Standard Adult Vaccines Required for All Adults

Seniors must receive all standard adult immigration vaccines if not previously documented:

• Td/Tdap (tetanus, diphtheria, pertussis) — 1 Tdap booster if primary series complete; Td booster every 10 years
• MMR (measles, mumps, rubella) — 2 doses or positive titers (most seniors born before 1957 are presumed immune to measles)
• Varicella (chickenpox) — 2 doses or positive titer or documented history of disease
• Hepatitis B — 3-dose series or positive anti-HBs titer
• Hepatitis A — 2-dose series or positive IgG titer
• Influenza — 1 dose annually
• COVID-19 — primary series

Age-Specific Vaccines for Seniors (65+)

Applicants aged 65 and older have the following additional vaccine requirements:

• PCV15 or PCV20 (pneumococcal conjugate vaccine) — 1 dose required for all applicants 65+
• PPSV23 (pneumococcal polysaccharide vaccine) — 1 dose required; timing relative to PCV depends on prior vaccination history
• High-dose or adjuvanted influenza vaccine — recommended for 65+ (standard dose acceptable if high-dose unavailable)

Presumed Immunity for Older Adults

Adults born before 1957 are generally presumed to be immune to measles, mumps, and rubella due to natural exposure during childhood. The civil surgeon may accept this presumption of immunity without requiring vaccination or titer testing.

Similarly, most adults who grew up before the varicella vaccine was available (introduced in 1995) had chickenpox as children and are immune. A history of chickenpox disease is an acceptable basis for immunity.

What If I Already Received Pneumococcal Vaccines?

If you have documentation of prior pneumococcal vaccination, the civil surgeon will review your records to determine whether you have received the required vaccines and whether any additional doses are needed.

The pneumococcal vaccine schedule for seniors is complex — the timing and sequence of PCV and PPSV23 doses depends on your prior vaccination history. The civil surgeon will determine the appropriate schedule for your situation.