QUICK REFERENCE GUIDE

November 2016
Table of Contents
Preface 3

Quick Reference Charts 4

Influenza (Flu) 7

Pneumonia 9

Meningococcal 11

Zoster 13

Varicella 15

Tetanus, Diphtheria Toxoid, and Acellular Pertussis (Tdap) 17

Hepatitis A 18

Hepatitis B 19

Hepatitis A & B 21

Human Papillomavirus (HPV) 22

Measles, Mumps, Rubella (MMR) 24

ACIP Immunizations for Children, Birth–6 years 26

ACIP Immunizations for Children, 7–18 years 27

ACIP Immunizations for Adults, by Age 28

ACIP Immunizations for Adults, by Health Condition 29

2 Immunization Quick Reference Guide

Preface
The Immunization Quick Reference Guide was designed to enable certified immunizing pharmacists and student
pharmacists to stay up-to-date on current vaccinations and guidelines and to help them answer questions from
patients and other practitioners.

This guide is created and updated by APhA’s Academy of Pharmacy Practice & Management (APPM) Immunizing
Pharmacists Special Interest Group (SIG). All information presented correlates to the vaccine recommendations
of CDC’s Advisory Committee for Immunization Practices (ACIP) and is current according to the date on the cover
page. The guide is meant to be used as a reference only; pharmacists and student pharmacists are encouraged to
review current ACIP guidelines for full, up-to-date information.

The following information is included for each vaccine presented herein: brand name(s) and manufacturer(s); dose
and route of administration; common adverse effects; storage and handling; additional comments; and the most
current version of the CDC immunization schedules.

Pharmacists who would like more information about vaccines and guidelines should consult the references used to
create this guide or refer to the package insert for a particular vaccine of interest.

References
CDC. Vaccines & Immunizations. Atlanta, GA: CDC; 2016. http://www.cdc.gov/vaccines/. Accessed January 12,
2016.

CDC. Epidemiology and prevention of vaccine-preventable diseases. The pink book: Course textbook. 13th ed.
Atlanta, GA: CDC; 2015. http://www.cdc.gov/vaccines/pubs/pinkbook/index.html/. Accessed October 25, 2016.

3 Immunization Quick Reference Guide

Quick Reference Charts
Meningococcal Meningococcal
Pneumococcal Pneumococcal Meningococcal conjugate polysaccharide serogroup B
(PPSV-23) (PCV-13) (MenACWY) (MPSV4) (MenB)

Brand name Pneumovax 23 Prevnar 13 Menactra Menomune Bexsero, Trumenba

Indications Patients 2–64 years with Children at 2, 4, 6 and Adolescents 11–18 years: Adults >55 years who Patients > 10 years who
immunocompromising 12–15 months • 1st dose at 11–12 years anticipate requiring only are at increased risk for
Please refer to conditions/long-term health • Booster at 16 years a single dose serogroup B infections:
Vaccine Information Patients 2–64 years with
problems: • Travelers 1. At risk from an
Statement (VIS) or immunocompromising Additionally:
1. Congenital or acquired • Community outbreaks outbreak
ACIP immunization conditions: 1. At risk from an outbreak
immunodeficiency 2. Splenectomy/
schedule for 1. Congenital 2. Splenectomy/ damaged spleen Store in refrigerator; do
2. Splenectomy/damaged damaged spleen
more complete or acquired 3. Taking eculizumab NOT freeze.
spleen 3. Taking eculizumab
indications. immunodeficiency 4. Traveling or living where
3. Cochlear implants 4. Microbiologists
2. Splenectomy/ meningococcal disease is
4. Chronic heart/liver /lung/renal who work with N.
damaged spleen common
disease meningitidis
3. Cochlear implants 5. First-year college student living
5. Diabetes
4. Chronic heart/ liver/ in dorms May also be given to
Adults 19–64 years who smoke lung/ renal disease 6. U.S. military recruits anyone 16–23 years
cigarettes or have asthma 5. Diabetes 7. Microbiologists who work with to provide short-term
N. meningitidis protection
AND OR
Preferred vaccine for people 2 The same vaccine must
Adults ≥ 65 years, 1 dose Adults ≥ 65 years, 1 months–55 years, have received be used for all doses.
dose MenACWY previously, or anticipate
*1 dose in lifetime requiring multiple doses.

No. and schedule of 1, 2, or 3 doses (3 for certain 1 dose 1 or 2 doses at least 8 weeks apart 1 or 2 doses at least 5 Bexsero: 2 doses at least
doses indications) at least 5 years apart years apart 4 weeks apart
May need revaccination every 5
years Trumenba: 3 doses at
months 0, 2, 6

Route of IM IM IM Subcutaneous IM
administration

Other pertinent *Separate PCV13 and PPSV23 by *Separate PCV13 and • Soreness or redness at injection • Soreness or redness • Soreness or redness at
information ≥12 months unless patient has PPSV23 by ≥12 months. site at injection site injection site
weakened immune system, then • Soreness or redness at • Mild fever • Mild fever • Tiredness/fatigue
at least 8 weeks apart. injection site • Headache
Reconstitution required
• Soreness/redness at injection • Drowsy/decreased • Fever/chills
site appetite

4 Immunization Quick Reference Guide

 Tetanus, diphtheria &
Shingles Varicella pertussis Tetanus, diphtheria
(herpes zoster) (chicken pox) (Tdap) (Td)

Brand name Zostavax Varivax Adacel, BOOSTRIX Tenivac

Indications Adults ≥60 years regardless of prior Children who have never had Persons ≥11 years Booster dose every 10 years
episode of herpes zoster chicken pox:
Please refer Health professionals Can be given earlier after a severe and
• 1st dose: 12–15 months
to VIS or ACIP Can be administered to patients ≥ • 2nd dose: 4–6 years; may be given dirty wound or burn
Persons having close contact with
immunization 50 years earlier if at least 3 months old a baby <12 months
schedule for after 1st dose
Live vaccine: store frozen;
more complete Pregnant women (every pregnancy
diluent: store refrigerated or at
indications. Persons ≥13 years who have never at 27–36 weeks gestation)
room temperature had chicken pox or received chicken
1 dose in lifetime pox vaccine: 2 doses at least 28
days apart

