Adult Immunization Schedule: Essential Vaccines by Age & Risk

Immunity wanes with age; new risks emerge. Staying current on vaccines prevents severe illness, hospitalization, and death.

Routinely Recommended for All Adults

• Influenza: Annual, any age. High-dose/adjuvanted for ≥65.
• COVID-19: Updated (2024–25 formula) annually; additional doses for immunocompromised.
• Tdap/Td: Tdap once if never received; then Td or Tdap every 10 yrs. Tdap each pregnancy (27–36 wks).

Age-Based

• ≥50: Shingles (Shingrix, 2 doses 2–6 mo apart) – >90% effective.
• ≥65: Pneumococcal: PCV20 alone OR PCV15 → PPSV23 ≥1 yr later. (Shared decision 50–64 with risk factors).
• ≥60: RSV (Arexvy or Abrysvo) – shared decision-making.

Risk-Based (Medical, Occupational, Behavioral, Travel)

• Hepatitis A: Chronic liver disease, MSM, PWID, homelessness, travel to endemic areas.
• Hepatitis B: Diabetes <60 (now all adults 19–59 per CDC 2022), sexual exposure risk, healthcare workers, travel.
• HPV: Through age 26 if not completed; 27–45 shared decision-making.
• Meningococcal (MenACWY/MenB): Asplenia, complement deficiency, microbiologists, college dorm/military recruits, travel to meningitis belt.
• MMR: Born ≥1957 without evidence of immunity (2 doses).
• Varicella: No immunity history (2 doses).
• Hib: Asplenia, HSCT, complement deficiency.

Special Situations

• Pregnancy: Tdap, inactivated flu, COVID, RSV (Abrysvo 32–36 wks). Avoid live vaccines.
• Immunocompromise: Avoid live vaccines (MMR, Varicella, LAIV, oral typhoid, yellow fever). Inactivated vaccines safe; may need extra doses.
• Travel: Typhoid, yellow fever, JE, rabies, cholera per itinerary.

Action Steps

1. Review immunization record (state IIS, patient portal).
2. Discuss gaps with clinician at annual visit.
3. Pharmacies administer most adult vaccines (no prescription needed in many states).

Vaccines are among the highest-value preventive interventions across the lifespan.