Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older — United States, 2022

Abstract

At its November 2021 meeting, the Advisory Committee on Immunization Practices* (ACIP) approved the Recommended Adult Immunization Schedule for Ages 19 Years or Older, United States, 2022. The 2022 adult immunization schedule summarizes ACIP recommendations, including several changes to the cover page, tables, and notes from the 2021 immunization schedule.† In addition, the 2022 adult immunization schedule provides an appendix that lists the contraindications to and precautions for all routinely recommended vaccines in the schedule. This schedule can be found on the CDC immunization schedule website (https://www.cdc.gov/vaccines/schedules). Health care providers are advised to use the cover page, tables, notes, and appendix together. This adult immunization schedule is recommended by ACIP (https://www.cdc.gov/vaccines/acip) and approved by CDC (https://www.cdc.gov), the American College of Physicians (https://www.acponline.org), the American Academy of Family Physicians (https://www.aafp.org), the American College of Obstetricians and Gynecologists (https://www.acog.org), the American College of Nurse-Midwives (https://www.midwife.org), the American Academy of Physician Associates (https://www.aapa.org), and the Society for Healthcare Epidemiology of America (https://www.shea-online.org).

Full text

Morbidity and Mortality Weekly Report
Weekly / Vol. 71 / No. 7 February 18, 2022
INSIDE
234 Advisory Committee on Immunization Practices
Recommended Immunization Schedule for Children
and Adolescents Aged 18 Years or Younger —
United States, 2022
238 Multistate Outbreak of SARS-CoV-2 B.1.1.529
(Omicron) Variant Infections Among Persons in a
Social Network Attending a Convention — New York
City, November 18–December 20, 2021
243 Investigation of SARS-CoV-2 Transmission
Associated With a Large Indoor Convention —
New York City, November–December 2021
249 Safety Monitoring of COVID-19 Vaccine Booster
Doses Among Adults — United States, September 22,
2021–February 6, 2022
255 Waning 2-Dose and 3-Dose Effectiveness of mRNA
Vaccines Against COVID-19–Associated Emergency
Department and Urgent Care Encounters and
Hospitalizations Among Adults During Periods of
Delta and Omicron Variant Predominance — VISION
Network, 10 States, August 2021–January 2022
264 Effectiveness of Maternal Vaccination with mRNA
COVID-19 Vaccine During Pregnancy Against
COVID-19–Associated Hospitalization in Infants Aged
<6 Months — 17 States, July 2021–January 2022
271 Hospitalizations of Children and Adolescents with
Laboratory-Confirmed COVID-19 — COVID-NET,
14 States, July 2021–January 2022
279 Notes from the Field: Outbreak of COVID-19 Among a
Highly Vaccinated Population Aboard a U.S. Navy
Ship After a Port Visit — Reykjavik, Iceland, July 2021
282 QuickStats
Continuing Education examination available at
https://www.cdc.gov/mmwr/mmwr_continuingEducation.html
U.S. Department of Health and Human Services
Centers for Disease Control and Prevention
Advisory Committee on Immunization Practices Recommended Immunization
Schedule for Adults Aged 19 Years or Older — United States, 2022
Neil Murthy, MD1; A. Patricia Wodi, MD1; Henry Bernstein, DO2; Veronica McNally, JD3; Sybil Cineas, MD4; Kevin Ault, MD5
At its November 2021 meeting, the Advisory Committee on
Immunization Practices* (ACIP) approved the Recommended
Adult Immunization Schedule for Ages 19 Years or Older,
United States, 2022. The 2022 adult immunization schedule
summarizes ACIP recommendations, including several changes
to the cover page, tables, and notes from the 2021 immuni-
zation schedule.† In addition, the 2022 adult immunization
schedule provides an appendix that lists the contraindications
to and precautions for all routinely recommended vaccines
in the schedule. This schedule can be found on the CDC
immunization schedule website (https://www.cdc.gov/vac-
cines/schedules). Health care providers are advised to use the
cover page, tables, notes, and appendix together. This adult
immunization schedule is recommended by ACIP (https://
www.cdc.gov/vaccines/acip) and approved by CDC (https://
www.cdc.gov), the American College of Physicians (https://
www.acponline.org), the American Academy of Family
Physicians (https://www.aafp.org), the American College of
Obstetricians and Gynecologists (https://www.acog.org), the
American College of Nurse-Midwives (https://www.midwife.
org), the American Academy of Physician Associates (https://
www.aapa.org), and the Society for Healthcare Epidemiology
of America (https://www.shea-online.org).