No. and schedule of 1 dose 2 doses 1 dose 1 dose every 10 years

doses

Route of Subcutaneous Subcutaneous Intramuscular Intramuscular

administration

Other pertinent • Soreness or redness at injection • Soreness/redness at injection site • Pain, soreness, or redness at • Pain, soreness, or redness at injection
information site • Mild fever injection site site
• Headache • Mild rash • Headache • Headache
• Mild fever • Mild fever
Reconstitution required Reconstitution required • Nausea, vomiting, diarrhea • Tiredness

5 Immunization Quick Reference Guide

 Human Measles, mumps,
Hepatitis A Hepatitis B papillomavirus rubella
(HAV) (HBV) Hepatitis A & B (HPV) (MMR)

Brand name Vaqta, Havrix Recombivax-HB, Engerix-B Twinrix Gardasil, Gardasil-9 M-M-R-II

Indications Any person seeking protection
from HAV infection or persons
Please refer with the any of the following
to VIS or ACIP
indications:
immunization
1. Men who have sex with
schedule for
men
more complete
2. Use illegal drugs
indications.
3. Work with HAV- infected
primates or in HAV
laboratory setting
4. Have chronic liver disease
5. Receive clotting factor
concentrates
6. Traveling or working
in countries with high/
intermediate risk of HAV
7. Anticipate contact with
international adoptee
during first 60 days of
arrival to U.S.
Any person seeking protection
from HBV infection or persons
with any of the following
indications:
1. Sex partners have HBV
2. Sexually active and not in a
long-term relationship
3. Being treated for an STD
4. Share syringes, needles, or
drug injection equipment
5. Have household contact with
HBV-infected persons
6. At risk for exposure to blood
or body fluids
7. Traveling to locations with
high rates of HBV
8. Diabetes
Adults needing
both HAV and HBV
vaccinations
Use Twinrix for all 3
doses of series.
Females and males 9–26
years
Recommended age is
11–12 years; may give
at 9 years per provider’s
discretion.
Adults > 18 years who
1. Were born after 1957 and
not vaccinated as a child
2. Received inactivated
vaccine or unknown type
High-risk persons: college
students, health care
workers, military recruits, and
international travelers
Live vaccine: store frozen or
refrigerated; diluent: store
refrigerated or at room
temperature.

No. and schedule of 2 doses at months 0, 6–12 3 doses at months 0, 1, 6 3 doses at months 0, 2 or 3 doses at months 0, 1 or 2 doses at least 28 days
doses 1, 6 6 or 0, 2, 6 apart

Route of Intramuscular Intramuscular Intramuscular Intramuscular Subcutaneous

administration

Other pertinent • Soreness or redness at • Soreness or redness at Accelerated schedule • Soreness or redness at • Mild rash
information injection site injection site for those >18 years if injection site • Fever
• Low-grade fever • Low-grade fever needed: 0, 7, 21–30 • Low-grade fever • Swelling of glands in
• Headache days, 12-month booster • Headache cheek/neck
• Tiredness
Reconstitution required

References
CDC. Adult immunization schedule: United States, 2016. http://www.cdc.gov/vaccines/schedules/hcp/adult.html/. Atlanta, GA: CDC; 2016. Accessed July 25, 2016.
CDC. Vaccine information statements (VISs). http://www.cdc.gov/vaccines/hcp/vis/index.html/. Atlanta, GA: CDC; 2016. Accessed July 25, 2016.

6 Immunization Quick Reference Guide

INFLUENZA (FLU)
Brand names (manufacturer)
• Trivalent, inactivated standard dose
o Alfuria (bioCSL)
o Fluvirin (Novartis)
• Trivalent, inactivated, high dose
o Fluzone High-Dose (Sanofi Pasteur)
• Trivalent, recombinant, standard dose
o FluBlok (Protein Sciences)
• Trivalent, inactivate, with adjuvant
o Fluad (Seqirus)
• Quadrivalent, inactivated, standard dose
o Fluarix Quadrivalent (GlaxoSmithKline)
o FluLaval Quadrivalent (ID Biomedical Corp; distributed by GlaxoSmithKline)
o Fluzone Quadrivalent (Sanofi Pasteur)
o Fluzone Intradermal Quadrivalent (Sanofi Pasteur)
• Quadrivalent, cell culture–based, standard dose
o Flucelvax (Novartis)
• Quadrivalent, live
o FluMist (MedImmune)
−− Not recommended for 2016–2017 influenza season per ACIP

Dose and Route of Administration: Administered annually

Product Indicated age Dose and route of administration

Fluzone Quadrivalent ≥6 months 6–35 months: 1–2 doses 0.25 mL IM, 4 weeks apart for 2 doses

36 months–8 years: 1–2 doses 0.5 mL IM, 4 weeks apart for 2

doses

≥9 years: 0.5 mL IM

FluMist 2–49 years Not recommended by ACIP for 2016–2017 season

FluLaval Quadrivalent ≥3 years 3–8 years, no previous vaccine: 2 doses of 0.5 mL IM, 4 weeks
apart

3–8 years, vaccinated in previous season: 1–2 doses of 0.5 mL IM

>9 years: 0.5 mL IM

Fluarix Quadrivalent ≥3 years 3–8 years, no previous vaccine: 2 doses of 0.5 mL IM, 4 weeks
apart

3–8 years, vaccinated in previous season: 1–2 doses of 0.5 mL IM

>9 years: 0.5 mL IM

continued

7 Immunization Quick Reference Guide

Dose and Route of Administration: Administered annually (continued)
Product Indicated age Dose and route of administration

Flucelvax ≥4 years 4–8 years: 1–2 doses 0.5 mL IM, 4 weeks apart for 2 doses

≥9 years: 0.5 mL IM

Fluvirin ≥4 years 0.5 mL IM

Alfuria ≥9 years: via needle 0.5 mL IM

18–64 years: via jet

injectors

FluBlok ≥18 years 0.5 mL IM

Fluzone Quadrivalent Intradermal 18–64 years 0.1 mL intradermally

Fluad ≥65 years 0.5 mL IM

Fluzone High-Dose ≥65 years 0.5 mL IM

Adverse effects
• Injection site: pain, erythema, tenderness
• Systemic: irritability (children), myalgia, headache, fever
Storage
• Refrigerate at 35°F–46°F (2°C–8°C).
• Do not freeze.
Comments
• Annual vaccination against influenza is recommended for all persons ≥ 6 months.
• Persons ≥ 6 months, including pregnant women, can receive the inactivated influenza vaccine (IIV). An age-
appropriate IIV formulation should be used.
• High-dose IIV and Fluad are options for persons ≥ 65 years.
• Refer to CDC’s Pink Book at http://www.cdc.gov/vaccines/pubs/pinkbook/appendix/appdx-b.html for
components of vaccines (excipients, thimerosal, latex).
• Recombinant vaccine (RIV), which does not contain any egg protein, may be administered to persons ≥ 18 years
with egg allergy of any severity; IIV may be used with additional safety measures for persons with hives-only
allergy to eggs.
• Health care personnel who care for severely immunocompromised persons who require care in a protected
environment should receive IIV or RIV.

