Recommended Vaccines

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Maryland Childhood Immunization Schedule

Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger (Printable Schedule PDF)

Recommended Adult Immunization Schedule by Age Group and Medical Condition (Printable Schedule PDF)

Maryland Childhood Immunization Schedule

Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger

Vaccinations are the best way to protect your child, your family, and your community from serious diseases. They help infants, children, and adults build strong defenses against illness. For people of all ages, particularly those with underlying health conditions, vaccines can lessen or prevent illnesses which can be dangerous. Vaccines in the U.S. are rigorously tested and monitored for safety. The vaccines recommended are supported by the nation’s leading medical groups, including the American Academy of Pediatrics, the American Academy of Family Physicians, and the American College of Obstetricians and Gynecologists, as well as experts at the Maryland Department of Health (MDH). If you have questions about any vaccine, talk to your child’s doctor.

The Vax Act (Health-General §18-112): Under Maryland law (Health-General §18-112, or “The Vax Act”), the Maryland Secretary of Health shall recommend immunizations, screenings, and preventive services for the State, as of July 1, 2026. These recommended vaccinations are required to be covered with no out-of-pocket costs by certain regulated insurance plans.

* Required for Maryland School Entry: Vaccines marked with an asterisk (*) are required for children enrolled in Maryland preschool and school programs (Education Article §7-403). For more information, visit the Maryland Department of Health Back-to-School page.

Table Legend / Recommendation Status

Range of recommended ages for all childrenRange of recommended ages for catch-up vaccinationRange of recommended ages for individuals with certain risk factors

Childhood and Adolescent Immunization Schedule (Birth through 18 Years)
Vaccines & Immunizing Agents	Birth	1 mo	2 mos	4 mos	6 mos	8 mos	12 mos	15 mos	18 mos	19–23 mos	2–3 yrs	4–6 yrs	7–10 yrs	11–12 yrs	13–15 yrs	16 yrs	17–18 yrs
Respiratory syncytial virus (RSV) monoclonal antibodies	1 dose in RSV season depending on maternal RSV vaccination status					1 dose, nirsevimab only (8–19 months) for children at high risk during RSV season
Hepatitis B vaccination *	1st dose	2nd dose		Catch-Up	3rd dose					Catch-Up
Rotavirus vaccination			1st dose	2nd dose	3rd dose for some brands
Diphtheria, tetanus, and pertussis (whooping cough) vaccination (DTaP) *			1st dose	2nd dose	3rd dose	Catch-Up		4th dose		Catch-Up		5th dose
Haemophilus influenzae type b (Hib) vaccination *			1st dose	2nd dose	3rd dose for some brands	Catch-Up	3rd or 4th dose		Catch-Up				Special Circumstances
Pneumococcal conjugate vaccination *			1st dose	2nd dose	3rd dose	Catch-Up	4th dose		Catch-Up				Special Circumstances
Polio vaccination *			1st dose	2nd dose	3rd dose					Catch-Up		4th dose	Catch-Up
COVID-19 vaccination					1 or more doses of annual updated vaccine						1 dose for those who desire protection Annual updated vaccine for children at high risk
Influenza/Flu vaccination					1 or 2 doses annual updated vaccine									1 dose annual updated vaccine
Measles, mumps, rubella (MMR) vaccination *					1 dose for some travel or outbreaks, does not count toward the childhood series		1st dose		Catch-Up			2nd dose	Catch-Up
Varicella/Chickenpox vaccination *							1st dose		Catch-Up			2nd dose	Catch-Up
Hepatitis A vaccination					Special Circumstances		2-dose series				Catch-Up
Tetanus, diphtheria, pertussis vaccination (Tdap) *													Catch-Up	1 dose	Catch-Up
Human papillomavirus (HPV) vaccination														2-dose series	Catch-Up
Meningococcal A, C, W, and Y vaccination *			Special Circumstances											1st dose	Catch-Up	2nd dose	Catch-Up
Meningococcal B vaccination														Special Circumstances		2 or 3 doses
Respiratory syncytial virus (RSV) vaccination														Seasonal during pregnancy (32 through 36 weeks), if not previously vaccinated
Mpox vaccination																	Special Circumstances

