What Changed in the 2023 U.S. Adult Immunization Schedule

About the schedule

The Advisory Committee on Immunization Practices (ACIP) approves a recommended immunization schedule for adults 19 and older each year. The 2023 schedule was approved in October 2022 and endorsed by CDC, the American College of Physicians, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, the American College of Nurse-Midwives, the American Academy of Physician Associates, the American Pharmacists Association (new this year) and the Society for Healthcare Epidemiology of America.

Providers should use the cover page, tables, notes and appendix together. The schedule is updated every year; for the one in force now, see CDC's immunization schedules and the ACIP recommendations.

The main changes for 2023

Cover page

• Added a new hepatitis B vaccine (PreHevbrio) and a new MMR vaccine (Priorix) to the list of vaccines and trade names.
• Added COVID-19 vaccines, with new abbreviations showing valency ("1v" monovalent, "2v" bivalent) and platform (mRNA or protein subunit, "aPS").
• Combined PCV15 and PCV20 into one row.
• Clarified which vaccines fall under the National Vaccine Injury Compensation Program and which under the Countermeasures Injury Compensation Program.

Table 1 — routine schedule by age

• COVID-19: a new row, shaded yellow — routinely recommended for all adults: "2- or 3-dose primary series and booster."
• MMR: a note at 65 and over pointing to guidance for health care personnel in that age group.
• Hepatitis A: "2, 3, or 4 doses depending on vaccine," allowing for an accelerated Twinrix series.

Table 2 — by medical condition

• COVID-19: a new row, recommended for adults with any listed condition, with "See Notes" for immunocompromise and HIV.
• Hepatitis A: the same "2, 3, or 4 doses" change.

Vaccine notes

• COVID-19: a new section — primary series for most adults and for the moderately or severely immunocompromised, with links to current booster, Janssen, preexposure prophylaxis and Emergency Use guidance.
• Hepatitis B: still universally recommended for adults 19–59. Adults 60 and older with risk factors should complete a series; those without known risk factors may. PreHevbrio added to the 3-dose series; the 4-dose series for hemodialysis moved to special situations.
• Influenza: at 65 and older, a high-dose, recombinant or adjuvanted quadrivalent vaccine is preferred; guidance for close contacts of severely immunocompromised patients and for egg allergy beyond hives moved into the notes.
• MMR: link to guidance on extra doses, including a third dose, in a mumps outbreak.
• Meningococcal B (Trumenba): if the third dose is given less than 4 months after the second, give a fourth at least 4 months after the third.
• Pneumococcal: substantially updated for PCV15 and PCV20 in people who had earlier pneumococcal vaccines; link to CDC's pneumococcal app.
• Polio: a new section — routine vaccination is not needed for U.S. adults, but IPV is described for those at increased risk of exposure.
• Tdap: clarified wording.
• Zoster (Shingrix): no blood test for prior chickenpox is needed before vaccination, with guidance if one shows susceptibility; guidance for immunocompromised adults with no history of chickenpox, varicella vaccine or shingles; immunocompromise includes HIV regardless of CD4 count.

Appendix — contraindications and precautions

• Column renamed "Contraindicated or not recommended."
• Influenza: egg-allergy guidance moved to the notes.
• Hepatitis B: Heplisav-B and PreHevbrio are not recommended in pregnancy for lack of safety data — use other hepatitis B vaccines — with pregnancy registry information.
• HPV: "pregnancy: HPV vaccination not recommended."

All vaccines in the adult tables except PCV20 and the recombinant zoster vaccine also appear in the child and adolescent schedule, and the two share harmonized notes. The 2023 adult schedule was also published in the Annals of Internal Medicine.

Sources

Based on Neil Murthy, A. Patricia Wodi, Veronica McNally, Sybil Cineas and Kevin Ault, "Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older — United States, 2023," Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention, by authors from CDC, the Franny Strong Foundation, Brown University and Western Michigan University; published by CDC.