* Recommendations for routine use of vaccines in adults are developed by ACIP,
a federal advisory committee chartered to provide expert external advice and
guidance to the CDC director on use of vaccines and related agents for the
control of vaccine-preventable diseases in the civilian population of the United
States. Recommendations for routine use of vaccines in adults are harmonized
to the greatest extent possible with recommendations made by the American
Academy of Pediatrics, the American Academy of Family Physicians, and the
American College of Obstetricians and Gynecologists. ACIP recommendations
approved by the CDC director become agency guidelines on the date published
in the Morbidity and Mortality Weekly Report. Additional information about
ACIP is available at https://www.cdc.gov/vaccines/acip.
† Past immunization schedules are available at https://www.cdc.gov/vaccines/
schedules/past.html.

Morbidity and Mortality Weekly Report
230 MMWR / February 18, 2022 / Vol. 71 / No. 7 US Department of Health and Human Services/Centers for Disease Control and Prevention
The MMWR series of publications is published by the Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention (CDC),
U.S. Department of Health and Human Services, Atlanta, GA 30329-4027.
Suggested citation: [Author names; first three, then et al., if more than six.] [Report title]. MMWR Morb Mortal Wkly Rep 2022;71:[inclusive page numbers].
Centers for Disease Control and Prevention
Rochelle P. Walensky, MD, MPH, Director
Debra Houry, MD, MPH, Acting Principal Deputy Director
Daniel B. Jernigan, MD, MPH, Deputy Director for Public Health Science and Surveillance
Rebecca Bunnell, PhD, MEd, Director, Office of Science
Jennifer Layden, MD, PhD, Deputy Director, Office of Science
Leslie Dauphin, PhD, Director, Center for Surveillance, Epidemiology, and Laboratory Services
MMWR Editorial and Production Staff (Weekly)
Charlotte K. Kent, PhD, MPH, Editor in Chief
Jacqueline Gindler, MD, Editor
Paul Z. Siegel, MD, MPH, Associate Editor
Mary Dott, MD, MPH, Online Editor
Terisa F. Rutledge, Managing Editor
Teresa M. Hood, MS, Lead Technical Writer-Editor
Leigh Berdon, Glenn Damon, Soumya Dunworth, PhD,
Tiana Garrett-Cherry, PhD, MPH, Srila Sen, MA,
Stacy Simon, MA, Morgan Thompson,
Technical Writer-Editors
Martha F. Boyd, Lead Visual Information Specialist
Alexander J. Gottardy, Maureen A. Leahy,
Julia C. Martinroe, Stephen R. Spriggs, Tong Yang,
Visual Information Specialists
Quang M. Doan, MBA, Phyllis H. King,
Terraye M. Starr, Moua Yang,
Information Technolog y Specialists
MMWR Editorial Board
Timothy F. Jones, MD, Chairman
Matthew L. Boulton, MD, MPH
Carolyn Brooks, ScD, MA
Jay C. Butler, MD
Virginia A. Caine, MD
Jonathan E. Fielding, MD, MPH, MBA
David W. Fleming, MD
William E. Halperin, MD, DrPH, MPH
Jewel Mullen, MD, MPH, MPA
Jeff Niederdeppe, PhD
Celeste Philip, MD, MPH
Patricia Quinlisk, MD, MPH
Patrick L. Remington, MD, MPH
Carlos Roig, MS, MA
William Schaffner, MD
Nathaniel Smith, MD, MPH
Morgan Bobb Swanson, BS
Abbigail Tumpey, MPH
Ian Branam, MA,
Acting Lead Health Communication Specialist
Shelton Bartley, MPH, Leslie Hamlin,
Lowery Johnson, Amanda Ray,
Health Communication Specialists
Will Yang, MA,
Visual Information Specialist
ACIP’s recommendations for the use of each vaccine are
developed after in-depth reviews of vaccine-related data,
including the epidemiology and societal impacts of the vaccine-
preventable disease, vaccine efficacy and effectiveness, vaccine
safety, quality of evidence, feasibility of program implemen-
tation, and economic analyses of immunization policy (1).
