Vaccine Guidance for Adults

Evidence-based guidance on recommended vaccines for adults.

Overview

Adult vaccination is one of the most underutilized preventive health interventions in the United States. While childhood vaccination rates typically exceed 90%, adult vaccination rates for recommended vaccines rarely surpass 50% — and for some vaccines fall below 30%.

Adults need vaccines for three reasons: to maintain immunity that may have waned since childhood, to receive vaccines not available when they were children, and to protect against diseases that are more severe in adults than in children.

The Adult Immunization Schedule

The CDC's Advisory Committee on Immunization Practices (ACIP) publishes an annual adult immunization schedule. Key recommended vaccines include:

Influenza

Annual vaccination recommended for all adults. High-dose or adjuvanted formulations recommended for adults 65+. Effectiveness varies by season (40–60% in most years).

COVID-19

Updated booster recommended annually for all adults. Composition updated each year to match circulating variants. Higher-dose options available for adults 65+.

Tdap / Td

One Tdap dose recommended for adults who have never received it, followed by Td booster every 10 years. Tdap also recommended during each pregnancy.

Shingles (Zoster)

Shingrix (recombinant zoster vaccine) recommended for all adults 50+, given as a 2-dose series. Approximately 90% effective at preventing shingles and post-herpetic neuralgia.

Pneumococcal

PCV15 or PCV20 recommended for all adults 65+ and for younger adults with certain medical conditions. Protects against pneumonia, meningitis, and bloodstream infections.

RSV

RSV vaccine (Abrysvo or Mresvia) recommended for adults 60+ using shared clinical decision-making. Also recommended during pregnancy (weeks 32–36) to protect newborns.

Adults Who Need Additional Vaccines

Certain adults require vaccines beyond the standard schedule:

Immunocompromised Adults

Adults with HIV, cancer, organ transplants, or immunosuppressive therapy have specific vaccine recommendations — some vaccines are contraindicated while others are especially important. Consult ACIP guidance for specific conditions.

Healthcare Workers

Annual influenza vaccination is required by most healthcare employers. Hepatitis B vaccination is recommended. Measles-mumps-rubella (MMR) and varicella immunity should be confirmed.

Travelers

International travel may require additional vaccines depending on destination: yellow fever, typhoid, hepatitis A, Japanese encephalitis, rabies, and others. Consult a travel medicine clinic 4–6 weeks before departure.

Pregnant Women

Influenza (any trimester), Tdap (27–36 weeks), RSV (32–36 weeks), and COVID-19 vaccination are recommended during pregnancy. Live vaccines (MMR, varicella) are contraindicated.

Why Adult Vaccination Rates Are Low

Research identifies several key barriers:

  • Lack of awareness: Many adults are unaware they need vaccines beyond childhood.
  • Cost and access: Without insurance coverage or convenient access, vaccination rates drop significantly.
  • Provider failure to recommend: Adults are significantly more likely to vaccinate when their physician proactively recommends it.
  • Vaccine hesitancy: Concerns about safety and necessity are more prevalent in adults than children due to school mandate removal.
  • Missing infrastructure: Unlike schools, workplaces do not systematically verify or require adult vaccination.

Where Adults Can Get Vaccinated

Primary care physician or internist office

Pharmacies (most vaccines available without appointment at major chains)

Community health centers and Federally Qualified Health Centers (FQHCs)

Employer occupational health programs

Travel medicine clinics (for travel-specific vaccines)

Local health departments

Sources & Citations

  • CDC. "Adult Immunization Schedule." cdc.gov/vaccines/schedules, 2023.
  • CDC. "National Immunization Survey — Adult." cdc.gov/nis, 2023.
  • ACIP. "General Best Practice Guidelines for Immunization." cdc.gov/vaccines/hcp/acip-recs, 2023.
  • Doherty TM et al. "Vaccination of special populations." Expert Review of Vaccines, 2016.

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