Additional Information

For recommendations for adults and during pregnancy, see the Maryland Recommended Adult Immunizations on health.maryland.gov/recommendedvaccines.
Children who fall behind or start late should be provided catch-up vaccination at the earliest opportunity, as indicated by the grey “catch-up” ages. Refer to the American Academy of Pediatrics (AAP) Recommended Catch-Up schedule (Table 2).
Information on travel vaccination requirements and recommendations is available from Immunize.org.
Prior to administering a dose of any vaccine, healthcare providers are required to give the patient, parent, or legal guardian the most current Vaccine Information Statement (VIS) for that specific immunization. Copies of these statements can be found on CDC’s website and are available in 30+ languages from Immunize.org.
Per Maryland law §18–109(d)(6)(iii), all vaccinations administered in Maryland must be reported to ImmuNet, Maryland's secure Immunization Information System, to maintain complete records across providers across the state.
Vaccines should not be administered when a contraindication is present. For information about situations when vaccines should not be administered, ask your provider or refer to AAP’s Guide to Contraindications and Precautions to Commonly Used Vaccines.
Report possible adverse events (negative side effects) following vaccination to the Vaccine Adverse Event Reporting System (VAERS) at www.vaers.hhs.gov or 800-822-7967. Anyone can report an adverse event to VAERS. Healthcare professionals are required to report certain adverse events, and vaccine manufacturers must report all adverse events that come to their attention. It is important to note that VAERS is not designed to determine if a vaccine caused a health problem but is used to detect unusual or unexpected patterns that might indicate a safety issue. (If your infant or toddler received RSV monoclonal antibodies, report adverse events to MedWatch Adverse Event Report Program. If given with other products, then report to VAERS.)
The National Vaccine Injury Compensation Program (VICP) is a no-fault alternative to the traditional legal system for resolving vaccine injury claims. All vaccines included in the child and adolescent vaccine schedule are covered by VICP except PPSV23, RSV, Mpox, and COVID-19 vaccines. Mpox and COVID-19 vaccines are covered by the Countermeasures Injury Compensation Program (CICP). For more information, see www.hrsa.gov/vaccinecompensation or www.hrsa.gov/cicp.
Providers refer to the American Academy of Pediatrics Recommended Child and Adolescent Schedule for details like dosing and special circumstances.

Recommendations by Vaccines/Immunizing Agents

Respiratory Syncytial Virus (RSV) Immunization & Vaccination

Respiratory syncytial virus (RSV) is a common respiratory virus that usually causes cold-like symptoms. RSV is spread through droplets from coughs or sneezes or from direct contact with an infected person or a surface that has the virus on it, typically in the fall and winter months. Infants and adults who are older or have certain risk factors are more likely to develop severe illness, including bronchiolitis or pneumonia (infections of the lower airways in the chest or lungs), which can lead to hospitalization and/or death. RSV is the most common cause of hospitalization in children under 1 year. There are new RSV vaccines and monoclonal antibody treatments available for older adults and pregnant people in the third trimester, as well as newborns, to protect against severe illness.

MDH recommends a single dose of an RSV antibody (either nirsevimab or clesrovimab) for all infants under 8 months during their first RSV season (if the parent did not receive RSV vaccine during pregnancy), as well as a dose of nirsevimab for children ages 8-19 months who remain at high risk entering their second season.

MDH recommends that pregnant individuals receive a single dose of the RSV vaccine (Abrysvo) between weeks 32 and 36 of pregnancy, optimally administered from September through March during peak RSV season. Repeat vaccination is not recommended for future pregnancies. Infants are generally not recommended to receive the RSV antibody if their mother received the RSV vaccine at least 14 days before birth. Adolescents who are immunocompromised should talk to their health care provider.

You can learn more from the MDH Respiratory Syncytial Virus (RSV) webpage, Respiratory Virus Prevention: Frequently Asked Questions, and the American College of Obstetricians and Gynecologists website.

Hepatitis B Vaccination *

Hepatitis B is a virus that can damage the liver and lead to lifelong health problems. Chronic infection can lead to liver damage, liver failure, liver cancer, or even death. Hepatitis B is transmitted through blood or body fluids, and adults with an infection may not be aware they carry the virus. Newborns can acquire hepatitis B at birth (perinatal hepatitis B) if the mother is infected with the hepatitis B virus. Administering a hepatitis B vaccine within 24 hours of birth, known as a birth dose, is highly effective in preventing infection in newborns.

MDH recommends universal hepatitis B vaccination for all infants, beginning with the first dose within 24 hours of birth with additional doses at 1-2 months and 6-18 months. *This vaccine is required for school enrollment (Education Article §7-403).

You can learn more from the MDH Hepatitis B fact sheet and Childhood Vaccines: Frequently Asked Questions.

Rotavirus Vaccination

Rotavirus is a highly contagious virus that infects the intestines, causing severe watery diarrhea, vomiting, and fever. Rotavirus commonly spreads in families, hospitals, and child care centers. Children may become dehydrated and need to be hospitalized, and can even die. Rotavirus vaccine is the most effective way to protect your child against rotavirus disease.

MDH recommends that all infants receive the oral rotavirus vaccine, either the two-dose (RV1 given at 2 months and 4 months) or three-dose series (RV5 given at 2 months, 4 months, and 6 months). First dose must be given before 15 weeks of age.

