Immunization of adults: Canadian Immunization Guide

For health professionals

Last complete chapter revision: August 2026

This chapter was updated based on the following statements from the National Advisory Committee on Immunization (NACI):

• April 10, 2026: Updated guidance on respiratory syncytial virus (RSV) vaccines for older adults and for adults at high risk of severe RSV disease [PDF]
• June 4, 2025: Updated recommendations on measles post-exposure prophylaxis
• May 15, 2025: NACI rapid response: Updated guidance on the use of Imvamune^® for the prevention of mpox [PDF]
• May 14, 2025: Updated recommendations on Herpes Zoster vaccination for adults who are immunocompromised [PDF]
• November 15, 2024: Recommendations on the use of pneumococcal vaccines in adults, including PNEU-C-21
• May 24, 2024: Interim guidance on the use of Imvamune^® in the context of a routine immunization program

Additionally, a new section on COVID-19 vaccine has been added, with a corresponding row in Table 1.

This information is captured in the table of updates.

On this page

• Introduction
• Health care provider responsibilities
• Strategies to improve vaccine uptake in adults
• Recommended immunization for adults
  • Table 1: Adult immunization - recommendations for routine immunization in healthy adults at low risk
• Chapter revision process
• Acknowledgements
• Selected references

Please note: The Public Health Agency of Canada (PHAC) recognizes that not all people giving birth or breastfeeding will identify as women or mothers. The writing in this chapter uses a gender additive approach where the term "woman" is used alongside gender neutral language. This is intended to demonstrate a commitment to redress the historic exclusion of trans and non-binary people, whilst avoiding the risk of marginalizing or erasing the experience of women within the health care environment. However, in line with best practice, it is recognized that when discussing or caring for individuals in a one-on-one capacity, language and documentation should reflect the gender identity of the individual. Finally, PHAC acknowledges the dynamic nature of language. It is likely that language deemed to be suitable or affirming in one context may not translate across others, and over the coming years will likely change and evolve with respect to appropriate representations.

Introduction

Prevention of infection by immunization is not just for children; adults require immunization to restore waning immunity against some vaccine preventable diseases and to establish immunity against other diseases that are more common in adults. In addition, immunization of adults prevents infection and, therefore, subsequent exposure of young children and others at increased risk of vaccine preventable diseases. For example, adults who are in contact with infants should be prioritized to receive pertussis and influenza vaccination to reduce the risk of transmission of these infections to infants who are too young to be fully protected. Some vaccines are needed by all adults and other vaccines may be required due to individual risk resulting from occupation, travel, underlying illness, lifestyle or age.

Despite vaccine recommendations for adults, the vaccination rates of adults in Canada are low, with the result that many adults remain vulnerable to vaccine preventable diseases.

Common reasons for incomplete immunization in adulthood include:

• lack of recognition of the importance of adult immunization
• lack of recommendations from health care providers
• lack of health care provider's knowledge about adult immunization and recommended vaccines
• misrepresentation and misunderstanding of the risks of vaccine and benefits of disease prevention in adults
• lack of understanding of vaccine safety and efficacy
• missed opportunities for vaccination in health care providers' offices, hospitals and nursing homes
• lack of publicly funded vaccine and reimbursement to vaccine providers
• lack of coordinated immunization programs for adults
• lack of regulatory or legal requirements
• fear of injections
• lack of availability of up-to-date records and recording systems

Adult immunization is an emerging issue that has seen an increasing emphasis in clinical care and health professional training programs.

Health care provider responsibilities

Health care providers have a responsibility to ensure that adults under their care have continuing and updated protection against vaccine preventable diseases through appropriate immunization. When considering immunization, the person's medical history will help to determine whether other immunizations are needed in addition to routinely recommended vaccines. Refer to Immunization in pregnancy and breastfeeding, Immunization of persons with chronic diseases and Immunization of immunocompromised persons in Part 3 for further information on how health conditions may modify vaccine recommendations.

