Recommendations
Additional Information for Adolescent and Adult Vaccines
Additional information and special considerations about vaccines recommended for anyone 11 years of age and older

• You may have already received all recommended doses of a certain vaccine; in this case, you may not need additional doses.
• You may recently have had a booster dose of a certain vaccine.
• If you have had the disease already, you don’t need the vaccine. This applies to the following diseases:
  • measles
  • mumps
  • rubella (German measles)
  • chickenpox
  • hepatitis A
  • hepatitis B

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Many teens and pre-teens still get sick with vaccine-preventable diseases such as chickenpox and measles. Although these are thought of as "childhood" diseases, anyone who is not vaccinated or immune can be infected by these diseases. Some of these diseases, like hepatitis B, can have serious consequences. If you are age 11-12 years old or a teenager and you have not had a recent visit with your doctor to discuss vaccination or your overall health, see your doctor or healthcare professional to talk about your

• health status
• possible risk factors for vaccine-preventable disease
• recommended immunizations (could include chickenpox, measles, mumps, rubella or German measles, tetanus, diphtheria, polio, or flu)
• complete vaccination for hepatitis B (series of 3 doses)
• possible vaccination for hepatitis A (series of 2 doses) and meningitis

Some schools and colleges require specific immunizations for admission, and this can be especially important for older adolescents.

For more information about vaccinations for adolescents, see Vaccines for Teens and College Students and review the recommended Childhood and Adolescent Immunization Schedule. You can also check the Catch-up Schedule for information about missed vaccinations, including vaccines to prevent diphtheria, tetanus, polio, measles, mumps, rubella, hepatitis B virus infection, and chickenpox.

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• You need influenza vaccine if you will be pregnant during the flu season. In the United States, flu season generally lasts from December through March; sometimes the season lasts until April. One shot given in the fall is recommended, and you can be vaccinated at any time during your pregnancy. If you have an allergy to eggs, discuss your allergy with your doctor and ask for advice about getting a flu shot.

• Check with your doctor to find out if you need hepatitis B vaccine. You may need it because of your age or for lifestyle reasons. You should also be screened for hepatitis B virus infection. If your test is positive, your baby should receive hepatitis B vaccine and hepatitis B immune globulin at birth.

• You should not receive measles, mumps, rubella (MMR) and chickenpox vaccines. If you need these shots, wait until after delivery to get them. MMR is recommended for individuals born in 1957 or later and chickenpox for individuals born in the U. S. in 1966 or later. Both MMR and chickenpox vaccines are recommended for college students, healthcare workers, and international travelers unless they have written proof of immunization or proof of immunity.

For more information about MMR, flu, and chickenpox vaccines and who should get them, see Vaccines for Adults.

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• Possible exposures. Hepatitis B vaccine is recommended if, through your work, you are exposed to blood or bodily fluids.

• Work with young children. If you work with or care for young children, it is especially important that you remain immune to vaccine-preventable childhood diseases yourself so that you can't infect children who might not be fully vaccinated. These diseases include chickenpox, measles, mumps, rubella (German measles), and flu.

• Work with the elderly. If you work with the elderly or with those who require chronic care or treatments that suppress the immune system, it is important that you are fully protected against vaccine-preventable diseases so that you do not infect those in your care or your co-workers. These diseases include measles, chickenpox, and flu.

• Work in a school. If you work in a school setting, you are encouraged to consider a yearly flu vaccination and to make sure all vaccinations are up to date. You might be exposed to vaccine-preventable diseases carried by unvaccinated children, or you might be a carrier who infects unvaccinated children and spreads disease to them and their close contacts.

• Work in an institution. If you work in a hospital, or in a prison, jail, or corrective institution, many of the patients, inmates, or residents may not be fully vaccinated or may be at high risk for certain vaccine-preventable diseases. Make sure you are up to date with vaccines so that you are fully protected from vaccine-preventable diseases and so that you do not act as a carrier for these diseases, which include measles, mumps, rubella, chickenpox, and flu.

