2019 Vaccine Guide & Insert - VG6

02/19/19

conditions (chronic heart [excluding hypertension],
lung, or liver disease; diabetes), alcoholism, or
cigarette smoking: 1 dose PPSV23
y Age 19 years or older with immunocompromising
conditions (congenital or acquired
immunodeficiency [including B- and T-lymphocyte
deficiency, complement deficiencies, phagocytic
disorders, HIV infection], chronic renal failure,
nephrotic syndrome, leukemia, lymphoma,
Hodgkin disease, generalized malignancy,
iatrogenic immunosuppression [e.g., drug or
radiation therapy], solid organ transplant,
multiple myeloma) or anatomical or functional
asplenia (including sickle cell disease and other
hemoglobinopathies): 1 dose PCV13 followed by
1 dose PPSV23 at least 8 weeks later, then another
dose PPSV23 at least 5 years after previous PPSV23;
at age 65 years or older, administer 1 dose PPSV23
at least 5 years after most recent PPSV23 (note: only
1 dose PPSV23 recommended at age 65 years or older)
y Age 19 years or older with cerebrospinal fluid leak
or cochlear implant: 1 dose PCV13 followed by 1 dose
PPSV23 at least 8 weeks later; at age 65 years or older,
administer another dose PPSV23 at least 5 years after
PPSV23 (note: only 1 dose PPSV23 recommended at
age 65 years or older)

y Age 19 through 64 years with chronic medical

Special situations

PCV13 if previously did not receive PCV13, followed by
1 dose PPSV23 at least 1 year after PCV13 and at least
5 years after last dose PPSV23
- Previously received PPSV23 but not PCV13 at age
65 years or older: 1 dose PCV13 at least 1 year after
PPSV23
- When both PCV13 and PPSV23 are indicated,
administer PCV13 first (PCV13 and PPSV23 should not
be administered during same visit)

(including HIV infection with CD4 count <200 cells/
μL): ZVL contraindicated; recommended use of RZV
under review

y Severe immunocompromising conditions

RZV until after pregnancy if RZV is otherwise indicated

y Pregnancy: ZVL contraindicated; consider delaying

Special situations

apart (minimum interval: 4 weeks; repeat dose if
administered too soon) regardless of previous herpes
zoster or previously received ZVL (administer RZV at
least 2 months after ZVL)
y Age 60 years or older: 2-dose series RZV 2-6 months
apart (minimum interval: 4 weeks; repeat dose if
administered too soon) or 1 dose ZVL if not previously
vaccinated (if previously received ZVL, administer RZV
at least 2 months after ZVL); RZV preferred over ZVL

y Age 50 years or older: 2-dose series RZV 2-6 months

Routine vaccination

Zoster vaccination

immunity to varicella: 1 dose VAR if previously
received 1 dose varicella-containing vaccine, or 2-dose
series VAR 4-8 weeks apart if previously did not receive
any varicella-containing vaccine, regardless of whether
U.S.-born before 1980
y HIV infection with CD4 count ≥200 cells/µL with no
evidence of immunity: Consider 2-dose series VAR
3 months apart based on individual clinical decision;
VAR contraindicated in HIV infection with CD4 count
<200 cells/μL
y Severe immunocompromising conditions: VAR
contraindicated

y Health care personnel with no evidence of

Centers for Disease Control and Prevention | Recommended Adult Immunization Schedule, United States, 2019 | Page 6

varicella: VAR contraindicated during pregnancy; after
pregnancy (before discharge from health care facility),
1 dose VAR if previously received 1 dose varicellacontaining vaccine, or dose 1 of 2-dose series VAR
(dose 2: 4-8 weeks later) if previously did not receive
any varicella-containing vaccine, regardless of whether
U.S.-born before 1980

y Pregnancy with no evidence of immunity to

Special situations

VAR 4-8 weeks apart if previously did not receive
varicella-containing vaccine (VAR or MMRV [measlesmumps-rubella-varicella vaccine] for children); if
previously received 1 dose varicella-containing
vaccine: 1 dose VAR at least 4 weeks after first dose
- Evidence of immunity: U.S.-born before 1980 (except
for pregnant women and health care personnel
[see below]), documentation of 2 doses varicellacontaining vaccine at least 4 weeks apart, diagnosis
or verification of history of varicella or herpes zoster
by a health care provider, laboratory evidence of
immunity or disease

y No evidence of immunity to varicella: 2-dose series

Routine vaccination

Varicella vaccination

series for tetanus, diphtheria, and pertussis: 1 dose
Tdap followed by 1 dose Td at least 4 weeks after Tdap,
and another dose Td 6-12 months after last Td (Tdap
can be substituted for any Td dose, but preferred as
first dose); Td booster every 10 years thereafter
y Pregnancy: 1 dose Tdap during each pregnancy,
preferably in early part of gestational weeks 27-36
y For information on use of Tdap or Td as tetanus
prophylaxis in wound management, see www.cdc.gov/
mmwr/volumes/67/rr/rr6702a1.htm

y Previously did not receive primary vaccination

Special situations

11 years: 1 dose Tdap, then Td booster every 10 years

y Previously did not receive Tdap at or after age

Routine vaccination

Routine vaccination

y Age 65 years or older (immunocompetent): 1 dose

Tetanus, diphtheria, and pertussis vaccination

Recommended Adult Immunization Schedule
United States, 2019

Pneumococcal vaccination

Notes
https://www.cdc.gov/mmwr/volumes/67/rr/rr6702a1.htm https://www.cdc.gov/mmwr/volumes/67/rr/rr6702a1.htm
2019 Vaccine Guide & Insert

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