Immunizations

Adult Immunizations

Recommended immunizations

Your need for immunizations does not end when you reach adulthood. The specific shots (injections) you need as an adult are determined by factors such as your age, gender, lifestyle, type and locations of travel, overall health, and previous immunizations. Tetanus and diphtheria shots need to be repeated every 10 years throughout adulthood in order to maintain immunity.

The U.S. Advisory Committee on Immunization Practices (ACIP), the American College of Obstetrics and Gynecologists, the American College of Physicians, and the American Academy of Family Physicians recommend a specific adult immunization schedule each year.

Your doctor will consider your medical and immunization history (and documentation) when deciding which shots you need.

To print a list of which shots you may need, go to the U.S. Centers for Disease Control and Prevention (CDC) interactive Web site at www2.cdc.gov/nip/adultImmSched.

Immunizations given during adulthood may include:

Chickenpox (varicella)(What is a PDF document?)

This shot, called Varivax, protects against chickenpox. Chickenpox infection can be very serious when it occurs after childhood.

Who should get it?

• Adults who are not already immune to the chickenpox virus need two doses, given at least 4 weeks apart.
• Women who don't have evidence of immunity and recently gave birth should get this shot.

Pregnant women and people with immune system problems should not get this shot.

Hepatitis A (Hep A)(What is a PDF document?)

This shot protects against hepatitis A.

Who should get it?

• Adults who will be traveling to certain foreign countries, such as those in Central or South America, need two doses given at least 6 months apart.
• Adults who have certain risk factors, such as long-term (chronic) liver disease, also need this shot.

Hepatitis B (Hep B)(What is a PDF document?)

This shot protects against hepatitis B.

Who should get it?

• Adults who have not received the vaccine series for hepatitis B need this shot when occupation, travel, health condition, or lifestyle increases their risk of exposure.

Three or four doses are needed over at least 4 months.

A hepatitis combination vaccine (Twinrix) is recommended for those who are at risk for both hepatitis A and hepatitis B. This vaccine is approved in the United States only for those 18 years of age or older.

Inactivated influenza (flu) shot(What is a PDF document?) or nasal spray flu vaccine (FluMist)(What is a PDF document?)

This immunization helps protect against the flu. Flu viruses are always changing, so the flu vaccines are updated every year. Protection lasts up to a year for both vaccine types.

Who should get it?

• Women who are or will be pregnant during the flu season; adults 50 years of age and older; and people with a chronic health condition, such as asthma, diabetes, chronic heart or lung disorders, or an impaired immune system (which puts them at high risk for complications of the flu), need this immunization.
• Household contacts and caregivers of all children younger than 5 years old and close contacts of others who are at high risk for complications of the flu also need this immunization each year.
• Residents of nursing homes and other chronic-care facilities need this immunization each year.
• Anyone who wants to reduce the chance of becoming ill with the flu or spreading it to others should get immunized.⁶

Healthy people ages 2 years through 49 years can usually get the nasal spray form of the vaccine, called FluMist. Pregnant women can get the flu shot but not FluMist.

For help deciding if the flu shot is right for you, see:

Should I get a flu shot?

Measles, mumps, and rubella (MMR)(What is a PDF document?)

This shot protects against measles, mumps, and rubella.

Who should get it?

• Adults born during or after 1957 may need one or two doses if they do not have evidence of immunity.

Women should avoid becoming pregnant for 28 days after getting the MMR shot. Women who are known or suspected to be pregnant and people who have impaired immune systems should not get this shot.¹⁰

Pneumococcal polysaccharide (PPV)(What is a PDF document?)

This shot does not necessarily reduce your risk of getting pneumonia, but it can prevent some of the serious complications of pneumonia, such as infection in the bloodstream (bacteremia) or throughout the body (septicemia).

Who should get it?

• All people 65 years of age and older need this shot.
• People ages 2 years to 64 years who have a chronic disease (such as heart or lung disease), do not have a spleen, or have a damaged spleen also need this shot.

This shot is different from the pneumococcal conjugate (PCV) shot that is recommended for children. Most adults only need one dose of PPV for protection. Some people might need to get a booster shot after 5 years.

Polio (IPV)(What is a PDF document?)

This shot protects against polio.

Who should get it?

• Adults whose travel puts them at increased risk for exposure to polio need this shot.

Routine polio immunization is not recommended for adults (age 18 and older) who live in the United States.

Shingles (herpes zoster)(What is a PDF document?)

This shot, called Zostavax, protects against shingles.

