Vaccines Recommended for Adults

While the importance of childhood immunizations is commonly understood, many adults are surprised to learn that immunizations are recommended throughout life. Most adult vaccines are in the form of “booster shots” following the primary series from childhood but some vaccines are specifically licensed and recommended for adults. As of 2008 only 2% of adults in the United States had been fully vaccinated with recommended vaccines.  Ensuring that immunization status is up to date should be a part of routine adult health care.

There are many compelling reasons for adults to be vaccinated:

  • Each year, many adults die from vaccine-preventable diseases such as influenza, pneumococcal and meningococcal disease, and less commonly tetanus. For many of these diseases, death rates increase as people age. Outside of infancy, the highest hospitalization and death rates caused by influenza occur in adults age 65 years and older.
  • Many vaccine-preventable diseases are more serious in adults than in children. Complications such as pneumonia and/or death are more likely to occur when an adult contracts varicella (chickenpox) than a child.
  • Some vaccine-preventable diseases such as chickenpox, influenza and tetanus can cause more severe illness in pregnant women or can harm the developing fetus, cause miscarriage or stillbirths (rubella and chickenpox). Learn more about the need for vaccines in pregnancy.
  • Some adults did not receive childhood vaccinations.
  • Some recommended vaccines were not available when many adults were children.
  • Some vaccines do not give lifelong protection. As immunity to infections fades over time, adults once again become susceptible to getting the infection (such as tetanus, diphtheria and pertussis) and all the complications that go with it.
  • Adults can have jobs that put them at increased risk of both acquiring and spreading vaccine-preventable diseases. These diseases may then spread to those who are least well able to fight them and have a high risk of complications and death, including very young infants, the elderly and people with impaired immune systems.

Specific Vaccine Recommendations for Adults

The Centers for Disease Control and Prevention (CDC) issue recommendations for vaccination in adults. A separate vaccination schedule is available for pregnant women and for adolescents.

Tetanus-Diphtheria-Acellular Pertussis (Tdap) Vaccine and Tetanus-Diphtheria (Td) Vaccine

Tdap (which differs from the DTaP vaccine given in the primary infant/child series in the amount of vaccine components it contains) should be substituted for one Td dose in adults who are receiving the primary series for the first time. It also should be given as a booster to adults under 65 years who have not previously received a dose of Tdap vaccine. One dose of Tdap should be given as early as 2 years after a Td booster to people whose risk of acquiring pertussis and transmitting it to infants is high, for example women in the immediate postpartum period (prior to hospital discharge), close contacts of infants < 12 months of age and all health care workers with direct patient contact.

Tetanus-diptheria (Td) vaccine is recommended for adults who have not completed their primary vaccination series for tetanus or diphtheria. Those for whom a reliable history cannot be obtained should begin or complete their primary series. The primary series consists of 3 doses of tetanus and diphtheria toxoid-containing vaccines. After completing the primary series of vaccination, a Tdap booster is recommended at 10 year intervals. For wound prophylaxis, Td can be administered more frequently and the ACIP statement dealing with wound management should be consulted.

Pregnant women who received Td more than two years previously should have Tdap in the immediate post-partum period (prior to hospital discharge). In almost all situations, Td can be deferred during pregnancy and Tdap given in the immediate post-partum period or Tdap can be given instead of Td in pregnancy after discussion between the pregnant woman and her doctor. Learn more about Td and Tdap vaccines.

Human Papillomavirus (HPV) Vaccine

Human papillomavirus (HPV) vaccine is recommended for all female adolescents and young women aged 11 to 26 years who have not already had the three-dose vaccine series. HPV vaccine is recommended for women even if they have a history of genital warts, abnormal Papanicolaou test (Pap smear) or positive HPV test because the vaccine may protect against other forms of HPV. To best protect women against acquiring HPV this vaccine should be given before women are exposed to HPV through sexual intercourse, however, women <27 years of age who are already sexually active should also be vaccinated. The vaccine is not recommended in pregnancy. Learn more about HPV vaccine.

