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 depend not only on your age, lifestyle, overall health, pregnancy status, and travel plans but also on who you are in close contact with and what vaccines you had as a child. Tetanus and diphtheria shots need to be repeated every 10 years throughout adulthood in order to keep your immunity.

Each year 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 (What is a PDF document?) .

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:⁹

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.

Flu shot (What is a PDF document?)

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

Who should get it?

Flu immunization is recommended once a year for:⁵

• Adults 50 years of age and older.
• People with a chronic health condition, such as asthma, diabetes, heart or lung disorders, or an impaired immune system (which puts them at high risk for complications of the flu).
• Women who are or will be pregnant during the flu season.
• 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.
• People who live in nursing homes or long-term care centers.
• Anyone who wants to reduce the chance of becoming ill with the flu or spreading it to others.

Healthy people ages 2 years through 49 years can usually get the nasal spray flu vaccine (FluMist) (What is a PDF document?) instead of the flu shot. Pregnant women can get the flu shot but not FluMist.

For the most current CDC guidelines about seasonal flu, go to www.cdc.gov/flu.

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

Should I get a flu shot?

H1N1 influenza (swine flu) (What is a PDF document?)

This shot helps protect against infection caused by the H1N1 flu virus. H1N1 flu may cause symptoms such as fever, cough, body aches, sore throat, and extreme tiredness. Most of the time, the illness is not serious. But severe cases can lead to pneumonia, serious lung problems, and death.

Who should get it?

Adults who most need the vaccine are:

• Pregnant women.
• People who live with or care for children younger than 6 months of age.
• Health care workers who take care of sick people.
• People ages 6 months to 24 years.
• People 25 to 64 years old who have long-term (chronic) health problems (such as asthma or diabetes) or who have a weak immune system.

After these people who most need the vaccine are immunized, then all people ages 25 to 64 should get immunized. Adults need one dose. The H1N1 shot can be given along with the seasonal flu shot. Healthy people ages 2 through 49 can usually get the nasal spray form (What is a PDF document?) of the vaccine instead of the shot (What is a PDF document?) .

For more information, see the topic H1N1 Influenza (Swine Flu). For the most current CDC guidelines, go to www.cdc.gov/h1n1flu.

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 two doses.
• Anyone who will be in close contact with an adopted child from a country that has high rates of hepatitis A needs two doses. This includes household contacts and babysitters. This recommendation only applies for the first 60 days the child is in the United States.⁶

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 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.

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 (PPSV, or Pneumovax 23) (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 or 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.
• People ages 19 to 64 years who have asthma or who smoke cigarettes need this shot.

This shot is different from the pneumococcal conjugate (PCV) shot that is given to all children. Most adults only need one dose of PPSV for protection. Some people may need a booster shot after 5 years.

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

This shot (called Zostavax) protects against shingles.

Who should get it?

• Adults ages 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 and diphtheria (Td) or Tetanus, diphtheria, and pertussis (Tdap) (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.
• Health care workers who have direct contact with patients.
• People who live with or care for infants younger than 12 months old. (Ideally, women would get this dose before pregnancy.)

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

You may need or want additional immunizations if certain situations raise your chance for exposure to disease. Or you may have missed shots when you were younger. Or a vaccine may not have been offered when you were younger. These immunizations may include:

Human papillomavirus (HPV) (What is a PDF document?)

The vaccines Cervarix and Gardasil protect against two types of human papillomavirus (HPV) that cause cervical cancer. Gardasil also protects against two types of HPV that cause genital warts. And it protects against some uncommon cancers, such as vaginal cancer.

Who should get it?

• Females 13 to 26 years old need three doses of either Cervarix or Gardasil, given over 6 months.
• Males ages 9 to 26 can get three Gardasil shots to reduce the chance of getting genital warts.

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.

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?

• An 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 ages 2 years to 55 years who need this immunization. Adults older than age 55 are immunized with the meningococcal polysaccharide (MPSV4) vaccine, called Menomune. Some people may need booster shots after 5 years.⁷

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

This shot protects against polio.

Who should get it?

• Adults whose travel or job puts them at increased risk for exposure to polio need three doses of this shot.
• Adults who never had the full series of oral polio vaccine (OPV) or inactivated polio vaccine (IPV) and who have an increased risk of being exposed to polio need the shots they missed.

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

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 pregnancy¹⁰

Before you become pregnant, discuss your immunization history with your doctor. 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 flu shots (seasonal and H1N1) for all women who are or who plan to be pregnant during the flu season. Pregnant women should not receive the nasal spray flu vaccines.

Also, pregnant women should not receive the HPV vaccine.

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 other children'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 for which doctors suggest that a person postpone or not get an immunization.

Talk with 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.

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Author:	Debby Golonka, MPH	Last Updated: February 26, 2010
Medical Review:	John Pope, MD - Pediatrics William Atkinson, MD, MPH - Public Health and Preventive Medicine
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