Recommended Adult Immunization Schedule UNITED STATES

for ages 19 years or older

Vaccines in the Adult Immunization Schedule*
2025
Vaccine Abbreviation(s) Trade name(s) How to use the adult immunization schedule
1 2 3 4
Comirnaty/Pfizer–BioNTech COVID–19 Vaccine
1vCOV–mRNA Determine Assess need Review vaccine Review
COVID–19 vaccine Spikevax/Moderna COVID–19 Vaccine
recommended for additional types, dosing contraindications
1vCOV–aPS Novavax COVID–19 Vaccine vaccinations by age recommended frequencies and and precautions
Haemophilus influenzae type b vaccine Hib ActHIB, Hiberix, PedvaxHIB (Table 1) vaccinations by intervals, and for vaccine types
medical condition considerations for (Appendix)
Hepatitis A vaccine HepA Havrix, Vaqta or other indication special situations
Hepatitis A and hepatitis B vaccine HepA–HepB Twinrix (Table 2) (Notes)
Engerix–B, Heplisav–B, PreHevbrio,
Hepatitis B vaccine HepB
Recombivax HB
Human papillomavirus vaccine HPV Gardasil 9
IIV3 Multiple
Report
y Suspected cases of reportable vaccine–preventable diseases or outbreaks to
Influenza vaccine (inactivated, egg-based) aIIV3 Fluad the local or state health department
HD–IIV3 Fluzone High–Dose
y Clinically significant adverse events to the Vaccine Adverse Event Reporting System at
www.vaers.hhs.gov or 800‑822‑7967
Influenza vaccine (inactivated, cell–culture) ccIIV3 Flucelvax
Influenza vaccine (recombinant) RIV3 Flublok
Questions or comments
Contact www.cdc.gov/cdc–info or 800-CDC-INFO (800-232-4636), in English or Spanish,
Influenza vaccine (live, attenuated) LAIV3 FluMist 8 a.m.–8 p.m. ET, Monday through Friday, excluding holidays.
Measles, mumps, and rubella vaccine MMR M–M–R II, Priorix
Download the CDC Vaccine Schedules app for providers at
MenACWY–CRM Menveo www.cdc.gov/vaccines/hcp/imz-schedules/app.html.
Meningococcal serogroups A, C, W, Y vaccine
MenACWY–TT MenQuadfi
MenB–4C Bexsero Helpful information
Meningococcal serogroup B vaccine y Complete Advisory Committee on Immunization Practices (ACIP) recommendations:
MenB–FHbp Trumenba www.cdc.gov/acip-recs/hcp/vaccine-specific/
MenACWY–TT/ y ACIP Shared Clinical Decision–Making Recommendations:
Meningococcal serogroup A, B, C, W, Y vaccine Penbraya
MenB–FHbp www.cdc.gov/acip/vaccine-recommendations/shared-clinical-decision-making.html
Mpox vaccine Mpox Jynneos y General Best Practice Guidelines for Immunization
www.cdc.gov/vaccines/hcp/acip–recs/general–recs/index.html
PCV15 Vaxneuvance y Vaccine information statements: www.cdc.gov/vaccines/hcp/vis/index.html
Pneumococcal conjugate vaccine PCV20 Prevnar 20 y Manual for the Surveillance of Vaccine–Preventable Diseases
PCV21 Capvaxive (including case identification and outbreak response):
www.cdc.gov/surv-manual/php/index.html
Pneumococcal polysaccharide vaccine PPSV23 Pneumovax 23
Poliovirus vaccine (inactivated) IPV Ipol
Respiratory syncytial virus vaccine RSV Abrysvo, Arexvy, mResvia
Tetanus and diphtheria vaccine Td Tenivac Scan QR code
Tetanus, diphtheria, and acellular pertussis for access to
Tdap Adacel, Boostrix online schedule
vaccine
Varicella vaccine VAR Varivax
Zoster vaccine, recombinant RZV Shingrix
*Administer recommended vaccines if vaccination history is incomplete or unknown.
Do not restart or add doses to vaccine series if there are extended intervals between doses.
The use of trade names is for identification purposes only and does not imply endorsement by the ACIP or CDC.
CS310021–E
Revised 07/02/2025
Table 1 Recommended Adult Immunization Schedule by Age Group, United States, 2025

Vaccine 19–26 years 27–49 years 50–64 years ≥65 years

2 or more doses of 2024-2025
COVID–19 1 or more doses of 2024–2025 vaccine (See Notes)
vaccine (See Notes)

Influenza inactivated (IIV3, ccIIV3)

1 dose annually
Influenza recombinant (RIV3)
1 dose annually
(HD–IIV3, RIV3, or aIIV3 preferred)
Influenza inactivated (aIIV3; HD–IIV3)
Solid organ transplant (See Notes)
Influenza recombinant (RIV3)

Influenza live, attenuated

1 dose annually
(LAIV3)

Respiratory syncytial virus 60 through 74 years

Seasonal administration during pregnancy (See Notes) ≥75 years
(RSV) (See Notes)

Tetanus, diphtheria, pertussis 1 dose Tdap each pregnancy; 1 dose Td/Tdap for wound management (See Notes)
(Tdap or Td) 1 dose Tdap, then Td or Tdap booster every 10 years
Measles, mumps, rubella 1 or 2 doses depending on indication For health care personnel
(MMR) (if born in 1957 or later) (See Notes)

Varicella 2 doses
2 doses
(VAR) (if born in 1980 or later)

Zoster recombinant
2 doses for immunocompromising conditions (See Notes) 2 doses
(RZV)

Human papillomavirus 2 or 3 doses depending on age at

27 through 45 years
(HPV) initial vaccination or condition

Pneumococcal See Notes

(PCV15, PCV20, PCV21, PPSV23) See Notes
Hepatitis A
2, 3, or 4 doses depending on vaccine
(HepA)

Hepatitis B
(HepB) 2, 3, or 4 doses depending on vaccine or 2,
condition
3, or 4 doses depending on vaccine or condition

Meningococcal A, C, W, Y
1 or 2 doses depending on indication (See Notes for booster recommendations)
(MenACWY)

Meningococcal B
2 or 3 doses depending on vaccine and indication (See Notes for booster recommendations)
(MenB) 19 through 23 years
Haemophilus influenzae type b
1 or 3 doses depending on indication
(Hib)

Mpox 2 doses

Inactivated poliovirus
Complete 3-dose series if incompletely vaccinated. Self–report of previous doses acceptable (See Notes)
(IPV)

  ecommended vaccination for adults who meet age requirement,

R
lack documentation of vaccination, or lack evidence of immunity  Recommended vaccination for adults with an
additional risk factor or another indication  Recommended vaccination based on shared
clinical decision–making  No Guidance/
Not Applicable

Page 2
 Table 2 Recommended Adult Immunization Schedule by Medical Condition or Other Indication, United States, 2025
Always use this table in conjunction with Table 1 and the Notes that follow. Medical conditions or indications are often not mutually exclusive. If multiple medical conditions or indications are present, refer to
guidance in all relevant columns. See Notes for medical conditions or indications not listed.
HIV infection CD4
Kidney failure,
percentage and count
Immunocompromised Asplenia, End–stage Chronic liver
(excluding HIV <15% or ≥15% and Men who have sex complement Heart or lung renal disease disease; Health care
VACCINE Pregnancy infection) <200/mm3 ≥200/mm3 with men deficiency disease or on dialysis alcoholisma Diabetes Personnelb

