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Guideline Summary
Guideline Title
Advisory Committee on Immunization Practices recommended immunization schedule for adults aged 19 years or older: United States, 2014.
Bibliographic Source(s)
Advisory Committee on Immunization Practices recommended immunization schedule for adults aged 19 years or older: United States, 2014. Ann Intern Med. 2014 Feb 4;160(3):190-7. [10 references]

Bridges CB, Coyne-Beasley T, Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC. Advisory committee on immunization practices recommended immunization schedule for adults aged 19 years or older - United States, 2014. MMWR Morb Mortal Wkly Rep. 2014 Feb 7;63(5):110-2. PubMed External Web Site Policy
Guideline Status

This is the current release of the guideline.

This guideline updates previous versions: Advisory Committee on Immunization Practices. Recommended adult immunization schedule: United States, 2013. Ann Intern Med. 2013 Feb 5;158(3):191-9.

Centers for Disease Control and Prevention. Advisory Committee on Immunization Practices (ACIP) recommended immunization schedule for adults aged 19 years and older -- United States, 2013. MMWR Morb Mortal Wkly Rep. 2013 Feb 1;62(Suppl 1):9-19.

Scope

Disease/Condition(s)

Vaccine-preventable diseases:

  • Diphtheria
  • Hepatitis A
  • Hepatitis B
  • Haemophilus influenzae type b infection
  • Herpes zoster
  • Human papillomavirus infection
  • Influenza
  • Measles
  • Meningococcal infection
  • Mumps
  • Pertussis
  • Pneumococcal infection
  • Rubella
  • Tetanus
  • Varicella (chickenpox)
Guideline Category
Prevention
Clinical Specialty
Family Practice
Geriatrics
Infectious Diseases
Internal Medicine
Obstetrics and Gynecology
Preventive Medicine
Intended Users
Advanced Practice Nurses
Allied Health Personnel
Health Care Providers
Health Plans
Hospitals
Managed Care Organizations
Nurses
Patients
Pharmacists
Physician Assistants
Physicians
Public Health Departments
Guideline Objective(s)

To update the adult immunization schedule to reflect current recommendations for the licensed vaccines

Target Population

Adults 19 years or older

Interventions and Practices Considered
  1. Vaccination with the following:
    • Influenza vaccine (inactivated influenza vaccine [IIV], recombinant [RIV], and live-attenuated influenza vaccine [LAIV])
    • Tetanus, diphtheria, and acellular pertussis vaccine (Td/Tdap)
    • Varicella vaccine
    • Human papillomavirus (HPV) vaccine
    • Herpes zoster vaccine
    • Measles, mumps, rubella (MMR) vaccine
    • Pneumococcal 13-valent conjugate (PCV13)
    • Pneumococcal polysaccharide vaccine (PPSV23)
    • Meningococcal conjugate vaccine (meningococcal conjugate vaccine, quadrivalent [MenACWY] and meningococcal polysaccharide vaccine [MPSV4])
    • Hepatitis A vaccine
    • Hepatitis B vaccine
    • Haemophilus influenza type b (Hib) vaccine
  2. Special consideration of immunization needs for adults based on medical and other conditions
Major Outcomes Considered

Not stated

Methodology

Methods Used to Collect/Select the Evidence
Searches of Electronic Databases
Searches of Unpublished Data
Description of Methods Used to Collect/Select the Evidence

To formulate policy recommendations, the Advisory Committee on Immunization Practices (ACIP) reviews many factors, including morbidity and mortality associated with the disease in the general U.S. population and in specific risk groups; available scientific literature (both published and unpublished) on the safety, efficacy, effectiveness, cost-effectiveness, and acceptability of the immunizing agent, with consideration of the relevant quality and quantity of published and unpublished data; clinical trial results and use information provided in the manufacturer's labeling or package insert; recommendations of other professional liaison organizations; and the feasibility of incorporating the vaccine into existing domestic immunization programs.

Source: Smith JC, Snider DE, Pickering LK; Advisory Committee on Immunization Practices. Immunization policy development in the United States: the role of the Advisory Committee on Immunization Practices. Ann Intern Med. 2009 Jan 6;150(1):45-9.

Number of Source Documents

Not stated

Methods Used to Assess the Quality and Strength of the Evidence
Expert Consensus
Rating Scheme for the Strength of the Evidence

Not applicable

Methods Used to Analyze the Evidence
Systematic Review with Evidence Tables
Description of the Methods Used to Analyze the Evidence

Using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework, the Advisory Committee on Immunization Practices (ACIP) systematically assesses the type or quality of evidence about a vaccine's expected health impacts and the balance of health benefits and risks, along with the values and preferences of persons affected, and health economic analyses. The evidence is grouped into four categories, with the order reflecting the level of confidence in the estimated effect of vaccination on health outcomes: 1) randomized controlled trials, or overwhelming evidence from observational studies; 2) randomized controlled trials with important limitations, or exceptionally strong evidence from observational studies; 3) observational studies, or randomized controlled trials with notable limitations; and 4) clinical experience and observations, observational studies with important limitations, or randomized controlled trials with several major limitations.

Randomized trials often cannot be used to assess the safety and efficacy of vaccination on rare or long-term outcomes, and such trials might be unethical to conduct for vaccines that are already licensed. Observational studies frequently are conducted for such assessments. The GRADE framework allows evaluation of evidence derived from immunogenicity or other intermediate outcomes as well as evaluation of evidence based on extrapolations from findings with similar vaccines in similar populations or other indirect forms of evidence. The balance of benefits and harms is assessed through review of the baseline risk for disease and the expected relative and absolute effects of vaccination on health outcomes. Health economic analyses include computations of cost per quality-adjusted life year gained. Determination of values includes assessing the relative importance of outcomes related to benefits, harms, and health economic analyses. Evidence tables are used to summarize the type of evidence for a vaccine's health impacts and its expected health benefits and risks.

Source: CDC. New framework (GRADE) for development of evidence-based recommendations by the Advisory Committee on Immunization Practices. MMWR. 2012;61(18):327-327.

Methods Used to Formulate the Recommendations
Expert Consensus
Description of Methods Used to Formulate the Recommendations

Workgroups

Committee workgroups are formed as a resource for gathering, analyzing, and preparing information for presentation to the Committee. Workgroups must be chaired by an Advisory Committee on Immunization Practices (ACIP) member and must include at least 2 ACIP members and a Centers for Disease Control and Prevention (CDC) subject-matter expert. Other workgroup members include relevant ex officio members, liaison representatives, members of academia, and invited consultants as required. Vaccine manufacturer representatives may not serve as workgroup members. Workgroups meet throughout the year to do in-depth reviews of vaccine-related data and to develop options for policy recommendations for presentation to the Committee. Four ACIP workgroups are permanent (Adult Immunization Schedule, Childhood/Adolescent Immunization Schedule, General Recommendations, Influenza Vaccines), and the remaining workgroups, which typically focus on 1 vaccine or a group of vaccines, are established and then disbanded as appropriate. All workgroup findings and options are presented to the ACIP in an open meeting, and this information is deliberated until members reach a majority decision. A recommendation, when voted on and approved by a majority of voting ACIP members, includes guidance on target groups for immunization, route of administration and dosing intervals, and precautions and contraindications.