• Work in a clinic or healthcare setting. If you work in clinic or healthcare professional's office, you may interact with clients or patients who are particularly susceptible to disease or at high risk for complications from some diseases. To protect yourself, the people you care for, and your colleagues, make sure that you have all the vaccines you need, including annual influenza vaccination. When you are properly vaccinated, you protect yourself from sickness and you avoid acting as a carrier for diseases.

For more information about chickenpox, measles, mumps, rubella, flu, and hepatitis B vaccines and who should get them, see Vaccines for Adults.

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• You need hepatitis A vaccine (2 shots) if you are traveling to areas where hepatitis A is widespread. Some international travel is considered low risk. If you are traveling to Canada, western Europe, Japan, Australia, or New Zealand, you are at no greater risk for hepatitis A virus infection than in the U.S.

• You need one dose of meningococcal vaccine if you are traveling to a country where meningitis is widespread. See Meningococcal Disease for more information.

• You need 2 doses of measles, mumps, rubella (MMR) vaccine unless you have already had 2 doses of vaccine, your blood tests show that you are immune to all three diseases, or you were born before 1957.

• You need 2 doses of chickenpox vaccine if you have never had chickenpox nor received the chickenpox vaccine.

• If you are pregnant, you should not receive MMR or chickenpox vaccines. If you need these vaccines, wait until after you deliver your baby.

• Depending on the country or countries you are visiting, you may need additional vaccinations. You can find immunization recommendations for specific countries on the CDC Traveler’s Health web site. Talk with your doctor about any other shots you may need.

For more information about vaccines for hepatitis A, meningitis, measles-mumps-rubella (MMR), or chickenpox (varicella) and who should get them, see the vaccine information statements for these vaccines.

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People with HIV have special needs for the protection vaccines offer, but some vaccines may not be appropriate for them. If HIV is a health concern for you or someone you know, discuss any need for the vaccines listed here with a doctor or healthcare professional.

• Chickenpox (varicella)
  You should check with your doctor or healthcare professional to find out if you need chickenpox vaccine. This vaccine is not give if your immune system is severely weakened or if you are pregnant.

• Flu (influenza)
  This vaccine is recommended once a year, in the fall. For more information, see the Influenza Vaccine Information Statement (VIS) Flu VIS for screen-reader devices

• Hib (Haemophilus Influenzae type B)
  Most adolescents and adults do not need Hib vaccine. However, people with HIV may need this vaccine. Ask your doctor or healthcare professional about your need for this vaccine.

• Pneumonia (pneumococcal)
  Two doses are recommended. One initial dose of pneumococcal vaccine is recommended, and a second dose follows after an interval of at least 5 years. For more information, see the Pneumococcal Vaccine Information Statement (VIS) or the Pneumococcal VIS for screen-reader devices .

• Measles, Mumps, Rubella (MMR)
  You should check with your doctor to find out if you need MMR vaccine. This vaccine is not given if the immune system is severely weakened or if you are pregnant. For more information, see the MMR Vaccine Information Statement (VIS) or MMR VIS for screen-reader devices

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Chickenpox vaccine is recommended for anyone born in the U.S. in 1980 or later who has never had chickenpox or has not been vaccinated against chickenpox. The vaccine is recommended for

• Anyone 11 to 18 years old
• Adults born in the U.S. in 1980 or later
• Healthcare workers born in the U.S. before 1980 who do not have evidence of immunity (i.e., documentation of vaccination, history of disease, laboratory evidence of immunity, laboratory confirmation of disease, or history of herpes zoster based on healthcare provider diagnosis) should consider vaccination against chickenpox.

The vaccine should not be given to

• Anyone who is pregnant. If you are pregnant, you should not receive chickenpox vaccine. Wait until after delivery of your baby to get this vaccine.

• Individuals with severely weakened immune systems.

Chickenpox can be a serious illness for people more than 14 years old.

For more information about this topic, see the Chickenpox Vaccine Information Statement (VIS) or Chickenpox VIS for screen-reader devices

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Many adults need flu vaccine once a year and should get the vaccine in the fall. Flu vaccine protects against flu (influenza) and serious complications of the flu, such as pneumonia. Groups for whom the vaccine is especially recommended include

• Persons aged 50 years and older

• Women who will be pregnant during the flu season

• Any person with a long-term health condition, including heart, lung, or kidney disease, asthma, diabetes, anemia or other blood disorders, HIV/AIDS, and persons undergoing therapies that suppress the immune system

• Healthcare workers (doctor, nurse, clinic attendant, EM personnel, etc.)

