Vaccinations

Vaccinations in Adults
Vaccines are recommended for adults on the basis of their age, prior vaccinations, health conditions, lifestyle, occupation,
and travel.

COVID-19
Harmonization of the components of COVID-19 mRNA and protein-based vaccines was recommended in 2023 by the
FDA Vaccines.
Primary series
• 2-dose series at 0, 4-8 weeks ( monovalent Moderna) or 2-dose series at 1, 3-8 weeks
( Novavax, monovalent Pfizer)
Moderately or severely immunocompromised
• 3-dose series at 0, 4, 8 weeks (Moderna) or at 0, 3, 7 weeks (Pfizer)
• 2-dose series at 0, 3 weeks (Novavax)
Booster
Bivalent mRNA vaccines (bivalent Moderna, bivalent Pfizer)
• Monovalent mRNA vaccines are not authorized as a booster dose
• Administer at least 2 months after completion of the primary series (for people who have not received any
booster doses), or at least 2 months after the last monovalent booster dose
Monovalent vaccine (Novavax) in limited situations
• Adults who have completed primary vaccination using any COVID-19 vaccine and have not received any
previous booster dose(s) may receive a monovalent Novavax booster dose at least 6 months after
completion of the primary series if they are unable (ie, contraindicated or not available) or unwilling to
receive an mRNA vaccine and would otherwise not receive a booster dose
Influenza
1 dose annually
• Influenza virus vaccine quadrivalent
• Influenza virus vaccine quadrivalent, intranasal
• Influenza virus vaccine quadrivalent, recombinant
• Influenza virus vaccine quadrivalent, cell-cultured
• Influenza virus vaccine quadrivalent, adjuvanted
Various influenza vaccines have been approved that are directed toward patients with egg allergy (eg, Flucelvax, Flublok)
and for elderly adults to provide a stronger immune response (eg, Fluzone High-Dose, Fluad).
Adults with a history of egg allergy who have only hives after exposure to egg should receive age-appropriate inactivated
influenza (IIV) or recombinant influenza vaccine (RIV). Adults with a history of egg allergy with symptoms other than hives
(eg, angioedema, respiratory distress, lightheadedness, recurrent emesis, or who required epinephrine or other
emergency intervention) may receive age-appropriate IIV or RIV. The selected vaccine should be administered in an
inpatient or outpatient medical setting and supervised by a healthcare provider who is able to recognize and manage
severe allergic conditions.
Tetanus, diphtheria, pertussis
Every 10 years
• Tetanus and reduced diphtheria toxoids/acellular pertussis vaccine (Tdap; Boostrix, Adacel)
• Regardless of the interval since receiving their last tetanus or diphtheria toxoid-containing vaccine, persons
aged 19 years or older who have never received a dose of Tdap should receive 1 dose of Tdap.
• To ensure continued protection against tetanus and diphtheria, booster doses of either Td or Tdap should
be administered every 10 years throughout life.
• Diphtheria and tetanus toxoids (Td)
Varicella
2 doses for adults without evidence of immunity
• Varicella virus vaccine live
Measles, mumps, rubella (M-M-R II, Priorix)
One or 2 doses should be documented for adults born after 1957.
