CS310021-A

Report

y Suspected cases of reportable vaccine-preventable diseases or outbreaks to 

the local or state health department

y Clinically significant postvaccination reactions to the Vaccine Adverse Event 

Reporting System at www.vaers.hhs.gov or 800-822-7967

Injury claims

All vaccines included in the adult immunization schedule except pneumococcal 

23-valent polysaccharide (PPSV23) and zoster (RZV) vaccines are covered by the 

Vaccine Injury Compensation Program. Information on how to file a vaccine injury 

claim is available at www.hrsa.gov/vaccinecompensation.

Questions or comments

Contact www.cdc.gov/cdc-info or 800-CDC-INFO (800-232-4636), in English or 

Spanish, 8 a.m.–8 p.m. ET, Monday through Friday, excluding holidays.

Helpful information

y Complete Advisory Committee on Immunization Practices (ACIP) recommendations: 

www.cdc.gov/vaccines/hcp/acip-recs/index.html

y General Best Practice Guidelines for Immunization

(including contraindications and precautions):

www.cdc.gov/vaccines/hcp/acip-recs/general-recs/index.html

y Vaccine information statements: www.cdc.gov/vaccines/hcp/vis/index.html

y Manual for the Surveillance of Vaccine-Preventable Diseases 

(including case identification and outbreak response): 

www.cdc.gov/vaccines/pubs/surv-manual 

y Travel vaccine recommendations: www.cdc.gov/travel

y Recommended Child and Adolescent Immunization Schedule, United States, 2022: 

www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html

y ACIP Shared Clinical Decision-Making Recommendations:

www.cdc.gov/vaccines/acip/acip-scdm-faqs.html

Recommended Adult Immunization Schedule

for ages 19 years or older

How to use the adult immunization schedule

1 Determine 

recommended 

vaccinations by 

age (Table 1)

2 Assess need 

for additional 

recommended 

vaccinations by 

medical condition 

or other indication 

(Table 2)

3 Review vaccine 

types, frequencies, 

intervals, and 

considerations for 

special situations 

(Notes)

4 Review 

contraindications 

and precautions 

for vaccine types 

(Appendix)

Recommended by the Advisory Committee on Immunization Practices 

(www.cdc.gov/vaccines/acip) and approved by the Centers for Disease 

Control and Prevention (www.cdc.gov), American College of Physicians 

(www.acponline.org), American Academy of Family Physicians (www.aafp.

org), American College of Obstetricians and Gynecologists (www.acog.org), 

American College of Nurse-Midwives (www.midwife.org), and American 

Academy of Physician Associates (www.aapa.org), and Society for Healthcare 

Epidemiology of America (www.shea-online.org).

UNITED STATES

2022

Vaccines in the Adult Immunization Schedule*

Vaccine Abbreviation(s) Trade name(s)

Haemophilus influenzae type b vaccine Hib ActHIB®

Hiberix®

PedvaxHIB®

Hepatitis A vaccine HepA Havrix®

Vaqta®

Hepatitis A and hepatitis B vaccine HepA-HepB Twinrix®

Hepatitis B vaccine HepB Engerix-B®

Recombivax HB®

Heplisav-B®

Human papillomavirus vaccine HPV Gardasil 9®

Influenza vaccine (inactivated) IIV4 Many brands

Influenza vaccine (live, attenuated) LAIV4 FluMist® Quadrivalent

Influenza vaccine (recombinant) RIV4 Flublok® Quadrivalent

Measles, mumps, and rubella vaccine MMR M-M-R II®

Meningococcal serogroups A, C, W, Y vaccine MenACWY-D

MenACWY-CRM

MenACWY-TT

Menactra®

Menveo®

MenQuadfi®

Meningococcal serogroup B vaccine MenB-4C

MenB-FHbp

Bexsero®

Trumenba®

Pneumococcal 15-valent conjugate vaccine PCV15 VaxneuvanceTM

Pneumococcal 20-valent conjugate vaccine PCV20 Prevnar 20TM

Pneumococcal 23-valent polysaccharide vaccine PPSV23 Pneumovax 23®

Tetanus and diphtheria toxoids Td Tenivac®

TdvaxTM

Tetanus and diphtheria toxoids and acellular pertussis vaccine Tdap Adacel®

Boostrix®

Varicella vaccine VAR Varivax®

Zoster vaccine, recombinant RZV Shingrix

*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.