Health care providers should provide adults under their care with factual information about immunization, including:

• information about vaccines
• expert recommendations regarding the use of vaccines
• benefits and risks of vaccination
• cost of the vaccine if it is not publicly funded
• possible consequences of declining a vaccine
• where vaccine can be obtained if the health care provider is unable to provide the vaccine

Health care providers should regularly review individuals under their care to ensure that the person's immunization status is up to date and that they have been made aware of new vaccines that are or may be indicated for them. Practitioners should routinely audit immunization records during clinical encounters. One effective strategy is to schedule these audits on specific birthdays, such as mid-decade birthdays (e.g., 25, 35 years of age, etc.), serving as a routine reminder. Health care institutions should have policies addressing immunization issues for patients and personnel. When more than one dose of a vaccine is required for optimal protection, the health care provider should arrange follow-up to encourage completion of the vaccine series.

In addition to routinely recommended immunization, certain vaccines are recommended for adults in specific risk situations. International travellers and workers in specific risk situations require assessment of immunization status, completion of routinely recommended vaccine series, and booster doses as necessary. Refer to Table 7 in Recommended immunization schedules in Part 1; Immunization of travellers, Immunization of workers, Immunization in pregnancy and breastfeeding, Immunization of immunocompromised persons and Immunization of persons with chronic diseases in Part 3; and vaccine-specific chapters in Part 4 for additional information.

Strategies to improve vaccine uptake in adults

All adults should be counselled concerning their immunization status. Opportunities for providing general immunization counselling to adults include:

• new patient encounters
• periodic health examinations
• pregnancy and the immediate post-partum period
• visits for chronic disease management
• assessment of new immigrants
• parents attending their child's vaccination visits
• hospitalization, especially when diagnosed with a chronic disease
• management protocols on admission to nursing homes, long-term care institutions, and acute care institutions
• management protocols on admission to health professional training programs
• new employee assessments in day care, health care and health care-related facilities
• persons requesting specific vaccination(s)
• persons with evidence of risk-taking behaviour, such as disordered use of substances or a sexually transmitted infection
• individuals requesting advice concerning travel

Additional effective strategies for increasing the uptake of immunization by adults include patient and health care provider education about indicated prevention practices, and increasing accessibility to immunization through immunization clinics and greater engagement of non-physician staff in the execution of immunization programs. A sample adult immunization record and information resources for adult immunization are available on the Immunize Canada website.

Recommended immunization for adults

All adults in Canada without contraindications should be routinely immunized against vaccine preventable diseases. Routinely recommended adult immunizations are summarized in Table 1. Recommended immunization schedules for adults who have no record or an uncertain immunization history are available in Recommended immunization schedules in Part 1.

COVID-19 vaccine

COVID-19 vaccination is recommended for all unvaccinated adults and some previously vaccinated adults at increased risk of SARS-CoV-2 infection or severe COVID-19 disease. Refer to COVID-19 vaccines in Part 4 for additional information.

Diphtheria toxoid-, tetanus toxoid-, containing vaccine

All adults in Canada should be immunized against diphtheria and tetanus. Booster doses of diphtheria and tetanus toxoid-containing vaccine are recommended every 10 years. Refer to Diphtheria toxoid and Tetanus toxoid in Part 4 for additional information.

Herpes zoster (shingles) vaccine

A two-dose series of recombinant zoster vaccine, (RZV) is recommended for:

• adults 50 years of age or older without contraindications, including those who have previously been immunized with live zoster vaccine (LZV), or who have had a previous episode of herpes zoster (HZ). Immunization with RZV may be considered at least one year after LZV or at least one year after an episode of HZ.
• adults 18 years of age and older who are or will be immunocompromised.

Individuals who have not been infected with varicella-zoster virus (VZV) and have not received varicella (chickenpox) vaccine are not at risk for HZ; however, neither serologic testing nor confirmation of previous infection are recommended before eligible individuals receive RZV. Refer to Herpes zoster (shingles) vaccine in Part 4 for additional information.

