During a system upgrade from Friday, Dec. 5, through Sunday, Dec. 7, the AAFP website, on-demand courses and CME purchases will be unavailable.

    • Adults 19 and Older Immunization Schedule

    This version of the adult immunization schedule has been adopted by the American Academy of Family Physicians.

    The CDC's 2025 immunization schedules, which are not endorsed by the AAFP, can be found here.

    Schedule Based on Age Group

    Schedule Based on Medical Condition or Other Indication

    Notes

    • 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 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.

    Routine Vaccination

    Age 19–64 years

    • Unvaccinated:
      • 1 dose Moderna, or Pfizer-BioTech, or Novavax
    • Previously vaccinated before vaccine with:
      • 1 or more doses Moderna or Pfizer-BioNTech: 1 dose Moderna or Novavax or Pfizer-BioNTech at least 8 weeks after the most recent dose.
      • 1 dose Novavax: 1 dose Novavax 3–8 weeks after most recent dose. If more than 8 weeks after most recent dose, administer 1 dose Moderna or Novavax or Pfizer-BioNTech.
      • 2 or more doses Novavax: 1 dose Moderna or Novavax or Pfizer-BioNTech at least 8 weeks after the most recent dose.
      • 1 or more doses Janssen: 1 dose Moderna or Novavax or Pfizer-BioNTech.

    Age 65 years and older

    • Unvaccinated: follow recommendations above for unvaccinated persons ages 19–64 years and administer dose 2 of Moderna or Novavax or Pfizer-BioNTech 6 months later (minimum interval 2 months).
    • Previously vaccinated before vaccine: follow recommendations above for previously vaccinated persons ages 19–64 years and administer dose 2 of Moderna or Novavax or Pfizer-BioNTech 6 months later (minimum interval 2 months).

    Special Situations

    Persons who are moderately or severely immunocompromised. Use vaccine from the same manufacturer for all doses in the initial vaccination series.

    • Unvaccinated:
      • 4 doses (3-dose initial series Moderna at 0, 4 weeks, and at least 4 weeks after dose 2, followed by 1 dose Moderna or Novavax or Pfizer-BioNTech 6 months later [minimum interval 2 months]); May administer additional doses.*
      • 4 doses (3-dose initial series Pfizer BioNTech at 0, 3 weeks, and at least 4 weeks after dose 2, followed by 1 dose of Moderna or Novavax or Pfizer-BioNTech 6 months later [minimum interval 2 months]); May administer additional doses.*
      • 3 doses (2-dose initial series Novavax at 0, 3 weeks, followed by 1 dose Moderna or Novavax or Pfizer-BioNTech 6 months later [minimum interval 2 months]); May administer additional doses.
    • Incomplete initial vaccination series before 2025–26 vaccine:
      • Previous vaccination with Moderna
        • 1 dose Moderna: complete initial series with 2 doses of Moderna at least 4 weeks apart (administer dose 1 4 weeks after most recent dose), followed by 1 dose Moderna or Novavax or Pfizer-BioNTech 6 months later (minimum interval 2 months). May administer additional doses.*
        • 2 doses Moderna: complete initial series with 1 dose Moderna at least 4 weeks after most recent dose, followed by 1 dose Moderna or Novavax or Pfizer-BioNTech 6 months later (minimum interval 2 months). May administer additional doses.*
      • Previous vaccination with Pfizer-BioNTech
        • 1 dose Pfizer-BioNTech: complete initial series with 2 doses of Pfizer-BioNTech at least 4 weeks apart (administer dose 1 3 weeks after most recent dose), followed by 1 dose of Moderna or Novavax or Pfizer-BioNTech 6 months later (minimum interval 2 months). May administer additional doses.*
        • 2 doses Pfizer-BioNTech: complete initial series with 1 dose of Pfizer-BioNTech at least 4 weeks after most recent dose, followed by 1 dose of Moderna or Novavax or Pfizer-BioNTech 6 months later (minimum interval 2 months). May administer additional doses.*
      • Previous vaccination with Novavax
        • 1 dose Novavax: complete initial series with 1 dose of Novavax at least 3 weeks after most recent dose, followed by 1 dose of Moderna or Novavax or Pfizer-BioNTech 6 months later (minimum interval 2 months). May administer additional doses.*
      • Completed the initial vaccination series before 2025–26 vaccine with:
        • 3 or more doses Moderna or 3 or more doses Pfizer BioNTech: 2 doses of Moderna or Novavax or Pfizer-BioNTech 6 months apart (minimum interval 2 months). Administer dose 1 at least 8 weeks after the most recent dose. May administer additional doses.*
        • 2 or more doses Novavax: 2 doses of Moderna or Novavax or Pfizer-BioNTech 6 months apart (minimum interval 2 months). Administer dose 1 at least 8 weeks after the most recent dose. May administer additional doses.*

    Special situations

    • 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

    Routine 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])

    Special situations

    • 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.
      • Chronic liver disease including 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
      • 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 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)

    Routine 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, 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

    *Note: A voluntary nationwide recall was initiated in November 2024 for the Hep B vaccine, PreHevbrio.

