Adult Immunization Schedule Notes

Recommendations for Ages 19 Years or Older, United States, 2024

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Vaccines in the Adult Immunization Schedule

How to use the schedule

To make vaccination recommendations, healthcare providers should:

Determine recommended vaccinations by age (Table 1 - By Age)
Assess need for additional recommended vaccinations by medical condition or other indication (Table 2 - By Medical Condition)
Review vaccine types, dosing frequencies and intervals, and considerations for special situations (Notes)
Review contraindications and precautions for vaccine types (Appendix)
Review new or updated ACIP guidance (Addendum)

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.

Additional information

For calculating intervals between doses, 4 weeks = 28 days. Intervals of ≥4 months are determined by calendar months.
Within a number range (e.g., 12–18), a dash (–) should be read as “through.”
Vaccine doses administered ≤4 days before the minimum age or interval are considered valid. Doses of any vaccine administered ≥5 days earlier than the minimum age or minimum interval should not be counted as valid and should be repeated. The repeat dose should be spaced after the invalid dose by the recommended minimum interval. For further details, see Table 3-2, Recommended and minimum ages and intervals between vaccine doses, in General Best Practice Guidelines for Immunization.
Information on travel vaccination requirements and recommendations is available at cdc.gov/travel/.
For vaccination of persons with immunodeficiencies, see Table 8-1, Vaccination of persons with primary and secondary immunodeficiencies, in General Best Practice Guidelines for Immunization.
For information about vaccination in the setting of a vaccine-preventable disease outbreak, contact your state or local health department.
The National Vaccine Injury Compensation Program (VICP) is a no-fault alternative to the traditional legal system for resolving vaccine injury claims. All vaccines included in the adult immunization schedule except PPSV23, RSV, RZV, Mpox, and COVID-19 vaccines are covered by the National Vaccine Injury Compensation Program (VICP). Mpox and COVID-19 vaccines are covered by the Countermeasures Injury Compensation Program (CICP). For more information, see www.hrsa.gov/vaccinecompensation or www.hrsa.gov/cicp.

COVID-19 vaccination

Age 19 years or older

Unvaccinated:
- 1 dose of updated (2023–2024 Formula) Moderna or Pfizer-BioNTech vaccine
- 2-dose series of updated (2023–2024 Formula) Novavax at 0, 3–8 weeks
Previously vaccinated* with 1 or more doses of any COVID-19 vaccine: 1 dose of any updated (2023–2024 Formula) COVID-19 vaccine administered at least 8 weeks after the most recent COVID-19 vaccine dose.

Persons who are moderately or severely immunocompromised**

Unvaccinated:
- 3-dose series of updated (2023–2024 Formula) Moderna at 0, 4, 8 weeks
- 3-dose series of updated (2023–2024 Formula) Pfizer- BioNTech at 0, 3, 7 weeks
- 2-dose series of updated (2023–2024 Formula) Novavax at 0, 3 weeks
Previously vaccinated* with 1 dose of any Moderna: 2-dose series of updated (2023–2024 Formula) Moderna at 0, 4 weeks (minimum interval between previous Moderna dose and dose 1: 4 weeks)
Previously vaccinated* with 2 doses of any Moderna: 1 dose of updated (2023–2024 Formula) Moderna at least 4 weeks after most recent dose.
Previously vaccinated* with 1 dose of any Pfizer- BioNTech: 2-dose series of updated (2023–2024 Formula) Pfizer-BioNTech at 0, 4 weeks (minimum interval between previous Pfizer-BioNTech dose and dose 1: 3 weeks).
Previously vaccinated* with 2 doses of any Pfizer- BioNTech: 1 dose of updated (2023–2024 Formula) Pfizer-BioNTech at least 4 weeks after most recent dose.
Previously vaccinated* with 3 or more doses of any Moderna or Pfizer-BioNTech: 1 dose of any updated (2023–2024 Formula) COVID-19 vaccine at least 8 weeks after the most recent dose.
Previously vaccinated* with 1 or more doses of Janssen or Novavax with or without dose(s) of any Original monovalent or bivalent COVID-19 vaccine: 1 dose of any updated (2023–2024 Formula) of COVID-19 vaccine at least 8 weeks after the most recent dose.

