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Adult Immunization Schedule AppendixRecommendations for Ages 19 Years or Older, United States, 2024						Print
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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**)
Appendix – 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, Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2023–24 Influenza Season, Contraindications and Precautions for COVID-19 Vaccination, and Contraindications and Precautions for JYNNEOS Vaccination.
COVID-19 and Flu Vaccinesadult vaccine schedule appendix
Vaccine
Contraindicated or Not Recommended1
Precautions2COVID-19 mRNA vaccines
[Pfizer-BioNTech, Moderna]
Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a component of an mRNA COVID-19 vaccine4
Diagnosed non-severe allergy (e.g., urticaria beyond the injection site) to a component of an mRNA COVID-19 vaccine4; or non-severe, immediate (onset less than 4 hours) allergic reaction after administration of a previous dose of an mRNA COVID-19 vaccine
Myocarditis or pericarditis within 3 weeks after a dose of any COVID-19 vaccine
Multisystem inflammatory syndrome in children (MIS-C) or multisystem inflammatory syndrome in adults (MIS-A)
Moderate or severe acute illness, with or without feverCOVID-19 protein subunit vaccine
[Novavax]
Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a component of a Novavax COVID-19 vaccine4
Diagnosed non-severe allergy (e.g., urticaria beyond the injection site) to a component of Novavax COVID-19 vaccine4; or non-severe, immediate (onset less than 4 hours) allergic reaction after administration of a previous dose of a Novavax COVID-19 vaccine
Myocarditis or pericarditis within 3 weeks after a dose of any COVID-19 vaccine
Multisystem inflammatory syndrome in children (MIS-C) or multisystem inflammatory syndrome in adults (MIS-A)
Moderate or severe acute illness, with or without feverInfluenza, 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
Moderate or severe acute illness with or without feverInfluenza, 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 feverInfluenza, 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 feverInfluenza, 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)
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 or older
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 feverWhen a contraindication is present, a vaccine should **NOT** be administered. Kroger A, Bahta L, Hunter P. ACIP General Best Practice Guidelines for Immunization.
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.
Vaccination providers should check FDA-approved prescribing information for the most complete and updated information, including contraindications, warnings, and precautions. See Package inserts for U.S.-licensed vaccines.
See package inserts and FDA EUA fact sheets for a full list of vaccine ingredients. mRNA COVID-19 vaccines contain polyethylene glycol (PEG).
Other Vaccinesadult vaccine schedule appendix
Vaccine
Contraindicated or Not Recommended1
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 feverHepatitis 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 feverHepatitis B (HepB)
Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 including yeast
Pregnancy: Heplisav-B and PreHevbrio are not recommended due to lack of safety data in pregnant persons.
Use other hepatitis B vaccines if HepB is indicated4
Moderate or severe acute illness with or without feverHepatitis 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 feverHuman papillomavirus (HPV)
Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
Pregnancy: HPV vaccination not recommended
Moderate or severe acute illness with or without feverMeasles, 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 feverMeningococcal ACWY (MenACWY)
(MenACWY-CRM) [Menveo]
(MenACWY-TT) [MenQuadfi]
Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
For MenACWY-D and MenACWY-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 feverMeningococcal 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 feverMeningococcal ABCWY
(MenACWY-TT/MenB-FHbp) [Penbraya]
Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
Severe allergic reaction to a tetanus toxoid-containing vaccine
Moderate or severe acute illness, with or without feverMpox [Jynneos]
Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
Moderate or severe acute illness, with or without feverPneumococcal conjugate (PCV15, 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 feverPneumococcal 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 feverPoliovirus vaccine, inactivated (IPV)
Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
Pregnancy
Moderate or severe acute illness with or without feverRespiratory syncytial virus vaccine (RSV)
Severe allergic reaction (e.g., anaphylaxis) to a vaccine component
Moderate or severe acute illness with or without feverTetanus, 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 stabilizedVaricella (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 feverZoster 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 infectionWhen 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
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
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.
For information on the pregnancy exposure registries for persons who were inadvertently vaccinated with Heplisav-B or PreHevbrio while pregnant, please visit heplisavbpregnancyregistry.com/ or www.prehevbrio.com/#safety.
							
					
							Last Reviewed:  December 6, 2023						Source: 	National Center for Immunization and Respiratory Diseases
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For Healthcare Providersplus icon
Child & Adolescent Immunization Scheduleplus icon
Vaccines in the Schedule
Table 1 – By Age
Table 2 – Catch-up
Table 3 – By Medical Indication
Notes
Appendix
Addendum
Adult Immunization Scheduleplus icon
Vaccines in the Schedule
Table 1 – By Age
Table 2 – By Medical Indication
Notes
Appendix
Addendum
Schedule Changes & Guidance
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Schedule-Related Resources
For You and Your Familyplus icon
Schedule for Infants and Children (Birth – 6 Years)
Schedule for Preteens and Teens (7 Years – 18 Years) Vaccines & ImmunizationsACIP Vaccination RecommendationsGeneral Acronyms and AbbreviationsVaccine Guidelines and Recommendations for Emergency SituationsDelays in Vaccine Supply


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