Vaccination schedule · 🇺🇸 United States

1 dose annually each influenza season for all adults. Adults >=65 should preferentially receive HD-IIV, RIV, or aIIV (preferentially recommended formulations).

Rationale: Universal annual influenza vaccination; high-dose/adjuvanted formulations preferred in older adults for improved immunogenicity.

1 dose Tdap (if not previously received as adult), then Td or Tdap booster every 10 years. Wound management per algorithm.

Rationale: Maintain anti-tetanus and pertussis immunity throughout adulthood.

1 or 2 doses depending on indication (1 dose for routine; 2 doses for healthcare personnel, students, international travelers, household contacts of immunocompromised).

Rationale: Catch-up of adults without documented MMR immunity; pertinent given measles outbreaks.

2 doses separated by 4-8 weeks (minimum 4 weeks). Serology not routinely required before vaccination.

Rationale: Adult varicella prevention; adult disease more severe than childhood.

Catch-up through age 26: 3-dose schedule (0, 1-2, 6 months) if initiated >=15 years; 2-dose (0, 6-12 months) if initiated <15.

Rationale: Catch-up of unvaccinated young adults; routine vaccination at 11-12 years.

Shared clinical decision making 27-45: not routinely recommended; may be administered if benefit likely (new sexual partners, immunocompromise).

Rationale: Population-level benefit limited at this age, but individual benefit possible.

2 doses separated by 2-6 months. If immunocompromised, interval may be shortened to 1-2 months.

Rationale: Prevention of herpes zoster and postherpetic neuralgia. Preferred over discontinued ZVL.

2 doses separated by 1-2 months (shortened interval). Indication added 2021.

Rationale: Higher zoster risk in immunocompromised adults.

1 dose PCV20 (or PCV21) for adults 50+ who have NOT previously received PCV. If PCV15 used, follow with PPSV23 >=1 year later. ACIP October 2024 lowered routine age from 65 to 50.

Rationale: Prevention of invasive pneumococcal disease and pneumonia. Age lowered to 50 by ACIP October 2024 vote based on disease burden and disparities.

1 dose, single lifetime dose currently. Routine recommendation for all adults >=75 per ACIP June 2024 update.

Rationale: Prevention of severe RSV-LRTI. Highest absolute benefit at 75+.

1 dose for adults 60-74 at increased risk of severe RSV (chronic heart/lung disease, immunocompromise, DM, ESRD, severe obesity, residence in long-term care).

Rationale: Risk-based recommendation in 60-74; routine universal recommendation was downgraded 2024.

Universal recommendation 19-59: 2-dose Heplisav-B (0, 1 mo) OR 3-dose Engerix/Recombivax (0, 1, 6 mo). 2022 ACIP shift from risk-based to universal in this age range.

Rationale: Universal HepB recommendation in 19-59 to close immunity gaps.

Shared clinical decision making 60+ without risk factor; 60+ with risk factor get standard recommendation.

Rationale: Differentiated guidance by risk status at 60+.

Per current CDC seasonal COVID-19 vaccination recommendation. Adults 65+ and immunocompromised: additional doses. Verify the current season's recommendation each fall.

Rationale: Reduction of severe COVID-19; recommendations updated each season.

MenACWY catch-up if not received at 16. MenB shared clinical decision making 16-23 (preferred 16-18). Pentavalent MenABCWY may be used for MenB doses.

Rationale: Outbreak risk in college residential settings.

1 dose Tdap each pregnancy, preferred at 27-36 weeks gestation, earlier in this window preferred.

Rationale: Transplacental antibody protection against pertussis for the infant.

1 dose during any trimester of pregnancy during influenza season. Postpartum if missed during pregnancy.

Rationale: Maternal influenza is severe; passive infant protection.

1 dose Abrysvo at 32-36 weeks gestation, September through January (Northern Hemisphere). Alternative: infant nirsevimab if mother not vaccinated.

Rationale: Protection of newborn against RSV-LRTI in first months of life. Abrysvo is the only RSV vaccine approved for pregnancy (Arexvy and mResvia are not).

Per current CDC seasonal recommendation. Pregnancy is a risk factor for severe COVID-19.

Rationale: Maternal severe disease risk; passive infant protection.

Defer MMR, varicella, LAIV, yellow fever (unless travel unavoidable to high-risk area). Counsel reproductive-age women on pregnancy avoidance for 4 weeks after live vaccines.

Rationale: Theoretical risk of live virus replication; no documented harm but caution preserved.

1 dose PCV20 (or PCV21) for adults 19-49 with above risk factors. If PCV15 used, follow with PPSV23 >=1 year later.