Factors and Evidence Considered in Immunization Policy Development

When data permit, specific rules of evidence, such as those followed by the U.S. Preventive Services Task Force, are used to judge the quality of data and make decisions regarding the nature and strength of recommendations. In the absence of data or when data are inadequate, expert opinions of voting members and other experts are used to make recommendations. Depending on the relative importance of the issue, either formal (for example, Delphi, nominal group techniques) or informal methods for soliciting expert opinions are used. Published statements of the ACIP explicitly describe the methods used for developing recommendations and provide the evidence used to develop the recommendations (for example, results of controlled trials, case–control studies, case series, expert opinion, meta-analyses, Delphi surveys, focus groups, cost-effectiveness analyses, and other inputs).

Source: Smith JC, Snider DE, Pickering LK; Advisory Committee on Immunization Practices. Immunization policy development in the United States: the role of the Advisory Committee on Immunization Practices. Ann Intern Med. 2009 Jan 6;150(1):45-9.

During the October 2010 ACIP meeting, the ACIP voted to adopt a new framework for developing evidence-based recommendations that is based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Key factors considered in the development of recommendations include the balance of benefits and harms, type of evidence, values and preferences of the people affected, and health economic analyses.

Formulating Recommendations

Category A recommendations will apply to all persons in an age- or risk-factor-based group, with the exception of persons who have a contraindication. Category B recommendations do not apply to all members of an age- or risk-based subgroup of the population, but in the context of a clinician-patient interaction, vaccination may be found to be appropriate for a person. The category B recommendation is similar to what was previously referred to by the ACIP as permissive recommendation. In some instances, the ACIP may decide not to make a recommendation if further information is needed.

The recommendation category depends on the balance between desirable (benefits, savings) and undesirable (harms, costs) effects of vaccination. A category A recommendation is one for which the desirable effects outweigh the undesirable effects (recommendation for) or that the undesirable effects outweigh the desirable effects (recommendation against). Key factors that can lead to a category B recommendation include smaller net benefit (e.g., low baseline risk, small relative or absolute effects); lower confidence in the estimated effect of vaccination on health outcomes (e.g., wide confidence intervals); variability in values attributed to benefits and harms; and lower cost-effectiveness or uncertainty about whether the net benefits are worth the costs (e.g., because of lack of data on input assumptions that substantially affect the results of economic models). Examples of category A recommendations include the ACIP recommendation to vaccinate all U.S. infants with rotavirus vaccine; recommendation to administer pneumococcal polysaccharide vaccine to all children aged 2 years or older with certain underlying medical conditions; and recommendation against use of the 2010–2011 Afluria influenza vaccine among children aged 6 months through 8 years. An example of a category B recommendation is the recommendation that the 2010–2011 Afluria vaccine may be used for a child aged 5–8 years with a medical condition that increases the child's risk for influenza complications if no other age-appropriate, seasonal influenza vaccine is available; providers should discuss with the parents or caregivers the benefits and risks of Afluria vaccination before use of the vaccine.

ACIP members consider all relevant factors for making recommendations. ACIP Work Groups include ACIP members and multiple external experts and stakeholders in the preparation of options for immunization to present to ACIP. ACIP meetings are open to the public, and experts and stakeholders from liaison organizations and other entities provide input during the ACIP decision-making process. Recommendations to the CDC/Health and Human Services (HHS) are passed by majority vote among committee members; recommendations are provisional pending acceptance by the Director of CDC/Secretary of HHS. Existing ACIP recommendations are updated on a periodic basis.

Source: Ahmed F, Temte JL, Campos-Outcalt D, Schünemann HJ; ACIP Evidence Based Recommendations Work Group (EBRWG). Methods for developing evidence-based recommendations by the Advisory Committee on Immunization Practices (ACIP) of the U.S. Centers for Disease Control and Prevention (CDC). Vaccine. 2011 Nov 15;29(49):9171-6.

Rating Scheme for the Strength of the Recommendations

Not applicable

Cost Analysis

Economic analysis is an important factor that informs judgments in formulating recommendations (e.g., cost-benefit, cost-utility, cost-effectiveness). Use of a fixed cut-off threshold such as $50,000 or $100,000 per quality adjusted life year (QALY) for determining cost-effectiveness, however, ignores other determinants of value. The methodology described above for assessing the type or quality of evidence is not intended to be applied to health economic analyses based on modeling. The Advisory Committee on Immunization Practices (ACIP) Work Group on Economic Analysis has published a document titled Guidance for Health Economic Studies Presented to the ACIP that provides a framework for the description and presentation of the methods and results, and that stipulates technical review by anonymous peer reviewers of any economic materials presented to the ACIP. Presentation of health economic data should be undertaken using the guidelines in that document.

Source: Ahmed F, Temte JL, Campos-Outcalt D, Schünemann HJ; ACIP Evidence Based Recommendations Work Group (EBRWG). Methods for developing evidence-based recommendations by the Advisory Committee on Immunization Practices (ACIP) of the U.S. Centers for Disease Control and Prevention (CDC). Vaccine. 2011 Nov 15;29(49):9171-6.

Method of Guideline Validation
External Peer Review
Internal Peer Review
Description of Method of Guideline Validation

After formulation by the relevant workgroup, draft recommendations are subjected to further extensive review by staff of the Centers for Disease Control and Prevention (CDC), U.S. Food and Drug Administration (FDA), other relevant federal agencies, Advisory Committee on Immunization Practices (ACIP) members, liaison members, and external expert consultants. Workgroup members or ACIP members may identify a need for additional data, corrections in data content, and modifications of the interpretation of the data, and members may critique and challenge expert opinions. Public comments also are solicited during each ACIP meeting and are considered in the decision-making process. These inputs are synthesized by the workgroup in an iterative process, and options are presented to the ACIP for final consideration and vote.

Source: Smith JC, Snider DE, Pickering LK; Advisory Committee on Immunization Practices. Immunization policy development in the United States: the role of the Advisory Committee on Immunization Practices. Ann Intern Med. 2009 Jan 6;150(1):45-9.

Recommendations

Major Recommendations

Note from the Centers for Disease Control and Prevention (CDC) and the National Guideline Clearinghouse (NGC): Please see the CDC's Advisory Committee on Immunization Practices (ACIP) Web site External Web Site Policy for any updates to vaccine-specific recommendations that have been approved since the publication of this guideline.

Note: ACIP annually reviews and updates the Adult Immunization Schedule. This schedule provides a brief summary of ACIP recommendations for the use of vaccines routinely recommended for adults in the form of 2 figures (see below), footnotes for each vaccine, and a table that includes the primary contraindications and precautions (see below). In October 2013, ACIP approved the Adult Immunization Schedule for 2014.

The primary updates for the 2014 schedule include adding Haemophilus influenzae type b (Hib) vaccine to the figures and updating information in the footnote about persons for whom Hib vaccine is recommended; adding information to the influenza vaccine footnote and contraindications table regarding the newly licensed recombinant influenza vaccine (RIV) and information about the use of RIV and inactivated influenza vaccine (IIV) among persons with egg allergies; moving the footnote for pneumococcal conjugate vaccine (PCV13) recommendations before the pneumococcal polysaccharide vaccine (PPSV23) recommendations because PCV13 should be administered first among persons for whom both vaccines are recommended; and clarifying information about the timing of the second and third doses of human papillomavirus (HPV) vaccine, use of meningococcal vaccines among adults, and recommendations for tetanus, diphtheria, acellular pertussis (Tdap) and tetanus, diphtheria (Td) vaccines.

