Immunization Schedule for Adults

Each year, a new vaccine must be prepared that will be effective against the types of influenza viruses that are expected to circulate in the upcoming flu season. These are known as seasonal flu vaccines.

Vaccine-preventable diseases are those diseases for which there is a shot that helps the immune system prepare for an infection. A person develops immunity after he or she has received a vaccine and responded to it. When a vaccinated person is exposed to a virus (for example, hepatitis B) or bacteria (for example, diphtheria), his or her body is able to destroy the virus or bacteria and prevent the disease. No vaccine is perfect, and some people who receive a vaccine can still get the disease. This is why it is important for everyone to get the vaccine. This gives the community what experts call "herd" immunity and means that, basically, there are very few people who could serve as a reservoir for the disease. Herd immunity prevents severe outbreaks of diseases.

The following table lists vaccine-preventable diseases:

The concerns surrounding the dangers of vaccines during pregnancy is mostly theoretical. The concern is related to the risk of transfer to the fetus. There is no evidence of any risk associated with the use of inactivated (killed) vaccines in pregnant women. The biggest concern is related to the use of live vaccines. While the risk is extremely low, the concern is that the live virus will be transferred from the mother to the fetus. There must be a discussion between the physician and the mother whenever a live vaccine is considered during pregnancy. The U.S. Centers for Disease Control and Prevention (CDC) has issued a guide to help expectant mothers and physicians make good decisions related to the risk and benefits of using a vaccine during pregnancy (https://www.cdc.gov/vaccines/pregnancy/hcp/guidelines.html). Tetanus-diphtheria with acellular pertussis (Tdap) vaccine, hepatitis A, hepatitis B vaccine, meningococcal vaccine, and rabies vaccine are generally considered safe during pregnancy. It is currently recommended that pregnant women not receive the following vaccines: human papillomavirus, live nasal influenza vaccine (no longer recommended for anyone due to lack of efficacy), measles, mumps, rubella, varicella, and zoster.

It is very important that health care workers are up to date on all of their required vaccines. Additionally, the CDC recommends that health care workers receive varicella (chickenpox) vaccine unless there is proof of immunity, prior vaccination, or documented history of the disease. Also, health care workers with direct patient contact, who have not previously received a pertussis-containing tetanus shot (Tdap), are required to receive one dose. For the complete recommendations, please consult the CDC web site at https://www.cdc.gov/vaccines/adults/rec-vac/hcw.html. Health care workers are required by most employers to have hepatitis B vaccination and annual influenza vaccinations.

Any licensed physician can order all approved vaccines. Many public-health departments also offer vaccination services at a reduced price. Vaccines are commonly administered by primary care providers, including pediatricians, family practitioners, and internists.

The Td and Tdap vaccines both contain vaccines against tetanus (lockjaw) and diphtheria. The Tdap also contains a vaccine against pertussis (whooping cough). Most adults are used to getting a tetanus shot when they get a cut. Up until 2005, adolescents and adults were not recommended to receive the pertussis vaccine due to an unacceptable rate of negative reactions. In 2005, a new acellular pertussis vaccine became available for both children and adults (although there are different ones for each group using different amounts of each vaccine). Whooping cough has become a serious problem again due to the lack of vaccination in adolescents and adults. It is therefore recommended that all adolescents and adults receive at least one dose of Tdap when they are due for their next tetanus shot. Health care workers should get one Tdap vaccination as soon as possible but at least two years since the last tetanus shot (Td).

Human papillomavirus (HPV) infection is the cause of cervical cancer and vaginal cancer in women, penile cancer in men, and throat and anal cancer in both men and women. There are over 100 different types of HPV, and two strains, HPV 16 and 18, are the types that cause about 66% of cervical cancers and the majority of other HPV-attributable cancers in the United States. The Gardasil-9 vaccine available in the U.S. protects against nine types of HPV -- the four contained in the original Gardasil vaccine (HPV-6, HPV-11, HPV-16, and HPV-18), plus five additional strains (HPV 31, 33, 45, 52, and 58).

Studies have shown that use of the vaccine will decrease the chance that a woman will get cervical cancer. As such, the vaccine must be given before the first sexual contact. The CDC recommends that all girls and boys receive the three-shot series beginning at 11 years of age. Boys need vaccination in order to prevent spread to girls and to protect against cancers of the anus, mouth/throat (oropharynx), and penis. Adult women who have not received the vaccine should do so up to 26 years of age. After 26 years of age, it is believed that most women would have been exposed to the virus and the vaccine would be of no use.

