Adult immunization schedule by age - Recommendations for ages 19 years or older, United States, 2025
Administer recommended vaccines if vaccination history is incomplete or unknown. Do not restart or add doses to vaccine series if there are extended intervals between doses. The use of trade names is for identification purposes only and does not imply endorsement by the ACIP or CDC.
NOTES
For vaccine recommendations for persons 18 years of age or younger, refer to the Recommended Child and Adolescent Immunization Schedule.
- For calculating intervals between doses, 4 weeks = 28 days. Intervals of ≥4 months are determined by calendar months.
- Within a number range (eg, 12-18), a dash (–) should be read as "through."
- Vaccine doses administered ≤4 days before the minimum age or interval are considered valid. Doses of any vaccine administered ≥5 days earlier than the minimum age or minimum interval should not be counted as valid and should be repeated. The repeat dose should be spaced after the invalid dose by the recommended minimum interval. For further details, refer to Table 3-2, Recommended and minimum ages and intervals between vaccine doses, in Timing and Spacing of Immunobiologics.
- Information on travel vaccination requirements and recommendations is available at cdc.gov/travel/.
- For vaccination of persons with immunodeficiencies, refer to Table 8-1, Vaccination of persons with primary and secondary immunodeficiencies, in Altered Immunocompetence.
- For information about vaccination in the setting of a vaccine-preventable disease outbreak, contact your state or local health department.
- The National Vaccine Injury Compensation Program (VICP) is a no-fault alternative to the traditional legal system for resolving vaccine injury claims. All vaccines included in the adult immunization schedule except PPSV23, RSV, RZV, mpox, and COVID-19 vaccines are covered by the National Vaccine Injury Compensation Program (VICP). Mpox and COVID-19 vaccines are covered by the Countermeasures Injury Compensation Program (CICP). For more information, refer to www.hrsa.gov/vaccinecompensation or www.hrsa.gov/cicp.
- Routine vaccination:
- Age 19-64 years.
- Unvaccinated:
- 1 dose 2024-25 Moderna or Pfizer-BioNTech.
- 2 doses 2024-25 Novavax at 0, 3-8 weeks.
- Previously vaccinated before 2024-25 vaccine with:
- 1 or more doses Moderna or Pfizer-BioNTech: 1 dose 2024-25 Moderna or Novavax or Pfizer-BioNTech at least 8 weeks after the most recent dose.
- 1 dose Novavax: 1 dose 2024-25 Novavax 3-8 weeks after most recent dose. If more than 8 weeks after the most recent dose, administer 1 dose 2024-25 Moderna or Novavax or Pfizer-BioNTech.
- 2 or more doses Novavax: 1 dose 2024-25 Moderna or Novavax or Pfizer-BioNTech at least 8 weeks after the most recent dose.
- 1 or more doses Janssen: 1 dose 2024-25 Moderna or Novavax or Pfizer-BioNTech.
- Age 65 years and older.
- Unvaccinated: Follow recommendations above for unvaccinated persons ages 19-64 years and administer dose 2 of 2024-25 Moderna or Novavax or Pfizer-BioNTech 6 months later (minimum interval 2 months).
- Previously vaccinated before 2024-25 vaccine: Follow recommendations above for previously vaccinated persons ages 19-64 years and administer dose 2 of 2024-25 Moderna or Novavax or Pfizer-BioNTech 6 months later (minimum interval 2 months).
- Special situations:
- Persons who are moderately or severely immunocompromised. Use vaccine from the same manufacturer for all doses in the initial vaccination series.
