US adult + occupational immunization
ACIP-recommended adult immunization schedule operationalized by CDC. Occupational vaccination of healthcare personnel rests on the OSHA Bloodborne Pathogens standard (29 CFR 1910.1030) plus ACIP HCP guidance. The occupational physician advises; vaccination is the worker's informed choice.
Occupational vaccines (HCW, lab, field exposure)
Hepatitis B is mandated for at-risk workers under the OSHA Bloodborne Pathogens standard (29 CFR 1910.1030): the employer must offer the series at no cost. MMR/Varicella for HCW without evidence of immunity, Tdap (with a booster every 10 years), and annual influenza complete the core HCW set.
Hepatitis B for healthcare personnel
HepB-HCW
Trigger: age 19+ · OCC-HCW · OCC-HCW-STUDENT
Schedule
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).
ACIP MMWR 2013;62(RR-10); OSHA 29 CFR 1910.1030
MMR for healthcare personnel
MMR-HCW
Trigger: age 19+ · OCC-HCW · OCC-HCW-STUDENT
Schedule
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).
ACIP MMWR 2011;60(RR-7) Immunization of HCP
Varicella for healthcare personnel
Varicella-HCW
Trigger: age 19+ · OCC-HCW · OCC-HCW-STUDENT
Schedule
2 doses Varivax >=4 weeks apart for HCP without documented evidence of immunity.
ACIP MMWR 2011;60(RR-7)
Tdap for healthcare personnel
Tdap-HCW
Trigger: age 19+ · OCC-HCW
Schedule
1 dose Tdap regardless of last Td booster interval; then Td/Tdap every 10 years.
ACIP MMWR 2011;60(RR-7); reaffirmed 2020
Annual influenza for healthcare personnel
Influenza-HCW
Trigger: age 19+ · OCC-HCW
Schedule
1 dose annually each influenza season. Strongly recommended by ACIP and required by many employers / state laws.
ACIP MMWR 2011;60(RR-7); annual ACIP influenza recommendations
Meningococcal ACWY + B for microbiologists
MenACWY-MenB-LAB
Trigger: age 19+ · OCC-LAB-MENING
Schedule
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.
ACIP MMWR 2020 (MenACWY/MenB high-risk)
Rabies pre-exposure prophylaxis
Rabies-PrEP
Trigger: age 19+ · OCC-VET · OCC-ANIMAL · OCC-LAB-RES
Schedule
PrEP per ACIP 2022 schedule: 2 doses IM (days 0 and 7). Serology and boosters per risk tier.
ACIP MMWR 2022;71(18):619-627 (Rabies PrEP updated)
Smallpox / Mpox (JYNNEOS) for orthopoxvirus laboratory personnel
JYNNEOS-LAB
Trigger: age 18+ · OCC-LAB-MPOX
Schedule
2 doses JYNNEOS 4 weeks apart; booster every 2 years for those at continuing exposure.
ACIP MMWR 2022 (JYNNEOS PrEP at-risk)
Hepatitis A for occupational exposure
HepA-OCC
Trigger: age 19+ · OCC-LAB-RES · OCC-FIRST-RESP · OCC-SEWAGE · OCC-HOMELESS-SVC
Schedule
2-dose Havrix or Vaqta (0, 6-18 months); or Twinrix 3-dose.
ACIP MMWR 2020 (HepA risk-based)
Hepatitis B for non-HCW occupational BBF exposure
HepB-OCC
Trigger: age 19+ · OCC-PUBSAFE · OCC-CORRECTIONAL · OCC-MORTUARY · OCC-TATTOO
Schedule
Complete HepB series. Verify anti-HBs >=10 mIU/mL post-series for personnel with anticipated frequent BBF exposure.
ACIP MMWR 2018;67(1):1-31 (HepB) + ACIP 2022 universal age 19-59
Seasonal influenza for swine and poultry workers (emphasized)
Influenza-AGRIC
Trigger: age 19+ · OCC-AGRIC-SWINE · OCC-AGRIC-POULTRY
Schedule
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.
CDC HAN 514 (H5N1 occupational); CDC Influenza in Pigs / Variant flu guidance
U.S. Military service member required immunizations
MIL-DoD
Trigger: age 17+ · OCC-MIL
Schedule
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.
DoD Joint Regulation AR 40-562 et al.