You can learn more from HealthyChildren.org.

Diphtheria, Tetanus, and Whooping Cough (Pertussis) Vaccination *

The combination DTaP or Tdap vaccines prevent diphtheria, tetanus, and pertussis (also known as whooping cough). Diphtheria and whooping cough spread through everyday contact, such as when an infected person talks, coughs, or sneezes. Diphtheria can lead to difficulty breathing, heart failure, paralysis, and/or death. Whooping cough can cause uncontrollable, violent coughing that makes it hard to breathe, eat, or drink. It can be extremely serious, especially in babies and young children, causing pneumonia, convulsions, brain damage, and/or death. Tetanus enters the body through cuts or wounds and causes painful and prolonged muscle contractions. It can lead to serious health problems, including being unable to open the mouth, having trouble swallowing and breathing, and/or death.

MDH recommends a routine five-dose DTaP series administered at 2, 4, and 6 months, with boosters at 15-18 months and 4-6 years, to protect children under the age of 7 against diphtheria, tetanus, and whooping cough.

MDH recommends that all adolescents receive a single dose of the Tdap vaccine at 11 or 12 years of age, followed by a Tdap or Td booster every 10 years.

*These vaccines are required for school enrollment (Education Article §7-403).

You can learn more about diphtheria, tetanus and whooping cough from the MDH website and Childhood Vaccines: Frequently Asked Questions.

Haemophilus Influenzae Type b (Hib) Vaccination *

Hib bacteria usually affect children under 5 years of age but can also affect adults with certain medical conditions. Hib can cause mild illness (ear infections or bronchitis), or severe illness (invasive blood infections and meningitis, or infection of the tissue covering the brain and spinal cord). Severe Hib infection requires treatment in a hospital and can sometimes result in death.

MDH recommends the Hib vaccine, either three or four doses, depending on brand, beginning at 2 months. Additional doses may be recommended for children with high-risk conditions, such as conditions that impair a child’s immune system. *This vaccine is required for school enrollment (Education Article §7-403).

You can learn more from the MDH Hib fact sheet and HealthyChildren.org.

Pneumococcal Conjugate Vaccination *

The pneumococcal conjugate vaccine can prevent pneumococcal disease, which is any illness caused by pneumococcal bacteria, including pneumonia (infection of the lungs), ear infections, sinus infections, meningitis (infection of the tissue covering the brain and spinal cord), and bacteremia (bloodstream infection). Infants, young children, older people, or those with underlying medical conditions, like sickle cell disease, are at increased risk of getting seriously sick or dying from pneumococcal disease.

MDH recommends four doses of the pneumococcal conjugate vaccine at 2, 4, 6 and 12-15 months. The vaccine may also be recommended for individuals who did not receive doses at these ages, depending on age and medical conditions, or other risk factors, including conditions that weaken the immune system. *This vaccine is required for school enrollment (Education Article §7-403).

You can learn more from the MDH Pneumococcal Disease fact sheet and HealthyChildren.org.

Polio Vaccination *

Polio is a highly contagious disease caused by the poliovirus. Polio can be spread through saliva or stool. It primarily affects the nervous system and can cause irreversible paralysis. Polio was once one of the most feared diseases in the United States, and while wild-type polio is no longer circulating, staying up to date with vaccination remains essential for people to stay protected.

MDH recommends four doses of inactivated polio vaccine (IPV) total, at 2 months, 4 months, between 6-18 months and 4-6 years. For catch-up, children and adolescents through age 17 should receive four doses, but after age 18, individuals can complete a three dose series on the adult schedule. *This vaccine is required for school enrollment (Education Article §7-403).

You can learn more from the MDH Childhood Vaccines: Frequently Asked Questions webpage and HealthyChildren.org.

COVID-19 Vaccination

COVID-19 is an infectious disease caused by the SARS-CoV-2 virus. COVID-19 symptoms include fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, and diarrhea. More severe symptoms include low blood oxygen, severe breathing difficulty, or significant lung damage, all of which can trigger life-threatening complications. Older adults and people who have certain underlying medical conditions are more likely to become severely ill. Post-COVID conditions (also known as Long COVID) can include a wide range of health problems that can last four or more weeks after contracting COVID-19.

MDH recommends the annual updated COVID-19 vaccine for all children 6-23 months old, and those over 2 years old who are at increased risk for severe COVID-19 or whose parents desire protection for their children. The number of doses in a completed series and the type of vaccine received can depend on the age, vaccination history, and health status of the individual.

You can learn more from the MDH COVID-19 webpage and HealthyChildren.org.