8 Immunization Quick Reference Guide

PNEUMOCOCCAL
Brand names (manufacturer)
• Inactivated, conjugated vaccine
o Prevnar 13 (Pfizer)
• Inactivated, polysaccharide vaccine
o Pneumovax 23 (Merck)

Dose and route of administration

Product Indicated age Dose and route of administration

Prevnar 13 (PCV-13) All children <5 years 6 weeks–5 years: 0.5 mL IM at 2, 4, 6, and 12–15 months

All adults ≥65 years 6–17 years: 0.5 mL single dose

All ≥6 years with risk ≥18 years: 0.5 mL single dose

factors

Pneumovax 23 (PPSV-23) All adults ≥65 years 0.5 mL IM or subcutaneously

2–64 years with high risk

of pneumococcal disease

• Adults > 65 years

o Vaccine naive
−− Give PCV-13 followed 1 year later by PPSV-23.
o If PPSV-23 vaccinated at ≥ 65 years
−− Give PCV-13 at least 1 year after PPSV-23.
o If PPSV-23 vaccinated younger than 65 years and are now ≥ 65 years
−− Give PCV-13 at age ≥ 65 years at least 1 year after PPSV-23.
−− Give second PPSV-23 6–12 months after PCV-13 if it has been ≥ 5 years since last PPSV-23 vaccine.
• High-risk patients
o 7–18 years, sickle cell anemia, asplenia, immunodeficiencies, HIV infection, immunosuppressive drugs,
leukemia
−− Never received PPSV-23 or PCV-13
♦♦ Give PCV-13.
♦♦ Give PPSV-23 ≥ 8 weeks after PCV-13, and revaccinate with another PPSV-23 in 5 years.
−− Previously received PCV-13
♦♦ Give PPSV-23 ≥ 8 weeks after most recent PCV-13, and revaccinate with another PPSV-23 in 5 years.
−− Previously received PPSV-23
♦♦ Give PCV-13 ≥ 8 weeks after most recent PPSV-23, and give with another PPSV-23 5 years after first
PPSV-23.
o 19–64 years
−− Chronic heart disease, chronic lung disease, chronic liver disease, asthma, diabetes, cigarette smoking
♦♦ Give 1 dose of PPSV-23; PCV-13 is not recommended until ≥ 65 years; revaccination with PPSV-23 is not
recommended until ≥ 65 years.
♦♦ At ≥ 65 years, follow recommendations above.

9 Immunization Quick Reference Guide

 −− Cochlear implants, cerebrospinal fluid leaks
♦♦ Give PCV-13.
♦♦ Give PPSV-23 ≥ 8 weeks after PCV-13. No additional pneumococcal recommended until ≥ 65 years.
♦♦ At ≥ 65 years, follow the ≥ 65 algorithms above.
−− Immunocompromised, asplenia, chronic renal failure, HIV infection, leukemia
♦♦ Never received PPSV-23 or PCV-13
• Give PCV-13.
• Give PPSV-23 ≥ 8 weeks after PCV-13, and revaccinate with another PPSV-23 in 5 years.
♦♦ Received only one PPSV-23 previously
• Give PCV-13 ≥ 1 year after PPSV-23.
• Revaccinate with PPSV-23 ≥ 8 weeks after PCV-13 and at least 5 years after first PPSV-23.
♦♦ Received two PPSV-23 previously
• Give PCV-13 ≥ 1 year after most recent PPSV-23.
• Give 1 more PPSV-23 at ≥ 65, and at least 5 years after last PPSV-23.
♦♦ Received PCV-13 previously
• Give PPSV-23 ≥ 8 weeks after PCV-13. Revaccinate with PPSV-23 in 5 years.

Adverse effects
• Injection site: erythema at injection site, pain at injection site
• Systemic: irritability (children), fatigue, fever

Storage
• Refrigerate at 35°F–46°F (2°C–8°C).
• Do not freeze.

Comments
• PCV-13 replaced PCV-7.
• PCV-13 approved for ≥ 50 years; ACIP recommends routine use for ≥ 65 years.
• CDC recommends only PPSV-23 for
o Adults ≥ 65 years
o Adults 19–64 years with asthma; diabetes; lung, heart, or liver disease; or alcoholism
o Cigarette smokers
o Residents of long-term or chronic care facilities (nursing homes)
o Alaska Native and American Indian adults 50–64 years where invasive disease is increased
• CDC recommends both PCV-13 and PPSV-23 for adults ≥ 19 years with
o Immunocompromising conditions (HIV, leukemia, chronic kidney disease, Hodgkin disease)
o Functional or anatomic asplenia
o Cochlear implants or cerebrospinal fluid leaks

10 Immunization Quick Reference Guide

MENINGOCOCCAL
Brand names (manufacturer)
• Meningococcal Serogroup Types A C Y W-135
o Conjugate (MenACWY or MCV4 – meningococcal 4-valent)
−− Menveo (Novartis)
−− Menactra (Sanofi Pasteur)
o Polysaccharide (MPSV4 – meningococcal 4-valent)
−− Menomune (Sanofi Pasteur) – only meningococcal vaccine given to adults ≥ 56 years
• Meningococcal Serogroup Type B
−− Bexsero (Novartis)
−− Trumenba (Pfizer)

Dose and Route of Administration:

MENINGOCOCCAL CONJUGATE VACCINE (MenACWY or MCV4)

Dose and route of

Product Indicated age administration Additional information

Menveo 2 months–55 years 0.5 mL IM Requires reconstitution; supplied in two vials