• Residents of long-term care facilities

• People who can spread influenza to those at high risk such as household contacts and out-of-home caretakers of children 0 through 4 years of age or anyone who is in close contact with people at risk for serious complications from influenza

• People with certain muscle or nerve disorders, such as seizure disorder, severe cerebral palsy, or spinal cord trauma, which can cause breathing or swallowing problems

• People 6 months to 18 years of age on long-term aspirin treatment (these people could develop Reye Syndrome if they got the flu)

Flu vaccine should be considered for the following:

• Students or other persons in institutional settings (e.g., those who reside in dormitories)

• Travelers at risk for complications of influenza who go to areas where influenza activity exists or who travel in organized tour groups

Caution: If you have an allergy to eggs, discuss your allergy with your doctor and ask for advice about getting a flu shot.

For more information about this vaccine and who should get it, see the Flu Vaccine Information Statement (VIS) or (Flu VIS for screen-reader devices.   You can also visit the CDC Flu website.

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• You live in a community where there have been high rates of hepatitis A AND you are 18 years old or younger.

• You live, work in, or travel to a region where hepatitis A occurs at high rates

• You have certain chronic medical conditions, such as chronic liver disease

• Your lifestyle exposes you to hepatitis A virus. Review details about hepatitis A risk factors in the Hepatitis A Vaccine Information Statement (VIS)

Hepatitis A vaccine protects against hepatitis A virus infection, which causes jaundice, diarrhea, and flu-like illness that can be severe. For full protection, you need two doses of the vaccine given at least 6 months apart.

For more information about hepatitis A vaccine, who should get the vaccine, and who should not be vaccinated, see the Hepatitis A Vaccine Information Statement (VIS) or Hepatitis A VIS for screen-reader devices . You can also visit the CDC-NCID Viral Hepatitis web site for more information about hepatitis A virus and areas with high rates of hepatitis A virus infection.

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• If you are 11 to 18 years old, you need hepatitis B vaccine unless you have already been vaccinated. Usually you need three shots to complete the series; check with your doctor or healthcare professional for details.

• You need hepatitis B vaccine if, through your work, you are at risk of exposure to blood or blood-contaminated body fluids.

• You need hepatitis B vaccine if you are exposed to the hepatitis B virus because of a medical condition, your country of origin, or lifestyle factors. See more information about conditions that make you high-risk for hepatitis B in the Hepatitis B Vaccine Information Statement (VIS)

• The hepatitis B vaccine is also recommended for any adult who wants to be protected against hepatitis B virus infection.

• This vaccine protects against hepatitis B virus infection, which can cause liver disease and liver cancer.

For more information about hepatitis B vaccine, who should get the vaccine, and who should not be vaccinated, see the Hepatitis B Vaccine Information Statement (VIS) or Hepatitis B VIS for screen-reader devices . You can also visit the CDC-NCID Viral Hepatitis web site for more information about hepatitis B virus infection.

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Most adolescents and adults do not need Hib vaccine, but you may need Hib vaccine if you have any of these medical conditions:

• sickle cell anemia
• leukemia
• HIV/AIDS
• removed or dysfunctional spleen
• bone marrow transplant
• cancer treatment with drugs

Hib vaccine may not be recommended for you if you

• have experienced a severe allergic reaction to a previous dose of Hib vaccine

• are moderately or severely sick when the vaccination is scheduled

For more information about Hib vaccine, who should get the vaccine, and who should not be vaccinated, see the Hib Vaccine Information Statement (VIS) or the Hib VIS for screen reader devices .

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Human papillomavirus (HPV) is a very common, sexually transmitted virus that includes many different viral types, some of which can cause infections that lead to cervical cancer. Other types are a major cause of genital warts. The vaccine is licensed for females 9-26 years of age. It is recommended to give the shot before the start of sexual activity, but women who are sexually active should still be vaccinated. The vaccine is given as 3 injections over a 6 month period. The vaccine will not provide protection against all types of HPV viruses that cause cervical cancer, therefore, patients should be counseled to continue routine screening for cervical cancer.