COVID–19 See Notes

Influenza inactivated Solid organ transplant

1 dose annually
Influenza recombinant (See Notes)
1 dose annually
LAIV3 1 dose annually if age 19–49 years
if age 19–49 years
Seasonal
Liver disease
RSV administration See Notes See Notes See Notes
(See Notes)
(See Notes)
Tdap: 1 dose each
Tdap or Td 1 dose Tdap, then Td or Tdap booster every 10 years
pregnancy

MMR *

VAR * See Notes

RZV See Notes

HPV * 3-dose series if indicated

Pneumococcal

HepA

Hep B See Notes

Age ≥ 60 years

MenACWY

MenB

Asplenia:
Hib HSCT: 3 dosesc
1 dose

Mpox See Notes See Notes See Notes

IPV Complete 3-dose series if incompletely vaccinated. Self–report of previous doses acceptable (See Notes)

      
Recommended for all adults Not recommended for all Recommended vaccination Recommended for all adults, Precaution: Might be Contraindicated or not No Guidance/
who lack documentation of adults, but recommended based on shared clinical and additional doses may be indicated if benefit of recommended Not Applicable
vaccination, OR lack evidence for some adults based on decision–making necessary based on medical protection outweighs *Vaccinate after pregnancy,
of immunity either age OR increased condition or other indications. risk of adverse reaction if indicated
risk for or severe outcomes See Notes.
from disease

a. Precaution for LAIV3 does not apply to alcoholism. b. See Notes for influenza; hepatitis B; measles, mumps, and rubella; and varicella vaccinations. c. Hematopoietic stem cell transplant.

Page 3
 Notes Recommended Adult Immunization Schedule for Ages 19 Years or Older, United States, 2025
For vaccination recommendations for persons ages COVID–19 vaccination
18 years or younger, see the Recommended Child and
Adolescent Immunization Schedule, 2025: www.cdc.gov/ Routine vaccination Special situations
vaccines/hcp/imz-schedules/child-adolescent-age.html Age 19–64 years (not pregnant) Persons who are moderately or severely
y Unvaccinated: immunocompromised. Use vaccine from the same
Additional Information
manufacturer for all doses in the initial vaccination series.
y For calculating intervals between doses, 4 weeks = - 1 dose 2024–25 Moderna or Pfizer-BioNTech
28 days. Intervals of ≥4 months are determined by - 2 doses 2024–25 Novavax at 0, 3–8 weeks y Unvaccinated:
calendar months. - 4 doses (3-dose initial series 2024–25 Moderna
y Previously vaccinated before 2024–25 vaccine with:
y Within a number range (e.g., 12–18), a dash (–) should at 0, 4 weeks, and at least 4 weeks after dose 2,
- 1 or more doses Moderna or Pfizer-BioNTech: 1 dose
be read as “through.” followed by 1 dose 2024–25 Moderna or Novavax or
2024–25 Moderna or Novavax or Pfizer-BioNTech at Pfizer-BioNTech 6 months later [minimum interval
y Vaccine doses administered ≤4 days before the least 8 weeks after the most recent dose.
minimum age or interval are considered valid. Doses 2 months]). May administer additional doses.*
- 1 dose Novavax: 1 dose 2024–25 Novavax 3–8 weeks
of any vaccine administered ≥5 days earlier than the - 4 doses (3-dose initial series 2024–25 Pfizer-
minimum age or minimum interval should not be after most recent dose. If more than 8 weeks after BioNTech at 0, 3 weeks, and at least 4 weeks after
counted as valid and should be repeated. The repeat most recent dose, administer 1 dose 2024–25 dose 2, followed by 1 dose 2024–25 Moderna or
dose should be spaced after the invalid dose by the Moderna or Novavax or Pfizer-BioNTech. Novavax or Pfizer-BioNTech 6 months later [minimum
recommended minimum interval. For further details, - 2 or more doses Novavax: 1 dose 2024–25 Moderna interval 2 months]). May administer additional
see Table 3–2, Recommended and minimum ages or Novavax or Pfizer-BioNTech at least 8 weeks after doses.*
and intervals between vaccine doses, in General Best the most recent dose. - 3 doses (2-dose initial series 2024–25 Novavax at
Practice Guidelines for Immunization at www.cdc.gov/ - 1 or more doses Janssen: 1 dose 2024–25 Moderna
vaccines/hcp/acip–recs/general–recs/timing.html. 0, 3 weeks, followed by 1 dose Moderna or Novavax
or Novavax or Pfizer-BioNTech. or Pfizer-BioNTech 6 months later [minimum interval
y Information on travel vaccination requirements and
Age 65 years and older 2 months]). May administer additional doses.*
recommendations is available at www.cdc.gov/travel/.
y Unvaccinated: follow recommendations above y Incomplete initial vaccination series before
y For vaccination of persons with immunodeficiencies,
see Table 8–1, Vaccination of persons with primary for unvaccinated persons ages 19–64 years and 2024–25 vaccine:
and secondary immunodeficiencies, in General administer dose 2 of 2024–25 Moderna or Novavax - Previous vaccination with Moderna
Best Practice Guidelines for Immunization at www. or Pfizer-BioNTech 6 months later (minimum interval  1 dose Moderna: complete initial series with
cdc.gov/vaccines/hcp/acip–recs/general–recs/ 2 months). 2 doses 2024–25 Moderna at least 4 weeks apart
immunocompetence.html (administer dose 1 4 weeks after most recent dose),
y Previously vaccinated before 2024–25 vaccine:
y For information about vaccination in the setting of a follow recommendations above for previously followed by 1 dose 2024–25 Moderna or Novavax or
vaccine–preventable disease outbreak, contact your vaccinated persons ages 19–64 years and administer Pfizer-BioNTech 6 months later (minimum interval
state or local health department. dose 2 of 2024–25 Moderna or Novavax or Pfizer- 2 months). May administer additional doses.*
y The National Vaccine Injury Compensation Program BioNTech 6 months later (minimum interval 2 months).  2 doses Moderna: complete initial series with
(VICP) is a no–fault alternative to the traditional 1 dose 2024–25 Moderna at least 4 weeks after
legal system for resolving vaccine injury claims. All most recent dose, followed by 1 dose 2024–25
vaccines included in the adult immunization schedule Moderna or Novavax or Pfizer-BioNTech 6 months
except PPSV23, RSV, RZV, Mpox, and COVID–19
later (minimum interval 2 months). May administer
vaccines are covered by the National Vaccine Injury
Compensation Program (VICP). Mpox and COVID–19 additional doses.*
vaccines are covered by the Countermeasures Injury
Compensation Program (CICP). For more information,
see www.hrsa.gov/vaccinecompensation or www.
hrsa.gov/cicp.
Page 4
 Notes Recommended Adult Immunization Schedule for Ages 19 Years or Older, United States, 2025
COVID-19 vaccination - continued Hepatitis A vaccination
- Previous vaccination with Pfizer-BioNTech *Additional doses of 2024–25 COVID-19 vaccine Routine vaccination
 1 dose Pfizer-BioNTech: complete initial series for moderately or severely immunocompromised: y Any person who is not fully vaccinated and requests
with 2 doses 2024–25 Pfizer-BioNTech at least based on shared clinical decision-making and vaccination (identification of risk factor not required):
4 weeks apart (administer dose 1 3 weeks after administered at least 2 months after the most recent complete 2-dose series HepA (Havrix 6–12 months
most recent dose), followed by 1 dose 2024–25 dose (see Table 2 at www.cdc.gov/vaccines/covid-19/ apart or Vaqta 6–18 months apart [minimum interval:
Moderna or Novavax or Pfizer-BioNTech 6 months clinical-considerations/interim-considerations-us. 6 months]) or 3-dose series HepA–HepB (Twinrix at 0,
later (minimum interval 2 months). May administer html#table-02.). For description of moderate and 1, 6 months [minimum intervals: dose 1 to dose 2 =
additional doses.* severe immunocompromising conditions and 4 weeks; dose 2 to dose 3 = 5 months])
 2 doses Pfizer-BioNTech: complete initial series with treatment, see www.cdc.gov/vaccines/covid-19/
Special situations
1 dose 2024–25 Pfizer-BioNTech at least 4 weeks clinical-considerations/interim-considerations-us.
html#immunocompromising-conditions-treatment. y Any person who is not fully vaccinated and who is at
after most recent dose, followed by 1 dose 2024–25
risk for hepatitis A virus infection or severe disease
Moderna or Novavax or Pfizer-BioNTech 6 months Unvaccinated persons have never received any
from hepatitis A virus infection: complete 2-dose
later (minimum interval 2 months). May administer COVID-19 vaccine doses. There is no preferential
series HepA or 3-dose series HepA–HepB as above.
additional doses.* recommendation for the use of one COVID-19 vaccine
Risk factors include:
- Previous vaccination with Novavax over another when more than one recommended age-
- Chronic liver disease including persons with
 1 dose Novavax: complete initial series with appropriate vaccine is available. Administer an age-
appropriate COVID-19 vaccine product for each dose. hepatitis B, hepatitis C, cirrhosis, fatty liver disease,
1 dose 2024–25 Novavax at least 3 weeks after alcoholic liver disease, autoimmune hepatitis, alanine
most recent dose, followed by 1 dose 2024–25 For information about interchangeability of COVID-19 aminotransferase (ALT) or aspartate aminotransferase
Moderna or Novavax or Pfizer-BioNTech 6 months vaccines, see wcms-wp.cdc.gov/vaccines/covid-19/ (AST) level greater than twice the upper limit of
later (minimum interval 2 months). May administer clinical-considerations/interim-considerations-us. normal.
additional doses.* html#Interchangeability.
- HIV infection
y Completed the initial vaccination series before Current COVID-19 schedule and dosage formulation - Men who have sex with men
2024–25 vaccine with: available at www.cdc.gov/covidschedule. For more
- Injection or noninjection drug use
- 3 or more doses Moderna or 3 or more doses Pfizer- information on Emergency Use Authorization (EUA)
- Persons experiencing homelessness
BioNTech: 2 doses 2024–25 Moderna or Novavax or indications for COVID-19 vaccines, see www.fda.gov/
emergency-preparedness-and-response/coronavirus- - Work with hepatitis A virus in research laboratory
Pfizer-BioNTech 6 months apart (minimum interval
2 months). Administer dose 1 at least 8 weeks after disease-2019-covid-19/covid-19-vaccines. or with nonhuman primates with hepatitis A
the most recent dose. May administer additional virus infection
doses.* Haemophilus influenzae type b vaccination - Travel in countries with high or intermediate
- 2 or more doses Novavax: 2 doses 2024–25 Moderna
endemic hepatitis A: HepA–HepB (Twinrix) may be
Special situations
or Novavax or Pfizer-BioNTech 6 months apart administered on an accelerated schedule of 3 doses
y Anatomical or functional asplenia (including sickle at 0, 7, and 21–30 days, followed by a booster dose
(minimum interval 2 months). Administer dose cell disease): 1 dose if previously did not receive Hib
1 at least 8 weeks after the most recent dose. May at 12 months.
vaccine - Close, personal contact with international adoptee
administer additional doses.*
- Elective splenectomy: 1 dose preferably at least (e.g., household or regular babysitting) in first 60 days
14 days before splenectomy after arrival from country with high or intermediate
y Hematopoietic stem cell transplant (HSCT): endemic hepatitis A: dose 1 as soon as adoption
3-dose series 4 weeks apart starting 6–12 months is planned; preferably at least 2 weeks before
after successful transplant, regardless of Hib adoptee’s arrival.
vaccination history
Page 5
 Notes Recommended Adult Immunization Schedule for Ages 19 Years or Older, United States, 2025