Routine recommendations:
• 11–12 years: MCV4 single
IM dose with booster dose
at 16 years
• First-year college students
aged 19–21 years who
live in residence halls and
have not been previously
vaccinated or who received
their first dose prior to age
16 years
Catch-up:
• 13–18 years: MCV4 single
IM dose if not previously
vaccinated
• If 1st dose at 13–15
years, booster dose at
16–18 years (with minimum
interval of 8 weeks)
• If 1st dose at ≥16 years, no
booster dose needed
that must be combined prior to administration.
Menveo is very difficult to reconstitute because it
may form a vacuum in the vial.
• Use a larger gauge Luer-Lok syringe (1 mL 20
g 1”; NDC 08290-3096-37) to withdraw the
diluent and inject into the powder vial.
• Shake well until the vaccine is dissolved.
• After reconstitution, it will have a clear,
colorless appearance.
• Withdraw the entire volume of the solution into
the Luer-Lok syringe. Tap the vial hard and
repeatedly to remove the vaccine.
• Unscrew needle from syringe when done, and
administer with a standard B-D Eclipse needle
for patient comfort.
• The solution is good for 8 hours after
reconstitution.

Adults with medical conditions

(HIV, asplenia): 2 doses at least
8 weeks apart

Menactra 9 months–55 years 0.5 mL IM; same schedule as Has clear to slightly turbid appearance
Menveo

11 Immunization Quick Reference Guide

 MENINGOCOCCAL POLYSACCHARIDE VACCINE (MPSV4)

Dose and route of

Product Indicated age administration Additional information

Menomune ≥2 years 1 dose 0.5 mL subcutaneously Supplied in two vials that must be combined prior
to administration
Preferred vaccine for adults
>55 years who require 1 dose Vial stoppers contain latex

Must be used within 30 minutes of reconstitution

MENINGOCOCCAL SEROGROUP TYPE B

Dose and route of

Product Indicated age administration Additional information

Bexsero 10–25 years 0.5 mL IM, 2 doses at least 1 The tip caps of prefilled syringes contain natural
month apart rubber latex.

Gently shake vaccine prior to administration.

Trumenba 10–25 years 0.5 mL IM, 3 doses at 0, 1–2, Gently shake vaccine prior to administration.
and 6 months
Routine administration for meningococcal
Newly approved schedule: vaccine, persons ≥10 years who are at increased
administer 2 doses 0 and 6 risk for serogroup B:
months apart. • Persons with persistent complement-
component deficiencies
• Persons with anatomic or functional asplenia
• Microbiologists routinely exposed to isolates of
N. meningitidis
• Persons identified to be at increased risk
because of serogroup B meningococcal
disease outbreak

May be administered to adolescents and young

adults 16–23 years (preferred age, 16–18 years) to
provide short-term protection against most strains
of serogroup B.

Adverse effects
• Injection site: erythema, pain
• Systemic: fatigue, nausea, headache, myalgia

Storage
• Menveo: Store vaccine and diluent at 35°F–46°F (2°C–8°C).
• Menactra: Store vaccine at 35°F–46°F (2°C–8°C).
• Menomune: Store vaccine and diluent at 35°F–46°F (2°C–8°C).
• Bexsero: Refrigerate at 2°C–8°C (36°F–46°F). Do not freeze, and protect from light.
• Trumenba: Store syringes horizontally, lying flat, and refrigerate at 2°C–8°C (36°F–46°F). Do not freeze.

12 Immunization Quick Reference Guide

HERPES ZOSTER (Shingles)
Brand name (manufacturer):
• Live attenuated vaccine:
o Zostavax (Merck)

Dose and Route of Administration:

Product Indicated age Dose and route of administration

Zostavax ≥60 years 0.65 mL (entire contents of vial) subcutaneously

Patient population
• FDA approved for prevention (not treatment) of adults ≥50 years. ACIP recommends that vaccination begin at
age 60 years.
• No specific ACIP or CDC recommendation for administration after an active case of shingles.
• No specific length of time that patient must wait after having shingles, but a general rule is to wait until
symptoms have resolved.

Additional information
• Zostavax may be administered with other indicated vaccines, including PPSV-23, during same visit,
• If simultaneous administration in not possible, administer Zostavax at any time before or after an inactivated
vaccine.
• Administer Zostavax at least 4 weeks before or after another live, attenuated vaccine (with oral typhoid, no time
lapse needed).

Adverse effects
• Injection site: redness, soreness, swelling, itching at the site of the injection
• Systemic: headache

Storage
• Prior to reconstitution, store lyophilized vaccine frozen between −50°C and 15°C (−58°F and 5°F); protect
from light. May use any freezer (including frost-free) as long as it has a separate sealed freezer door and the
temperature is reliably maintained between −50°C and −15°C (−58°F and 5°F). Use of dry ice may expose
vaccine to temperatures colder than −50°C (−58°F).
• Store the diluent separately at a room temperature of 20°C–25°C (68°F–77°F) or in the refrigerator at 2°C–8°C
(36°F–46°F).
• Reconstitute the lyophilized vaccine immediately after removing from freezer. Discard reconstituted vaccine if not
used within 30 minutes because it will lose potency. Do not freeze reconstituted vaccine.

13 Immunization Quick Reference Guide

Comments
• Immunocompromised persons: Do not administer zoster vaccines to persons with primary or acquired
immunodeficiency, after including
o Leukemia, lymphoma, or other malignant neoplasms affecting bone marrow or lymphatic system
−− Exception: patients with leukemia in remission and not receiving chemotherapy or radiation for at least 3
months can receive vaccine
−− AIDS or other clinical manifestation of HIV, including CD4+ ≤ 200 or ≤ 15% of total lymphocytes
• Persons undergoing immunosuppressive therapy
−− High-dose corticosteroid (≥ 20 mg/day of prednisone or equivalent) lasting 2 or more weeks. Zoster should
be deferred for at least 1 month after discontinuation of corticosteroid.
−− Short-term corticosteroid (< 14 days), low to moderate dose (< 20 mg/day of prednisone or equivalent),
topical, intra-articular, bursal, tendon injections, or long-term alternate-day treatment with low to moderate
doses of short-acting systemic corticosteroids are not considered immunosuppressive; persons receiving
this dose or schedule can receive zoster vaccine.
−− Low-dose methotrexate (< 0.4 mg/kg/week), azathioprine (< 3.0 mg/kg/day), or 6-mercaptopurine (<1.5
mg/kg/day) for treatment of rheumatoid arthritis, psoriasis, polymyositis, sarcoidosis, inflammatory bowel
disease, and other conditions are not a concern and are not contraindicated for administration of zoster
vaccine.
• Clinical or laboratory evidence or other unspecific cellular immunodeficiency. Persons with impaired humoral
immunity can receive zoster vaccine.
• Persons undergoing hematopoietic stem cell transplant. Physicians should assess the immune status of zoster
vaccine; the vaccine should be administered at least 24 months after transplantation.
• Persons receiving recombinant human immune mediators and immune modulators, especially the antitumor
necrosis factor agents adalimumab, infliximab, and entercept. Safety and efficacy of zoster vaccine administered
concurrently with these agents is unknown. If not possible to administer vaccine before initiation of therapy,
physicians should assess immune status of recipient. Vaccination should be deferred for at least 1 month after
discontinuation of such therapy.

14 Immunization Quick Reference Guide

VARICELLA (Chicken Pox)
Brand name (manufacturer)
• Live, attenuated vaccine
o Varivax (Merck)

Dose and route of administration

Dose and route of
Product Indicated age administration Additional information

Varivax ≥12 months 0.5 mL subcutaneously
2-dose series for children
12–15 months and 4–6 years;
minimal interval between
varicella doses is 3 months if
<13 years
2-dose series for ≥ 13 years: 2
doses at least 4 weeks apart
(if extended interval between
1st and 2nd dose, no need to
repeat 1st dose)
Routine vaccination at 12–15 months regardless
of prior history of varicella.
Administer to all persons ≥13 years without
evidence of varicella immunity.
ACIP strongly recommends Varivax to be
administered with other recommended vaccines
at 12–15 months.
If simultaneous administration is not possible,
administer Varivax at any time before or after an
inactivated vaccine.
Administer Varivax at least 4 weeks before or
after another live, attenuated vaccine (with oral
typhoid, no time lapse needed).

• Indication
o FDA approved for prevention (not treatment) of varicella in individuals ≥ 12 months

Adverse effects
• Injection site: redness, soreness, swelling, itching at the injection site
• Systemic: fever (≥ 102°F, 1–12 years; ≥ 100°F, ≥ 13 years), mild rash

Storage
• Prior to reconstitution, store lyophilized vaccine in freezer between –58°F and +5°F (–50°C and –15°C).
• Before reconstitution, protect from light.
• May be stored at refrigerator temperature (36°F–46°F, 2°C–8°C) for up to 72 continuous hours prior to
reconstitution. Vaccine stored at 36°F–46°F (2°C–8°C) that is not used within 72 hours of removal from +5°F
(–15°C) storage should be discarded.
• Store diluent separately at room temperature (68°F–77°F, 20°C–25°C) or in the refrigerator.

Comments
• Duration of protection from a varicella infection after vaccination is unknown.
• Contraindications: allergy to gelatin or neomycin or reaction to a previous vaccine, pregnancy, primary or
acquired immunodeficiency states, any febrile illness or active infection (including untreated tuberculosis)
• Precautions
o Avoid vaccinating persons with moderate or severe acute illness until they recover
o Persons with moderate or severe cellular immunodeficiency resulting from HIV, including those with AIDS,

15 Immunization Quick Reference Guide

 should not receive varicella vaccine.
o Women of childbearing years should avoid pregnancy for 3 months after vaccine.
o Avoid use of salicylates for 6 weeks following administration of Varivax to children and adolescents because of
risk of Reye’s syndrome during wild-type varicella infections.
o Administration of blood products (whole blood, packed red blood cells) and varicella vaccine should be
separated by 3–11 months after receipt of antibody-containing blood products.
o Persons with immunosuppression due to leukemia, lymphoma, generalized malignancy, or
immunosuppressive therapy should not receive varicella vaccine.
• Not considered contraindications
o HIV-infected children with CD4 T-lymphocyte percentage of 15% or higher and older children and adults with
a CD4 count of 200 per microliter or higher
−− May receive single-antigen varicella vaccines but not combination MMR + varicella vaccine (ProQuad)
o Low-dose (< 2 mg/kg/day), alternate day, topical, replacement, inhaled steroid products, and steroid therapy
discontinued for 1 month
o Chemotherapy discontinued for 3 months
• Reconstitution required
o Reconstitute lyophilized vaccine immediately after removing from the freezer. Discard reconstituted vaccine if
not used within 30 minutes due to loss of potency. Do not freeze reconstituted vaccine.
o When reconstituted, the vaccine is a clear, colorless to pale yellow liquid.

16 Immunization Quick Reference Guide

TETANUS, DIPHTHERIA TOXOID and
ACELLULAR PERTUSSIS (Tdap)
Brand names (manufacturer)
• Boostrix (GlaxoSmithKline)
• Adacel (Sanofi Pasteur)

Dose and route of administration:

Dose and route of
Product Indicated age administration Additional information

Adacel 10–64 years 0.5 mL IM Shake well before use.

Contents should be white and opaque.

Boostrix ≥10 years 0.5 mL IM
Tip caps of prefilled syringes may contain latex.

• Typical dosage by age

o Adolescents 11–12 years: 1 dose of Tdap
o Adolescents 11–18 years who have not received Tdap: 1 dose followed by a Td booster dose every 10 years
thereafter
o Adults: substitute 1 dose of Tdap for Td booster, then boost with Td every 10 years.
• Additional Tdap indications
o Children 7–10 years who are not fully vaccinated against pertussis
o Adults with unknown or incomplete history of completing a 3-dose primary series with Td vaccines should
begin or complete a primary series, including a Tdap dose.
o Adults ≥ 65 years who have or anticipate having close contact with an infant < 12 months.
o All pregnant women
−− One dose of Tdap vaccine during each pregnancy regardless of interval since prior Td or Tdap vaccination
−− Optimal time for administration is between 27 and 36 weeks gestation, although Tdap may be given at any
time during pregnancy
−− Wound management

Adverse effects
• Adacel
o Injection site: pain, swelling, erythema
o Systemic: headache, body ache or muscle weakness
• Boostrix
o 10–18 years: increase in arm circumference of injected arm
o 10–64 years: pain, redness, swelling at injection site, headache, fatigue, gastrointestinal symptoms
o ≥ 65 years: pain at injection site

Storage
• Refrigerate at 35°F–46°F (2°C–8°C).
• Do not freeze.

