Ask the Experts: Vaccine Recommendations

Note: Recommendations for specific vaccines are included in the Ask the Expert set for that vaccine – see vaccine index.

Results (18)

Vaccine recommendations in the U.S. are issued primarily by two national bodies—the CDC Advisory Committee on Immunization Practices (ACIP) and the American Academy of Pediatrics (AAP) Committee on Infectious Diseases. To access the most current ACIP recommendations, visit ACIP Vaccine Recommendations and Guidelines (CDC) for statements in alphabetical order or ACIP Vaccine Recommendations (Immunize.org) for statements in chronological order (can also be sorted by vaccine). AAP vaccine recommendations are published in the AAP Red Book, and are generally available on the AAP website.

Last reviewed: January 20, 2025

The ACIP-recommended child and adolescent schedules are and approved by the CDC (www.cdc.gov), American Academy of Pediatrics (www.aap.org), American Academy of Family Physicians (AAFP, www.aafp.org), American College of Obstetricians and Gynecologists (ACOG, www.acog.org), American College of Nurse-Midwives (www.midwife.org), American Academy of Physician Associates (AAPA, www.aapa.org), and National Association of Pediatric Nurse Practitioners (www.napnap.org).

The ACIP-recommended adult schedules are approved by CDC and American College of Physicians (www.acponline.org), AAFP, ACOG, American College of Nurse-Midwives, AAPA, American Pharmacists Association (www.pharmacist.com), and Society for Healthcare Epidemiology of America (www.shea-online.org).

Last reviewed: January 20, 2025

You can download electronic versions of the schedules from CDC’s website at www.cdc.gov/vaccines/hcp/imz-schedules. Immunize.org has also created laminated booklet versions of the child and adolescent schedule, as well as the adult schedule, which make an excellent resource for placement in each exam room. Each is based on the immunization schedules recommended by ACIP and approved and published by CDC. You can find them by going to shop.immunize.org.

Last reviewed: January 20, 2025

There are several very easy to read pieces that can be downloaded from the Immunize.org website. This includes “Vaccinations for Infants and Children, Age 0–10 Years”, “When do children and teens need vaccinations?”, “Vaccinations for Preteens and Teens” and “You’re 16…We Recommend These Vaccines for You”. These handouts can be found at www.immunize.org/clinical/topic/parent-handouts/.

Last reviewed: January 20, 2025

Immunize.org has developed several resources that can help patients identify what they may need. These include:

Translations of these handouts are also available in several languages. To access all of Immunize.org’s clinical resources available in languages other than English, visit www.immunize.org/translations/.  All of these clinical resources can be found in the subsection of clinical resources that address adult immunization:  www.immunize.org/clinical/topic/adult-vaccination/.

Last reviewed: March 26, 2025

There is usually very close agreement between vaccine package inserts and ACIP statements. The Food and Drug Administration (FDA) must approve the package insert and requires documentation for all data and recommendations made in the insert. Occasionally, ACIP may use different data to formulate its recommendations, or try to add flexibility to its recommendations, which results in wording different than in the package insert. ACIP sometimes makes recommendations based on expert opinion and public health considerations. Published recommendations of ACIP should be considered equally as authoritative as those on the package insert.

Last reviewed: January 20, 2025

Vaccines must always be dispensed with a prescription or order from a physician or other healthcare provider authorized by the state to prescribe medications. However, there are situations where vaccines can be administered using a standing order or vaccine protocol that is not patient-specific. In these situations, a physician or other healthcare provider does not need to be physically present for the vaccine to be administered. Several studies have shown that the use of standing orders can improve vaccination rates, and ACIP recommends the use of standing orders programs in both outpatient and inpatient settings. A comprehensive set of standing orders for the routine vaccines given to children and adults can be found at www.immunize.org/clinical/topic/standing-orders-templates/.

