Routine Pediatric and Adult Immunizations

Immunization recommendations change frequently. For the latest recommendations see http://www.cdc.gov/vaccines/schedules/hcp/index.html.

For Canadian recommendations see the Canadian Immunization Guide (Public Health Agency of Canada) https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-1-key-immunization-information/page-13-recommended-immunization-schedules.html

ROUTINE PEDIATRIC IMMUNIZATIONS (0–18 yr)

GENERIC NAME (BRAND NAMES)	ROUTE/DOSAGE	CONTRAINDICATIONS	ADVERSE REACTIONS/SIDE EFFECTS	NOTES
COVID-19 (mRNA) vaccine (Pfizer BioNTech)	Primary Series: Pfizer BioNTech (12–17 yr): 2 doses of 0.3 mL IM separated by 21 days Pfizer BioNTech (5–11 yr): 2 doses of 0.2 mL IM separated by 21 days Booster Dose: Pfizer BioNTech (12–17 yr): 0.3 mL as a single dose IM 5 months after last primary series dose Pfizer BioNTech (5–11 yr): Not recommended	Anaphylactic reaction after a previous dose or to vaccine component; history of immediate allergic reaction (regardless of severity and occurring within 4 hours) to a previous dose	Pain/redness/swelling at injection site, myocarditis, pericarditis, arthralgia, chills, diarrhea, fatigue, fever, headache, myalgia, nausea, vomiting	3rd dose (0.3 mL for 12–17 yr; 0.2 mL for 5–11 yr) given 28 days after 2nd dose recommended for immunocompromised patients (receiving immunosuppressive therapy; receipt of CAR-T-cell or hematopoietic stem cell transplant within 2 years of transplantation; moderate or severe primary immunodeficiency; advanced or untreated HIV infection)
Diphtheria toxoid, tetanus toxoid, and acellular pertussis vaccine(DTaP, Daptacel, Infanrix)	0.5 mL IM at 2, 4, 6, 15–18 mo and 4–6 yr (1st dose may be given as early as age 6 wk; 4th dose may be given as early as age 12 mo).	Anaphylactic reaction after a previous dose or to vaccine component; encephalopathy within 7 days of administration of previous dose of Tdap, DTP, or DTaP vaccines.	Crying, ↓ appetite, fever, irritability, malaise, redness, tenderness, vomiting.	Individual components may be given as separate injections if unusual reactions occur. The same product should be used for all doses when possible. Do not give to children 7 yr.
Haemophilus b conjugate vaccine(Hib, ActHIB, Hiberix, PedvaxHIB)	ActHIB or Hiberix — 0.5 mL IM at 2, 4, and 6 mo, with a booster at 12–15 mo (1st dose may be given as early as age 6 wk); PedvaxHIB — 0.5 mL IM at 2 and 4 mo, with a booster dose at 12–15 mo (1st dose may be given as early as age 6 wk).	Anaphylactic reaction after a previous dose or to vaccine component.	Anorexia, crying, diarrhea, fever, irritability, malaise, tenderness, vomiting, weakness.	If different brands of vaccine are used for 1st and 2nd doses, need to administer 3rd dose followed by a booster after 12 mo. Give only one dose to unvaccinated children 5–18 yr who are at ↑ risk for invasive Hib disease (i.e., HIV, splenectomy, chemotherapy/radiation). Give only one dose to unvaccinated children 15–59 mo.
Hepatitis A vaccine(HepA, Havrix, Vaqta)	0.5 mL IM at 12–23 mo, followed by 0.5 mL IM of either Vaqta 6–18 mo after the 1st dose OR Havrix 6–12 mo after the 1st dose.	Anaphylactic reaction after a previous dose or to vaccine component.	↓appetite, drowsiness, fever, headache, irritability, pain at injection site, weakness.	Also recommended in children 1 yr who live in areas with high rates of hepatitis A or are in other high-risk groups (e.g., chronic liver disease, HIV, illicit drug users, experiencing homelessness, adolescent males who have sex with other males, close personal contact within first 60 days of arrival of international adoptee from country where hepatitis A is endemic).
Hepatitis B vaccine(HepB, Engerix-B, Recombivax HB)	0.5 mL IM within 24 hr of birth, and then at 1–2 mo, and then 8 wk after 2nd dose or 16 wk after 1st dose (but no earlier than age 24 wk); if mother's HBsAg status is unknown, administer hepatitis B vaccine within 12 hr of birth. Infants born to HBsAg-positive mothers: Administer 0.5 mL of hepatitis B immune globulin IM and 1st dose of hepatitis B vaccine within 12 hr of birth; give 2nd and 3rd doses of hepatitis B vaccine at 1–2 mo and then 8 wk after 2nd dose or 16 wk after 1st dose (but no earlier than age 24 wk), respectively.	Anaphylactic reaction after a previous dose or to vaccine component (including yeast).	Injection site reactions.	A 2-dose series (separated by 4 mo) of the adult formulation (Recombivax HB) can be used in children 11–15 yr.
