17 Adult Vaccines: Who to Consider for Each
A review of 4 factors can help primary care clinicians with an initial decision about adult vaccination: Health, Age, Lifestyle, and Occupation, or HALO.
Suggested factors to consider under each HALO category that may influence a decision to administer a vaccination to an adult.
Adult vaccines that are routine or recommended for all those aged 18 years and older include: COVID-19, influenza, PPSV23
Adult vaccines that are routine or recommended for all those aged 18 years and older include: Tdap/Td and varicella
Vaccination against hepatitis A is recommended for adults: with Certain chronic diseases * Immunosuppressed (including HIV infection) Anyone of any age who wants to be protected * MSM * User of injecting or noninjecting drugs *Homelessness * International traveler * Close contact of international adoptee * Certain lab workers * People who live/work in an outbreak area
Vaccination against hepatitis B is recommended for adults based on the following Health, Age, Lifestyle, and Occupational factors: Certain chronic diseases * Immunosuppressed (including HIV infection) * History of STI * Routine through 59 yrs and based on risk factors for 60+ yrs and older; may give to anyone 60+ * MSM * Not in long-term exclusive relationship * User of injecting or noninjecting drugs *International traveler * Certain lab workers * People who live/work in an outbreak area
Vaccination against Hib is recommended for adults based on the following Health factors: Certain chronic diseases * Asplenia
Vaccination against HPV is recommended for adults based on the following Age factors: Routinely through 26 yrs; based on shared clinical decision making for 27–45 yrs.
Vaccination against polio with the inactivated polio vaccine is recommended for adults based on the following Age, Lifestyle, and Occupational factors: any adult known or suspected of being unvaccinated * International travelers * Certain laboratory workers
Vaccination against meningococcal strains ACWY is recommended for adults based on the following Health, Lifestyle, and Occupational factors: Certain chronic diseases * Immunosuppressed (including HIV infection) * Asplenia * International travelers * College students * Certain lab workers * People who live in areas of outbreak
Vaccination against meningococcal strain B is recommended for adults based on the following Health, and Occupational factors: Certain chronic diseases* Asplenia *Based on shared clinical decision making for 16–23 yrs * Certain lab workers * People who live in areas of outbreak
Vaccination against measles, mumps, and rubella is recommended for adults based on the following Health, Age, Lifestyle, and Occupational factors: Vaccination may be indicated depending on degree of immunosuppression * Routine 1 dose if born after 1956; 2nd dose for some * International travelers * College students* Healthcare workers* People who live in areas of outbreak
Vaccination against monkey pox is recommended for adults based on the following Health, Lifestyle, and Occupational factors: History of STI * MSM * Not in a long-term monogamous relationship * Certain lab workers. (Post-exposure vaccination also recommended. Further evaluation for specific risks is required.)
Vaccination against pneumococcal disease with a PCV is recommended for adults based on the following Health, and Lifestyle factors: Certain chronic diseases * Immunosuppressed (including HIV infection) * Asplenia * Cochlear implant/candidate * Organ transplant * CSF leak * Alcoholism * Routine for
age ≥50 yrs; based on risk factors for 19–49 yrs * Tobacco smoking
Vaccination against RSV is recommended for adults based on the following Health, and Age, and Occupational factors: Pregnancy * Certain chronic diseases * Immunosuppressed (including HIV infection) * Routine 1 dose for age ≥75 yrs; based on risk factors for 60–74 yrs * Adults in congregate settings
Vaccination against the herpes zoster virus is recommended for adults based on the following Health, and Age factors: Certain chronic diseases * Immunosuppressed (including HIV infection) * Organ transplant * Routine for 50+ yrs; for 19–49 yrs with immunocompromise
Source: Before you vaccinate adults, consider their 'H-A-L-O'! Immunize.org. Accessed February 1, 2025. Available at https://www.immunize.org/wp-content/uploads/catg.d/p3070.pdf
Some vaccinations for adults are recommended by the CDC's Advisory Committee on Immunization Practices (ACIP) for all adults, regardless of health, lifestyle, or occupational factors. Others are highly recommended for specific populations that may be at greater risk for a vaccine-preventable disease. A simple mnemonic from Immunize.org guides clinicians to consider factors related to health, age, lifestyle, and occupation, or HALO, when making an initial decision about vaccination for a specific adult. A definitive decision, the organization says, should be based on the more detailed information published in the complete vaccine recommendations of the ACIP.
The short slide show above summarizes the HALO factors most relevant to consider for 17 adult vaccines.
