Recommended Adult Immunization Schedule for ages 19 years or

CS310021-D

6/27/2024

Report

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

the local or state health department

y Clinically signicant adverse events to the Vaccine Adverse Event Reporting System at

www.vaers.hhs.gov or 800-822-7967

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 ACIP Shared Clinical Decision-Making Recommendations:

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

y General Best Practice Guidelines for Immunization

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 identication and outbreak response):

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

How to use the adult immunization schedule

Determine

recommended

vaccinations

by age

(Table1)

Assess need

for additional

recommended

vaccinations by

medical

condition or

other indication

(Table2)

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)

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), American Academy of Physician Associates (www.aapa.

org), American Pharmacists Association (www.pharmacist.com), and Society for Healthcare

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

Vaccines in the Adult Immunization Schedule*

Vaccine Abbreviation(s) Trade name(s)

COVID-19 vaccine

1vCOV-mRNA

Comirnaty®/Pzer-BioNTech COVID-19 Vaccine

Spikevax®/Moderna COVID-19 Vaccine

1vCOV-aPS Novavax COVID-19 Vaccine

Haemophilus inuenzae 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®

Heplisav-B®

PreHevbrio®

Recombivax HB®

Human papillomavirus vaccine HPV Gardasil 9®

Inuenza vaccine (inactivated) IIV4 Many brands

Inuenza vaccine (live, attenuated) LAIV4 FluMist® Quadrivalent

Inuenza vaccine (recombinant) RIV4 Flublok® Quadrivalent

Measles, mumps, and rubella vaccine MMR

M-M-R II®

Priorix®

Meningococcal serogroups A, C, W, Y vaccine

MenACWY-CRM

MenACWY-TT

Menveo®

MenQuad®

Meningococcal serogroup B vaccine

MenB-4C

MenB-FHbp

Bexsero®

Trumenba®

Meningococcal serogroup A, B, C, W, Y vaccine

MenACWY-TT/

MenB-FHbp

Penbraya™

Mpox vaccine Mpox Jynneos®

Pneumococcal conjugate vaccine

PCV15

PCV20

Vaxneuvance™

Prevnar 20™

Pneumococcal polysaccharide vaccine PPSV23 Pneumovax 23®

Poliovirus vaccine IPV Ipol®

Respiratory syncytial virus vaccine RSV

Arexvy®

Abrysvo™

Tetanus and diphtheria toxoids Td

Tenivac®

Tdvax™

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 identication 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

Recommended Adult Immunization Schedule

for ages 19years or older

UNITED STATES

2024

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

COVID-19 1 or more doses of updated (2023–2024 Formula) vaccine (See Notes)

Inuenza inactivated (IIV4) or

Inuenza recombinant (RIV4)

1 dose annually

Inuenza live, attenuated

(LAIV4)

1 dose annually

Respiratory Syncytial Virus

(RSV)

Seasonal administration during pregnancy. See Notes. >60 years

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)

For healthcare personnel,

see notes

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)

See Notes

Hepatitis A

(HepA)

2, 3, or 4 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)

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

Haemophilus inuenzae type b

(Hib)

1 or 3 doses depending on indication

Mpox

oror



Recommended vaccination for adults who meet age requirement,

lack documentation of vaccination, or lack evidence of immunity 

Recommended vaccination for adults with an

additional risk factor or another indication



Recommended vaccination based on shared

clinical decision-making



No recommendation/

Not applicable

19 through 23 years

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

Table 1

Recommended Adult Immunization Schedule by Age Group, United States, 2024

Table 2

Recommended Adult Immunization Schedule by Medical Condition or Other Indication, United States, 2024

Always use this table in conjunction with Table 1 and the Notes that follow. Medical conditions or indications are often not mutually exclusive. If multiple medical conditions or indications are present, refer to

guidance in all relevant columns. See Notes for medical conditions or indications not listed.

VACCINE Pregnancy

Immunocompromised

(excluding HIV

infection)

HIV infection CD4

percentage and count

Men who have sex

with men

Asplenia,

complement

deciency

Heart or lung

disease

Kidney failure,

End-stage

renal disease

or on dialysis

Chronic liver

disease;

alcoholism

Diabetes

Healthcare

Personnel

<15% or

<200mm

≥15% and

≥200mm

COVID-19 See Notes

IIV4 or RIV4 1 dose annually

LAIV4

1 dose annually

if age 19–49 years

RSV

Seasonal

administration.