Human papillomavirus vaccine, 9–valent(HPV9, Gardasil 9)	0.5 mL IM at age 11–12 yr; if initiated before age 15, give 2 doses (1st dose may be given as early as age 9 yr), with 2nd dose being given 6–12 mo after 1st dose. If initiated at 15 yr, give 3 doses, with 2nd and 3rd doses being given at 1–2 mo and 6 mo, respectively after 1st dose.	Anaphylactic reaction after a previous dose or to vaccine component (including yeast).	Dizziness, fever, headache, pain at injection site, syncope.	Used to prevent: 1) cervical, vulvar, and vaginal cancers caused by HPV types 16, 18, 31, 33, 45, 52, and 58 in females; 2) anal, oropharyngeal, and other head and neck cancers caused by HPV types 16, 18, 31, 33, 45, 52, and 58 in males and females; 3) genital warts caused by HPV types 6 and 11 in males and females; and 4) various precancerous or dysplastic lesions caused by HPV types 16, 18, 31, 33, 45, 52, and 58 in males and females.
Influenza vaccine(Afluria Quadrivalent, Fluarix Quadrivalent, Flucelvax Quadrivalent, FluLaval Quadrivalent, Fluzone Quadrivalent)	For 2021, infants and children 6 mo to <9 years of age who received 2 doses of trivalent or quadrivalent influenza vaccine prior to July 1, 2020 need only one dose of the 2021–2022 seasonal influenza vaccine. The 2 doses need not have been received during the same season or consecutive seasons. All other children <9 years of age (including those whose vaccination status cannot be determined) should receive 2 doses separated by 4 wk in order to achieve satisfactory antibody response. Age 6–35 mo: 1–2 doses (see note above) of 0.25 mL (Afluria Quadrivalent or Fluzone Quadrivalent) or 0.5 mL (Fluzone Quadrivalent) IM. Age 6 mo–8 yr (Fluarix Quadrivalent, Flucelvax Quadrivalent, or FluLaval Quadrivalent): 1–2 doses (see above note) of 0.5 mL IM. Age 3–8 yr (Afluria Quadrivalent): 1–2 doses (see above note) of 0.5 mL IM. Age 9 yr: 0.5 mL IM single dose annually.	Anaphylactic reaction after a previous dose or to vaccine component, including eggs/egg products (except for Flucelvax Quadrivalent). Avoid use in patients with acute neurologic compromise.	Local soreness, fever, myalgia, possible neurologic toxicity.	If patient experiences anaphylactic reaction to eggs or egg-containing foods, inactivated influenza vaccine (all except for Flucelvax Quadrivalent) should be administered by health care professional with experience in recognition and management of severe allergic conditions and patient should be closely monitored for 15 min after vaccination.
Measles, mumps, and rubella vaccine(MMR, M-M-R II)	0.5 mL subcut at 12–15 mo and at 4–6 yr (2nd dose may be given earlier if 4 wk have elapsed since the 1st dose).	Anaphylactic reaction after a previous dose or to vaccine component (including neomycin or gelatin); severe immunosuppression (in the absence of severe immunosuppression, HIV is not a contraindication); pregnancy.	Arthralgia, encephalitis, fever, pain at injection site.	If unusual reactions occur, individual components may be given as separate injections. Immunosuppression may ↓ antibody response to injection and ↑ the risk of viral transmission.
Meningococcal conjugate vaccine Serogroups A,C,W, and Y conjugate vaccines: (Menactra [MenACWY-D], MenQuadfi [MenACWY-TT]), Menveo [MenACWY-CRM])); Serogroup B vaccines: (Bexsero [MenB-4C], Trumenba [MenB-FHbp])	Menactra, MenQuadfi, or Menveo: 0.5 mL IM single dose at 11–12 yr with a booster dose at age 16 yr; if received 1st dose at age 13–15 yr, should receive booster dose at age 16–18 yr [with an interval of 8 wk between doses] if received 1st dose at age 16 yr, no booster dose needed. Single dose should be given to previously unvaccinated college freshmen (21 yr) living in dormitories. Bexsero or Trumenba: Young adults aged 16–23 yr who are not at ↑ risk for meningococcal disease may be given 2 doses of either Bexsero (1 mo apart) or Trumenba (6 mo apart) (based on shared decision making).	Anaphylactic reaction after a previous dose or to vaccine component.	Anorexia, arthralgia, diarrhea, fatigue, fever, headache, myalgia, nausea, irritability, malaise, pain at injection site, vomiting.	Routine vaccination with meningococcal serogroup A, C, W, and Y conjugate vaccine is also recommended for certain children (2 mo for Menveo; 9 mo for Menactra; 2 yr for MenQuadfi) who are at high risk (anatomic or functional asplenia [including sickle cell disease] HIV; persistent complement component deficiency; complement inhibitor use; travel in areas where meningococcal disease is hyperendemic or epidemic). Routine vaccination with meningococcal serogroup B vaccine is also recommended for certain children (10 yr) who are at high risk (anatomic or functional asplenia [including sickle cell disease] persistent complement component deficiency; complement inhibitor use).