Last reviewed: January 20, 2025

No. According to ACIP, vaccines administered outside the U.S. generally can be accepted as valid if the schedule (i.e., minimum ages and intervals) is similar to that recommended in the U.S. However, with the exception of the influenza and pneumococcal polysaccharide vaccines, only written documentation should be accepted as evidence of previous vaccination. In general, if records cannot be located or will definitely not be available anywhere because of the patient’s circumstances, children without adequate documentation should be considered susceptible and should be started on the age-appropriate vaccination schedule. Serologic testing for immunity is an alternative to vaccination for certain antigens. More information is available in the relevant subsection of CDC’s General Best Practices for Immunization, available at  www.cdc.gov/vaccines/hcp/imz-best-practices/special-situations.html#cdc_report_pub_study_section_7-persons-vaccinated-outside-the-united-states.

Last reviewed: January 20, 2025

The following information is taken from the CDC web page with information on the vaccination of U.S.-bound refugees and V-93 applicants (www.cdc.gov/immigrant-refugee-health/hcp/panel-physicians/vaccination.html):

CDC has specific criteria to determine which vaccines applicants for a United States Immigrant Visa are required to show proof of having received.

The criteria are as follows:

The vaccine must be an age-appropriate vaccine, as recommended by the Advisory Committee on Immunization Practices (ACIP) for the general U.S. population AND at least one of the following:

  • The vaccine must protect against a disease that has the potential to cause an outbreak. An outbreak is defined as the occurrence of more cases of disease than expected in a given area or among a specific group of people, over a given period of time. For endemic diseases, an outbreak occurs when incidence rises above the normally expected level. For diseases with seasonal variation, the average incidence rates over particular weeks or months of previous years, or average high or low levels over a period of years, may be used as baselines.
  • The vaccine must protect against a disease that has been eliminated in the United States or is in the process of being eliminated in the United States.

Therefore, the vaccines required for applicants do not include all the vaccines recommended by the ACIP and CDC for routine U.S. domestic use, and are limited to vaccination for the following diseases:

  • Diphtheria
  • Tetanus
  • Pertussis
  • Polio
  • Measles
  • Mumps
  • Rubella
  • Rotavirus
  • Haemophilus influenzae type b (Hib)
  • Hepatitis A
  • Hepatitis B
  • Meningococcal disease
  • Varicella
  • Pneumococcal disease
  • Influenza
  • COVID-19

ACIP recommends vaccines for a certain age range in the general U.S. public. ACIP recommendations are used to decide which vaccines are age-appropriate for the general immigrant population. Refer to the CDC table of vaccines required for immigrant visa applicants by age: www.cdc.gov/immigrant-refugee-health/media/pdfs/Vaccine-Requirements-According-to-Applicant-Age-panel-physicians-p.pdf.

Children adopted from outside the U.S. and political refugees are recommended to receive age-appropriate vaccination, with catch-up vaccination as appropriate. More information is available in the “Special Situations” section of CDC’s General Best Practices for Immunization, available at  www.cdc.gov/vaccines/hcp/imz-best-practices/special-situations.html#cdc_report_pub_study_section_7-persons-vaccinated-outside-the-united-states. People entering the U.S. as visitors are not required to provide proof of vaccination regardless of the length of stay.

Last reviewed: January 20, 2025

ACIP recommends that people working in healthcare settings be vaccinated against COVID-19, influenza, hepatitis B, measles, mumps, rubella, varicella, and pertussis. Adults are generally assumed to have been vaccinated against polio in childhood; any adult known or strongly suspected of being unvaccinated against polio should be vaccinated. For measles, mumps, rubella, and varicella, serologic evidence of immunity is an acceptable substitute for documentation of vaccination. In addition, microbiologists working in a laboratory should receive vaccination against meningococcal ACWY and meningococcal serogroup B disease. In rare cases, some laboratory personnel should also receive a single polio vaccine booster and typhoid vaccines. For more information, refer to the current CDC recommended adult immunization schedule or the 2011 ACIP recommendations for immunization of healthcare personnel, www.cdc.gov/mmwr/pdf/rr/rr6007.pdf.