Hepatitis A vaccination - continued Hepatitis B vaccination

- Pregnancy if at risk for infection or severe outcome Routine vaccination  Current or recent injection drug use
from infection during pregnancy y Age 19 through 59 years: complete a 2- or 3- or  Percutaneous or mucosal risk for exposure to
- Settings for exposure, including health care setting 4-dose series blood e.g., household contacts of HBsAg–positive
serving persons who use injection or noninjection - 2-dose series only applies when 2 doses of persons, residents and staff of facilities for
drugs, or group homes and nonresidential day care Heplisav–B are used at least 4 weeks apart developmentally disabled persons, health care and
facilities for developmentally disabled persons - 3-dose series Engerix–B, PreHevbrio*, or Recombivax public safety personnel with reasonably anticipated
(individual risk factor screening not required) HB at 0, 1, 6 months (minimum intervals: dose 1 to risk for exposure to blood or blood–contaminated
dose 2 = 4 weeks; dose 2 to dose 3 = 8 weeks; dose 1 body fluids, persons on maintenance dialysis
to dose 3 = 16 weeks) (including in–center or home hemodialysis and
- 3-dose series HepA–HepB (Twinrix) at 0, 1, 6 months peritoneal dialysis), persons who are predialysis,
(minimum intervals: dose 1 to dose 2 = 4 weeks; dose and patients with diabetes**
2 to dose 3 = 5 months)  Incarceration
- 4-dose series HepA–HepB (Twinrix) accelerated  Travel in countries with high or intermediate
schedule of 3 doses at 0, 7, and 21–30 days, followed endemic hepatitis B
by a booster dose at 12 months **Age 60 years or older with diabetes: Based on
*Note: PreHevbrio is not recommended in pregnancy shared clinical decision making, 2-, 3-, or 4-dose series
due to lack of safety data in pregnant women. as above.
y Age 60 years or older without known risk factors Special situations
for hepatitis B virus infection may receive a HepB y Patients on dialysis: complete a 3- or 4-dose series
vaccine series. - 3-dose series Recombivax HB at 0, 1, 6 months
y Age 60 years or older with known risk factors for (Note: Use Dialysis Formulation 1 mL = 40 mcg)
hepatitis B virus infection should receive a HepB - 4-dose series Engerix–B at 0, 1, 2, and 6 months
WHITE SPACE vaccine series. (Note: Use 2 mL dose instead of the normal adult
INTENTIONALLY y Any adult age 60 years of age or older who requests
dose of 1 mL)
LEFT BLANK HepB vaccination should receive a HepB vaccine series. y Age 20 years or older with an immunocompromising
- Risk factors for hepatitis B virus infection include: condition: complete a 2- or 3- or 4-dose series.
 Chronic liver disease including persons - 3-dose series Recombivax HB at 0,1, 6 months
with hepatitis C, cirrhosis, fatty liver disease, (Note: Use Dialysis Formulation 1ml = 40 mcg)
alcoholic liver disease, autoimmune hepatitis, - 4-dose series Engerix–B at 0,1,2, and 6 months
alanine aminotransferase (ALT) or aspartate (Note: Use 2mL dose instead of the normal adult
aminotransferase (AST) level greater than twice the dose of 1mL)
upper limit of normal. - 2-doses series Heplisav–B at 0, 1 months
 HIV infection - 3-dose series PreHevbrio* at 0,1, 6 months
 Sexual exposure risk e.g., sex partners of hepatitis B
surface antigen (HBsAg)–positive persons, sexually
active persons not in mutually monogamous
relationships, persons seeking evaluation or
treatment for a sexually transmitted infection,
men who have sex with men
Page 6
 Notes Recommended Adult Immunization Schedule for Ages 19 Years or Older, United States, 2025

