Recommended immunization schedules for adults: Clinical practice guidelines by the Escmid Vaccine Study Group (EVASG), European Geriatric Medicine Society (EUGMS) and the World Association for Infectious Diseases and Immunological Disorders (WAidid)

Figures & data

Table 1. Categories of populations and vaccine type.

Population	Type of vaccines
Adults	Influenza
	Pneumococcal
	dTp
	HPV
	MMR and V
Old adults	Influenza
	Pneumococcal
	dTp
	Herpes zoster
	TBE
Immunocompromised adults	Influenza
	Pneumococcal
	dTp
	HPV
	MMR
	V and herpes zoster
	Hib
	Meningococcal
	HAV
	HBV
	Yellow fever
Pregnant	Influenza
	Pneumococcal
	dTp
	MMR and V
	HPV
	Meningococcal
	HAV
	HBV
Healthcare workers	Influenza
	Pneumococcal
	dTp
	MMR and V
	HPV
	Meningococcal
	HBV

dTp: diphtheria, tetanus, pertussis; HAV: hepatitis A virus; HBV: hepatitis B virus; Hib: Haemophilus influenzae type b; MMR: measles, mumps, rubella; HPV: human papillomavirus; TBE: tick born encephalitis; V: varicella.

Table 2. Recommendations on vaccination for adults and the elderly.