Influenza / Flu Vaccination

Influenza, also known as the flu, is a highly contagious viral infection that attacks the respiratory system (nose, throat, and lungs), but can also involve the musculoskeletal and gastrointestinal systems, and less commonly, the brain. Flu can cause mild to severe illness, and can lead to death. Flu vaccines are updated yearly for each flu season (generally October-May), and the vaccine has been shown to prevent flu and lessen the severity of a flu infection.

MDH recommends annual flu shots to all children starting at 6 months. The updated vaccine should be received by the end of October for optimal protection before the influenza season. The first time an infant or child 8 years of age or younger receives the flu shot, a two dose series is given; the first dose primes the immune system and the second dose builds lasting protection.

The live attenuated influenza vaccine (LAIV or nasal spray) can be administered without an injection. It should not be given to children under age 2, or people who are immunocompromised, pregnant, or living with someone who is severely immunocompromised. It is also not recommended for children ages 2-4 years with asthma or recent wheezing, those on long-term aspirin therapy, children with severe vaccine allergies, or those taking flu antivirals.

You can learn more from the MDH Influenza webpage and HealthyChildren.org.

Measles, Mumps, Rubella (MMR) Vaccination *

The combination MMR vaccine protects against Measles, Mumps, and Rubella. Measles is a highly contagious and serious illness that causes a high fever with a full-body rash. Measles infection can affect the body's respiratory, immune, and central nervous systems. Mumps is an illness known for causing painful, swollen salivary glands under the jaw, which can lead to a distinctly puffy-cheeked appearance and potentially serious complications like meningitis (infection of the tissue around the brain and spinal cord), hearing loss, and reduced fertility. Rubella, also called "German measles," is an illness that usually causes mild, flu-like symptoms and a rash in children. If a pregnant person gets infected, it can cause birth defects in the baby. These three infections spread easily between people.

MDH recommends all children receive two doses of MMR vaccine at 12-15 months and 4-6 years. Additional or early vaccination may be recommended if living in or traveling to areas where measles is active, starting at 6 months. *This vaccine is required for school enrollment (Education Article §7-403).

You can learn more from the MDH measles, mumps, and rubella webpages, and Childhood Vaccines: Frequently Asked Questions.

Varicella / Chickenpox Vaccination *

Chickenpox is a highly contagious disease caused by the varicella-zoster virus that spreads through air or physical contact. Symptoms of chickenpox include a very itchy, blister-like rash and a fever. The infection can cause serious problems, especially for pregnant people, young children, and people with conditions that affect their immune system. Children may have hundreds of blisters, which can lead to bacterial infection that spreads to the bloodstream, lungs (pneumonia), or brain (encephalitis).

MDH recommends two doses of the varicella vaccine to all children at 12-15 months and 4-6 years. Most people who get the varicella vaccine are protected for life, and it lowers the risk of shingles later in life. *This vaccine is required for school enrollment (Education Article §7-403).

You can learn more from the MDH Chickenpox fact sheet and Childhood Vaccines: Frequently Asked Questions.

Hepatitis A Vaccination

Hepatitis A is an infection of the liver caused by the hepatitis A virus. It is very contagious and can spread through contaminated food or water. People who get hepatitis A may feel sick for a few weeks or several months, with symptoms including fever, feeling tired or unwell, loss of appetite, diarrhea, nausea, abdominal discomfort, dark-colored urine and jaundice (yellowing of the eyes and skin). In rare cases, hepatitis A can cause liver failure and even death.

MDH recommends two doses of the Hepatitis A (HepA) vaccine for all children and adolescents starting at 12-23 months of age, with the second dose at least 6 months after the first.

You can learn more from the MDH Hepatitis A fact sheet.

Human Papillomavirus Vaccination

HPV, or human papillomavirus, is a common virus that is known to cause six different types of cancer. HPV infection is spread by intimate contact, is sometimes associated with genital warts, but often has no symptoms. HPV can cause serious health problems, including cancers of the mouth, throat, cervix, and genitals. Once exposed and infected, there is no treatment for the infection itself, but vaccination can prevent over 90% of cancer caused by the virus.

MDH recommends HPV vaccination for all children starting between 9 and 12 years old, which requires two doses spaced 6-12 months apart. If vaccination begins after age 15, or the child is immunocompromised, three doses may be recommended.

You can learn more from the MDH HPV webpage and HealthyChildren.org.

Meningococcal ACWY and B Vaccinations

Meningococcal disease is a serious bacterial infection that spreads from close contact with an infected person. The disease strikes quickly with symptoms resembling a severe flu and worsens rapidly over hours to a few days. Symptoms may include fever, severe headache, neck stiffness, nausea and vomiting, skin rash, confusion, and sensitivity to light. The two most common and dangerous forms are meningitis (infection of the brain and spinal cord lining) and septicemia (infection of the bloodstream), which can cause serious complications, including death.

