart
  • 3–dose series Engerix–B, PreHevbrio*, or Recombivax HB at 0, 1, 6 months (minimum intervals: dose 1 to dose 2 = 4 weeks; dose 2 to dose 3 = 8 weeks; dose 1 to dose 3 = 16 weeks)
  • 3–dose series HepA–HepB (Twinrix) at 0, 1, 6 months (minimum intervals: dose 1 to dose 2 = 4 weeks; dose 2 to dose 3 = 5 months)
  • 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

• Age 60 years or older without known risk factors for hepatitis B virus infection may receive a HepB vaccine series.
• Age 60 years or older with known risk factors for hepatitis B virus infection should receive a HepB vaccine series.
• Any adult age 60 years of age or older who requests HepB vaccination should receive a HepB vaccine series.
  • Risk factors for hepatitis B virus infection include:
    • Chronic liver disease including persons with hepatitis C, cirrhosis, fatty liver disease, alcoholic liver disease, autoimmune hepatitis, alanine aminotransferase (ALT) or aspartate aminotransferase (AST)
    • HIV infection
    • Sexual exposure risk e.g., sex partners of hepatitis B surface antigen (HBsAg)–positive persons, sexually active persons not in mutually monogamous relationships, persons seeking evaluation or treatment for a sexually transmitted infection, men who have sex with men
    • Current or recent injection drug use
    • Percutaneous or mucosal risk for exposure to blood e.g., household contacts of HBsAg–positive persons, residents and staff of facilities for developmentally disabled persons, health care and public safety personnel with reasonably anticipated risk for exposure to blood or blood–contaminated body fluids, persons on maintenance dialysis (including in–center or home hemodialysis and peritoneal dialysis), persons who are predialysis, and patients with diabetes**
    • Incarceration
    • Travel in countries with high or intermediate endemic hepatitis B

**Age 60 years or older with diabetes: Based on shared clinical decision making, 2-, 3-, or 4-dose series as above.

• 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)
• Age 20 years or older with an immunocompromising condition: complete a 2– or 3– or 4–dose series.
  • 3–dose series Recombivax HB at 0,1, 6 months(Note: Use Dialysis Formulation 1ml = 40 mcg)
  • 4 dose series Engerix–B at 0,1,2, and 6 months(Note: Use 2mL dose instead of the normal adult dose of 1mL)
  • 2 dose series Heplisav–B at 0, 1 months
  • 3 dose series PreHevbrio* at 0,1, 6 months

*Note: PreHevbrio is not recommended in pregnancy due to lack of safety data in pregnant persons.

• All persons through age 26 years: complete 2– or 3–dose series depending on age at initial vaccination or condition
  • 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
  • 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)
• No additional dose recommended when any HPV vaccine series of any valency has been completed using the recommended dosing intervals.

• Adults age 27–45 years: Based on shared clinical decision-making, complete a 2-dose series (if initiated age 9-14 years) or 3-dose series (if initiated ≥15 years)

For additional information on shared clinical decision-making for HPV; see www.cdc.gov/vaccines/hcp/admin/downloads/isd-job-aid-scdm-hpv-shared-clinical-decision-making-hpv.pdf

• Age ranges recommended above for routine and catch-up vaccination or shared clinical decision-making also apply in special situations
  • Immunocompromising conditions, including HIV infection: complete 3-dose series, even for those who initiate vaccination at age 9 through 14 years.
  • Pregnancy: Pregnancy testing is not needed before vaccination. HPV vaccination is not recommended until after pregnancy. No intervention needed if inadvertently vaccinated while pregnant.

• Age 19 years or older: 1 dose any influenza vaccine appropriate for age and health status annually.
  • Solid organ transplant recipients aged 19 through 64 years receiving immunosuppressive medications: HD-IIV3 and aIIV3 are acceptable options. No preference over other age–appropriate IIV3 or RIV3.
  • Age 65 years or older: Any one of HD-IIV3, RIV3, or aIIV3 is preferred. If none of these three vaccines is available, then any other age–appropriate influenza vaccine should be used.
• For the 2024–25 season, see www.cdc.gov/mmwr/volumes/73/rr/rr7305a1.htm
• For the 2025–26 season, see the 2025–26 ACIP influenza vaccine recommendations.

• Close contacts (e.g., caregivers, healthcare workers) of severely immunosuppressed persons who require a protected environment: should not receive LAIV3. If LAIV3 is given, they should avoid contact with/caring for such immunosuppressed persons for 7 days after vaccination.

Note: Persons with an egg allergy can receive any influenza vaccine (egg-based or non-egg based) appropriate for age and health status.