Download the CDC Vaccine Schedules app for providers at 

www.cdc.gov/vaccines/schedules/hcp/schedule-app.html.

Scan QR code 

for access to 

online schedule
Vaccine 19–26 years 27–49 years 50–64 years ≥65 years

Influenza inactivated (IIV4) or 

Influenza recombinant (RIV4) 1 dose annually

Influenza live, attenuated

(LAIV4) 1 dose annually

Tetanus, diphtheria, pertussis 

(Tdap or Td)

1 dose Tdap each pregnancy; 1 dose Td/Tdap for wound management (see notes)

1 dose Tdap, then Td or Tdap booster every 10 years

Measles, mumps, rubella 

(MMR)

 1 or 2 doses depending on indication 

 (if born in 1957 or later)

Varicella 

(VAR)

2 doses

(if born in 1980 or later) 2 doses

Zoster recombinant 

(RZV) 2 doses for immunocompromising conditions (see notes) 2 doses

Human papillomavirus (HPV) 2 or 3 doses depending on age at 

initial vaccination or condition 27 through 45 years

Pneumococcal

(PCV15, PCV20, PPSV23)

1 dose PCV15 followed by PPSV23

OR

1 dose PCV20 (see notes)

1 dose PCV15 followed by PPSV23

OR

1 dose PCV20

Hepatitis A 

(HepA) 2 or 3 doses depending on vaccine

Hepatitis B 

(HepB) 2, 3, or 4 doses depending on vaccine or condition

Meningococcal A, C, W, Y 

(MenACWY) 1 or 2 doses depending on indication, see notes for booster recommendations

Meningococcal B 

(MenB)

Haemophilus influenzae type b 

(Hib) 1 or 3 doses depending on indication

Table 1 Recommended Adult Immunization Schedule by Age Group, United States, 2022

or or

 Recommended vaccination for adults who meet age requirement, 

lack documentation of vaccination, or lack evidence of past infection  Recommended vaccination for adults with an additional risk factor or another indication  Recommended vaccination based on shared 

clinical decision-making  No recommendation/

Not applicable

2 or 3 doses depending on vaccine and indication, see notes for booster recommendations

19 through 23 years

2, 3, or 4 doses depending on vaccine or condition
Vaccine Pregnancy

Immunocompromised 

(excluding HIV 

infection)

HIV infection CD4 

percentage and count Asplenia, 

complement 

deficiencies

End-stage 

renal 

disease, or on 

hemodialysis

Heart or 

lung disease; 

alcoholism1

Chronic liver 

disease Diabetes Health care 

personnel2

Men who 

have sex 

<15% or with men

<200 mm3

≥15% and 

≥200 mm3

IIV4 or RIV4 1 dose annually

LAIV4 Contraindicated Precaution 1 dose annually

Tdap or Td 1 dose Tdap each 

pregnancy 1 dose Tdap, then Td or Tdap booster every 10 years

MMR Contraindicated* Contraindicated 1 or 2 doses depending on indication

VAR Contraindicated* Contraindicated 2 doses

RZV 2 doses at age ≥19 years 2 doses at age ≥50 years

HPV Not

Recommended* 3 doses through age 26 years 2 or 3 doses through age 26 years depending on age at initial vaccination or condition

Pneumococcal 

(PCV15, PCV20, 

PPSV23)

HepA

HepB 3 doses

(see notes) 2, 3, or 4 doses depending on vaccine or condition

MenACWY

MenB Precaution

Hib 3 doses HSCT3

recipients only 1 dose

1 or 2 doses depending on indication, see notes for booster recommendations

2 or 3 doses depending on vaccine and indication, see notes for booster recommendations

2 or 3 doses depending on vaccine

Table 2 Recommended Adult Immunization Schedule by Medical Condition or Other Indication, United States, 2022

 Recommended vaccination for adults who meet 

age requirement, lack 

documentation of 

vaccination, or lack 

evidence of past infection

 Recommended vaccination 

for adults with an additional 

risk factor or another 

indication

 Recommended vaccination 

based on shared clinical 

decision-making

 Precaution—vaccination might be indicated if 

benefit of protection 

outweighs risk of adverse 

reaction

 Contraindicated or not 

recommended—vaccine 

should not be administered. 