- Unvaccinated:
- 4 doses (3-dose initial series 2024-25 Moderna at 0, 4 weeks, and at least 4 weeks after dose 2, followed by 1 dose 2024-25 Moderna or Novavax or Pfizer-BioNTech 6 months later [minimum interval 2 months]). May administer additional doses.††
- 4 doses (3-dose initial series 2024-25 Pfizer-BioNTech at 0, 3 weeks, and at least 4 weeks after dose 2, followed by 1 dose 2024-25 Moderna or Novavax or Pfizer-BioNTech 6 months later [minimum interval 2 months]). May administer additional doses.††
- 3 doses (2-dose initial series 2024-25 Novavax at 0, 3 weeks, followed by 1 dose Moderna or Novavax or Pfizer-BioNTech 6 months later [minimum interval 2 months]). May administer additional doses.††
- Incomplete initial vaccination series before 2024-25 vaccine:
- Previous vaccination with Moderna
- 1 dose Moderna: Complete initial series with 2 doses 2024-25 Moderna at least 4 weeks apart (administer dose 1 4 weeks after most recent dose), followed by 1 dose 2024-25 Moderna or Novavax or Pfizer-BioNTech 6 months later (minimum interval 2 months). May administer additional doses.††
- 2 doses Moderna: Complete initial series with 1 dose 2024-25 Moderna at least 4 weeks after most recent dose, followed by 1 dose 2024-25 Moderna or Novavax or Pfizer-BioNTech 6 months later (minimum interval 2 months). May administer additional doses.††
- Previous vaccination with Pfizer-BioNTech
- 1 dose Pfizer-BioNTech: Complete initial series with 2 doses 2024-25 Pfizer-BioNTech at least 4 weeks apart (administer dose 1 3 weeks after most recent dose), followed by 1 dose 2024-25 Moderna or Novavax or Pfizer-BioNTech 6 months later (minimum interval 2 months). May administer additional doses.††
- 2 doses Pfizer-BioNTech: Complete initial series with 1 dose 2024-25 Pfizer-BioNTech at least 4 weeks after most recent dose, followed by 1 dose 2024-25 Moderna or Novavax or Pfizer-BioNTech 6 months later (minimum interval 2 months). May administer additional doses.††
- Previous vaccination with Novavax
- 1 dose Novavax: Complete initial series with 1 dose 2024-25 Novavax at least 3 weeks after most recent dose, followed by 1 dose 2024-25 Moderna or Novavax or Pfizer-BioNTech 6 months later (minimum interval 2 months). May administer additional doses.††
- Completed the initial vaccination series before 2024-25 vaccine with:
- 3 or more doses Moderna or 3 or more doses Pfizer-BioNTech: 2 doses 2024-25 Moderna or Novavax or Pfizer-BioNTech 6 months apart (minimum interval 2 months). Administer dose 1 at least 8 weeks after the most recent dose. May administer additional doses.††
- 2 or more doses Novavax: 2 doses 2024-25 Moderna or Novavax or Pfizer-BioNTech 6 months apart (minimum interval 2 months). Administer dose 1 at least 8 weeks after the most recent dose. May administer additional doses.††
- †† Additional doses of 2024-25 COVID-19 vaccine for moderately or severely immunocompromised:
- Contraindications and precautions:
- For contraindications and precautions to COVID-19 vaccination, refer to COVID-19 Appendix.
- Routine vaccination:
- Age 19 years or older: 1 dose any influenza vaccine appropriate for age and health status annually.
- Solid organ transplant recipients aged 19 through 64 years receiving immunosuppressive medications: HD-IIV3 and aIIV3 are acceptable options. No preference over other age-appropriate IIV3 or RIV3.
- Age 65 years or older: Any one of HD-IIV3, RIV3, or aIIV3 is preferred. If none of these three vaccines are available, then any other age-appropriate influenza vaccine should be used.
- For the 2024-25 season, refer to www.cdc.gov/mmwr/volumes/73/rr/rr7305a1.htm.
- For the 2025-26 season, refer to the 2025-26 ACIP influenza vaccine recommendations.
- Special situations:
- Close contacts (eg, caregivers, health care workers) of severely immunosuppressed persons who require a protected environment: Should not receive LAIV3. If LAIV3 is given, they should avoid contact with/caring for such immunosuppressed persons for 7 days after vaccination.
