THE RECOMMENDED IMMUNIZATION SCHEDULE FOR ADULTS
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Immunization does not end in childhood; to maintain optimal immunity, certain vaccines are given as booster doses in adults. Some vaccines are also required for special populations, or those with certain medical conditions.
This article is focused on the recommended vaccines for adults in general, including which illnesses and diseases are prevented by each vaccine. This immunization schedule is applicable to adults (19 years of age and above). For adults with certain risk factors or certain medical conditions, additional vaccines may be required, while other types of vaccines may need more doses than recommended for the adult population.
Diphtheria, tetanus & pertussis (Tdap or Td)
The combination vaccine containing diphtheria, tetanus and pertussis has two forms. The first one, called DTaP, is usually given during the childhood immunization schedule and contains the full-strength dose of each vaccine. This is given to children less than 7 years old.
Booster doses are needed for adults and children 7 years old and above. The Tdap vaccine contains all three vaccines but does not have full-strength doses of diphtheria and pertussis. This is because recipients of the Tdap vaccine need only a smaller dose to boost and maintain their immune response.
Diphtheria is a vaccine-preventable infection caused by Corynebacterium diphtheria. This bacteria produces toxins that can lead to fever, swollen lymph nodes, body weakness and a sore throat. If the disease progresses, heart failure and paralysis can develop.
Tetanus is another bacterial infection, due to Clostridium tetani. Also known as lockjaw, this infection causes fever, headache, difficulty swallowing, and muscle spasms or stiffness. Left untreated, it can lead to difficulty breathing, blood clot formation, tight vocal cords and even fractures (due to muscle stiffness). Some cases may end in death.
Pertussis is a bacterial infection caused by Bordetella pertussis. It is commonly referred to as “whooping cough”. Affected individuals may present with cough, colds, and difficulty breathing. In severe cases, patients may develop pneumonia.
The Tdap vaccine is usually given as one dose for children at 11 years old, followed by a booster dose every 10 years. If the primary vaccination series (DTaP) was not given, a revised schedule will be followed by the healthcare provider.
For pregnant individuals, one dose of the vaccine is given for each pregnancy at around 27-36 weeks age of gestation. For those who sustain clean and minor wounds, one dose of Td (tetanus-only vaccine) or Tdap is given if the last tetanus vaccine was given more than 10 years ago. For those with contaminated or major wounds, one dose of Tdap is given if the last tetanus vaccine was given more than 5 years ago.
Pneumococcal conjugate and polysaccharide
Streptococcus pneumoniae is a bacteria that can cause pneumonia, sepsis or meningitis, with severe cases leading to death.
The pneumococcal polysaccharide (PPSV23) vaccine is given to combat Streptococcus pneumoniae. It protects against 23 types of pneumococci. This is usually given as one dose in persons aged 65 years and older.
This vaccine may also be administered in certain situations. This includes those with chronic medical conditions, immunocompromised individuals, and those with a cerebrospinal fluid leak or a cochlear implant.
The pneumococcal conjugate (PCV13) vaccine protects against 13 types of pneumococci. This is usually given during childhood; however, certain cases may need a booster dose for those 65 years and older. This is decided on a case-to-case basis by involved healthcare providers.
Influenza is a respiratory infection due to the influenza virus. It may cause only mild symptoms, such as fever, colds, cough, and sore throat, but it can also develop into a serious illness by causing a secondary bacterial infection. This can lead to pneumonia, ear infections, or sinus infections. People with asthma, diabetes or congestive heart failure may experience worsening of their symptoms.
There are three types of influenza vaccine. The inactivated influenza vaccine (IIV), live attenuated influenza vaccine (LAIV4), or recombinant influenza vaccine (RIV4) may be given to adults once a year. The IIV and RIV4 may be given for all adults, regardless of age, while the LAIV4 may only be given to those aged 19 to 49 years old.
Some individuals may experience severe allergic reactions to this vaccine, even if they have no previous history of allergies to other vaccines or substances.
LAIV4 should not be given to pregnant women, those with a known history of severe allergic reaction to any vaccine component, those who are immunocompromised, close contacts of immunocompromised persons, and those who have previously developed Guillain-Barré syndrome 6 weeks after a previous influenza vaccine dose.
Measles, mumps, rubella
The measles, mumps, and rubella vaccine (MMR) is a combination vaccine, given as part of the recommended immunization schedule of children. In adults, one booster dose is given between 19-64 years old.
