Harvard Women's Health Watch

In brief: Experts issue immunization guidelines

In brief

Experts issue immunization guidelines

Immunization is not just for children and travelers — and it's not just about getting a flu shot. Adults are vulnerable to complications caused by many diseases vaccines can prevent. Women, in particular, benefit from vaccinations. They live longer than men, so they have a greater chance of being exposed to infectious disease in later life. They're also more likely to work in health care, education, and child care, where they're at risk for whooping cough (pertussis), hepatitis B, measles, mumps, rubella, and chickenpox (varicella), as well as influenza.

In October 2005, the Advisory Committee on Immunization Practices (ACIP), which makes recommendations to the Centers for Disease Control and Prevention, issued an updated schedule of adult immunizations (see below). It also voted to recommend routine vaccination of adults against whooping cough, which is on the rise in the United States. According to the schedule, adults ages 19–64 should be vaccinated with a newly formulated tetanus-diphtheria-pertussis (Tdap) vaccine. (Tdap replaces the tetanus-diphtheria, or Td, vaccine current in 2005.)

Recommended adult immunization schedule 2005–2006



Tetanus, diphtheria (Td)*

All adults. Booster every 10 years. Adults with uncertain vaccination histories should receive a primary series of 3 doses (first 2 doses at least 4 weeks apart and a third dose 6–12 months later).

Measles, mumps, rubella (MMR)

Adults born after 1956 who are uncertain of their immune status. Usually 1 dose; 2 doses for college students, health care workers, adults recently exposed to measles, and international travelers. MMR should not be given to pregnant women and women who might become pregnant within the next month.


Adults ages 19–49 who have not had chickenpox or have not been determined to have antibodies to varicella. Two doses 4–8 weeks apart. Age 50 and over, only necessary in those with medical, occupational, or lifestyle risk factors. Do not take if allergic to gelatin or neomycin. Should not be given to pregnant women, women who might become pregnant within the next month, or people infected with HIV.


Adults ages 50 and over; younger adults with chronic cardiovascular, pulmonary, kidney, liver, or immunosuppressive disease or diabetes; health care workers; and women who are pregnant during flu season. One dose annually. Should not be given to anyone who is allergic to chicken eggs. Healthy adults under age 50 (and not pregnant) may opt for intranasal vaccine (FluMist).

Pneumococcal (polysaccharide)

Adults ages 65 and over; younger adults with chronic cardiovascular, pulmonary, kidney, liver, or immunosuppressive disease or diabetes. Usually 1 dose. For at-risk adults, 1 dose followed by a second dose 5 years later.

Additional vaccinations for special risk groups

Hepatitis A

Adults with chronic liver disease or blood clotting disorders; health care workers; laboratory workers who work with hepatitis A; travelers to certain countries.** Two doses 6–12 months apart.

Hepatitis B

Adults who are on hemodialysis or who have blood clotting disorders; health care workers; travelers to certain countries.** Three doses (second dose 1–2 months after the first dose and a third dose 2–4 months later). Not recommended for people highly allergic to baker's yeast.


College freshmen living in dormitories; adults with no functioning spleen or with hereditary terminal complement component deficiency; military recruits; travelers to certain countries.** One dose; revaccinate after 5 years if risk of disease continues.

* After the 2005–2006 adult immunization schedule was released, the ACIP issued a recommendation that adults ages 19–64 receive the newly licensed tetanus-diphtheria-pertussis (Tdap) vaccine, rather than Td.

** Information about diseases related to travel is available at www.cdc.gov/travel/diseases.htm.

Source: Adapted from the Recommended Adult Immunization Schedule — United States, October 2005–September 2006, Centers for Disease Control and Prevention, available at www.cdc.gov/nip/recs/adult-schedule.htm.

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