Table 1: Recommendations for Immunizations in Adults

1 Adapted from Gershon AA, Gardner P, Peter G, et al. Quality Standards for immunization. Clin Infect Dis. 1997;25:782-6. Copyrighted 1997, University of Chicago.
2 For all adults lacking immunity.
3 Adults born in or before 1956 are considered naturally immune; adults born after 1956 should receive one dose of MMR vaccine and some adults, such as college students, persons working in health care facilities, and international travelers, may need two doses.
4 For all adults > 65 years of age and for persons with chronic illnesses (all adults > 50 years as per updated recommendations for influenza).
5 Includes other persons at high risk such as those with chronic cardiopulmonary disease, chronic metabolic diseases (including diabetes mellitus), chronic renal dysfunction, hemoglobinopathies, and immunosuppression, as well as residents of long-term care facilities, providers of home health care or health care to high-risk persons, and other individuals who wish to avoid influenza.
6 Includes younger individuals with high-risk conditions such as cardiopulmonary disease, diabetes, alcoholism, chronic liver disease, chronic renal failure, or CSF leaks or immunocompromise due to conditions such as splenic dysfunction or asplenia, Hodgkin's disease, lymphoma, multiple myeloma, nephrotic syndrome, and organ transplantation; revaccination should be considered for persons at highest risk who received the 14-valent vaccine or the 23-valent vaccine > 6 years previously.
7 For all adults in high-risk groups.
8 Includes those who are exposed to blood and blood products during their work (eg, health care workers), clients and staff of institutions for the developmentally disabled, hemodialysis patients, sexually active homosexual or bisexual males, injection drug users, recipients of certain blood products such as factor VIII or IX concentrates, household and sexual contacts of hepatitis B virus (HBV) carriers, sexually active heterosexual individuals with multiple partners or a recent episode of a sexually transmitted disease, inmates of long-term correctional facilities, individuals from high-risk populations (eg, Pacific Islanders, Alaskan natives, and first generation immigrants and/or refugees from countries where HBV infection is of high or intermediate endemicity), and international travelers planning prolonged visits to areas with high rates of hepatitis B.
9 Includes susceptible persons who may be at increased risk of exposure or who have close contact with persons at high risk for serious complications from varicella infection including health care workers, susceptible family contacts of immunocompromised individuals, teachers of young children, day care workers, residents and staff in institutional settings, college students, inmates and staff of correctional institutions, military personnel, nonpregnant women of childbearing age, and international travelers.
10 Includes persons traveling to or working in countries with high rates of hepatitis A virus (HAV) infections, persons who live in communities with high rates of HAV infections (eg, Native Americans, Alaskan natives, and Pacific Islanders), homosexual and bisexual males, injection drug users, persons with chronic liver disease, and food handlers (optional.)

Table 1:
Recommendations for Immunizations in Adults
Vaccine	Recommendations
MMR^2,3	Two doses for persons born after 1956 who are at high risk of exposure; one dose for persons born after 1956 who are at low risk of exposure.
Tetanus/diphtheria²	Primary series consisting of first dose, second dose after 1 month, and third dose 6-12 months later, followed by a booster every 10 years or once at the age of 50 years.
Influenza^4,⁵	Annual vaccination
Pneumococcal⁴^,⁶	One vaccination, with possible revaccination after > 6 years
Hepatitis B⁷^,⁸	First dose, followed by second dose 1-2 months later; third dose 5 months later.
Varicella⁷^,⁹	First dose, followed by second dose 1-2 months later.
Hepatitis A⁷^,¹⁰	First dose, followed by second dose 6-12 months later.
1 Adapted from Gershon AA, Gardner P, Peter G, et al. Quality Standards for immunization. Clin Infect Dis. 1997;25:782-6. Copyrighted 1997, University of Chicago. 2 For all adults lacking immunity. 3 Adults born in or before 1956 are considered naturally immune; adults born after 1956 should receive one dose of MMR vaccine and some adults, such as college students, persons working in health care facilities, and international travelers, may need two doses. 4 For all adults > 65 years of age and for persons with chronic illnesses (all adults > 50 years as per updated recommendations for influenza). 5 Includes other persons at high risk such as those with chronic cardiopulmonary disease, chronic metabolic diseases (including diabetes mellitus), chronic renal dysfunction, hemoglobinopathies, and immunosuppression, as well as residents of long-term care facilities, providers of home health care or health care to high-risk persons, and other individuals who wish to avoid influenza. 6 Includes younger individuals with high-risk conditions such as cardiopulmonary disease, diabetes, alcoholism, chronic liver disease, chronic renal failure, or CSF leaks or immunocompromise due to conditions such as splenic dysfunction or asplenia, Hodgkin's disease, lymphoma, multiple myeloma, nephrotic syndrome, and organ transplantation; revaccination should be considered for persons at highest risk who received the 14-valent vaccine or the 23-valent vaccine > 6 years previously. 7 For all adults in high-risk groups. 8 Includes those who are exposed to blood and blood products during their work (eg, health care workers), clients and staff of institutions for the developmentally disabled, hemodialysis patients, sexually active homosexual or bisexual males, injection drug users, recipients of certain blood products such as factor VIII or IX concentrates, household and sexual contacts of hepatitis B virus (HBV) carriers, sexually active heterosexual individuals with multiple partners or a recent episode of a sexually transmitted disease, inmates of long-term correctional facilities, individuals from high-risk populations (eg, Pacific Islanders, Alaskan natives, and first generation immigrants and/or refugees from countries where HBV infection is of high or intermediate endemicity), and international travelers planning prolonged visits to areas with high rates of hepatitis B. 9 Includes susceptible persons who may be at increased risk of exposure or who have close contact with persons at high risk for serious complications from varicella infection including health care workers, susceptible family contacts of immunocompromised individuals, teachers of young children, day care workers, residents and staff in institutional settings, college students, inmates and staff of correctional institutions, military personnel, nonpregnant women of childbearing age, and international travelers. 10 Includes persons traveling to or working in countries with high rates of hepatitis A virus (HAV) infections, persons who live in communities with high rates of HAV infections (eg, Native Americans, Alaskan natives, and Pacific Islanders), homosexual and bisexual males, injection drug users, persons with chronic liver disease, and food handlers (optional.)