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Massachusetts Association of Occupational Health Nurses

2018 Immunization schedule for adults - with changes

Posted 10 months ago by Nancy Clover

The 2018 Immunization Schedule for those 19 years and older has been published. The changes in the schedule are discussed in the MMWR from February 9, 2018 (attachment 1) and are outlined below. The MMWR can be found at:


Figures, footnotes, and tables of the schedule are published on the CDC immunization schedule website at: This provides readers electronic access to the most current version of the schedules and footnotes on the CDC website.


Changes to the 2018 immunization schedule for adults 19 years of age and older are outlined below:

Zoster Vaccines

The newly licensed recombinant zoster vaccine (RZV), Shingrix, by GlaxoSmithKline has been added to the schedule.  Shingrix is a 2-dose vaccine containing recombinant glycoprotein E and an adjuvant (AS01B).  RZV is approved for use in those >50 years for the prevention of shingles and its complications.  Care should be taken not to confuse the two different zoster vaccine formulations.  RZV (Shingrix) is stored in the refrigerator and administered intramuscularly (IM) as a 2-dose series.  Zoster vaccine live (ZVL) (Zostavax) is stored in the freezer and administered subcutaneously (SC) as a single dose.

  • Administer 2 doses of RZV (Shingrix) 2–6 months apart to adults aged 50 years or older regardless of past episode of herpes zoster or receipt of ZVL (Zostavax).
  • Administer 2 doses of RZV 2–6 months apart to adults who previously received ZVL at least 2 months after ZVL.
  • For adults aged 60 years or older, administer either RZV or ZVL.  (RZV is preferred.)
  • “ZVL” has replaced the term “HZV” (herpes zoster vaccine) that was used in past adult immunization schedules to refer to the live zoster vaccine. A row for RZV was added above the row for ZVL and a dashed line was used to separate RZV and ZVL rows to denote that the 2 zoster vaccines are recommended for the same purpose.

MMR Vaccine

  • Administer 1 dose of MMR to adults who previously received ≤2 doses of mumps-containing vaccine and are identified by a public health authority to be at increased risk during a mumps outbreak.
  • The text in the indication bar for Figure 1 for MMR has been changed to “1 or 2 doses depending on indication (if born in 1957 or later).”

HPV Vaccine

  • In Figure 1, the text in the indication bars for HPV vaccine for females and males has been revised to “2 or 3 doses depending on age at series initiation.”

MenACWY Vaccine

  • In figures 1 and 2, the text in the indication bar for MenACWY (serogroups A, C, W, and Y meningococcal vaccine) has been revised to “1 or 2 doses depending on indication, then booster every 5 years if risk remains.”
  • MPSV4 (4-valent meningococcal polysaccharide vaccine) is no longer available and has been removed from the adult immunization schedule.

Tdap/Td Vaccines

  • Td/Tdap” has been replaced by “Tdap or Td” in Figures 1 and 2 and the text in the indication bar has been revised to “1 dose Tdap, then Td booster every 10 years.”


The 2018 Adult Immunization Schedule was also published on February 6, 2017 in the Annals of Internal Medicine and can be found at:


Immunization coverage rates among adults remain unacceptably low. The latest data can be found on the CDC website: You can also see Massachusetts immunization rates by visiting our Vaccine-Preventable Disease page, which also reviews vaccine-preventable incidence and other immunization coverage rates. In addition, you can share the Vaccine Information for Adults page with patients so they understand what vaccines may be recommended based on age, health conditions, job, lifestyle, or travel habits.


All providers should follow the Standards for Adult Immunization Practice, which can be found at: We urge you to:

  • Routinely assess adults’ vaccination status at every clinical encounter
  • Strongly recommend needed vaccines
  • Offer needed vaccines or refer patients to a provider who can administer them
  • Document vaccines administered in Massachusetts Immunization Information System (MIIS)


Join us at the 23rd Annual Massachusetts Adult Immunization Conference on Tuesday, April 10, 2018 if you are interested in learning more about adult immunizations, including recent changes to the immunization schedule, evidence-based strategies to improve adult immunization rates, and networking opportunities to build and maintain partnerships. Find out more by visiting the conference website.