The Adult Vaccine Assessment Tool

Questions:

1. Are you
   Male
   Female
 I am pregnant
 I am not pregnant
 I am trying to get pregnant
 I am not sure if I’m pregnant
 I cannot become pregnant (for example, menopause, some form of permanent birth control, etc.)
2. What year were you born? (some vaccines are age-related)
   19001901190219031904190519061907190819091910191119121913191419151916191719181919192019211922192319241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006


Have you ever had the chickenpox vaccine?
OR
Has a healthcare provider diagnosed you with chickenpox ever in your life, or do you have laboratory results showing that you had chickenpox sometime in your life?
Yes
No
Not Sure


3. Are you considered in frail health with your body not having the ability to cope with minor illnesses that would normally have minimal impact if you were healthy?
   Yes
   No
   Not Sure
4. Will you be traveling outside the U.S. in the near future?
   Yes
   No
5. Have you ever completed a polio vaccine series?
   Yes
   No
   Not Sure
6. Are you a first-year college student who lives in a college dormitory or a new military recruit?
   Yes
   No
7. Do you work with patients in a doctor’s office, hospital, nursing home, or other health care setting?
   Yes
   No
8. Do you work in a laboratory setting?
   Yes
   No
9. Do you work in public safety and come in contact with blood or body fluids (for example, police officer or firefighter)?
   Yes
   No
10. Are you a close contact (such as a caregiver or a healthcare worker) of someone who is severely immunocompromised who requires a protected environment?
    Yes
    No
    Not Sure

  Some medical conditions and other situations can put you at higher risk for certain infections.

11. Do you have any of these medical conditions?  Check all that apply to you.
     Chronic heart disease (for example, congestive heart failure)
     Diabetes mellitus type 1 or 2 (also called "sugar diabetes")
     Chronic lung disease (for example, asthma, emphysema, and chronic obstructive pulmonary disease [COPD])
     Kidney failure, end-stage renal disease, on dialysis, or other kidney replacement treatment
     Chronic liver disease (for example, cirrhosis or alcoholic liver disease) or hepatitis C infection
     Spleen has been damaged or removed (for example, due to surgery or sickle cell disease)  Cancer or cancer treatment
     Bone marrow transplant recipient
     HIV infection
    
    What is your CD4 count and CD4 percent?
     Under 200 or less than 15%
     Over 200 and more than 15%
     Not sure
     Weakened immune system due to illness or medications
     Organ transplant recipient
     Cochlear implant recipient
     Cerebrospinal fluid (CSF) leak
     Severe Obesity
     Disease of nerves or muscles that makes it difficult to breath.
     Sickle cell or other chronic blood diseases
12. Review the items listed below and check those that apply to you:
     Heavy alcohol use
     Smoke cigarettes
     Share needles or injection drug use
     Gay, bisexual, and other men who have sex with men, transgender or nonbinary people
    
    1. In the past 6 months, have you ever had (check all that apply)
        A new diagnosis of at least 1 sexually transmitted disease
        More than 1 sexual partner
        Sex at a commercial sex venue
        Sex in association with a large public event
       
    2. Are you a sexual partner of any of the persons described above:
       Yes
       No
       Not Sure
    3. Do you anticipate experiencing any of the situations described above:
       Yes
       No
       Not Sure
     Experiencing Homeless
     Living in a rural or remote area
     Living in a nursing home or other long-term care facility
     Contact with an international adoptee (for example, adopting a child from a foreign country or an any adult who has regular contact with an international adoptee, such as caretaker, au pair, or babysitter of an international adoptee)

That's it! Just click "My Results" to find out which vaccines you may need.