Category	Type of vaccination	Recommendation
Adults	Influenza	Influenza vaccination of healthy adults both for individual protection and for the overall reduction of disease burden and virus circulation, which is demonstrated in the presence of a good match between the vaccine and circulating strains
	Pneumococcal	No pneumococcal vaccines are routinely recommended for adults <65 y with no underlying risk factors. PCV13 vaccination (with the possible addition of PPV23 at least 1 y later) may be recommended for the individual protection against IPD and all-cause pneumonia.
	dTp	An effective boosting policy every 10 y with dTp in young adults
	HPV	All adolescent women and men before becoming sexual active up to 20 y of age. Vaccination of older women up to 45 y of age is advised as an individual protective measure not reimbursed by public health programmes
	MMR and V	All adults lacking evidence of immunity (whether natural or acquired, due to prior vaccination) against any of measles, mumps or rubella should receive 2 doses of the MMR vaccine with a minimum interval of 4 weeks. Similarly, healthy adults lacking anamnestic recall of experiencing varicella should receive 2 doses of the V vaccine with a minimum interval of 4 weeks
	TBE	In areas where the disease is highly endemic, TBE vaccination is recommended in all age groups
Old adults	Influenza vaccination	Routine annual influenza vaccination for all individuals 65 y of age and older
	Pneumococcal vaccination	In the 65 y and older population: without previous PPV23 vaccination, the use of the PCV13 vaccine first and a second vaccination with PPV23 8 weeks to 6 months after the PCV13 shot; with previous PPV23 vaccination, a new vaccination with PCV13 at least 12 months after the PPV23 vaccination; PPV23 or PCV13 may be co-administered with the influenza vaccine; the use of PPV23 together with or before PCV13 is not recommended.If PCV13 is not available, experts recommend the use of PPV23 for any patients 75 y or older and a risk-based strategy for population between 65 and 75 y
	dTp	Vaccination with dT for all elderly individuals (≥ 65 y) every 10 y; dTap, according to the extent of the outbreak in each country
	Herpes zoster	ZLAV for individuals aged 50 y and older, even in the absence of a previous zoster episode. Re-vaccination is not recommended
	TBE	Vaccination against TBE for older people (≥ 65 y) in areas at risk
Immuno-compromised adults	Influenza	Annual vaccination with inactivated influenza vaccine
	Pneumococcal	Pneumococcal vaccination for patients with asplenia or sickle cell disease, those with primary immunodeficiency disorders, those HIV-infected, those with solid or haematologic cancer, HSCT patients, SOT candidates and recipients, those with end-stage heart, kidney, liver or lung disease, those patients with chronic inflammatory illness in treatment with immunosuppressive drugs, and cochlear implant candidates. Pneumococcal vaccination schedule includes PPV23 administration ≥ 8 weeks after PCV13, and a second dose of PPV23 5 y later. For those who were previously immunized with PPV23, PCV13 should be administered ≥ 1 y after the last PPV23 dose
	dTp	dTap is recommended for all patients 6 months after HSCT, 3 months after cancer chemotherapy, in those with chronic inflammatory illness in treatment with immunosuppressive drugs, in the HIV-infected, in SOT candidates or those with end-stage heart, kidney, liver and lung disease
	HPV	HIV-infected individuals and for any other person immunocompromised due to disease or medication through age 26 y, of both genders, with a 3-dose schedule
	MMR	MMR vaccine 3 months after chemotherapy and 6 months after anti-B-cell antibody therapy, in HSCT, seronegative individuals 2 y after transplant if they have no GVHD and do not receive any immunosuppressive drug, in HIV-infected patients with CD4 T-lymphocyte counts ≥ 200 cells/mm.^3 In these patients, the MMR vaccine should not be administered in combination with the V vaccine
	V and herpes zoster	The V vaccine for patients without a history of varicella, prior vaccination or serological evidence of VZV infection, if HIV-infected without severe immunosuppression or with a primary immune deficiency disorder without defective T-cell-mediated immunity. In the case of immunosuppressive therapy, the V vaccine should be administered 4 weeks before treatment with a 2-dose schedule separated by a 4-week interval. The V vaccine should not be administered in combination with the MMR vaccine. ZLAV is actually contra-indicated in immunocompromised persons and only those with leukemia in remission and who have not received chemotherapy or radiation for at least 3 months can receive ZLAV
	Hib	Hib vaccination in asplenic patients or those who have sickle cell disease and in HSCT patients
	Meningococcal	Conjugated meningococcal vaccine should be administered to patients with primary complement deficiencies and to those who are asplenic or who have sickle cell disease
	HAV	The HAV vaccine is indicated for immunocompromised, seronegative adults if HIV-infected, patients with solid or haematologic cancer, HSCT patients, SOT recipients, those who are asplenic or who have sickle cell disease, persons with chronic inflammatory diseases on immunosuppressive medications, and patients with liver disease.
	HBV	The HBV vaccine is indicated for immunocompromised, seronegative adults with solid or haematologic cancer, HIV-infected patients, HSCT patients, SOT patients, those who are asplenic or who have sickle cell disease, persons with chronic inflammatory disease on immunosuppressive medications and patients with liver disease
	Yellow fever	If travel to an endemic area cannot be avoided, yellow fever vaccination can be considered only in asymptomatic HIV-infected individuals with CD4 T-cell lymphocyte counts ≥ 200 cells/mm^3
	Household contacts	They should receive the MMR, V, ZLAV, rotavirus, and inactivated influenza vaccine. They can safety receive the yellow fever vaccine and oral typhoid vaccine. Oral polio vaccine (OPV) administration is contraindicated
Adults at risk	Pregnant women	The LAIV, MMR, and V are contraindicated for pregnant women, whereas HPV is not recommended to be administered to pregnant women. They should receive the inactivated trivalent or quadrivalent influenza vaccine, dTap, PPV23 if some other risk factor is present, meningococcal vaccination, if indicated, HAV vaccine if another high-risk condition or other indication is present, HBV vaccine for pregnant women who are at risk for HBV infection
	HCWs	Annual inactivated influenza vaccine, dT boosters every 10 y, 2 doses of varicella vaccine 4 weeks apart, 2 doses of MMR vaccine at least 28 d apart, and the tetravalent conjugated meningococcal vaccine in those who are routinely exposed to isolates of Neisseria meningitidis.

dTap: diphtheria, tetanus, acellular pertussis; dT: diphtheria, tetanus; dTp: diphtheria, tetanus, pertussis; GVHD : graft versus host disease; HAV: hepatitis A virus; HBV: hepatitis B virus; HCWs : health care workers; Hib: Haemophilus influenzae type b; HIV : human immunodeficiency virus; HPV: human papillomavirus; HSCT : haematological stem cell transplantation; IPD : invasive pneumococcal disease; MMR: measles, mumps, rubella; PCV13 : 13-valent pneumococcal conjugated vaccine; PPV23 : 23-valent pneumococcal polysaccharide vaccine; SOT : solid organ transplant; TBE: tick-borne encephalitis; V: varicella; ZLAV : live attenuated vaccine against herpes zoster.

Maggi S. Vaccination and healthy aging. Expert Rev Vaccines 2010; 9 (3 Suppl.):3-6; PMID:20192710; http://dx.doi.org/10.1586/erv.10.26

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