Recommended adult immunization schedule: United States, 2013*.

Vaccines are recommended for adults on the basis of their age, prior vaccinations, health conditions, lifestyle, occupation, and travel. Current levels of vaccine uptake for adult vaccines are low (1). Providers should be aware of the importance of routinely assessing patients’ vaccination histories and recommending and providing routinely recommended vaccines. A strong recommendation from a vaccine provider is associated with increased uptake of vaccines (2, 3). Other interventions shown to increase vaccine uptake, such as implementation of reminder/recall systems and standing orders, have been summarized by the Community Guide (3). The Advisory Committee on Immunization Practices (ACIP) annually reviews and updates the Adult Immunization Schedule (Figures 1 and 2), which is designed to provide vaccine providers with a summary of existing ACIP recommendations regarding the routine use of vaccines for adults. The Adult Immunization Schedule also includes a table summarizing the primary contraindications and precautions for routinely recommended vaccines (Table). In October 2012, ACIP approved the Adult Immunization Schedule for 2013. This schedule also incorporates changes to vaccine recommendations voted on by ACIP at the 24–25 October 2012 meeting. The primary updates include adding information for the first time on the use of 13-valent pneumococcal conjugate vaccine (PCV13) and the timing of administration of PCV13 relative to the 23-valent pneumococcal polysaccharide vaccine (PPSV23) in adults (4). PCV13 is recommended for adults aged 19 years or older with immunocompromising conditions (including chronic renal failure and nephrotic syndrome), functional or anatomic asplenia, cerebrospinal fluid leaks, or cochlear implants. The schedule also clarifies which adults would need 1 or 2 doses of PPSV23 before the age of 65 years. Other changes to the PPSV23 footnote include adding information regarding recommendations for vaccination when vaccination status is unknown. For tetanus, diphtheria, and acellular pertussis (Tdap) vaccine, recommendations have been expanded to include routine vaccination of adults aged 65 years or older and for pregnant women to receive Tdap vaccine with each pregnancy. The ideal timing of Tdap vaccination during pregnancy is during 27 to 36 weeks’ gestation. This recommendation was made to increase the likelihood of optimal protection for the pregnant woman and her infant during the first few months of the infant’s life when the child is too young for vaccination but at highest risk for severe illness and death from pertussis (5, 6). Manufacturers of the live attenuated influenza vaccine (LAIV) have obtained approval from the U.S. Food and Drug Administration for a quadrivalent influenza vaccine that contains 1 influenza A (H3N2), 1 influenza A (H1N1), and 2 influenza B vaccine virus strains, one from each lineage of circulating influenza B viruses. In approximately half of the recent influenza seasons, the trivalent influenza vaccine has included an influenza B vaccine virus from a lineage different from that of the predominant circulating influenza B strains (7). Inclusion of both lineages of influenza B virus is intended to increase the likelihood that the vaccine provides cross-reactive antibody against a higher proportion of circulating influenza B viruses. For the LAIV, beginning with the 2013–14 season, it is expected that only the quadrivalent formulation will be available and manufacture of the trivalent formulation will cease. It is possible that quadrivalent inactivated influenza vaccine formulations may be available for the 2013–14 season as well. Because a mix of quadrivalent and trivalent influenza vaccines may be available in 2013–14, the abbreviation for inactivated influenza vaccine has been changed from TIV (trivalent inactivated influenza vaccine) to IIV (inactivated influenza vaccine). The abbreviation for live-attenuated influenza vaccine (LAIV) remains unchanged. Minor wording changes, clarifications, or simplifications were made to footnotes for measles, mumps, rubella vaccine (MMR), human papillomavirus vaccine (HPV), zoster vaccine, and hepatitis A and hepatitis B vaccines. A correction was made to Figure 1 for MMR vaccine: The bar that indicated the vaccine might be used in certain situations for persons born before 1957 has been removed. Persons born before 1957 are considered immune and routine vaccination is not recommended. Considerations for the possible use of MMR vaccine in outbreak situations are included in the 2011 MMWR Recommendations and Reports publication on vaccination of health care personnel (8). In addition, a correction was made to Figure 2 for PPSV23: This vaccine is indicated for men who have sex with men if they have another risk factor (such as age or