• Adults aged 19-59 years: 0.5 mL SC; administer a second dose 28 days later for high-risk adults
 • Adults aged 50 years or older: 0.5 mL SC; administer one dose only
• Additional dose during mumps outbreak: During an outbreak, persons identified as being at increased risk
who have received 2 or fewer doses of mumps virus–containing vaccine or have unknown vaccination
status should receive 1 dose
• Measles mumps and rubella vaccine, live
Human papillomavirus 9-valent (HPV)
The recommendations for the HPV 9-valent vaccine:
• Adolescents and adults aged 15-26 years: 2-3 doses (depending on vaccination history) if immunization
series was not completed during childhood (ie, age 9-14 years) [5]
• Adults aged 27-45 years: Need for vaccination based on shared decision making between patient and
clinician
• Human papillomavirus vaccine, nonavalent
Zoster
Two doses of recombinant zoster vaccine (RZV)
• ACIP recommendations:
• Administer two doses of RZV (Shingrix) 2-6 months apart to adults aged 50 years or older regardless of
past episode of herpes zoster or receipt of ZVL (Zostavax)
• Adults younger than 50 years with immunocompromising conditions should receive 2 doses
• Zoster vaccine recombinant
Pneumococcal vaccines
The recommendations for pneumococcal vaccines:
• Aged 50 years and older: 1 dose PCV15 or 1 dose PCV20
• If PCV15 is administered, follow with a dose of PPSV23 given at least 1 year after the PCV15 dose
• A minimum interval of 8 weeks between PCV15 and PPSV23 can be considered for adults with an
immunocompromising condition, cochlear implant, or cerebrospinal fluid leak to minimize the risk for
invasive pneumococcal disease caused by serotypes unique to PPSV23 in these vulnerable groups
• Adults aged 19-64: ACIP guidelines recommend use for adults with immunocompromising conditions,
cerebrospinal fluid leak, or cochlear implant.
• Pneumococcal vaccine 20-valent (PCV20 once, OR
• Pneumococcal vaccine 15-valent (PCV14) once plus Pneumococcal vaccine polyvalent (PPSV23)
administered 1 year after PCV15
Additional vaccines that may be recommended in adults depending on risk factors and vaccination history
Polio (IPV)
Routine poliovirus vaccination of adults residing in the United States is not necessary.
Adults at increased risk for exposure to poliovirus with
• Polio vaccine inactivated
• No evidence of completed polio vaccination series (ie, at least 3 doses): Administer remaining doses (1, 2,
or 3 doses) to complete a 3-dose series
• Evidence of completed polio vaccination series (ie, at least 3 doses): May administer 1 lifetime IPV booster
Haemophilus influenza type b (Hib)
• Haemophilus influenzae type b vaccine
Meningococcal
• Meningococcal A C Y and W-135 diphtheria conjugate vaccine
• Meningococcal A C Y and W-135 polysaccharide vaccine combined
Hepatitis A and B
• Hepatitis A vaccine inactivated
• Hepatitis A/B vaccine
• Hepatitis B vaccine

Vaccinations in Infants and Children

All children from birth through age 6 years
The vaccines listed below are administered via intramuscular (IM) injection unless otherwise stated. IM administration in
the anterolateral thigh muscle is preferred in neonates, infants, and small children. IM administer in the deltoid muscle is
preferred in young children (eg, aged 4-6 years) who are of normal weight.
Hepatitis B vaccine (HepB)
• Minimum age: Birth
• 3 doses
• First dose of monovalent HepB before hospital discharge
• Second dose with monovalent or combination vaccine at age 1 or 2 months
• Third dose at age 6-18 months
• *If mother is HBsAg-positive, also administer hepatitis B immune globulin (HBIG) 0.5 mL within 12 hours of
birth
• *If mother’s HBsAg status is unknown, also administer HBIG to infants weighing < 2 kg within 12 hours of
birth; determine mother’s HBsAg status as soon as possible, and, if mother is HBsAg-positive, also
administer HBIG in infants weighing ≥2 kg as soon as possible, but no later than age 7 days
Rotavirus vaccine (RV)
• Minimum age: 6 weeks
• 2 or 3 doses administered orally
• If Rotarix is used, administer a 2-dose series at age 2 and 4 months
• If RotaTeq is used, administer a 3-dose series at age 2, 4, and 6 months
• If any dose in the series was RotaTeq or vaccine product is unknown for any dose in the series, a total of 3
doses of RV vaccine should be administered
Diphtheria, tetanus, acellular pertussis vaccine (DTaP)
• Minimum age: 6 weeks
• Doses at ages 2 months, 4 months, 6 months, and 12-15 months
• Final dose at age 4-6 years
• If the fourth-dose DTaP vaccine was administered 4 month or more after the third dose, at an appropriate
age, it can be counted as valid and need not be repeated after the recommended 6-month interval between
doses 3 and 4.