*Vaccinate after pregnancy.

 No recommendation/ Not applicable

or or

1. Precaution for LAIV4 does not apply to alcoholism. 2. See notes for influenza; hepatitis B; measles, mumps, and rubella; and varicella vaccinations. 3. Hematopoietic stem cell transplant.

1 dose PCV15 followed by PPSV23 OR 1 dose PCV20 (see notes)
For vaccine recommendations for persons 18 years 

of age or younger, see the Recommended Child 

and Adolescent Immunization Schedule.

COVID-19 Vaccination

COVID-19 vaccines are recommended within the 

scope of the Emergency Use Authorization or 

Biologics License Application for the particular 

vaccine. ACIP recommendations for the use of 

COVID-19 vaccines can be found at www.cdc.gov/

vaccines/hcp/acip-recs/vacc-specific/covid-19.html. 

CDC’s interim clinical considerations for use of 

COVID-19 vaccines can be found at www.cdc.gov/ 

vaccines/covid-19/clinical-considerations/covid-19-

vaccines-us.html.

Haemophilus influenzae type b vaccination

Special situations

y 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

y Hematopoietic stem cell transplant (HSCT): 3-dose 

series 4 weeks apart starting 6–12 months after successful 

transplant, regardless of Hib vaccination history

Hepatitis A vaccination

Routine vaccination

y Not at risk but want protection from hepatitis A

(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 HepAHepB (Twinrix at 0, 1, 6 months [minimum intervals: dose 1 

to dose 2: 4 weeks / dose 2 to dose 3: 5 months]) 

Special situations

y At risk for hepatitis A virus infection: 2-dose series HepA 

or 3-dose series HepA-HepB as above

- 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)

Hepatitis B vaccination

Routine vaccination

y 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 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

- 4-dose series Engerix-B at 0, 1, 2, and 6 months for persons 

on adult hemodialysis (note: each dosage is double that of 

normal adult dose, i.e., 2 mL instead of 1 mL)

*Note: Heplisav-B not recommended in pregnancy due to 

lack of safety data in pregnant women

Special situations

y Age 60 years or older* and at risk for hepatitis B virus 

infection: 2-dose (Heplisav-B) or 3-dose (Engerix-B, 

Recombivax HB) series or 3-dose series HepA-HepB 

(Twinrix) as above

- 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 

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; hemodialysis, peritoneal 

dialysis, home dialysis, and predialysis patients; patients 

with diabetes)

- Incarcerated persons

- Travel in countries with high or intermediate endemic 

hepatitis B

*Note: Anyone age 60 years or older who does not meet 

risk-based recommendations may still receive Hepatitis B 

vaccination.

Human papillomavirus vaccination

Routine vaccination

y HPV vaccination recommended for all persons 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

Notes Recommended Adult Immunization Schedule for ages 19 years or older, United States, 2022
y Interrupted schedules: If vaccination schedule is 

interrupted, the series does not need to be restarted

y No additional dose recommended when any HPV 

vaccine series has been completed using the 

recommended dosing intervals.

Shared clinical decision-making

y Some adults age 27–45 years: Based on shared clinical 

decision-making, 2- or 3-dose series as above

Special situations

y Age ranges recommended above for routine and catchup 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

Influenza vaccination

Routine vaccination

y Age 19 years or older: 1 dose any influenza vaccine 

appropriate for age and health status annually

y For the 2021–2022 season, see www.cdc.gov/mmwr/

volumes/70/rr/rr7005a1.htm

y For the 2022–23 season, see the 2022–23 ACIP influenza 

vaccine recommendations.