• No evidence of immunity to measles, mumps, or rubella: 1 dose
  • Evidence of immunity: Born before 1957 (except for health care personnel, see below), documentation of receipt of MMR vaccine, laboratory evidence of immunity or disease (diagnosis of disease without laboratory confirmation is not evidence of immunity)

• Pregnancy with no evidence of immunity to rubella: MMR contraindicated during pregnancy; after pregnancy (before discharge from health care facility): 1 dose
• Nonpregnant persons of childbearing age with no evidence of immunity to rubella: 1 dose
• HIV infection with CD4 percentages ≥15% and CD4 count ≥200 cells/mm3 for at least 6 months and no evidence of immunity to measles, mumps, or rubella: complete 2-dose series at least 4 weeks apart; MMR contraindicated for HIV infection with CD4 percentage <15% or CD4 count <200 cells/mm³
• Severe immunocompromising conditions: MMR contraindicated
• Students in postsecondary educational institutions, international travelers, and household or close, personal contacts of immunocompromised persons with no evidence of immunity to measles, mumps, or rubella: complete 2-dose series at least 4 weeks apart if previously did not receive any doses of MMR or 1 dose if previously received 1 dose MMR
• In mumps outbreak settings, for information about additional doses of MMR (including 3rd dose of MMR), see www.cdc.gov/mmwr/volumes/67/wr/mm6701a7. htm
• Health care personnel:
  • Born before 1957 with no evidence of immunity to measles, mumps, or rubella: Consider 2-dose series at least 4 weeks apart for protection against measles or mumps or 1 dose for protection against rubella
  • Born in 1957 or later with no evidence of immunity to measles, mumps, or rubella: complete 2–dose series at least 4 weeks apart for protection against measles or mumps or at least 1 dose for protection against rubella

• Anatomical or functional asplenia (including sickle cell disease), HIV infection, persistent complement component deficiency, complement inhibitor (e.g., eculizumab, ravulizumab) use: 2–dose primary series Menveo or MenQuadfi at least 8 weeks apart; 1 booster dose 5 years after primary series and every 5 years if risk remains.
• Travel in countries with hyperendemic or epidemic meningococcal disease, or for microbiologists routinely exposed to Neisseria meningitidis: 1 dose Menveo or MenQuadfi; 1 booster dose 5 years after primary series and every 5 years if risk remains.
• First–year college students who live in residential housing (if not previously vaccinated at age 16 years or older) or military recruits: 1 dose Menveo or MenQuadfi.

Note: MenACWY vaccines may be administered simultaneously with MenB vaccines if indicated, but at a different anatomic site, if feasible.

• 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.
  • Bexsero or Trumenba (use same brand for all doses): 2–dose series at least 6 months apart (if dose 2 is administered earlier than 6 months, administer dose 3 at least 4 months after dose 2)

• Anatomical or functional asplenia (including sickle cell disease), persistent complement component deficiency, complement inhibitor (e.g., eculizumab, ravulizumab) use, or microbiologists routinely exposed to Neisseria meningitidis.
  • Bexsero or Trumenba (use same brand for all doses including booster doses): 3–dose primary series at 0, 1–2, 6 months (if dose 2 was administered at least 6 months after dose 1, dose 3 not needed; if dose 3 is administered earlier than 4 months after dose 2, a 4th dose should be administered at least 4 months after dose 3).
  • Booster doses: 1 booster dose one year after primary series and every 2–3 years if risk remains.
• Pregnancy: Delay MenB until after pregnancy due to lack of safety data in pregnant persons. May administer if at increased risk and vaccination benefits outweigh potential risks.

For MenB recommendations in outbreak setting (e.g., in community or organizational settings, or among men who have sex with men) and additional meningococcal vaccination information, see ww.cdc.gov/mmwr/volumes/69/rr/rr6909a1.htm.

For contraindications and precautions to Meningococcal ACWY (MenACWY)
[MenACWY-CRM (Menveo^®); MenACWY-D (Menactra^®); MenACWY-TT (MenQuadfi^®)], see MenACWY Appendix

For contraindications and precautions to Meningococcal B (MenB)
[MenB-4C (Bexsero^®); MenB-FHbp (Trumenba^®)], see MenB Appendix

• Any person at risk for mpox infection: complete 2–dose series, 28 days apart.
  Risk factors for mpox infection include:
  • Persons who are gay or bisexual and other MSM, transgender, or nonbinary people who in the past 6 months have had:
    • A new diagnosis of at least 1 sexually transmitted disease
    • More than 1 sex partner
    • Sex at a commercial sex venue
    • Sex in association with a large public event in a geographic area where mpox transmission is occurring
  • Persons who are sexual partners of the persons described above.
  • Persons who anticipate experiencing any of the situations described above.
• Pregnancy: There is currently no ACIP recommendation for Jynneos use in pregnancy due to lack of safety data in pregnant persons. Pregnant persons with any risk factor described above may receive Jynneos.
• Health care personnel: Vaccination to protect against occupational risk in healthcare settings is not routinely recommended.
  For detailed information, see: www.cdc.gov/mpox/hcp/vaccine-considerations/vaccination-overview.html.