Human papillomavirus vaccination Influenza vaccination Measles, mumps, and rubella vaccination
Routine vaccination Routine vaccination Routine vaccination
y All persons through age 26 years: complete 2– or y Age 19 years or older: 1 dose any influenza vaccine y No evidence of immunity to measles, mumps, or
3-dose series depending on age at initial vaccination appropriate for age and health status annually rubella: 1 dose
or condition. - Solid organ transplant recipients aged 19 - Evidence of immunity: Born before 1957 (except for
- Age 9–14 years at initial vaccination and received through 64 years receiving immunosuppressive health care personnel, see below), documentation
1 dose or 2 doses less than 5 months apart: medications: HD–IIV3 and aIIV3 are acceptable of receipt of MMR vaccine, laboratory evidence of
1 additional dose options. No preference over other age–appropriate immunity or disease (diagnosis of disease without
- Age 9–14 years at initial vaccination and received IIV3 or RIV3. laboratory confirmation is not evidence of immunity)
2 doses at least 5 months apart: HPV vaccination - Age 65 years or older: Any one of HD-IIV3, RIV3, or Special situations
series complete, no additional dose needed aIIV3 is preferred. If none of these three vaccines is y Pregnancy with no evidence of immunity to rubella:
- Age 15 years or older at initial vaccination: 3-dose available, then any other age–appropriate influenza MMR contraindicated during pregnancy; after
series at 0, 1–2 months, 6 months (minimum vaccine should be used. pregnancy (before discharge from health care facility):
intervals: dose 1 to dose 2 = 4 weeks; dose 2 to dose y For the 2024–25 season, see www.cdc.gov/mmwr/ 1 dose
3 = 12 weeks; dose 1 to dose 3 = 5 months; repeat volumes/73/rr/rr7305a1.htm y Nonpregnant women of childbearing age with no
dose if administered too soon)
y For the 2025–26 season, see the 2025–26 ACIP evidence of immunity to rubella: 1 dose
y No additional dose recommended when any HPV influenza vaccine recommendations. y HIV infection with CD4 percentages ≥15% and CD4
vaccine series of any valency has been completed Special situations count ≥200 cells/mm3 for at least 6 months and no
using the recommended dosing intervals.
y Close contacts (e.g., caregivers, healthcare evidence of immunity to measles, mumps, or rubella:
Shared clinical decision–making workers) of severely immunosuppressed persons complete 2-dose series at least 4 weeks apart; MMR
y Adults age 27–45 years: Based on shared clinical who require a protected environment: should not contraindicated for HIV infection with CD4 percentage
decision–making, complete a 2-dose series (if initiated receive LAIV3. If LAIV3 is given, they should avoid <15% or CD4 count <200 cells/mm3
age 9–14 years) or 3-dose series (if initiated ≥15 years). contact with/caring for such immunosuppressed y Severe immunocompromising conditions:
For additional information on shared clinical decision– persons for 7 days after vaccination. MMR contraindicated
making for HPV; see www.cdc.gov/vaccines/hcp/admin/ Note: Persons with an egg allergy can receive any y Students in postsecondary educational institutions,
downloads/isd–job–aid–scdm–hpv–shared–clinical– influenza vaccine (egg-based or non–egg based) international travelers, and household or close,
decision–making–hpv.pdf appropriate for age and health status. personal contacts of immunocompromised persons
Special situations with no evidence of immunity to measles, mumps,
y Age ranges recommended above for routine and or rubella: complete 2-dose series at least 4 weeks
catch–up vaccination or shared clinical decision– apart if previously did not receive any doses of MMR
making also apply in special situations or 1 dose if previously received 1 dose MMR
- Immunocompromising conditions, including HIV y In mumps outbreak settings, for information about
infection: complete 3-dose series, even for those additional doses of MMR (including 3rd dose of MMR), see
WHITE SPACE
who initiate vaccination at age 9 through 14 years. www.cdc.gov/mmwr/volumes/67/wr/mm6701a7.htm
INTENTIONALLY
- Pregnancy: Pregnancy testing is not needed before
vaccination. HPV vaccination is not recommended LEFT BLANK
until after pregnancy. No intervention needed if
inadvertently vaccinated while pregnant.

Page 7
 Notes Recommended Adult Immunization Schedule for Ages 19 Years or Older, United States, 2025

Measles, mumps, and rubella vaccination Meningococcal vaccination

- continued
Special situations for MenACWY Special situations for MenB
y Health care personnel: y Anatomical or functional asplenia (including sickle y Anatomical or functional asplenia (including sickle
- Born before 1957 with no evidence of immunity cell disease), HIV infection, persistent complement cell disease), persistent complement component
to measles, mumps, or rubella: Consider 2-dose component deficiency, complement inhibitor (e.g., deficiency, complement inhibitor (e.g., eculizumab,
series at least 4 weeks apart for protection against eculizumab, ravulizumab) use: 2-dose primary ravulizumab) use, or microbiologists routinely
measles or mumps or 1 dose for protection against series Menveo or MenQuadfi at least 8 weeks apart; exposed to Neisseria meningitidis.
rubella. 1 booster dose 5 years after primary series and every - Bexsero or Trumenba (use same brand for all doses
- Born in 1957 or later with no evidence of immunity 5 years if risk remains including booster doses): 3-dose primary series at
to measles, mumps, or rubella: complete 2-dose y Travel in countries with hyperendemic or epidemic 0, 1–2, 6 months (if dose 2 was administered at least
series at least 4 weeks apart for protection against meningococcal disease, or for microbiologists 6 months after dose 1, dose 3 not needed; if dose 3
measles or mumps or at least 1 dose for protection routinely exposed to Neisseria meningitidis: 1 dose is administered earlier than 4 months after dose 2, a
against rubella. Menveo or MenQuadfi; 1 booster dose 5 years after 4th dose should be administered at least 4 months
primary series and every 5 years if risk remains after dose 3).
y First–year college students who live in residential - Booster doses: 1 booster dose one year after primary
housing (if not previously vaccinated at age 16 years series and every 2–3 years if risk remains
or older) or military recruits: 1 dose Menveo or y Pregnancy: Delay MenB until after pregnancy due to
MenQuadfi lack of safety data in pregnant women. May administer
For MenACWY recommendations in outbreak setting if at increased risk and vaccination benefits outweigh
(e.g., in community or organizational settings, or potential risks.
among men who have sex with men) and additional For MenB recommendations in outbreak setting (e.g.,
meningococcal vaccination information, see www.cdc. in community or organizational settings, or among men
gov/mmwr/volumes/69/rr/rr6909a1.htm who have sex with men) and additional meningococcal
Shared clinical decision–making for MenB vaccination information, see ww.cdc.gov/mmwr/
y Adolescents and young adults age 16–23 years volumes/69/rr/rr6909a1.htm.
(age 16–18 years preferred)* not at increased risk Note: MenB vaccines may be administered
WHITE SPACE for meningococcal disease: based on shared clinical simultaneously with MenACWY vaccines if indicated,
INTENTIONALLY decision–making but at a different anatomic site, if feasible.
LEFT BLANK - Bexsero or Trumenba (use same brand for all Adults may receive a single dose of Penbraya
doses): 2-dose series at least 6 months apart (if dose (MenACWY–TT/MenB–FHbp) as an alternative to
2 is administered earlier than 6 months, administer separate administration of MenACWY and MenB when
dose 3 at least 4 months after dose 2) both vaccines would be given on the same clinic day.
*To optimize rapid protection (e.g., for students starting For adults not at increased risk, if Penbraya is used for
college in less than 6 months), a 3-dose series (0, 1–2, dose 1 MenB, then MenB–FHbp (Trumenba) should be
6 months) may be administered. administered for dose 2 MenB. For adults at increased
For additional information on shared clinical decision– risk of meningococcal disease, Penbraya may be used
making for MenB, see www.cdc.gov/vaccines/hcp/ for additional MenACWY and MenB doses (including
admin/downloads/isd–job–aid–scdm–mening–b– booster doses) if both would be given on the same
shared–clinical–decision–making.pdf clinic day and at least 6 months have elapsed since
most recent Penbraya dose.