Special situations

y Egg allergy, hives only: any influenza vaccine appropriate 

for age and health status annually

y Egg allergy–any symptom other than hives (e.g., 

angioedema, respiratory distress) or required epinephrine 

or another emergency medical intervention: see Appendix 

listing contraindications and precautions

y Severe allergic reaction (e.g., anaphylaxis) to a vaccine 

component or a previous dose of any influenza vaccine: 

see Appendix listing contraindications and precautions

y History of Guillain-Barré syndrome within 6 weeks after 

previous dose of influenza vaccine: Generally, should 

not be vaccinated unless vaccination benefits outweigh 

risks for those at higher risk for severe complications from 

influenza

Measles, mumps, and rubella vaccination

Routine vaccination

y No evidence of immunity to measles, mumps, or 

rubella: 1 dose

- Evidence of immunity: Born before 1957 (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)

Special situations

y Pregnancy with no evidence of immunity to rubella: 

MMR contraindicated during pregnancy; after pregnancy 

(before discharge from health care facility), 1 dose

y Nonpregnant women of childbearing age with no 

evidence of immunity to rubella: 1 dose

y 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

y Severe immunocompromising conditions: MMR 

contraindicated

y 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

y 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 measles or mumps or 1 dose for 

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 measles or mumps or at least 1 dose for 

rubella

Meningococcal vaccination

Special situations for MenACWY

y 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-D 

(Menactra, Menveo, or MenQuadfi) at least 8 weeks apart 

and revaccinate every 5 years if risk remains

y Travel in countries with hyperendemic or epidemic 

meningococcal disease, or microbiologists routinely 

exposed to Neisseria meningitidis: 1 dose MenACWY 

(Menactra, Menveo, or MenQuadfi) and revaccinate every 5 

years if risk remains

y 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 (Menactra, 

Menveo, or MenQuadfi)

y For MenACWY 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

Shared clinical decision-making for MenB

y Adolescents and young adults age 16–23 years (age 

16–18 years preferred) not at increased risk for 

meningococcal disease: Based on shared clinical decisionmaking, 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)

Special situations for MenB

y 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: 

y 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); 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

Notes Recommended Adult Immunization Schedule, United States, 2022
2/17/2022 Centers for Disease Control and Prevention | Recommended Adult Immunization Schedule, United States, 2022

y Pregnancy: Delay MenB until after pregnancy unless at 

increased risk and vaccination benefits outweigh potential 

risks

y 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.

Pneumococcal vaccination

Routine vaccination

y Age 65 years or older who have not previously received 

a pneumococcal conjugate vaccine or whose previous 

vaccination history is unknown: 1 dose PCV15 or 1 dose 

PCV20. If PCV15 is used, this should be followed by 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 with an 

immunocompromising condition,* cochlear implant, or 

cerebrospinal fluid leak to minimize the risk of invasive 

pneumococcal disease caused by serotypes unique to 

PPSV23 in these vulnerable groups.

y For guidance for patients who have already received a 

previous dose of PCV13 and/or PPSV23, see 

www.cdc.gov/mmwr/volumes/71/wr/mm7104a1.htm.

Special situations 

y Age 19–64 years with certain underlying medical 

conditions or other risk factors** who have not previously 

received a pneumococcal conjugate vaccine or whose 

previous vaccination history is unknown: 1 dose PCV15 

or 1 dose PCV20. If PCV15 is used, this should be followed 

by 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 with an 

immunocompromising condition,* cochlear implant, or 

cerebrospinal fluid leak to minimize the risk of invasive 

pneumococcal disease caused by serotypes unique to 

PPSV23 in these vulnerable groups.

y For guidance for patients who have already received a 

previous dose of PCV13 and/or PPSV23, see 

www.cdc.gov/mmwr/volumes/71/wr/mm7104a1.htm.

*Note: Immunocompromising conditions include chronic 

renal failure, nephrotic syndrome, immunodeficiency, 

iatrogenic immunosuppression, generalized malignancy, 

human immunodeficiency virus, Hodgkin disease, leukemia, 

lymphoma, multiple myeloma, solid organ transplants, 

congenital or acquired asplenia, 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, Hodgkin disease, 

immunodeficiency, iatrogenic immunosuppression, 

leukemia, lymphoma, multiple myeloma, nephrotic 

syndrome, solid organ transplants, or sickle cell disease or 

other hemoglobinopathies.

