2019 Vaccine Guide & Insert - VG4

Special situations

02/19/19

HepA or 3-dose series HepA-HepB as above
- Chronic liver disease
- Clotting factor disorders
- Men who have sex with men
- Injection or non-injection drug use
- Homelessness
- Work with hepatitis A virus in research laboratory or
nonhuman primates with hepatitis A virus infection
- Travel in countries with high or intermediate
endemic hepatitis A
- Close personal contact with international adoptee
(e.g., household, regular babysitting) in first 60 days
after arrival from country with high or intermediate
endemic hepatitis A (administer dose 1 as soon
as adoption is planned, at least 2 weeks before
adoptee's arrival)

y At risk for hepatitis A virus infection: 2-dose series

Special situations

(identification of risk factor not required): 2-dose
series HepA (Havrix 6-12 months apart or Vaqta
6-18 months apart [minimum interval: 6 months]) or
3-dose series HepA-HepB (Twinrix at 0, 1, 6 months
[minimum intervals: 4 weeks between doses 1 and 2,
5 months between doses 2 and 3])

y Not at risk but want protection from hepatitis A

Routine vaccination

Hepatitis A vaccination

cell disease): 1 dose Hib if previously did not receive
Hib; if elective splenectomy, 1 dose Hib, preferably at
least 14 days before splenectomy
y Hematopoietic stem cell transplant (HSCT): 3-dose
series Hib 4 weeks apart starting 6-12 months after
successful transplant, regardless of Hib vaccination
history

y Anatomical or functional asplenia (including sickle

Routine vaccination

infection) through age 26 years: 3-dose series HPV
vaccine at 0, 1-2, 6 months as above
y Men who have sex with men and transgender
persons through age 26 years: 2- or 3-dose series
HPV vaccine depending on age at initial vaccination
as above
y Pregnancy through age 26 years: HPV vaccination
not recommended until after pregnancy; no
intervention needed if vaccinated while pregnant;
pregnancy testing not needed before vaccination

y Immunocompromising conditions (including HIV

Special situations

age 21 years: 2- or 3-dose series HPV vaccine
depending on age at initial vaccination; males age
22 through 26 years may be vaccinated based on
individual clinical decision (HPV vaccination routinely
recommended at age 11-12 years)
y Age 15 years or older at initial vaccination: 3-dose
series HPV vaccine at 0, 1-2, 6 months (minimum
intervals: 4 weeks between doses 1 and 2, 12 weeks
between doses 2 and 3, 5 months between doses
1 and 3; repeat dose if administered too soon)
y Age 9 through 14 years at initial vaccination and
received 1 dose, or 2 doses less than 5 months
apart: 1 dose HPV vaccine
y Age 9 through 14 years at initial vaccination and
received 2 doses at least 5 months apart: HPV
vaccination complete, no additional dose needed
y If completed valid vaccination series with any HPV
vaccine, no additional doses needed

Centers for Disease Control and Prevention | Recommended Adult Immunization Schedule, United States, 2019 | Page 4

(Heplisav-B) or 3-dose (Engerix-B, Recombivax HB)
series HepB, or 3-dose series HepA-HepB as above
- Hepatitis C virus infection
- Chronic liver disease (e.g., cirrhosis, fatty liver
disease, alcoholic liver disease, autoimmune
hepatitis, alanine aminotransferase [ALT] or aspartate
aminotransferase [AST] level greater than twice
upper limit of normal)
- HIV infection
- Sexual exposure risk (e.g., sex partners of hepatitis B
surface antigen (HBsAg)-positive persons; sexually
active persons not in mutually monogamous
relationships, persons seeking evaluation or
treatment for a sexually transmitted infection, men
who have sex with men)
- Current or recent injection drug use
- Percutaneous or mucosal risk for exposure to
blood (e.g., household contacts of HBsAg-positive
persons; 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; persons with diabetes mellitus age younger than 60 years and, at discretion of
treating clinician, those age 60 years or older)
- Incarcerated persons
- Travel in countries with high or intermediate
endemic hepatitis B

y At risk for hepatitis B virus infection: 2-dose

Special situations

(identification of risk factor not required): 2- or 3-dose
series HepB (2-dose series Heplisav-B at least 4 weeks
apart [2-dose series HepB only applies when 2 doses
of Heplisav-B are used at least 4 weeks apart] or 3-dose
series Engerix-B or Recombivax HB at 0, 1, 6 months
[minimum intervals: 4 weeks between doses 1 and 2,
8 weeks between doses 2 and 3, 16 weeks between
doses 1 and 3]) or 3-dose series HepA-HepB (Twinrix at
0, 1, 6 months [minimum intervals: 4 weeks between
doses 1 and 2, 5 months between doses 2 and 3])

y Females through age 26 years and males through

Routine vaccination

y Not at risk but want protection from hepatitis B

Human papillomavirus vaccination

Hepatitis B vaccination

Recommended Adult Immunization Schedule
United States, 2019

Haemophilus influenzae type b vaccination

Notes
2019 Vaccine Guide & Insert

Table of Contents for the Digital Edition of 2019 Vaccine Guide & Insert
