Recommended Adult Immunization Schedule, United States, 2022.

Abstract

Clinical GuidelinesMarch 2022Recommended Adult Immunization Schedule, United States, 2022*FREENeil Murthy, MD, MPH, MSJ, A. Patricia Wodi, MD, MPH, Henry Bernstein, DO, MHCM, and Kevin A. Ault, MD, for the Advisory Committee on Immunization Practices†Neil Murthy, MD, MPH, MSJCenters for Disease Control and Prevention, Atlanta, Georgia (N.M., A.P.W.)Search for more papers by this author, A. Patricia Wodi, MD, MPHCenters for Disease Control and Prevention, Atlanta, Georgia (N.M., A.P.W.)Search for more papers by this author, Henry Bernstein, DO, MHCMCohen Children's Medical Center, New Hyde Park, and Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (H.B.)Search for more papers by this author, and Kevin A. Ault, MDUniversity of Kansas Medical Center, Kansas City, Kansas (K.A.A.).Search for more papers by this author, for the Advisory Committee on Immunization Practices†Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M22-0036 Eligible for CME Point-of-Care SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In November 2021, the Advisory Committee on Immunization Practices (ACIP) voted to approve the Recommended Adult Immunization Schedule for Ages 19 Years or Older, United States, 2022. The 2022 adult immunization schedule, available at www.cdc.gov/vaccines/schedules/hcp/imz/adult.html, summarizes ACIP recommendations in the cover page, tables, notes, and appendix (Figure). The appendix lists the contraindications and precautions for all routinely recommended vaccines on the adult immunization schedule (Figure). The full ACIP recommendations for each vaccine are available at www.cdc.gov/vaccines/hcp/acip-recs/index.html. The 2022 schedule has also been approved by the director of the Centers for Disease Control and Prevention (CDC) and by the American College of Physicians (www.acponline.org), the American Academy of Family Physicians (www.aafp.org), the American College of Obstetricians and Gynecologists (www.acog.org), the American College of Nurse-Midwives (www.midwife.org), the American Academy of Physician Associates (www.aapa.org), and the Society for Healthcare Epidemiology of America (www.shea-online.org).Figure. Recommended Adult Immunization Schedule for Ages 19 Years or Older, United States, 2022. Download figure Download PowerPoint Figure. Continued Download figure Download PowerPoint Figure. Continued Download figure Download PowerPoint Figure. Continued Download figure Download PowerPoint Figure. Continued Download figure Download PowerPoint Figure. Continued Download figure Download PowerPoint Figure. Continued Download figure Download PowerPoint Figure. Continued Download figure Download PowerPoint The ACIP develops recommendations on the use of each vaccine after in-depth review of vaccine-related data, such as the epidemiology and burden of the vaccine-preventable disease (VPD), vaccine efficacy and effectiveness, vaccine safety, quality of evidence, feasibility of program implementation, and economic analyses of immunization policy (1). The ACIP recommendations can be complex and challenging to implement. The purpose of the immunization schedule, published annually, is to consolidate and summarize updates to ACIP recommendations on vaccination of adults and to assist providers in implementing current ACIP recommendations. The use of vaccine trade names in this article and in the schedule is for identification purposes only and does not imply endorsement by the ACIP or CDC.Changes to the 2022 Adult Immunization ScheduleHaemophilus influenzae type b (Hib) vaccination. Routine recommendations for Hib vaccination have not changed.Hepatitis A (HepA) vaccination. Routine recommendations for HepA vaccination have not changed.Hepatitis B vaccination (2). ACIP recommends universal vaccination of all adults aged 19 through 59 years, and vaccination of adults aged 60 years and older at risk for hepatitis B virus (HBV) infection. Additionally, ACIP recommends vaccination of adults aged 60 years and older requesting protection from HBV without the need to acknowledge a specific risk factor. In the notes for hepatitis B vaccine, the 2-, 3-, and 4-dose series are described in detail under the “Routine vaccination” section, which now states that all adults aged 19 through 59 years are recommended to receive vaccination. The “Special situations” section outlines the risk-based recommendations for adults aged 60 years and older.Human papillomavirus (HPV) vaccination (3). Routine recommendations for HPV vaccination have not changed. A minor edit was made to increase clarity