See Notes

See Notes See Notes

Tdap or Td

Tdap: 1 dose

each pregnancy

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

MMR *

VAR * See Notes

RZV See Notes

HPV * 3 dose series if indicated

Pneumococcal

HepA

Hep B See Notes

Age ≥ 60 years

MenACWY

MenB

Hib HSCT: 3 doses

Asplenia:

1 dose

Mpox See Notes See Notes See Notes



Recommended for all adults

who lack documentation of

vaccination, OR lack evidence

of immunity



Not recommended for all

adults, but recommended

for some adults based on

either age OR increased

risk for or severe outcomes

from disease



Recommended based

on shared clinical

decision-making



Recommended for all adults,

and additional doses may be

necessary based on medical

condition or other indications.

See Notes.



Precaution: Might be

indicated if benet of

protection outweighs

risk of adverse reaction



Contraindicated or not

recommended

*Vaccinate after pregnancy,

if indicated



No Guidance/

Not Applicable

1 dose annually if age 19–49 years

a. Precaution for LAIV4 does not apply to alcoholism. b. See notes for inuenza; hepatitis B; measles, mumps, and rubella; and varicella vaccinations. c. Hematopoietic stem cell transplant.

For vaccination recommendations for persons ages

18 years or younger, see the Recommended Child and

Adolescent Immunization Schedule, 2024: www.cdc.gov/

vaccines/schedules/hcp/child-adolescent.html

Additional Information

y For calculating intervals between doses, 4 weeks =

28 days. Intervals of ≥4 months are determined by

calendar months.

y Within a number range (e.g., 12–18), a dash (–) should

be read as “through.”

y Vaccine doses administered ≤4 days before the

minimum age or interval are considered valid. Doses

of any vaccine administered ≥5 days earlier than the

minimum age or minimum interval should not be

counted as valid and should be repeated. The repeat

dose should be spaced after the invalid dose by the

recommended minimum interval. For further details,

see Table 3-2, Recommended and minimum ages

and intervals between vaccine doses, in General Best

Practice Guidelines for Immunization at www.cdc.gov/

vaccines/hcp/acip-recs/general-recs/timing.html.

y Information on travel vaccination requirements and

recommendations is available at www.cdc.gov/travel/.

y For vaccination of persons with immunodeciencies,

see Table 8-1, Vaccination of persons with primary and

secondary immunodeciencies, in General Best Practice

Guidelines for Immunization at www.cdc.gov/vaccines/

hcp/acip-recs/general-recs/immunocompetence.html

y For information about vaccination in the setting of a

vaccine-preventable disease outbreak, contact your

state or local health department.

y The National Vaccine Injury Compensation Program

(VICP) is a no-fault alternative to the traditional legal

system for resolving vaccine injury claims. All vaccines

included in the adult immunization schedule except

PPSV23, RSV, RZV, Mpox, and COVID-19 vaccines are

covered by the National Vaccine Injury Compensation

Program (VICP). Mpox and COVID-19 vaccines are

covered by the Countermeasures Injury Compensation

Program (CICP). For more information, see www.hrsa.

gov/vaccinecompensation or www.hrsa.gov/cicp.

COVID-19 vaccination

Routine vaccination

Age 19 years or older

y Unvaccinated:

- 1 dose of updated (2023–2024 Formula) Moderna or

Pzer-BioNTech vaccine

- 2-dose series of updated (2023–2024 Formula)

Novavax at 0, 3–8 weeks

y Previously vaccinated* with 1 or more doses of any

COVID-19 vaccine: 1 dose of any updated (2023–2024

Formula) COVID-19 vaccine administered at least 8

weeks after the most recent COVID-19 vaccine dose.

Special situations

Persons who are moderately or severely

immunocompromised**

y Unvaccinated:

- 3-dose series of updated (2023–2024 Formula)

Moderna at 0, 4, 8 weeks

- 3-dose series of updated (2023–2024 Formula)

Pzer-BioNTech at 0, 3, 7 weeks

- 2-dose series of updated (2023–2024 Formula)

Novavax at 0, 3 weeks

y Previously vaccinated* with 1 dose of any

Moderna: 2-dose series of updated (2023–2024

Formula) Moderna at 0, 4 weeks (minimum interval

between previous Moderna dose and dose 1: 4 weeks)

y Previously vaccinated* with 2 doses of any

Moderna: 1 dose of updated (2023–2024 Formula)

Moderna at least 4 weeks after most recent dose.

y Previously vaccinated* with 1 dose of any Pzer-

BioNTech: 2-dose series of updated (2023–2024

Formula) Pzer-BioNTech at 0, 4 weeks (minimum

interval between previous Pzer-BioNTech dose and

dose 1: 3 weeks).

y Previously vaccinated* with 2 doses of any Pzer-

BioNTech: 1 dose of updated (2023–2024 Formula)

Pzer-BioNTech at least 4 weeks after most recent

dose.

y Previously vaccinated* with 3 or more doses of any

Moderna or Pzer-BioNTech: 1 dose of any updated

(2023–2024 Formula) COVID-19 vaccine at least 8

weeks after the most recent dose.

y Previously vaccinated* with 1 or more doses of

Janssen or Novavax with or without dose(s) of any

Original monovalent or bivalent COVID-19 vaccine:

1 dose of any updated (2023–2024 Formula) of

COVID-19 vaccine at least 8 weeks after the most

recent dose.

There is no preferential recommendation for the use

of one COVID-19 vaccine over another when more

than one recommended age-appropriate vaccine is

available.

Current COVID-19 vaccine information available at

www.cdc.gov/covidschedule. For information on

Emergency Use Authorization (EUA) indications for

COVID-19 vaccines, see www.fda.gov/emergency-

preparedness-and-response/coronavirus-disease-2019-

covid-19/covid-19-vaccines.

*Note: Previously vaccinated is dened as having

received any Original monovalent or bivalent COVID-19

vaccine (Janssen, Moderna, Novavax, Pzer-BioNTech)

prior to the updated 2023 –2024 formulation.

**Note: Persons who are moderately or severely

immunocompromised have the option to receive

one additional dose of updated (2023 –2024 Formula)

COVID-19 vaccine at least 2 months following the

last recommended updated (2023– 2024 Formula)

COVID-19 vaccine dose. Further additional updated

(2023–2024 Formula) COVID-19 vaccine dose(s) may

be administered, informed by the clinical judgement

of a healthcare provider and personal preference and

circumstances. Any further additional doses should be

administered at least 2 months after the last updated

(2023–2024 Formula) COVID-19 vaccine dose.

Recommended Adult Immunization Schedule for Ages 19 Years or Older, United States, 2024

Notes

Recommended Adult Immunization Schedule for Ages 19 Years or Older, United States, 2024

Notes

Haemophilus inuenzae type b vaccination

Special situations

y Anatomical or functional asplenia (including sickle

cell disease): 1 dose if previously did not receive

Hib vaccine; if elective splenectomy, 1 dose preferably

at least 14 days before splenectomy.

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 Any person who is not fully vaccinated and requests

vaccination (identication 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

y Any person who is not fully vaccinated and who is at

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

or 3-dose series HepA-HepB as above. Risk factors for

hepatitis A virus infection include:

- Chronic liver disease (e.g., persons with

hepatitis B, hepatitis C, cirrhosis, fatty liver disease,

alcoholic liver disease, autoimmune hepatitis,

alanine aminotransferase [ALT] or aspartate

aminotransferase [AST] level greater than

twice the upper limit of normal)

- HIV infection

- Men who have sex with men

- Injection or noninjection drug use

- Persons experiencing homelessness

- Work with hepatitis A virus in research

laboratory or with nonhuman primates

with hepatitis A virus infection

- Travel in countries with high or intermediate

endemic hepatitis A (HepA-HepB [Twinrix] may

be administered on an accelerated schedule of

3 doses at 0, 7, and 21–30 days, followed by a

booster dose at 12 months)

- Close, personal contact with international adoptee

(e.g., household or regular babysitting) in rst 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, PreHevbrio*, 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: Heplisav-B and PreHevbrio are not

recommended in pregnancy due to lack of safety data

in pregnant persons.

y Age 60 years or older without known risk factors

for hepatitis B virus infection may receive a

HepB vaccine series.

y Age 60 years or older with known risk factors for

hepatitis B virus infection should receive a

HepB vaccine series.

y Any adult age 60 years of age or older who requests

HepB vaccination should receive a HepB vaccine

series.