Page 8
 Notes Recommended Adult Immunization Schedule for Ages 19 Years or Older, United States, 2025

Mpox vaccination Pneumococcal vaccination

Special situations Routine vaccination Special situations
y Any person at risk for mpox infection: complete y Age 50 years or older who have: y Age 19–49 years with certain underlying medical
2-dose series, 28 days apart. - Not previously received a dose of PCV13, PCV15, conditions or other risk factors** who have:
Risk factors for mpox infection include: PCV20, or PCV21 or whose previous vaccination - Not previously received a PCV13, PCV15, PCV20,
- Persons who are gay or bisexual, and other MSM, history is unknown: 1 dose PCV15 or 1 dose PCV20 or PCV21 or whose previous vaccination history is
transgender or nonbinary people who in the past or 1 dose PCV21 unknown: 1 dose PCV15 or 1 dose PCV20 or 1 dose
6 months have had:  If PCV15 is used, administer 1 dose PPSV23 at least PCV21
 A new diagnosis of at least 1 sexually transmitted 1 year after the PCV15 dose (may use minimum  If PCV15 is used, administer 1 dose PPSV23
disease interval of 8 weeks for adults with an at least 1 year after the PCV15 dose (may use
 More than 1 sex partner immunocompromising condition,* cochlear minimum interval of 8 weeks for adults with
 Sex at a commercial sex venue implant, or cerebrospinal fluid leak). an immunocompromising condition,* cochlear
- Previously received only PCV7: follow the implant, or cerebrospinal fluid leak).
 Sex in association with a large public event in
a geographic area where mpox transmission is recommendation above. - Previously received only PCV7: follow the
occurring - Previously received only PCV13: 1 dose PCV20 or recommendation above.
- Persons who are sexual partners of the persons 1 dose PCV21 at least 1 year after the last PCV13 dose - Previously received only PCV13: 1 dose PCV20 or
described above - Previously received only PPSV23: 1 dose PCV15 or 1 dose PCV21 at least 1 year after the last PCV13 dose
- Persons who anticipate experiencing any of the 1 dose PCV20 or 1 dose PCV21, at least 1 year after - Previously received only PPSV23: 1 dose PCV15 or
situations described above the last PPSV23 dose. 1 dose PCV20 or 1 dose PCV21, at least 1 year after
 If PCV15 is used, no additional PPSV23 doses are the last PPSV23 dose.
y Pregnancy: There is currently no ACIP recommendation
recommended.  If PCV15 is used, no additional PPSV23 doses are
for Jynneos use in pregnancy due to lack of safety data
- Previously received both PCV13 and PPSV23 but recommended.
in pregnant women. Pregnant women with any risk
factor described above may receive Jynneos. NO PPSV23 was received at age 65 years or older: - Previously received PCV13 and 1 dose of PPSV23:
1 dose PCV20 or 1 dose PCV21 at least 5 years after  Cochlear implant, cerebrospinal fluid leak, or an
y Health care personnel: Vaccination to protect against
the last pneumococcal vaccine dose. immunocompromising condition*: 1 dose PCV20
occupational risk in healthcare settings is not routinely
- Previously received both PCV13 and PPSV23, AND or 1 dose PCV21 at least 5 years after the last
recommended.
PPSV23 was received at age 65 years or older: Based pneumococcal vaccine dose.
For detailed information, see www.cdc.gov/mpox/hcp/ on shared clinical decision–making, 1 dose of PCV20  Alcoholism, chronic heart/liver/lung disease,
vaccine-considerations/vaccination-overview.html. or 1 dose of PCV21 at least 5 years after the last cigarette smoking, or diabetes mellitus: no
pneumococcal vaccine dose. additional PCV or PPSV23 doses recommended at
this time. Review pneumococcal recommendations
when age 50 years or older.
Adults aged 19 years and older who have received
PCV20 or PCV21: no additional pneumococcal vaccine
dose recommended.
WHITE SPACE
INTENTIONALLY Pregnancy: no recommendation for PCV or PPSV23
due to limited data. Summary of existing data on
LEFT BLANK
pneumococcal vaccination during pregnancy can
be found at www.cdc.gov/mmwr/volumes/72/rr/
rr7203a1.htm.
Page 9
 Notes Recommended Adult Immunization Schedule for Ages 19 Years or Older, United States, 2025

Pneumococcal vaccination - continued Poliovirus vaccination Respiratory syncytial virus vaccination