This year, the figures, footnotes, and table are not being published simultaneously in the Morbidity and Mortality Weekly Report (MMWR) Recommendations and Reports. Instead, the MMWR will be publishing only the introduction, with the full schedule posted and maintained on the CDC Web site at www.cdc.gov/vaccines/schedules External Web Site Policy to facilitate updating the schedule during the year, if needed. If errors or omissions are detected after publication of the pediatric or adult immunizations schedules, the CDC posts revised versions. The CDC encourages organizations that have previously relied on copying and posting PDF files of the schedules to their Web sites to instead use "content syndication" to ensure that current and accurate immunization schedule information appears on each organization's Web site. This one-time step ensures that Web sites display current yearly schedules as soon as they are published or revised. Instructions for copying and placing syndication code are available at www.cdc.gov/vaccines/schedules/syndicate.html External Web Site Policy. The CDC offers technical assistance for organizations implementing this form of content syndication. For assistance, readers can complete the e-mail form on the CDC's National Center for Immunization and Respiratory Diseases (NCIRD) Web support page (www.cdc.gov/vaccines/about/contact/web_problem_form.htm External Web Site Policy), and an NCIRD Web team staff member will contact them to provide assistance.

Recommendations from ACIP for specific vaccines can be found at http://www.cdc.gov/vaccines/hcp/acip-recs/index.html External Web Site Policy. Information on reporting vaccine-related adverse events is available at www.vaers.hhs.gov External Web Site Policy or by (800) 822-7967. This schedule has been reviewed and approved by the American Academy of Family Physicians, American College of Physicians, American College of Obstetricians and Gynecologists, and American College of Nurse-Midwives.

Changes for 2014

Changes to the Footnotes for 2014

  • The Hib vaccine recommendations were updated. The vaccine is recommended for certain adults at increased risk for Hib who have not received the vaccine before. Adults who have had a successful hematopoietic stem cell transplant are recommended to receive a 3-dose series of Hib vaccine 6 to 12 months after the transplant regardless of prior Hib vaccination status. Prior Hib vaccine guidance recommended that Hib vaccination of persons infected with human immunodeficiency virus (HIV) be considered, but updated guidance no longer recommends Hib vaccination of previously unvaccinated adults with HIV infection because their risk for Hib infection is low.
  • Information on the RIV and the use of RIV and IIV among egg-allergic patients was added to the footnote and indicates that RIV or IIV can be used among persons with hives-only allergy to eggs. The RIV contains no egg protein and can be used among persons aged 18 to 49 years who have egg allergy of any severity.
  • The Td/Tdap vaccine footnote was edited to harmonize with the language used in the pediatric immunization schedule. A single dose of Tdap vaccine is recommended for previously unvaccinated persons aged 11 years or older, and Td booster should be administered every 10 years thereafter. Pregnant women continue to be recommended to receive a dose of Tdap vaccine during each pregnancy, preferably during 27 to 36 weeks' gestation, regardless of the interval since the prior dose of Tdap or Td vaccination.
  • Information was added to the HPV vaccine footnote to clarify the timing between the second and third doses and to harmonize language between the pediatric and adult immunization schedules; no changes in recommendations were made.
  • Both the HPV vaccine footnote and the zoster footnote were simplified, with removal of the bullet regarding health care personnel (HCP). Being a health care worker is not a specific indication for these vaccines, but they should be given to HCP and others who meet age and other indications for these vaccines. Information on HCP vaccination for all vaccines can be found at www.cdc.gov/mmwr/preview/mmwrhtml/rr6007a1.htm External Web Site Policy.
  • Because PCV13 is recommended to be administered before PPSV23 among persons for whom both vaccines are recommended, the PCV13 footnote now precedes the PPSV23 footnote and includes wording to remind providers of the appropriate order of these vaccines when both are indicated.
  • The meningococcal vaccine footnote was edited to clarify which persons need either 1 or 2 doses of vaccine and to provide greater clarity regarding which patients should receive the meningococcal conjugate (MenACWY) versus the meningococcal polysaccharide (MPSV4) quadrivalent vaccines.
  • No changes or minor clarifications were made to the footnotes for the measles, mumps, rubella (MMR), hepatitis A, or hepatitis B vaccines; no changes in recommendations were made.

Changes to Figures 2014

  • For Figure 1 and 2, a row for Hib vaccine was added and the PCV13 vaccine row was moved before PPSV23 as a reminder that PCV13 vaccines should be administered first among patients for whom both vaccines are recommended.

Changes to the Contraindications and Precautions Table for 2014

  • The contraindications and precautions table was updated to include information on RIV, an influenza vaccine that contains no egg protein and is indicated for persons aged 18 to 49 years.
  • The Hib vaccine was added to the table.

Figure 1: Recommended Adult Immunization Schedule, by Vaccine and Age Group1

Note: These recommendations must be read with the footnotes that follow containing number of doses, intervals between doses, and other important information.

Vaccine 19-21 years 22-26 years 27-49 years 50-59 years 60-64 years ≥65 years
Influenza2,* 1 dose annually
Tetanus, diphtheria, pertussis (Td/Tdap)3,* Substitute 1-time dose of Tdap for Td booster; then boost with Td every 10 yrs
Varicella4,* 2 doses
Human papillomavirus (HPV)5,* Female 3 doses        
Human papillomavirus (HPV)5,* Male 3 d oses        
Zoster6         1 dose
Measles, mumps, rubella (MMR)7,* 1 or 2 doses      
Pneumococcal 13-valent conjugate (PCV13)8
Pneumococcal polysaccharide (PPSV23)9,10 1 dose
Meningococcal11,*
Hepatitis A12,*
Hepatitis B13,*
Haemophilus influenza type b (Hib)14,*

*Covered by the Vaccine Injury Compensation Program

    For all persons in this category who meet the age requirements and who lack documentation of vaccination or have no evidence of previous infection; zoster vaccine recommended regardless of prior episode of zoster   Recommended if some other risk factor is present (e.g., on the basis of medical, occupational, lifestyle, or other indication)     No recommendation
     

Figure 2: Vaccines that Might Be Indicated for Adults Based on Medical and Other Indications1

Note: These recommendations must be read with the footnotes that follow containing number of doses, intervals between doses, and other important information.