17 Immunization Quick Reference Guide

HEPATITIS A
Brand names (manufacturer):
• Inactivated vaccines:
o Havrix (Glaxo Smith Kline)– prefilled syringes may contain latex, preservative free
o Vaqta (Merck)

Dose and route of administration

Dose and route of
Product Indicated age administration Additional information

Havrix (720 EL. U) 1–18 years 0.5 mL IM at 0, 6–12 months Series should be completed with same product. If
Pediatric original product is unknown or unavailable, series
Formulation may be completed with another brand.

Havrix (1440 EL. U) ≥19 years 1 mL IM at 0, 6–12 months

Adult Formulation

Vaqta (25 U) 1–18 years 0.5 mL IM at 0, 6–18 months

Pediatric
Formulation

Vaqta (50 U) ≥19 years 1 mL IM at 0, 6–18 months

Adult Formulation

• Indications
o Men who have sex with men
o Persons who use injection or non-injection illicit drugs
o Persons travelling to or working in countries that have high or immediate endemicity of HAV
o Persons working with HAV-infected primates or with HAV in a research setting
o Persons with chronic liver disease and persons who receive clotting factor concentrates
o Unvaccinated persons who anticipate close contact with an international adoptee during the first 60 days after
arrival in the U.S. from a country with high or intermediate endemicity
o Catch-up for children: minimum age is 12 months

Adverse effects
• Injection site: pain, erythema, swelling
• Systemic: malaise, fatigue, low-grade fever

Storage
• Refrigerate at 35°F–46°F (2°C–8°C).
• Do not freeze.

18 Immunization Quick Reference Guide

HEPATITIS B
Brand names (manufacturer)
• Inactivated vaccines
o Recombivax HB (Merck)
o Enerix B (GlaxoSmithKline)

Dose and route of administration

Dose and route of
Product Indicated age administration Additional information

Recombivax HB 0–19 years 0.5 mL IM, 3-dose series at 0, Vaccination series started with one brand may be
(5 mg) Pediatric/ 1, 6 months completed with another brand.
Adolescent
Both vaccines are preservative free.
Formulation
An accelerated series can be performed for the
Recombivax HB 11–15 years 1 mL IM, 2-dose series at traveler in immediate need of vaccination by
(10 µg) Adult administering at 0, 1, and 2 months with booster
(accelerated) 0, 4–6 months at 12 months.
Formulation

Recombivax HB ≥20 years 1 mL IM, 3-dose series at

(10 µg) Adult
0, 1, 6 months
Formulation

Recombivax HB ≥20 years 1 mL IM, 3-dose series at

(40 µg) Dialysis
0, 1, 6 months
Formulation

Engerix B (10 µg) 0–19 years 0.5 mL IM, 3-dose series at 0,

1, 6 months

Engerix B (20 µg) ≥20 years 1 mL IM, 3-dose series at 0, 1,

6 months

Engerix B (20 µg) ≥20 years 2 mL IM, 4-dose series at 0, 1,

2, 6 months
Adult patients on
dialysis

• Indications
o Sexually active persons who are not in monogamous relationships
o Injection drug users
o Men who have sex with men
o Health care and public safety workers
o International travelers
o Persons with end-stage renal disease or chronic liver disease
o Persons with HIV infection
o Immunocompromised persons
o Persons with diabetes
o Unvaccinated adults 19–59 years with diabetes; at clinician’s discretion > 60 years.

19 Immunization Quick Reference Guide

Adverse effects
• Recombivax HB
o Injection site: pain
o Systemic: irritability, fever, diarrhea, fatigue/weakness, diminished appetite, rhinitis
• Engerix B
o Injection site: Soreness, pain
o Systemic: fatigue

Storage
• Refrigerate at 35°F–46°F (2°C–8°C).
• Do not freeze.

20 Immunization Quick Reference Guide

HEPATITIS A & B
Brand name (manufacturer)
• Inactivated vaccine
o Twinrix (HAV and HBV vaccine; GlaxoSmithKline)

Dose and route of administration

Dose and route of
Product Indicated age Administration Additional information

Twinrix (HAV and ≥18 years 1 mL IM at 0, 1, 6 months Accelerated dosing schedule: 0, 7, 21–30 days
HBV vaccine) and booster dose 12 months after 1st dose

Prefilled syringe tip cap contains latex, but vial

stoppers are latex free.

Gently shake the vaccine before withdrawal and

use.

Adverse effects
• Injection site: soreness, redness
• Systemic: headache, fatigue

Storage
• Refrigerate at 35°F–46°F (2°C–8°C).
• Do not freeze.

Comments
• Combination of Havrix and Engerix
• Covers both Hepatitis A and B
• For adults ≥ 18 years

21 Immunization Quick Reference Guide

HUMAN PAPILLOMAVIRUS (HPV)
Brand names (manufacturer)
• Inactivated quadrivalent vaccine
o Gardasil 4 (HPV4; Merck) – withdrawn from market at end of 2016
• Inactivated 9-valent vaccine
o Gardasil 9 (HPV9; Merck)
• Inactivated bivalent vaccine
o Cervarix (GlaxoSmithKline) – withdrawn from market at end of 2016

Dose and route of administration

Dose and route of
Product Indicated age administration Additional information

Gardasil 9 (HPV9) 9–26 years 0.5 mL IM Preservative free.

(types 6, 11, 16, 18, 2-dose regimen (9–14 years) at Shake vaccine well prior to withdrawal and
31, 33, 45, 52, 58) 0, 6–12 months* administration.

3-dose regimen (9–14 years) at If started series with another product may
0, 2, 6 months complete with this product.

3-dose regimen (15–26 years) Observe patients for 15 minutes after

at 0, 2, 6 months administration for possible syncopal events.