Pneumococcal conjugate vaccine, 13–valent(PCV13, Prevnar 13)	0.5 mL IM at 2, 4, 6, and 12–15 mo.	Anaphylactic reaction after a previous dose or to vaccine component (including diphtheria toxoid).	Arthralgia, chills, ↓ appetite, fatigue, fever, headache, insomnia, irritability, myalgia, pain at injection site, rash.	One dose may also be given to previously unvaccinated healthy children age 24–59 mo. For high-risk children (e.g., sickle cell disease; anatomic or functional asplenia; chronic cardiac, pulmonary, liver, or renal disease; diabetes; HIV; immunosuppression; cerebrospinal fluid leaks; cochlear implant) age 2–5 yr with <3 PCV13 doses, give 2 doses (8 wk apart, with 1st dose being given 8 wk after most recent dose). If previously received 3 doses, give 1 dose 8 wk after most recent dose. Should be administered before PPSV23.
Pneumococcal polysaccharide vaccine(PPSV23, Pneumovax 23)	0.5 mL IM or subcut 8 wk after final dose of PCV in high-risk children 2 yr (see Notes section for pneumococcal conjugate vaccine for definition of high risk).	Anaphylactic reaction after a previous dose or to vaccine component.	Chills, fever, injection site reactions.	A 2nd dose may be given 5 yr later in children with immunosuppression, sickle cell disease, chronic renal failure, or anatomic/functional asplenia.
Polio vaccine, inactivated (IPV, IPOL)	0.5 mL IM or subcut at 2, 4, and 6–18 mo and at 4–6 yr.	Anaphylactic reaction after a previous dose or to vaccine component (including neomycin, streptomycin, or polymyxin B).	Anorexia, fatigue, fever, irritability, pain at injection site, vomiting.	Oral polio vaccine (OPV) is no longer recommended for use in the United States.
Rotavirus vaccine(RV, Rotarix, RotaTeq)	Rotarix — 1 mL PO at 2 and 4 mo; RotaTeq — 2 mL PO at 2, 4, and 6 mo. First dose of either product may be given as early as age 6 wk; final dose should be given no later than age 8 mo.	Anaphylactic reaction after a previous dose or to vaccine component (if allergic to latex, do not use Rotarix); history of uncorrected congenital malformation of GI tract (Rotarix only); history of intussusception; severe combined immunodeficiency disease.	Diarrhea, fever, irritability, vomiting.	Series should not be started in infants 15 wk. Series should be completed with same product, when possible. If RotaTeq used in any of the doses, a total of 3 doses should be given.
Tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine absorbed(Tdap, Adacel, Boostrix)	0.5 mL IM given at age 11–12 yr if previously completed DTaP series, then followed by booster doses of either Td or Tdap every 10 yr; one-time dose may be given if age 7 yr if did not previously complete DTaP series.	Anaphylactic reaction after a previous dose or to vaccine component; encephalopathy within 7 days of administration of previous dose of Tdap, DTP, or DTaP vaccines.	Abdominal pain, arthralgia, chills, diarrhea, fatigue, headache, myalgia, nausea, pain at injection site, vomiting.	Should also be given to pregnant adolescents during each pregnancy (preferably during 27–36 wk gestation) regardless of interval since prior Td or Tdap.
Varicella vaccine(Var, Varivax)	0.5 mL subcut at 12–15 mo and at 4–6 yr (2nd dose may be given earlier if 3 mo have elapsed since the 1st dose); for persons 7–18 yr who do not have evidence of immunity, 2 doses should be given (3 mo apart if 7–12 yr or 4 wk apart if 13 yr).	Anaphylactic reaction after a previous dose or to vaccine component (including gelatin or neomycin); severe immunosuppression (in the absence of severe immunosuppression, HIV is not a contraindication); pregnancy.	Anorexia, chills, diarrhea, fatigue, fever, headache, injection site reaction, irritability, nausea, vomiting.	Immunosuppression may ↓ antibody response to injection and ↑ the risk of viral transmission.