PPSV23 not available: adults aged 19 years or older Routine vaccination Routine vaccination
who received PCV15 but have not yet completed y Adults known or suspected to be unvaccinated y Pregnant women of any age:
PPSV23 series, can complete the series with either or incompletely vaccinated: administer remaining - Pregnant at 32 weeks 0 days through 36 weeks
1 dose of PCV20 or 1 dose of PCV21 if they no longer doses (1, 2, or 3 IPV doses) to complete a 3-dose and 6 days gestation from September through
have access to PPSV23. primary series.* Unless there are specific reasons to January in most of the continental United States*:
For guidance on determining which pneumococcal believe they were not vaccinated, most adults who 1 dose Abrysvo. Administer RSV vaccine regardless
vaccines a patient needs and when, please refer to were born and raised in the United States can assume of previous RSV infection.
the mobile app which can be downloaded here: they were vaccinated against polio as children. - Either maternal RSV vaccination with Abrysvo
www.cdc.gov/pneumococcal/hcp/vaccine- Special situations or infant immunization with nirsevimab (RSV
recommendations/app.html. y Adults at increased risk for exposure to poliovirus monoclonal antibody) is recommended to prevent
*Note: Immunocompromising conditions who completed primary series*: may administer one severe respiratory syncytial virus disease in infants.
include chronic renal failure, nephrotic syndrome, lifetime IPV booster. - All other pregnant women: RSV vaccine not
immunodeficiencies, iatrogenic immunosuppression, *Note: Complete primary series consists of at least recommended
generalized malignancy, HIV infection, Hodgkin disease, 3 doses of IPV or trivalent oral poliovirus vaccine (tOPV) - Subsequent pregnancies: additional doses not
leukemia, lymphoma, multiple myeloma, solid organ in any combination. recommended. No data are available to inform
transplant, congenital or acquired asplenia, or sickle cell whether additional doses are needed in subsequent
disease or other hemoglobinopathies. For detailed information, see www.cdc.gov/vaccines/
pregnancies. Infants born to pregnant women who
vpd/polio/hcp/recommendations.html
**Note: Underlying medical conditions or other received RSV vaccine during a previous pregnancy
risk factors include alcoholism, chronic heart/liver/ should receive nirsevimab.
lung disease, chronic renal failure, cigarette smoking, *Note: Providers in jurisdictions with RSV seasonality
cochlear implant, congenital or acquired asplenia, that differs from most of the continental United States
CSF leak, diabetes mellitus, generalized malignancy, (e.g., Alaska, jurisdictions with tropical climate) should
HIV infection, Hodgkin disease, immunodeficiencies, follow guidance from public health authorities on
iatrogenic immunosuppression, leukemia, lymphoma, timing of administration. Refer to the 2025 Child and
multiple myeloma, nephrotic syndrome, solid Adolescent Immunization Schedule for considerations
organ transplant, or sickle cell disease or other regarding nirsevimab administration to infants.
hemoglobinopathies.
Age 75 years or older
WHITE SPACE y Unvaccinated: 1 dose (Arexvy or Abrysvo or mResvia).
INTENTIONALLY Additional doses not recommended
LEFT BLANK y Previously vaccinated: additional doses not
recommended. No data are available to inform
whether additional doses are needed.

Page 10
 Notes Recommended Adult Immunization Schedule for Ages 19 Years or Older, United States, 2025

Respiratory syncytial virus vaccination - continued Tetanus, diphtheria, and pertussis vaccination
Special situations - Chronic hematologic conditions e.g., sickle cell Routine vaccination
y Age 60–74 years: disease, thalassemia
y Completed primary series and received at least
- Unvaccinated and at increased risk of severe RSV - Severe obesity (body mass index ≥ 40 kg/m2) 1 dose Tdap at age 10 years or older: Td or Tdap every
disease**: 1 dose (Arexvy or Abrysvo or mResvia). - Moderate or severe immune compromise 10 years thereafter
Additional doses not recommended. y Completed primary series and did NOT receive Tdap
- Residence in a nursing home
- Previously vaccinated: additional doses not at age 10 years or older: 1 dose Tdap, then Td or Tdap
- Other chronic medical conditions or risk factors that
recommended. No data are available to inform every 10 years thereafter
a health care provider determines would increase the
whether additional doses are needed. y Unvaccinated or incomplete primary vaccination
risk of severe disease due to viral respiratory infection
Persons 60 years and older can get RSV vaccine at any e.g., frailty, concern for presence of undiagnosed series for tetanus, diphtheria, or pertussis: administer
time but it is best to administer in late summer and chronic medical conditions, residence in a remote remaining doses (1, 2, or 3 doses) to complete 3-dose
early fall before RSV spreads in communities—ideally or rural community where escalation of medical care primary series. 1 dose Tdap followed by 1 dose Td or
August through October in most of continental United is challenging. Tdap at least 4 weeks later, and a third dose of Td or
States. For further guidance, see www.cdc.gov/mmwr/ Tdap 6–12 months later (Tdap is preferred as first dose
volumes/73/wr/mm7332e1.htm. and can be substituted for any Td dose), then Td or
**Note: People can self–attest to the presence of a risk Tdap every 10 years thereafter.
factor. The following medical and other conditions Special situations
increase the risk of severe RSV disease: y Pregnancy: 1 dose Tdap during each pregnancy,
- Chronic cardiovascular disease e.g., heart failure, preferably in early part of gestational weeks 27–36
coronary artery disease, congenital heart disease. y Wound management: Persons with 3 or more doses
Excludes isolated hypertension. of tetanus–toxoid–containing vaccine: For clean and
- Chronic lung or respiratory disease e.g., chronic minor wounds, administer Tdap or Td if more than 10
obstructive pulmonary disease, emphysema, asthma, years since last dose of tetanus–toxoid–containing
interstitial lung disease, cystic fibrosis vaccine; for all other wounds, administer Tdap or Td if
more than 5 years since last dose of tetanus–toxoid–
- End stage renal disease or dependence on
WHITE SPACE containing vaccine. Tdap is preferred for persons who
hemodialysis or other renal replacement therapy
have not previously received Tdap or whose Tdap
- Diabetes mellitus complicated by chronic kidney INTENTIONALLY history is unknown. If a tetanus–toxoid–containing
disease, neuropathy, retinopathy, or other end–organ LEFT BLANK vaccine is indicated for a pregnant woman, use Tdap.
damage For detailed information, see www.cdc.gov/mmwr/
- Diabetes mellitus requiring treatment with insulin or volumes/69/wr/mm6903a5.htm
sodium–glucose cotransporter 2 (SGLT2) inhibitor
- Neurologic or neuromuscular conditions causing
impaired airway clearance or respiratory muscle
weakness e.g., post–stroke dysphagia, amyotrophic
lateral sclerosis, muscular dystrophy. Excludes history
of stroke without impaired airway clearance.
- Chronic liver disease e.g., cirrhosis

Page 11
 Notes Recommended Adult Immunization Schedule for Ages 19 Years or Older, United States, 2025