The adult immunization schedule is published annually to
consolidate and summarize updates to ACIP recommendations
on vaccination of adults and to assist health care providers in
implementing current ACIP recommendations. The use of
vaccine trade names in this report and in the adult immuniza-
tion schedule is for identification purposes only and does not
imply endorsement by ACIP or CDC.
For further guidance on the use of each vaccine, includ-
ing any changes that might occur between annual pub-
lication of the adult immunization schedule, health care
providers are referred to the respective ACIP vaccine
recommendations at https://www.cdc.gov/vaccines/hcp/
acip-recs.§ Printable versions of the 2022 adult immuniza-
tion schedule and ordering instructions are available at
§ CDC encourages organizations to use syndication as a more reliable method
for displaying the most current and accurate immunization schedules on an
organization’s website rather than copying these schedules to their websites.
Use of content syndication requires a one-time step that ensures an organization’s
website displays current schedules as soon as they are published or revised;
instructions for the syndication code are available on CDC’s website (https://
www.cdc.gov/vaccines/schedules/syndicate.html). CDC also offers technical
assistance for implementing this form of content syndication (requests can be
e-mailed to ncirdwebteam@cdc.gov).
https://www.cdc.gov/vaccines/schedules/hcp/adult.html#note.
For CDC’s interim clinical considerations for the use of
COVID-19 vaccines, health care providers are referred to:
https://www.cdc.gov/vaccines/covid-19/clinical-consider-
ations/covid-19-vaccines-us.html.
Changes in the 2022 Adult Immunization Schedule
Vaccine-specific changes in the 2022 immunization sched-
ule for adults aged ≥19 years include new or updated ACIP
recommendations for hepatitis B vaccine (HepB) (2), influ-
enza vaccine (3), pneumococcal vaccines (4), recombinant
zoster vaccine (RZV) (5), and COVID-19 vaccine (available
at https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/
covid-19.html). Changes have also been made to the human
papillomavirus (HPV); measles, mumps, and rubella (MMR);
meningococcal; and varicella (VAR) vaccination sections to
improve clarity in the language. In addition, an appendix list-
ing the contraindications to and precautions for each vaccine
has been added to the schedule this year.
Cover page
• A step instructing providers to review the newly added
appendix has been added to the “How to use the adult
immunization schedule” box.
• The Society for Healthcare Epidemiology of America has
been added as a partner organization approving the
adult schedule.

Morbidity and Mortality Weekly Report
MMWR / February 18, 2022 / Vol. 71 / No. 7 231
US Department of Health and Human Services/Centers for Disease Control and Prevention
• PCV15 (Vaxneuvance) and PCV20 (Prevnar 20) have been
added to the table of vaccine abbreviations and trade names.
• PCV13 (Prevnar 13) has been removed from the list of
vaccine abbreviations and trade names.
• A QR code has been added at the bottom of the cover page
for health care providers to access the online schedule (https://
www.cdc.gov/vaccines/schedules/hcp/imz/adult.html).
Table 1 (Routine Immunization Schedule)
• Zoster row: For adults aged 19–49 years, the color of the
row was changed to purple indicating that RZV is now
recommended for adults in this age group who have
immunocompromising conditions. The text overlay now
states, “2 doses for immunocompromising conditions
(see notes).”
• Pneumococcal row: All recommended pneumococcal
vaccines (i.e., PCV15, PCV20, and PPSV23) have been
collapsed into one row. Guidance on which vaccines are
indicated for certain age groups is displayed by the
corresponding colors and overlying text. For adults aged
19–64 years, the row is purple, indicating that pneumococcal
vaccination is recommended for adults in this age group
only if they have an additional risk factor or another
indication. For adults aged ≥65 years, the row is yellow,
indicating that pneumococcal vaccination is universally
recommended for adults in this age group, if they have
never received a pneumococcal conjugate vaccine
previously or if their previous pneumococcal vaccination
history is unknown. The text overlay now states, “1 dose
PCV15 followed by PPSV23 OR 1 dose PCV20
(see notes).”