Typhoid (Vi capsular polysaccharide or live oral Ty21a)
Typhoid-TRAVEL
Trigger: age 19+ · OCC-TRAVEL · OCC-LAB-RES
Schedule
ViCPS: 1 dose IM, booster every 2 years if continued risk. Ty21a oral: 4 capsules every other day, booster every 5 years.
ACIP MMWR 2015;64(11):305-308 (Typhoid)
Yellow fever (YF-Vax)
YF-TRAVEL
Trigger: age 19+ · OCC-TRAVEL · OCC-MIL · OCC-LAB-RES
Schedule
1 dose SC; booster after 10 years per WHO and ACIP depending on continued occupational exposure and risk.
ACIP MMWR 2015;64(23):647-650 (YF booster); CDC Yellow Book 2024
Japanese encephalitis (IXIARO)
JE-TRAVEL
Trigger: age 19+ · OCC-TRAVEL · OCC-MIL
Schedule
2 doses IM at days 0 and 28 (accelerated 0, 7 if 18-65 years). Booster >=1 year if continued risk.
ACIP MMWR 2019;68(2):1-33 (JE updated)
Polio (IPV) booster for adults at risk
Polio-IPV-TRAVEL
Trigger: age 19+ · OCC-TRAVEL · OCC-HCW · OCC-LAB-RES
Schedule
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).
ACIP MMWR 2023;72(13):359-363 (Adult polio)
Anthrax (BioThrax / Cyfendus)
Anthrax-AVA
Trigger: age 18-65 · OCC-LAB-RES · OCC-MIL
Schedule
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).
ACIP MMWR 2019;68(4):86-89 (Anthrax updates)
Cholera (Vaxchora live attenuated CVD 103-HgR)
Cholera-CVD
Trigger: age 18-64 · OCC-TRAVEL
Schedule
1 oral dose, single use. Indicated for adults 18-64 traveling to area of active V. cholerae O1 transmission. Limited indication.
ACIP MMWR 2017;66(18):482-485 (Cholera)
MMR for childcare workers
MMR-CHILDCARE
Trigger: age 19+ · OCC-CHILDCARE
Schedule
1 dose MMR if no immunity (childcare workers in some states; HCP standard requires 2 doses).
ACIP Adult Schedule 2026; ACIP MMR 2013
Annual influenza for childcare workers
Influenza-CHILDCARE
Trigger: age 19+ · OCC-CHILDCARE
Schedule
Annual seasonal influenza vaccination.
ACIP Adult Schedule 2026
COVID-19 for healthcare personnel
COVID19-HCW
Trigger: age 19+ · OCC-HCW
Schedule
Per current ACIP / CDC seasonal COVID-19 recommendation. Update yearly.
CDC interim clinical considerations; CMS rescinded HCP COVID-19 mandate 2024
Latent TB screening for healthcare personnel (NOT a vaccine — included as TB baseline; BCG not routinely used in US)
TB-IGRA-pre-employment
Trigger: age 19+ · OCC-HCW · OCC-CORRECTIONAL
Schedule
Pre-employment IGRA (T-SPOT.TB or QuantiFERON) preferred over TST. Annual testing NOT recommended unless ongoing exposure risk per CDC 2019.
Sosa LE et al. MMWR Recomm Rep 2019;68(19)
Rabies PrEP for wildlife biologists, animal control, spelunkers
Rabies-WILDLIFE
Trigger: age 19+ · OCC-ANIMAL · OCC-FOREST-WILDLAND
Schedule
2-dose IM PrEP days 0 and 7 per ACIP 2022. Serologic monitoring or boosters per risk tier.
ACIP MMWR 2022;71(18):619-627
Pregnancy programme
Tdap each pregnancy (preferred 27-36 weeks), inactivated influenza at any stage, and maternal RSV (Abrysvo) at 32-36 weeks gestation (Sept-Jan, Northern Hemisphere). Live vaccines are deferred during pregnancy.
Tetanus, diphtheria, acellular pertussis (during each pregnancy)
Tdap
1 dose Tdap each pregnancy, preferred at 27-36 weeks gestation, earlier in this window preferred.
ACIP MMWR 2020;69(3):77-83 (Tdap during pregnancy)
Seasonal influenza (inactivated; LAIV contraindicated in pregnancy)
Influenza
1 dose during any trimester of pregnancy during influenza season. Postpartum if missed during pregnancy.
ACIP Adult Schedule 2026 (Influenza pregnancy)
RSVpreF (Abrysvo) maternal
RSV-maternal
1 dose Abrysvo at 32-36 weeks gestation, September through January (Northern Hemisphere). Alternative: infant nirsevimab if mother not vaccinated.