Measles is a viral infection presenting with fever, cough, rashes, and red eyes. In severe cases, pneumonia, or encephalitis (a brain infection) can develop.
Mumps is a viral infection causing fever, headache, muscle pains, and swollen salivary glands. This condition may progress to affect other organs, such as the ears, brain and spinal cord, causing inflammation and even deafness.
Rubella is a viral infection that causes fever, rashes, and swollen lymph nodes. This infection is dangerous to pregnant women, as it can pass on to unborn children during pregnancy. Congenital defects, miscarriages and premature delivery are possible consequences.
For pregnant women with no immunity to rubella, one dose of the MMR vaccine is given after delivery. For frequent travelers, students under postsecondary education and close contacts of immunocompromised persons, the vaccine is given in 2 doses, four weeks apart if they have no previous history of MMR vaccination. The MMR vaccine is contraindicated for those are severely immunocompromised.
Human papillomavirus (HPV) is a common sexually transmitted virus that may or may not resolve on its own. Genital warts are a common manifestation of this infection. If the infection is persistent, cancer may develop on affected areas, such as the cervix, vagina, vulva, penis, tongue, tonsils, and even the back of the throat.
The recommended number of doses is as follows, according to the CDC:
- 3 doses, for those whose first HPV vaccine was at 15 years of age or older
- 1 dose, for those whose first HPV vaccine was between 9-14 years old, with only one dose given or the second dose given less than 5 months from the first dose
- no doses needed, for those whose first HPV vaccine was between 9-14 years old, with the second dose given at least 5 months from the first dose
For immunocompromised individuals, 3 doses should be given.
Meningococcal disease is a serious bacterial infection due to Neisseria meningitis. Initial symptoms include fever, headache, a stiff neck, rashes, and sensitivity to light. The infection can progress rapidly and cause loss of a limb, inflammation of the coverings of the brain (meningitis), kidney problems, and even hearing loss.
The meningococcal B (MenB) vaccine targets the B serogroup of the infection. In adults, meningococcal B vaccine is recommended for ages 19-23 years old.
What about the COVID-19 vaccine?
As of writing, the COVID-19 vaccine has not been included in the 2021 CDC-recommended vaccination schedule. However, WHO-approved COVID-19 vaccines may be administered to adults. You may contact your local hospital or government facility to inquire about the availability and scheduling, and for other concerns related to the COVID-19 vaccine.
Vaccines are one of the most important scientific developments that has ensured the safety of people worldwide. A high rate of vaccination in a certain area will protect not only an individual, but the people surrounding them as well. Vaccines continue to protect us, from childhood to adulthood. Let us all protect each other by getting vaccinated.
- Recommended Adult Immunization Schedule for ages 19 years or older, United States, 2021. Centers for Disease Control and Prevention. Taken from: https://www.cdc.gov/vaccines/schedules/downloads/adult/adult-combined-schedule.pdf
- 2021 Recommended Vaccinations for Infants and Children (birth through 6 years) Parent-Friendly Version. Centers for Disease Control and Prevention. Taken from: https://www.cdc.gov/vaccines/schedules/easy-to-read/child-easyread.html
- About HPV. Centers for Disease Control and Prevention. Taken from: https://www.cdc.gov/hpv/parents/about-hpv.html
- Meningococcal ACWY Vaccines: What You Need to Know (VIS). American Academy of Pediatrics. Taken from: https://www.healthychildren.org/English/safety-prevention/immunizations/Pages/Meningococcal-Vaccines-What-You-Need-to-Know.aspx
- Meningococcal Disease. Department of Public Health, City and County of San Francisco. Taken from: https://www.sfcdcp.org/infectious-diseases-a-to-z/meningococcal-disease/
- The Difference Between the Tdap and DTaP Vaccines: What to Know for Adults and Kids. Taken from: https://www.healthline.com/health/adult-vaccines/tdap-vs-dtap-vaccines-difference
- Key Facts About Influenza (Flu). Centers for Disease Control and Prevention. Taken from: https://www.cdc.gov/flu/about/keyfacts.htm
- Shingles (Herpes Zoster) Vaccination. Centers for Disease Control and Prevention. Taken from: https://www.cdc.gov/vaccines/vpd/shingles/index.html
As we enter the new year, countries around the world are preparing to start mass vaccination in an effort to end the COVID-19 pandemic. Multiple vaccine candidates have been approved by different health authorities worldwide, and some countries have already started vaccinating their citizens.
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