What is a vaccine schedule?
A vaccine schedule is a list of recommended routine vaccines organized by recipient age or special medical condition. The Centers for Disease Control and Prevention (CDC) creates the vaccine schedules for the United States based on recommendations made by the Advisory Committee on Immunization Practices (ACIP). The ACIP meets three times a year to discuss the safety and effectiveness of vaccines and revises its recommendations. The CDC then updates the immunization schedules yearly based on the changes. The immunization schedules are also approved by multiple other medical organizations. The main purpose of publishing these schedules is to protect individuals of all ages from vaccine-preventable diseases.
What vaccines do I need? (for 18 years and older)
- Influenza
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- The influenza vaccine is recommended for individuals ages 18 and older and should be obtained annually. One can receive one of the following flu vaccine options: inactivated (IIV4), recombinant (RIV4), or live attenuated (LAIV4) (up to age 49).
- COVID-19
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- The COVID-19 vaccine is recommended for individuals ages 18 and older. The types of COVID-19 vaccines available are mRNA (Moderna and Pfizer-BioNTech), protein subunit (Novavax), and adenovius vector (Janssen). These vaccines usually consist of a primary series with two doses and a single dose booster with the exception of the adenovius vector vaccine which consists of a one dose primary series and a one dose booster (of Moderna or Pfizer). The adenovius vector vaccine is only recommended in certain situations. The newest booster vaccine formulation is bivalent as opposed to monovalent (manufactured by Moderna and Pfizer). This means that it protects against the original COVID-19 virus as well as the Omicron variant. It is recommended that individuals age 12 and older receive this bivalent booster if it has been at least two months since their last COVID-19 vaccine dose (final primary series dose or monovalent booster). Individuals who have received more than one monovalent booster should also receive a bivalent booster.
- Tetanus, diphtheria, pertussis (Tdap or Td)
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- The Tdap vaccine is recommended for individuals ages 19 and older. This vaccine consists of one Tdap dose followed by a Tdap or Td booster every 10 years.
- Measles, mumps, rubella (MMR)
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- The MMR vaccine is currently recommended for individuals ages 19 to 64 (born in 1957 or later). It consists of one or two doses depending on indication.
- Varicella (VAR)
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- The varicella vaccine is currently recommended for individuals ages 19 to 42 (born in 1980 or later). It consists of two doses.
- Zoster recombinant (RZV)
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- This shingles vaccine is recommended for individuals ages 50 and older. It consists of two doses.
- Human papillomavirus (HPV)
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- The HPV vaccine is recommended for individuals ages 19 to 26. It consists of two or three doses depending on recipient age at initial vaccination or special condition.
- Pneumococcal (PCV15, PCV20, PPSV23)
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- The pneumococcal vaccine is recommended for individuals ages 65 and older. There are two possible series one may receive. The first is one dose of PCV15 followed by PPSV23. The second is one dose of PCV20.
- Hepatitis B (HepB)
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- The HepB vaccine is recommended for individuals ages 19 to 59. It may consist of two, three, or four doses depending on the specific vaccine or recipient special condition.
Special Considerations
Some of the vaccine recommendations are different for individuals who have special medical conditions. The CDC has a different published vaccine schedule for these individuals. Vaccines may be recommended for certain conditions and not recommended on the original adult vaccine schedule. Vaccines can be contraindicated, meaning that the vaccine should not be administered to that individual. Others can have a precaution warning meaning the vaccine may be indicated when the benefits outweigh the risks for that individual. Vaccines can also be recommended based on shared clinical decision-making or presence of an additional risk factor.
- Heart disease, asthma, COPD, diabetes, end stage renal disease, hemodialysis, and chronic liver disease
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- Individuals with these conditions have a few differences in vaccine recommendations as compared to the original adult schedule. The LAIV4 flu vaccine has a precaution warning, however the IIV4 or RIV4 vaccine is still recommended. The hepatitis A (HepA) vaccine is recommended for individuals with chronic liver disease. It can consist of two or three doses depending on the specific vaccine. All other vaccines are recommended according to the original adult schedule.
- HIV
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- Recommendations for individuals with HIV are dependent on CD4 count (<15% or <200mm3; >15% and >200mm3). The LAIV4 flu vaccine is contraindicated for all HIV patients however the IIV4 or RIV4 vaccine is still recommended. The MMR vaccine is contraindicated for HIV patients with a CD4 count within the lower interval. The varicella vaccine is contraindicated for HIV patients with a CD4 count within the lower interval and is recommended based on shared clinical decision making for HIV patients with a CD4 count within the higher interval. The HepA vaccine is recommended for all HIV patients. The meningococcal (MenACWY) vaccine is also recommended for all HIV patients. It can consist of one or two doses depending on indication.
- Pregnancy
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- The vaccines that are contraindicated during pregnancy are LAIV4, MMR, VAR, and HPV. It is recommended that a woman who is pregnant receive one Tdap dose each pregnancy. Three doses of the HepB vaccine are recommended excluding the Heplisav-B vaccine, which is contraindicated.
Frequently Asked Questions
- Are vaccines safe?
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- Vaccines are very safe. The United States has a vaccine safety system to ensure that all vaccines are safe. The US currently has the safest vaccine supply in its history. Despite the COVID-19 vaccines being developed rapidly, they are equally as safe as older vaccines. Research and development of vaccines similar to the COVID-19 vaccines has been occurring for decades. The effectiveness and safety of these new vaccines were ensured by clinical trials, authorization, and vaccine monitoring systems.
- Can vaccines cause autism?
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- No. There is currently no research to prove a relationship between vaccines and autism.
- What are common side effects of vaccines?
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- The most common side effect is injection site pain or swelling. Individuals may also experience a low-grade fever. These effects only last a few days.
- Why should I get the COVID-19 vaccine if I might get COVID-19 anyway?
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- The COVID-19 vaccine significantly lowers the risk of severe illness, hospitalization, or death if infected with COVID-19. Unvaccinated individuals have a much higher risk of these situations than vaccinated individuals. Vaccinated individuals also have a decreased chance of spreading COVID-19 to other individuals.
- Why haven’t we gotten rid of most of the diseases in the United States?
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- The only two diseases to be eradicated due to vaccination are smallpox and rinderpest. Other diseases still remain present in the US in small quantities. If vaccination were to cease, these few cases would spread very quickly and could eventually lead to a pandemic. This is why it is important to get vaccinated. The more individuals who become vaccinated, the less serious diseases will spread.
Written By:
Sophie Orsulak
PharmD Candidate 2025
Philadelphia College of Pharmacy
Resources
Adult immunization schedule by vaccine and age group. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html. Published February 17, 2022. Accessed October 5, 2022.
Answers to your most common questions about childhood vaccines. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/parents/FAQs.html. Published July 7, 2022. Accessed October 5, 2022.
Frequently asked questions about covid-19 vaccination. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/faq.html. Published October 3, 2022. Accessed October 5, 2022.
Stay up to date with covid-19 vaccines including boosters. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html. Published October 4, 2022. Accessed October 5, 2022.
Vaccines indicated for adults based on medical indications. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/schedules/hcp/imz/adult-conditions.html#table-conditions. Published February 17, 2022. Accessed October 5, 2022.
Who sets the immunization schedule? Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/parents/schedules/sets-schedule.html. Published February 10, 2021. Accessed October 5, 2022.