    • 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) 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 HBsAgpositive 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 and persons who are predialysis; 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.

    Special situations  

    • 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-doses series Heplisav–B at 0, 1 months

    Routine 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.

    Shared clinical decision–making

    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)

    Special situations

    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.

    Routine vaccination

    • 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.

    FluMist (LAIV3) for Self-or Care Administration: FluMist has been approved for self-administration for persons aged ≥18 years, or by a caregiver who is ≥18 years for recipients aged 2 through 17 years. FluMist (LAIV3) will continue to be available for administration by healthcare professionals as previously recommended. There are no changes made to the recommendations regarding the appropriate populations, contraindications, or precautions.

    Special situations

    Close contacts (e.g., caregivers, healthcare workers) of severely immunosuppressed persons who require a protected environment: these persons 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 and non-egg based) appropriate for age and health status.

    Routine 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)

    Special situations

    • 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
    • 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.

    Special situations for MenACWY

    • Anatomical or functional asplenia (including sickle cell disease), HIV infection, persistent complement component deficiency, complement inhibitor (e.g., eculizumab, ravulizumab) use: 2-dose series 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 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 Menveo or MenQuadfi

    Shared clinical decision–making for MenB

    • 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)

    *To optimize rapid protection (e.g., for students starting college in less than 6 months), a 3-dose series (0, 1–2, 6 months) may be administered.

    Special situations for MenB

    • 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 unless at increased risk and vaccination benefits outweigh potential risks.

    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 (MenACWY–TT/MenB–FHbp) 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, then 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.

    Special situations

    • Any person at risk for Mpox infection: 2-dose series, 28 days apart.
      • 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 contacts of the persons described above.
      • Persons who anticipate experiencing any of the situations described above.
      • Persons deemed at risk by public health authorities in mpox outbreak settings.
    • Health care personnel: Vaccination to protect against occupational risk in healthcare settings is not routinely recommended.

    Routine vaccination

    Age 65 years or older who have:

    • 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.
      • 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) OR 1 dose PCV21. 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. Administer either PCV15 or PCV20 at least 1 year after the last PPSV23 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.

    Special situations

    • 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: 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 PCV13 and 1 dose of PPSV23: 1 dose PCV20 or 1 dose PCV21 at least 5 years after the last pneumococcal vaccine dose.
    • Adults aged 19 years and older who have received PCV20 or PCV21: no additional pneumococcal vaccine dose recommended.
    • Pregnancy: no recommendation for PCV or PPSV23 due to limited data.
      • PPSV23 not available: adults aged 19 years or older who received PCV15 but have not yet completed PPSV23 series, can complete the series with either 1 dose of PCV20 or 1 dose of PCV21 if they no longer have access to PPSV23.

    *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.

    Routine 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.

    Special situations

    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

    Routine vaccination

    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 or clesrovimab (RSV monoclonal antibodies) are 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. If vaccine was not provided during the current pregnancy, the infant should receive nirsevimab or clesrovimab

    *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.

    Special Situations

    Age 50–74 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 50 years and older can get RSV vaccine at any time but it is best to administer in late summer and early fall before RSV spreads in communities—ideally August through October in most of continental United States.