Rationale: Risk-based pneumococcal protection below age 50.

1 dose PCV20 OR 1 dose PCV15 followed by PPSV23 >=8 weeks later. Adults >=65 may receive additional PPSV23 5 years after first PPSV23.

Rationale: Highest-risk groups warrant pneumococcal coverage regardless of age.

2-dose primary series 8 weeks apart; booster every 5 years if risk persists.

Rationale: High-risk groups for invasive meningococcal disease.

Bexsero: 2 doses >=1 month apart; OR Trumenba: 3 doses 0, 1-2, 6 months. Booster 1 year after primary, then every 2-3 years if risk persists. Use single product for full series.

Rationale: MenB protection in highest-risk groups.

1 dose for unvaccinated adults with asplenia (preferably >=14 days before elective splenectomy). Stem cell transplant recipients: 3 doses 6-12 months post-transplant.

Rationale: Hib invasive disease risk in functional/anatomic asplenia.

2-dose series (0, 6-18 months) of Havrix or Vaqta; OR 3-dose Twinrix (HepA+HepB) at 0, 1, 6 months.

Rationale: Risk-based HepA recommendation; outbreaks ongoing in PWID and homeless populations.

Standard 2-dose Heplisav-B or 3-dose Engerix/Recombivax. Hemodialysis: high-dose 40 mcg formulation (4 doses).

Rationale: Adults 60+ with risk factors are recommended; without risk factors fall under shared decision.

2 doses subcutaneous (or intradermal 0.1 mL alternative if supply-limited), 4 weeks apart. Pre-exposure prophylaxis for at-risk populations.

Rationale: PrEP and post-exposure prophylaxis for mpox; ongoing US transmission.

Annual seasonal influenza vaccination; do not delay for any of these conditions.

Rationale: Higher complication risk emphasizes adherence to annual influenza vaccination.

MMR recommended if HIV without severe immunosuppression (CD4 >=200 cells/uL for >=6 months) and no evidence of immunity.

Rationale: Measles risk persists in HIV; safe if CD4 sufficient.

Contraindicated. Avoid in primary or severe acquired immunodeficiency, hematologic malignancy with chemo, solid organ transplant recipients on immunosuppression, HIV with CD4 <200.

Rationale: Live attenuated virus risk.

2 doses RZV separated by 1-2 months. RZV is non-live and is preferred regardless of prior zoster history or ZVL.

Rationale: Lowered age for immunocompromise; ZVL no longer marketed in US since 2020.

Complete HepB series (2-dose Heplisav-B or 3-dose Engerix/Recombivax). Document anti-HBs >=10 mIU/mL 1-2 months post-series. Required by OSHA 29 CFR 1910.1030 (employer must offer at no cost).

Rationale: Healthcare personnel BBF exposure risk; OSHA BBP standard mandates employer offering.

2 doses MMR (>=28 days apart) for healthcare personnel without documented evidence of immunity (regardless of birth year — birth-before-1957 presumption does NOT apply for HCP).

Rationale: Patient and personnel protection from measles, mumps, rubella outbreaks in healthcare settings.

2 doses Varivax >=4 weeks apart for HCP without documented evidence of immunity.

Rationale: Nosocomial varicella prevention.

1 dose Tdap regardless of last Td booster interval; then Td/Tdap every 10 years.

Rationale: Pertussis protection in HCP, especially those caring for infants.

1 dose annually each influenza season. Strongly recommended by ACIP and required by many employers / state laws.

Rationale: Patient protection; nosocomial influenza prevention.

MenACWY: 2 doses 8 weeks apart, booster every 5 years if exposure continues. MenB: Bexsero 2 doses or Trumenba 3 doses; booster 1 year, then every 2-3 years if exposure continues.

Rationale: Laboratory acquisition of N. meningitidis isolates has caused fatal cases — highest occupational meningococcal risk.

PrEP per ACIP 2022 schedule: 2 doses IM (days 0 and 7). Serology and boosters per risk tier.

Rationale: Reduced exposure-response burden after subsequent contact (PEP requires only 2 doses if PrEP given).

2 doses JYNNEOS 4 weeks apart; booster every 2 years for those at continuing exposure.

Rationale: Laboratory protection against replication-competent orthopoxviruses (vaccinia, mpox, variola — though variola is restricted).

2-dose Havrix or Vaqta (0, 6-18 months); or Twinrix 3-dose.

Rationale: Occupational HepA exposure risk in research labs working with HAV; sewage exposure debated but recommended in select scenarios; sustained outbreaks among PEH may extend to service personnel.