to now say, “No additional dose recommended when any HPV vaccine series has been completed using the recommended dosing intervals.” Additionally, minor wording changes were made in the “Special situations” section, under the immunocompromising conditions subbullet, to now read “3-dose series, even for those who initiate vaccination at age 9 through 14 years.” The wording for the pregnancy subbullet was rearranged to improve clarity.Influenza vaccination (4). Updates to the seasonal influenza vaccine recommendations reflect discussions during public meetings of ACIP held on 28 October 2020, 25 February 2021, and 24 June 2021. For the 2021–2022 influenza season, routine annual influenza vaccination is recommended for all persons aged 6 months and older who do not have contraindications. No preferential recommendation is made for one influenza vaccine product over another in persons for whom more than one licensed and recommended product based on patient age and health status is available. The composition of the 2021–2022 U.S. influenza vaccines includes updates to the influenza A(H1N1)pdm09 and influenza A(H3N2) components. All seasonal influenza vaccines expected to be available for the 2021–2022 season are quadrivalent, containing hemagglutinin (HA) derived from one influenza A(H1N1)pdm09 virus, one influenza A(H3N2) virus, one influenza B/Victoria lineage virus, and one influenza B/Yamagata lineage virus. For the 2021–2022 season, U.S. egg-based influenza vaccines (i.e., vaccines other than cell-culture–based inactivated influenza vaccine [ccIIV4] and recombinant influenza vaccine [RIV4]) will contain influenza A/Victoria/2570/2019 (H1N1)pdm09–like virus, an influenza A/Cambodia/e0826360/2020 (H3N2)–like virus, an influenza B/Washington/02/2019 (Victoria lineage)–like virus, and an influenza B/Phuket/3073/2013 (Yamagata lineage)–like virus. U.S. ccIIV4 and RIV4 influenza vaccines will contain HA derived from an influenza A/Wisconsin/588/2019 (H1N1)pdm09–like virus, an influenza A/Cambodia/e0826360/2020 (H3N2)–like virus, an influenza B/Washington/02/2019 (Victoria lineage)–like virus, and an influenza B/Phuket/3073/2013 (Yamagata lineage)–like virus.A previous severe allergic reaction to influenza vaccine is no longer a contraindication to future receipt of any influenza vaccine. Rather, individuals with a history of severe allergic reaction to an influenza vaccine may have a precaution to receive a different type of influenza vaccine. Details about contraindications and precautions to influenza vaccination can now be found in the newly added appendix section of the adult immunization schedule.Measles, mumps, and rubella (MMR) vaccination (5). Routine recommendations for MMR vaccination have not changed. However, in the “Special situations” section, CD4 percentages in addition to CD4 counts in the HIV infection bullet were added to harmonize language with the child and adolescent schedule.Meningococcal vaccination (6). Routine recommendations for meningococcal vaccination have not changed. However, a note was added at end of section that states, “MenB vaccines may be administered simultaneously with MenACWY vaccines if indicated, but at a different anatomical site, if feasible.”Pneumococcal vaccination (7). ACIP recommends routine vaccination against pneumococcal infection for all adults aged 65 years or older. For persons aged 65 years and older who have not previously received a pneumococcal conjugate vaccine or whose previous vaccination history is unknown, they should receive 1 dose of PCV15 or 1 dose of PCV20. If PCV15 is used, this should be followed by a dose of PPSV23. This guidance has now been included in the “Routine vaccination” section. Persons aged 19 through 64 years with certain underlying medical conditions or other risk factors who have not previously received a pneumococcal conjugate vaccine or whose previous vaccination history is unknown should receive 1 dose of PCV15 or 1 dose of PCV20. If PCV15 is used, this should be followed by a dose of PPSV23. This guidance is now included in the “Special situations” section. Guidance for dosing intervals between PCV15 and PPSV23 and for patients who have previously received PCV13 or PPSV23 in the past is also included. A note is added to the end listing all the underlying medical conditions or risk factors that would make those aged 19 through 64 years eligible to receive pneumococcal vaccination.Tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccination. Routine recommendations for Tdap or Td vaccination have not changed.Varicella vaccination (8). Routine recommendations for varicella