Adult Immunization Schedule Appendix

Recommendations for Ages 19 Years or Older, United States, 2024

Purpose

Guide health care providers in determining contraindications and precautions for each vaccine type.

How to use the schedule

Vaccines in the Adult Immunization Schedule

To make vaccination recommendations, healthcare providers should:

  1. Determine recommended vaccine by age (Table 1 - By Age)
  2. Assess need for additional recommended vaccinations by medical condition or other indication (Table 2 - By Medical Condition)
  3. Review vaccine types, dosing frequencies and intervals, and considerations for special situations (Notes)
  4. Review contraindications and precautions for vaccine types (Appendix)
  5. Review new or updated ACIP guidance (Addendum)

Appendix – Guide to Contraindications and Precautions to Commonly Used Vaccines

Adapted from Table 4-1 in Advisory Committee on Immunization Practices (ACIP) General Best Practice Guidelines for Immunization: Contraindication and Precautions, Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2023–24 Influenza Season, Contraindications and Precautions for COVID-19 Vaccination, and Contraindications and Precautions for JYNNEOS Vaccination.

COVID-19 and Flu Vaccines

Vaccine Contraindicated or Not Recommended1 Precautions2
COVID-19 mRNA vaccines
[Pfizer-BioNTech, Moderna]
  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a component of an mRNA COVID-19 vaccine4
  • Diagnosed non-severe allergy (e.g., urticaria beyond the injection site) to a component of an mRNA COVID-19 vaccine4; or non-severe, immediate (onset less than 4 hours) allergic reaction after administration of a previous dose of an mRNA COVID-19 vaccine
  • Myocarditis or pericarditis within 3 weeks after a dose of any COVID-19 vaccine
  • Multisystem inflammatory syndrome in children (MIS-C) or multisystem inflammatory syndrome in adults (MIS-A)
  • Moderate or severe acute illness, with or without fever
COVID-19 protein subunit vaccine
[Novavax]
  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a component of a Novavax COVID-19 vaccine4
  • Diagnosed non-severe allergy (e.g., urticaria beyond the injection site) to a component of Novavax COVID-19 vaccine4; or non-severe, immediate (onset less than 4 hours) allergic reaction after administration of a previous dose of a Novavax COVID-19 vaccine
  • Myocarditis or pericarditis within 3 weeks after a dose of any COVID-19 vaccine
  • Multisystem inflammatory syndrome in children (MIS-C) or multisystem inflammatory syndrome in adults (MIS-A)
  • Moderate or severe acute illness, with or without fever
Influenza, egg-based, inactivated injectable (IIV4)
  • Severe allergic reaction (e.g., anaphylaxis) after previous dose of any influenza vaccine (i.e., any egg-based IIV, ccIIV, RIV, or LAIV of any valency)
  • Severe allergic reaction (e.g., anaphylaxis) to any vaccine component3 (excluding egg)
  • Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any type of influenza vaccine
  • Moderate or severe acute illness with or without fever
Influenza, cell culture-based inactivated injectable
(ccIIV4)[Flucelvax Quadrivalent]
  • Severe allergic reaction (e.g., anaphylaxis) to any ccIIV of any valency, or to any component3 of ccIIV4
  • Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any type of influenza vaccine
  • Persons with a history of severe allergic reaction (e.g., anaphylaxis) after a previous dose of any egg-based IIV, RIV, or LAIV of any valency. If using ccIV4, administer in medical setting under supervision of health care provider who can recognize and manage severe allergic reactions. May consult an allergist.
  • Moderate or severe acute illness with or without fever
Influenza, recombinant injectable (RIV4)
[Flublok Quadrivalent]
  • Severe allergic reaction (e.g., anaphylaxis) to any RIV of any valency, or to any component3 of RIV4
  • Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any type of influenza vaccine
  • Persons with a history of severe allergic reaction (e.g., anaphylaxis) after a previous dose of any egg-based IIV, ccIIV, or LAIV of any valency. If using RIV4, administer in medical setting under supervision of health care provider who can recognize and manage severe allergic reactions. May consult an allergist.
  • Moderate or severe acute illness with or without fever
Influenza, live attenuated (LAIV4)
[Flumist Quadrivalent]
  • Severe allergic reaction (e.g., anaphylaxis) after previous dose of any influenza vaccine (i.e., any egg-based IIV, ccIIV, RIV, or LAIV of any valency)
  • Severe allergic reaction (e.g., anaphylaxis) to any vaccine component3 (excluding egg)
  • Anatomic or functional asplenia
  • Immunocompromised due to any cause including, but not limited to, medications and HIV infection
  • Close contacts or caregivers of severely immunosuppressed persons who require a protected environment
  • Pregnancy
  • Cochlear implant
  • Active communication between the cerebrospinal fluid (CSF) and the oropharynx, nasopharynx, nose, ear, or any other cranial CSF leak
  • Received influenza antiviral medications oseltamivir or zanamivir within the previous
    48 hours, peramivir within the previous 5 days, or baloxavir within the previous 17 days.
  • Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of any type of influenza vaccine
  • Asthma in persons aged 5 years or older
  • Persons with underlying medical conditions (other than those listed under contraindications) that might predispose to complications after wild-type influenza virus infection [e.g., chronic pulmonary, cardiovascular (except isolated hypertension), renal, hepatic, neurologic, hematologic, or metabolic disorders (including diabetes mellitus)]
  • Moderate or severe acute illness with or without fever
  1. When a contraindication is present, a vaccine should NOT be administered. Kroger A, Bahta L, Hunter P. ACIP General Best Practice Guidelines for Immunization.
  2. When a precaution is present, vaccination should generally be deferred but might be indicated if the benefit of protection from the vaccine outweighs the risk for an adverse reaction. Kroger A, Bahta L, Hunter P. ACIP General Best Practice Guidelines for Immunization.
  3. Vaccination providers should check FDA-approved prescribing information for the most complete and updated information, including contraindications, warnings, and precautions. See Package inserts for U.S.-licensed vaccines.
  4. See package inserts and FDA EUA fact sheets for a full list of vaccine ingredients. mRNA COVID-19 vaccines contain polyethylene glycol (PEG).

