What Changed in the 2020 U.S. Adult Immunization Schedule

This page describes the adult immunization schedule for 2020. The schedule is updated every year, so check CDC's current schedule before making vaccination decisions.

At its October 2019 meeting, the Advisory Committee on Immunization Practices (ACIP) voted to approve the 2020 recommended immunization schedule for adults aged 19 and older. The schedule, also approved by the CDC director, the American College of Physicians, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists and the American College of Nurse-Midwives, summarizes ACIP's recommendations in two tables with accompanying notes, which clinicians should use together.

ACIP bases each vaccine recommendation on in-depth review of the disease's epidemiology and burden, vaccine efficacy, effectiveness and safety, the quality of evidence, feasibility and economics. The schedule is published every year to bring updates together; recommendations can change between editions, and CDC posts those changes online.

Main changes for 2020

The 2020 schedule reflected new or revised recommendations for hepatitis A, HPV, influenza, serogroup B meningococcal (MenB), pneumococcal and Tdap vaccines.

Shared clinical decision-making. A new blue box marked vaccines for which clinician and patient should decide together:

• HPV for adults aged 27–45;
• PCV13 (pneumococcal conjugate vaccine) for adults 65 and older who have no immunocompromising condition, cerebrospinal fluid leak or cochlear implant, while one dose of PPSV23 was still recommended for them;
• MenB for people aged 16–23 who are not at increased risk of meningococcal disease.

HPV. Catch-up HPV vaccination was now recommended for all adults through age 26, so the separate rows for men and women were combined and the 19–21 and 22–26 age columns merged, leaving four age columns instead of five.

Tetanus. Either Td or Tdap may now be used for the booster every 10 years, for tetanus prevention in wound care, and for catch-up vaccination.

Hepatitis A. Previously unvaccinated people living with HIV, regardless of CD4 count, should now be vaccinated. The note also added vaccination in settings of exposure, adjusted the definition of chronic liver disease and the pregnancy guidance, and dropped clotting factor disorders as an indication.

Other updates to the notes:

• Influenza: a list of when live attenuated influenza vaccine should not be used, and edits to guidance for people with a history of Guillain-Barré syndrome.
• MMR: clearer recommendations for health care personnel born in 1957 or later, and before 1957, who lack evidence of immunity.
• Meningococcal: use of the complement inhibitor ravulizumab added as an indication for MenB, and, for people at continued risk, a MenB booster one year after the primary series and every two to three years after that.
• Varicella: vaccination may be considered for people with HIV and no evidence of immunity whose CD4 count is at least 200 cells/μL.
• Hepatitis B: minor changes to the chronic liver disease definition and pregnancy guidance.

Presentation. Trademark symbols were added to vaccine names, PedvaxHIB was added to the list of Hib vaccine brands, and the cover now says not to restart or add doses to a vaccine series when doses are delayed. In the tables, gray boxes now read "No recommendation/not applicable" and red boxes "Not recommended/contraindicated," with "Contraindicated" in the red bars changed to "Not Recommended." Wording in the notes was brought in line with the child and adolescent schedule where possible.

Sources

• Freedman MS, Hunter P, Ault K, Kroger A. Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older — United States, 2020. MMWR Morb Mortal Wkly Rep 69(5). https://www.cdc.gov/mmwr/volumes/69/wr/mm6905a4.htm
• CDC immunization schedules: https://www.cdc.gov/vaccines/schedules/index.html; ACIP recommendations: https://www.cdc.gov/vaccines/hcp/acip-recs/index.html