ACIP MMWR 2023;72(41):1115-1122 (Maternal RSV)
COVID-19 in pregnancy
COVID19
Per current CDC seasonal recommendation. Pregnancy is a risk factor for severe COVID-19.
ACIP current statement; CDC interim clinical considerations
Live vaccines contraindicated during pregnancy
live-contraindicated
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.
ACIP Adult Schedule 2026 (Live vaccines and pregnancy)
Pneumococcal — PCV20 (or PCV21), or PCV15 + PPSV23
ACIP (October 2024) lowered the routine age to 50. One dose of PCV20 (or PCV21) for adults who have not previously received a conjugate vaccine; if PCV15 is used, follow with PPSV23.
Pneumococcal conjugate (PCV15, PCV20, or PCV21)
age 50+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.
ACIP MMWR 2025 (Pneumococcal age lowered to 50)
Pneumococcal (risk-based age 19-49)
age 19-491 dose PCV20 (or PCV21) for adults 19-49 with above risk factors. If PCV15 used, follow with PPSV23 >=1 year later.
ACIP MMWR 2025 (Pneumococcal simplified)
Pneumococcal (immunocompromise / CSF leak / cochlear implant)
age 19+1 dose PCV20 OR 1 dose PCV15 followed by PPSV23 >=8 weeks later. Adults >=65 may receive additional PPSV23 5 years after first PPSV23.
ACIP MMWR 2025
COVID-19 — seasonal per ACIP
Per the current CDC seasonal recommendation, with the formulation updated each fall. Verify the active ACIP statement at the time of use.
COVID-19 (current updated formulation per CDC season)
COVID19Per current CDC seasonal COVID-19 vaccination recommendation. Adults 65+ and immunocompromised: additional doses. Verify the current season's recommendation each fall.
ACIP Adult Schedule 2026 (COVID-19); current CDC interim clinical considerations
COVID-19 in pregnancy
COVID19Per current CDC seasonal recommendation. Pregnancy is a risk factor for severe COVID-19.
ACIP current statement; CDC interim clinical considerations
COVID-19 for healthcare personnel
COVID19-HCWPer current ACIP / CDC seasonal COVID-19 recommendation. Update yearly.
CDC interim clinical considerations; CMS rescinded HCP COVID-19 mandate 2024
US ↔ UK ↔ FR divergence
| Dimension | 🇺🇸 US | 🇬🇧 UK | 🇫🇷 FR |
|---|---|---|---|
| Adult tetanus | Tdap once, then Td/Tdap every 10 yr | No routine adult booster (Td/IPV at-risk only) | Boosters at fixed ages (25/45/65, then 10-yearly) |
| RSV in pregnancy | Abrysvo 32-36 wk | From 28 wk (UK window) | ~32-36 wk (close to US) |
| Pneumococcal (older adult) | PCV20/PCV21 routine from 50 | PPSV23 at 65 | Risk-based conjugate + polysaccharide |
UK/FR columns are indicative cross-references for context; see each country's page for the authoritative schedule.
Healthcare-worker mandates — state variation
ACIP recommendations are scientific and federal; HCW vaccination mandates are set at state (and facility) level and vary widely — e.g. California AB-1797 (immunization registry) and New York Public Health Law (HCW influenza masking-or-vaccination rule, litigated). Treat these as state-specific and verify the current facility/state requirement at the point of use; do not over-claim a uniform national mandate.
State immunization exemption frameworks (informational; affects compliance not clinical indication): 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).
Pharmacist immunization administration authority (informational; affects access): All 50 states authorize pharmacist administration of some adult vaccines; specific authority varies by state and age. PREP Act federal authorization broad through 2024.
Under the physician's clinical judgement
- OH provides advisory capability assessment + accommodation recommendations; the employer makes employment decisions (ACOEM Code of Ethical Conduct).
- Vaccination is informed consent: vaccination status is protected medical data, not shared with the employer without the worker's consent (HIPAA + ADA + GINA segregation; only fitness/clearance is communicated).
- ADA medical-inquiry rules: no medical inquiry pre-offer; post-offer any inquiry if applied uniformly; current employees only if job-related and consistent with business necessity (29 CFR 1630.14).
- No patient data stored beyond statutory retention (OSHA medical records: employment + 30 years, 29 CFR 1910.1020).