Nursing Implications:

Assessment

Assess previous immunization history and history of hypersensitivity.
Assess for history of latex allergy. Some prefilled syringes may use latex components and should be avoided in those with hypersensitivity.

Implementation

Measles, mumps, and rubella vaccine and diphtheria toxoid, tetanus toxoid, and pertussis vaccine may be given concomitantly.
Administer each immunization by appropriate route:
PO: Rotavirus.
Subcut: measles, mumps, rubella, polio, varicella, pneumococcal polysaccharide.
IM: diphtheria, tetanus toxoid, pertussis, polio, Haemophilus b, hepatitis B, meningococcal conjugate, hepatitis A, pneumococcal conjugate, pneumococcal polysaccharide, influenza injection, human papillomavirus.

Patient/Family Teaching

Inform parent of potential and reportable side effects of immunization. Notify health care professional if patient develops fever higher than 39.4° C (103° F); difficulty breathing; hives; itching; swelling of eyes, face, or inside of nose; sudden, severe tiredness or weakness; or convulsions.
Review next scheduled immunization with parent.

Evaluation

Prevention of diseases through active immunity.

ROUTINE ADULT IMMUNIZATIONS
GENERIC NAME (BRAND NAMES) INDICATIONS DOSAGE/ROUTE CONTRAINDICATIONS ADVERSE REACTIONS/SIDE EFFECTS
COVID-19 (mRNA) vaccine (Moderna, Pfizer BioNTech) All adults Primary Series:Moderna: 2 doses of 0.5 mL IM separated by 28 days; 3rd dose of 0.5 mL IM 28 days after 2nd dose recommended for immunocompromised patients Pfizer BioNTech: 2 doses of 0.3 mL IM separated by 21 days; 3rd dose of 0.3 mL IM 28 days after 2nd dose recommended for immunocompromised patients Booster Dose:Moderna: 0.25 mL as a single dose IM 5 months after last primary series dose Pfizer BioNTech: 0.3 mL as a single dose IM 5 months after last primary series dose Anaphylactic reaction after a previous dose or to vaccine component; history of immediate allergic reaction (regardless of severity and occurring within 4 hours) to a previous dose Pain/redness/swelling at injection site, myocarditis, pericarditis, arthralgia, chills, diarrhea, fatigue, fever, headache, myalgia, nausea, vomiting
Hepatitis A vaccine(HepA, Havrix, Vaqta) Chronic liver disease; HIV; experiencing homelessness; users of injection/noninjection illicit drugs; men who have sex with men; working with infected primates or with hepatitis A virus in a research laboratory setting; health care facilities providing services to injection or noninjection drug users or group homes and nonresidential day care facilities for developmentally disabled persons; pregnancy (if at risk for infection or severe outcome from infection during pregnancy); travel to endemic areas; unvaccinated individuals who anticipate close personal contact with an international adoptee during the initial 60 days after their arrival in the U.S. from a country with intermediate or high endemicity. 1 mL IM initially, followed by 1 mL IM 6–12 mo (for Havrix) or 6–18 mo (for Vaqta) later. Anaphylactic reaction after a previous dose or to vaccine component. ↓appetite, drowsiness, fever, injection site reactions, irritability, headache.
Hepatitis B vaccine(HepB, Engerix-B, Heplisav-B, Recombivax HB) Chronic liver disease; HIV; sex partners of persons with chronic hepatitis B virus infection; sexually active persons not in mutually monogamous relationships; persons seeking evaluation or treatment for a sexually transmitted infection; men who have sex with men; experiencing homelessness; receive clotting factor concentrates; users of injection/noninjection illicit drugs; men who have sex with men; injection drug users; household contacts of persons with chronic hepatitis B infection; residents and staff of facilities for developmentally disabled persons; health care and public safety personnel with reasonably anticipated risk for exposure to blood or blood-contaminated body fluids; hemodialysis, peritoneal dialysis, home dialysis, and predialysis patients; diabetes mellitus (19–59 yr; 60 yr through shared decision making); incarcerated persons; pregnancy (if at risk for infection or severe outcome from infection during pregnancy); travel to endemic areas. Recombivax HB and Engerix–B: 1 mL IM initially, followed by 1 mL IM at 1 mo and 6 mo after initial dose.
Heplisav-B: 0.5 mL IM initially, followed by 0.5 mL IM 4 wk later. Anaphylactic reaction after a previous dose or to vaccine component. Injection site reactions.
Human papillomavirus vaccine, 9–valent(HPV9, Gardasil 9) All previously unvaccinated or partially vaccinated persons through age 26.. Received no previous doses or received 1st dose at 15 yr of age or later: 0.5 mL IM initially, followed by 0.5 mL at 1–2 mo and 6 mo after initial dose.
