Guide to Clinical Preventive Services, 2009: Appendix Table 5: Recommended Adult Immunization Schedule, by Vaccine and Medical and Other Indications

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Table 5: Vaccines That Might Be Indicated for Adults Based On Medical and Other Indications

United States, October 2007-September 2009

Vaccine	Indication
	Pregnancy	Immuno-compromising conditions (excluding human immunodeficiency virus [HIV])¹³	HIV infection^3,12,13 CD 4+ T lymphocyte count		Diabetes; heart disease; chronic pulmonary disease; chronic alcoholism	Asplenia¹² (including elective splenectomy and terminal complement component deficiencies)	Chronic liver disease	Kidney failure, end-stage renal disease, recipients of hemodialysis	Healthcare workers
	Pregnancy		< 200 cells/µL	> 200 cells/µL			Chronic liver disease		Healthcare workers
Tetanus, diphtheria, pertussis (Td/Tdap)^1,*		1-dose Td booster every 10 years^a
Tetanus, diphtheria, pertussis (Td/Tdap)^1,*		Substitute 1 dose of Tdap for Td
Human papillomavirus (HPV)^2,*		3 doses for females through age 26 years (0, 2, 6 months)^a
Varicella^3,*	Contraindicated			2 doses (0, 4-8 wks)^a
Zoster^4,*	Contraindicated			1 doses (0, 4-8 wks)^a
Measles, mumps, rubella (MMR)^5,*	Contraindicated			1 or 2 doses^a
Influenza^6,*	1 dose TIV annually^a								1 dose TIV or LAIV annually^a
Pneumococcal (polysaccharide)^{7, 8}	1-2 doses^b	1-2 doses^a							1-2 doses^b
Hepatitis A^9,*	2 doses (0, 6-12 months, or 0, 6-18 months)^b					2 doses (0, 6-12 months, or 0, 6-18 months)^a	2 doses (0, 6-12 months, or 0, 6-18 months)^b
Hepatitis B^10,*	3 doses (0, 1-2, 4-6 mos)^b		3 doses (0, 1-2, 4-6 mos)^a		3 doses (0, 1-2, 4-6 mos)^b			3 doses (0, 1-2, 4-6 mos)^a
Meningococcal^11,*	1 or more doses^b					1 or more doses^a	1 or more doses^b

* Covered by the Vaccine Injury Compensation Program.

Key

	^a For all persons in this category who meet the age requirements and who lack evidence of immunity (e.g., lack documentation of vaccination or have no evidence of prior infection).
	^b Recommended if some other risk factor is present (e.g., on the basis of medical, occupational, lifestyle, or other indications).

Note: These recommendations must be read along with the footnotes available at: http://www.cdc.gov/vaccines/recs/schedules/adult-schedule.htm.

These schedules indicate the recommended age groups and medical indications for which administration of currently licensed vaccines is commonly indicated for adults ages 19 years and older, as of January 1, 2009. Licensed combination vaccines may be used whenever any components of the combination are indicated and when the vaccine’s other components are not contraindicated. For detailed recommendations on all vaccines, including those used primarily for travelers or that are issued during the year, consult the manufacturers’ package inserts and the complete statements from the Advisory Committee on Immunization Practices (http://www.cdc.gov/vaccines/pubs/acip-list.htm).

The recommendations in this schedule were approved by the Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP), the American Academy of Family Physicians (AAFP), the American College of Obstetricians and Gynecologists (ACOG), and the American College of Physicians (ACP).

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