| Vaccine Recommendations |
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| Note:
Recommendations for specific vaccines are included in the Ask the Expert set for that vaccine.
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| Where can I
find the most current vaccine recommendations? |
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| Vaccine recommendations in the U.S. are issued primarily by two national bodies—the Centers for
Disease Control and Prevention (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, go to
www.cdc.gov/vaccines/hcp/acip-recs/index.html
for statements in alphabetical order or www.immunize.org/acip
for statements in chronological order. AAP vaccine recommendations are published in the AAP Red Book and are generally available on the AAP website at
www.aappublications.org.
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| Timely clinical considerations for vaccines of special interest may be accessed directly on the CDC website: |
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| What organizations endorse the ACIP recommended immunization schedules? |
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| 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).
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| 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). |
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| How do I obtain copies of the newest U.S. recommended immunization schedules for children and for adults? |
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| You can download electronic versions of the current child and adolescent immunization schedule and the adult immunization schedule
from CDC's website at www.cdc.gov/vaccines/schedules/hcp/index.html.
Every spring, following publication of updated CDC immunization schedules, Immunize.org offers for sale durable, laminated versions of the schedules,
which make an excellent resource for a year of clinic use. The laminated schedules may be found at https://shop.immunize.org.
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| What resources does Immunize.org have to help parents and child caretakers evaluate the immunization needs of children and adolescents? |
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| There are some printable patient handouts 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, Age 11–19 Years". These handouts can be found at www.immunize.org/handouts/.
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| What resources are available to help adult patients evaluate their individual immunization needs? |
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| Immunize.org has developed several screening questionnaires for patient use. These include:
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Vaccinations for Adults—You're never too old to get immunized! |
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Vaccinations Needed During Pregnancy |
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Vaccinations for Adults with Diabetes |
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Vaccinations for Adults with Heart Disease |
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Vaccinations for Adults with Lung Disease |
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Vaccinations for Adults with HIV Infection |
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Vaccinations for Adults with Chronic Liver Disease or Infection |
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Vaccinations for Adults Without a Spleen |
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Vaccinations for Men Who Have Sex with Men |
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Should You Be Vaccinated Against Hepatitis B? A screening questionnaire for adults, and |
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Should You Be Vaccinated for Hepatitis A? A screening questionnaire for adults. |
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| These patient handouts can be found at www.immunize.org/handouts/. |
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In addition, CDC offers an online interactive tool for adults to assess their personal vaccination needs at www2.cdc.gov/nip/adultImmSched/.
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| Why do ACIP recommendations not always agree with package inserts? |
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| 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. |
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| Can vaccinations be given without a physician's order? |
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| 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/standing-orders. If you have questions about the use of standing orders in your state, contact your state health department or immunization program. |
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| Is it standard practice to revaccinate a child who is adopted from another country? |
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| 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 ACIP General Best Practice Guidelines for on Immunization, available at
www.cdc.gov/vaccines/hcp/acip-recs/general-recs/special-situations.html. |
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| CDC has published vaccination guidance specifically for children who received COVID-19 vaccination outside the U.S. It is available at
www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us-appendix.html#appendix-b.
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| What vaccinations are recommended for new immigrants to the United States? |
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| Since December 14, 2009, CDC has used the following vaccination criteria to determine what is required for U.S. immigration: |
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| The vaccine must be age-appropriate* for the immigrant applicant, AND: |
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(1) The vaccine must protect against a disease that has the potential to cause an outbreak, |
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OR |
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(2) The vaccine must protect against a disease that has been eliminated or is in the process of being eliminated in the United States |
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| *ACIP recommends vaccines for a certain age range in the general U.S. public. These ACIP recommendations will be used to decide which vaccines are age-appropriate for the general immigrant population. |
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| Current
immigration law requires that immigrants have
proof of vaccination against mumps, measles,
rubella, tetanus, diphtheria, pertussis,
meningococcal
disease, pneumococcal disease, Haemophilus
influenzae type B, rotavirus, varicella,
influenza, hepatitis A, hepatitis B, polio, and COVID-19. Human papillomavirus
(HPV) and zoster vaccines are not required for
immigrants. Additional information is
available on the CDC website at
www.cdc.gov/immigrantrefugeehealth/laws-regs/vaccination-immigration/revised-vaccination-criteria-immigration.html. |
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| U.S. Citizenship and Immigration Services announced COVID-19 vaccination requirements for immigration medical examinations on September 14, 2021:
www.uscis.gov/newsroom/alerts/covid-19-vaccination-required-for-immigration-medical-examinations.
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| Children adopted from outside the U.S. and new immigrants are recommended to receive age-appropriate vaccination, with catch-up vaccination as appropriate, per the guidance in CDC’s General Best Practice Guidelines for Immunization.
Additional information may be found at www.cdc.gov/vaccines/hcp/acip-recs/general-recs/special-situations.html.
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| Current clinical considerations for vaccines of special interest may be accessed directly on the CDC website: |
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| Which vaccines
are recommended for healthcare personnel (HCP)? |
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| ACIP recommends that people working in healthcare settings be vaccinated against COVID-19, influenza, hepatitis B, measles, mumps,
rubella, varicella, and pertussis. 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 with a possibility of exposure to meningococcal bacteria should be vaccinated against all
vaccine-preventable meningococcal serotypes (A, C, W, Y, and B). In certain cases, some laboratory personnel should also receive polio, rabies, and typhoid vaccines.
For more information, see www.cdc.gov/mmwr/pdf/rr/rr6007.pdf.