- Risk factors for hepatitis B virus infection include:

 Chronic liver disease e.g., persons with hepatitis C,

cirrhosis, fatty liver disease, alcoholic liver disease,

autoimmune hepatitis, alanine aminotransferase

(ALT) or aspartate aminotransferase (AST) level

greater than twice the upper limit of normal

 HIV infection

 Sexual exposure risk e.g., sex partners of hepatitis

B surface antigen (HBsAg)-positive persons, sexually

active persons not in mutually monogamous

relationships, persons seeking evaluation or

treatment for a sexually transmitted infection,

men who have sex with men

 Current or recent injection drug use

 Percutaneous or mucosal risk for exposure

to blood e.g., household contacts of HBsAg-

positive persons, residents and sta of facilities for

developmentally disabled persons, health care and

public safety personnel with reasonably anticipated

risk for exposure to blood or blood-contaminated

body uids; persons on maintenance dialysis

(including in-center or home hemodialysis and

peritoneal dialysis), persons who are predialysis, and

patients with diabetes*

 Incarceration

 Travel in countries with high or intermediate

endemic hepatitis B

*Age 60 years or older with diabetes: Based on

shared clinical decision making, 2-, 3-, or 4-dose series

as above.

Recommended Adult Immunization Schedule for Ages 19 Years or Older, United States, 2024

Notes

Special situations

y 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)

Human papillomavirus vaccination

Routine vaccination

y 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)

y No additional dose recommended when any HPV

vaccine series of any valency has been completed

using the recommended dosing intervals.

Shared clinical decision-making

y Adults age 27–45 years: Based on shared clinical

decision-making, complete a 2-dose series (if initiated

age 9-14 years) or 3-dose series (if initiated ≥15 years)

For additional information on shared clinical decision-

making for HPV; see www.cdc.gov/vaccines/hcp/admin/

downloads/isd-job-aid-scdm-hpv-shared-clinical-

decision-making-hpv.pdf

Special situations

y Age ranges recommended above for routine and

catch-up vaccination or shared clinical decision-

making also apply in special situations

- Immunocompromising conditions, including HIV

infection: 3-dose series, even for those who initiate

vaccination at age 9 through 14 years.

- Pregnancy: Pregnancy testing is not needed before

vaccination. HPV vaccination is not recommended

until after pregnancy. No intervention needed if

inadvertently vaccinated while pregnant.

Inuenza vaccination

Routine vaccination

y Age 19 years or older: 1 dose any inuenza vaccine

appropriate for age and health status annually.

- Age 65 years or older: Any one of quadrivalent

high-dose inactivated inuenza vaccine (HD-

IIV4), quadrivalent recombinant inuenza vaccine

(RIV4), or quadrivalent adjuvanted inactivated

inuenza vaccine (aIIV4) is preferred. If none of these

three vaccines are available, then any other age-

appropriate inuenza vaccine should be used.

y For the 2023–2024 season, see www.cdc.gov/mmwr/

volumes/72/rr/rr7202a1.htm

y For the 2024–2025 season, see the 2024–2025 ACIP

inuenza vaccine recommendations.

Special situations

y Close contacts (e.g., caregivers, healthcare

workers) of severely immunosuppressed persons

who require a protected environment: should not

receive LAIV4. If LAIV4 is given, they should avoid

contact with/caring for such immunosuppressed

persons for 7 days after vaccination.

Note: Persons with an egg allergy can receive any

inuenza vaccine (egg-based and non-egg based)

appropriate for age and health status.

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 (except for

health care personnel, see below), documentation

of receipt of MMR vaccine, laboratory evidence of

immunity or disease (diagnosis of disease without

laboratory conrmation 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 persons of childbearing age with no

evidence of immunity to rubella: 1 dose

y HIV infection with CD4 percentages ≥15% and CD4

count ≥200 cells/mm

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/mm

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 In mumps outbreak settings, for information about

additional doses of MMR (including 3rd dose of MMR), see

www.cdc.gov/mmwr/volumes/67/wr/mm6701a7.htm

Recommended Adult Immunization Schedule for Ages 19 Years or Older, United States, 2024

Notes

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 protection against

measles or mumps or 1 dose for protection against

rubella

- Born in 1957 or later with no evidence of immunity

to measles, mumps, or rubella: 2-dose series at

least 4 weeks apart for protection against measles

or mumps or at least 1 dose for protection against

rubella

Meningococcal vaccination

Special situations for MenACWY

y Anatomical or functional asplenia (including sickle

cell disease), HIV infection, persistent complement

component deciency, complement inhibitor

(e.g., eculizumab, ravulizumab) use: 2-dose series

MenACWY (Menveo or MenQuad) 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