Measles, Mumps, Rubella (MMR) Vaccine

Measles, mumps, rubella (MMR) vaccine is recommended for adults based on the risk of acquiring and need for protection against measles, mumps or rubella in a given situation. Adults born before 1957 are assumed to have had natural infection with measles and mumps and are considered immune to both infections.

  • To protect against measles adults born during or after 1957 should receive one or more doses of MMR unless they have:
  • A medical contraindication (for example people with HIV/AIDS, weakened immune systems, cancer, low platelet counts, those being treated for another condition with steroids or those who have recently received a blood transfusion)
  • Documentation that they received ≥ two doses of MMR already
  • A history of measles infection from their healthcare provider
  • Laboratory evidence that they are immune

A second dose of MMR (given at least 4 weeks after the first dose) is recommended for adults who:

  • Were recently exposed to measles or if there is a measles outbreak
  • Were vaccinated with killed measles vaccine rather then the currently available live vaccine
  • Were vaccinated with an unknown type of measles vaccine during 1963-1967
  • Are students
  • Work in a health care setting
  • Plan to travel internationally

To protect against mumps adults born during or after 1957 should receive one or more doses of MMR unless they have:

  • A medical contraindication (for example people with HIV/AIDS, weakened immune systems, cancer, low platelet counts, those being treated for another condition with steroids or those who have recently received a blood transfusion)
  • A history of mumps infection from their healthcare provider
  • Laboratory evidence that they are immune

A second dose of MMR (given at least 4 weeks after the first dose) is recommended for adults who:

  • Are in an age group affected during a mumps outbreak
  • Are students in a postsecondary institution
  • Work in a health care facility
  • Plan to travel internationally

To protect against rubella, MMR vaccine is recommended for women who cannot prove they received rubella vaccine in the past or who do not have laboratory evidence that they are immune. Women of childbearing age should routinely have their rubella immunity checked.

Pregnant women should not receive MMR vaccine and women of child-bearing age should be advised to avoid pregnancy for 4 weeks after receiving MMR. Rubella non-immune women should receive MMR as soon as their pregnancy is completed before discharge from the hospital and can be given at the same time as the Tdap vaccine. Learn more about MMR vaccine.

Varicella Vaccine

Varicella vaccine is recommended for adults who do not have evidence of immunity to varicella (prior chickenpox infection). They should receive two doses of this vaccine. This is especially important for people who have close contact with people at high risk of developing severe varicella disease, such as health-care workers and family contacts of people with immunodeficiency, or people who are at high risk of coming into contact with or spreading varicella (for example teachers, daycare workers, college students, those living with young children, non-pregnant women of child-bearing age and international travelers. Acceptable evidence of immunity includes:

  • Documentaed proof that two doses of varicella vaccine have been given at least 4 weeks apart
  • Born in the US before 1980 (people with immunodeficiency, healthcare workers and pregnant women need additional proof of immunity)
  • History of varicella infection documented by a health care provider
  • History of herpes zoster infection (shingles) documented by a healthcare provider
  • Laboratory evidence of immunity

Pregnant women should not receive varicella vaccine and women of child-bearing age should be advised to avoid pregnancy for four weeks after receiving varicella vaccine. Women without evidence of varicella immunity should receive varicella vaccine as soon as their pregnancy is completed. Learn more about varicella vaccine.

