1. Influenza Vaccine

The influenza vaccine protects against up to two strains of influenza A and influenza B in both trivalent and quadrivalent formulations. The following groups should receive the influenza vaccine each year:

● All adults ≥50 years

● Adults with chronic pulmonary and cardiovascular disorders including asthma (but excluding hypertension), and renal, hepatic, neurologic, hematologic, or metabolic disorders including diabetes

● Adults who are immunosuppressed from medication or HIV

● Residents of nursing homes and other long-term care facilities; adults with morbid obesity (BMI ≥40)

● Household contacts and caregivers of children under 5 years and adults ≥50 years, especially those with clinical conditions placing them at risk for severe complications from influenza.

2. Pneumococcal Vaccine

PCV13 protects against 13 of the 90 types of pneumococcal bacteria; these types cause infection in about half of the affected adults. PPSV23 protects against 23 types of pneumococcal bacteria.

● Adults aged ≥65 years: Older adults who have not previously received PCV13 should receive PCV13 first, followed 6 to 12 months later by PPSV23. Those who have already received one or more doses of PPSV23 should receive PCV13 at least 1 year after the most recent dose of PPSV23. The recommendations for routine PCV13 use among adults aged ≥65 years will be re-evaluated in 2018.

● Adults aged 19 to 64 years: This age group should also be vaccinated as above if they have the following conditions: HIV infection, long-term immunosuppressive therapy, chronic renal failure, nephrotic syndrome, functional or anatomic asplenia, cochlear implants, sickle cell disease or other hemoglobinopathies, congenital or acquired immunodeficiencies, generalized malignancy, Hodgkin disease, leukemia, multiple myeloma, solid organ transplant, or cerebrospinal fluid leaks.

3. Zoster Vaccine

The approved herpes zoster vaccine is a live attenuated vaccine. Efficacy against herpes zoster is 70% in people aged 50 to 59 years, falling to 38% in those aged 70 or more years. Efficacy against postherpetic neuralgia after age 60 years is 66%. 

HZ/su vaccine, a new recombinant subunit vaccine containing varicella-zoster virus glycoprotein E in an AS01B adjuvant system, is currently being investigated. It has an efficacy of 97% across all age groups, but significant local site injection reactions and myalgias have been reported.

● All adults aged ≥60 years, regardless of whether they have already had either chicken pox or shingles, should be vaccinated.

● Contraindications: The vaccine should not be given to adults with a history of a primary or acquired immunodeficiency state, including leukemia, lymphoma, or other malignant neoplasm affecting the bone marrow or lymphatic system, or with HIV/AIDS or to those receiving immunosuppressive therapy, including high-dose corticosteroids.

4. Tetanus/diphtheria (Td) and Tetanus/diphtheria/pertussis (Tdap)  Vaccine

● All adults aged ≥19 years, including those aged ≥65 years: All adults aged ≥19 years who have not been vaccinated with Tdap should receive a single dose of Tdap regardless of the time interval since last receiving Td. After receiving Tdap, they should receive Td boosters at 10-year intervals. For adults aged ≥65 years, this will reduce the likelihood of transmission to infants aged <12 months.

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