Immunizations

Recommended immunizations

Your need for immunizations does not end when you reach adulthood. The specific shots (injections) you need as an adult depend not only on your age, lifestyle, overall health, pregnancy status, and travel plans but also on who you are in close contact with and what vaccines you had as a child. Tetanus and diphtheria shots need to be repeated every 10 years throughout adulthood in order to keep your immunity.

Each year the U.S. Advisory Committee on Immunization Practices (ACIP), the American College of Obstetrics and Gynecologists, the American College of Physicians, and the American Academy of Family Physicians recommend a specific adult immunization schedule (What is a PDF document?).

Your doctor will consider your medical and immunization history (and documentation) when deciding which shots you need.

To print a list of which shots you may need, go to the U.S. Centers for Disease Control and Prevention (CDC) interactive website at www2.cdc.gov/nip/adultImmSched.

Immunizations given during adulthood may include:⁹

Chickenpox (varicella)(What is a PDF document?)

This shot (called Varivax) protects against chickenpox. Chickenpox infection can be very serious when it occurs after childhood.

Who should get it?

Adults who are not already immune to the chickenpox virus need two doses, given at least 4 weeks apart.
Women who don't have evidence of immunity and recently gave birth should get this shot.

Pregnant women and people with immune system problems should not get this shot.

Flu (influenza)(What is a PDF document?)

This immunization helps protect against the seasonal flu and the H1N1 (swine) flu. Flu viruses are always changing, so the flu vaccines are updated every year. Protection lasts up to a year for each flu vaccine type.

Who should get it?

Flu immunization is recommended once a year for:⁶

All adults. It is especially important for:
- People with a chronic health condition, such as asthma, diabetes, heart or lung disorders, or an impaired immune system (which puts them at high risk for complications of the flu).
- Women who are or will be pregnant during the flu season.
- Household contacts and caregivers of all children younger than 5 years old and close contacts of others who are at high risk for complications of the flu.
- People who live in nursing homes or long-term care centers.

Healthy people ages 2 years through 49 years can usually get the nasal spray flu vaccine (FluMist) (What is a PDF document?) instead of the flu shot. Pregnant women can get the flu shot but not FluMist.

Adults ages 65 and older can get a high-dose flu shot, starting in the fall of 2010.¹⁰ Studies are being done to see if the high-dose shot protects older adults better than the standard-dose shot.

For more information about the flu, see the topics Influenza (Seasonal Flu) and H1N1 Influenza (Swine Flu). For the most current CDC guidelines about seasonal flu, go to www.cdc.gov/flu. For the most current CDC guidelines about H1N1 flu, go to www.cdc.gov/h1n1flu.

For help deciding if the flu shot is right for you, see:

Flu Vaccines: Should I Get a Flu Vaccine?

Myths About the Flu Vaccine.

Hepatitis A (Hep A)(What is a PDF document?)

This shot protects against hepatitis A.

Who should get it?

Adults who will be traveling to certain foreign countries, such as those in Central or South America, need two doses given at least 6 months apart.
Adults who have certain risk factors, such as long-term (chronic) liver disease, also need two doses.
Anyone who will be in close contact with an adopted child from a country that has high rates of hepatitis A needs two doses. This includes household contacts and babysitters. This recommendation only applies for the first 60 days the child is in the United States.⁷

Hepatitis B (Hep B)(What is a PDF document?)

This shot protects against hepatitis B.

Who should get it?

Adults who have not received the vaccine series for hepatitis B need this shot when occupation, travel, health condition, or lifestyle increases their risk of exposure.

Three doses are needed over at least 4 months.

A hepatitis combination vaccine (Twinrix) is recommended for those who are at risk for both hepatitis A and hepatitis B. This vaccine is approved in the United States only for those 18 years of age or older.

Measles, mumps, and rubella (MMR)(What is a PDF document?)

This shot protects against measles, mumps, and rubella.

Who should get it?

Adults born during or after 1957 may need one or two doses if they do not have evidence of immunity.

Women should avoid becoming pregnant for 28 days after getting the MMR shot. Women who are known or suspected to be pregnant and people who have impaired immune systems should not get this shot.¹¹

Pneumococcal polysaccharide (PPSV, or Pneumovax 23)(What is a PDF document?)

This shot does not necessarily reduce your risk of getting pneumonia, but it can prevent some of the serious complications of pneumonia, such as infection in the bloodstream (bacteremia) or throughout the body (septicemia).

Who should get it?

All people 65 years of age or older need this shot.
People ages 2 years to 64 years who have a chronic disease (such as heart or lung disease), do not have a spleen, or have a damaged spleen also need this shot.
People ages 19 to 64 years who have asthma or who smoke cigarettes need this shot.