Partially vaccinated with 1st dose before 15 yr of age: If 2 doses administered 5 mo apart, no additional doses needed.
Partially vaccinated with 1st dose before 15 yr of age: If only one dose administered or if 2 doses administered <5 mo apart, administer one additional dose of 0.5 mL IM. Anaphylactic reaction after a previous dose or to vaccine component (including yeast); pregnancy. Dizziness, fever, headache, pain at injection site, syncope.
Influenza vaccine
(Afluria Quadrivalent, Fluad Quadrivalent, Fluarix Quadrivalent, Flublok Quadrivalent, Flucelvax Quadrivalent, FluLaval Quadrivalent, Fluzone High-Dose Quadrivalent, Fluzone Quadrivalent) All adults. All ages (all vaccines except for Fluzone High-Dose Quadrivalent): 0.5 mL IM annually.
65 yr (Fluzone High-Dose Quadrivalent): 0.7 mL IM annually If patient experiences anaphylactic reaction to eggs or egg-containing foods, inactivated influenza vaccine should be administered by health care professional with experience in recognition and management of severe allergic conditions and patient should be closely monitored for 15 min after vaccination.
Flucelvax Quadrivalent and Flublok Quadrivalent are the only egg-free influenza vaccines available in the U.S. Fever, injection site reactions, myalgia.
Measles, mumps, and rubella vaccine(MMR, M-M-R II) Adults born in or after 1957 with unreliable documentation of previous vaccination (unless have laboratory evidence of immunity to all 3 diseases); health care workers born before 1957 who do not have laboratory evidence of immunity to measles, mumps, or rubella. Adults born in or after 1957 with unreliable documentation of previous vaccination: 1 or 2 doses of 0.5 mL subcut (with 28 days between doses); high-risk groups should receive a total of 2 doses (with 28 days between doses). Allergy to gelatin or neomycin; severe immunosuppression (in the absence of severe immunosuppression, HIV is not a contraindication); pregnancy (also avoid becoming pregnant for 4 wk after immunization). Burning, stinging, pain at injection site; arthritis/arthralgia; fever; encephalitis; allergic reactions.
Immunosuppression may ↓ antibody response to injection and ↑ the risk of viral transmission (live vaccine).
Meningococcal conjugate vaccine
Serogroups A,C,W, and Y conjugate vaccines: (Menactra [MenACWY-D], MenQuadfi [MenACWY-TT]), Menveo [MenACWY-CRM]);
Serogroup B vaccines: (Bexsero [MenB-4C], Trumenbra [MenB-FHbp]) Serogroups A,C,W, and Y conjugate vaccines — First-year college students living in residential housing if they have not previously received a dose on or after their 16th birthday; military recruits; anatomic or functional asplenia (including sickle cell disease); HIV; persistent complement component deficiency; complement inhibitor use; travel in areas in which meningococcal disease is hyperendemic or epidemic; persons at risk during a community outbreak.
Serogroup B vaccines: Anatomic or functional asplenia (including sickle cell disease); persistent complement component deficiency; complement inhibitor use. May also administer to young adults aged 16–23 yr who are not at ↑ risk for meningococcal disease (based on shared decision making). Serogroups A,C,W, and Y conjugate vaccines —
Adults not previously vaccinated with functional or anatomic asplenia, HIV, persistent complement deficiency, or complement inhibitor use: 0.5 mL IM initially, followed by 0.5 mL IM 2 mo later. Repeat dose every 5 yr if person remains at ↑ risk.
Adults not previously vaccinated who are traveling to areas where meningococcal disease is endemic/hyperendemic; at risk during a community outbreak; or military recruits: 0.5 mL IM single dose. Repeat dose every 5 yr if person remains at ↑ risk.
Adults not previously vaccinated who are first-year college students living in residential housing: 0.5 mL IM single dose.
Serogroup B vaccines —
Patients at ↑ risk for serogroup B meningococcal disease: Bexsero: 0.5 mL IM initially, followed by 0.5 mL IM 1 mo after initial dose; Trumenba: 0.5 mL IM initially, followed by 0.5 mL IM 1–2 mo, and 6 mo after initial dose.
Patients 16–23 yr of age who are not at risk for serogroup B meningococcal disease: Bexsero: 0.5 mL IM initially, followed by 0.5 mL IM 1 mo after initial dose; Trumenba: 0.5 mL IM initially, followed by 0.5 mL 6 mo after initial dose. Anaphylactic reaction after a previous dose or to vaccine component. Anorexia, arthralgia, diarrhea, fatigue, fever, headache, myalgia, nausea, irritability, malaise, pain at injection site, vomiting.
