Vaccines for Adults

Vaccines are most often discussed in the context of childhood, where they’re given according to a recommended schedule to prevent common (and not-so-common) childhood illnesses. Frequent and routine “well child” visits to the doctor help ensure children are kept up-to-date on their vaccines.

With fewer doctor visits as we age, however, the percentage of the population up-to-date on recommended vaccines wanes. Data from the U.S. Centers for Disease Control and Prevention show that only about half of all teenagers have received the recommended meningococcal vaccine, which protects against bacterial infections that may lead to amputation of infected limbs and death. Similarly, only about half of adolescents received the recommended influenza vaccine during the 2010-2011 flu season. By adulthood, many of us have forgotten that vaccines are available – and important – for everyone, not just kids.

Apart from protecting themselves, adults should consider the benefits of vaccination to the family and community. In most cases, a person vaccinated against a disease cannot spread that disease to other people. High rates of vaccination help protect those around us who cannot be immunized for health reasons (such as illness, age, or allergy). This principle is known as , or community immunity.

Following are vaccines typically recommended for adults. Note that younger adults may have received vaccines that were more recently developed, such as those against chickenpox or hepatitis A, as children. If so, they may not need to receive the vaccines again.

If you think you may need to receive one or more of these vaccines, consult your doctor.

Pneumococcal Vaccine

Pneumococcal disease includes various illnesses caused by the bacterium Streptococcus pneumoniae. Different types of pneumococcal disease include pneumococcal bacteremia, meningitis, and pneumonia.

The pneumococcal vaccine is recommended for adults based on various risk factors. It is recommended for the following groups:

• Anyone who is 65 or older
• Anyone between 19 and 65 years of age with asthma, or who is a smoker
• Anyone between the ages of 2 and 65 with one of the following long-term health problems: heart disease, lung disease, sickle cell disease, diabetes, alcoholism, cirrhosis, leaks of cerebrospinal fluid, or cochlear implant
• Anyone between the ages of 2 and 65 with a condition that lowers resistance to infection, including lymphoma, leukemia, HIV or AIDS, kidney failure, a damaged or missing spleen, or organ transplant
• Anyone between the ages of 2 and 65 receiving a treatment that lowers resistance to infection, including radiation therapy, some cancer drugs, or long-term steroids
• Anyone living in a nursing home or long-term care facility

Human papillomavirus (HPV) Vaccine

HPV vaccines protect against multiple strains of HPV that cause cervical, vaginal, and vulvar cancer. One of the two HPV vaccines also provides protection against genital warts.

HPV vaccination is recommended for children in the routine childhood immunization schedule, but is also recommended for adults who were not vaccinated as children.

• Women who are 26 years old or younger can receive either version of the HPV vaccine for protection against cervical, vaginal, and vulvar cancer. The vaccine may also protect against oral and anal cancer, and the quadrivalent version of the vaccine protects against genital warts.
• Men who are 26 years old or younger can receive the quadrivalent vaccine, which offers protection against genital warts and may protect against oral, anal, and penile cancer caused by HPV.

Influenza Vaccine

Seasonal influenza vaccination is recommended annually for all adults; in fact, it is recommended for everyone over 6 months. The vaccine protects against respiratory illness caused by influenza viruses. Because new strains of influenza appear frequently, the seasonal flu vaccine usually changes each year. Each season’s vaccine is designed to protect against three strains of influenza. Influenza vaccine is available as an injected or inhaled vaccine, but for adults 50 years of age and older, only the injectable vaccine is recommended.

Tetanus/Diphtheria and Tetanus/Diphtheria/Pertussis Booster Vaccines

A combination vaccine against tetanus, diphtheria, and pertussis (whooping cough) is given in childhood in a series of shots called DTaP. After that, everyone needs a booster shot for tetanus and diphtheria every 10 years, given in a vaccine called Td. One of those boosters should be replaced with a shot of the Tdap vaccine (which provides protection against tetanus, diphtheria, and pertussis). A Tdap booster is particularly recommended for health care workers and anyone who has contact with an infant. (This is because infants are too young to receive their own vaccination against whooping cough, which can be fatal in young children. Therefore, it is important that anyone in contact with the child be protected against whooping cough, so as not to expose the child to the disease.) Pregnant women are recommended to take the Tdap vaccine during the last trimester of each pregnancy, to protect the baby via maternal antibody until age 2 months. At two months of age, the baby can receive DTaP.

Separate from routine boosters given every 10 years, Td is also given to individuals who have suffered injuries or wounds that may have exposed them to tetanus bacteria. Tdap can also be used in this instance, to provide protection against pertussis.

Hepatitis A Vaccine

Hepatitis A vaccines were added to the routine childhood immunization schedule in 2006, but are also recommended for adults at an increased risk for hepatitis A. This includes the following groups:

• Anyone traveling to developing countries
• Men who have sex with men
• Anyone who uses illegal drugs
• Anyone who works with non-human primates infected with hepatitis A, or who works with hepatitis A in a research setting
• Anyone with chronic liver disease
• Anyone with clotting factor disorders

Separately, hepatitis A vaccination may be considered for food handlers because of their potential to transmit the virus to others.