vaccination have not changed. However, in the “Special situations” section, CD4 percentages in addition to CD4 counts in the HIV infection bullet were added to harmonize language with the child and adolescent schedule.Zoster vaccination (9). In the “Special situations” section under the pregnancy bullet, the language was revised to increase clarity. This bullet now states, “There is currently no ACIP recommendation for RZV use in pregnancy. Consider delaying RZV until after pregnancy.” Additionally, the immunocompromising conditions bullet was revised to reflect the new ACIP recommendations for zoster vaccination. This bullet now states “RZV is recommended for use in persons aged 19 years and older who are or will be immunodeficient or immunosuppressed because of disease or therapy.”Revised Content, Format, and GraphicsCover Page. The cover page of the 2022 schedule provides basic instructions on how to use the schedule to systematically identify vaccination needs of adults and lists routinely recommended vaccines and their standardized abbreviations and trade names. Major edits to the cover page include adding a fourth step in the “How to use the adult immunization schedule” box that directs providers to reference the appendix for all contraindications and precautions to the vaccines listed in the adult immunization schedule. Additionally, PCV15 and PCV20 have been included in the table of vaccine abbreviations and trade names and PCV13 has now been removed to reflect the new ACIP pneumococcal vaccination recommendations. Like in past annual schedules, web links are provided, where providers can download the CDC Vaccine Schedules app and access reference materials for the surveillance of VPDs, including case identification and disease outbreak response. Instructions on reporting suspected cases of reportable VPDs to local or state health departments and significant postvaccination adverse events to the Vaccine Adverse Event Reporting System are listed. Information on the Vaccine Injury Compensation Program is provided, as well as web links to other resources, such as vaccine information statements, recommended vaccines for travelers, and shared clinical decision-making guidance.Table 1. Recommended Adult Immunization Schedule by Age Group. Table 1 describes routine and catch-up vaccination recommendations for adults by age. For 2022, the zoster row of Table 1 on the adult immunization schedule was changed to purple for adults aged 19 through 49 years, indicating that recombinant zoster vaccine (RZV) is now recommended for adults in this age group who have immunocompromising conditions. The text overlay now states, “2 doses for immunocompromising conditions (see notes).” For pneumococcal vaccination in Table 1, all recommended pneumococcal vaccines (i.e., PCV15, PCV20, and PPSV23) have been collapsed to one row. Guidance for which vaccines are indicated for certain age groups is displayed by the corresponding colors and overlying text. The row is purple from 19 through 64 years and yellow for adults aged 65 years and older. The text overlay now states, “1 dose PCV15 followed by PPSV23 OR 1 dose PCV20 (see notes).” The Hepatitis B row is now yellow from 19 through 59 years of age, and purple for adults aged 60 years and older. The text overlay now states, “2, 3, or 4 doses depending on vaccine or condition.”Table 2. Recommended Adult Immunization Schedule by Medical Condition and Other Indications. Table 2 describes vaccination recommendations for adults based on medical conditions or other indications. For 2022, the header now includes CD4 percentages in addition to CD4 counts in the HIV infection columns, to harmonize the way this information is presented in the child and adolescent schedule. Additionally, the description of the color red in the legend has been reworded to “Contraindicated or not recommended.” The red boxes in the LAIV4, MMR, and VAR rows now have a text overlay of “Contraindicated” (as opposed to “Not Recommended” in the 2021 schedule) to increase clarity and to align more closely with ACIP recommendations. In the RZV row, under the Immunocompromised and HIV infection columns, the row is yellow indicating that RZV is recommended for these subgroups. Additionally, the text overlay under these columns now states, “2 doses at age ≥19 years.” The HepB row is now entirely yellow, indicating that hepatitis B vaccination is recommended for all risk-based groups in Table 2. The text overlay states, “3 doses (see notes),” in the pregnancy column, and “2, 3, or 4 doses depending on vaccine or condition,” for the remaining columns.Notes. Recommended