For contraindications and precautions to Mpox, see Mpox Appendix

• Age 50 years or older who have:
  • Not previously received a dose of PCV13, PCV15, PCV20, or PCV21 or whose previous vaccination history is unknown: 1 dose PCV15 or 1 dose PCV20 or 1 dose PCV21.
    • If PCV15 is used, administer 1 dose PPSV23 at least 1 year after the PCV15 dose (may use minimum interval of 8 weeks for adults with an immunocompromising condition,* cochlear implant, or cerebrospinal fluid leak).
  • Previously received only PCV7: follow the recommendation above.
  • Previously received only PCV13: 1 dose PCV20 or 1 dose PCV21 at least 1 year after the last PCV13 dose.
  • Previously received only PPSV23: 1 dose PCV15 or 1 dose PCV20 or 1 dose PCV21 at least 1 year after the last PPSV23 dose.
    • If PCV15 is used, no additional PPSV23 doses are recommended.
  • Previously received both PCV13 and PPSV23 but NO PPSV23 was received at age 65 years or older: 1 dose PCV20 or 1 dose PCV21 at least 5 years after the last pneumococcal vaccine dose.
  • 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 or 1 dose of PCV21 at least 5 years after the last pneumococcal vaccine dose.

• Age 19–49 years with certain underlying medical conditions or other risk factors** who have:
  • Not previously received a PCV13, PCV15, PCV20, or PCV21 or whose previous vaccination history is unknown: 1 dose PCV15 or 1 dose PCV20 or 1 dose PCV21.
    • If PCV15 is used, administer 1 dose PPSV23 at least 1 year after the PCV15 dose (may use minimum interval of 8 weeks for adults with an immunocompromising condition,* cochlear implant, or cerebrospinal fluid leak).
  • Previously received only PCV7: follow the recommendation above.
  • Previously received only PCV13: 1 dose PCV20 or 1 dose PCV21 at least 1 year after the last PCV13 dose.
  • Previously received only PPSV23: dose PCV15 or 1 dose PCV20 or PCV21, at least 1 year after the last PPSV23 dose.
    • If PCV15 is used, no additional PPSV23 doses are recommended.
  • Previously received PCV13 and 1 dose of PPSV23: 1 dose PCV20 or 1 dose PCV21 at least 5 years after the last pneumococcal vaccine dose.

For contraindications and precautions to Pneumococcal conjugate (PCV15 and PCV20), see PCV Appendix; and for Pneumococcal polysaccharide (PPSV23), see PPSV23 Appendix

• Adults known or suspected to be unvaccinated or incompletely vaccinated: administer remaining doses (1, 2, or 3 IPV doses) to complete a 3-dose primary series.* Unless there are specific reasons to believe they were not vaccinated, most adults who were born and raised in the United States can assume they were vaccinated against polio as children.

*Note: Complete primary series consists of at least 3 doses of IPV or trivalent oral poliovirus vaccine (tOPV) in any combination.

• Adults at increased risk for exposure to poliovirus who completed primary series*: may administer one lifetime IPV booster

*Note: Complete primary series consists of at least 3 doses of IPV or trivalent oral poliovirus vaccine (tOPV) in any combination.

For contraindications and precautions to Poliovirus vaccine, inactivated (IPV), see Poliovirus Appendix

• Pregnant persons of any age
  • Pregnant at 32 weeks 0 days through 36 weeks and 6 days gestation from September through January in most of the continental United States*: 1 dose Abrysvo. Administer RSV vaccine regardless of previous RSV infection.
  • Either maternal RSV vaccination with Abrysvo or infant immunization with nirsevimab (RSV monoclonal antibody) is recommended to prevent severe respiratory syncytial virus disease in infants.
  • All other pregnant persons: RSV vaccine not recommended.
  • Subsequent pregnancies: additional doses not recommended. No data are available to inform whether additional doses are needed in subsequent pregnancies. Infants born to pregnant persons who received RSV vaccine during a previous pregnancy should receive nirsevimab.

*Note: Providers in jurisdictions with RSV seasonality that differs from most of the continental United States (e.g., Alaska, jurisdictions with tropical climate) should follow guidance from public health authorities on timing of administration. Refer to the 2025 Child and Adolescent Immunization Schedule for considerations regarding nirsevimab administration to infants.