    **Note: People can self–attest to the presence of a risk factor. The following medical and other conditions increase the risk of severe RSV disease:

    • Chronic cardiovascular disease e.g., heart failure, coronary artery disease, congenital heart disease. Excludes isolated hypertension.
    • Chronic lung or respiratory disease e.g., chronic obstructive pulmonary disease, emphysema, asthma, interstitial lung disease, cystic fibrosis
    • End stage renal disease or dependence on hemodialysis or other renal replacement therapy
    • Diabetes mellitus complicated by chronic kidney disease, neuropathy, retinopathy, or other end–organ damage
    • Diabetes mellitus requiring treatment with insulin or sodium–glucose cotransporter 2 (SGLT2) inhibitor
    • Neurologic or neuromuscular conditions causing impaired airway clearance or respiratory muscle weakness e.g., post–stroke dysphagia, amyotrophic lateral sclerosis, muscular dystrophy. Excludes history of stroke without impaired airway clearance.
    • Chronic liver disease e.g., cirrhosis
    • Chronic hematologic conditions e.g., sickle cell disease, thalassemia
    • Severe obesity (body mass index ≥ 40 kg/m2)
    • Moderate or severe immune compromise
    • Residence in a nursing home
    • Other chronic medical conditions or risk factors that a health care provider determines would increase the risk of severe disease due to viral respiratory infection e.g., frailty, concern for presence of undiagnosed chronic medical conditions, residence in a remote or rural community where escalation of medical care is challenging.

    Routine vaccination

    • 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.

    Special situations

    • 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

    Routine 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.

    Special situations

    • 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.

    Routine 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.

    Special situations

    • 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 https://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

    Appendix: Contraindications and Precautions to Commonly Used Vaccines

    When a contraindication is present, a vaccine should NOT be administered. Vaccination providers should check FDA-approved prescribing information for the most complete and updated information, including contraindications, warnings, and precautions. 

    Vaccines and Other Immunizing Agents Contraindicated or Not Recommended Precautions

    COVID-19 mRNA vaccines

    [Pfizer-BioNTech, Moderna]

    Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a component ofan mRNA COVID-19 vaccine. See package inserts and FDA EUA fact sheets for a full list of vaccine ingredients. mRNA COVID-19 vaccines contain polyethylene glycol (PEG).
    • Diagnosed non-severe allergy (e.g., urticaria beyond the injection site) to a component of an mRNA COVID-19 vaccine; 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 fever

    COVID-19 protein subunit vaccine

    [Novavax]

    Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a component ofan mRNA COVID-19 vaccine. See package inserts and FDA EUA fact sheets for a full list of vaccine ingredients. mRNA COVID-19 vaccines contain polyethylene glycol (PEG).
    • 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 fever
    Influenza, egg-based, inactivated injectable (IIV3)
    • 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 component (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 fever
    Influenza, cell culture-based inactivated injectable (ccIIV3)[Flucelvax] Severe allergic reaction (e.g., anaphylaxis) to any ccIIV of any valency, or to anycomponent of ccIIV3  

     

    • 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 ccIIV4, 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 (RIV3)

    [Flublok]

    		 Severe allergic reaction (e.g., anaphylaxis) to any RIV of any valency, or to any component of RIV3

     

    • 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 (LAIV3)

    [Flumist]
    • 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 fever
    Haemophilus influenzae type b (Hib) Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component 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 component 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
    • Pregnancy: PreHevbrio has been recalled and is not recommended due to lack of safety data in pregnant persons. Use other hepatitis B vaccines if HepB is indicated. For information on the pregnancy exposure registry for persons who were inadvertently vaccinated with PreHevbrio while pregnant, please visit www.prehevbrio.com/#safety.
    		 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 component 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 component.
    • Pregnancy: HPV vaccination not recommended
    		 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-TT) [MenQuadfi]
    • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
    • For 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 fever

    Meningococcal B (MenB)

    MenB-4C [Bexsero]

    MenB-FHbp [Trumenba]

    		 Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
    • Pregnancy
    • For MenB-4C only: Latex sensitivity
    • Moderate or severe acute illness with or without fever

    Meningococcal ABCWY

    (MenACWY-TT/MenB-FHbp) [Penbraya]
    • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
    • Severe allergic reaction to a tetanus toxoid–containing vaccine
    		 Moderate or severe acute illness with or without fever
    Mpox [Jynneos] Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component Moderate or severe acute illness with or without fever

    Pneumococcal conjugate

    (PCV15, PCV20, PCV21)
    • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
    • Severe allergic reaction (e.g., anaphylaxis) to any diphtheria-toxoid-containing vaccine or to its vaccine component
    		 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 component Moderate or severe acute illness with or without fever
    Poliovirus vaccine, inactivated (IPV) Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
    • Pregnancy
    • Moderate or severe acute illness with or without fever
    Respiratory syncytial virus vaccine (RSV) Severe allergic reaction (e.g., anaphylaxis) to a vaccine component

    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 component
    • 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 component
    • 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 component
    • Moderate or severe acute illness with or without fever
    • Current episode of herpes zoster

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