Adult Immunization Schedule. Additional language has been added to the box containing COVID-19 vaccination recommendations. In addition to including the hyperlink to the Interim ACIP recommendations for the use of COVID-19 vaccines, the hyperlink to CDC's Interim Clinical Considerations for the use of COVID-19 vaccines is also included in this box. Each recommended vaccine for adults in Tables 1 and 2 is accompanied by a note (previously known as a footnote), which is designed to provide additional information on routine vaccination and recommendations in special situations. Each section contains concise information on vaccine indications, dosing frequencies and intervals, and other published ACIP recommendations. New or revised language for influenza, hepatitis B, pneumococcal, and zoster vaccination has been added to their respective sections in the notes. Changes were also made to the MMR vaccine, HPV vaccine, meningococcal vaccine, and varicella vaccine sections to improve clarity in the language. All vaccines identified in Tables 1 and 2 (except PCV15, PCV20, and RZV) also appear in the Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger, United States, 2022 (www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html). The notes for vaccines that appear in both the adult immunization schedule and the child and adolescent immunization schedule have been harmonized to the greatest extent possible.Appendix. Recommended Adult Immunization Schedule. The appendix lists all the contraindications and precautions to each of the vaccines listed in the 2022 adult immunization schedule. The information presented in this appendix is adapted from the 2021–2022 influenza vaccine recommendations (2) and from ACIP General Best Practice Guidelines for Immunization (10).Vaccination During the Coronavirus Disease 2019 (COVID-19) PandemicVaccination is an essential medical service for all children, adolescents, and adults; vaccines are ideally administered in the medical home. Providers should administer all due and overdue vaccines according to the routine immunization schedule during the same visit. In addition, providers should implement strategies to catch up all patients on any overdue vaccines. The CDC's interim guidance for the safe delivery of vaccines during the COVID-19 pandemic (11) includes the use of personal protective equipment and physical distancing. Routine immunization services remain critical during the COVID-19 pandemic as they prevent disease in individuals, families, and communities (11). For more information, see www.cdc.gov/vaccines/pandemic-guidance/index.html.The CDC has partnered with the National Adult and Influenza Immunization Summit, which has developed a checklist of best practices for vaccination clinics held at satellite, temporary, or off-site locations, and can be downloaded at www.izsummitpartners.org/content/uploads/2019/02/off-site-vaccination-clinic-checklist.pdf. This checklist is a step-by-step guide to help clinic coordinators/supervisors overseeing vaccination clinics held at satellite, temporary, or off-site locations follow the CDC guidelines and best practices for vaccine shipment, transport, storage, handling, preparation, administration, and documentation. This checklist can be used in any nontraditional vaccination clinic settings, such as workplaces, community centers, schools, makeshift clinics in remote areas, and medical facilities when vaccination occurs in the public areas or classrooms.Appendix ARecommendations for routine use of vaccines in children, adolescents, and adults are developed by the Advisory Committee on Immunization Practices (ACIP). ACIP is chartered as a federal advisory committee to provide expert external advice and guidance to the Director of the Centers for Disease Control and Prevention (CDC) on the use of vaccines and related agents to control vaccine-preventable diseases in the civilian population of the United States. Recommendations for routine use of vaccines in children and adolescents are harmonized to the extent possible with recommendations made by the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), and the American College of Obstetricians and Gynecologists (ACOG). Recommendations for routine use of vaccines in adults are harmonized with recommendations of AAFP, ACOG, the American College of Physicians (ACP), the American College of Nurse-Midwives (ACNM), and the American Academy of Physician Assistants (AAPA). ACIP recommendations adopted by the CDC Director become agency guidelines on the date they are published in the Morbidity and Mortality Weekly Report (MMWR). Additional information on ACIP is available at www.cdc.gov/vaccines/acip.Members of the ACIPUnless otherwise indicated, the members listed were nonauthor collaborators to this article.José R. Romero, MD, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas (Chair); Amanda Cohn, MD, Centers for Disease Control and Prevention, Atlanta, Georgia (Executive Secretary); Robert L. Atmar, MD, Baylor College of Medicine, Houston, Texas; Kevin A. Ault, MD*, University of Kansas Medical Center, Kansas City, Kansas; Lynn Bahta, RN, MPH, CPH, Minnesota Department of Health, Saint Paul, Minnesota; Beth P. Bell, MD, MPH, University of Washington, Seattle, Washington; Henry Bernstein, DO, MHCM*, Cohen Children's Medical Center, New Hyde Park, and Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York; Sybil Cineas, MD, The Warren Alpert Medical School of Brown University, Providence, Rhode Island; Sharon E. Frey, MD, Saint Louis University Medical School, Saint Louis, Missouri; Paul Hunter, MD, City of Milwaukee Health Department, Milwaukee, Wisconsin; Grace M. Lee, MD, MPH, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, California; Veronica V. McNally, JD, Franny Strong Foundation, West Bloomfield, Michigan; Katherine A. Poehling, MD, MPH, Wake Forest School of Medicine, Winston-Salem, North Carolina; Pablo J. Sánchez, MD, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio; Peter Szilagyi, MD, MPH, University of California, Los Angeles, Los Angeles, California; Helen Keipp Talbot, MD, MPH, Vanderbilt University, Nashville, Tennessee. A list of current ACIP members is available at www.cdc.gov/vaccines/acip/committee/members.html.ACIP Combined Immunization Work GroupWork Group Co-Chair: Kevin A. Ault, MD*, Kansas City, Kansas.Work Group Members: Sybil Cineas, MD, Providence, Rhode Island; Sarah Coles, MD, Phoenix, Arizona; Katherine Debiec, MD, Seattle, Washington; Marci Drees, MD, Philadelphia, Pennsylvania; John Epling, MD, Roanoke, Virginia; Holly Fontenot, PhD, Boston, Massachusetts; Sandra Fryhofer, MD, Atlanta, Georgia; Molly Howell, MPH, Bismarck, North Dakota; Marie-Michelle Leger, MPH, PA-C, Alexandria, Virginia; Susan Lett, MD, MPH, Boston, Massachusetts; Veronica V. McNally, JD, West Bloomfield, Michigan; Sarah McQueen, DMS, PA-C, Charlotte, North Carolina; Amy Middleman, MD, MSEd, MPH, Oklahoma City, Oklahoma; Sean O’Leary, MD, MPH, Denver, Colorado; Chad Rittle, DNP, MPH, RN, Pittsburgh, Pennsylvania; William Schaffner, MD, Nashville, Tennessee; Ken Schmader, MD, Durham, North Carolina; Rhoda Sperling, MD, New York, New York; Patricia Stinchfield, RN, MS, Saint Paul, Minnesota; Thomas Weiser, MD, MPH, Portland, Oregon.Work Group Contributors: Anna M. Acosta, MD, Atlanta, Georgia; Tara C. Anderson, DVM, PhD, Atlanta, Georgia; Kathy Byrd, MD, MPH, Atlanta, Georgia; Margaret M. Cortese, MD, Atlanta, Georgia; Kathleen Dooling, MD, MPH, Atlanta, Georgia; Amy Parker Fiebelkorn, MSN, MPH, Atlanta, Georgia; Mark Freedman, DVM, MPH, New York, New York; Paul A. Gastañaduy, MD, Atlanta, Georgia; Lisa Grohskopf, MD, MPH, Atlanta, Georgia; Susan Hariri, PhD, Atlanta, Georgia; Aaron M. Harris, MD, Atlanta, Georgia; Fiona Havers, MD, PhD, Atlanta, Georgia; Holly Hill, PhD, MD, Atlanta, Georgia; Tara Jatlaoui, MD, MPH, Atlanta, Georgia; Suzanne Johnson-DeLeon, MPH, Atlanta, Georgia; Miwako Kobayashi, MD, MPH, Atlanta, Georgia; Ram Kopakka, MD, MPH, Atlanta, Georgia; Andrew Kroger, MD, MPH, Atlanta, Georgia; Tatiana M. Lanzieri, MD, Atlanta, Georgia; Lucy McNamara, PhD, MS, Atlanta, Georgia; Mona Marin, MD, Atlanta, Georgia; Lauri Markowitz, MD, Atlanta, Georgia; Sarah A. Mbaeyi, MD, Atlanta, Georgia; Elissa Meites, MD, MPH, Atlanta, Georgia; Noele P. Nelson, MD, PhD, Atlanta, Georgia; Sara Oliver, MD, MSPH, Atlanta, Georgia; Priti Patel, MD, MPH, Atlanta, Georgia; Tamara Pilishvili, MPH, BS, Atlanta, Georgia; Hilda Razzaghi, PhD, Atlanta, Georgia; Janell Routh, MD, Atlanta, Georgia; Sarah Schillie, MD, Atlanta, Georgia; Mark K. Weng, MD, Atlanta, Georgia; Akiko Wilson, BFA, Atlanta, Georgia; JoEllen Wolicki, BSN, Atlanta, Georgia.Work Group Consultants: Henry Bernstein, DO, MHCM*, New Hyde Park, New York; Caroline Bridges, MD, Moscow, Idaho; Kathleen Harriman, PhD, MPH, RN, Richmond, California; Robert H. Hopkins Jr., MD, Little Rock, Arkansas; Karen Ketner, DNP, Redwood City, California; David Kim, MD, MPH, Washington, DC; Jane Kim, MD, MPH, Durham, North Carolina; Diane Peterson, Saint Paul, Minnesota; Litjen Tan, PhD, Chicago, Illinois.Work Group Co-Leads: Neil Murthy, MD, MPH, MSJ*, Atlanta, Georgia; A. Patricia Wodi, MD, MPH*.* Authored the article.