Adult Immunisation Schedule Guide
The adult schedule for India, stratified by the risks this patient carries · v1.8- Enter the age band, the sex, whether she is pregnant or planning a pregnancy, and every comorbidity the patient carries.
- You get the vaccines indicated for that risk profile, with doses and intervals, following the API consensus for India alongside WHO and ACIP.
- Read its list against what the patient has already had, because it takes no vaccination history.
- Check whether a vaccine is live before it is drawn up for a pregnant or immunocompromised patient. The Evidence tab carries the list.
- Anyone below 19 years, and the childhood and adolescent schedule.
- Travel vaccination, and anything a yellow fever certificate requires.
- Post-exposure prophylaxis after an animal bite, a contaminated wound or an occupational exposure.
- The patient's existing vaccination history, which it neither asks for nor can see.
1. Age Group
2. Biological Sex
3. Pregnant or Planning Pregnancy? ?
4. Comorbidities & Risk Factors ?
Evidence and Practice Points
1. The Tetanus Toxoid (TT) Practice Advisory
Avoid Standalone TT: In India, there is a widespread unsafe practice of prescribing standalone Tetanus Toxoid (TT) for wound management or during pregnancy. Why it changed: adult immunity against diphtheria wanes, and what protection remains rests on herd immunity, so the Government of India replaced TT with Td (Tetanus and adult-dose Diphtheria) in the National Immunisation Schedule in 2018-19. Prescribe Td or Tdap. Never standalone TT.
2. Which Vaccines Are Live, and Who Must Not Have Them
A live attenuated vaccine can replicate in a host who cannot contain it. That is why they are strictly contraindicated in pregnant women, where the organism can cross the placenta, and in severely immunocompromised patients.
Mnemonic: "Be A VIP, MMR!"
BCG
Adenovirus (oral)
Varicella
Influenza (LAIV - Intranasal only)
Polio (OPV - Oral)
Measles, Mumps, Rubella (MMR)
*Also includes Yellow Fever and Zoster (ZVL/Zostavax).
BCG
Adenovirus (oral)
Varicella
Influenza (LAIV - Intranasal only)
Polio (OPV - Oral)
Measles, Mumps, Rubella (MMR)
*Also includes Yellow Fever and Zoster (ZVL/Zostavax).
3. Why Adult Immunisation Matters in India
- Immunosenescence: Innate and adaptive immune function declines with age. That raises both the susceptibility of older adults to influenza, pneumococcal disease and herpes zoster, and the mortality once they have them.
- Comorbidity Burden: Diabetes, CKD and COPD are all rising in India, and each leaves a patient less able to withstand a respiratory infection. For those patients vaccination is part of treating the underlying condition.
- AMR Stewardship: Viral vaccines (like Influenza) prevent secondary bacterial pneumonias, directly reducing unnecessary empirical broad-spectrum antibiotic prescriptions.
4. Pneumococcal Strategy
Practice advisory, spacing: Never give PCV and PPSV23 at the same time. ACIP's stated reason is that co-administration studies found a lower antibody response than when the two are spaced. Space them as set out below.
What API 2026 changed: PCV20 is now the preferred single-dose pneumococcal vaccine. It covers 7 additional serotypes compared to PCV13, eliminating the need for the older, sequential PCV13 → (wait 1 year) → PPSV23 approach, which suffered from high drop-out rates and polysaccharide-induced hyporesponsiveness.
5. Herpes Zoster (Shingles) Vaccination
| Vaccine Type | Pathophysiology & Recommendation |
|---|---|
| RZV (Shingrix) Recommended |
Recombinant glycoprotein E antigen with AS01B adjuvant. Non-live. Safe in immunocompromised patients. Recommended for ALL adults ≥50 years, and immunocompromised ≥18 years. |
| ZVL (Zostavax) Obsolete |
Live-attenuated virus. Contraindicated in immunosuppression. Waning efficacy. No longer recommended by API or CDC. |
6. Vaccination in Pregnancy
Two patients, one injection. Influenza protects the mother from severe disease; Tdap protects the newborn, through IgG that crosses the placenta before a baby can make any antibody of its own.
| Status | Vaccines |
|---|---|
| STRONGLY RECOMMENDED | Tdap: 27-36 weeks, in EACH pregnancy to maximise transplacental pertussis antibodies. Inactivated Influenza: Any trimester. |
| USE IF INDICATED | Hepatitis B (if at risk and unvaccinated); Pneumococcal. |
| CONTRAINDICATED | Live Vaccines (MMR, Varicella, LAIV, BCG, Yellow Fever). Wait at least 4 weeks after a live vaccine before conceiving. HPV is deferred until after delivery. It is a recombinant vaccine, not a live one, and no action is needed if a dose was given before the pregnancy was known. |
7. What This Tool Does Not Print
- A serological check after any vaccine but hepatitis B. The result names an anti-HBs target after that series and no titre for anything else.