- NOTE: Persons with an egg allergy can receive any influenza vaccine (egg-based and non-egg-based) appropriate for age and health status.
- Contraindications and precautions:
- Routine vaccination:
- Pregnant persons of any age.
- Pregnant at 32 weeks 0 days through 36 weeks and 6 days gestation from September through January in most of the continental United States (NOTE: Providers in jurisdictions with RSV seasonality that differs from most of the continental United States [eg, Alaska, jurisdiction with tropical climate] should follow guidance from public health authorities on timing of administration. Refer to the 2025 Child and Adolescent Immunization Schedule for considerations regarding nirsevimab administration to infants): 1 dose Abrysvo. Administer RSV vaccine regardless of previous RSV infection.
- Either maternal RSV vaccination with Abrysvo or infant immunization with nirsevimab (RSV monoclonal antibody) is recommended to prevent severe respiratory syncytial virus disease in infants.
- All other pregnant persons: RSV vaccine not recommended.
- Subsequent pregnancies: Additional doses not recommended. No data are available to inform whether additional doses are needed in subsequent pregnancies. Infants born to pregnant persons who received RSV vaccine during a previous pregnancy should receive nirsevimab.
- Age 75 years or older.
- Unvaccinated: 1 dose (Arexvy or Abrysvo or mResvia). Additional doses not recommended.
- Previously vaccinated: Additional doses not recommended. No data are available to inform whether additional doses are needed.
- Special situations:
- Age 60-74 years.
- Unvaccinated and at increased risk of severe RSV disease***: 1 dose (Arexvy or Abrysvo or mResvia). Additional doses not recommended.
- Previously vaccinated: Additional doses not recommended. No data are available to inform whether additional doses are needed.
- Persons 60 years and older can get RSV vaccine at any time but best to administer in late summer and early fall before RSV spreads in communities—ideally August through October in most of continental United States. For further guidance, refer to www.cdc.gov/mmwr/volumes/73/wr/mm7332e1.htm.
- *** People can self-attest to the presence of a risk factor. The following medical and other conditions increase the risk of severe RSV disease:
- Chronic cardiovascular disease (eg, heart failure, coronary artery disease, congenital heart disease). Excludes isolated hypertension.
- Chronic lung or respiratory disease (eg, chronic obstructive pulmonary disease, emphysema, asthma, interstitial lung disease, cystic fibrosis).
- End-stage renal disease, dependence on hemodialysis, or other renal replacement therapy.
- Diabetes mellitus complicated by chronic kidney disease, neuropathy, retinopathy, or other end-organ damage.
- Diabetes mellitus requiring treatment with insulin or sodium-glucose cotransporter 2 (SGLT2) inhibitor.
- Neurologic or neuromuscular conditions causing impaired airway clearance or respiratory muscle weakness (eg, post-stroke dysphagia, amyotrophic lateral sclerosis, muscular dystrophy). Excludes history of stroke without impaired airway clearance.
- Chronic liver disease (eg, cirrhosis).
- Chronic hematologic conditions (eg, sickle cell disease, thalassemia).
- Severe obesity (body mass index ≥40 kg/m2).
- Moderate or severe immune compromise.
- Residence in a nursing home.
- Other chronic medical conditions or risk factors that a health care provider determines would increase the risk of severe disease due to viral respiratory infection (eg, frailty, concern for presence of undiagnosed chronic medical conditions, residence in a remote or rural community where escalation of medical care is challenging).
- Contraindications and precautions:
- For contraindications and precautions to RSV vaccine, refer to RSV Appendix.
Reproduced from: Advisory Committee on Immunization Practices. Adult Immunization Schedule by Age, Recommendations for Ages 19 Years or Older, United States, 2025. Centers for Disease Control and Prevention. Available at:
https://www.cdc.gov/vaccines/hcp/imz-schedules/adult-age.html (Accessed on December 10, 2024).