*CDC recommendation as of 10/19/2016: If 2nd dose is administered earlier than 5 months after 1st dose,
administer a 3rd dose at least 4 months after 2nd dose.
• Indications
o For prophylaxis only, not for treatment
o Vaccination should be initiated to all adolescents aged 11–12 years but can be administered as young
as 9 years
o Patients who have not been previously vaccinated or have not completed vaccine series should be
vaccinated, including
o Females up to age 26 years
o Males up to age 26 years
o Men who have sex with men through age 26 years

Adverse effects
• Cervarix (HPV2)
o Injection site: pain, redness, swelling
o Systemic: fatigue, headache, myalgia, gastrointestinal symptoms, arthralgia
• Gardasil (HPV4)
o Injection site: pain, swelling, erythema, pruritus, bruising
o Systemic: headache, fever, nausea, dizziness
• Gardasil 9 (HPV9)
o Female
−− Injection site: pain, swelling, erythema

22 Immunization Quick Reference Guide

 −− Systemic: headache
o Male
−− Injection site: pain, swelling, erythema

Storage
• Refrigerate at 35°F–46°F (2°C–8°C).
• Do not freeze.

Comments
• If vaccine schedule is interrupted, the vaccination series does not need to be restarted.
o If vaccination series started with Cervarix or Gardasil 4, Gardasil 9 may be used to continue or complete a
series. Intervals between doses remain the same regardless of the vaccine used to complete the series.
• Counsel women to continue cervical cancer screenings per standard of care.
• Recipients of vaccine should continue anal cancer screenings, if recommended by provider.

23 Immunization Quick Reference Guide

MEASLES, MUMPS, RUBELLA (MMR)
Brand name (manufacturer)
• Live vaccine
o MMR-II (Merck)

Dose and route of administration

Dose and route of
Product Indicated age administration Additional information

MMR-II ≥12 months 0.5 mL subcutaneously Advise women of childbearing age not to become pregnant
for 3 months after vaccination.
2-dose series for children
12–15 months and 4–6 Can be given on same day as other live vaccines. If not
years administered on same day, vaccines must be separated by >
28 days.

PPD tests: If tuberculin skin test (TST) is to be done,

administer vaccine 48 hours after. If vaccine has been
administered before TST screening, then TST screening
should be delayed at least 28 days after vaccination.

Vaccine must be reconstituted with sterile diluent supplied

with the vaccine.

Use the vaccine as soon as possible after reconstitution.

Store reconstituted vaccine in the vaccine vial in dark place at
36°F–46°F (2°C– 8°C), and discard if not used within 8 hours.

Adverse effects
• Injection site: redness, stinging, burning, pain
• Systemic: fever, diarrhea, nausea

Storage
• Refrigerate at 35°F–46°F (2°C–8°C).
• Store diluent refrigerated or at room temperature.

Comments
• Adults born before 1957 are considered immune.
• Adults born after 1957 or later without documented evidence of immunity should receive at least one dose of
vaccine.
• High-risk groups: health care workers, college students, international travelers, women of childbearing age
without evidence of immunity/vaccination
• Catch-up vaccination
o Ensure all school-aged children and adolescences have had 2 doses of MMR; minimum interval between the 2
doses is 4 weeks.
• Contraindications: allergy to gelatin or neomycin, pregnancy, immunosuppression, receipt of blood products
• Women of childbearing age should avoid pregnancy for 3 months after vaccine. Severely immunocompromised
individuals should not receive MMR.

24 Immunization Quick Reference Guide

 2016 Recommended Immunizations for Children from Birth Through 6 Years Old

1 2 4 6 12 15 18 19–23 2–3 4–6

Birth month months months months months months months months years years
HepB HepB HepB
RV RV RV
DTaP DTaP DTaP DTaP DTaP
Hib Hib Hib Hib
Is your family PCV PCV PCV PCV
growing? To protect
your new baby and
yourself against whooping
IPV IPV IPV IPV
cough, get a Tdap vaccine
in the third trimester Influenza (Yearly)*
of each pregnancy. Talk
to your doctor for more MMR MMR

details.
Varicella Varicella

Shaded boxes indicate the

vaccine can be given during
shown age range.
HepA§

See back page

NOTE: If your child misses a shot,
you don’t need to start over,
just go back to your child’s
doctor for the next shot.
Talk with your child’s doctor
if you have questions
about vaccines.
FOOTNOTES: * Two doses given at least four weeks apart are recommended for children aged 6 months through 8 years of
age who are getting an influenza (flu) vaccine for the first time and for some other children in this age group. for more
§ Two doses of HepA vaccine are needed for lasting protection. The first dose of HepA vaccine should be information on
given between 12 months and 23 months of age. The second dose should be given 6 to 18 months later. vaccine­
HepA vaccination may be given to any child 12 months and older to protect against HepA. Children and preventable
adolescents who did not receive the HepA vaccine and are at high-risk, should be vaccinated against HepA. diseases and the
If your child has any medical conditions that put him at risk for infection or is traveling outside the vaccines that
United States, talk to your child’s doctor about additional vaccines that he may need. prevent them.

For more information, call toll free

1-800-CDC-INFO (1-800-232-4636)
or visit
http://www.cdc.gov/vaccines

Reference
CDC. Vaccines & Immunizations. Atlanta, GA: CDC; 2016. http://www.cdc.gov/vaccines/. Accessed January 12, 2016.

25 Immunization Quick Reference Guide

 INFORMATION FOR PARENTS 2016 Recommended Immunizations for Children 7-18 Years Old

Talk to your child’s doctor or nurse about the vaccines recommended for their age.
Tdap Meningococcal MMR
HPV
Flu Tetanus, Inactivated Measles, Chickenpox
Human Pneumococcal Hepatitis B Hepatitis A
Influenza diphtheria, MenACWY MenB Polio mumps, Varicella
papillomavirus
pertussis rubella

7-8 Years

9-10 Years

11-12 Years

13-15 Years

16-18 Years

More Preteens and teens Preteens and teens Both girls and boys All 11-12 year Teens, 16-18
information: should get a flu should get one should receive olds should be years old, may be
vaccine every year. shot of Tdap at age 3 doses of HPV vaccinated with vaccinated with a
11 or 12 years. vaccine to protect a single dose of MenB vaccine.
against HPV- a quadrivalent
related disease. meningococcal
HPV vaccination conjugate vaccine
can start as early as (MenACWY). A
age 9 years. booster shot is
recommended at
age 16.