Tetanus, diphtheria, and pertussis vaccination

Routine vaccination

y Previously did not receive Tdap at or after age 11 years: 

1 dose Tdap, then Td or Tdap every 10 years

Special situations

y 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 after Tdap 

and another dose Td or Tdap 6–12 months after last Td 

or Tdap (Tdap can be substituted for any Td dose, but 

preferred as first dose), Td or Tdap every 10 years thereafter

y Pregnancy: 1 dose Tdap during each pregnancy, preferably 

in early part of gestational weeks 27–36

y 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-toxoidcontaining vaccine is indicated for a pregnant woman, use 

Tdap. For detailed information, see www.cdc.gov/mmwr/

volumes/69/wr/mm6903a5.htm

Varicella vaccination

Routine vaccination

y 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 varicellacontaining vaccine, 1 dose at least 4 weeks after first dose

- Evidence of immunity: U.S.-born before 1980 (except for 

pregnant women 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

Special situations

y 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

y Health care personnel with no evidence of immunity 

to varicella: 1 dose if previously received 1 dose varicellacontaining 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

y 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

y Severe immunocompromising conditions: VAR 

contraindicated

Zoster vaccination

Routine vaccination

y Age 50 years or older: 2-dose series 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 (administer RZV at least 2 months after ZVL)

Special situations

y Pregnancy: There is currently no ACIP recommendation 

for RZV use in pregnancy. Consider delaying RZV until after 

pregnancy.

y Immunocompromising conditions (including HIV): RZV 

recommended for use in persons age 19 years or older 

who are or will be immunodeficient or immunosuppressed 

because of disease or therapy. For detailed information, see 

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

Notes Recommended Adult Immunization Schedule, United States, 2022
Appendix Recommended Adult Immunization Schedule, United States, 2022

Vaccine Contraindications1 Precautions2

Influenza, egg-based, 

inactivated injectable (IIV4)

• Severe allergic reaction (e.g., anaphylaxis) after previous dose of any influenza vaccine 

(i.e., any egg-based IIV, ccIIV, RIV, or LAIV of any valency) 

• Severe allergic reaction (e.g., anaphylaxis) to any vaccine component3 (excluding egg)

• Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any type of 

influenza vaccine

• Persons with egg allergy with symptoms other than hives (e.g., angioedema, 

respiratory distress) or required epinephrine or another emergency medical 

intervention: Any influenza vaccine appropriate for age and health status may be 

administered. If using egg-based IIV4, administer in medical setting under supervision 

of health care provider who can recognize and manage severe allergic reactions. May 

consult an allergist.

• Moderate or severe acute illness with or without fever

Influenza, cell culture-based 

inactivated injectable 

[(ccIIV4), Flucelvax® 

Quadrivalent]

• Severe allergic reaction (e.g., anaphylaxis) to any ccIIV of any valency, or to any 

component3 of ccIIV4

• Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any type of 

influenza vaccine

• Persons with a history of severe allergic reaction (e.g., anaphylaxis) after a previous 

dose of any egg-based IIV, RIV, or LAIV of any valency. If using ccIV4, administer in 

medical setting under supervision of health care provider who can recognize and 

manage severe allergic reactions. May consult an allergist.

• Moderate or severe acute illness with or without fever

Influenza, recombinant 

injectable [(RIV4), Flublok® 

Quadrivalent]

• Severe allergic reaction (e.g., anaphylaxis) to any RIV of any valency, or to any 

component3 of RIV4

• Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any type of 

influenza vaccine

• Persons with a history of severe allergic reaction (e.g., anaphylaxis) after a previous 

dose of any egg-based IIV, ccIIV, or LAIV of any valency. If using RIV4, administer in 

medical setting under supervision of health care provider who can recognize and 

manage severe allergic reactions. May consult an allergist.