Vaccine Pregnancy Immuno-compromising conditions (excluding human immunodeficiency virus [HIV])4,6,7,8,15 HIV infection
CD4 + T lymphocyte count4,6,7,8,15
Men who have sex with men (MSM) Kidney failure, end-stage renal disease, receipt of hemodialysis Heart disease, chronic lung disease, chronic alcoholism Asplenia (including elective splenectomy and persistent complement component deficiencies)8,14 Chronic liver disease Diabetes Healthcare personnel
<200 cells/μL ≥200 cells/μL
Influenza2,* 1 dose IIV annually 1 dose IIV or LAIV annually 1 dose IIV annually 1 dose IIV or LAIV annually
Tetanus, diphtheria, pertussis (Td/Tdap)3,* 1 dose Tdap each pregnancy Substitute 1-time dose of Tdap for Td booster; then boost with Td every 10 yrs
Varicella4,* Contraindicated 2 doses
Human papillomavirus (HPV) Female5,*   3 doses through age 26 yrs   3 doses through age 26 yrs
Human papillomavirus (HPV) Male5,*   3 doses through age 26 yrs 3 doses through age 21 yrs
Zoster6 Contraindicated   1 dose
Measles, mumps, rubella (MMR)7,* Contraindicated 1 or 2 doses
Pneumococcal 13-valent conjugate (PCV13)8     1 d ose  
Pneumococcal polysaccharide (PPSV23)9,10   1 or 2 doses
Meningococcal11,* 1 or more doses  
Hepatitis A12,*    
Hepatitis B13,* 3 doses  
Haemophilus influenza type b (Hib)14,*   post-HSCT recipients only  

*Covered by the Vaccine Injury Compensation Program

    For all persons in this category who meet the age requirements and who lack documentation of vaccination or have no evidence of previous infection; zoster vaccine recommended regardless of prior episode of zoster   Recommended if some other risk factor is present (e.g., on the basis of medical, occupational, lifestyle, or other indications)     No recommendation
     

Footnotes

  1. Additional information
  2. Influenza vaccination
    • Annual vaccination against influenza is recommended for all persons aged 6 months and older.
    • Persons 6 months and older, including pregnant women and persons with hives-only allergy to eggs, can receive the inactivated influenza vaccine (IIV). An age-appropriate IIV formulation should be used.
    • Adults aged 18 to 49 years can receive the recombinant influenza vaccine (RIV) (FluBlok). RIV does not contain any egg protein.
    • Healthy, nonpregnant persons aged 2 to 49 years without high-risk medical conditions can receive either intranasally administered live, attenuated influenza vaccine (LAIV) (FluMist) or IIV. Health-care personnel who care for severely immunocompromised persons (i.e., those who require care in a protected environment) should receive IIV or RIV rather than LAIV.
    • The intramuscularly or intradermally administered IIV are options for adults aged 18 to 64 years.
    • Adults aged 65 years and older can receive the standard dose IIV or the high-dose IIV (Fluzone High-Dose).
  3. Tetanus, diphtheria, and acellular pertussis (Td/Tdap) vaccination
    • Administer 1 dose of Tdap vaccine to pregnant women during each pregnancy (preferred during 27 to 36 weeks' gestation), regardless of interval since prior Td or Tdap vaccination.
    • Persons aged 11 years or older who have not received Tdap vaccine or for whom vaccine status is unknown should receive a dose of Tdap followed by tetanus and diphtheria toxoids (Td) booster doses every 10 years thereafter. Tdap can be administered regardless of interval since the most recent tetanus or diphtheria-toxoid containing vaccine.
    • Adults with an unknown or incomplete history of completing a 3-dose primary vaccination series with Td-containing vaccines should begin or complete a primary vaccination series including a Tdap dose.
    • For unvaccinated adults, administer the first 2 doses at least 4 weeks apart and the third dose 6 to 12 months after the second.
    • For incompletely vaccinated (i.e., less than 3 doses) adults, administer remaining doses.
    • Refer to the ACIP statement for recommendations for administering Td/Tdap as prophylaxis in wound management (see footnote #1).
  4. Varicella vaccination
    • All adults without evidence of immunity to varicella (as defined below) should receive 2 doses of single-antigen varicella vaccine or a second dose if they have received only 1 dose.
    • Vaccination should be emphasized for those who have close contact with persons at high risk for severe disease (e.g., health care personnel and family contacts of persons with immunocompromising conditions) or are at high risk for exposure or transmission (e.g., teachers; child care employees; residents and staff members of institutional settings, including correctional institutions; college students; military personnel; adolescents and adults living in households with children; nonpregnant women of childbearing age; and international travelers).
    • Pregnant women should be assessed for evidence of varicella immunity. Women who do not have evidence of immunity should receive the first dose of varicella vaccine upon completion or termination of pregnancy and before discharge from the healthcare facility. The second dose should be administered 4 to 8 weeks after the first dose.
    • Evidence of immunity to varicella in adults includes any of the following:
      • Documentation of 2 doses of varicella vaccine at least 4 weeks apart
      • U.S.-born before 1980 except healthcare personnel and pregnant women
      • History of varicella based on diagnosis or verification of varicella disease by a health care provider
      • History of herpes zoster based on diagnosis or verification of herpes zoster by a health care provider
      • Laboratory evidence of immunity or laboratory confirmation of disease
  5. Human papillomavirus (HPV) vaccination
    • Two vaccines are licensed for use in females, bivalent HPV vaccine (HPV2) and quadrivalent HPV vaccine (HPV4), and one HPV vaccine for use in males (HPV4).
    • For females, either HPV4 or HPV2 is recommended in a 3-dose series for routine vaccination at age of 11 or 12 years and for those aged 13 through 26 years, if not previously vaccinated.
    • For males, HPV4 is recommended in a 3-dose series for routine vaccination at age of 11 or 12 years and for those aged 13 through 21 years, if not previously vaccinated. Males aged 22 through 26 years may be vaccinated.
    • HPV4 is recommended for men who have sex with men (MSM) through age 26 years for those who did not get any or all doses when they were younger.
    • Vaccination is recommended for immunocompromised persons (including those with HIV infection) through age 26 years for those who did not get any or all doses when they were younger.
    • A complete series for either HPV4 or HPV2 consists of 3 doses. The second dose should be administered 4 to 8 weeks (minimum interval of 4 weeks) after the first dose; the third dose should be administered 24 weeks after the first dose and 16 weeks after the second dose (minimum interval of at least 12 weeks).
    • HPV vaccines are not recommended for use in pregnant women. However, pregnancy testing is not needed before vaccination. If a woman is found to be pregnant after initiating the vaccination series, no intervention is needed; the remainder of the 3-dose series should be delayed until completion of pregnancy.
  6. Zoster vaccination
    • A single dose of zoster vaccine is recommended for adults aged 60 years or older regardless of whether they report a prior episode of herpes zoster. Although the vaccine is licensed by the U.S. Food and Drug Administration for use among and can be administered to persons aged 50 years and older, ACIP recommends that vaccination begins at age 60 years.
    • Persons aged 60 years and older with chronic medical conditions may be vaccinated unless their condition constitutes a contraindication, such as pregnancy or severe immunodeficiency.
  7. Measles, mumps, rubella (MMR) vaccination
    • Adults born before 1957 generally are considered immune to measles and mumps. All adults born in 1957 or later should have documentation of 1 or more doses of MMR vaccine, unless they have a medical contraindication to the vaccine, or laboratory evidence of immunity to each of the 3 diseases. Documentation of provider-diagnosed disease is not considered acceptable evidence of immunity for measles, mumps, or rubella.

    Measles component:

    • A routine second dose of MMR vaccine, administered a minimum of 28 days after the first dose, is recommended for adults who:
      • Are students in a postsecondary educational institution
      • Work in a health care facility
      • Plan to travel internationally
    • Persons who received inactivated (killed) measles vaccine or measles vaccine of unknown type during 1963 to 1967 should be revaccinated with 2 doses of MMR vaccine.