These shaded boxes indicate when the vaccine is These shaded boxes indicate the vaccine should be
recommended for all children unless your doctor tells given if a child is catching-up on missed vaccines.
you that your child cannot safely receive the vaccine.

These shaded boxes indicate the vaccine is
recommended for children with certain health or
lifestyle conditions that put them at an increased risk for
serious diseases. See vaccine-specific recommendations
at www.cdc.gov/vaccines/hcp/acip-recs/index.html
This shaded box indicates the vaccine is recommended
for children not at increased risk but who wish to get
the vaccine after speaking to a provider.

Reference
CDC. Vaccines & Immunizations. Atlanta, GA: CDC; 2016. http://www.cdc.gov/vaccines/. Accessed January 12, 2016.

26 Immunization Quick Reference Guide

 INFORMATION FOR ADULT PATIENTS 2016 Recommended Immunizations for Adults: By Age

If you are
this age, talk to your healthcare professional about these vaccines
Flu Td/Tdap Shingles Pneumococcal Meningococcal MMR HPV Chickenpox Hepatitis A Hepatitis B Hib
Influenza Tetanus, Zoster Measles, Human papillomavirus Varicella Haemophilus
diphtheria, mumps, influenzae
pertussis MenACWY rubella type b
PCV13 PPSV23 MenB for women for men
or MPSV4

19 - 21 years

22 - 26 years

27 - 49 years

50 - 59 years

60 - 64 years

1 or 2
65+ year doses

More You should You should You should You should get 1 dose of PCV13 You should get this vaccine if you did not get it when you were a child.
get flu vaccine get a Td get shingles and at least 1 dose of PPSV23
Information: every year. booster every vaccine even depending on your age and You should get HPV vaccine if
10 years. You if you have health condition. you are a woman through age
also need had shingles 26 years or a man through age
1 dose of before. 21 years and did not already
Tdap. Women complete the series.
should get a
Tdap vaccine
during every
pregnancy to
protect the
baby.

For more information, call 1-800-CDC-INFO

(1-800-232-4636) or visit www.cdc.gov/vaccines
Recommended For You: This vaccine is
recommended for you unless your healthcare If you are traveling outside the United States, you
professional tells you that you cannot safely receive
it or that you do not need it. may need additional vaccines.
May Be Recommended For You: This vaccine
Ask your healthcare professional about which vaccines
is recommended for you if you have certain risk you may need at least 6 weeks before you travel.
factors due to your health, job, or lifestyle that are
not listed here. Talk to your healthcare professional
to see if you need this vaccine.

CS262412

Reference
CDC. Vaccines & Immunizations. Atlanta, GA: CDC; 2016. http://www.cdc.gov/vaccines/. Accessed January 12, 2016.

27 Immunization Quick Reference Guide

 INFORMATION FOR ADULT PATIENTS 2016 Recommended Immunizations for Adults: By Health Condition
If you have
this health
condition, talk to your healthcare professional about these vaccines
Flu Td/Tdap Shingles Pneumococcal Meningococcal MMR HPV Chickenpox Hepatitis A Hepatitis B Hib
Influenza Tetanus, Zoster Measles, Human papillomavirus Varicella Haemophilus
diphtheria, mumps, influenzae
pertussis MenACWY rubella type b
PCV13 PPSV23 MenB for women for men
or MPSV4

Pregnancy

Weakened SHOULD SHOULD SHOULD

NOT GET NOT GET NOT GET
Immune System VACCINE VACCINE VACCINE

HIV: CD4 count

less than 200
HIV: CD4 count
200 or greater

Kidney disease
or poor kidney
function

Asplenia (if you

do not have a
spleen or if it does
not work well)
Heart disease
Chronic lung
disease
Chronic
alcoholism
Diabetes
(Type 1 or Type 2)
Chronic Liver
Disease

More You should You should get You should You should get 1 dose of PCV13 You should get this vaccine if you did not get it when you were a child. You should get
get flu vaccine a Td booster get shingles and at least 1 dose of PPSV23 Hib vaccine
Information: every year. every 10 years. vaccine if depending on your age and You should get HPV vaccine if if you do not
You also need you are age health condition. you are a woman through age have a spleen,
1 dose of 60 years or 26 years or a man through age have sickle
Tdap vaccine. older, even 21 years and did not already cell disease,
Women if you have complete the series. or received a
should get had shingles bone marrow
Tdap vaccine before. transplant.
during every
pregnancy. For more information, call 1-800-CDC-INFO
(1-800-232-4636) or visit www.cdc.gov/vaccines

Recommended For You: This vaccine
is recommended for you unless your
healthcare professional tells you that you
cannot safely receive it or that you do not
need it.
May Be Recommended For You: This YOU SHOULD NOT GET THIS VACCINE
vaccine is recommended for you if you have
certain other risk factors due to your age,
health, job, or lifestyle that are not listed
here. Talk to your healthcare professional to
see if you need this vaccine.
CS262412

Reference
CDC. Vaccines & Immunizations. Atlanta, GA: CDC; 2016. http://www.cdc.gov/vaccines/. Accessed January 12, 2016.

28 Immunization Quick Reference Guide

AUTHORS
Created and updated by members of the APhA Immunizing Pharmacists Special Interest Group (SIG)

Monali Majmudar, PharmD

Pharmacy Manager and Area 81 Immunization Lead
Walgreens Boots Alliance

Sheila Seed, PharmD, MPH

Professor of Pharmacy Practice
MCPHS University

Genevieve Levans, PharmD, MBA

Associate Director of Pharmacy
Hospital of the University of Pennsylvania

Jamie Remines, PharmD

District C Patient Care Coordinator
Kroger Mid-Atlantic

Jennifer Wilson, PharmD, BCACP

Assistant Professor of Pharmacy
Wingate University

Nicole Gattas, PharmD, BCPS, FAPhA

Associate Professor, Pharmacy Practice
St. Louis College of Pharmacy

Jennifer Borden
PharmD Candidate 2017
Shenandoah University

Brittany Hayes
PharmD Candidate 2017
Belmont University

Lindsay Kunkle, PharmD

Director, Practice & Science Affairs
American Pharmacists Association

Last updated: October 25, 2016

29 Immunization Quick Reference Guide

30 Immunization Quick Reference Guide