• Moderate or severe acute illness with or without fever

Influenza, live attenuated 

[LAIV4, Flumist® 

Quadrivalent]

• Severe allergic reaction (e.g., anaphylaxis) after previous dose of any influenza vaccine 

(i.e., any egg-based IIV, ccIIV, RIV, or LAIV of any valency) 

• Severe allergic reaction (e.g., anaphylaxis) to any vaccine component3 (excluding egg)

• Adults age 50 years or older

• Anatomic or functional asplenia

• Immunocompromised due to any cause including, but not limited to, medications and 

HIV infection

• Close contacts or caregivers of severely immunosuppressed persons who require a 

protected environment

• Pregnancy

• Cochlear implant

• Active communication between the cerebrospinal fluid (CSF) and the oropharynx, 

nasopharynx, nose, ear, or any other cranial CSF leak

• Received influenza antiviral medications oseltamivir or zanamivir within the previous 48 

hours, peramivir within the previous 5 days, or baloxavir within the previous 17 days.

• Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any type of 

influenza vaccine

• Asthma in persons aged 5 years old or older

• Persons with egg allergy with symptoms other than hives (e.g., angioedema, 

respiratory distress) or required epinephrine or another emergency medical 

intervention: Any influenza vaccine appropriate for age and health status may be 

administered. If using LAIV4 (which is egg based), administer in medical setting under 

supervision of health care provider who can recognize and manage severe allergic 

reactions. May consult an allergist.

• Persons with underlying medical conditions (other than those listed under 

contraindications) that might predispose to complications after wild-type influenza 

virus infection [e.g., chronic pulmonary, cardiovascular (except isolated hypertension), 

renal, hepatic, neurologic, hematologic, or metabolic disorders (including diabetes 

mellitus)]

• Moderate or severe acute illness with or without fever

1. When a contraindication is present, a vaccine should NOT be administered. Kroger A, Bahta L, Hunter P. ACIP General Best Practice Guidelines for Immunization. www.cdc.gov/vaccines/hcp/acip-recs/general-recs/

contraindications.html

2. When a precaution is present, vaccination should generally be deferred but might be indicated if the benefit of protection from the vaccine outweighs the risk for an adverse reaction. Kroger A, Bahta L, Hunter P. 

ACIP General Best Practice Guidelines for Immunization. www.cdc.gov/vaccines/hcp/acip-recs/general-recs/contraindications.html

3. Vaccination providers should check FDA-approved prescribing information for the most complete and updated information, including contraindications, warnings, and precautions. Package inserts for U.S.-

licensed vaccines are available at www.fda.gov/vaccines-blood-biologics/approved-products/vaccines-licensed-use-united-states.

Guide to Contraindications and Precautions to Commonly Used Vaccines

Adapted from Table 4-1 in Advisory Committee on Immunization Practices (ACIP) General Best Practice Guidelines for Immunization: Contraindication and Precautions available at www.cdc.

gov/vaccines/hcp/acip-recs/general-recs/contraindications.html and ACIP’s Recommendations for the Prevention and Control of 2021-22 Seasonal Influenza with Vaccines available at 

www.cdc.gov/mmwr/volumes/70/rr/rr7005a1.htm

Interim clinical considerations for use of COVID-19 vaccines including contraindications and precautions can be found at

www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html
Appendix Recommended Adult Immunization Schedule, United States, 2022

Vaccine Contraindications1 Precautions2

Haemophilus influenzae type b 

(Hib) 

• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3

• For Hiberix, ActHib, and PedvaxHIB only: History of severe allergic reaction to dry natural latex

• Moderate or severe acute illness with or without fever

Hepatitis A (HepA) • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 including 

neomycin

• Moderate or severe acute illness with or without fever

Hepatitis B (HepB) • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 including 

yeast

• For Heplisav-B only: Pregnancy

• Moderate or severe acute illness with or without fever

Hepatitis A- Hepatitis B vaccine 

[HepA-HepB, (Twinrix®)]

• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 including 

neomycin and yeast

• Moderate or severe acute illness with or without fever

Human papillomavirus (HPV) • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 • Moderate or severe acute illness with or without fever

Measles, mumps, rubella (MMR) • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3

• Severe immunodeficiency (e.g., hematologic and solid tumors, receipt of chemotherapy, congenital 

immunodeficiency, long-term immunosuppressive therapy or patients with HIV infection who are 

severely immunocompromised)

• Pregnancy 

• Family history of altered immunocompetence, unless verified clinically or by laboratory testing as 

immunocompetent

• Recent (≤11 months) receipt of antibody-containing blood product (specific interval depends on 

product)

