Preventive Medicine
Adult Vaccination Schedule
Preventive Medicine

Adult Vaccination Schedule

Routine, high-risk, and PEP vaccinations for adults.

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◆Routine adult vaccines

  • •Influenza: annual, age ≥6 months; severe egg allergy NOT a contraindication to inactivated
  • •Tdap once + Td booster q10 years; Tdap each pregnancy at 27–36 weeks
  • •MMR: 2 doses if born after 1957 without immunity
  • •Varicella: 2 doses if no immunity (live — avoid in pregnancy + immunocompromised)
  • •Zoster (Shingrix recombinant): all ≥50 (and immunocompromised ≥19); SAFE in immunocompromised (not live)
  • •HPV: all 11–12 (can start at 9); catch-up to 26 (shared decision 27–45). <15 yrs = 2 doses; ≥15 or immunocompromised = 3 doses
  • •Hepatitis B: universal for adults 19–59

◆Pneumococcal (adults)

  • •19–64 with chronic conditions (heart, lung, liver, DM, smoking): PPSV23 alone
  • •19–64 very high risk (immunocompromised, asplenia, CSF leak, cochlear implant, CKD): PCV15 followed by PPSV23 ≥8 weeks later
  • •≥65 (no prior vaccine): PCV20 alone OR PCV15 then PPSV23 ≥1 year later

◆Meningococcal

  • •Routine: primary dose at 11–12, booster at 16
  • •High-risk (start ≥2 months): asplenia, complement deficiency, HIV, endemic travel
  • •Asplenia: meningococcal + pneumococcal + Hib boosters

◆RSV

  • •Adults ≥60: shared decision
  • •Pregnant: 32–36 weeks (passive antibody to newborn)

◆Pregnancy

  • •GIVE: Tdap (27–36 wks), inactivated influenza, RSV (32–36 wks), RhoGAM 28 wks if Rh-
  • •CONTRAINDICATED (live): MMR, varicella, live-attenuated intranasal influenza
  • •HPV: not given in pregnancy (not because of teratogenicity, but lack of data)
  • •Hepatitis A/B: high-risk OK

◆Post-exposure prophylaxis (PEP)

  • •Tetanus: clean minor — Tdap if <3 doses/unknown OR ≥3 doses + ≥10 yrs; dirty/severe — Tdap + TIG if <3 doses/unknown OR ≥3 doses + ≥5 yrs
  • •Varicella: immunocompetent → vaccine within 5 days; high-risk (pregnant, immunocompromised, infants) → VZIG
  • •Rabies: high-risk animal (bat, raccoon, fox) → vaccine + RIG (DIFFERENT arms); low-risk (rabbits, rodents) → only wound care
  • •Hepatitis B: unvaccinated + HBsAg+ exposure → HBV vaccine + HBIG; vaccinated immune (anti-HBs ≥10) → no PEP
  • •HIV: 3-drug ART within 72 hours × 28 days

◆Contraindications

  • •Rotavirus: history of intussusception, SCID
  • •Pertussis (DTaP): anaphylaxis, encephalopathy, uncontrolled epilepsy
  • •Live vaccines: pregnancy, severe immunocompromise (CD4 <200, transplant, biologics)
  • •Mild illness (low-grade fever, cough): SAFE — only postpone for moderate/severe systemic illness

High-yield pearls

  • ◆Shingrix is recombinant — safe in immunocompromised (Zostavax was live)
  • ◆Egg allergy isn't a contraindication to inactivated flu
  • ◆Asplenia needs THREE boosters: meningococcal, pneumococcal, Hib
  • ◆RIG and rabies vaccine: different anatomic sites (prevent neutralization)
  • ◆Always treat both Mg before K in repletion (low Mg blunts K)
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