(Menveo or MenQuad) 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 (Menveo or MenQuad)

y For MenACWY booster dose recommendations for

groups listed under “Special situations” and in an

outbreak setting (e.g., in community or organizational

settings, or among men who have sex with men) and

additional meningococcal vaccination information,

see 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

decision-making, 2-dose series MenB-4C (Bexsero)

at least 1 month apart or 2-dose series MenB-FHbp

(Trumenba) at 0, 6 months (if dose 2 was administered

less than 6 months after dose 1, administer dose 3

at least 4 months after dose 2); MenB-4C and

MenB-FHbp are not interchangeable (use same

product for all doses in series).

For additional information on shared clinical decision-

making for MenB, see www.cdc.gov/vaccines/hcp/

admin/downloads/isd-job-aid-scdm-mening-b-shared-

clinical-decision-making.pdf

Special situations for MenB

y Anatomical or functional asplenia (including sickle

cell disease), persistent complement component

deciency, complement inhibitor (e.g., eculizumab,

ravulizumab) use, or microbiologists routinely

exposed to Neisseria meningitidis:

2-dose primary series MenB-4C (Bexsero) at least

1 month apart or 3-dose primary series

MenB-FHbp (Trumenba) at 0, 1–2, 6 months

(if dose 2 was administered at least 6 months after

dose 1, dose 3 not needed; if dose 3 is administered

earlier than 4 months after dose 2, a fourth dose

should be administered at least 4 months after dose

3); MenB-4C and MenB-FHbp are not interchangeable

(use same product for all doses in series); 1 dose MenB

booster 1 year after primary series and revaccinate

every 2–3 years if risk remains.

y Pregnancy: Delay MenB until after pregnancy unless

at increased risk and vaccination benets 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 dierent anatomic site, if feasible.

Adults may receive a single dose of Penbraya as an

alternative to separate administration of MenACWY and

MenB when both vaccines would be given on the same

clinic day. For adults not at increased risk, if Penbraya

is used for dose 1 MenB, MenB-FHbp (Trumenba)

should be administered for dose 2 MenB. For adults

at increased risk of meningococcal disease, Penbraya

may be used for additional MenACWY and MenB doses

(including booster doses) if both would be given on

the same clinic day and at least 6 months have elapsed

since most recent Penbraya dose.

Mpox vaccination

Special situations

y Any person at risk for Mpox infection: 2-dose series,

28 days apart.

Risk factors for Mpox infection include:

- Persons who are gay, bisexual, and other MSM,

transgender or nonbinary people who in the past 6

months have had:

 A new diagnosis of at least 1 sexually transmitted

disease

 More than 1 sex partner

 Sex at a commercial sex venue

 Sex in association with a large public event in

a geographic area where Mpox transmission is

occurring

- Persons who are sexual partners of the persons

described above

- Persons who anticipate experiencing any of the

situations described above

Recommended Adult Immunization Schedule for Ages 19 Years or Older, United States, 2024

Notes

y Pregnancy: There is currently no ACIP recommendation

for Jynneos use in pregnancy due to lack of safety data

in pregnant persons. Pregnant persons with any risk

factor described above may receive Jynneos.

y Healthcare personnel: Except in rare circumstances

(e.g. no available personal protective equipment),

healthcare personnel who do not have any of the

sexual risk factors described above should not receive

Jynneos.

For detailed information, see: www.cdc.gov/vaccines/

acip/meetings/downloads/slides-2023-10-25-26/04-

MPOX-Rao-508.pdf

Pneumococcal vaccination

Routine vaccination

y Age 65 years or older who have:

- Not previously received a dose of PCV13, PCV15,

or PCV20 or whose previous vaccination history is

unknown: 1 dose PCV15 OR 1 dose PCV20.

 If PCV15 is used, administer 1 dose PPSV23 at least

1 year after the PCV15 dose (may use minimum

interval of 8 weeks for adults with an

immunocompromising condition,* cochlear

implant, or cerebrospinal uid leak).

- Previously received only PCV7: follow the

recommendation above.

- Previously received only PCV13: 1 dose PCV20 OR

1 dose PPSV23.