MDH recommends the Meningococcal ACWY vaccine to protect against meningococcal disease caused by serogroups A, C, W, and Y. The first dose is given at 11-12 years, and the second dose (booster) at 16 years. *This vaccine is required for school enrollment (Education Article §7-403).

MDH recommends two or three doses of the Meningococcal B vaccine for individuals 10 and older with specific high-risk conditions, and for healthy teens and young adults aged 16-23 years who decide with their doctor to get the vaccine, with a preferred administration window of 16-18 years old. This is especially important for young people living in dorms or congregate settings.

You can learn more from the MDH Meningococcal Disease fact sheet and Healthychildren.org.

Mpox Vaccination

Mpox is a viral illness caused by the mpox virus and spreads through close, personal, skin-to-skin contact. It typically causes a painful or itchy rash with fluid-filled blisters, accompanied by flu-like symptoms like fever, headache, and muscle aches, which can lead to complications such as severe skin infections, pneumonia, or vision loss. The illness typically lasts 2-4 weeks.

MDH recommends two doses of the mpox vaccine for individuals 18 years and older who are at increased risk for infection due to recent outbreaks, sexual networks, or occupational hazards.

You can learn more from the MDH mpox webpage.

Adult Immunization Schedule

Recommended Adult Immunization Schedule by Age Group and Medical Condition

Download Printable Schedule (PDF)

Under Maryland law (Health-General §18-112, or “The Vax Act”): The Maryland Secretary of Health shall recommend immunizations, screenings, and preventive services for the State, as of July 1, 2026. These Recommended vaccinations are required to be covered at no out-of-pocket cost by certain regulated insurance plans. Some schools and employers, such as hospitals and long-term care facilities, may have certain requirements for proof of vaccination or documented immunity for their employees.

Table Legend / Recommendation Status

Recommended vaccination for adults who meet age requirement, lack documentation of vaccination or, for some diseases, lack evidence of past infectionRecommended vaccination for adults with an additional risk factor or another circumstanceNo Recommendations/Not Applicable

Recommended Adult Immunization Schedule by Age Group and Medical Condition
Vaccine / Immunizing Agent	Pregnancy	19–49 years	50–64 years	65 years and Older
COVID-19 vaccination	Annual updated COVID vaccine	Annual updated COVID vaccine	Annual updated COVID vaccine	Annual updated COVID vaccine (followed by 2nd dose 6 months later)
Influenza/Flu vaccination	Annual updated flu vaccine (Standard flu shot only - Do NOT use nasal spray)	Annual updated flu vaccine (Standard flu shot or nasal spray option)	Annual updated flu vaccine (Standard flu shot only)	Annual updated flu vaccine (High-dose, recombinant or adjuvanted flu shots preferred)
Respiratory syncytial virus vaccination	1 dose seasonally at 32-36 weeks if not previously vaccinated	1 dose if immunocompromised	1 dose (50 through 74 years, if at high risk)	1 dose (75 years and up)
Tetanus, diphtheria, pertussis vaccination	1 dose Tdap at 27-36 weeks of each pregnancy	1 dose Td or Tdap for wound management depending on circumstance 1 dose Tdap, then Td or Tdap booster every 10 years
Measles, mumps, rubella vaccination	Not recommended	1 or 2 doses depending on circumstance (If born in 1957 or later)		2 doses for health care personnel depending on circumstance
Varicella/Chickenpox vaccination	Not recommended	2 doses (If born in U.S. in 1980 or later)	2 doses
Zoster recombinant/Shingles vaccination		2 doses if immunocompromised	2 doses
Human papillomavirus vaccination	Not recommended	2 or 3 doses depending on age at first vaccination Complete series through age 45
Pneumococcal conjugate vaccination	In special circumstances	1 dose in special circumstances	1 or 2 doses depending on vaccine	1 dose if not previously vaccinated Additional dose depending on vaccine(s) received
Hepatitis A vaccination	In special circumstances	2, 3 or 4 doses depending on vaccine
Hepatitis B vaccination	If not previously vaccinated	2, 3 or 4 doses depending on vaccine or condition (19 through 59 years)
Meningococcal A, C, W, Y and B vaccination	In special circumstances	1 or 2 doses depending on circumstance
Meningococcal B vaccination (MenB)	In special circumstances (If at high risk during active outbreak)	2 or 3 doses depending on vaccine and circumstance 19 through 23 years in congregate settings	2 or 3 doses depending on circumstance
Haemophilus influenzae type b (Hib) vaccination		1 or 3 doses depending on circumstance
Mpox vaccination	In special circumstances (If known or suspected exposure)	2 doses
Polio Vaccination	In special circumstances	Complete 3-dose series if not completely vaccinated