Note that this comprehensive ACIP recommendation was published in 2011 and pre-dates COVID-19 and updated rabies recommendations.
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| Where can I
get the most up-to-date information on
vaccination recommendations for people who
travel outside the U.S.? |
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| 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.
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| COVID-19 vaccination guidance for international travel to and from the United States may be found at:
www.cdc.gov/coronavirus/2019-ncov/travelers/international-travel-during-covid19.html. |
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| What vaccines
should I administer to an infant who will be
traveling internationally? |
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| Infants who will travel outside the United States should be up to date for all routinely recommended vaccines, including age-appropriate COVID-19 vaccination. 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/.
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| COVID-19 vaccination guidance for international travel to and from the United States may be found at:
www.cdc.gov/coronavirus/2019-ncov/travelers/international-travel-during-covid19.html.
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| Where can I
find information about the special vaccine
needs of patients with immunodeficiencies
caused by a medical condition or
treatment,
including stem cell transplants? |
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| 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 current recommended immunization schedules, available at
www.cdc.gov/vaccines/schedules/index.html,
provide specific guidance for routine vaccination of immunocompromised individuals.
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| CDC’s General Best Practice Guidelines for Immunization outline vaccine recommendations for people with various types of altered immunocompetence here:
www.cdc.gov/vaccines/hcp/acip-recs/general-recs/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.
Additional information is available in the 2013 Infectious Diseases Society of America (IDSA) expert guideline on vaccination of the immunocompromised host,
which informed CDC’s recommendations: www.idsociety.org/practice-guideline/vaccination-of-the-immunocompromised-host/.
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| CDC also provides detailed clinical guidance for certain vaccines of special interest for people with various types of altered immunocompetence: |
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| What vaccines
are indicated for someone who does not have a
functioning spleen? |
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| People who do not have a functioning spleen or who have had a splenectomy (i.e., those with functional or anatomic asplenia)
are at increased risk for infection with encapsulated bacteria, especially Pneumococcus, Neisseria meningitidis, and Haemophilus influenzae type b (Hib). Refer to table 2 (asplenia column) in the current CDC
recommended immunization schedules for adults and table 3 in the schedule for children to review the specific schedules of pneumococcal, meningococcal,
and Hib vaccinations recommended for children or adults with asplenia. Links to the current schedules are available here:
www.cdc.gov/vaccines/schedules/index.html. |
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| Do any of the
bacterial vaccines that are recommended for
people with functional or anatomic asplenia need to be given before splenectomy? Do the
doses count if they are given during the 2
weeks prior to surgery? |
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| Ideally, pneumococcal vaccination, both types of meningococcal (MenACWY and MenB) vaccination,
and Hib vaccination should all be completed at least 2 weeks before a scheduled splenectomy, if time permits. When preparing a patient for splenectomy,
follow the CDC recommended schedule for a patient who is already asplenic, as published in table 2 of the CDC recommended immunization schedule for adults and table
3 of the childhood schedule. Links to both schedules are available here: www.cdc.gov/vaccines/schedules/index.html. |
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Vaccine doses administered less than 2 weeks before surgery or after surgery are valid; however, administration at least two weeks before surgery ensures the patient is protected from the moment the spleen is removed. If vaccinations cannot be completed, administer as many as feasible at least 2 weeks prior to surgery. Postponing splenectomy to complete vaccination is not recommended. |
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| Because the most likely vaccine-preventable threat to the patient is from pneumococcal sepsis, CDC subject matter experts consider pneumococcal vaccination the highest priority before splenectomy. Pneumococcal vaccination of adults may be completed most rapidly by administration of a single dose of 20-valent pneumococcal conjugate vaccine (PCV20). See the recommended schedules for children and adults for detailed recommendations based upon the patient’s past history of pneumococcal vaccination and for vaccination options involving PCV15 and PPSV23 products.
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Splenectomy patients require a two-dose primary series of MenACWY, given at least 8 weeks apart. Menveo and MenQuadfi brands of MenACWY may be administered at the same visit with (or any time before or after) PCV. The Menactra brand of MenACWY may interfere with the immune response to PCV, therefore, if using Menactra, delay the first dose until 4 weeks after completion of PCV vaccination. |
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The MenB primary vaccination series requires 2–3 doses, depending upon the brand. |
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| My 36-year-old patient was diagnosed with idiopathic thrombocytopenic purpura and had a splenectomy three weeks ago. Prior to the splenectomy, he had one dose each of Hib, MenB, PCV20, and MenACWY. What vaccines are recommended now? |
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| 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. |
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The series of MenB (whether a 3-dose Trumenba series or a 2-dose Bexsero series) 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. Brands of MenB are not interchangeable: the same MenB vaccine brand should be used for all doses in the series, including booster doses. |
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Because the patient received PCV20, no further pneumococcal vaccine 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. |
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| What are the
ACIP recommendations for vaccination of
preterm infants? |
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| 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. |
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If an infant age 6 weeks or older has been in the hospital since birth, CDC recommends deferring rotavirus vaccination until the time of discharge. This is done to avoid the theoretical risk of vaccine virus being transmitted to infants in the same unit who are acutely ill or to infants who are not age-eligible for vaccine. The rotavirus vaccine series should not be initiated for infants age 15 weeks, 0 days, or older. |
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For more information, see the Vaccination of Preterm Infants section of the ACIP General Best Practice Guidelines for Immunization, available at
www.cdc.gov/vaccines/hcp/acip-recs/general-recs/special-situations.html. |
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ACIP Recommendations
Vaccine Information Statements 