    Mumps component:

    • A routine second dose of MMR vaccine, administered a minimum of 28 days after the first dose, is recommended for adults who:
      • Are students in a postsecondary educational institutions
      • Work in a health care facility
      • Plan to travel internationally
    • Persons vaccinated before 1979 with either killed mumps vaccine or mumps vaccine of unknown type who are at high risk for mumps infection (e.g., persons who are working in a health care facility) should be considered for revaccination with 2 doses of MMR vaccine.

    Rubella component:

    • For women of childbearing age, regardless of birth year, rubella immunity should be determined. If there is no evidence of immunity, women who are not pregnant should be vaccinated. Pregnant women who do not have evidence of immunity should receive MMR vaccine upon completion or termination of pregnancy and before discharge from the health care facility.

    Health care personnel born before 1957:

    • For unvaccinated HCP born before 1957 who lack laboratory evidence of measles, mumps, and/or rubella immunity or laboratory confirmation of disease, health care facilities should consider vaccinating personnel with 2 doses of MMR vaccine at the appropriate interval for measles and mumps and 1 dose of MMR vaccine for rubella.
  8. Pneumococcal conjugate (PCV13) vaccination
    • Adults aged 19 years or older with immunocompromising conditions (including chronic renal failure and nephrotic syndrome), functional or anatomic asplenia, cerebrospinal fluid leaks, or cochlear implants who have not previously received PCV13 or PPSV23 should receive a single dose of PCV13 followed by a dose of PPSV23 at least 8 weeks later.
    • Adults aged 19 years or older with the aforementioned conditions who have previously received 1 or more doses of PPSV23 should receive a dose of PCV13 one or more years after the last PPSV23 dose was received. For adults who require additional doses of PPSV23, the first such dose should be given no sooner than 8 weeks after PCV13 and at least 5 years after the most recent dose of PPSV23.
    • When indicated, PCV13 should be administered to patients who are uncertain of their vaccination status history and have no record of previous vaccination.
    • Although PCV13 is licensed by the U.S. Food and Drug Administration for use among and can be administered to persons aged 50 years or older, ACIP recommends PCV13 for adults aged 19 years or older with the specific medical conditions noted above.
  9. Pneumococcal polysaccharide (PPSV23) vaccination
    • When PCV13 is also indicated, PCV13 should be given first (see footnote 8).
    • Vaccinate all persons with the following indications:
      • All adults aged 65 years and older
      • Adults younger than 65 years with chronic lung disease (including chronic obstructive pulmonary disease, emphysema, and asthma); chronic cardiovascular diseases; diabetes mellitus; chronic renal failure; nephrotic syndrome; chronic liver disease (including cirrhosis); alcoholism; cochlear implants; cerebrospinal fluid leaks; immunocompromising conditions; and functional or anatomic asplenia (e.g., sickle cell disease and other hemoglobinopathies, congenital or acquired asplenia, splenic dysfunction, or splenectomy [if elective splenectomy is planned, vaccinate at least 2 weeks before surgery])
      • Residents of nursing homes or long-term care facilities
      • Adults who smoke cigarettes
    • Persons with immunocompromising conditions and other selected conditions are recommended to receive PCV13 and PPSV23 vaccines. See footnote #8 for information on timing of PCV13 and PPSV23 vaccinations.
    • Persons with asymptomatic or symptomatic HIV infection should be vaccinated as soon as possible after their diagnosis.
    • When cancer chemotherapy or other immunosuppressive therapy is being considered, the interval between vaccination and initiation of immunosuppressive therapy should be at least 2 weeks. Vaccination during chemotherapy or radiation therapy should be avoided.
    • Routine use of PPSV23 is not recommended for American Indians/Alaska Natives or other persons younger than age 65 years unless they have underlying medical conditions that are PPSV23 indications. However, public health authorities may consider recommending PPSV23 for American Indians/Alaska Natives who are living in areas where the risk for invasive pneumococcal disease is increased.
    • When indicated, PPSV23 should be administered to patients who are uncertain of their vaccination status and there is no record of previous vaccination.
  10. Revaccination with PPSV23
    • One-time revaccination 5 years after the first dose of PPSV23 is recommended for persons aged 19 through 64 years with chronic renal failure or nephrotic syndrome, functional or anatomic asplenia (e.g., sickle cell disease or splenectomy), or immunocompromising conditions.
    • Persons who received 1 or 2 doses of PPSV23 before age 65 years for any indication should receive another dose of the vaccine at age 65 years or later if at least 5 years have passed since their previous dose.
    • No further doses of PPSV23 are needed for persons vaccinated with PPSV23 at or after age 65 years.
  11. Meningococcal vaccination
    • Administer 2 doses of quadrivalent meningococcal conjugate vaccine (MenACWY [Menactra, Menveo]) at least 2 months apart to adults of all ages with functional asplenia or persistent complement component deficiencies. HIV infection is not an indication for routine vaccination with MenACWY. If an HIV-infected person of any age is vaccinated, 2 doses of MenACWY should be administered at least 2 months apart.
    • Administer a single dose of meningococcal vaccine to microbiologists routinely exposed to isolates of Neisseria meningitidis, military recruits, persons at risk during an outbreak attributable to a vaccine serogroup, and persons who travel to or live in countries in which meningococcal disease is hyperendemic or epidemic.
    • First-year college students up through age 21 years who are living in residence halls should be vaccinated if they have not received a dose on or after their 16th birthday.
    • MenACWY is preferred for adults with any of the preceding indications who are aged 55 years and younger as well as for adults aged 56 years or older who a) were vaccinated previously with MenACWY and are recommended for revaccination, or b) for whom multiple doses are anticipated. Meningococcal polysaccharide vaccine (MPSV4 [Menomune]) is preferred for adults aged 56 years or older who have not received MenACWY previously and who require a single dose only (e.g., travelers).
    • Revaccination with MenACWY every 5 years is recommended for adults previously vaccinated with MenACWY or MPSV4 who remain at increased risk for infection (e.g., adults with anatomic or functional asplenia, those with persistent complement component deficiencies, or microbiologists).
  12. Hepatitis A vaccination
    • Vaccinate any person seeking protection from hepatitis A virus (HAV) infection and persons with any of the following indications:
      • Men who have sex with men and persons who use injection or noninjection illicit drugs.
      • Persons working with HAV-infected primates or with HAV in a research laboratory setting.
      • Persons with chronic liver disease and persons who receive clotting factor concentrates.
      • Persons traveling to or working in countries that have high or intermediate endemicity of hepatitis A.
      • Unvaccinated persons who anticipate close personal contact (e.g., household or regular babysitting) with an international adoptee during the first 60 days after arrival in the United States from a country with high or intermediate endemicity. (See footnote 1 for more information on travel recommendations.) The first dose of the 2-dose hepatitis A vaccine series should be administered as soon as adoption is planned, ideally 2 or more weeks before the arrival of the adoptee.
    • Single-antigen vaccine formulations should be administered in a 2-dose schedule at either 0 and 6 to 12 months (Havrix), or 0 and 6 to 18 months (Vaqta). If the combined hepatitis A and hepatitis B vaccine (Twinrix) is used, administer 3 doses at 0, 1, and 6 months; alternatively, a 4-dose schedule may be used, administered on days 0, 7, and 21 to 30, followed by a booster dose at month 12.
  13. Hepatitis B vaccination
    • Vaccinate persons with any of the following indications and any person seeking protection from hepatitis B virus (HBV) infection:
      • Sexually active persons who are not in a long-term, mutually monogamous relationship (e.g., persons with more than one sex partner during the previous 6 months); persons seeking evaluation or treatment for a sexually transmitted disease (STD); current or recent injection-drug users; and men who have sex with men.
      • Health care personnel and public safety workers who are potentially exposed to blood or other potentially infectious body fluids.
      • Persons with diabetes younger than age 60 years as soon as feasible after diagnosis; persons with diabetes who are 60 years or older at the discretion of the treating clinician based on the likelihood of acquiring HBV infection, including the risk posed by an increased need for assisted blood glucose monitoring in long-term care facilities, the likelihood of experiencing chronic sequelae if infected with HBV, and the likelihood of immune response to vaccination.
      • Persons with end-stage renal disease, including patients receiving hemodialysis; persons with HIV infection; and persons with chronic liver disease.
      • Household contacts and sex partners of hepatitis B surface antigen-positive persons; clients and staff members of institutions for persons with developmental disabilities; and international travelers to countries with high or intermediate prevalence of chronic HBV infection.
      • All adults in the following settings: STD treatment facilities; HIV testing and treatment facilities; facilities providing drug-abuse treatment and prevention services; health care settings targeting services to injection-drug users or men who have sex with men; correctional facilities; end-stage renal disease programs and facilities for chronic hemodialysis patients; and institutions and nonresidential day care facilities for persons with developmental disabilities.
    • Administer missing doses to complete a 3-dose series of hepatitis B vaccine to those persons not vaccinated or not completely vaccinated. The second dose should be administered 1 month after the first dose; the third dose should be given at least 2 months after the second dose (and at least 4 months after the first dose). If the combined hepatitis A and hepatitis B vaccine (Twinrix) is used, give 3 doses at 0, 1, and 6 months; alternatively, a 4-dose Twinrix schedule, administered on days 0, 7, and 21 to 30, followed by a booster dose at month 12 may be used.
    • Adult patients receiving hemodialysis or with other immunocompromising conditions should receive 1 dose of 40 µg/mL (Recombivax HB) administered on a 3-dose schedule at 0, 1, and 6 months or 2 doses of 20 µg/mL (Engerix-B) administered simultaneously on a 4-dose schedule at 0, 1, 2, and 6 months.
  14. Haemophilus influenzae type b (Hib) vaccination
    • One dose of Hib vaccine should be administered to persons who have functional or anatomic asplenia or sickle cell disease, or are undergoing elective splenectomy if they have not previously received Hib vaccine. Hib vaccination 14 or more days before splenectomy is suggested.
    • Recipients of a hematopoietic stem cell transplant should be vaccinated with a 3-dose regimen 6 to 12 months after a successful transplant, regardless of vaccination history; at least 4 weeks should separate doses.
    • Hib vaccine is not recommended for adults with HIV infection since their risk for Hib infection is low.
  15. Immunocompromising conditions
    • Inactivated vaccines generally are acceptable (e.g., pneumococcal, meningococcal and inactivated influenza vaccine), and live vaccines generally are avoided in persons with immune deficiencies or immunocompromising conditions. Information on specific conditions is available at http://www.cdc.gov/vaccines/hcp/acip-recs/index.html External Web Site Policy.