Last reviewed: January 27, 2025

You can get this information from CDC’s Travel Health website at wwwnc.cdc.gov/travel/. CDC also publishes Health Information for International Travel (a.k.a. the “Yellow Book”) as a reference for those who advise international travelers of health risks. The Yellow Book is written primarily for healthcare providers, although others might find it useful. The contents of the book are available on the CDC Travel Health website. The book can also be ordered in print form. See the Yellow Book at wwwnc.cdc.gov/travel/page/yellowbook-home.

For Immunize.org’s curated list of resources for travel vaccination, see www.immunize.org/vaccines/travel-vaccines/.

Last reviewed: January 20, 2025

Infants who will travel outside the United States should be up to date for all routinely recommended vaccines. One dose of MMR is recommended for infants age 6 through 11 months before international travel. This dose does not count toward the two doses needed to complete the childhood schedule. Infants 6 through 11 months of age traveling to an area at risk for hepatitis A exposure also should receive a dose of hepatitis A vaccine. This dose does not count toward the two doses needed to complete the childhood schedule. Infants younger than age 12 months traveling to a hepatitis A endemic area are not recommended to receive immune globulin for prevention of hepatitis A because immune globulin could interfere with the response to MMR. Varicella vaccine is not recommended before age 12 months, even for travelers. For other vaccine recommendations for travelers, consult the CDC travel website at wwwnc.cdc.gov/travel/.

Last reviewed: January 20, 2025

Due to the variety of causes and consequences of altered immunocompetence, and limited studies of vaccination with these conditions, vaccination recommendations for primary and secondary immunodeficiencies are generally based upon expert opinion.

CDC’s “General Best Practices for Immunization” includes a subsection for vaccine recommendations for people with altered immunocompetence here: www.cdc.gov/vaccines/hcp/imz-best-practices/altered-immunocompetence.html. For a summary of specific vaccine recommendations for people with different types of primary and secondary immunodeficiencies, refer to Table 8-1 at that site.

Last reviewed: January 20, 2025

People who do not have a functioning spleen or who have had a splenectomy are at increased risk for infection with encapsulated bacteria, especially Pneumococcus, Neisseria meningitidis, and Haemophilus influenzae type b (Hib).

In addition to receiving routine vaccinations, children and adults without a functioning spleen who are age 2 years and older need additional pneumococcal vaccinations, with specific recommendations dependent on an individual’s age and specific pneumococcal vaccination history. Refer to current immunization schedules, Immunize.org’s standing orders templates for pneumococcal vaccination, or CDC’s PneumoRecs VaxAdvisor Mobile App.

All asplenic people should receive a primary series of at least 2 doses of meningococcal ACWY vaccine (MenACWY) with periodic booster doses as recommended to sustain protection. See the MenACWY recommendation table at www.immunize.org/catg.d/p2018.pdf for details. Asplenic people age 10 years and older should also receive a 3-dose series of meningococcal serogroup B vaccine (MenB) with an initial booster dose one year after completion of the primary series and subsequent booster doses every 2–3 years thereafter. A pentavalent MenABCWY vaccine (Penbraya, Pfizer) is also an option in certain circumstances.

Two doses of Hib vaccine should be given to unimmunized children 12–59 months of age (defined as a child who received zero or 1 dose before 12 months of age). A single dose of Hib vaccine should be administered to unimmunized people age 5 years or older (in this case, “unimmunized” is defined as those who have not received at least 1 dose of Hib vaccine after 14 months of age).

Last reviewed: January 27, 2025

Pneumococcal conjugate vaccine (PCV), Haemophilus influenzae type b (Hib) vaccine, MenACWY, and meningococcal B vaccine should be given at least 14 days before a scheduled splenectomy, if possible. This is done so the patient is protected from these diseases before the spleen is removed; however, doses given during the 14 days before surgery also can be counted as valid. If the doses cannot be given prior to the splenectomy, they should be given as soon as the patient’s condition has stabilized after surgery. If PCV20 or PCV21 is given, pneumococcal polysaccharide vaccine (PPSV23) is not needed; if PCV15 is given, administer a dose of PPSV23 at least 8 weeks after the dose of PCV15 if the patient is age 2 years or older.