Who should get it?

• Adults age 60 and older need one dose, whether or not they've had shingles before.

Zostavax is not a substitute for the chickenpox shot (Varivax).

Tetanus, diphtheria, and pertussis (Tdap)(What is a PDF document?) and Tetanus and diphtheria (Td)(What is a PDF document?)

The Tdap shot protects against tetanus, diphtheria, and whooping cough (pertussis). The Td shot does not protect against pertussis.

Who should get it?

• All adults need Td booster shots every 10 years throughout life.
• All adults 19 to 64 years of age should have one shot of Tdap in place of a Td shot.

Tdap is usually only given if it has been at least 10 years since a person's last Td booster. The CDC recommends getting Tdap 2 years or less from the last dose of Td for:

• People with greater risk for pertussis.
• Child care providers and other adults having close contact with infants less than 12 months old. (Women would ideally get this dose before pregnancy.)
• Health care workers with direct patient contact.

The more immunizations you get in a short time frame, the more likely you are to react with arm swelling and redness at the site of the shot. But it may be worth a mild reaction to protect a young infant who is at risk for pertussis.

Other immunizations

Some adults may need or want additional immunizations for situations that increase a person's chance for exposure to disease. These immunizations may include:

Meningococcal (MCV4 or MPSV4, depending on your age)(What is a PDF document?)

This shot protects against bacterial meningitis and blood infections (sepsis).

Who should get it?

• Any adult needs this shot if he or she:
  • Has a greater chance of becoming infected during an outbreak of bacterial meningitis.
  • Has a damaged spleen or has had the spleen removed.
  • Travels to or lives in areas of the world where meningitis is common, such as to certain parts of Africa or to Saudi Arabia during the Hajj.
  • Lives in a college dorm.

The meningococcal conjugate (MCV4) vaccine, called Menactra, is given to people 2 years to 55 years of age who need this immunization. Adults older than age 55 are immunized with the meningococcal polysaccharide (MPSV4) vaccine, called Menomune.

Human papillomavirus (HPV), for women(What is a PDF document?)

This shot, called Gardasil, protects against four types of HPV that together cause most cases of cervical cancer and genital warts.⁸

Who should get it?

• The CDC recommends this shot for females 13 to 26 years old who did not get it when they were younger. (Three doses are given over 6 months.) But the American Cancer Society states that there is not enough evidence to recommend for or against the shot for women 19 to 26 years old.⁹

If you already have HPV infection, talk with your doctor about whether to get immunized. The shot has not been shown to help existing HPV infection, but it may protect you from other HPV infections.⁸

Consult your doctor or public health department if you missed an immunization or to find out whether you need a specific immunization. For more information about each vaccine, see the topic Vaccine Information Statements.

Immunizations and pregnancy

Before you become pregnant, it is best to discuss your immunization history with your health professional. If you need the chickenpox or measles, mumps, and rubella (MMR) shots, wait at least 4 weeks after the immunization before becoming pregnant.

The CDC recommends the inactivated influenza vaccine (flu shot) for all women who are or who plan to be pregnant during the flu season. Pregnant women should not receive the nasal spray flu vaccine.¹⁰

Pregnant women who are due for their tetanus booster can get immunized with Td vaccine. The CDC recommends that women who have not previously had Tdap should get a dose of Tdap before getting pregnant or right after their baby is born. This is to protect the newborn baby from whooping cough (pertussis).

If you are pregnant, your children should still get their immunizations on schedule. You do not need to speed up or delay your child's immunizations.

Immunizations and new health threats

In 2007, the FDA approved the first vaccine for humans against bird flu (avian influenza). Immunization is not currently recommended for the public. The vaccine will be kept in the U.S. government stockpile.¹¹

Immunization safety

You may worry that immunizations are dangerous if given when you have a cold or other minor illness. Talk to your doctor if you have concerns about the timing of shots. But keep in mind that shots can usually still be given during a mild illness, while medicines are being taken, and in other situations where you may not be in perfect health. There are very few reasons that doctors suggest a person postpone or not get an immunization.

Consult your doctor or public health department if your child missed an immunization or to find out whether you need a specific immunization. For more information about each vaccine, see the topic Vaccine Information Statements.

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Author:	Debby Golonka, MPH	Last Updated: February 29, 2008
Medical Review:	Adam Husney, MD - Family Medicine Michael J. Sexton, MD - Pediatrics William Atkinson, MD, MPH - Public Health and Preventive Medicine
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