Reference — Infection Control
Adult Immunization Schedule Reference
The routine adult and older-adult vaccines — who gets what, at what age, and how often — plus the recent CDC/ACIP changes that show up as test updates and the vaccines that are recommended (or avoided) in pregnancy.
Educational use only. Schedules change frequently — always confirm against the current CDC/ACIP adult immunization schedule and your facility’s protocol. Risk-based and catch-up schedules differ from this routine overview. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Routine Adult Schedule
| Vaccine | Who / age | Schedule & notes |
|---|---|---|
| Influenza (flu) | All adults, annually | One dose every year; adults ≥65 preferentially get a high-dose, recombinant, or adjuvanted product. (2025–2026: all U.S. flu vaccines are trivalent.) |
| Td / Tdap (tetanus) | All adults | One-time Tdap dose if not already given as an adult, then a Td or Tdap booster every 10 years. One Tdap in EVERY pregnancy (weeks 27–36). |
| Pneumococcal (PCV) | All adults ≥50; 19–49 if at risk | One dose of PCV15, PCV20, or PCV21 for PCV-naive adults ≥50 (if PCV15 is used, follow with PPSV23). Age lowered from 65 to 50 in 2024–2025. |
| Zoster (RZV / Shingrix) | Immunocompetent ≥50; immunocompromised ≥19 | 2 doses, 2–6 months apart (recombinant, not live). Give even after prior shingles or prior Zostavax. |
| RSV | All adults ≥75; 50–74 if at increased risk | A single (non-annual) dose. The at-risk band was expanded down to 50 in 2025. |
| COVID-19 | Individual / shared clinical decision-making | No longer a universal recommendation (2025) — decided with the patient; strongest rationale for adults ≥65 and those with risk factors. |
| Hepatitis B | Universal ages 19–59; 60+ by risk or on request | 2-dose (Heplisav-B) or 3-dose (0, 1, 6 months) series. |
| HPV | Routine through age 26 | Catch-up if not fully vaccinated; ages 27–45 by shared decision-making. |
| MMR / Varicella | Adults lacking evidence of immunity | MMR: 1 dose (2 for HCP, students, travelers). Varicella: 2 doses. Both are LIVE — avoid in pregnancy and significant immunosuppression. |
A simplified routine overview; exact intervals, products, and risk-based/catch-up dosing follow the official CDC/ACIP schedule.
Recent CDC/ACIP Changes (High-Yield)
| Change | What to know |
|---|---|
| Pneumococcal age lowered 65 → 50 | Routine PCV now for all PCV-naive adults ≥50 (ACIP Oct 2024 / MMWR Jan 2025); PCV21 added as an option. |
| COVID-19 no longer universal | Moved to individual / shared clinical decision-making for all ages ≥6 months (ACIP Sept 2025) — highest benefit ≥65 and with risk factors. |
| RSV at-risk band expanded to 50–74 | Routine ≥75; single dose ≥50 with increased-risk conditions (down from the prior 60–74 band). Not an annual vaccine. |
| Influenza is trivalent for 2025–2026 | The B/Yamagata lineage was dropped; egg-allergic patients may receive any age-appropriate flu vaccine with no extra precautions. |
Vaccines in Pregnancy
| Vaccine | Note |
|---|---|
| Tdap — recommended | One dose in EVERY pregnancy, preferably weeks 27–36, to protect the newborn from pertussis. |
| Influenza (inactivated) — recommended | Any trimester during flu season; the inactivated injection, not the live nasal spray. |
| RSV (maternal, Abrysvo) — recommended | One dose at 32 0/7–36 6/7 weeks during RSV season (if the infant won't get nirsevimab). |
| MMR & varicella — CONTRAINDICATED | Live vaccines are avoided in pregnancy; give postpartum before discharge if non-immune. |
The rule of thumb: inactivated vaccines are safe in pregnancy; live vaccines (MMR, varicella) are deferred to postpartum.
Contraindications & Cautions
Live vaccines (MMR, varicella, live intranasal influenza) are contraindicated in pregnancy and significant immunosuppression — note that RZV/Shingrix is recombinant (not live) and IS given to immunocompromised adults ≥19.
True contraindication: anaphylaxis to a prior dose or vaccine component. NOT contraindications: mild illness or low-grade fever, current antibiotics, breastfeeding, or a mild local reaction to a previous dose.
Egg allergy is no longer a barrier to influenza vaccine — any age-appropriate flu vaccine may be given with routine precautions.
NCLEX Pearls
- ✦Pneumococcal is now routine at age 50 (lowered from 65): a single PCV15, PCV20, or PCV21 for PCV-naive adults.
- ✦Zoster (RZV/Shingrix) is 2 doses at ≥50 — it's recombinant, so it's also given to immunocompromised adults ≥19; the old live Zostavax is gone.
- ✦RSV: single dose at ≥75, or ≥50 with increased-risk conditions — it is NOT an annual vaccine.
- ✦COVID-19 is now individual / shared decision-making, not a blanket recommendation — benefit is greatest for ≥65 and those with risk factors.
- ✦Tdap is given in EVERY pregnancy (weeks 27–36); the inactivated flu shot is safe in any trimester; live MMR/varicella wait until postpartum.
- ✦Mild illness, low-grade fever, and antibiotics are NOT reasons to defer a vaccine — only true contraindications are.
Related Resources
Standards & sources
This page is written to align with CDC / HICPAC · Infectious Diseases Society of America (IDSA) / SHEA. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →