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. Will you be traveling outside the U.S. in the near future?
   Yes No
4. Have you ever completed a polio vaccine series?
   Yes No Not Sure
5. Are you a first-year college student who lives in a college dormitory or a new military recruit?
   Yes No
6. Do you work with patients in a doctor’s office, hospital, nursing home, or other health care setting?
   Yes No
7. Do you work in a laboratory setting?
   Yes No
8. Do you work in public safety and come in contact with blood or body fluids (for example, police officer or firefighter)?
   Yes No
9. 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.

8. Do you have any of these medical conditions?  Check all that apply to you.
    Heart disease (for example, congestive heart failure)
    Diabetes mellitus type 1 or 2 (also called "sugar diabetes")
    Chronic lung disease (for example, asthma and chronic obstructive pulmonary disease [COPD])
    Kidney failure, end-stage renal disease, or on dialysis
    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
9. Review the items listed below and check those that apply to you:
    Heavy alcohol use
    Smoke cigarettes
    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
    Homeless
    Share needles or injection drug use
    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.