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/PRECAUTIONS | ADVERSE REACTIONS/SIDE EFFECTS | NOTES |
|---|---|---|---|---|
| COVID-19 (mRNA) vaccine (Moderna, Novavax, Pfizer BioNTech) | Age 6 mo–<5 yr: Moderna: 0.25 mL (25 mcg) IM initially, then at 4–8 wk after 1st dose; Pfizer BioNTech: 0.3 mL (3 mcg) IM initially, then at 3–8 wk after 1st dose, and at ≥8 wk after 2nd dose Age 5–<12 yr: Moderna: 0.25 mL (25 mcg) IM × 1 dose; Pfizer BioNTech: 0.3 mL (10 mcg) IM × 1 dose Age ≥12 yr: Moderna: 0.5 mL (50 mcg) IM x 1 dose; Novavax: 0.5 mL (5 mcg rS protein and 50 mcg Matrix-M adjuvant) IM initially, then 3–8 wk after 1st dose; Pfizer BioNTech: 0.3 mL (30 mcg) IM × 1 dose | Contraindications: Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a component of the vaccine. Precautions: History of diagnosed nonsevere allergy to a component of the vaccine; history of immediate nonsevere allergic reaction (regardless of severity and occurring within 4 hr) to a previous dose; moderate or severe acute illness with or without fever; history of multisystem inflammatory syndrome or history of myocarditis or pericarditis within 3 wk after a dose of any COVID-19 vaccine. | Local reactions: pain; tenderness; swelling; erythema of injection site. Systemic reactions: fever; fatigue/malaise; headache; chills; myalgia; arthralgia; in children <3 yr, irritability/crying sleepiness, and anorexia; localized axillary lymphadenopathy on the side of injection; myocarditis/pericarditis (especially in males age 12–39 yr). | Please see the latest guidance from the CDC for patients who are moderately or severely immunocompromised.1 Observe for ≥15 min after vaccine dose and for 30 min if history of nonsevere, immediate allergic reaction to previous dose of COVID-19 vaccine. |
| Diphtheria toxoid, tetanus toxoid, andacellular pertussis vaccine—DTaP (DaptacelInfanrix) | 5-dose series: 0.5 mL IM at age 2 mo, 4 mo, 6 mo, 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). | Contraindications: Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to vaccine component; encephalopathy within 7 days of administration of previous dose of Tdap, DTP, or DTaP vaccines. Precautions: Guillain-Barré syndrome within 6 wk after previous dose of tetanus-toxoid–containing vaccine; history of Arthus-type hypersensitivity reaction to vaccine components; progressive neurologic disorder; moderate or severe acute illness with or without fever; allergy to latex; syncope. | Injection site reactions (pain, redness, swelling); fever; drowsiness; irritability/fussiness; crying; lethargy; anorexia. | 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 influenzae type b vaccination—Hib(ActHIBHiberixPedvaxHIB) | ActHIB or Hiberix: 4-dose series (0.5 mL/dose IM) (3-dose primary series at age 2 mo, 4 mo, and 6 mo, followed by a booster dose* at 12–15 mo). PedvaxHIB: 3-dose series (0.5 mL/dose IM) (2-dose primary series at age 2 mo and 4 mo, followed by a booster dose at 12–15 mo). | Contraindications: Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to vaccine component; history of severe allergic reaction to dry natural latex. Precautions: Moderate or severe acute illness with or without fever. | Sleepiness; fever; injection site reactions (pain, redness, swelling); crying; diarrhea, vomiting. | Please see the latest guidance from the CDC for children undergoing chemotherapy, hematopoietic stem cell transplant, anatomic or functional asplenia, splenectomy, HIV, immunoglobulin deficiency, and early component deficiency. |
