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Adult immunizations

3 recommendations CDC / ACIP 2025 · AAFP 2026 · ACP 2026 Updated Sept. 25, 2026

Recommendations

CDC / ACIP2025

Influenza yearly. COVID-19: 2026-2027 vaccine for all adults (2 doses 6 months apart at 65+). One Tdap, then Td or Tdap every 10 years; Tdap each pregnancy. RZV 2 doses at 50+ (19+ if immunocompromised). Pneumococcal if PCV-naive at 50+, or 19 to 49 with risk conditions: PCV20 or PCV21, or PCV15 then PPSV23 1+ year later. Hepatitis B all 19 to 59; 60+ with risk factors or on request. RSV once at 75+, or 50 to 74 at increased risk. HPV through 26 (shared decision 27 to 45).

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AAFP2026

2026-2027 respiratory season, nonpregnant immunocompetent adults 19+: annual influenza vaccine and an updated COVID-19 vaccine for all. At 65+, prefer an enhanced influenza vaccine (high-dose, adjuvanted, recombinant, or mRNA) but do not delay to get one, and give two COVID-19 doses about 6 months apart. RSV: single dose at 75+ and at 50 to 74 with increased risk. All three can be given at the same visit.

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ACP2026Grade Rapid practice points

Adults who are not pregnant or immunocompromised (practice points issued for the 2025-2026 season): 65+ should get an updated mRNA COVID-19 vaccine; 18 to 64 at increased risk should get one; 18 to 64 not at increased risk may consider it. Influenza: standard-dose vaccine at 18 to 64, high-dose at 65+. RSV: protein subunit vaccine at 75+; 60 to 74 at increased risk may consider it. In August 2026 ACP stated support for the updated AAFP and ACOG adult schedules.

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Who this applies to

  • Influenza: everyone 6 months and older, every fall. Adults 65 and older should preferentially get a high-dose, adjuvanted or recombinant vaccine (ACIP 2022).
  • COVID-19: for 2026 to 2027 the CDC recommends a vaccine for all adults 18 and older, with 2 doses 6 months apart at 65 and older; the AAFP gives the same advice for adults 19 and older. Recommendations are revisited yearly, so confirm at the CDC schedule link each season.
  • RSV: a single dose for everyone 75 and older, and for 50 to 74 at increased risk (ACIP 2025, lowered from 60). In pregnancy, one dose at 32 to 36 weeks during RSV season, or nirsevimab for the infant.
  • Pneumococcal: all adults 50 and older (ACIP, October 2024): one dose of PCV20 or PCV21, or PCV15 followed by PPSV23 a year later. Adults 19 to 49 with risk conditions. Anyone who had only PPSV23 gets a conjugate vaccine a year later.
  • Zoster: Shingrix, 2 doses 2 to 6 months apart, from age 50, and from 19 if immunocompromised, even after prior shingles or Zostavax.
  • Tetanus and pertussis: one Tdap if never given, then Td or Tdap every 10 years; Tdap in every pregnancy at 27 to 36 weeks.
  • HPV: through age 26, with 2 doses if started before 15 and 3 otherwise; ages 27 to 45 by shared decision.
  • Hepatitis B: universal for ages 19 to 59 (ACIP 2022) and for 60 and older with risk factors or on request. MMR: 1 dose for adults without evidence of immunity, and 2 doses for health care personnel, college students, international travelers and people with HIV and adequate CD4 counts. Varicella: 2 doses for adults without evidence of immunity.

How it is done in practice

  • Give vaccines together at different sites; RSV, influenza and COVID-19 can be given at one visit.
  • Check the state immunization registry before assuming a gap, and record refusals so the question is asked again next year.
  • Immunocompromised adults: no live vaccines (MMR, varicella, live attenuated influenza), though adults with HIV and adequate CD4 counts should get MMR; pneumococcal, zoster and hepatitis B become indicated from age 19.

What changed recently

Recent changes: the pneumococcal age dropped from 65 to 50 (October 2024) and PCV21 was added; RSV expanded to ages 50 to 74 at increased risk (April 2025); and for 2026 to 2027 the CDC and AAFP recommend a COVID-19 vaccine for all adults, with 2 doses at 65 and older. The AAFP now publishes its own adult schedule, which the ACP supports. Recommendations have changed from season to season, so check this page against the CDC and AAFP schedules at the start of every season.

Points that matter in clinic

  • Warn about Shingrix side effects (sore arm, fatigue, fever for a day or two) so patients come back for dose 2.
  • A severe allergic reaction to a prior dose or a vaccine component is the one contraindication shared by all vaccines (live vaccines add pregnancy and severe immunocompromise); egg allergy no longer restricts influenza vaccine choice.
  • Adults who had childhood series in another country usually still need documentation; when in doubt, revaccinate rather than test titers for most antigens.

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