Hepatitis B Vaccine

Hepatitis B vaccines were added to the routine childhood immunization schedule in 1991, but are also recommended for adults who are at an increased risk for hepatitis B. This includes the following groups:

• Anyone living with or having sex with a hepatitis B-infected person
• Anyone having sex with multiple partners
• Anyone seeking treatment for sexually transmitted diseases, HIV testing (or treatment), or drug treatment
• Men who have sex with men
• Anyone who uses illegal drugs
• Anyone with a job that involves direct contact with human blood
• Anyone who works in facilities for the developmentally disabled
• Anyone who receives hemodialysis or has end-stage kidney disease
• Anyone who has HIV
• Anyone who receives dialysis
• Anyone with chronic liver disease
• Anyone who is a prisoner in a correctional facility
• Anyone traveling to a country where the virus is common

Measles, Mumps, and Rubella (MMR) Vaccine

Any adult born in the United States before 1957 is considered immune to both measles and mumps, because the diseases were so widespread in the pre-vaccine era.

Individuals born after 1957 may need to receive booster shots or be revaccinated with MMR if they are members of one of the following groups:

• Anyone who is a college student
• Anyone who is a health care worker
• Anyone traveling internationally (particularly to countries with high rates of measles, mumps or rubella – a travel clinic can provide additional information)
• Anyone who received the killed measles vaccine, or a measles vaccine of unknown type, from 1963 to 1967. (The immunity provided by the killed vaccine was inadequate, and individuals immunized with this vaccine may not be protected against measles. Your doctor can provide more information.)
• Women of childbearing age who want to become pregnant and have no evidence of immunity against rubella

Chickenpox (Varicella) Vaccine

The chickenpox vaccine was added to the recommended childhood immunization schedule in 1996, but is also recommended for adults with no evidence of chickenpox immunity.

Anyone born in the United States before 1980 is considered immune to chickenpox. (Note: health care workers and pregnant women born before 1980 are not considered immune to determine whether the vaccine should be administered. Health care workers should receive the vaccine; pregnant women should receive the first dose of the vaccine after their pregnancies.)

Anyone born in 1980 or later should receive the varicella vaccine, unless they can provide documentation of having received two doses of the vaccine at least one month apart, or of having had a case of chickenpox or herpes zoster diagnosed by a doctor and/or confirmed by a laboratory.

Shingles (zoster) Vaccine

The shingles vaccine is licensed by the Food and Drug Administration for individuals 50 years of age or older. The vaccine is recommended for anyone 60 years of age or older, even if they have reported a previous case of shingles.

Meningococcal Vaccine

Meningococcal disease includes a variety of illnesses caused by the bacterium, Neisseria meningitidis. Different types of meningococcal disease include meningococcal meningitis and meningococcemia (blood infection). 

The meningococcal vaccine is recommended for adults based on a variety of risk factors. It is recommended for the following groups:

• Anyone who is a member of the military
• Anyone with a damaged or removed spleen
•  Anyone doing research that exposes him/her to Neisseria meningitidis 
•  Anyone traveling to a country where meningococcal disease is common
• Anyone with terminal complement deficiency
• Anyone starting college who has not received a dose of the vaccine during the past five years

Travel Vaccines

In addition to the vaccines listed above, some of which are recommended if you are traveling to an area with many cases of the diseases they prevent, other vaccines may be recommended if you are traveling internationally.

In addition, some vaccines may be required before you are allowed to enter a particular country or region. For example, if you are traveling to certain countries in tropical South America or sub-Saharan Africa, international health regulations require you to be vaccinated against yellow fever. (These requirements made national news in 2011, when the World Cup was held in South Africa. South Africa requires proof of yellow fever vaccination before issuing travel visas, and fans in Uganda, where there was a shortage of the vaccine, .)

Vaccines that may be recommended before traveling internationally, particularly to developing countries, include those against typhoid, rabies, and Japanese encephalitis. More information can be found on the Centers for Disease Control and Prevention’s , where you can  or  that specializes in travel health. In addition to vaccines, travel medicine centers can advise on important issues, such as the prevention of malaria, and the prevention and potential treatment of travel related illnesses, such as diarrhea.

Sources 

• Centers for Disease Control and Prevention. . December 27, 1996. Accessed 01/17/2018.
• CDC. . Updated 01/11/2017. Accessed 01/17/2018.
• CDC. . Updated 03/01/2017. Accessed 01/17/2018.
• CDC. . Updated 05/19/2017. Accessed 01/17/2018.
• Centers for Disease Control and Prevention.  Updated 12/06/2017. Accessed 04/05/2017.
• Immunization Action Coalition. . IAC website. 2012. (152 KB). Accessed 04/05/2017.