| Hepatitis A vaccine—HepA(HavrixVaqta) | 2-dose series: 0.5 mL IM at 12–23 mo, then 0.5 mL IM of either Vaqta 6–18 mo after the 1st dose OR Havrix 6–12 mo after the 1st dose. | Contraindications: Severe allergic reaction (e.g., anaphylaxis) to a previous dose or to vaccine component (including neomycin). Precautions: Moderate or severe acute illness with or without fever; latex allergy; syncope. | Injection site soreness; headache; anorexia; fever; malaise. | 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-BRecombivax HB) | Infants born to HBsAg-negative mothers (3-dose series): Birth weight >2000 g: 0.5 mL IM within 24 hr of birth, at age 1–2 mo, and at age 6–18 mo; Birth weight <2,000 g: 0.5 mL at chronological age of 1 mo or at hospital discharge, at age 1–2 mo, and then at age 6–18 mo. Infants born to HBsAg-positive mothers: Birth weight >2000 g (3-dose series): 0.5 mL IM within 12 hr of birth, at age 1–2 mo, and then at age 6 mo. Birth weight <2000 g (4-dose series): 0.5 mL IM within 12 hr of birth, at age 1 mo, at age 2–3 mo, and then at age 6 mo. | Contraindications: Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to vaccine component (including yeast). Precautions: Moderate or severe acute illness with or without fever. | Injection site reactions; fatigue; dizziness; headache; fever. | Determine mother’s HBsAg status to guide vaccine administration. |
| Human papillomavirus vaccine, 9-valent—HPV9 (Gardasil 9) | 0.5 mL IM at age 11–12 yr; if initiated before age 15 yr, 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. Minimum interval is 5 mo. If initiated at ≥age 15 yr, give 3-dose series (minimum intervals: dose 1 to dose 2: 4 wk; dose 2 to dose 3: 12 wk; dose 1 to dose 3: 5 mo). | Contraindications: Serious allergic reaction (e.g., anaphylaxis) after a previous dose or to vaccine component (including yeast). Precautions: Moderate or severe acute illness with or without fever. | Injection site reactions; dizziness; fever; headache; syncope. | Immunocompromised patients: 3-dose series is indicated even with initiation of vaccination at age 9–14 yr. If history of sexual abuse or assault, then start at age 9 yr. |
| Influenza vaccine (Afluria QuadrivalentFluad QuadrivalentFluarix QuadrivalentFlublok QuadrivalentFlucelvax QuadrivalentFluLaval QuadrivalentFluzone High-Dose QuadrivalentFluzone Quadrivalent) | For the 2023–2024 influenza season: Age 6 mo–8 yr and have received fewer than 2 influenza vaccine doses before July 1, 2023, or if vaccination history is unknown: 2 doses separated by at ≥4 wk; age 6 mo–8 yr and have received ≥2 influenza doses before July 1, 2023: 1 dose; age ≥9 yr: 1 dose | Contraindications: Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component. Precautions: Guillain-Barré syndrome within 6 wk after a previous dose of any type of influenza vaccine; moderate or severe acute illness with or without fever. | Injection site reactions; headache; fatigue; fever; myalgia, possible neurologic toxicity. | Minimum age for inactivated vaccine is 6 mo, live/attenuated vaccine is 2 yr, and recombinant influenza vaccine is 18 yr. There are multiple contraindications and precautions for the various influenza vaccines; refer to the CDC or manufacturer information. |
| Measles, mumps, and rubella vaccine—MMR (M-M-R IIPriorix) | 2-dose series: 0.5 mL SUBQ at age 12–15 mo and at age 4–6 yr (2nd dose may be given earlier if ≥4 wk have elapsed since the 1st dose). | Contraindications: Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to vaccine component; severe immunodeficiency; pregnancy. Precautions: Recent receipt or antibody-containing blood product; history of thrombocytopenia or thrombocytopenic purpura; moderate or severe acute illness with or without fever. | Injection site reactions; irritability; fever; rash; diarrhea, vomiting. | If unusual reactions occur, individual components may be given as separate injections. Immunosuppression may ↓ antibody response to injection and ↑ the risk of viral transmission. Do not administer IM or IV. |