If a person receives the vaccine before age 15 and is going to receive the Gardasil 9, it is a two-shot series; however, if the vaccine is not received until after the 15th birthday or if the series was begun using an earlier version of the Gardasil vaccine or the discontinued Cervarix vaccine, it is recommended that they receive a three-shot series.

Meningococcal disease is a serious acute illness caused by a bacterium. Those infected can develop meningitis and sepsis, and these are often fatal diseases. There are two different quadrivalent meningococcal vaccines that provide protection against meningococcal serogroups A, C, W, and Y (MenACWY, MPSV4). A newer vaccine (Bexsero or Trumenba) against meningococcal serogroup B is also now available and should be given to high-risk individuals, with the injection given at the same time as the quadrivalent vaccine but at a different body site. The disease is more common in adolescents and college students. Therefore, meningococcal vaccine is recommended for all children between 11-12 years of age, with a booster dose at 16 years of age. If the child has not received the vaccine by 11-12 years of age, they should receive it up to age 18. College freshmen who have not received the vaccine should be vaccinated. The vaccines are also recommended for adults with special medical conditions.

In 2017, the CDC changed their recommendation for people age 16 to 23 to now receive serogroup B meningococcal vaccines (MenB) (Bexsero or Trumenba). It has not been mandated, but doctors are recommended to consider the serogroup B vaccine in this age group. Additionally, if there are any outbreaks of serogroup B meningococcal disease on a college campus, the CDC recommends the use of serogroup B meningococcal vaccines (Bexsero or Trumenba).

The MMR vaccine contains vaccines against the diseases measles, mumps, and rubella (German measles). These are all dangerous and potentially fatal diseases that have been successfully limited in the United States through aggressive vaccine programs. Adolescents and adults who have not received the MMR or MMRV (MMR, plus the varicella vaccine) should receive two doses of the vaccine at least one month apart. People who do not have medical documentation of having had the diseases or cannot prove previous vaccination should have titers (blood tests to check levels of immunity) drawn to make sure they are immune to these agents. If they do not have laboratory evidence of immunity, they should receive a two-dose series of vaccine.

Varicella is the virus that causes chickenpox. While the disease is usually self-limited, it can cause death and permanent injury. The groups at greatest risk are infants, people over 15 years of age, and immunocompromised people. The vaccine came out in the mid-1990s and unfortunately does not offer complete protection, but even those who get the disease after vaccination have a milder form of the condition. Prior to use of the vaccine, hundreds of children died every year from chickenpox. It is recommended that all adolescents and adults without documented evidence of chickenpox or previous vaccination receive the two-dose series.

Streptococcus pneumoniae (also called pneumococcus) is a bacterium that can cause severe illness, including meningitis and pneumonia. The vaccine is routinely given to children; however, it is only given to adolescents and adults who are at higher risk (patients with chronic diseases like heart disease and diabetes, immunocompromised individuals, smokers, and asthmatics). Elderly adults are one group that is considered at higher risk, and it is recommended that all adults aged 65 or older receive both available vaccines, PCV13 followed by PPSV23 (PCV13–PPSV23 sequence). The new recommendation for 2016 is that the vaccines be spaced over one year apart for immunocompetent adults aged 65 or older.

Influenza (flu) is an acute viral illness that can kill even healthy people. Unfortunately, the influenza virus changes a little each year, and scientists have to make educated guesses about which forms of the virus will be infecting people and circulating each year. Based on the best available evidence, they create a vaccine each year containing three of the likely influenza virus types.

The annual flu vaccine is an inactivated vaccine (shot). You cannot get the flu from getting the flu shot because it has inactivated virus (virus killed with heat or chemicals). The immunity from the vaccines is limited, and vaccinations must be repeated yearly. It is recommended that all people older than 6 months of age receive an annual vaccination. In 2017, the American College of Allergy, Asthma, and Immunology changed their guidance for patients with egg allergy. They no longer recommend that doctors screen for egg allergy prior to administering the flu shot, and they recommend that patients with egg allergy receive the currently available flu shot even though it has been created in eggs. There is only minimal egg protein in the shot, and there is no increased risk of reaction for patients with egg allergy. There is also a vaccine recombinant hemagglutinin influenza vaccine (RIV) that contains no egg protein because it is not manufactured with eggs. Although the CDC encourages that any adult who wants to decrease the chance of getting the flu get the influenza vaccine, certain high-risk groups are recommended to always get the annual flu vaccine. Adults over 50 years of age are considered to be at high risk and should receive the yearly influenza vaccination.