• Hepatitis B row: For adults aged 19–59 years, the row is
yellow, indicating that HepB vaccination is universally
recommended for adults in this age group, and purple for
adults aged ≥60 years, indicating that HepB vaccination
is recommended for adults in this age group if they have
an additional risk factor or another indication. The text
overlay now states “2, 3, or 4 doses depending on vaccine
or condition.”
Table 2 (Immunization by Medical Indication Schedule)
• Header: For the HIV infection columns, CD4 percentages
are displayed along with CD4 counts to harmonize
presentation of this information with that in the child/
adolescent schedule.
• Legend: The description of the color red in the legend has
been reworded to “Contraindicated or not recommended.”
• LAIV4 row: The text overlay in the red box was changed
to “Contraindicated” to increase clarity in the language
and to align more closely with ACIP recommendations.
• MMR row: The text overlay for the red boxes was changed
to “Contraindicated” to increase clarity in the language
and to align more closely with ACIP recommendations.
• VAR row: The text overlay for the red boxes was changed
to “Contraindicated” to increase clarity in the language
and to align more closely with ACIP recommendations.
• RZV row: Under the Immunocompromised and HIV
infection columns, the row is yellow indicating that RZV is
recommended for these subgroups. In addition, the text overlay
under these columns now states, “2 doses at age ≥19 years.”
• HepB row: The row is now entirely yellow, indicating that
hepatitis B vaccination is recommended for all risk-based
groups in Table 2. The text overlay states, “3 doses (see notes)”
in the pregnancy column, and “2, 3, or 4 doses depending
on vaccine or condition,” in the remaining columns.
Notes
The notes for each vaccine are presented in alphabetical
order. Edits have been made throughout the Notes section
to harmonize language between the child/adolescent and the
adult immunization schedules to the greatest extent possible.
• COVID-19: The hyperlinks to the ACIP recommendations
for the use of COVID-19 vaccines and the CDC’s Interim
Clinical Considerations for the use of COVID-19 vaccines
are included in this box.
• HepB: The “Routine vaccination” section now states that
adults aged 19–59 years are recommended to receive a 2-,
3-, or 4-dose series, with details provided. The “Special
situations” section outlines the risk-based recommendations
for adults aged ≥60 years. In addition, language has been
added stating that “anyone age 60 years or older who does
not meet risk-based recommendations may still receive
Hepatitis B vaccination.”
• HPV: A minor edit was made to the “Routine vaccination”
section to increase clarity; it now states, “No additional
dose recommended when any HPV vaccine series has been
completed using the recommended dosing intervals.” In
addition, minor wording changes were made to the “Special
situations” section, under the immunocompromising
conditions sub-bullet, which now reads, “3-dose series,
even for those who initiate vaccination at age 9 through
14 years.” Wording for the pregnancy sub-bullet was
rearranged to improve clarity.
• Influenza: The language was edited to clarify the age as
“19 years or older,” to be consistent with the schedule. A
hyperlink to the 2021–22 influenza recommendations and
a bullet for the 2022–23 influenza recommendations were
added. The “Special situations” section was condensed by
referring health care providers to the appendix listing the
contraindications and precautions for the influenza vaccines.

Morbidity and Mortality Weekly Report
232 MMWR / February 18, 2022 / Vol. 71 / No. 7 US Department of Health and Human Services/Centers for Disease Control and Prevention
• Meningococcal vaccination: At the end of the section, a
note was added that states, “MenB vaccines may be
administered simultaneously with MenACWY vaccines if
indicated, but at a different anatomic site, when feasible.”
• MMR: In the “Special situations” section, CD4
percentages in addition to CD4 counts in the HIV
infection bullet were added to harmonize language with
the child/adolescent schedule.