There is no preferential recommendation for the use of one COVID-19 vaccine over another when more than one recommended age-appropriate vaccine is available.

Current COVID-19 vaccine information available at www.cdc.gov/covidschedule. For information on Emergency Use Authorization (EUA) indications for COVID-19 vaccines, see www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/covid-19-vaccines.

*Note: Previously vaccinated is defined as having received any Original monovalent or bivalent COVID-19 vaccine (Janssen, Moderna, Novavax, Pfizer-BioNTech) prior to the updated 2023-2024 formulation.

**Note: Persons who are moderately or severely immunocompromised have the option to receive one additional dose of updated (2023–2024 Formula) COVID-19 vaccine at least 2 months following the last recommended updated (2023–2024 Formula) COVID-19 vaccine dose. Further additional updated (2023–2024 Formula) COVID-19 vaccine dose(s) may be administered, informed by the clinical judgement of a healthcare provider and personal preference and circumstances. Any further additional doses should be administered at least 2 months after the last updated (2023–2024 Formula) COVID-19 vaccine dose.

For contraindications and precautions to COVID-19 vaccination, see COVID-19 Appendix

Haemophilus influenzae type b vaccination

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

For contraindications and precautions to Haemophilus influenzae type b (Hib) vaccination, see Hib Appendix

Hepatitis A vaccination

Any person who is not fully vaccinated and requests vaccination (identification of risk factor not required): 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: 2-dose series HepA or 3-dose series HepA-HepB as above. Risk factors for hepatitis A virus infection include
- Chronic liver disease (e.g., 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 (administer dose 1 as soon as adoption is planned, 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 targeting services to injection or noninjection drug users or group homes and nonresidential day care facilities for developmentally disabled persons (individual risk factor screening not required)

For contraindications and precautions to Hepatitis A (HepA) vaccination, see HepA Appendix

Hepatitis B vaccination

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 RecombivaxHB at 0, 1, 6 months [minimum intervals: dose 1 to dose 2: 4 weeks / dose 2 to dose 3: 8 weeks / dose 1to 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

†Note: Heplisav-B and PreHevbrio are not recommended in pregnancy due to lack of safety data in pregnant persons.

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 e.g., persons with 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
  - 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)

For contraindications and precautions to Hepatitis B (HepB) vaccination, see HepB Appendix

Human papillomavirus vaccination

All persons up through age 26 years: 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: 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.

For contraindications and precautions to Human papillomavirus (HPV) vaccination, see HPV Appendix

Influenza vaccination

Age 19 years or older: 1 dose any influenza vaccine appropriate for age and health status annually.
Age 65 years or older: Any one of quadrivalent high-dose inactivated influenza vaccine (HD-IIV4), quadrivalent recombinant influenza vaccine (RIV4), or quadrivalent adjuvanted inactivated influenza vaccine (aIIV4) is preferred. If none of these three vaccines are available, then any other age-appropriate influenza vaccine should be used.
For the 2023–2024 season, see cdc.gov/mmwr/ volumes/72/rr/rr7202a1.htm
For the 2024–2025 season, see the 2024–2025 ACIP influenza vaccine recommendations.

Close contacts (e.g., caregivers, healthcare workers) of severely immunosuppressed persons who require a protected environment: should not receive LAIV4. If LAIV4 is given, they should avoid contact with/caring for such immunosuppressed persons for 7 days after vaccination.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 and non-egg based) appropriate for age and health status.

For contraindications and precautions to Influenza vaccination, see IIV4 Appendix, LAIV4 Appendix, ccIIV4 Appendix, and RIV4 Appendix.

Measles, mumps, and rubella vaccination

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: 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: 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: 2-dose series at least 4 weeks apart for protection against measles or mumps or at least 1 dose for protection against rubella

For contraindications and precautions to measles, mumps, and rubella (MMR) vaccine, see MMR Appendix

Meningococcal vaccination

Anatomical or functional asplenia (including sickle cell disease), HIV infection, persistent complement component deficiency, complement inhibitor (e.g., eculizumab, ravulizumab) use: 2-dose series MenACWY (Menveo or MenQuadfi) at least 8 weeks apart and revaccinate every 5 years if risk remains
Travel in countries with hyperendemic or epidemic meningococcal disease, or microbiologists routinely exposed to Neisseria meningitidis: 1 dose MenACWY (Menveo or MenQuadfi) and revaccinate 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 MenACWY (Menveo or MenQuadfi)
For MenACWY booster dose recommendations for groups listed under “Special situations” and in an outbreak setting, (e.g., in community or organizational settings, or among men who have sex with men) and additional meningococcal vaccination information, see cdc.gov/mmwr/volumes/69/rr/rr6909a1.htm

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)

For additional information on shared clinical decision-making for MenB, see www.cdc.gov/vaccines/hcp/admin/downloads/isd-job-aid-scdm-mening-b-shared-clinical-decision-making.pdf.