Influenza Vaccine

Influenza vaccine is recommended annually for all adults who are 50 years old or older. For adults between the ages of 19 and 49, annual vaccination is recommended in the following situations -

Medical conditions:

  • Immunodeficiency (HIV and drug-induced)
  • Chronic cardiac or respiratory diseases including asthma
  • Chronic metabolic diseases including diabetes mellitus, renal failure, hemoglobinopathies
  • Any condition that compromises respiratory function
  • Women who will be pregnant any time during the influenza season
  • Occupational indications (health care workers including those employed in long-term care and assisted living facilities)
  • Residents of nursing homes, long-term care and assisted-living facilities
  • People likely to transmit influenza to those at high risk for complications of influenza, for example, those living with or caring for children under the age of 5 years or people with any medical indication listed above.
  • Anyone who would like to be protected against influenza

Two influenza vaccines are available for use in adults. The live, attenuated influenza vaccine (LAIV) that is given via intranasal spray can be given to healthy non-pregnant adults who are younger than 49 years old, who do not have any medical conditions listed above and are not contacts of severely immunocompromized persons (such as bone-marrow transplant patients). However TIV is recommended for all other adults.

Pneumococcal Polysaccharide Vaccine

Pneumococcal polysaccharide vaccine is recommended for all adults 65 years of age or older. For adults under 64 years of age annual vaccination is recommended in the following situations.

  • Medical indications:
  • Chronic respiratory disorders except asthma
  • Cardiovascular disease
  • Diabetes mellitus
  • Chronic liver disease
  • Chronic alcoholism
  • Chronic renal failure or nephrotic syndrome
  • After removal of the spleen or when the spleen is not functioning
  • Disorders of the immune system
  • Certain malignancies
  • People undergoing chemotherapy or taking drugs that affect the immune system
  • People with cochlear implants who are at high risk of getting pneumococcal meningitis
  • People with cerebrospinal fluid leaks
  • Alaskan natives and certain Native American populations
  • Residents of nursing homes, longterm-care and assisted living facilities

The vaccine should be repeated once 5 years after the first dose is given in the following situations.

  • Chronic renal failure or nephrotic syndrome
  • After removal of the spleen or when the spleen is not functioning
  • Disorders of the immune system
  • Certain malignancies
  • People undergoing chemotherapy or taking drugs that affect the immune system
  • People who are 65 years of age or older who were vaccinated more than five years previously and who were aged less than 65 years old at that time

Hepatitis A Vaccine

Hepatitis A vaccine is recommended for adults who have risk factors for acquiring the illness including:

Medical indications:

  • Chronic liver disease
  • People who receive clotting factor concentrates, for example those with hemophilia

Behavior indications:

  • Men who have sex with men
  • Illegal drug users
  • Laboratory workers and researchers who are likely to be in contact with the hepatitis A virus or animals infected with it
  • Travelers to or workers in countries where hepatitis A is endemic.

Hepatitis B Vaccine

Hepatitis B vaccine is recommended for adults who have risk factors for acquiring the illness including:

Medical indications

  • Renal failure including patients receiving hemodialysis
  • People being evaluated or treated for a sexually transmitted infection (STI)
  • People with HIV infection
  • Chronic liver disease
  • Occupational indications
    • Health care and other workers exposed to blood or other possibly infected body fluids
  • Behavior indications
  • People with more than one sex partner in the previous six months
  • Men who have sex with men
  • Current or past intravenous drug users
  • Household contacts and sex partners of people with chronic hepatitis B virus (HBV) infection
  • Members and workers in institutions for people with developmental disabilities
  • Travelers to or workers in countries where chronic HBV is common.
  • Any adult who wants to be protected from HBV

In addition HBV vaccine is recommended for all adults in STI, HIV or drug-abuse facilities, health care facilities for men who have sex with men or for drug abuse, correctional facilities, facilities for patients with end-stage renal disease and hemodialysis and facilities for persons with developmental disabilities.

Meningococcal Vaccinations

Meningococcal vaccines licensed for use in adults (meningococcal polysaccharide vaccine [MPSV4] and meningococcal conjugate vaccine [MCV4]) protect against 4 types of meningococcal disease, types A, C, Y and W135. MCV4 is licensed for ages 11-55 years and is the preferred meningococcal vaccine in this age group. Meningococcal conjugate vaccination in adults is indicated for the following situations:

  • Medical indications
  • People who have a damaged spleen or have had their spleen removed
  • People with certain immune deficiencies, including asplenia, t complement deficiency or HIV