 If PCV20 is selected, administer at least 1 year after

the last PCV13 dose.

 If PPSV23 is selected, administer at least 1 year after

the last PCV13 dose (may use minimum interval of

8 weeks for adults with an immunocompromising

condition,* cochlear implant, or cerebrospinal

uid leak).

- Previously received only PPSV23: 1 dose PCV15 OR

1 dose PCV20. Administer either PCV15 or PCV20 at

least 1 year after the last PPSV23 dose.

 If PCV15 is used, no additional PPSV23 doses are

recommended.

- Previously received both PCV13 and PPSV23 but

NO PPSV23 was received at age 65 years or older:

1 dose PCV20 OR 1 dose PPSV23.

 If PCV20 is selected, administer at least 5 years after

the last pneumococcal vaccine dose.

 If PPSV23 is selected, see dosing schedule at

www.cdc.gov/vaccines/vpd/pneumo/downloads/

pneumo-vaccine-timing.pdf.

- Previously received both PCV13 and PPSV23, AND

PPSV23 was received at age 65 years or older: Based

on shared clinical decision-making, 1 dose of PCV20

at least 5 years after the last pneumococcal vaccine

dose.

y For guidance on determining which pneumococcal

vaccines a patient needs and when, please refer to the

mobile app, which can be downloaded here: www.cdc.

gov/vaccines/vpd/pneumo/hcp/pneumoapp.html.

Special situations

y Age 19–64 years with certain underlying medical

conditions or other risk factors** who have:

- Not previously received a PCV13, PCV15, or PCV20

or whose previous vaccination history is unknown:

1 dose PCV15 OR 1 dose PCV20.

 If PCV15 is used, administer 1 dose PPSV23

at least 1 year after the PCV15 dose (may use

minimum interval of 8 weeks for adults with

an immunocompromising condition,* cochlear

implant, or cerebrospinal uid leak).

- Previously received only PCV7: follow the

recommendation above.

- Previously received only PCV13: 1 dose PCV20 OR

1 dose PPSV23.

 If PCV20 is selected, administer at least 1 year after

the PCV13 dose.

 If PPSV23 is selected, see dosing schedule at

www.cdc.gov/vaccines/vpd/pneumo/downloads/

pneumo-vaccine-timing.pdf

- Previously received only PPSV23: 1 dose PCV15 OR

1 dose PCV20. Administer either PCV15 or PCV20 at

least 1 year after the last PPSV23 dose.

 If PCV15 is used, no additional PPSV23 doses are

recommended.

- Previously received PCV13 and 1 dose of PPSV23:

1 dose PCV20 OR 1 dose PPSV23.

- If PCV20 is selected, administer at least 5 years after

the last pneumococcal vaccine dose.

- If PPSV23 is selected, see dosing schedule at

www.cdc.gov/vaccines/vpd/pneumo/downloads/

pneumo-vaccine-timing.pdf

y For guidance on determining which pneumococcal

vaccines a patient needs and when, please refer to the

mobile app which can be downloaded here: www.cdc.

gov/vaccines/vpd/pneumo/hcp/pneumoapp.html

*Note: Immunocompromising conditions

include chronic renal failure, nephrotic syndrome,

immunodeciencies, 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, immunodeciencies,

iatrogenic immunosuppression, leukemia, lymphoma,

multiple myeloma, nephrotic syndrome, solid

organ transplant, or sickle cell disease or other

hemoglobinopathies.

Poliovirus vaccination

Routine vaccination

y 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 specic 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.

Recommended Adult Immunization Schedule for Ages 19 Years or Older, United States, 2024

Notes

Special situations

y 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

Respiratory syncytial virus vaccination

Routine vaccination

y 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

RSV vaccine (Abrysvo™). Administer RSV vaccine

regardless of previous RSV infection.

- Either maternal RSV vaccination or infant

immunization with nirsevimab (RSV monoclonal

antibody) is recommended to prevent respiratory

syncytial virus lower respiratory tract infection in

infants.

y All other pregnant persons: RSV vaccine not

recommended

There is currently no ACIP recommendation for RSV

vaccination in subsequent pregnancies. No data are

available to inform whether additional doses are

needed in later pregnancies.