Additional Information

For recommendations for children through age 18 years, see the Maryland Recommended Childhood Immunizations on health.maryland.gov/recommendedvaccines.
Information on travel vaccination requirements and recommendations is available at vaccineinformation.org.
For vaccination of persons with immunodeficiencies, refer to the AAFP.
Prior to administering a dose of any vaccine, healthcare providers are required to give the patient, parent, or legal guardian the most current Vaccine Information Statement (VIS) for that specific immunization. Copies of these statements can be found on CDC’s website and are available in 30+ languages from Immunize.org.
Per Maryland law §18–109(d)(6)(iii), all vaccinations administered in Maryland must be reported to ImmuNet, Maryland's secure Immunization Information System, to maintain complete records across providers across the state.
Vaccines should not be administered when a contraindication is present. For information about common contraindications, including immunodeficiencies, ask your provider or refer to AAFP’s Recommended Adult Immunization Schedule by Medical Condition or Other Indication (Table 2).
For information on timing and spacing of vaccines, including catch-up vaccines, ask your provider or see Immunize.org.
Report clinically significant adverse events to the Vaccine Adverse Event Reporting System (VAERS) at www.vaers.hhs.gov or 800-822-7967. Anyone can report an adverse event (possible negative side effect) to VAERS. Healthcare professionals are required to report certain adverse events, and vaccine manufacturers must report all adverse events that come to their attention. VAERS is not designed to determine if a vaccine caused a health problem but is used to detect unusual or unexpected patterns that might indicate a safety issue.
The National Vaccine Injury Compensation Program (VICP) is a no-fault alternative to the traditional legal system for resolving vaccine injury claims. Mpox and COVID-19 vaccines are covered by the Countermeasures Injury Compensation Program (CICP). A few vaccines are not covered by either program. For more information, see www.hrsa.gov/vaccinecompensation or www.hrsa.gov/cicp.
Providers refer to the American Academy of Family Physicians (AAFP) adult immunization schedule and the American College of Obstetricians and Gynecologists (ACOG) for clinical guidance, including dosing and special circumstances.

Recommendations by Vaccines/Immunizing Agents

COVID-19 vaccination

COVID-19 is an infectious disease caused by the SARS-CoV-2 virus. COVID-19 symptoms include: fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, and diarrhea. More severe symptoms include low blood oxygen, severe breathing difficulty, or significant lung damage, all of which can trigger life-threatening complications. Older adults and people who have certain underlying medical conditions are more likely to get severely ill. Post-COVID conditions (also known as Long COVID) can include a wide range of health problems that can last four or more weeks after contracting COVID-19.

MDH recommends the annual updated COVID-19 vaccine for all adults ages 19-64. Adults 65 years and older should receive a second dose of the updated COVID-19 vaccine 6 months after the initial dose to help maintain protection as immunity wanes over time. It is especially important to get a vaccine if you are 65 years and older, at increased risk for severe COVID-19 infection, or have never received a COVID-19 vaccine. The annual updated COVID-19 vaccine is also recommended during pregnancy or postpartum, including while breastfeeding.

You can learn more from the MDH COVID-19 webpage.

Influenza/flu vaccination

Influenza, also known as the flu, is a highly contagious viral infection that attacks the respiratory system (nose, throat, and lungs), but can also involve the musculoskeletal and gastrointestinal systems, and, less commonly, the brain. Flu can cause mild to severe illness and can lead to death. Flu vaccines are updated yearly for each flu season (generally October-May), and the vaccine has been shown to prevent flu and lessen the severity of a flu infection.

The live attenuated influenza vaccine (LAIV or nasal spray) can be administered without an injection. It should not be given to people who are immunocompromised, pregnant, or living with someone who is severely immunocompromised.

MDH recommends one dose of the updated flu shot annually for all adults 19-64. The updated dose should be received by the end of October for optimal protection for the respiratory season. Adults aged 65 and older are recommended to receive a high-dose, recombinant, or adjuvanted shot for stronger protection when available but should not delay vaccination to obtain one. One dose; is also recommended during pregnancy or postpartum, including while breastfeeding; the nasal spray or mRNA vaccine are not recommended during pregnancy.

You can learn more from the MDH Influenza webpage.

Respiratory syncytial virus vaccination

Respiratory syncytial virus (RSV) is a common respiratory virus that usually causes mild, cold-like symptoms. RSV is spread through droplets from coughs or sneezes or from direct contact with an infected person or a surface that has the virus on it, typically in the fall and winter months. Infants and adults who are older or have certain risk factors are more likely to develop severe illness, including bronchiolitis or pneumonia (infections of the lower airways in the chest or lungs), which can lead to hospitalization and/or death. There are new RSV vaccines available for older adults and pregnant people in the third trimester, as well as monoclonal antibody treatments for newborns, to protect against severe illness.