| Meningococcal conjugate vaccine Serogroups A, C, W, and Y conjugate vaccines:MenQuadfi [MenACWY-TT])Menveo [MenACWY-CRM]) Serogroup B vaccines:Bexsero [MenB-4C]Trumenba [MenB-FHbp] | MenQuadfi or Menveo: 0.5 mL IM single dose at age 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 of MenQuadfi or Menveo should be given to previously unvaccinated college freshmen (≤21 yr) living in dormitories. Bexsero or Trumenba: Young adults age 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). | Contraindications: Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to vaccine component. Precautions: Pregnancy; latex sensitivity (MenB-4C only); moderate or severe illness with or without fever; Guillain-Barré syndrome (if there is a previous history). | Injection site reactions; anorexia; arthralgia; diarrhea; fatigue; fever; headache; myalgia; nausea; irritability; drowsiness; vomiting. | Special situations for use of serogroups A, C, W, and Y conjugate vaccines outside the recommended age range include anatomic or functional asplenia (including sickle cell disease); HIV; persistent complement component deficiency; complement inhibitor (e.g., eculizumab, ravulizumab) use; travel to countries with hyperendemic or epidemic meningococcal disease; 1st-yr college students who live in residential housing (if not previously vaccinated at age ≥16 yr); military recruits; and adolescent vaccination of children who received MenACWY prior to age 10 yr. Special situations for use of serogroups B vaccine include anatomic or functional asplenia (including sickle cell disease); persistent complement component deficiency; and complement inhibitor (e.g., eculizumab, ravulizumab) use. Bexsero and Trumenba are not interchangeable. |
| Pneumococcal conjugate vaccine, 15-valent or 20-valent—PCV15 or PCV20 (PCV15Vaxneuvance) (PCV20Prevnar 20) | 4-dose series: 0.5 mL IM at age 2 mo, 4 mo, 6 mo, and 12–15 mo. | Contraindications: Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to vaccine component (including diphtheria toxoid). Precautions: Moderate or severe acute illness with or without fever. | Injection site reactions; arthralgia; chills; anorexia; fatigue; fever; headache; insomnia; irritability; myalgia. | One dose may also be given to previously unvaccinated healthy children age 24–59 mo; two doses (given ≥8 wk apart) may also be given to previously unvaccinated children age 24–59 mo with conditions that ↑ the risk of pneumococcal disease. |
| Pneumococcal polysaccharide vaccine—PPSV23(Pneumovax 23) | 0.5 mL IM or SUBQ ≥8 wk after final dose of PCV in high-risk children age ≥2 yr. | Contraindications: Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to vaccine component; age <2 yr. Precautions: Moderate or severe acute illness with or without fever. | Injection site reactions; headache; fatigue; myalgia; fever. | |
| Polio vaccine, inactivated—IPV (IPOL) | 4-dose series: 0.5 mL IM or SUBQ at age 2 mo, 4 mo, 6–18 mo, and 4–6 yr. Administer the final dose on or after age 4 yr and ≥6 mo after the previous dose. | Contraindications: Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to vaccine component (including neomycin, 2-phenoxyethanol, formaldehyde, streptomycin, or polymyxin B); moderate or severe illness with fever. Precautions: Illness with or without fever. | Injection site reactions; anorexia; fatigue; fever; irritability; vomiting. | Oral polio vaccine (OPV) is no longer recommended for use in the United States. |
| Rotavirus vaccine (RotarixRotaTeq) | Rotarix: 2-dose series of 1 mL PO at age 6 wk and then ≥4 wk later. Complete series by age 24 wk. RotaTeq: 3-dose series of 2 mL PO at age 2 mo, 4 mo, and 6 mo. Complete series by age 32 wk. | Contraindications: Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to vaccine component; latex allergy (Rotarix only); history of uncorrected congenital malformation of GI tract (Rotarix only); history of intussusception; severe combined immunodeficiency disease. Precautions: Chronic GI disease; spina bifida (Rotarix only); moderate or severe acute illness with or without fever. | Diarrhea; fever; anorexia; vomiting; cough; runny nose; irritability. | First dose of either product may be given as early as age 6 wk. Series should not be started when age ≥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. Delay vaccine if infants are suffering from acute diarrhea or vomiting. Rotavirus shedding occurs in stool after vaccination, which should be considered if close contacts are immunocompromised. |
| Tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine absorbed (TdapAdacelBoostrix) | 0.5 mL IM 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. | Contraindications: Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to vaccine component; encephalopathy within 7 days of administration of previous dose of Tdap, DTP, or DtaP vaccines. Precautions: Guillain-Barré syndrome within 6 wk after previous dose of tetanus-toxoid–containing vaccine; history of Arthus-type hypersensitivity; progressive or unstable neurological disorder; uncontrolled seizures, or progressive encephalopathy; moderate or severe acute illness with or without fever. | Injection site reactions; abdominal pain; fever; rash; arthralgia; chills; diarrhea; fatigue; headache; myalgia; nausea; 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 (VarVarivax) | 2-dose series: 0.5 mL IM or SUBQ at age 12–15 mo and at 4–6 yr (2nd dose may be given earlier if ≥3 mo have elapsed since 1st dose); if age 7–18 yr with no evidence of immunity, 2 doses should be given (≥3 mo apart if age 7–12 yr or ≥4–8 wk apart if age ≥13 yr). | Contraindications: Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to vaccine component (including gelatin or neomycin); severe immunosuppression; pregnancy or planning to become pregnant in next 3 mo. Precautions: Recent receipt of antibody-containing blood product; receipt of specific antiviral drugs 24 hr before vaccination (avoid use for 14 days after vaccination); use of salicylates (avoid use for 6 wk after vaccination); moderate or severe acute illness with or without fever. | Injection site reactions; anorexia; chills; diarrhea; fatigue; fever; rash; headache; irritability; nausea; vomiting. | Immunosuppression may ↓ antibody response to injection and ↑ the risk of viral transmission. |
ROUTINE ADULT IMMUNIZATIONS
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| GENERIC NAME (BRAND NAMES) | INDICATIONS | DOSAGE/ROUTE | CONTRAINDICATIONS | ADVERSE REACTIONS/SIDE EFFECTS |
|---|---|---|---|---|
| COVID-19 (mRNA) vaccine (ModernaNovavaxPfizer BioNTech) | All adults | Age ≥12 yr: Moderna: 0.5 mL (50 mcg) IM × 1 dose; Novavax: 0.5 mL (5 mcg rS protein and 50 mcg Matrix-M adjuvant) IM initially, then 3–8 wk after 1st dose; Pfizer-BioNTech: 0.3 mL (30 mcg) IM × 1 dose. | Contraindications: Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a component of the vaccine. Precautions: History of diagnosed nonsevere allergy to a component of the vaccine; history of immediate nonsevere allergic reaction (regardless of severity and occurring within 4 hr) to a previous dose; moderate or severe acute illness with or without fever; history of multisystem inflammatory syndrome or history of myocarditis or pericarditis within 3 wk after a dose of any COVID-19 vaccine. | Local reactions: pain; tenderness; swelling; erythema of injection site. Systemic reactions: fever; fatigue/malaise; headache; chills; myalgia; arthralgia; localized axillary lymphadenopathy on the side of injection; myocarditis/pericarditis (especially in males age 12–39 yrs). |
| Hepatitis A vaccine—HepA (HavrixVaqta) | Chronic liver disease; HIV; experiencing homelessness; users of injection/noninjection illicit drugs; men who have sex with men; working 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. | 2-dose series: 1 mL IM initially, then 1 mL IM 6–12 mo (Havrix) or 6–18 mo (Vaqta) after initial dose. | Contraindications: Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a component of the vaccine (including neomycin). Precautions: Moderate or severe acute illness with or without fever; syncope. | Injection site reactions; anorexia; nausea; fatigue; ↓ appetite, fever; irritability; headache. |