• Routine vaccination is recommended for adolescents 11-12 years of age.
  
• HPV vaccine is also recommended for females 13-26 years of age who previously have not received the vaccine.
• Vaccination can be given as early as age 9 at the discretion of the doctor.
  

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Meningococcal vaccine protects against bacterial meningitis (infection of the brain and spinal cord coverings) and blood disease. Meningococcal vaccine is recommended for the following:

• Those with a missing or non-functional spleen. You need meningococcal vaccine if your spleen has been removed or doesn�t function. One dose of meningococcal vaccine is usually recommended, although an additional dose may be needed if you continue to be at high risk. Check with your doctor or healthcare professional.

• Children 11-12 years of age.

• Teens entering high school (~ 15 years old).

• College freshman. If you are a college freshman AND live in a dormitory, you should receive this vaccine.

• International travelers. If you travel to or live in countries where meningitis is widespread, you should receive this vaccine. See Meningococcal Disease for more information.

• Laboratory workers or microbiologists. If you work in a research, clinical, or industrial laboratory and are routinely exposed to meningococcal bacteria, you should receive this vaccine.

• Military recruits.

• Those with terminal complement component deficiency, an immune system disorder. Talk with your doctor or healthcare professional to find out about your need for meningococcal vaccine. The vaccine is given for certain diseases of the immune system.

For more information about meningococcal vaccine, who should get the vaccine, and who should not get the vaccine, see the Meningococcal Vaccine Information Statement (VIS) or the Meningococcal VIS for screen-reader devices.

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You need MMR vaccine if you were born in 1957 or later and you have never had measles, mumps, or rubella (German measles) or if you have never received a dose of MMR vaccine.

MMR is recommended for

• Anyone 11 to 18 years old.

• Students in college or a post-high school educational institution.

• Healthcare workers born in 1957 or later. Proof of immunity (i.e., documentation of vaccination, history of disease, laboratory evidence of immunity, or laboratory confirmation of disease) is desirable for healthcare workers born before 1957. To provide protection against mumps, healthcare workers born before 1957 should consider receiving 1 dose of MMR in non-outbreak settings and 2 doses during a mumps outbreak.

• International travelers.

• Women of childbearing age who are not pregnant. This includes women of childbearing age born before 1957, unless they have proof of immunity to or vaccination against rubella. Immunity to rubella is especially important for women who plan to become pregnant because the rubella virus, which causes German measles, can cause birth defects.

You should not receive the vaccine if you

• have had a severe allergic reaction to gelatin, the antibiotic neomycin, or a previous dose of MMR vaccine

• are pregnant

Talk with your doctor or healthcare professional about the need for the vaccine if you

• have HIV/AIDS or any disease affecting the immune system
• are being treated with drugs that affect the immune system
• have cancer or are receiving cancer treatment with drugs or x-rays
• have a blood disorder or have recently received any blood products

For more information about MMR vaccine, who should get the vaccine, and who should not get the vaccine, see the MMR Vaccine Information Statement (VIS) or MMR VIS for screen reader devices)

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Pneumococcal vaccine protects against infections of the lungs, the blood, and the brain, any of which can be serious or even life-threatening.

You may need pneumococcal vaccine if you

• Are 65 or older.

• Reside in a nursing home and have not been previously vaccinated with pneumococcal vaccine.

• Are 2 years old or older and have long-term health conditions other than asthma. These conditions include heart, lung, liver, kidney, or sickle cell disease, diabetes, alcoholism, leaks of cerebrospinal fluid, cancer, HIV/AIDS, a weaken immune system, or a removed or damaged spleen.

• Are a member of a community with high rates of pneumococcal infection. Certain Native American (i.e., Alaska Native, Navajo, and Apache) populations are at increased risk for invasive pneumococcal disease. Pneumococcal vaccine is recommended for these groups.

  Usually a single dose of the vaccine is enough for protection. Some persons need a second dose, which follows 5 years after the first dose.

For more information about the vaccine and who should get the vaccine, see the Pneumococcal Vaccine Information Statement Pneumococcal VIS for screen-reader devices .