Table. Contraindications and Precautions to Commonly Used Vaccines in Adults: United States, 20141*†

Vaccine Contraindications Precautions
Influenza, inactivated vaccine (IIV)2 Severe allergic reaction (e.g., anaphylaxis) after previous dose of any IIV or LAIV or to a vaccine component, including egg protein. Moderate or severe acute illness with or without fever.
History of Guillain-Barré Syndrome within 6 weeks of previous influenza vaccination.
Persons who experience only hives with exposure to eggs may receive RIV (if age 18–49 years) or, with additional safety precautions, IIV.2
Influenza, recombinant (RIV) Severe allergic reaction (e.g., anaphylaxis) after previous dose of RIV or to a vaccine component. RIV does not contain any egg protein.2 Moderate or severe acute illness with or without fever.
History of Guillain-Barré Syndrome within 6 weeks of previous influenza vaccination.
Influenza, live attenuated (LAIV)2,3 Severe allergic reaction (e.g., anaphylaxis) after previous dose of any IIV or LAIV or to a vaccine component, including egg protein.
Conditions for which the Advisory Committee on Immunization Practices (ACIP) recommends against use, but which are not contraindications in vaccine package insert: immune suppression, certain chronic medical conditions (such as asthma, diabetes, heart or kidney disease), and pregnancy.2, 3
Moderate or severe acute illness with or without fever.
History of Guillain-Barré Syndrome within 6 weeks of previous influenza vaccination.
Receipt of specific antivirals (i.e., amantadine, rimantadine, zanamivir, or oseltamivir) within 48 hours before vaccination. Avoid use of these antiviral drugs for 14 days after vaccination.
Tetanus, diphtheria, pertussis (Tdap);
tetanus, diphtheria (Td)
Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component.
For pertussis-containing vaccines: encephalopathy (e.g., coma, decreased level of consciousness, or prolonged seizures) not attributable to another identifiable cause within 7 days of administration of a previous dose of Tdap or diphtheria and tetanus toxoids and pertussis (DTP) or diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine.
Moderate or severe acute illness with or without fever.
Guillain-Barré Syndrome within 6 weeks after a previous dose of tetanus toxoid–containing vaccine.
History of Arthus-type hypersensitivity reactions after a previous dose of tetanus or diphtheria toxoid–containing vaccine; defer vaccination until at least 10 years have elapsed since the last tetanus toxoid–containing vaccine.
For pertussis-containing vaccines: progressive or unstable neurologic disorder, uncontrolled seizures, or progressive encephalopathy until a treatment regimen has been established and the condition has stabilized.
Varicella3 Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component.
Known severe immunodeficiency (e.g., from hematologic and solid tumors, receipt of chemotherapy, congenital immunodeficiency, or long-term immunosuppressive therapy4 or patients with human immunodeficiency virus [HIV] infection who are severely immunocompromised).
Pregnancy.
Recent (within 11 months) receipt of antibody-containing blood product (specific interval depends on product).5
Moderate or severe acute illness with or without fever.
Receipt of specific antivirals (i.e., acyclovir, famciclovir, or valacyclovir) 24 hours before vaccination; avoid use of these antiviral drugs for 14 days after vaccination.
Human papillomavirus (HPV) Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component. Moderate or severe acute illness with or without fever.
Pregnancy.
Zoster3 Severe allergic reaction (e.g., anaphylaxis) to a vaccine component.
Known severe immunodeficiency (e.g., from hematologic and solid tumors, receipt of chemotherapy, or long-term immunosuppressive therapy4 or patients with HIV infection who are severely immunocompromised).
Pregnancy.
Moderate or severe acute illness with or without fever.
Receipt of specific antivirals (i.e., acyclovir, famciclovir, or valacyclovir) 24 hours before vaccination; avoid use of these antiviral drugs for 14 days after vaccination.
Measles, mumps, rubella (MMR)3 Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component.
Known severe immunodeficiency (e.g., from hematologic and solid tumors, receipt of chemotherapy, congenital immunodeficiency, or long-term immunosuppressive therapy4 or patients with HIV infection who are severely immunocompromised).
Pregnancy.
Moderate or severe acute illness with or without fever.
Recent (within 11 months) receipt of antibody-containing blood product (specific interval depends on product).5
History of thrombocytopenia or thrombocytopenic purpura.
Need for tuberculin skin testing.6
Pneumococcal conjugate (PCV13)
Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component, including to any vaccine containing diphtheria toxoid. 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.
Meningococcal, conjugate (MenACWY); meningococcal, polysaccharide (MPSV4) 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. 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. Moderate or severe acute illness with or without fever.
Haemophilus influenzae type b (Hib) Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component. Moderate or severe acute illness with or without fever.
  1. Vaccine package inserts and the full ACIP recommendations for these vaccines should be consulted for additional information on vaccine-related contraindications and precautions and for more information on vaccine excipients. Events or conditions listed as precautions should be reviewed carefully. Benefits of and risks for administering a specific vaccine to a person under these circumstances should be considered. If the risk from the vaccine is believed to outweigh the benefit, the vaccine should not be administered. If the benefit of vaccination is believed to outweigh the risk, the vaccine should be administered. A contraindication is a condition in a recipient that increases the chance of a serious adverse reaction. Therefore, a vaccine should not be administered when a contraindication is present.
  2. For more information on use of influenza vaccines among persons with egg allergies and a complete list of conditions that the Centers for Disease Control and Prevention considers to be reasons to avoid receiving LAIV, see Centers for Disease Control and Prevention. Prevention and control of seasonal influenza with vaccines. Recommendations of the Advisory Committee on Immunization Practices (ACIP)—United States, 2013-2014. MMWR Recomm Rep. 2013;62(RR-07):1-43.
  3. LAIV, MMR, and varicella, or zoster vaccines can be administered on the same day. If not administered on the same day, live vaccines should be separated by at least 28 days.
  4. Immunosuppressive steroid dose is considered to be ≥2 weeks of daily receipt of 20 mg of prednisone or equivalent. Vaccination should be deferred for at least 1 month after discontinuation of such therapy. Providers should consult ACIP recommendations for complete information on the use of specific live vaccines among persons receiving immune-suppressing medications or with immune suppression because of other reasons.
  5. Vaccine should be deferred for the appropriate interval if replacement immune globulin products are being administered. See CDC. General recommendations on immunization–recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2011;60(RR-02):1-64; available at www.cdc.gov/vaccines/hcp/acip-recs/index.html External Web Site Policy.
  6. Measles vaccination might suppress tuberculin reactivity temporarily. Measles-containing vaccine may be administered on the same day as tuberculin skin testing. If testing cannot be performed until after the day of MMR vaccination, the test should be postponed for at least 4 weeks after the vaccination. If an urgent need exists to skin test, do so with the understanding that reactivity might be reduced by the vaccine.