Pneumococcal conjugate vaccine, 13–valent(PCV13, Prevnar 13) 65 yr (based on shared decision making if previously did not receive); adults 19 yr with chronic renal failure, anatomic or functional asplenia (including sickle cell disease), cerebrospinal fluid leaks, cochlear implants, or immunosuppression (including HIV). Adults 65 yr: 0.5 mL IM single dose followed by single dose of PPSV23 1 yr later; if already received PPSV23, give PCV13 single dose (0.5 mL IM) 1 yr after dose of PPSV23.
Adults 19 yr with specified medical conditions (under Indications column): 0.5 mL IM single dose followed by single dose of PPSV23 8 wk later; if already received PPSV23, give PCV13 single dose (0.5 mL IM) 1 yr after dose of PPSV23. Anaphylactic reaction after a previous dose or to vaccine component including diphtheria toxoid. Arthralgia, chills, ↓ appetite, fatigue, fever, headache, insomnia, irritability, myalgia, pain at injection site, rash.
Pneumococcal polysaccharide vaccine(PPSV23, Pneumovax 23) All adults 65 yr; 19–64 yr with chronic cardiac (excluding hypertension), pulmonary (including COPD and asthma), or liver disease; alcoholism; diabetes, or cigarette smoking; 19 yr with chronic renal failure, anatomic or functional asplenia (including sickle cell disease), cerebrospinal fluid leaks, cochlear implants, or immunosuppression (including HIV). 0.5 mL IM or subcut; one-time revaccination should also be given 5 yr after 1st dose to those 65 yr (if 1st dose was given 5 yr ago and before age 65) and to high-risk patients age 19 yr (chronic renal failure, anatomic or functional asplenia, sickle cell disease, immunosuppression) 5 yr after 1st dose (if the most recent dose of PPSV23 was administered before age 65 yr, at age 65 yr, give another dose of PPSV23 8 wk after PCV13 and 5 yr after the most recent dose of PPSV23). Anaphylactic reaction after a previous dose or to vaccine component. Chills, fever, injection site reactions.
Tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine absorbed(Tdap, Adacel, Boostrix) Single dose should be given to replace one of the 10-yr Td boosters in all adults who did not previously receive a dose of Tdap or if their vaccine status is unknown. Single dose should also be given as soon as feasible to all pregnant women (preferred during 27–36 wks' gestation), close contacts of infants <12 mo, and health care workers with direct patient contact. 0.5 mL IM single dose. Anaphylactic reaction after a previous dose or to vaccine component; encephalopathy within 7 days of administration of previous dose of Tdap, DTP, or DTaP vaccines. Abdominal pain, arthralgia, chills, diarrhea, fatigue, headache, myalgia, nausea, pain at injection site, vomiting.
Tetanus-diphtheria(Td, Tenivac) All adults who lack written documentation of a primary series consisting of 3 doses of tetanus– and diphtheria–toxoid-containing vaccine; booster dose should be given to all adults every 10 yr (see info above regarding use of Tdap to replace one dose of Td in booster series). Unimmunized: 0.5 mL IM initially, followed by 0.5 mL IM 4 wk after initial dose; Immunized: 0.5 mL IM booster every 10 yr. Anaphylactic reaction after a previous dose or to vaccine component. Arthralgia, chills, diarrhea, fatigue, headache, myalgia, nausea, pain at injection site.
Varicella vaccine(Var, Varivax) Any adult without a history of chickenpox or herpes zoster (shingles), without a history of receiving 2 doses of varicella vaccine 4 wk apart, or without laboratory evidence of immunity. Health care workers and pregnant women born in U.S. before 1980 who do not meet the above criteria should be tested for immunity. 0.5 mL subcut initially, followed by 0.5 mL subcut 4–8 wk after initial dose. Anaphylactic reaction after a previous dose or to vaccine component (including gelatin or neomycin); severe immunosuppression (in the absence of severe immunosuppression, HIV is not a contraindication); pregnancy (also avoid becoming pregnant for 4 wk after immunization). Fever, pain at injection site. Immunosuppression may ↓ antibody response to injection and ↑ the risk of viral transmission (live vaccine).
Zoster vaccine(Shingrix) All adults 50 yr (regardless of previous history of herpes zoster or vaccination with Zostavax). 0.5 mL subcut initially, followed by 0.5 mL subcut 2–6 mo after initial dose. Anaphylactic reaction after a previous dose or to vaccine component (including gelatin or neomycin); severe immunosuppression (in the absence of severe immunosuppression, HIV is not a contraindication); pregnancy (also avoid becoming pregnant for 4 wk after immunization). Fever, pain at injection site. Immunosuppression may ↓ antibody response to injection and ↑ the risk of viral transmission (live vaccine).
SOURCE: Adapted from the recommendations of the Department of Health and Human Services, Centers for Disease Control and Prevention: http://www.cdc.gov/vaccines/schedules/hcp/index.html.