• Age 75 years or older
  • Unvaccinated: 1 dose (Arexvy or Abrysvo or mResvia). Additional doses not recommended.
  • Previously vaccinated: additional doses not recommended. No data are available to inform whether additional doses are needed.

• Age 60–74 years:
  • Unvaccinated and at increased risk of severe RSV disease**: 1 dose (Arexvy or Abrysvo or mResvia). Additional doses not recommended.
  • Previously vaccinated: additional doses not recommended. No data are available to inform whether additional doses are needed.

Persons 60 years and older can get RSV vaccine at any time but best to administer in late summer and early fall before RSV spreads in communities—ideally August through October in most of continental United States. For further guidance, see www.cdc.gov/mmwr/volumes/73/wr/mm7332e1.htm.

For contraindications and precautions to Respiratory syncytial virus vaccine (RSV), see RSV Appendix

• Completed primary series and received at least 1 dose Tdap at age 10 years or older: Td or Tdap every 10 years thereafter.
• Completed primary series and did NOT receive Tdap at age 10 years or older: 1 dose Tdap, then Td or Tdap every 10 years thereafter.
• Unvaccinated or incomplete primary vaccination series for tetanus, diphtheria, or pertussis: administer remaining doses (1, 2, or 3 doses) to complete 3–dose primary series. 1 dose Tdap followed by 1 dose Td or Tdap at least 4 weeks later, and a third dose of Td or Tdap 6–12 months later (Tdap is preferred as first dose and can be substituted for any Td dose), then Td or Tdap every 10 years thereafter.

• Pregnancy: 1 dose Tdap during each pregnancy, preferably in early part of gestational weeks 27–36.
• Wound management: Persons with 3 or more doses of tetanus–toxoid–containing vaccine: For clean and minor wounds, administer Tdap or Td if more than 10 years since last dose of tetanus–toxoid–containing vaccine; for all other wounds, administer Tdap or Td if more than 5 years since last dose of tetanus–toxoid–containing vaccine. Tdap is preferred for persons who have not previously received Tdap or whose Tdap history is unknown. If a tetanus–toxoid–containing vaccine is indicated for a pregnant woman, use Tdap. For detailed information, see www.cdc.gov/mmwr/volumes/69/wr/mm6903a5.htm.

• No evidence of immunity to varicella: 2-dose series 4–8 weeks apart if previously did not receive varicella-containing vaccine (VAR or MMRV [measles-mumps-rubella-varicella vaccine] for children); if previously received 1 dose varicella-containing vaccine, 1 dose at least 4 weeks after first dose
  • Evidence of immunity: U.S.-born before 1980 (except for pregnant persons and health care personnel [see below]), documentation of 2 doses varicella-containing vaccine at least 4 weeks apart, diagnosis or verification of history of varicella or herpes zoster by a health care provider, laboratory evidence of immunity or disease

• Pregnancy with no evidence of immunity to varicella: VAR contraindicated during pregnancy; after pregnancy (before discharge from health care facility), 1 dose if previously received 1 dose varicella–containing vaccine or dose 1 of 2–dose series
  (dose 2: 4–8 weeks later) if previously did not receive any varicella–containing vaccine, regardless of whether U.S.–born before 1980.
• Health care personnel with no evidence of immunity to varicella: 1 dose if previously received 1 dose varicella–containing vaccine; 2–dose series 4–8 weeks apart if previously did not receive any varicella–containing vaccine, regardless of whether U.S.–born before 1980.
• HIV infection with CD4 percentages ≥15% and CD4 count ≥200 cells/mm³ with no evidence of immunity: Vaccination may be considered (2 doses 3 months apart); VAR contraindicated for HIV infection with CD4 percentage <15% or CD4 count <200 cells/mm³
• Severe immunocompromising conditions: VAR contraindicated.

• Age 50 years or older*: 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 history of zoster vaccine live (ZVL, Zostavax) vaccination.

*Note: Serologic evidence of prior varicella is not necessary for zoster vaccination. However, 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, and there are limited data on the use of RZV in persons without a history of varicella or varicella vaccination.

• Pregnancy: There is currently no ACIP recommendation for RZV use in pregnancy. Consider delaying RZV until after pregnancy.
• Immunocompromising conditions (including persons with HIV regardless of CD4 count)**: 2–dose series recombinant zoster vaccine (RZV, Shingrix)
  2–6 months apart (minimum interval: 4 weeks; repeat dose if administered too soon). For detailed information, see www.cdc.gov/shingles/hcp/vaccine–considerations/immunocompromised–adults.html

**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: www.cdc.gov/mmwr/volumes/71/wr/mm7103a2.htm