*Adapted from "Table 6. Contraindications and Precautions to Commonly Used Vaccines," found in: General Recommendations on Immunization: Recommendations of the Advisory Committee on Immunization Practices. MMWR. 2011;60(RR-2):40-1; and Appendix A in "The Pink Book": Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine Preventable Diseases, 12th Edition (2011), at www.cdc.gov/vaccines/pubs/pinkbook/index.html External Web Site Policy.

†Regarding latex allergy: Consult the package insert for any vaccine administered.

Clinical Algorithm(s)

None provided

Evidence Supporting the Recommendations

Type of Evidence Supporting the Recommendations

The type of evidence supporting the recommendations is not specifically stated.

Benefits/Harms of Implementing the Guideline Recommendations

Potential Benefits
  • Appropriate administration of vaccines to adults
  • Decline in vaccine-preventable diseases among adults
Potential Harms

Adverse reactions to vaccination

See the table, "Contraindications and Precautions to Commonly Used Vaccines in Adults," in the "Major Recommendations" field, for details.

Contraindications

Contraindications

See the table, "Contraindications and Precautions to Commonly Used Vaccines in Adults," in the "Major Recommendations" field, for information on contraindications to vaccines.

Additional information about the vaccines in this schedule, extent of available data, and contraindications for vaccination is also available at http://www.cdc.gov/vaccines/ External Web Site Policy or from the CDC-INFO Contact Center at 800-CDC-INFO.

Qualifying Statements

Qualifying Statements

Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services.

Implementation of the Guideline

Description of Implementation Strategy

An implementation strategy was not provided.

Implementation Tools
Chart Documentation/Checklists/Forms
Foreign Language Translations
Mobile Device Resources
Patient Resources
Pocket Guide/Reference Cards
Resources
For information about availability, see the Availability of Companion Documents and Patient Resources fields below.

Institute of Medicine (IOM) National Healthcare Quality Report Categories

IOM Care Need
Staying Healthy
IOM Domain
Effectiveness
Patient-centeredness

Identifying Information and Availability

Bibliographic Source(s)
Advisory Committee on Immunization Practices recommended immunization schedule for adults aged 19 years or older: United States, 2014. Ann Intern Med. 2014 Feb 4;160(3):190-7. [10 references]

Bridges CB, Coyne-Beasley T, Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC. Advisory committee on immunization practices recommended immunization schedule for adults aged 19 years or older - United States, 2014. MMWR Morb Mortal Wkly Rep. 2014 Feb 7;63(5):110-2. PubMed External Web Site Policy
Adaptation

Not applicable: The guideline was not adapted from another source.

Date Released
2007 Nov 20 (revised 2014 Feb 4)
Guideline Developer(s)
Centers for Disease Control and Prevention - Federal Government Agency [U.S.]
Source(s) of Funding

United States Government

Guideline Committee

Advisory Committee on Immunization Practices (ACIP)

ACIP Adult Immunization Work Group

Composition of Group That Authored the Guideline

Advisory Committee on Immunization Practice (ACIP) Members: Jonathan Temte, MD, PhD (Chair), University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Larry K. Pickering, MD (Executive Secretary), Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, Georgia; Nancy Bennett, MD, MS, University of Rochester School of Medicine and Dentistry, Rochester, New York; Joseph A. Bocchini Jr., MD, Louisiana State University Health Sciences Center, Shreveport, Louisiana; Douglas Campos-Outcalt, MD, MPA, University of Arizona College of Medicine–Phoenix, Phoenix, Arizona; Tamera Coyne-Beasley, MD, MPH, North Carolina Child Health Research Network, North Carolina Translational and Clinical Sciences, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Jeffrey Duchin, MD, Public Health—Seattle and King County, University of Washington School of Medicine, Seattle, Washington; Kathleen Harriman, PhD, MPH, RN, California Department of Public Health, Richmond, California; Lee H. Harrison, MD, University of Pittsburgh, Pittsburgh, Pennsylvania; Renée R. Jenkins, MD, Howard University College of Medicine, Washington, DC; Ruth A. Karron, MD, Center for Immunization Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Allison Kempe, MD, University of Colorado School of Medicine, The Children's Hospital of Denver, Denver, Colorado; Cynthia Pellegrini, March of Dimes, Washington, DC; Arthur L. Reingold, MD, University of California School of Public Health, Berkeley, California; Lorry Rubin, MD, Steven and Alexandra Cohen Children's Medical Center of New York, North Shore–Long Island Jewish Health System, New Hyde Park, New York; and Marietta Vázquez, MD, Yale University School of Medicine, New Haven, Connecticut