Complete HepB series. Verify anti-HBs >=10 mIU/mL post-series for personnel with anticipated frequent BBF exposure.

Rationale: Occupational BBF exposure outside traditional healthcare setting.

Annual seasonal influenza vaccination strongly emphasized. Note: seasonal influenza vaccine does NOT protect against novel zoonotic strains (variant H1/H3, HPAI H5N1) but reduces reassortment risk.

Rationale: Reduce co-infection / reassortment risk between human and avian/swine influenza viruses. Sit-rep 2024-2026: ongoing HPAI H5N1 dairy and poultry outbreaks in US.

Per DoD AR 40-562 / NAVMED P-5052-9 / AFI 48-110: includes adenovirus types 4 & 7 (entry recruits), anthrax (selected populations), smallpox/JYNNEOS, yellow fever for deployable forces, typhoid for select deployments, plus all ACIP routine.

Rationale: Deployable readiness and biothreat protection.

ViCPS: 1 dose IM, booster every 2 years if continued risk. Ty21a oral: 4 capsules every other day, booster every 5 years.

Rationale: Endemic-area occupational travel; laboratory exposure.

1 dose SC; booster after 10 years per WHO and ACIP depending on continued occupational exposure and risk.

Rationale: International travel to endemic areas (sub-Saharan Africa, tropical South America); ICVP requirement for some destinations.

2 doses IM at days 0 and 28 (accelerated 0, 7 if 18-65 years). Booster >=1 year if continued risk.

Rationale: Occupational travel to endemic Asia (rice-growing rural areas) with significant outdoor exposure.

Adults at increased risk of polio exposure who have completed primary series: 1 lifetime IPV booster. Adults without documented primary series: complete 3-dose IPV (0, 1-2 mo, 6-12 mo).

Rationale: Polio reintroduction risk; recent NY outbreak 2022.

Pre-exposure: 5-dose IM schedule (0, 1, 6, 12, 18 months) + annual boosters per ACIP/DoD. Cyfendus is the post-exposure adjuvanted product (2-dose).

Rationale: Occupational research and DoD-designated populations with potential Bacillus anthracis exposure.

1 oral dose, single use. Indicated for adults 18-64 traveling to area of active V. cholerae O1 transmission. Limited indication.

Rationale: Occupational travel to active cholera-affected areas (humanitarian, health workers).

1 dose MMR if no immunity (childcare workers in some states; HCP standard requires 2 doses).

Rationale: Increased exposure to children in pre-vaccination age.

Annual seasonal influenza vaccination.

Rationale: Bidirectional transmission risk with young children.

Per current ACIP / CDC seasonal COVID-19 recommendation. Update yearly.

Rationale: Patient and personnel protection. CMS mandate sunset 2024; state and employer requirements vary.

Pre-employment IGRA (T-SPOT.TB or QuantiFERON) preferred over TST. Annual testing NOT recommended unless ongoing exposure risk per CDC 2019.

Rationale: Identify and treat LTBI; BCG vaccine not routinely used in US (consider only for HCP in high-risk areas where MDR-TB likely).

2-dose IM PrEP days 0 and 7 per ACIP 2022. Serologic monitoring or boosters per risk tier.

Rationale: Continuing potential exposure to rabies-vector species.

1 dose MMR; 2 doses for HCP, students, international travelers, household contacts of immunocompromised.

Rationale: Catch-up to close measles immunity gap; particularly relevant with current outbreaks.

2 doses 4-8 weeks apart.

Rationale: Adult varicella severity.

Complete series per chosen product; Heplisav-B 2 doses or Engerix/Recombivax 3 doses.

Rationale: Closing immunity gap given 2022 universal recommendation 19-59.

Complete 3-dose series 0, 1-2, 6 months (if initiated >=15 years).

Rationale: Routine catch-up; routine series typically given at 11-12.

3-dose IPV at 0, 1-2 months, 6-12 months.

Rationale: Following NY 2022 vaccine-derived polio detection, ACIP clarified adult catch-up.

All 50 states allow medical exemptions for school/workplace requirements. Religious exemptions permitted in most states (notable exceptions: CA, NY, ME, MS, WV, CT). Philosophical exemptions vary (~15 states).

Rationale: Document patient declination per state framework. ACIP scientific recommendation is independent of state exemption law.

All 50 states authorize pharmacist administration of some adult vaccines; specific authority varies by state and age. PREP Act federal authorization broad through 2024.

Rationale: Operational note for ingestion engine: vaccines may be accessed via pharmacy or via occupational clinic; documentation source varies.