Adult vaccination is one of the least glamorous corners of preventive medicine and one of the most consequential. In a brisk visit, a clinician may check the flu box and move on, leaving a handful of other recommended vaccines unaddressed for years. The gap is not usually oversight so much as time pressure. That means the burden of asking often falls to the patient.
The Advisory Committee on Immunization Practices (ACIP) updates its adult schedule annually. What follows tracks the current guidance, with an emphasis on the vaccines most likely to be missed.
The seasonal and standing recommendations
Most adults are aware of the yearly flu shot, which ACIP recommends for essentially everyone 6 months and older. Fewer are current on the Tdap booster, which is due every ten years and is particularly important for adults around newborns. If you cannot remember your last Tdap, you are almost certainly due.
COVID-19 vaccination remains an ACIP-recommended annual update for adults, with formulation matched to circulating variants. Adults with immunocompromise, pregnancy, or particular occupational exposures may need additional doses.
The ones frequently overlooked
Several high-value vaccines tend to fall through the cracks.
- Shingles (recombinant zoster): two doses for all adults 50 and older, and for immunocompromised adults 19 and older. Even people who had shingles previously should be vaccinated.
- Pneumococcal: recommended for all adults 65 and older, and earlier for those with chronic heart, lung, kidney, or liver disease, diabetes, smoking, or immunocompromise. The current ACIP schedule allows for a simpler single-dose PCV20 or PCV21 in most cases.
- RSV: a single dose for adults 75 and older, and for adults 60-74 at increased risk. Also recommended in pregnancy between 32 and 36 weeks during RSV season to protect newborns.
- HPV: routine through age 26, and shared decision-making from 27 to 45. Many adults who were too old when HPV vaccination was first introduced are now eligible.
- Hepatitis B: recommended for all adults 19-59, and for older adults with risk factors. This was expanded relatively recently and is often missed.
- MMR and varicella: check immunity if born after 1957 without documented vaccination or disease. Measles in particular has resurfaced in outbreaks.
Vaccines for specific circumstances
Several vaccines are recommended based on travel, occupation, or health status rather than age alone.
- Hepatitis A: for travelers to endemic areas, people with chronic liver disease, and others at risk.
- Meningococcal: for adults with certain immune conditions, functional or anatomic asplenia, or specific occupational exposures.
- Mpox: for adults at elevated risk based on sexual health guidance.
- Typhoid, yellow fever, Japanese encephalitis: destination-dependent, best addressed at a travel clinic 4-6 weeks before departure.
The most common reason an adult is under-vaccinated is not refusal. It is that no one has asked.
How to catch up
If your immunization history is uncertain, several practical steps help.
First, request a copy of your vaccine record from your primary care office and, if applicable, your state immunization information system. Most U.S. states maintain a registry that consolidates records across providers.
Second, review the current ACIP adult schedule with your clinician or pharmacist. Both are qualified to administer most adult vaccines, and pharmacies often have shorter waits.
Third, if records are missing, most missed vaccines can be safely re-administered without harm. There is no penalty for a second Tdap when the record cannot be found.
The bottom line
Staying current on adult vaccines is one of the highest-yield preventive actions available, and the list is longer than most people realize. Shingles, RSV, pneumococcal, HPV, and hepatitis B are the ones most commonly missed. Ask by name rather than waiting to be offered.