Varicella vaccination Zoster vaccination

Routine vaccination Routine vaccination
y No evidence of immunity to varicella: 2-dose series y Age 50 years or older*: 2-dose series recombinant
4–8 weeks apart if previously did not receive varicella– zoster vaccine (RZV, Shingrix) 2–6 months apart
containing vaccine (VAR or MMRV [measles–mumps– (minimum interval: 4 weeks; repeat dose if
rubella–varicella vaccine] for children); if previously administered too soon), regardless of previous
received 1 dose varicella–containing vaccine, 1 dose at herpes zoster or history of zoster vaccine live
least 4 weeks after first dose. (ZVL, Zostavax) vaccination.
- Evidence of immunity: U.S.–born before 1980 *Note: Serologic evidence of prior varicella is not
(except for pregnant women and health care necessary for zoster vaccination. However, if serologic
personnel [see below]), documentation of 2 doses evidence of varicella susceptibility becomes available,
varicella–containing vaccine at least 4 weeks apart, providers should follow ACIP guidelines for varicella
diagnosis or verification of history of varicella or vaccination first. RZV is not indicated for the prevention
herpes zoster by a health care provider, laboratory of varicella, and there are limited data on the use of
evidence of immunity or disease. RZV in persons without a history of varicella or varicella
Special situations vaccination.
y Pregnancy with no evidence of immunity to Special situations
varicella: VAR contraindicated during pregnancy; y Pregnancy: There is currently no ACIP
after pregnancy (before discharge from health care recommendation for RZV use in pregnancy. WHITE SPACE
facility), 1 dose if previously received 1 dose varicella– Consider delaying RZV until after pregnancy. INTENTIONALLY
containing vaccine or dose 1 of 2-dose series
(dose 2: 4–8 weeks later) if previously did not receive
y Immunocompromising conditions (including LEFT BLANK
persons with HIV regardless of CD4 count)**: 2-dose
any varicella–containing vaccine, regardless of
series recombinant zoster vaccine (RZV, Shingrix)
whether U.S.–born before 1980.
2–6 months apart (minimum interval: 4 weeks;
y Health care personnel with no evidence of immunity repeat dose if administered too soon). For detailed
to varicella: 1 dose if previously received 1 dose information, see www.cdc.gov/shingles/hcp/vaccine–
varicella–containing vaccine; 2-dose series 4–8 weeks considerations/immunocompromised–adults.html
apart if previously did not receive any varicella–
**Note: If there is no documented history of varicella,
containing vaccine, regardless of whether U.S.–born
varicella vaccination, or herpes zoster, providers should
before 1980.
refer to the clinical considerations for use of RZV in
y HIV infection with CD4 percentages ≥15% and CD4 immunocompromised adults aged ≥19 years and the
count ≥200 cells/mm3 with no evidence of immunity: ACIP varicella vaccine recommendations for further
Vaccination may be considered (2 doses 3 months guidance: www.cdc.gov/mmwr/volumes/71/wr/
apart); VAR contraindicated for HIV infection with CD4 mm7103a2.htm
percentage <15% or CD4 count <200 cells/mm3.
y Severe immunocompromising conditions:
VAR contraindicated

Page 12
 Appendix Recommended Adult Immunization Schedule for Ages 19 Years or Older, United States, 2025
Contraindications and Precautions to Commonly Used Vaccines
Adapted from Table 4–1 in Advisory Committee on Immunization Practices (ACIP) General Best Practice Guidelines for Immunization: Contraindication and Precautions, Prevention and Control of Seasonal Influenza with
Vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2024–25 Influenza Season | MMWR (cdc.gov), and Contraindications and Precautions for COVID–19 Vaccination

Vaccines and Other

Contraindicated or Not Recommended1 Precautions2
Immunizing Agents
COVID–19 mRNA vaccines • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a component of • Diagnosed non–severe allergy (e.g., urticaria beyond the injection site) to a component of
[Pfizer–BioNTech, Moderna] an mRNA COVID–19 vaccine3 an mRNA COVID–19 vaccine3; or non–severe, immediate (onset less than 4 hours) allergic
reaction after administration of a previous dose of an mRNA COVID–19 vaccine
• Myocarditis or pericarditis within 3 weeks after a dose of any COVID–19 vaccine
• Multisystem inflammatory syndrome in children (MIS–C) or multisystem inflammatory
syndrome in adults (MIS–A)
• Moderate or severe acute illness, with or without fever
COVID–19 protein subunit • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a component of a • Diagnosed non–severe allergy (e.g., urticaria beyond the injection site) to a component of
vaccine Novavax COVID–19 vaccine3 Novavax COVID–19 vaccine3; or non–severe, immediate (onset less than 4 hours) allergic
[Novavax] reaction after administration of a previous dose of a Novavax COVID–19 vaccine
• Myocarditis or pericarditis within 3 weeks after a dose of any COVID–19 vaccine
• Multisystem inflammatory syndrome in children (MIS–C) or multisystem inflammatory
syndrome in adults (MIS–A)
• Moderate or severe acute illness, with or without fever
Influenza, egg-based, • Severe allergic reaction (e.g., anaphylaxis) after previous dose of any influenza vaccine • Guillain–Barré syndrome (GBS) within 6 weeks after a previous dose of any
inactivated injectable (IIV3) (i.e., any egg-based IIV, ccIIV, RIV, or LAIV of any valency) type of influenza vaccine
• Severe allergic reaction (e.g., anaphylaxis) to any vaccine component4 (excluding egg) • Moderate or severe acute illness with or without fever
Influenza, cell culture–based • Severe allergic reaction (e.g., anaphylaxis) to any ccIIV of any valency, or to any • Guillain–Barré syndrome (GBS) within 6 weeks after a previous dose of any
inactivated injectable (ccIIV3) component4 of ccIIV3 type of influenza vaccine
[Flucelvax] • Persons with a history of severe allergic reaction (e.g., anaphylaxis) after a previous dose of
any egg-based IIV, RIV, or LAIV of any valency. If using ccIIV3, administer in medical setting
under supervision of health care provider who can recognize and manage severe allergic
reactions. May consult an allergist.
• Moderate or severe acute illness with or without fever
Influenza, recombinant • Severe allergic reaction (e.g., anaphylaxis) to any RIV of any valency, or to any component4 of RIV3 • Guillain–Barré syndrome (GBS) within 6 weeks after a previous dose of any
injectable (RIV3) type of influenza vaccine
[Flublok] • Persons with a history of severe allergic reaction (e.g., anaphylaxis) after a previous dose of
any egg-based IIV, ccIIV, or LAIV of any valency. If using RIV3, administer in medical setting
under supervision of health care provider who can recognize and manage severe allergic
reactions. May consult an allergist.
• Moderate or severe acute illness with or without fever
Influenza, live attenuated • Severe allergic reaction (e.g., anaphylaxis) after previous dose of any influenza vaccine • Guillain–Barré syndrome (GBS) within 6 weeks after a previous dose of any
(LAIV3) (i.e., any egg-based IIV, ccIIV, RIV, or LAIV of any valency) type of influenza vaccine
[Flumist] • Severe allergic reaction (e.g., anaphylaxis) to any vaccine component4 (excluding egg) • Asthma in persons aged 5 years or older
• Anatomic or functional asplenia • Persons with underlying medical conditions (other than those listed under
• Immunocompromised due to any cause including, but not limited to, medications and contraindications) that might predispose to complications after wild–type influenza virus
HIV infection infection [e.g., chronic pulmonary, cardiovascular (except isolated hypertension), renal,
• Close contacts or caregivers of severely immunosuppressed persons who require a hepatic, neurologic, hematologic, or metabolic disorders (including diabetes mellitus)]
protected environment • Moderate or severe acute illness with or without fever
• Pregnancy
• Cochlear implant
• Active communication between the cerebrospinal fluid (CSF) and the oropharynx,
nasopharynx, nose, ear, or any other cranial CSF leak
• Received influenza antiviral medications oseltamivir or zanamivir within the previous
48 hours, peramivir within the previous 5 days, or baloxavir within the previous 17 days.
1. When a contraindication is present, a vaccine should NOT be administered. Kroger A, Bahta L, Hunter P. ACIP General Best Practice Guidelines for Immunization.
2. When a precaution is present, vaccination should generally be deferred but might be indicated if the benefit of protection from the vaccine outweighs the risk for an adverse reaction. Kroger A, Bahta L, Hunter P. ACIP General
Best Practice Guidelines for Immunization.
3. See package inserts and FDA EUA fact sheets for a full list of vaccine ingredients. mRNA COVID–19 vaccines contain polyethylene glycol (PEG).
4. Vaccination providers should check FDA–approved prescribing information for the most complete and updated information, including contraindications, warnings, and precautions. See Package inserts for U.S.–licensed
vaccines.