ACIP Adult Immunization Work Group Members: Tamera Coyne-Beasley, MD, MPH (Chair), Chapel Hill, North Carolina; Sandra Fryhofer, MD, Atlanta, Georgia; Kathleen Harriman, PhD, Richmond, California; Molly Howell, MPH, Bismarck, North Dakota; Linda Kinsinger, MD, MPH, Durham, North Carolina; Laura Pinkston Koenigs, MD, Springfield, Massachusetts; Marie-Michele Leger, MPH, PA-C, Alexandria, Virginia; Susan M. Lett, MD, Boston, Massachusetts; Terri Murphy, RN, MSN, Durham, North Carolina; Robert Palinkas, MD, Urbana, Illinois; Gregory Poland, MD, Rochester, Minnesota; Joni Reynolds, MPH, Denver, Colorado; Laura E. Riley, MD, Boston, Massachusetts; William Schaffner, MD, Nashville, Tennessee; Kenneth Schmader, MD, Durham, North Carolina; Jonathan L. Temte, MD, PhD, Madison, Wisconsin; Richard Zimmerman, MD, MPH, Pittsburgh, Pennsylvania

Work Group Contributors: Elizabeth Briere, MD, MPH, Atlanta, Georgia; Amy Fiebelkorn, MSN, MPH, Atlanta, Georgia; Lisa Grohskopf, MD, MPH, Atlanta, Georgia; Craig Hales, MD, MPH, Atlanta, Georgia; Rafael Harpaz, MD, MPH, Atlanta, Georgia; Charles LeBaron, MD, Atlanta, Georgia; Jennifer L. Liang, DVM, MPVM, Atlanta, Georgia; Jessica MacNeil, MPH, Atlanta, Georgia; Lauri Markowitz, MD, Atlanta, Georgia; Matthew Moore, MD, Atlanta, Georgia; Tamara Pilishvili, MPH, Atlanta, Georgia; Sarah Schillie, MD, Atlanta, Georgia; Raymond A. Strikas, MD, MPH, Atlanta, Georgia; Walter W. Williams, MD, MPH, Atlanta, Georgia

Work Group Consultants: Diane Peterson, Saint Paul, Minnesota; Litjen Tan, PhD, Chicago, Illinois

Work Group Secretariat: Carolyn B. Bridges, MD, Atlanta, Georgia

Financial Disclosures/Conflicts of Interest

To assure the integrity of the Advisory Committee on Immunization Practices (ACIP), the U.S. Department of Health and Human Services has taken steps to assure that there is technical adherence to ethics statutes and regulations regarding financial conflicts of interest. Concerns regarding the potential for the appearance of a conflict are addressed, or avoided altogether, through both pre- and postappointment considerations. Individuals with particular vaccine-related interests will not be considered for appointment to the committee. Potential nominees are screened for conflicts of interest, and if any are found, they are asked to divest or forgo certain vaccine-related activities. In addition, at the beginning of each ACIP meeting, each member is asked to declare his or her conflicts. Members with conflicts are not permitted to vote if the conflict involves the vaccine or biological being voted on. Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-2826 External Web Site Policy.

Guideline Status

This is the current release of the guideline.

This guideline updates previous versions: Advisory Committee on Immunization Practices. Recommended adult immunization schedule: United States, 2013. Ann Intern Med. 2013 Feb 5;158(3):191-9.

Centers for Disease Control and Prevention. Advisory Committee on Immunization Practices (ACIP) recommended immunization schedule for adults aged 19 years and older -- United States, 2013. MMWR Morb Mortal Wkly Rep. 2013 Feb 1;62(Suppl 1):9-19.

Guideline Availability

Electronic copies: Available from the Centers for Disease Control and Prevention (CDC) Web site External Web Site Policy and the Annals of Internal Medicine Web site External Web Site Policy.

Print copies: Available from the Centers for Disease Control and Prevention, MMWR, Atlanta, GA 30333. Additional copies can be purchased from the Superintendent of Documents, U.S. Government Printing Office, Washington, DC 20402-9325; (202) 783-3238.

Availability of Companion Documents

The following are available:

  • Centers for Disease Control and Prevention (CDC). New framework (GRADE) for development of evidence-based recommendations by the Advisory Committee on Immunization Practices. MMWR. 2012;61(18):327-327. Electronic copies: Available from the Centers for Disease Control and Prevention (CDC) Web site External Web Site Policy.
  • Ahmed F, Temte JL, Campos-Outcalt D, Schünemann HJ; ACIP Evidence Based Recommendations Work Group (EBRWG). Methods for developing evidence-based recommendations by the Advisory Committee on Immunization Practices (ACIP) of the U.S. Centers for Disease Control and Prevention (CDC). Vaccine. 2011 Nov 15;29(49):9171-6. Electronic copies: Available to subscribers from the Vaccine Web site External Web Site Policy.
  • Smith JC, Snider DE, Pickering LK; Advisory Committee on Immunization Practices. Immunization policy development in the United States: the role of the Advisory Committee on Immunization Practices. Ann Intern Med. 2009 Jan 6;150(1):45-9. Electronic copies: Available from the Annals of Internal Medicine Web site External Web Site Policy.

The following are also available:

  • 2014 adult immunization schedule (vaccines recommended for adults 19 years of age and older). Electronic copies: Available in Portable Document Format (PDF), as well as a variety of formats, including pocket-size and smartphone download, from the CDC Web site External Web Site Policy.
  • Advisory Committee on Immunization Practices (ACIP) recommendation statements for specific vaccines are available in PDF from the CDC Web site External Web Site Policy.

A variety of resources for healthcare professionals and providers, including vaccine record forms; information on vaccine storage, handling, and administration; and immunization education and training are available from the CDC Web site External Web Site Policy. Information is also available in Spanish External Web Site Policy. Flyers and brochures for practice/patients are also available from the CDC Web site External Web Site Policy.

Patient Resources

The following is available:

Various tools for adults, including a personalized immunization scheduler tool, a vaccination screening form, and a vaccine quiz are available from the CDC Web site External Web Site Policy. Flyers and brochures are also available from the CDC Web site External Web Site Policy.

Additional resources and information on immunization for pregnant women are available from the CDC Web site External Web Site Policy.

Please note: This patient information is intended to provide health professionals with information to share with their patients to help them better understand their health and their diagnosed disorders. By providing access to this patient information, it is not the intention of NGC to provide specific medical advice for particular patients. Rather we urge patients and their representatives to review this material and then to consult with a licensed health professional for evaluation of treatment options suitable for them as well as for diagnosis and answers to their personal medical questions. This patient information has been derived and prepared from a guideline for health care professionals included on NGC by the authors or publishers of that original guideline. The patient information is not reviewed by NGC to establish whether or not it accurately reflects the original guideline's content.

NGC Status

This NGC summary was completed by ECRI Institute on February 20, 2008. This NGC summary was updated by ECRI Institute on March 5, 2010, March 30, 2011, July 6, 2012, March 7, 2013, and on February 24, 2014.

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