Special situations

y Age 60 years or older: Based on shared clinical

decision-making, 1 dose RSV vaccine (Arexvy® or

Abrysvo™). Persons most likely to benet from

vaccination are those considered to be at increased

risk for severe RSV disease.** For additional

information on shared clinical decision-making for RSV

in older adults, see www.cdc.gov/vaccines/vpd/rsv/

downloads/provider-job-aid-for-older-adults-508.pdf

For further guidance, see www.cdc.gov/mmwr/

volumes/72/wr/mm7229a4.htm

*Note: Providers in jurisdictions with RSV seasonality

that diers from most of the continental United

States (e.g., Alaska, jurisdiction with tropical climate)

should follow guidance from public health authorities

(e.g., CDC, health departments) or regional medical

centers on timing of administration based on local RSV

seasonality. Refer to the 2024 Child and Adolescent

Immunization Schedule for considerations regarding

nirsevimab administration to infants.

**Note: Adults age 60 years or older who are at

increased risk for severe RSV disease include those

with chronic medical conditions such as lung diseases

(e.g., chronic obstructive pulmonary disease, asthma),

cardiovascular diseases (e.g., congestive heart failure,

coronary artery disease), neurologic or neuromuscular

conditions, kidney disorders, liver disorders,

hematologic disorders, diabetes mellitus, and moderate

or severe immune compromise (either attributable to

a medical condition or receipt of immunosuppressive

medications or treatment); those who are considered

to be frail; those of advanced age; those who reside in

nursing homes or other long-term care facilities; and

those with other underlying medical conditions or

factors that a health care provider determines might

increase the risk of severe respiratory disease.

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 later,

and a third dose of Td or Tdap 6–12 months later (Tdap

is preferred as rst dose and can be substituted for any

Td 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-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

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 varicella-containing vaccine, 1 dose at

least 4 weeks after rst 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 verication 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.

2/29/2024 Centers for Disease Control and Prevention

Recommended Adult Immunization Schedule, United States, 2024

Recommended Adult Immunization Schedule for Ages 19 Years or Older, United States, 2024

Notes

y 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.

y HIV infection with CD4 percentages ≥15% and CD4

count ≥200 cells/mm

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/mm

y Severe immunocompromising conditions:

VAR contraindicated.

Zoster vaccination

Routine vaccination

y 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 rst. 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

y Pregnancy: There is currently no ACIP

recommendation for RZV use in pregnancy.

Consider delaying RZV until after pregnancy.

y Immunocompromising conditions (including

persons with HIV regardless of CD4 count)**: 2-dose

series recombinant zoster vaccine (RZV, Shingrix)

2–6 months apart (minimum interval: 4 weeks;

repeat dose if administered too soon). For detailed

information, see www.cdc.gov/shingles/vaccination/

immunocompromised-adults.html

**Note: If there is no documented history of varicella,

varicella vaccination, or herpes zoster, providers should

refer to the clinical considerations for use of RZV in

immunocompromised adults aged ≥19 years and the

ACIP varicella vaccine recommendations for further

guidance: www.cdc.gov/mmwr/volumes/71/wr/

mm7103a2.htm

Recommended Adult Immunization Schedule for Ages 19 Years or Older, United States, 2024

Appendix

Vaccines and Other

Immunizing Agents

Contraindicated or Not Recommended

Precautions

COVID-19 mRNA vaccines

[Pzer-BioNTech, Moderna]

• Severeallergic reaction (e.g., anaphylaxis) after a previous dose or to a component of

an mRNA COVID-19 vaccine



• 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 inammatory syndrome in children (MIS-C) or multisystem inammatory

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 of a

Novavax COVID-19 vaccine

• Diagnosed non-severe allergy (e.g., urticaria beyond the injection site) to a component of

Novavax COVID-19 vaccine

; 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 inammatory syndrome in children (MIS-C) or multisystem inammatory

syndrome in adults (MIS-A)

• Moderate or severe acute illness, with or without fever

Inuenza, egg-based,

inactivated injectable (IIV4)

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

• Moderate or severe acute illness with or without fever

Inuenza, cell culture-based

inactivated injectable (ccIIV4)

[Flucelvax Quadrivalent]

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

component

of ccIIV4

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

type of inuenza 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

Inuenza, recombinant

injectable (RIV4)

[Flublok Quadrivalent]

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

of RIV4 • Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any

type of inuenza 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

Inuenza, live attenuated

(LAIV4)

[Flumist Quadrivalent]

• Severe allergic reaction (e.g., anaphylaxis) after previous dose of any inuenza 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)

• 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 uid (CSF) and the oropharynx,

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

• Received inuenza 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 inuenza 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 inuenza 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.