Hepatitis A is an acute viral illness that is spread through contaminated water and food. It is less common in the United States but is still a common cause of hepatitis worldwide. The disease is very common in many other parts of the world, including Central and South America, Africa, the Middle East, the Western Pacific, and Asia. It is primarily prevented by using good hygiene and through vaccination. Hepatitis A vaccine is routinely given to children; however, it is only recommended for certain high-risk adolescents and adults. Foreign travel is the most common reason for adults and adolescents to receive hepatitis A vaccination.

Hepatitis B is an acute viral illness that is primarily spread through the exposure to body fluids of an infected individual. It is highly contagious and can be transmitted through sexual intercourse as well as by sharing needles (drug abusers). Approximately 50% of infected individuals will be asymptomatic (have no symptoms of the disease). Most cases resolve without long-term complications. However, 1%-2% will develop chronic hepatitis. Hepatitis B vaccine is given routinely to children. Adolescents who did not receive their three-shot series as a child should be given the vaccine. Adults are not routinely given the hepatitis B vaccine unless they belong to certain high-risk groups. One high-risk group is health care workers.

Polio is an acute viral illness that can cause severe paralysis and even death. Prior to the use of vaccine, tens of thousands of children developed paralytic polio (the worst form) in the U.S. every year. Since instituting an aggressive vaccine campaign, polio has been almost completely eradicated in the U.S. Most cases now in the U.S. are seen in people traveling from other countries or unvaccinated people from the U.S. traveling to other countries.

There are two forms of the polio vaccine: an oral form made from a live attenuated virus and an injection form made from an inactivated virus. The oral form of the vaccine (oral polio vaccine or OPV) is no longer used in the U.S. because it has been shown to cause polio in a small number of people. Only the shot form of the vaccine (intramuscular polio vaccine or IPV) is now used in the U.S. All children receive four doses of IPV. Adolescents who did not receive all four doses should be given an additional vaccine. Adults are not recommended to receive the polio vaccine unless they will be traveling to areas where polio still exists.

Herpes zoster is a reactivation of an old infection with the varicella virus (chickenpox). This rash can occur shortly after the infection with chickenpox or many years later. It causes a severely painful skin rash, and it can lead to chronic pain even after the rash is gone. In order to prevent the severe rash and the chronic pain, a vaccine (Zostavax) was developed and is recommended for all adults over 60 years of age.

Typhoid fever is an acute febrile illness caused by the bacterium Salmonella typhi. It is spread by contaminated food and water. Although quite common at one time in the U.S., it is very rare today. Most cases are in people who have traveled outside the U.S. Worldwide, the disease affects 13 million people. People who are traveling to areas with high rates of typhoid fever should receive the vaccine prior to leaving the U.S. Travelers should consult the CDC web site for specific recommendations depending on the countries they plan to visit (https://wwwnc.cdc.gov/travel/).

Yellow fever is an acute illness caused by a virus. The disease is extremely rare in the U.S., and it is usually found in people who have traveled outside the country. The disease is mild in many people, but it can cause liver failure and death. Approximately 20% of those who get the disease will die. Travelers to going to sub-Saharan Africa and tropical South America are required by international health regulations to have a yellow fever vaccination. Travelers should consult the CDC web site for specific recommendations depending on the countries they plan to visit (https://wwwn.cdc.gov/travel/).

Rabies is an acute viral infection that is considered universally fatal even with excellent treatment (there has been one reported survival with extremely aggressive treatment). Rabies is extremely rare in the U.S. because all states require dogs and cats to be vaccinated. Most cases in the U.S. are from bites from wild animals (raccoons, bats, foxes, and skunks). However, rabies is common in dogs and cats as well as wild animals in other parts of the world. Travelers who are visiting areas where rabies is prevalent should receive the vaccine. The vaccine can also be given after an animal bite, but it must be given quickly. Travelers should consult the CDC web site for specific recommendations depending on the countries they plan to visit (https://wwwn.cdc.gov/travel/).

Japanese encephalitis is a mosquito-borne viral infection that is a leading cause of encephalitis in Asia. It is uncommon in the U.S. and, therefore, is not recommended as a routine vaccination. People traveling to certain countries in Asia are recommended to receive the vaccine. Travelers should consult the CDC web site for specific recommendations depending on the countries they plan to visit (https://wwwn.cdc.gov/travel/).

Any vaccine can cause side effects, but for the most part, the side effects are minor. Common side effects are pain, swelling, and redness at the injection site, low-grade fever, shivering, fatigue, headache, muscle aches, and joint aches. The side effects for all of the different vaccines can be found on the CDC web site (https://www.cdc.gov/vaccines/vac-gen/side-effects.htm). Vaccines do not cause autism; however, there are rare serious side effects that can be serious or even fatal. Many more people died of vaccine-preventable diseases prior to vaccines than ever suffer serious complications of vaccines.