Other Vaccines

Vaccine Contraindicated or Not Recommended1 Precautions2
Haemophilus influenzae type b (Hib)
  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
  • For Hiberix, ActHib, and PedvaxHIB only: History of severe allergic reaction to dry natural latex
  • Moderate or severe acute illness with or without fever
Hepatitis A (HepA)
  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 including neomycin
  • Moderate or severe acute illness with or without fever
Hepatitis B (HepB)
  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 including yeast
  • Pregnancy: Heplisav-B and PreHevbrio are not recommended due to lack of safety data in pregnant persons.
    Use other hepatitis B vaccines if HepB is indicated4
  • Moderate or severe acute illness with or without fever
Hepatitis A-Hepatitis B vaccine (HepA-HepB)
[Twinrix]
  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3 including neomycin and yeast
  • Moderate or severe acute illness with or without fever
Human papillomavirus (HPV)
  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
  • Pregnancy: HPV vaccination not recommended
  • Moderate or severe acute illness with or without fever
Measles, mumps, rubella (MMR)
  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
  • Severe immunodeficiency (e.g., hematologic and solid tumors, receipt of chemotherapy, congenital immunodeficiency, long-term immunosuppressive therapy or patients with HIV infection who are severely immunocompromised)
  • Pregnancy
  • Family history of altered immunocompetence, unless verified clinically or by laboratory testing as immunocompetent
  • Recent (≤11 months) receipt of antibody-containing blood product (specific interval depends on product)
  • History of thrombocytopenia or thrombocytopenic purpura
  • Need for tuberculin skin testing or interferon-gamma release assay (IGRA) testing
  • Moderate or severe acute illness with or without fever
Meningococcal ACWY (MenACWY)
(MenACWY-CRM) [Menveo]
(MenACWY-TT) [MenQuadfi]
  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
  • For MenACWY-D and MenACWY-CRM only: severe allergic reaction to any diphtheria toxoid–or CRM197–containing vaccine
  • For MenACWY-TT only: severe allergic reaction to a tetanus toxoid-containing vaccine
  • Moderate or severe acute illness with or without fever
Meningococcal B (MenB)
MenB-4C [Bexsero]
MenB-FHbp [Trumenba]
  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
  • Pregnancy
  • For MenB-4C only: Latex sensitivity
  • Moderate or severe acute illness with or without fever
Meningococcal ABCWY
(MenACWY-TT/MenB-FHbp) [Penbraya]
  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
  • Severe allergic reaction to a tetanus toxoid-containing vaccine
  • Moderate or severe acute illness, with or without fever
Mpox [Jynneos]
  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
  • Moderate or severe acute illness, with or without fever
Pneumococcal conjugate (PCV15, PCV20)
  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
  • Severe allergic reaction (e.g., anaphylaxis) to any diphtheria-toxoid–containing vaccine or to its vaccine component3
  • Moderate or severe acute illness with or without fever
Pneumococcal polysaccharide (PPSV23)
  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
  • Moderate or severe acute illness with or without fever
Poliovirus vaccine, inactivated (IPV)
  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
  • Pregnancy
  • Moderate or severe acute illness with or without fever
Respiratory syncytial virus vaccine (RSV)
  • Severe allergic reaction (e.g., anaphylaxis) to a vaccine component
  • Moderate or severe acute illness with or without fever
Tetanus, diphtheria, and acellular pertussis (Tdap)
Tetanus, diphtheria (Td)
  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
  • For Tdap only: Encephalopathy (e.g., coma, decreased level of consciousness, prolonged seizures), not attributable to another identifiable cause, within 7 days of administration of previous dose of DTP, DTaP, or Tdap
  • Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of tetanus-toxoid–containing vaccine
  • History of Arthus-type hypersensitivity reactions after a previous dose of diphtheria-toxoid– containing or tetanus-toxoid–containing vaccine; defer vaccination until at least 10 years have elapsed since the last tetanus-toxoid–containing vaccine
  • Moderate or severe acute illness with or without fever
  • For Tdap only: Progressive or unstable neurological disorder, uncontrolled seizures, or progressive encephalopathy until a treatment regimen has been established and the condition has stabilized
Varicella (VAR)
  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
  • Severe immunodeficiency (e.g., hematologic and solid tumors, receipt of chemotherapy, congenital immunodeficiency, long-term immunosuppressive therapy or patients with HIV infection who are severely immunocompromised)
  • Pregnancy
  • Family history of altered immunocompetence, unless verified clinically or by laboratory testing as immunocompetent
  • Recent (≤11 months) receipt of antibody-containing blood product (specific interval depends on product)
  • Receipt of specific antiviral drugs (acyclovir, famciclovir, or valacyclovir) 24 hours before vaccination (avoid use of these antiviral drugs for 14 days after vaccination)
  • Use of aspirin or aspirin-containing products
  • Moderate or severe acute illness with or without fever
Zoster recombinant vaccine (RZV)
  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component3
  • Moderate or severe acute illness with or without fever
  • Current herpes zoster infection
  1. When a contraindication is present, a vaccine should NOT be administered. Kroger A, Bahta L, Hunter P. ACIP General Best Practice Guidelines for Immunization. www.cdc.gov/vaccines/hcp/acip-recs/general-recs/contraindications.html
  2. When a precaution is present, vaccination should generally be deferred but might be indicated if the benefit of protection from the vaccine outweighs the risk for an adverse reaction. Kroger A, Bahta L, Hunter P. ACIP General Best Practice Guidelines for Immunization. www.cdc.gov/vaccines/hcp/acip-recs/general-recs/contraindications.html
  3. Vaccination providers should check FDA-approved prescribing information for the most complete and updated information, including contraindications, warnings, and precautions. Package inserts for U.S.-licensed vaccines are available at www.fda.gov/vaccines-blood-biologics/approved-products/vaccines-licensed-use-united-states.
  4. For information on the pregnancy exposure registries for persons who were inadvertently vaccinated with Heplisav-B or PreHevbrio while pregnant, please visit heplisavbpregnancyregistry.com/ or www.prehevbrio.com/#safety.
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Content Source:
National Center for Immunization and Respiratory Diseases