- An Indian recommendation for RSV vaccine. The result names the ACIP position and says to check availability here.
- What to do when a live vaccine has been given in a pregnancy not yet known. The HPV line in section 6 does not extend to MMR or varicella.
Abbreviations: AIDS (Acquired Immunodeficiency Syndrome) · AMR (Antimicrobial Resistance) · ACIP (Advisory Committee on Immunization Practices) · anti-HBs (Antibody to Hepatitis B Surface Antigen) · API (Association of Physicians of India) · BCG (Bacille Calmette-Guérin) · CDC (Centers for Disease Control and Prevention) · CHF (Congestive Heart Failure) · CKD (Chronic Kidney Disease) · CLD (Chronic Liver Disease) · COPD (Chronic Obstructive Pulmonary Disease) · DM (Diabetes Mellitus) · HCW (Healthcare Worker) · HepA/B (Hepatitis A/B) · Hib (Haemophilus influenzae type b) · HIV (Human Immunodeficiency Virus) · HPV (Human Papillomavirus) · IgG (Immunoglobulin G) · IIV (Inactivated Influenza Vaccine) · IIV4 (Quadrivalent Inactivated Influenza Vaccine) · IM (Intramuscular) · LAIV (Live Attenuated Influenza Vaccine) · MenACWY (Meningococcal Vaccine Against Serogroups A, C, W and Y) · MMR (Measles, Mumps, Rubella) · MSM (Men Who Have Sex With Men) · NIS (National Immunization Schedule) · OPV (Oral Polio Vaccine) · PCV (Pneumococcal Conjugate Vaccine) · PCV13 (13-Valent Pneumococcal Conjugate Vaccine) · PCV15 (15-Valent Pneumococcal Conjugate Vaccine) · PCV20 (20-Valent Pneumococcal Conjugate Vaccine) · PPSV23 (23-Valent Pneumococcal Polysaccharide Vaccine) · RSV (Respiratory Syncytial Virus) · RZV (Recombinant Zoster Vaccine) · SC (Subcutaneous) · Td (Tetanus and adult Diphtheria) · Tdap (Tetanus, Diphtheria and acellular Pertussis) · TT (Tetanus Toxoid) · ZVL (Zoster Vaccine Live)
References
- Association of Physicians of India (API). Indian Consensus Guidelines on Adult Immunization, 2026 Update. API; 2026.
- Dhawan AM, Desai A, Gvalani A, Anand S, Das P. A comprehensive review of the latest Indian guidelines on adult immunization. Int J Community Med Public Health. 2025;12(2):1159-1165.
- Centers for Disease Control and Prevention (CDC). Adult Immunization Schedule by Age. ACIP; Updated 2026.
- Giriappa B, Choraria N, Ponce P, et al. Immunogenicity and safety of 20-valent PCV (PCV20) in adults ≥18 y of age in India. Hum Vaccin Immunother. 2026;22(1):2605847.
- World Health Organization. WHO Recommendations for Routine Immunization: Summary Tables. Geneva: WHO; 2023.
How to Cite This Tool
DOIhttps://doi.org/10.5281/zenodo.22401539
AMA Style:Umakanth S. Adult Immunisation Schedule Guide. Version 1.8. MEDiscuss Clinical Decision Support System. Published 2026. Accessed . https://mediscuss.org/cdss/adult-immunization. doi:10.5281/zenodo.22401539
Vancouver Style:Umakanth S. Adult Immunisation Schedule Guide [Internet]. Version 1.8. MEDiscuss.org; 2026 [cited ]. Available from: https://mediscuss.org/cdss/adult-immunization. doi:10.5281/zenodo.22401539
Save this calculation
Whatever you type here stays on this device and is not sent anywhere. The server receives only a scrambled code made from it, so nobody with access to the server can tell which patient a saved calculation belongs to. Enter the same nickname the next time to see that patient's earlier values. What is stored
Category Immunisation & ProphylaxisGuide
Specialties Internal Medicine, Immunology
Status Essential