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: 2-dose primary series MenB-4C (Bexsero) at least 1 month apart or 3-dose primary series MenB-FHbp (Trumenba) 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 fourth dose should be administered at least 4 months after dose 3); MenB-4C and MenB-FHbp are not interchangeable (use same product for all doses in series); 1 dose MenB booster 1 year after primary series and revaccinate every 2–3 years if risk remains
Pregnancy: Delay MenB until after pregnancy unless at increased risk and vaccination benefits outweigh potential risks
For MenB booster dose recommendations for groups listed under “Special situations” and in an outbreak setting (e.g., in community or organizational settings and among men who have sex with men) and additional meningococcal vaccination information, see www.cdc.gov/mmwr/volumes/69/rr/rr6909a1.htm

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

Adults may receive a single dose of Penbraya^™ as an alternative to separate administration of MenACWY and MenB when both vaccines would be given on the same clinic day. For adults not at increased risk, if Penbraya^™ is used for dose 1 MenB, MenB-FHbp (Trumenba) should be administered for dose 2 MenB. For adults at increased risk of meningococcal disease, Penbraya^™ may be used for additional MenACWY and MenB doses (including booster doses) if both would be given on the same clinic day and at least 6 months have elapsed since most recent Penbraya^™ dose.

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

Mpox vaccination

Any person at risk for Mpox infection: 2-dose series, 28 days apart.
Risk factors for Mpox infection include:
- Persons who are gay, 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.
Healthcare personnel: Except in rare circumstances (e.g. no available personal protective equipment), healthcare personnel who do not have any of the sexual risk factors described above should not receive Jynneos.
For detailed information, see: www.cdc.gov/vaccines/acip/meetings/downloads/slides-2023-10-25-26/04-MPOX-Rao-508.pdf

For contraindications and precautions to Mpox, see Mpox Appendix

Pneumococcal vaccination

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 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 PPSV23.
  - If PCV20 is selected, administer at least 1 year after the last PCV13 dose.
  - If PPSV23 is selected, administer at least 1 year after the last PCV13 dose (may use minimum interval of 8 weeks for adults with an immunocompromising condition,* cochlear implant, or cerebrospinal fluid leak).
- Previously received only PPSV23: 1 dose PCV15 OR 1 dose PCV20. Administer either PCV15 or PCV20 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 PPSV23.
  - If PCV20 is selected, administer at least 5 years after the last pneumococcal vaccine dose.
  - If PPSV23 is selected, see dosing schedule at cdc.gov/vaccines/vpd/pneumo/downloads/pneumo-vaccine-timing.pdf.
- 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.

For guidance on determining which pneumococcal vaccines a patient needs and when, please refer to the mobile app, which can be downloaded here: cdc.gov/vaccines/vpd/pneumo/hcp/pneumoapp.html.

Age 19–64 years with certain underlying medical conditions or other risk factors** who have:
- Not previously received a PCV13, PCV15, or PCV20 or whose previous vaccination history is unknown: 1 dose PCV15 OR 1 dose PCV20.
  - 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
- Previously received only PCV13: 1 dose PCV20 OR 1 dose PPSV23.
  - If PCV20 is selected, administer at least 1 year after the PCV13 dose.
  - If PPSV23 is selected, see dosing schedule at cdc.gov/vaccines/vpd/pneumo/downloads/ pneumo-vaccine-timing.pdf
- Previously received only PPSV23: 1 dose PCV15 OR 1 dose PCV20. Administer either PCV15 or PCV20 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 PPSV23.
  - If PCV20 is selected, administer at least 5 years after the last pneumococcal vaccine dose.
  - If PPSV23 is selected, see dosing schedule at cdc.gov/vaccines/vpd/pneumo/downloads/pneumo-vaccine-timing.pdf
For guidance on determining which pneumococcal vaccines a patient needs and when, please refer to the mobile app which can be downloaded here: cdc.gov/vaccines/vpd/pneumo/hcp/pneumoapp.html

*Note: Immunocompromising conditions include chronic renal failure, nephrotic syndrome, immunodeficiencies, iatrogenic immunosuppression, generalized malignancy, HIV infection, Hodgkin disease, leukemia, lymphoma, multiple myeloma, solid organ transplant, congenital or acquired asplenia, or sickle cell disease or other hemoglobinopathies.