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Information

GENERIC NAME (BRAND NAMES)	INDICATIONS	DOSAGE/ROUTE	CONTRAINDICATIONS	ADVERSE REACTIONS/SIDE EFFECTS
COVID-19 (mRNA) vaccine (Moderna, Pfizer BioNTech)	All adults	Primary Series:Moderna: 2 doses of 0.5 mL IM separated by 28 days; 3rd dose of 0.5 mL IM 28 days after 2nd dose recommended for immunocompromised patients Pfizer BioNTech: 2 doses of 0.3 mL IM separated by 21 days; 3rd dose of 0.3 mL IM 28 days after 2nd dose recommended for immunocompromised patients Booster Dose:Moderna: 0.25 mL as a single dose IM 5 months after last primary series dose Pfizer BioNTech: 0.3 mL as a single dose IM 5 months after last primary series dose	Anaphylactic reaction after a previous dose or to vaccine component; history of immediate allergic reaction (regardless of severity and occurring within 4 hours) to a previous dose	Pain/redness/swelling at injection site, myocarditis, pericarditis, arthralgia, chills, diarrhea, fatigue, fever, headache, myalgia, nausea, vomiting
Hepatitis A vaccine(HepA, Havrix, Vaqta)	Chronic liver disease; HIV; experiencing homelessness; users of injection/noninjection illicit drugs; men who have sex with men; working with infected primates or with hepatitis A virus in a research laboratory setting; health care facilities providing services to injection or noninjection drug users or group homes and nonresidential day care facilities for developmentally disabled persons; pregnancy (if at risk for infection or severe outcome from infection during pregnancy); travel to endemic areas; unvaccinated individuals who anticipate close personal contact with an international adoptee during the initial 60 days after their arrival in the U.S. from a country with intermediate or high endemicity.	1 mL IM initially, followed by 1 mL IM 6–12 mo (for Havrix) or 6–18 mo (for Vaqta) later.	Anaphylactic reaction after a previous dose or to vaccine component.	↓appetite, drowsiness, fever, injection site reactions, irritability, headache.
Hepatitis B vaccine(HepB, Engerix-B, Heplisav-B, Recombivax HB)	Chronic liver disease; HIV; sex partners of persons with chronic hepatitis B virus infection; sexually active persons not in mutually monogamous relationships; persons seeking evaluation or treatment for a sexually transmitted infection; men who have sex with men; experiencing homelessness; receive clotting factor concentrates; users of injection/noninjection illicit drugs; men who have sex with men; injection drug users; household contacts of persons with chronic hepatitis B infection; residents and staff of facilities for developmentally disabled persons; health care and public safety personnel with reasonably anticipated risk for exposure to blood or blood-contaminated body fluids; hemodialysis, peritoneal dialysis, home dialysis, and predialysis patients; diabetes mellitus (19–59 yr; 60 yr through shared decision making); incarcerated persons; pregnancy (if at risk for infection or severe outcome from infection during pregnancy); travel to endemic areas.	Recombivax HB and Engerix–B: 1 mL IM initially, followed by 1 mL IM at 1 mo and 6 mo after initial dose. Heplisav-B: 0.5 mL IM initially, followed by 0.5 mL IM 4 wk later.	Anaphylactic reaction after a previous dose or to vaccine component.	Injection site reactions.
Human papillomavirus vaccine, 9–valent(HPV9, Gardasil 9)	All previously unvaccinated or partially vaccinated persons through age 26..	Received no previous doses or received 1st dose at 15 yr of age or later: 0.5 mL IM initially, followed by 0.5 mL at 1–2 mo and 6 mo after initial dose. Partially vaccinated with 1st dose before 15 yr of age: If 2 doses administered 5 mo apart, no additional doses needed. Partially vaccinated with 1st dose before 15 yr of age: If only one dose administered or if 2 doses administered <5 mo apart, administer one additional dose of 0.5 mL IM.	Anaphylactic reaction after a previous dose or to vaccine component (including yeast); pregnancy.	Dizziness, fever, headache, pain at injection site, syncope.
Influenza vaccine (Afluria Quadrivalent, Fluad Quadrivalent, Fluarix Quadrivalent, Flublok Quadrivalent, Flucelvax Quadrivalent, FluLaval Quadrivalent, Fluzone High-Dose Quadrivalent, Fluzone Quadrivalent)	All adults.	All ages (all vaccines except for Fluzone High-Dose Quadrivalent): 0.5 mL IM annually. 65 yr (Fluzone High-Dose Quadrivalent): 0.7 mL IM annually	If patient experiences anaphylactic reaction to eggs or egg-containing foods, inactivated influenza vaccine should be administered by health care professional with experience in recognition and management of severe allergic conditions and patient should be closely monitored for 15 min after vaccination. Flucelvax Quadrivalent and Flublok Quadrivalent are the only egg-free influenza vaccines available in the U.S.	Fever, injection site reactions, myalgia.
Measles, mumps, and rubella vaccine(MMR, M-M-R II)	Adults born in or after 1957 with unreliable documentation of previous vaccination (unless have laboratory evidence of immunity to all 3 diseases); health care workers born before 1957 who do not have laboratory evidence of immunity to measles, mumps, or rubella.	Adults born in or after 1957 with unreliable documentation of previous vaccination: 1 or 2 doses of 0.5 mL subcut (with 28 days between doses); high-risk groups should receive a total of 2 doses (with 28 days between doses).	Allergy to gelatin or neomycin; severe immunosuppression (in the absence of severe immunosuppression, HIV is not a contraindication); pregnancy (also avoid becoming pregnant for 4 wk after immunization).	Burning, stinging, pain at injection site; arthritis/arthralgia; fever; encephalitis; allergic reactions. Immunosuppression may ↓ antibody response to injection and ↑ the risk of viral transmission (live vaccine).