MDH recommends that adults ages 50 through 74 years who are at high risk receive one dose of RSV vaccine, and all adults 75 years and older receive one dose if they have not previously received the vaccine. It is best to administer in late summer and early fall before RSV spreads in communities. Additional doses are not recommended. Adults under 50 years who are immunocompromised should talk to their health care provider. During pregnancy, a single dose of the RSV vaccine (Abrysvo) is recommended between weeks 32 and 36 of pregnancy, optimally administered from September through March during peak RSV season. Repeat vaccination is not recommended for future pregnancies.

You can learn more from the MDH Respiratory Syncytial Virus (RSV) webpage and Respiratory Virus Prevention: Frequently Asked Questions.

Tetanus, diphtheria, and whooping cough (pertussis) vaccination

The combination Tdap vaccine can prevent tetanus, diphtheria, and pertussis (also known as whooping cough). Tetanus enters the body through cuts or wounds and causes painful and prolonged muscle contractions. It can lead to serious health problems, including being unable to open the mouth, having trouble swallowing and breathing, and/or death. Diphtheria and whooping cough spread through everyday contact, such as when an infected person talks, coughs, or sneezes. Diphtheria can lead to difficulty breathing, heart failure, paralysis, and/or death. Whooping cough can cause uncontrollable, violent coughing that makes it hard to breathe, eat, or drink. It can be extremely serious, causing pneumonia, convulsions, brain damage, and/or death.

MDH recommends that adults receive one dose of the Tdap vaccine if they have never had one, followed by a Td or Tdap booster shot every 10 years. If wounded, a booster dose of tetanus toxoid-containing vaccine may be required, based on the type of the injury and vaccination history. During pregnancy, one dose is recommended during the third trimester (ideally between 27 and 36 weeks) of every pregnancy, regardless of how long it has been since the last shot. It can also be given in the postpartum period, including while breastfeeding.

You can learn more from the MDH tetanus, diphtheria, and whooping cough webpages.

Measles, mumps, and rubella vaccination

The combination MMR vaccine protects against Measles, Mumps, and Rubella. Measles is a highly contagious illness that causes a high fever and a full-body rash. Measles infection can affect the body's respiratory, immune, and central nervous systems. Mumps is an illness known for causing painful, swollen salivary glands under the jaw, which can lead to a distinctly puffy-cheeked appearance and potentially serious complications like meningitis, hearing loss, and reduced fertility. Rubella, also called "German measles," is an illness that usually causes mild, flu-like symptoms and a rash. It may cause birth defects for the infant of an infected pregnant mother. These three infections spread easily between people.

MDH recommends that adults born in 1957 or later get at least one dose of the MMR vaccine if they don't have proof of immunity (such as documentation of past vaccination, laboratory evidence of immunity, or a history of the disease). Adults born before 1957 are generally considered immune through exposure. All health care personnel, regardless of when they were born, should have immunization or documented evidence of immunity. It is not recommended during pregnancy.

You can learn more from the MDH measles, mumps, and rubella webpages.

Varicella/chickenpox vaccination

Chickenpox is a highly contagious disease caused by the varicella-zoster virus which spreads easily through the air or physical contact. Symptoms of chickenpox include a very itchy, blister-like rash and a fever. The infection can cause serious problems, especially for pregnant people, young children, and people with conditions that affect their immune system. People may have hundreds of blisters, which can lead to bacterial infection that spreads to the bloodstream, lungs (pneumonia), or brain (encephalitis). Most people who get the varicella vaccine are protected for life, and it lowers the risk of shingles later in life.

MDH recommends that adults who do not have proof of immunity to chickenpox (such as documentation of past vaccination, laboratory evidence of immunity, a history of the disease, or being born in the U.S. before 1980) receive two doses of the varicella vaccine. It is not recommended during pregnancy.

You can learn more from the MDH Chickenpox fact sheet.

Zoster recombinant/Shingles vaccination

Shingles is a painful rash caused by the reactivation of the chickenpox (varicella) virus, which stays quiet in your body’s nerve cells after you recover from chickenpox as a child. Shingles usually starts with burning, tingling, or numbness on one side of the body, followed by a blistering rash that can take several weeks to heal. Nearly one-third of people will get shingles during their lifetime. Most people have it only once, but it can happen more than once.

MDH recommends two doses of the shingles vaccine for all adults aged 50 and older, as well as younger adults with weak immune systems.

You can learn more about shingles at familydoctor.org.