| Hepatitis B vaccine—HepB (Engerix-BHeplisav-BPreHevbrioRecombivax 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; 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 EngerixB, and PreHevbrio (3-dose series): 1 mL IM initially, then 1 mL IM at 1 mo and 6 mo after initial dose. Heplisav-B (2-dose series): 0.5 mL IM initially, then 0.5 mL IM ≥4 wk later. | Contraindications: Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a component of the vaccine (including yeast); pregnancy (Heplisav-B and PreHevbrio not recommended). Precautions: Moderate or severe acute illness with or without fever. | Injection site reactions; fatigue; dizziness; headache; fever. |
| Human papillomavirus vaccine, 9-valent—HPV9 (Gardasil 9) | All previously unvaccinated or partially vaccinated adults ≤45 years of age. | If age ≥15 yr at initial vaccination, give 3-dose series: 0.5 mL IM initially, then 0.5 mL IM at 1–2 mo and 6 mo after initial dose. | Contraindications: Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a component of the vaccine (including yeast); pregnancy. | Injection site reactions; dizziness; fever; headache; syncope. |
| Influenza vaccine (Afluria QuadrivalentFluad QuadrivalentFluarix QuadrivalentFlublok QuadrivalentFlucelvax QuadrivalentFluLaval QuadrivalentFluzone High-Dose QuadrivalentFluzone Quadrivalent) | All adults. | All ages (all vaccines except for Fluzone High-Dose Quadrivalent): 0.5 mL IM annually. ≥65 yr: Any one of quadrivalent high-dose inactivated influenza vaccine, quadrivalent recombinant influenza vaccine, or quadrivalent adjuvanted inactivated influenza vaccine is preferred. | Contraindications: Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a component of the vaccine. Precautions: Guillain-Barré syndrome within 6 wk of influenza vaccine; moderate or severe acute illness with or without fever. If patient experiences anaphylactic reaction to eggs or egg-containing foods, any vaccine other than Flublok Quadrivalent or Flucelvax Quadrivalent should be administered and supervised by health care professional with experience in recognition and management of severe allergic conditions. | Fever; headache; injection site reactions; malaise; drowsiness; myalgia. |
| Measles, mumps, and rubella vaccine—MMR (M-M-R IIPriorix) | 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 SUBQ (with ≥28 days between doses); high-risk groups should receive a total of 2 doses (with ≥28 days between doses). | Contraindications: Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a component of the vaccine (including gelatin and neomycin); severe immunodeficiency; active untreated tuberculosis; pregnancy. Precautions: Recent receipt or antibody-containing blood product; history of thrombocytopenia or thrombocytopenic purpura; moderate or severe acute illness with or without fever. | Injection site reactions; arthralgia; fever; rash; encephalitis. 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:MenQuadfi [MenACWY-TT])Menveo [MenACWY-CRM] Serogroup B vaccines:Bexsero [MenB-4C]Trumenbra [MenB-FHbp] | Serogroups A, C, W, and Y conjugate vaccines: 1st-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; microbiologists routinely exposed to Neisseria meningitidis; 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, then 0.5 mL IM ≥8 wk 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, or microbiologists routinely exposed to Neisseria meningitidis: 0.5 mL IM × 1 dose. Repeat dose every 5 yr if person remains at ↑ risk. Military recruits: 0.5 mL IM × 1 dose. Adults not previously vaccinated who are 1st-year college students living in residential housing: 0.5 mL IM × 1 dose. Serogroup B vaccines: Patients at ↑ risk for serogroup B meningococcal disease: Bexsero: 0.5 mL IM initially, then 0.5 mL IM ≥1 mo after initial dose; Trumenba: 0.5 mL IM initially, then 0.5 mL IM 1–2 mo, and 6 mo after initial dose. Patients age 16–23 yr who are not at risk for serogroup B meningococcal disease: Bexsero: 0.5 mL IM initially, then 0.5 mL IM ≥1 mo after initial dose; Trumenba: 0.5 mL IM initially, then 0.5 mL 6 mo after initial dose. | Serogroups A, C, W, and Y conjugate vaccines: Contraindications: Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a component of the vaccine (including diphtheria toxoid or CRM197-containing vaccine [MenACWY-CRM only] or tetanus toxoid [MenACWY-TT only]). Precautions: Moderate or severe acute illness with or without fever. Serogroup B vaccines: Contraindications: Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a component of the vaccine. Precautions: Pregnancy; latex sensitivity (MenB-4C only); moderate or severe illness with or without fever. | Injection site reactions; anorexia; arthralgia; diarrhea; fatigue; fever; headache; myalgia; nausea; irritability; malaise. |