For individuals who are known to be susceptible to VZV, vaccine providers should refer to Varicella (chickenpox) vaccines below for further guidance.

Human papillomavirus vaccine

Human papillomavirus (HPV) vaccine is recommended for individuals up to and including 26 years of age and may be administered to those 27 years of age and older who are at ongoing risk of exposure with shared decision making and discussion with a healthcare provider. Refer to Human papillomavirus vaccines in Part 4 for additional information.

Influenza vaccine

Seasonal influenza vaccine is recommended annually for all adults without contraindications, with particular focus on individuals who are at high risk of influenza-related complications or hospitalization, who are capable of transmitting influenza to those at high risk, who provide essential community services and whose occupational or recreational activities increase their risk of exposure to avian influenza A(H5N1) viruses. Refer to Influenza vaccines in Part 4 for additional information.

Measles-mumps- rubella vaccine

Combined measles-mumps-rubella (MMR) vaccine is recommended for vaccination of adults born in or after 1970 susceptible to one or more of these viruses. Although adults born before 1970 are presumed to have acquired natural immunity, those at the greatest risk of measles or mumps exposure, such as travellers, health care workers, students in post-secondary educational settings, and military personnel, may require immunization. If MMR vaccine is indicated for a pregnant woman or pregnant person, it should be given in the immediate post-partum period before discharge from hospital (unless they have received Rh immunoglobulin [RhIg] or other blood products recently). For MMR immunization of post-partum women and post-partum individuals who received RhIg or other blood products, refer to Blood products, human immunoglobulin and timing of immunization in Part 1. Refer to Measles vaccines, Mumps vaccines and Rubella vaccines in Part 4 for additional information including criteria for determining susceptibility/immunity to measles, mumps and rubella.

Meningococcal vaccine

Healthy adults up to and including 24 years of age should receive meningococcal vaccine if it was not received in adolescence. Quadrivalent conjugate meningococcal vaccine is recommended for young adults not immunized in adolescence (routinely provided at 12 years of age), even if they have previously been vaccinated as an infant or toddler. In addition, serogroup B meningococcal vaccine may be considered on an individual basis to protect against invasive meningococcal disease caused by relevant serogroup B strains. Refer to Meningococcal vaccines in Part 4 for additional information.

Pertussis-containing vaccine

All adults (18 years of age and older) should receive one dose of acellular pertussis-containing vaccine (tetanus, diphtheria [reduced], acellular pertussis [reduced] [Tdap]) if it was not previously received during adulthood. This vaccine can be administered regardless of the interval since the last dose of tetanus and diphtheria toxoid-containing vaccine. In particular, adults who have not previously received Tdap vaccine in adulthood, and who anticipate having regular contact with an infant, should receive Tdap vaccine, ideally administered at least 2 weeks before contact with the infant. All pregnant women and pregnant individuals should receive one dose of Tdap vaccine in every pregnancy, ideally between 27 and 32 weeks of gestation. Refer to Pertussis (whooping cough) vaccines in Part 4 for additional information.

Pneumococcal vaccine

Pneumococcal 20-valent conjugate (Pneu-C-20) or pneumococcal 21-valent conjugate (Pneu-C-21) vaccine is recommended for all adults 65 years of age and older. Pneu-C-20 or Pneu-C-21 is also recommended for adults under 65 years of age with risk factors for invasive pneumococcal disease (IPD). Refer to Pneumococcal vaccines in Part 4 for additional information.