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Td vaccine protects against tetanus (lockjaw), a disease that causes severe muscle spasms and can kill, and diphtheria, a severe infection of the nose, throat, or airway, involving the mucus membrane in those parts of the body and causing formation of a thick, painful membrane that can block the airways.

• You need an initial series of 3 shots to be fully vaccinated with Td vaccine.

• After the initial series of 3 shots, a booster dose of Td is recommended every 10 years to help prevent tetanus and diphtheria infections.

• A one-time booster dose of tetanus, diphtheria, and pertussis (Tdap) vaccine is generally recommended to replace a single dose of tetanus and diphtheria (Td) vaccine for booster immunization against tetanus, diphtheria, and pertussis. Later booster doses should be given using Td.

For more information about tetanus and diphtheria vaccine, see the Tetanus and Diphtheria (Td) Vaccine Information Statement (VIS) or Td VIS for screen-reader devices .

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Tdap vaccine protects against tetanus (lockjaw), a disease that causes severe muscle spasms and can kill; diphtheria, a severe infection of the nose, throat, or airway, involving the mucus membrane and causing formation of a thick, painful membrane that can block the airways; and pertussis (whooping cough) which causes coughing spells that can make it hard to eat, drink, or breathe and can lead to pneumonia, seizures, brain damage, and death, especially in infants.

• A one-time booster dose of tetanus, diphtheria, and pertussis (Tdap) vaccine is generally recommended to replace a single dose of tetanus and diphtheria (Td) vaccine for booster immunization against tetanus, diphtheria, and pertussis. Later booster doses should be given using Td.

• A dose of Tdap is recommended for adolescents who received DTaP or DTP as children but have not received a dose of Td. The preferred age is 11-12.

• Adolescents who have already received a booster dose of Td are encouraged to get a dose of Tdap as well, for protection against pertussis. Waiting at least 5 years between Td and Tdap is encouraged, but not required.
  


• Adolescents who did not get all their scheduled doses of DTaP or DTP as children should complete the series using a combination of Td and Tdap.

• Adults, 19-64 years of age, who received their last dose of Td 10 or more years ago should receive a single dose of Tdap to replace a single dose of Td for booster immunization against tetanus, diphtheria, and pertussis.
  
  Tdap for adults may be given at an interval as short as 2 years since the last Td dose if protection against pertussis is needed.



• Pregnant women who have not received Tdap should be vaccinated with Tdap after delivery if it has been 2 or more years since the last Td. A shorter interval may be used if protection against pertussis is needed.
  


• Tdap may be substituted for tetanus and diphtheria (Td) vaccine during pregnancy if protection against pertussis is needed.
  


• Close contacts of infants less than 12 months of age and healthcare workers having direct patient contact should receive a one time Tdap booster which may be given at an interval as short as 2 years since their last dose of Td.

For more information about tetanus, diphtheria, and pertussis vaccine, see the Tetanus, Diphtheria, and Pertussis (Tdap) Vaccine Information Statement or Tdap VIS for screen-reader devices.

Shingles is a painful skin rash, often with blisters. The rash usually appears on one side of the face or body and lasts from 2 to 4 weeks. Its main symptom is pain, which can be quite severe. For about 1 person in 5 with shingles, severe pain can continue even after the rash clears up.

Shingles is caused by the same virus that causes chickenpox. The virus can stay in the body for many years in an inactive state. It can reappear later in life and cause a case of shingles. Shingles is seen more frequently in people who are older or who have weakened immune systems.

• A single dose of Zoster vaccine is recommended for adults 60 years of age and older, including those who have already had shingles.
  
• In clinical trials, the vaccine prevented shingles in about half of those 60 and older and reduced the pain associated with shingles.
  
• Those who should not receive this vaccine include:
  • Individuals with a weaken immune system caused by:
    • HIV/AIDS or another disease that affects the immune system.
    • Treatment with drugs that affect the immune system, such as steroids.
    • Cancer treatment such as radiation or chemotherapy.
    • A history of cancer affecting the bone marrow or lymphatic system, such as leukemia or lymphoma.
  • Someone with active, untreated tuberculosis.

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This page last modified on February 28, 2007