| Pneumococcal conjugate vaccine, 15-valent or 20-valent—PCV15 or PCV20 (PCV15VaxneuvancePCV20Prevnar 20) | All adults ≥65 yr: who have not previously received a dose of PCV13, PCV15, or PCV20; whose previous vaccination history is unknown; who have previously received only PCV7, PCV13, or PPSV23; or who have previously received both PCV13 and PPSV23 but NO PPSV23 was received at age ≥65 yr. Adults 19–64 yr with alcoholism, chronic heart/liver/lung disease, chronic renal failure, cigarette smoking, cochlear implant, congenital or acquired asplenia, cerebrospinal fluid leak, diabetes, malignancy, HIV, immunodeficiency, solid organ transplants, or sickle cell disease. | 0.5 mL IM x 1 dose. Patients who have not previously received a dose of PCV13, PCV15, or PCV20 or whose previous vaccination history is unknown: 1 dose of PCV15 OR 1 dose of PCV20. If PCV15 is used, this should be followed by a dose of PPSV23 given ≥1 yr after the PCV15 dose. | Contraindications: Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a component of the vaccine (including neomycin). Precautions: Moderate or severe acute illness with or without fever; syncope. | Arthralgia; injection site reactions; chills, anorexia; fatigue; fever; headache; insomnia; irritability; myalgia; rash. |
| Pneumococcal polysaccharide vaccine—PPSV23 (Pneumovax 23 | All adults ≥65 yr: who have not previously received a dose of PCV13, PCV15, or PCV20; whose previous vaccination history is unknown; who have previously received only PCV7, PCV13, or PPSV23; or who have previously received both PCV13 and PPSV23 but NO PPSV23 was received at age ≥65 yr. Adults 19–64 yr with alcoholism, chronic heart/liver/lung disease, chronic renal failure, cigarette smoking, cochlear implant, congenital or acquired asplenia, cerebrospinal fluid leak, diabetes, malignancy, HIV, immunodeficiency, solid organ transplants, or sickle cell disease. | 0.5 mL IM or SUBQ × 1 dose. Patients who have not previously received a dose of PCV13, PCV15, or PCV20 or whose previous vaccination history is unknown: 1 dose of PCV15 OR 1 dose of PCV20. If PCV15 is used, this should be followed by a dose of PPSV23 given ≥1 yr after the PCV15 dose. A minimum interval of 8 wk between PCV15 and PPSV23 can be considered for adults with an immunocompromising condition, cochlear implant, or cerebrospinal fluid leak. | Contraindications: Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a component of the vaccine. Precautions: Moderate or severe acute illness with or without fever. | Chills; fever; injection site reactions; fatigue; myalgia. |
| Respiratory syncytial virus vaccine—RSV (AbrysvoArexvy) | Age ≥60 yr (based on shared decision-making); pregnancy (during wk 32–36) (Abrysvo only). | 0.5 mL IM × 1 dose. | Contraindications: Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a component of the vaccine. Precautions: Immunocompromising conditions; syncope. | Injection site pain; fatigue; myalgia; headache; arthralgia. |