Poliomyelitis vaccine

All adults in Canada should be immune to polio. For previously unimmunized adults, a primary series of inactivated poliomyelitis vaccine (IPV) should be provided at the time of immunization with a tetanus and diphtheria toxoid-containing vaccine. For adults that have previously received a primary series of tetanus and diphtheria toxoid-containing vaccine, IPV-containing vaccine can be provided at the time of routine tetanus and diphtheria toxoid-containing vaccine booster immunization. Unimmunized or incompletely immunized adults at increased risk of exposure should complete a primary series of IPV-containing vaccine; previously immunized adults at increased risk of exposure should receive a single lifetime booster dose of IPV-containing vaccine. Refer to Poliomyelitis (polio) vaccines in Part 4 for additional information.

Respiratory syncytial virus (RSV) vaccines

To reduce severe RSV outcomes in adults 65 years of age and older, a single dose of RSV vaccine is recommended, especially for those at increased risk of severe RSV disease (List 2). A single dose of RSV vaccine may be considered by adults 18 to 64 years of age at increased risk of severe RSV disease and who are not among the recommended groups for publicly funded vaccine programs, following discussion with their health care provider.

The RSVpreF vaccine may be considered by a pregnant woman or pregnant person at 28 to 36 weeks of gestation, in advance of, or during, the RSV season, to protect infants expected to be born during the RSV season. RSVpreF may be administered regardless of past RSV infection. For adults 18 years of age and older, a single dose of RSVpreF or mRNA-1345 can be used. For adults 50 years of age and older, a single dose of RSVPreF3, RSVpreF or mRNA-1345 can be used.

Refer to Respiratory syncytial virus (RSV) vaccines in Part 4 for more information.

Varicella (chickenpox) vaccine

Univalent varicella vaccine is recommended for susceptible adults 18 to 49 years of age and in the rare circumstance that an adult 50 years of age and over is known to be serologically susceptible to varicella based on previous laboratory testing. Refer to Varicella (chickenpox) vaccines in Part 4 for additional information and to Herpes zoster (shingles) vaccine for guidance on the immunization of other adults 50 years of age and older.

Chapter revision process

This chapter was updated to include NACI's recent guidance on the use of measles post-exposure prophylaxis, mpox, RSV, herpes zoster, pneumococcal, and COVID-19 vaccines in Canada.

Acknowledgements

Recent updates were prepared by L Coward, A Nunn, N Mohamed and reviewed by E Abrams, W Siu, C Jensen, and O Baclic.

NACI gratefully acknowledges the contribution of: N Haddad and C Tremblay.

Selected references

• Canadian Coalition for Immunization Awareness and Promotion. Adult Immunization. Are you up to date pamphlet from Immunize Canada. May 2012. Accessed February 2015.
• Canadian Medical Protective Association. New Vaccines - What are your obligations? An article for physicians by physicians. Originally published September 2008, revised January 2009. Accessed February 2015.
• Committee to Advise on Tropical Medicine and Travel (CATMAT). Statement on poliovirus and the international traveller. Can Comm Dis Rep 2014;40(13):282-287.
• Committee to Advise on Tropical Medicine and Travel (CATMAT). Statement on Travellers' Diarrhea. 2015. Accessed July 2025.
• Coulibaly N, De Serres G. Coverage of anti-tetanus vaccinations in adults in Canada-year 2002. Can J Public Health 2004;95(6):456-9.
• Johansen H, Nguyen K, Mao L et al. Influenza vaccination. Health Rep 2004;15(2):33-43.
• Johnston BL, Conly JM. Routine adult immunization in Canada: recommendations and performance. Can J Infect Dis 2002;13(4):226-231.
• Lau DT, Hewlett AT. Screening for hepatitis A and B antibodies in patients with chronic liver disease. Am J Med 2005;118 Suppl 10A:28S-33S.
• Shefer A, Briss P, Rodewald L, et al. Improving immunization coverage rates: an evidence-based review of the literature. Epidemiol Rev 1999;21(1):96-142.
• Stone EG, Morton SC, Hulscher ME et al. Interventions that increase use of adult immunization and cancer screening services: a meta-analysis. Ann Intern Med 2002;136(9):641-51.