This shot is different from the pneumococcal conjugate (PCV) shot that is given to all children. Most adults only need one dose of PPSV for protection. Some people may need a booster shot after 5 years.

Shingles (herpes zoster)(What is a PDF document?)

This shot (called Zostavax) protects against shingles.

Who should get it?

Adults ages 60 and older need one dose, whether or not they've had shingles before. People ages 50 to 59 can also get this shot.

Zostavax is not a substitute for the chickenpox shot (Varivax).

Tetanus and diphtheria (Td) or Tetanus, diphtheria, and pertussis (Tdap)(What is a PDF document?)

The Tdap shot protects against tetanus, diphtheria, and whooping cough (pertussis). The Td shot does not protect against pertussis.

Who should get it?

All adults need Td booster shots every 10 years throughout life.
All adults 19 to 64 years of age should have one shot of Tdap in place of a Td shot.
All adults (including adults older than 64) who have or expect to have close contact with a baby younger than 1 year of age should get one Tdap shot.

Adults age 65 and older can get one Tdap shot if they want protection from pertussis.

Other immunizations

You may need or want additional immunizations if certain situations raise your chance for exposure to disease. Or you may have missed shots when you were younger. Or a vaccine may not have been offered when you were younger. These immunizations may include:

Human papillomavirus (HPV)

The vaccines Cervarix (What is a PDF document?) and Gardasil (What is a PDF document?) protect against two types of human papillomavirus (HPV) that cause cervical cancer. Gardasil also protects against two types of HPV that cause genital warts. And it protects against some uncommon cancers, such as vaginal cancer.

Who should get it?

Females 13 to 26 years old need three doses of either Cervarix or Gardasil, given over 6 months.
Males ages 9 to 26 can get three Gardasil shots to reduce the chance of getting genital warts.

If you already have HPV infection, talk with your doctor about whether to get immunized. The shot has not been shown to help existing HPV infection, but it may protect you from other HPV infections.

Meningococcal (conjugate or polysaccharide, depending on your age)(What is a PDF document?)

This shot protects against bacterial meningitis and blood infections (sepsis).

Who should get it?

Adults who have a damaged or missing spleen or who have certain immune system problems need two initial doses and then a booster dose every 5 years.
Adults who have a higher risk than others for getting and having severe problems from meningitis need one shot. This includes adults who will travel or live in areas of the world where the disease is common.

The meningococcal conjugate vaccine is usually given to people ages 2 years to 55 years who need this immunization. Adults older than age 55 are immunized with the meningococcal polysaccharide (MPSV4) vaccine, called Menomune. Some people may need booster shots.

Polio (IPV)(What is a PDF document?)

This shot protects against polio.

Who should get it?

Adults whose travel or job puts them at increased risk for exposure to polio need three doses of this shot.
Adults who never had the full series of oral polio vaccine (OPV) or inactivated polio vaccine (IPV) and who have an increased risk of being exposed to polio need the shots they missed.

Routine polio immunization is not recommended for adults (ages 18 and older) who live in the United States.

Consult your doctor or public health department if you missed an immunization or to find out whether you need a specific immunization. For more information about each vaccine, see the topic Vaccine Information Statements.

Immunizations and pregnancy¹¹

Before you become pregnant, discuss your immunization history with your doctor. If you need the chickenpox or measles, mumps, and rubella (MMR) shots, wait at least 4 weeks after the immunization before becoming pregnant.

The CDC recommends the inactivated flu shots (seasonal and H1N1) for all women who are or who plan to be pregnant during the flu season. Pregnant women should not receive the nasal spray flu vaccines.

Also, pregnant women should not receive the HPV vaccine.

Pregnant women who are due for their tetanus booster can get immunized with Td vaccine. The CDC recommends that women who have not previously had Tdap should get a dose of Tdap before getting pregnant or right after their baby is born. This is to protect the newborn baby from whooping cough (pertussis).

If you are pregnant, your children should still get their immunizations on schedule. You do not need to speed up or delay your other children's immunizations.

Immunizations and new health threats

In 2007, the FDA approved the first vaccine for humans against bird flu (avian influenza). Immunization is not currently recommended for the public. The vaccine will be kept in the U.S. government stockpile.¹²

Immunization safety

You may worry that immunizations are dangerous if given when you have a cold or other minor illness. Talk to your doctor if you have concerns about the timing of shots. But keep in mind that shots can usually still be given during a mild illness, while medicines are being taken, and in other situations where you may not be in perfect health. There are very few reasons for which doctors suggest that a person postpone or not get an immunization.

Talk with your doctor or public health department if you missed an immunization or to find out whether you need a specific immunization. For more information about each vaccine, see the topic Vaccine Information Statements.

Travel Immunizations

By:	Healthwise Staff	Last Revised: May 27, 2011
Medical Review:	John Pope, MD - Pediatrics

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