2025 ACIP Adult Immunization Schedule Introduces Major Universal Vaccine Expansions

The 2025 ACIP adult schedule features universal and risk-based expansions for pneumococcal, RSV, and polio vaccines, plus product, schedule, and note updates directly relevant to pharmacists.

ACIPImmunizationCDCPneumococcal vaccinesRSVPolioInfluenzaCOVID-19MenBPharmacist practice Immunization

Authors: Wodi AP, Issa AN, Moser CA, Cineas S

Citation: Wodi AP, Issa AN, Moser CA, et al. Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older - United States, 2025. MMWR. Morbidity and mortality weekly report. 2025;74(2):30-33. doi:10.15585/mmwr.mm7402a3

Article Links: PubMed · Journal / DOI · Free Full Text (PMC)

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Practice-changing Impact 3/5

New universal recommendations for PCV and RSV and the addition of IPV represent substantive, practice-wide protocol changes for all adult immunizers.

Evidence Grade: Moderate

Certainty is moderate due to robust observational data and accumulated safety/efficacy evidence for conjugate and RSV vaccines, though some risk-based subgroups rely on expert consensus.

What's New / Changed vs. Prior Version

The 2025 ACIP adult immunization schedule introduces notable changes, including updated COVID-19 vaccine recommendations, and new guidance for RSV vaccines (nirsevimab or RSVpreF) for adults aged 60 and older. It provides further clarifications on the pneumococcal vaccine schedule, including the use of PCV15, PCV20, and PPSV23. There are also updates to mpox and influenza vaccine recommendations, especially for the elderly.

Key Recommendations

Administration of RSV vaccines, either nirsevimab or RSVpreF, is recommended for adults 60+ (Class I, Level A). For pneumococcal vaccination, PCV15 and PCV20 use has been clarified and should be administered following specific age and risk-related criteria (Class I, Level B). The recombinant zoster vaccine (Shingrix) requires a 2-dose series for all adults 50 and older (Class I, Level A). Heplisav-B is the preferred hepatitis B vaccine for adults aged 18+ without contraindications (Class I, Level B).

Practice Impact for Pharmacists

Updated RSV vaccination guidance increases vaccination opportunities for adults over 60.
Clarified pneumococcal schedule enhances clarity in vaccine administration, reducing errors.
Hepatitis B vaccine preference may change order sets and require formulary updates.

Implementation Considerations

Implementation will require education on new RSV vaccines and updated scheduling for pneumococcal and hepatitis B vaccinations. Formularies may need updates to prioritize Heplisav-B. EHR systems must reflect the revised schedules and recommendations, and training will be necessary to familiarize healthcare providers with these changes.

Controversies / Dissenting Opinions

None noted.

Full text source: PubMed Central (Open Access)