Last reviewed: November 15, 2024

Since the patient is asplenic, the second dose of the primary series of MenACWY should be given at least 8 weeks after the first dose. He will need a dose of MenACWY every 5 years for the rest of his life. The 3-dose series of MenB (whether Trumenba [Pfizer] or Bexsero [GSK]) should be completed. The first booster dose of MenB will be due one year after completion of the primary series and subsequent booster doses are recommended every 2–3 years for the rest of his life. The same MenB vaccine should be used for all doses in the series, including booster doses. People who receive Trumenba brand MenB vaccine have an option to receive MenABCWY (Penbraya, Pfizer) when both MenACWY and MenB vaccines are due at the same visit, as long as doses of Penbraya are spread out by at least 6 months. The patient has already received one dose of PCV20, in accordance with pneumococcal vaccination recommendations for immunocompromised adults younger than age 50, so no further doses are needed. Based on the patient’s age, only one dose of Hib vaccine is recommended, so no further doses are needed. The patient should receive influenza vaccine annually.

Any of these vaccines can be given at the same appointment.

Last reviewed: November 15, 2024

Preterm infants should be vaccinated at the same chronological age and according to the same schedule as full-term infants, regardless of birth weight, with the exception of the birth dose of hepatitis B vaccine. Infants weighing less than 2 kg (4.4 lb) whose mothers’ HBsAg status is either positive or unknown should receive HBIG (hepatitis B immune globulin) and hepatitis B vaccine within 12 hours of birth. This dose of hepatitis B vaccine should not be counted as a valid first dose in the series, and it should be repeated at age 1 month. If the preterm infant’s mother’s HBsAg status is negative, the infant’s first dose of hepatitis B vaccine should be withheld until the infant is chronologically 1 month of age or is ready to be discharged from the hospital, whichever occurs first. For more information, see the Vaccination of Preterm Infants subsection of the Special Situations section of CDC’s “General Best Practices for Immunization”, available at www.cdc.gov/vaccines/hcp/imz-best-practices/special-situations.html#cdc_report_pub_study_section_4-vaccination-of-preterm-infants.

Last reviewed: January 27, 2025

This question has arisen more frequently since the introduction of the RSV preventive antibody, nirsevimab (Beyfortus, Sanofi), which has an injection volume of 1 mL for infants younger than 8 months who weigh 5 kg or more at the time of immunization. High risk children entering their second RSV season require a Beyfortus dose volume of 2 mL. Beyfortus is often administered at a routine visit when other infant immunizations are due.

There is no specific guidance to not exceed 1 mL in one muscle. In fact, there is no clear standard of practice and reference texts vary in guidance. Facilities or health systems may have medication policies/procedures that outline guidance for their staff. Professional judgement is needed when administering intramuscular medications or immunizations to people, including children, because muscle size varies from person to person.

CDC experts suggest a range of volume, depending upon the muscle injected. For the deltoid, the typical volume injected is 0.5 mL (maximum: 2 mL). For the vastus lateralis (the thigh): the typical volume that may be injected is 1–4 mL (maximum: 5 mL). Infants and toddlers fall at the lower end of these ranges, whereas adolescents and adults generally fall on the higher end of the range.

If more than 1 mL of volume needs to be injected into the thigh, that can be done while staying well within the acceptable range. Use of combination vaccines, when indicated and available, can decrease injection volume.

Last reviewed: January 20, 2025

This page was updated on .

Our Affiliated Sites

For the Public: VaccineInformation.org
For Coalitions: ImmunizationCoalitions.org
65+ Flu Defense
Protect vulnerable, older adult patients from influenza.
Give2MenACWY.org
Improve protection from meningococcal serogroups ACWY.
Mass Vaccination Resources
Access guidance documents, toolkits, and helpful resources.
NAIIS
Home of the National Adult and Influenza Immunization Summit.