**Note: Underlying medical conditions or other risk factors include alcoholism, chronic heart/liver/lung disease, chronic renal failure, cigarette smoking, cochlear implant, congenital or acquired asplenia, CSF leak, diabetes mellitus, generalized malignancy, HIV infection, Hodgkin disease, immunodeficiencies, iatrogenic immunosuppression, leukemia, lymphoma, multiple myeloma, nephrotic syndrome, solid organ transplant, or sickle cell disease or other hemoglobinopathies.

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

Poliovirus vaccination

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 of 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 detailed information, see: www.cdc.gov/vaccines/vpd/polio/hcp/recommendations.html

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

Respiratory syncytial virus vaccination

Pregnant at 32-36 weeks gestation from September through January in most of the continental United States*: 1 dose RSV vaccine (Abrysvo^™). Administer RSV vaccine regardless of previous RSV infection.
- Either maternal RSV vaccination or infant immunization with nirsevimab (RSV monoclonal antibody) is recommended to prevent respiratory syncytial virus lower respiratory tract infection in infants.
All other pregnant persons: RSV vaccine not recommended

There is currently no ACIP recommendation for RSV vaccination in subsequent pregnancies. No data are available to inform whether additional doses are needed in later pregnancies.

*Note: Providers in jurisdictions with RSV seasonality that differs from most of the continental United States (e.g., Alaska, jurisdiction with tropical climate) should follow guidance from public health authorities (e.g., CDC, health departments) or regional medical centers on timing of administration based on local RSV seasonality. Refer to the 2024 Child and Adolescent Immunization Schedule for considerations regarding nirsevimab administration to infants.

Age 60 years or older: Based on shared clinical decision-making, 1 dose RSV vaccine (Arexvy^® or Abrysvo^™). Persons most likely to benefit from vaccination are those considered to be at increased risk for severe RSV disease.** For additional information on shared clinical decision-making for RSV in older adults, see www.cdc.gov/vaccines/vpd/rsv/downloads/provider-job-aid-for-older-adults-508.pdf.

For further guidance, see www.cdc.gov/mmwr/volumes/72/wr/mm7229a4.htm

**Note: Adults age 60 years or older who are at increased risk for severe RSV disease include those with chronic medical conditions such as lung diseases (e.g., chronic obstructive pulmonary disease, asthma), cardiovascular diseases (e.g., congestive heart failure, coronary artery disease), neurologic or neuromuscular conditions, kidney disorders, liver disorders, hematologic disorders, diabetes mellitus, and moderate or severe immune compromise (either attributable to a medical condition or receipt of immunosuppressive medications or treatment); those who are considered to be frail; those of advanced age; those who reside in nursing homes or other long-term care facilities; and those with other underlying medical conditions or factors that a health care provider determines might increase the risk of severe respiratory disease.

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

Tetanus, diphtheria, and pertussis (Tdap) vaccination

Previously did not receive Tdap at or after age 11 years*: 1 dose Tdap, then Td or Tdap every 10 years

*Note: Tdap administered at age 10 years may be counted as the adolescent dose recommended at age 11-12 years

Previously did not receive primary vaccination series for tetanus, diphtheria, or pertussis: 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), 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

*Note: Tdap administered at age 10 years may be counted as the adolescent dose recommended at age 11–12 years.

For contraindications and precautions to Tetanus, diphtheria, and acellular pertussis (Tdap) vaccine, see Tdap Appendix

Varicella vaccination

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.

For contraindications and precautions to Varicella (VAR) vaccine, see VAR Appendix

Zoster vaccination

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/vaccination/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

For contraindications and precautions to Zoster recombinant vaccine (RZV), see RZV Appendix