• History of thrombocytopenia or thrombocytopenic purpura

• Need for tuberculin skin testing or interferon-gamma release assay (IGRA) testing

• Moderate or severe acute illness with or without fever

Meningococcal ACWY 

(MenACWY)

[MenACWY-CRM (Menveo®); 

MenACWY-D (Menactra®); 

MenACWY-TT (MenQuadfi®)]

• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3

• For MenACWY-D and Men ACWY-CRM only: severe allergic reaction to any diphtheria toxoid– or 

CRM197–containing vaccine

• For MenACWY-TT only: severe allergic reaction to a tetanus toxoid-containing vaccine

• Moderate or severe acute illness with or without fever

Meningococcal B (MenB)

[MenB-4C (Bexsero); MenB-FHbp 

(Trumenba)]

• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 • Pregnancy

• For MenB-4C only: Latex sensitivity 

• Moderate or severe acute illness with or without fever

Pneumococcal conjugate (PCV15) • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3

• Severe allergic reaction (e.g., anaphylaxis) to any diphtheria-toxoid–containing vaccine or to its vaccine 

component3

• Moderate or severe acute illness with or without fever

Pneumococcal conjugate (PCV20) • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3

• Severe allergic reaction (e.g., anaphylaxis) to any diphtheria-toxoid– containing vaccine or to its vaccine 

component3

• Moderate or severe acute illness with or without fever

Pneumococcal polysaccharide 

(PPSV23)

• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 • Moderate or severe acute illness with or without fever

Tetanus, diphtheria, and acellular 

pertussis (Tdap) 

Tetanus, diphtheria (Td) 

• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3

• For Tdap only: Encephalopathy (e.g., coma, decreased level of consciousness, prolonged seizures), not 

attributable to another identifiable cause, within 7 days of administration of previous dose of DTP, DTaP, 

or Tdap

• Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of tetanus-toxoid–containing 

vaccine

• History of Arthus-type hypersensitivity reactions after a previous dose of diphtheria-toxoid— 

containing or tetanus-toxoid– containing vaccine; defer vaccination until at least 10 years have 

elapsed since the last tetanus-toxoid–containing vaccine

• Moderate or severe acute illness with or without fever

• For Tdap only: Progressive or unstable neurological disorder, uncontrolled seizures, or progressive 

encephalopathy until a treatment regimen has been established and the condition has stabilized

Varicella (VAR) • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3

• Severe immunodeficiency (e.g., hematologic and solid tumors, receipt of chemotherapy, congenital 

immunodeficiency, long- term immunosuppressive therapy or patients with HIV infection who are 

severely immunocompromised)

• Pregnancy

• Family history of altered immunocompetence, unless verified clinically or by laboratory testing as 

immunocompetent

• Recent (≤11 months) receipt of antibody-containing blood product (specific interval depends on 

product)

• Receipt of specific antiviral drugs (acyclovir, famciclovir, or valacyclovir) 24 hours before vaccination 

(avoid use of these antiviral drugs for 14 days after vaccination)

• Use of aspirin or aspirin-containing products

• Moderate or severe acute illness with or without fever

Zoster recombinant vaccine (RZV) • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 • Moderate or severe acute illness with or without fever

• Current herpes zoster infection

1. When a contraindication is present, a vaccine should NOT be administered. Kroger A, Bahta L, Hunter P. ACIP General Best Practice Guidelines for Immunization. www.cdc.gov/vaccines/hcp/acip-recs/general-recs/contraindications.html

2. When a precaution is present, vaccination should generally be deferred but might be indicated if the benefit of protection from the vaccine outweighs the risk for an adverse reaction. Kroger A, Bahta L, Hunter P. ACIP General 

Best Practice Guidelines for Immunization. www.cdc.gov/vaccines/hcp/acip-recs/general-recs/contraindications.html

3. Vaccination providers should check FDA-approved prescribing information for the most complete and updated information, including contraindications, warnings, and precautions. Package inserts for U.S.-licensed vaccines 

are available at www.fda.gov/vaccines-blood-biologics/approved-products/vaccines-licensed-use-united-states.