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Adult Immunization Recommendations Receive Update for 2023


The Advisory Committee on Immunization Practices released the update to the Recommended Adult Immunization Schedule for all US residents aged 19 years and older, which has been approved by the CDC and medical groups.

The Recommended Adult Immunization Schedule for Ages 19 Years or Older was released with an update for 2023, as published in Annals of Internal Medicine. The new recommendations, which focus on residents of the United States, can also be found on the CDC website.

The Advisory Committee on Immunization Practices voted to approve these recommendations in October 2022. Recommendations were developed after in-depth review of the epidemiology and burden of vaccine-preventable disease, vaccine safety, vaccine efficacy, economic analyses of immunization policy, quality of evidence, and feasibility of implementation of immunization programs.

The biggest changes coming to the 2023 version of the recommendations are new wording regarding COVID-19 vaccines and influenza vaccines, as well as new vaccines for measles, mumps, and rubella (MMR) and hepatitis B.

“Both schedules include recommendations for situations requiring additional doses of the MMR vaccine during a mumps outbreak and a description of the use of inactivated poliovirus vaccine in people 18 years of age and older who are at increased risk for exposure to polioviruses,” said Neil Murthy, MD, MPH, MSJ, medical epidemiologist at the CDC and the lead author of the adult immunization schedule, which will also be summarized in the Morbidity and Mortality Weekly Report.

Recommendations for the COVID-19 vaccine were added in a new section, which included those that were approved and authorized by the FDA. Notes on the primary series of vaccines for the general population were given as well as notes for those who are immunocompromised. Booster dose recommendations and recommendations for people who had received the Janssen vaccine were also provided.

“The inclusion of COVID-19 vaccines in the Tables and Notes sections of the Schedules this year is an important step forward and emphasizes the public health message that all persons 6 months of age and older should be vaccinated against COVID-19,” said Murthy. “Having [the] COVID-19 vaccine presented in the same way as other routinely recommended vaccines ‘normalizes’ the vaccine and can help encourage vaccine uptake.”

A new vaccine aimed at hepatitis B, named PreHevbrio, was added as a new option in a 3-dose series. Universal recommendation for vaccination continues in adults aged 19 to 59 years, and new language was added to encourage adults 60 years and older to get vaccinated if they have known risk factors.

Annual influenza vaccination continues to be recommended for all US residents aged 6 months and older. These vaccines can include any of the quadrivalent high-dose inactivated influenza vaccine, the quadrivalent recombinant influenza vaccine, or the quadrivalent adjuvanted inactivated influenza vaccine, which are all preferred compared with other influenza vaccine products. Other age-appropriate influenza vaccines can be used if any of the other vaccines are not available.

Among the other changes to the recommendations, notes on zoster vaccinations clarify that serologic evidence of prior varicella is not necessary to receive the zoster vaccination.

These recommendations will be given to all health care providers to inform their patients about immunization. Support for health care providers will also be given for partner organizations.

“Studies have shown that a recommendation for vaccination from a trusted source such as a health care provider is one of the greatest motivators for a person to receive a vaccine, so these schedules are a tool that health care providers can use to make a strong recommendation,” said Murthy.


Murthy N, Wodi AP, Cineas S, Ault KA. Recommended adult immunization schedule, United States, 2023. Ann Intern Med. Published online February 10, 2023. doi:10.7326/m23-0127

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