Page 13
 Appendix Recommended Adult Immunization Schedule for Ages 19 Years or Older, United States, 2025
Vaccine Contraindicated or Not Recommended1 Precautions2
Haemophilus influenzae type b (Hib) • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 • 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 component3 including neomycin • 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 component3 including yeast • Moderate or severe acute illness with or without fever
• Pregnancy: PreHevbrio is not recommended due to lack of safety data in pregnant women. Use other hepatitis B
vaccines if HepB is indicated4
Hepatitis A–Hepatitis B vaccine • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 including neomycin and yeast • Moderate or severe acute illness with or without fever
(HepA–HepB) [Twinrix]

Human papillomavirus (HPV) • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 • Moderate or severe acute illness with or without fever
• Pregnancy: HPV vaccination not recommended
Measles, mumps, rubella (MMR) • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 • Recent (≤11 months) receipt of antibody–containing blood product (specific
• Severe immunodeficiency (e.g., hematologic and solid tumors, receipt of chemotherapy, congenital immunodeficiency, interval depends on product)
long–term immunosuppressive therapy or patients with HIV infection who are severely immunocompromised) • History of thrombocytopenia or thrombocytopenic purpura
• Pregnancy • Need for tuberculin skin testing or interferon–gamma release assay (IGRA) testing
• Family history of altered immunocompetence, unless verified clinically or by laboratory testing as immunocompetent • Moderate or severe acute illness with or without fever
Meningococcal ACWY (MenACWY) • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 • Moderate or severe acute illness with or without fever
(MenACWY–CRM) [Menveo] • For MenACWY–CRM only: severe allergic reaction to any diphtheria toxoid– or CRM197–containing vaccine
(MenACWY–TT) [MenQuadfi] • For MenACWY–TT only: severe allergic reaction to a tetanus toxoid–containing vaccine
Meningococcal B (MenB) • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 • Pregnancy
MenB–4C [Bexsero] • For MenB–4C only: Latex sensitivity
MenB–FHbp [Trumenba] • Moderate or severe acute illness with or without fever
Meningococcal ABCWY • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 • Moderate or severe acute illness, with or without fever
(MenACWY–TT/MenB–FHbp) • Severe allergic reaction to a tetanus toxoid–containing vaccine
[Penbraya]
Mpox [Jynneos] • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 • Moderate or severe acute illness, with or without fever
Pneumococcal conjugate • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 • Moderate or severe acute illness with or without fever
(PCV15, PCV20, PCV21) • Severe allergic reaction (e.g., anaphylaxis) to any diphtheria–toxoid–containing vaccine or to its vaccine component3
Pneumococcal polysaccharide (PPSV23) • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 • Moderate or severe acute illness with or without fever
Poliovirus vaccine, inactivated (IPV) • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 • Pregnancy
• Moderate or severe acute illness with or without fever
Respiratory syncytial virus vaccine (RSV) • Severe allergic reaction (e.g., anaphylaxis) to a vaccine component • Moderate or severe acute illness with or without fever
Tetanus, diphtheria, and acellular • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 • Guillain–Barré syndrome (GBS) within 6 weeks after a previous dose of tetanus–
pertussis (Tdap) • For Tdap only: Encephalopathy (e.g., coma, decreased level of consciousness, prolonged seizures), not attributable to toxoid–containing vaccine
Tetanus, diphtheria (Td) another identifiable cause, within 7 days of administration of previous dose of DTP, DTaP, or Tdap • History of Arthus–type hypersensitivity reactions after a previous dose of
diphtheria–toxoid containing or tetanus–toxoid–containing vaccine; defer
vaccination until at least 10 years have elapsed since the last tetanus–toxoid–
containing vaccine
• Moderate or severe acute illness with or without fever
• For Tdap only: Progressive or unstable neurological disorder, uncontrolled
seizures, or progressive encephalopathy until a treatment regimen has been
established and the condition has stabilized
Varicella (VAR) • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 • Recent (≤11 months) receipt of antibody–containing blood product (specific
• Severe immunodeficiency (e.g., hematologic and solid tumors, receipt of chemotherapy, congenital immunodeficiency, interval depends on product)
long–term immunosuppressive therapy or patients with HIV infection who are severely immunocompromised) • Receipt of specific antiviral drugs (acyclovir, famciclovir, or valacyclovir) 24 hours
• Pregnancy before vaccination (avoid use of these antiviral drugs for 14 days after vaccination)
• Family history of altered immunocompetence, unless verified clinically or by laboratory testing as immunocompetent • Use of aspirin or aspirin–containing products
• Moderate or severe acute illness with or without fever
Zoster recombinant vaccine (RZV) • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 • Moderate or severe acute illness with or without fever
• Current episode of herpes zoster
1. When a contraindication is present, a vaccine should NOT be administered. Kroger A, Bahta L, Hunter P. ACIP General Best Practice Guidelines for Immunization. www.cdc.gov/vaccines/hcp/acip–recs/general–recs/contraindications.html.
2. When a precaution is present, vaccination should generally be deferred but might be indicated if the benefit of protection from the vaccine outweighs the risk for an adverse reaction. Kroger A, Bahta L, Hunter P. ACIP General Best Practice Guidelines
for Immunization. www.cdc.gov/vaccines/hcp/acip–recs/general–recs/contraindications.html.
3. Vaccination providers should check FDA–approved prescribing information for the most complete and updated information, including contraindications, warnings, and precautions. Package inserts for U.S.–licensed vaccines are available at www.
fda.gov/vaccines–blood–biologics/approved–products/vaccines–licensed–use–united–states.
4. For information on the pregnancy exposure registry for persons who were inadvertently vaccinated with PreHevbrio while pregnant, please visit www.prehevbrio.com/#safety.
Page 14
 Addendum Recommended Adult Immunization Schedule for Ages 19 Years or Older, United States, 2025
In addition to the recommendations presented in the previous sections of this immunization schedule, CDC has approved the following ACIP recommendations since October 24, 2024.

Vaccines Recommendations Effective Date of Recommendation†

Meningococcal ACIP recommends GSK's MenABCWY vaccine may be used when both MenACWY and MenB are indicated at the same visit* June 25, 2025
(MenACWY-CRM/MenB-FHbp, *(1) healthy persons aged 16–23 years (routine schedule) when shared clinical decision-making favors administration of MenB vaccine and (2) persons aged ≥10 years
Penmenvy) who are at increased risk for meningococcal disease (e.g., because of persistent complement deficiencies, complement inhibitor use, or functional or anatomic asplenia).

RSV ACIP recommends adults 50–59 years of age who are at increased risk of severe RSV diseasea receive a single dose of RSV vaccine.b,c June 25, 2025
(Abrysvo,Arexvy,mResvia) a. CDC will publish Clinical Considerations that describe chronic medical conditions and other risk factors for severe RSV disease for use in this risk-based
recommendation.
b. At this time, RSV vaccination is recommended as a single dose only. Persons who have already received RSV vaccination are NOT recommended to receive another
dose.
c. RSV vaccine can be administered with any product licensed in this age group.

Note: As of May 29, 2025, the schedule incorporates the HHS directive regarding COVID-19 vaccine recommendations. (Changes were made to tables and notes for COVID-19 vaccines in pregnant women.)

The effective date is the date when the recommendation was adopted and became official.
†

Page 15