• Pneumococcal vaccination: The section has been updated
to reflect ACIP’s new recommendations for PCV15 and
PCV20 vaccines. The “Routine vaccination” section now
states that persons aged ≥65 years “who have not previously
received a pneumococcal conjugate vaccine or whose
previous vaccination history is unknown should receive
1 dose of PCV15 or 1 dose of PCV20. If PCV15 is used,
this should be followed by a dose of PPSV23.” Similarly,
the “Special situations” section has changed, and this
section states that anyone “aged 19 through 64 years with
certain underlying medical conditions or other risk factors
who has not previously received a pneumococcal conjugate
vaccine or whose previous vaccination history is unknown
should receive 1 dose of PCV15 or 1 dose of PCV20. If
PCV15 is used, this should be followed by a dose of
PPSV23.” Guidance for dosing intervals between PCV15
and PPSV23 and for patients who have previously received
PCV13 or PPSV23 in the past is also included. A note
added at the end lists all the underlying medical conditions
or risk factors that would render those aged 19–64 years
eligible to receive pneumococcal vaccination.
• Varicella: In the “Special situations” section, CD4
percentages in addition to CD4 counts in the HIV
infection bullet were added to harmonize language with
the child/adolescent schedule.
• Zoster: In the “Special situations” section under the
pregnancy bullet, the language was revised to increase
clarity. This bullet now states, “There is currently no ACIP
recommendation for RZV use in pregnancy. Consider
delaying RZV until after pregnancy.” In addition, the
immunocompromising conditions bullet was revised to
reflect the new ACIP recommendations for zoster
vaccination. This bullet now states, “RZV is recommended
for use in persons aged 19 years and older who are or will
be immunodeficient or immunosuppressed because of
disease or therapy.”
Appendix (Contraindications and Precautions)
• The appendix includes all the contraindications to and
precautions for each of the vaccines listed in the 2022
adult immunization schedule. The information presented
in this appendix is adapted from the 2021–22 influenza
vaccine recommendations (3) and from ACIP General
Best Practice Guidelines for Immunization (6).
Additional Information
The Recommended Adult Immunization Schedule, United
States, 2022, is available at https://www.cdc.gov/vaccines/
schedules/hcp/adult.html and in the Annals of Internal Medicine
(https://www.acpjournals.org/doi/10.7326/M22-0036). The
full ACIP recommendations for each vaccine are also avail-
able at https://www.cdc.gov/vaccines/hcp/acip-recs/index.
html. All vaccines identified in Tables 1 and 2 (except PCV15,
PCV20, and zoster vaccine) also appear in the Recommended
Immunization Schedule for Children and Adolescents, United
States, 2022 (https://www.cdc.gov/vaccines/schedules/hcp/
imz/child-adolescent.html). The notes and appendices for
vaccines that appear in both the adult immunization schedule
and the child and adolescent immunization schedule have been
harmonized to the greatest extent possible.
Acknowledgments
Rosters of current and past members of the Advisory Committee
on Immunization Practices are available at https://www.cdc.gov/
vaccines/acip/committee/members-archive.html.
ACIP Combined Immunization Schedule Work Group
Kevin Ault (Chair). Members: Henry Bernstein, Carolyn Bridges,
Uzo Chukwuma, Sybil Cineas, Sarah Coles, Sean Dade, Katherine
Debiec, Marci Drees, John Epling, Holly Fontenot, Sandra Fryhofer,
Kathleen Harriman, Robert Hopkins, Molly Howell, Paul Hunter,
Karen Ketner, David Kim, Jane Kim, Marie-Michelle Leger, Susan
Lett, Veronica McNally, Sarah McQueen, Amy B. Middleman,
Sean O’Leary, Diane Peterson, Chad Rittle, William Schaffner, Ken
Schmader, Rhoda Sperling, Patricia Stinchfield, Peter Szilagyi, L.J.