| Smallpox and monkeypox vaccine—Mpox (Jynneos) | Age ≥18 yr and the following risk factors for Mpox infection: 1) persons who are gay, bisexual, and other men who have sex with men, transgender, or nonbinary people who in the past 6 mo have had: a) a new diagnosis of ≥1 sexually transmitted infection; b) >1 sex partner; c) sex at a commercial sex venue; d) sex in association with a large public event in a geographic area where Mpox transmission is occurring; 2) Persons who are sexual partners of the persons described above; 3) Persons who anticipate experiencing any of the situations described above. | 0.1 mL intradermally initially, then 0.1 mL intradermally 4 wk later. | Contraindications: Severe allergic reaction (e.g. anaphylaxis) after a previous dose or to a component of the vaccine. Precautions: Moderate or severe acute illness, with or without fever. | Change in appetite; nausea; injection site reactions; chills; fatigue; headache; arthralgia, myalgia |
| Tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine absorbed—Tdap (AdacelBoostrix) | Single dose should be given to replace one of the every 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. | Previously did not receive Tdap at or after age 11 years: 1 dose of Tdap (0.5 mL IM), then Td or Tdap every 10 yr. | Contraindications: Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a component of the vaccine; encephalopathy within 7 days of administration of previous dose of DTP, DTaP, or Tdap. Precautions: Guillain-Barré syndrome within 6 wk after a previous dose; history of Arthus-type sensitivity; moderate or severe acute illness with or without fever; progressive or unstable neurological disorder; uncontrolled seizures; progressive encephalopathy. | Abdominal pain; arthralgia; chills, diarrhea; fatigue, headache; myalgia, nausea; pain at injection site; vomiting. |
| Tetanus-diphtheria—Td (TenivacTDVax | 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). | Previously did not receive Tdap at or after age 11 yr: 1 dose of Tdap, then Td (0.5 mL IM) or Tdap every 10 yr. If adult did not receive the primary vaccination for tetanus, diphtheria, or pertussis: 1 dose of Tdap followed by 1 dose of Td or Tdap ≥4 wk later, and then 1 dose of Td or Tdap 6–12 mo later, then Td or Tdap every 10 yr thereafter. | Contraindications: Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a component of the vaccine. Precautions: Guillain-Barré syndrome within 6 wk after a previous dose; history of Arthus-type sensitivity; moderate or severe acute illness with or without fever. | Injection site reactions; arthralgia; chills; diarrhea; fatigue; headache; myalgia; nausea. |
| Varicella vaccine—Var (Varivax) | Any adult with no evidence of immunity to varicella. | 2-dose series: 0.5 mL SUBQ initially, then 0.5 mL SUBQ 4–8 wk after initial dose. | Contraindications: Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a component of the vaccine (including gelatin or neomycin); pregnancy or planning to become pregnant in next 3 mo; severe immunodeficiency; active febrile illness; active, untreated tuberculosis. Precautions: Recent receipt of antibody-containing blood product; use of antiviral drugs 24 hr before vaccination (avoid for 14 days after vaccination), use of aspirin-containing products; moderate or severe acute illness with or without fever. | Fever; rash; injection site reactions. 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 or varicella vaccine). | 2-dose series: 0.5 mL SUBQ initially, then 0.5 mL SUBQ 2–6 mo after initial dose. | Contraindications: Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a component of the vaccine (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). Precautions: Moderate to severe illness in persons with acute herpes zoster (vaccination should be delayed until the acute stage has resolved and symptoms abate). | Injection-site reactions; myalgia; fatigue. Immunosuppression may ↓ antibody response to injection and ↑ the risk of viral transmission (live vaccine). |
It is recommended that the health care provider regularly review vaccine information on the Centers for Disease Control and Prevention website, as recommendations and guidelines can change. This information is not all-encompassing, and each vaccine has additional information. Regularly review for special conditions, catch-up immunization schedule, and guidelines for immunocompromising conditions.