Human papillomavirus vaccination

MDH recommends the HPV vaccine for adults ages 18 through 26. Additionally, adults aged 27 through 45 may decide to complete the series after talking with their provider. It is not recommended during pregnancy; if a series was started, delay remaining doses until after pregnancy.

You can learn more from the MDH HPV webpage.

Pneumococcal conjugate vaccination

The pneumococcal conjugate vaccine can prevent pneumococcal disease, which is any illness caused by pneumococcal bacteria, including pneumonia (infection of the lungs), ear infections, sinus infections, meningitis (infection of the tissue covering the brain and spinal cord), and bacteremia (bloodstream infection). Young children, older people, or those with underlying medical conditions, like sickle cell disease, are at increased risk of getting seriously sick or dying from pneumococcal disease.

MDH recommends the pneumococcal vaccine to all adults ages 50 and older, as well as younger adults with certain chronic health conditions or weakened immune systems, to protect against severe lung and blood infections. It can be given during pregnancy for those who are at high risk.

You can learn more from the MDH Pneumococcal Disease fact sheet.

Hepatitis A vaccination

Hepatitis A is an infection of the liver caused by the hepatitis A virus. It is very contagious and can spread through contaminated food or water. People who get hepatitis A may feel sick for a few weeks or months with symptoms like fever, feeling tired or unwell, loss of appetite, diarrhea, nausea, abdominal discomfort, dark-colored urine, and jaundice (yellowing of the eyes and skin). In rare cases, hepatitis A can cause liver failure and even death.

MDH recommends two-four doses of the Hepatitis A vaccine (depending on the type of vaccine) to adults with an increased risk of exposure, such as through travel, certain medical conditions, or lifestyle factors. It can be given during pregnancy for those who are at high risk or experiencing severe illness from the virus.

You can learn more from the MDH Hepatitis A fact sheet.

Hepatitis B vaccination

MDH recommends two to four doses of the hepatitis B vaccine (depending on the vaccine and prior doses) for adults under age 60, as well as older adults with known risk factors or who want protection from the virus. This series is recommended during pregnancy for those not previously vaccinated.

You can learn more from the MDH Hepatitis B fact sheet.

Meningococcal A, C, W, Y and B vaccination

MDH recommends the Meningococcal ACWY vaccine to protect against meningococcal disease caused by serogroups A, C, W, and Y for unvaccinated adults who are at a higher risk of exposure due to specific medical conditions, travel, or living environments like college dorms. It can be given during pregnancy for those with certain risk factors.

MDH recommends the meningococcal B vaccine for those at an increased risk due to specific immune system conditions, laboratory work, or a local outbreak and for healthy teens and young adults aged 16-23 years who decide with their doctor to get the vaccine, with a preferred administration window of 16-18 years old. This is especially important for young people living in dorms or congregate settings. It is not recommended during pregnancy, unless at high risk.

You can learn more from the MDH Meningococcal Disease fact sheet.

Haemophilus influenzae type b (Hib) vaccination

Hib is a bacteria that can cause many different kinds of infections. These infections usually affect children under 5 years of age but can also affect adults with certain medical conditions. Hib can cause mild illness (ear infections or bronchitis), or severe illness (invasive blood infections and meningitis). Severe Hib infection requires treatment in a hospital and can sometimes result in death.

MDH recommends one or three doses, depending on condition, for adults with specific high-risk conditions, such as not having a functioning spleen or undergoing a bone marrow transplant.

You can learn more from the MDH Hib fact sheet.

Mpox vaccination

Mpox is a viral illness caused by the mpox virus that spreads through close, personal, skin-to-skin contact. It typically causes a painful or itchy rash with fluid-filled blisters, accompanied by flu-like symptoms like fever, headache, and muscle aches, which can lead to complications such as severe skin infections, pneumonia, or vision loss. The illness typically lasts 2-4 weeks.

MDH recommends two doses of the mpox vaccine for individuals 18 years and older who are at increased risk for infection due to recent outbreaks, sexual networks, or occupational hazards. It is not recommended during pregnancy but can be considered if there is a known exposure or high risk of catching the virus.

You can learn more from the MDH mpox webpage.

Polio Vaccination

Polio is a highly contagious disease caused by the poliovirus. Polio can be spread through saliva or stool. It primarily affects the nervous system and can cause irreversible paralysis. Polio was once one of the most feared diseases in the United States and, while wild-type polio is no longer circulating, staying up to date with vaccination remains essential for people to stay protected.

MDH recommends three doses for any adult who is unvaccinated or unsure of their vaccination status. If a person is already fully vaccinated but faces a high risk of exposure, including traveling to certain countries or working in a lab, they may receive a single booster dose. It is not recommended during pregnancy unless at high-risk of exposure.

You can learn more about Polio at familydoctor.org.