Meningococcal conjugate vaccine Serogroups A,C,W, and Y conjugate vaccines: (Menactra [MenACWY-D], MenQuadfi [MenACWY-TT]), Menveo [MenACWY-CRM]); Serogroup B vaccines: (Bexsero [MenB-4C], Trumenbra [MenB-FHbp])	Serogroups A,C,W, and Y conjugate vaccines — First-year college students living in residential housing if they have not previously received a dose on or after their 16th birthday; military recruits; anatomic or functional asplenia (including sickle cell disease); HIV; persistent complement component deficiency; complement inhibitor use; travel in areas in which meningococcal disease is hyperendemic or epidemic; persons at risk during a community outbreak. Serogroup B vaccines: Anatomic or functional asplenia (including sickle cell disease); persistent complement component deficiency; complement inhibitor use. May also administer to young adults aged 16–23 yr who are not at ↑ risk for meningococcal disease (based on shared decision making).	Serogroups A,C,W, and Y conjugate vaccines — Adults not previously vaccinated with functional or anatomic asplenia, HIV, persistent complement deficiency, or complement inhibitor use: 0.5 mL IM initially, followed by 0.5 mL IM 2 mo later. Repeat dose every 5 yr if person remains at ↑ risk. Adults not previously vaccinated who are traveling to areas where meningococcal disease is endemic/hyperendemic; at risk during a community outbreak; or military recruits: 0.5 mL IM single dose. Repeat dose every 5 yr if person remains at ↑ risk. Adults not previously vaccinated who are first-year college students living in residential housing: 0.5 mL IM single dose. Serogroup B vaccines — Patients at ↑ risk for serogroup B meningococcal disease: Bexsero: 0.5 mL IM initially, followed by 0.5 mL IM 1 mo after initial dose; Trumenba: 0.5 mL IM initially, followed by 0.5 mL IM 1–2 mo, and 6 mo after initial dose. Patients 16–23 yr of age who are not at risk for serogroup B meningococcal disease: Bexsero: 0.5 mL IM initially, followed by 0.5 mL IM 1 mo after initial dose; Trumenba: 0.5 mL IM initially, followed by 0.5 mL 6 mo after initial dose.	Anaphylactic reaction after a previous dose or to vaccine component.	Anorexia, arthralgia, diarrhea, fatigue, fever, headache, myalgia, nausea, irritability, malaise, pain at injection site, vomiting.
Pneumococcal conjugate vaccine, 13–valent(PCV13, Prevnar 13)	65 yr (based on shared decision making if previously did not receive); adults 19 yr with chronic renal failure, anatomic or functional asplenia (including sickle cell disease), cerebrospinal fluid leaks, cochlear implants, or immunosuppression (including HIV).	Adults 65 yr: 0.5 mL IM single dose followed by single dose of PPSV23 1 yr later; if already received PPSV23, give PCV13 single dose (0.5 mL IM) 1 yr after dose of PPSV23. Adults 19 yr with specified medical conditions (under Indications column): 0.5 mL IM single dose followed by single dose of PPSV23 8 wk later; if already received PPSV23, give PCV13 single dose (0.5 mL IM) 1 yr after dose of PPSV23.	Anaphylactic reaction after a previous dose or to vaccine component including diphtheria toxoid.	Arthralgia, chills, ↓ appetite, fatigue, fever, headache, insomnia, irritability, myalgia, pain at injection site, rash.
Pneumococcal polysaccharide vaccine(PPSV23, Pneumovax 23)	All adults 65 yr; 19–64 yr with chronic cardiac (excluding hypertension), pulmonary (including COPD and asthma), or liver disease; alcoholism; diabetes, or cigarette smoking; 19 yr with chronic renal failure, anatomic or functional asplenia (including sickle cell disease), cerebrospinal fluid leaks, cochlear implants, or immunosuppression (including HIV).	0.5 mL IM or subcut; one-time revaccination should also be given 5 yr after 1st dose to those 65 yr (if 1st dose was given 5 yr ago and before age 65) and to high-risk patients age 19 yr (chronic renal failure, anatomic or functional asplenia, sickle cell disease, immunosuppression) 5 yr after 1st dose (if the most recent dose of PPSV23 was administered before age 65 yr, at age 65 yr, give another dose of PPSV23 8 wk after PCV13 and 5 yr after the most recent dose of PPSV23).	Anaphylactic reaction after a previous dose or to vaccine component.	Chills, fever, injection site reactions.
Tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine absorbed(Tdap, Adacel, Boostrix)	Single dose should be given to replace one of the 10-yr Td boosters in all adults who did not previously receive a dose of Tdap or if their vaccine status is unknown. Single dose should also be given as soon as feasible to all pregnant women (preferred during 27–36 wks' gestation), close contacts of infants <12 mo, and health care workers with direct patient contact.	0.5 mL IM single dose.	Anaphylactic reaction after a previous dose or to vaccine component; encephalopathy within 7 days of administration of previous dose of Tdap, DTP, or DTaP vaccines.	Abdominal pain, arthralgia, chills, diarrhea, fatigue, headache, myalgia, nausea, pain at injection site, vomiting.
Tetanus-diphtheria(Td, Tenivac)	All adults who lack written documentation of a primary series consisting of 3 doses of tetanus– and diphtheria–toxoid-containing vaccine; booster dose should be given to all adults every 10 yr (see info above regarding use of Tdap to replace one dose of Td in booster series).	Unimmunized: 0.5 mL IM initially, followed by 0.5 mL IM 4 wk after initial dose; Immunized: 0.5 mL IM booster every 10 yr.	Anaphylactic reaction after a previous dose or to vaccine component.	Arthralgia, chills, diarrhea, fatigue, headache, myalgia, nausea, pain at injection site.
Varicella vaccine(Var, Varivax)	Any adult without a history of chickenpox or herpes zoster (shingles), without a history of receiving 2 doses of varicella vaccine 4 wk apart, or without laboratory evidence of immunity. Health care workers and pregnant women born in U.S. before 1980 who do not meet the above criteria should be tested for immunity.	0.5 mL subcut initially, followed by 0.5 mL subcut 4–8 wk after initial dose.	Anaphylactic reaction after a previous dose or to vaccine component (including gelatin or neomycin); severe immunosuppression (in the absence of severe immunosuppression, HIV is not a contraindication); pregnancy (also avoid becoming pregnant for 4 wk after immunization).	Fever, pain at injection site. Immunosuppression may ↓ antibody response to injection and ↑ the risk of viral transmission (live vaccine).
Zoster vaccine(Shingrix)	All adults 50 yr (regardless of previous history of herpes zoster or vaccination with Zostavax).	0.5 mL subcut initially, followed by 0.5 mL subcut 2–6 mo after initial dose.	Anaphylactic reaction after a previous dose or to vaccine component (including gelatin or neomycin); severe immunosuppression (in the absence of severe immunosuppression, HIV is not a contraindication); pregnancy (also avoid becoming pregnant for 4 wk after immunization).	Fever, pain at injection site. Immunosuppression may ↓ antibody response to injection and ↑ the risk of viral transmission (live vaccine).