Tan, Thomas Weiser. Contributors: Neil Murthy (CDC co-Lead),
A. Patricia Wodi (CDC co-Lead). CDC Contributors: Anna Acosta,
Tara Anderson, Kathy Byrd, Margaret Cortese, Kathleen Dooling,
Amy Parker-Fiebelkorn, Mark Freedman, Paul Gastañaduy, Lisa
Grohskopf, Susan Hariri, Aaron Harris, Fiona Havers, Holly Hill,
Tara Jatlaoui, Suzanne Johnson-DeLeon, Miwako Kobayashi, Ram
Koppaka, Andrew Kroger, Tatiana Lanzieri, Mona Marin, Lauri
Markowitz, Sarah Mbaeyi, Lucy McNamara, Elissa Meites, Noele
Nelson, Sara Oliver, Gabriela Paz-Bailey, Priti Patel, Tamara Pilishvili,
Hilda Razzaghi, Janell Routh, Sarah Schillie, Mark Weng, Akiko
Wilson, JoEllen Wolicki.
Corresponding author: Neil Murthy, ycz4@cdc.gov, 404-718-5514.
1Immunization Services Division, National Center for Immunization and
Respiratory Diseases, CDC; 2Zucker School of Medicine at Hofstra/Northwell
and Cohen Children’s Medical Center, New Hyde Park, New York; 3Fanny
Strong Foundation, West Bloomfield, Michigan; 4The Warren Alpert Medical
School of Brown University, Providence, Rhode Island; 5University of Kansas
Medical Center, Kansas City, Kansas.

Morbidity and Mortality Weekly Report
MMWR / February 18, 2022 / Vol. 71 / No. 7 233
US Department of Health and Human Services/Centers for Disease Control and Prevention
All authors have completed and submitted the International
Committee of Medical Journal Editors form for disclosure of
potential conflicts of interest. Henry Bernstein reports that he is
the editor of Current Opinion in Pediatrics Office Pediatrics Series
and received a presentation honorarium from the Florida chapter
of American Academy of Pediatrics. Veronica McNally reports that
she is the president of the Franny Strong Foundation. Kevin Ault
reports having received a grant from the National Cancer Institute,
consulting fees from PathoVax, and payments supporting attending
meetings and/or travel from the American College of Obstetricians
and Gynecologists. In addition, Kevin Ault reports that he serves as
a volunteer on the medical advisory board of Family Fighting Flu,
and as a member of the infectious disease working group for the
American College of Obstetricians and Gynecologists. No other
potential conflicts of interest were disclosed.
References
1. CDC. Charter of the Advisory Committee on Immunization Practices.
Atlanta, GA: US Department of Health and Human Services, CDC;
2018. https://www.cdc.gov/vaccines/acip/committee/acip-charter.pdf
2. CDC: Advisory Committee on Immunization Practices (ACIP). ACIP
Recommendations. Atlanta, GA: US Department of Health and Human
Services, CDC; 2021. Accessed January 25, 2022. https://www.cdc.gov/
vaccines/acip/recommendations.html
3. Grohskopf LA, Alyanak E, Ferdinands JM, et al. Prevention and
control of seasonal influenza with vaccines: recommendations of the
Advisory Committee on Immunization Practices—United States,
2021–22 influenza season. MMWR Recomm Rep 2021;70(RR-5):1–28.
PMID:34448800 https://doi.org/10.15585/mmwr.rr7005a1
4. Kobayashi M, Farrar JL, Gierke R, et al. Use of 15-valent pneumococcal
conjugate vaccine and 20-valent pneumococcal conjugate vaccine among
U.S. adults: updated recommendations of the Advisory Committee on
Immunization Practices—United States, 2022. MMWR Morb Mortal
Wkly Rep 2022;71:109–17. PMID:35085226 https://doi.org/10.15585/
mmwr.mm7104a1
5. Anderson TC, Masters NB, Guo A, et al. Use of recombinant zoster
vaccine in immunocompromised adults aged ≥19 years: recommendations
of the Advisory Committee on Immunization Practices—United States,
2022. MMWR Morb Mortal Wkly Rep 2022;71:80–4. PMID:35051134
https://doi.org/10.15585/mmwr.mm7103a2
6. Kroger A, Bahta L, Hunter P. General best practice guidelines for
immunization: best practices guidance of the Advisory Committee on
Immunization Practices (ACIP). Atlanta, GA: Advisory Committee on
Immunization Practices: 2021. https://www.cdc.gov/vaccines/hcp/acip-
recs/general- recs/downloads/generalrecs.pdf