Haemophilus influenza type b vaccine (Hib)
• Minimum age: 6 weeks
• 2- or 3-dose primary series and 1 booster dose (dose 3 or 4 depending on vaccine used for primary series)
at age 12-15 months
• Doses at ages 2 months, 4 months, 6 months (brand dependent), and booster at 12-15 months
Pneumococcal vaccine 13-valent (PCV13) or pneumococcal vaccine 15-valent (PCV15)
• Minimum age: 6 weeks
• Doses at ages 2 months, 4 months, 6 months, and 12-15 months
The Advisory Committee on Immunization Practices (ACIP) provided recommendations on the pneumococcal
polysaccharide vaccine (PPSV23) and the pneumococcal conjugate vaccine (PCV13 or PCV15), summarized as follows:
• The ACIP currently recommends that a dose of PCV13 or PCV15 be followed by a dose of PPSV23 in
persons aged 2 years or older who are at high risk for pneumococcal disease because of underlying
medical conditions.
• Children with an immunocompromising condition or functional or anatomic asplenia should receive a
second dose of PPSV23 at least 5 years after the first PPSV23 dose.
Inactivated poliovirus vaccine (IPV)
• Minimum age: 6 weeks
• 4 doses administered IM (may administer SC or IM in deltoid in older children)
• Doses at ages 2 months, 4 months, 6-18 months, and age 4-6 years
COVID-19
Primary series
• Age 6 months-4 years: 2-dose series at 0, 4-8 weeks ( monovalent Moderna) or 3-dose series at 0, 3-8, 11-
16 weeks ( monovalent Pfizer); note – 3rd dose may be bivalent Pfizer vaccine
• Age 5-11 years: 2-dose series at 0, 4-8 weeks (Moderna) or 2-dose series at 0, 3-8 weeks (Pfizer)
• Age 12-18 years: 2-dose series at 0, 4-8 weeks (Moderna) or 2-dose series at 0, 3-8 weeks (Novavax,
Pfizer)
Moderately or severely immunocompromised
• Age 6 months-4 years: 3-dose series at 0, 4, 8 weeks (Moderna) or at 0, 3, 11 weeks (Pfizer)
• Age 5-11 years: 3-dose series at 0, 4, 8 weeks (Moderna) or at 0, 3, 7 weeks (Pfizer)
• Age 12-18 years: 3-dose series at 0, 4, 8 weeks (Moderna) or 2-dose series at 0, 3 weeks ( Novavax) or 3-
dose series at 0, 3, 7 weeks (Pfizer)
Booster
< 18 years: Monovalent mRNA or protein-based vaccines are not authorized as a booster dose
Bivalent mRNA vaccines (bivalent Moderna, bivalent Pfizer)
 • Aged 6 months and older: Are recommended to receive 1 bivalent mRNA booster dose after completion of
any FDA-approved or FDA-authorized primary series or previously received monovalent booster dose(s)
with the following
• Exception: Children 6 months-4 years who receive a 3-dose Pfizer primary series are not authorized to
receive a booster dose at this time regardless of which Pfizer vaccine (ie, a monovalent or bivalent) was
administered for the third primary series dose
Influenza vaccines
• Minimum age: 6 months
• Children aged 6 months to 8 years who are receiving their first influenza vaccination should receive 2 doses
(separated by at least 4 weeks) and then 1 dose in subsequent years
• Influenza virus vaccine quadrivalent
• Influenza virus vaccine quadrivalent, cell-cultured
Measles, mumps, and rubella vaccine (M-M-R II, Priorix)
• Minimum age: 12 months
• Administer by SC into the outer aspect of the arm
• Two dose series at ages 12-15 months and 4-6 years
Varicella virus vaccine
• Minimum age: 12 months
• Administer by SC injection into the outer aspect of the upper arm or the anterolateral thigh
• Two-dose series at ages 12-15 months and 4-6 years
Hepatitis A vaccine (HepA)
• Minimum age: 12 months
• Two-dose series beginning at ages 12-23 months; second dose is given 6-18 months later