2. When a precaution is present, vaccination should generally be deferred but might be indicated if the benet 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.

3. 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.

4. Seepackage insertsandFDA EUA fact sheetsfor a full list of vaccine ingredients. mRNA COVID-19 vaccines contain polyethylene glycol (PEG).

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 Inuenza with

Vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2023–24 Inuenza Season | MMWR (cdc.gov), Contraindications and Precautions for COVID-19 Vaccination, and

Contraindications and Precautions for Jynneos Vaccination

Recommended Adult Immunization Schedule for Ages 19 Years or Older, United States, 2024

Appendix

Vaccine Contraindicated or Not Recommended

Precautions

Haemophilus inuenzae 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 component

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 indicated

• 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 component

• Severe immunodeciency (e.g., hematologic and solid tumors, receipt of chemotherapy, congenital immunodeciency,

long-term immunosuppressive therapy or patients with HIV infection who are severely immunocompromised)

• Pregnancy

• Family history of altered immunocompetence, unless veried clinically or by laboratory testing as immunocompetent

• Recent (≤11 months) receipt of antibody-containing blood product (specic

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) [MenQuad]

• 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)

• 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 identiable 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 immunodeciency (e.g., hematologic and solid tumors, receipt of chemotherapy, congenital immunodeciency,

long-term immunosuppressive therapy or patients with HIV infection who are severely immunocompromised)

• Pregnancy

• Family history of altered immunocompetence, unless veried clinically or by laboratory testing as immunocompetent

• Recent (≤11 months) receipt of antibody-containing blood product (specic

interval depends on product)

• Receipt of specic 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 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

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

gov/vaccines-blood-biologics/approved-products/vaccines-licensed-use-united-states.

4. 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.

Recommended Adult Immunization Schedule for Ages 19 Years or Older, United States, 2024

Addendum

Vaccine Recommendations Eective Date of Recommendation*

COVID-19 • ACIP recommends persons ≥65 years of age should receive an additional dose of 2023–2024 Formula COVID-19 vaccine.

• For detailed information, see: www.cdc.gov/covidschedule

February 28, 2024

COVID-19 (Moderna,

Pzer-BioNTech, Novavax)

• ACIP recommends 2024-2025 COVID-19 vaccines as authorized or approved by FDA in persons ≥6 months of age. June 27, 2024

Inuenza • ACIP rearms the recommendation for routine annual inuenza vaccination of all persons aged ≥6 months who do not have

contraindications.

• ACIP recommends high-dose inactivated (HD-IIV3) and adjuvanted inactivated (aIIV3) inuenza vaccines as acceptable options for

inuenza vaccination of solid organ transplant recipients aged 18 through 64 years who are on immunosuppressive medication regimens,

without a preference over other age-appropriate IIV3s or RIV3.

June 27, 2024

Pneumococcal conjugate

vaccine

• ACIP recommends PCV21 as an option for adults aged ≥19 years who currently have a recommendation to receive a dose of PCV. June 27, 2024

Respiratory syncytial

virus vaccine (RSV)

• ACIP recommends adults 75 years of age and older receive a single dose of RSV vaccine.

a,b

• ACIP recommends adults 60–74 years of age and older who are at increased risk of severe RSV disease receive a single dose of RSV

vaccine.

a,b

June 26, 2024

RSV vaccination is recommended as a single lifetime dose only. Persons who have already received RSV vaccination are NOT recommended to receive another dose.

These recommendations supplant the current recommendation that adults 60 years of age and older may receive RSV vaccination, using shared clinical decision-making. Adults 60–74 years of age who are not at

increased risk of severe RSV disease are NOT recommended to receive RSV vaccination.

CDC will publish Clinical Considerations that describe chronic medical conditions and other risk factors for severe RSV disease for use in this risk-based recommendation.

In addition to the recommendations presented in the previous sections of this immunization schedule, ACIP has approved the following recommendations by majority vote since October 26, 2023. The

following recommendations have been adopted by the CDC Director and are now ocial. Links are provided if these recommendations have been published in Morbidity and Mortality Weekly Report (MMWR).

*The eective date is the date when the CDC director adopted the recommendation and when the ACIP recommendation became ocial.