Summary of recommendations for adult immunization

Summary of Recommendations for Adult Immunization
(Page 1 of 4)
Vaccine name
Contraindications and precautions
For whom vaccination is recommended
Schedule for vaccine administration
and route
(mild illness is not a contraindication) Seasonal
• Beginning with the 2010–11 influenza season, vaccination is • Give 1 dose every year in the fall or winter.
Contraindications
Influenza
recommended for all adults. (This includes healthy adults ages • Begin vaccination services as soon as • Previous anaphylactic reaction to this vaccine, to any of its vaccine is available and continue until the • LAIV is only approved for healthy nonpregnant people age • For LAIV only: pregnancy; chronic pulmonary (including • Continue to give vaccine to unvaccinated asthma), cardiovascular (except hypertension), renal, hepatic, Note: LAIV may not be given to some adults; see contraindica-
neurological/neuromuscular, hematologic, or metabolic tions and precautions listed in far right column.
(including when influenza activity is present (including diabetes) disorders; immunosuppression (including in the community) and at other times when Precautions
• If 2 or more of the following live virus vac- • Moderate or severe acute illness.
• History of Guillain-Barré syndrome (GBS) within 6wks fol- and/or yellow fever—they should be given lowing previous influenza vaccination.
on the same day. If they are not, space them • For LAIV only: close contact with an immunosuppressed person when the person requires protective isolation.
• For LAIV only: receipt of specific antivirals (i.e., amantadine, rimantadine, zanamivir, or oseltamivir) 48hrs before vaccina- tion. Avoid use of these antiviral drugs for 14d after vaccination.
Pneumococcal
• Give 1 dose if unvaccinated or if previous Contraindication
polysaccharide
• People younger than age 65yrs who have chronic illness or Previous anaphylactic reaction to this vaccine or to any of its other risk factors, including chronic cardiac or pulmonary • Give a 1-time revaccination 5yrs or more disease (including asthma), chronic liver disease, alcoholism, Precaution
diabetes, CSF leaks, cigarette smoking, as well as people living in special environments or social settings (including American Indian/Alaska Natives age 50 through 64yrs if recommended by - At highest risk of fatal pneumococcal infection or rapid antibody loss (see the • Those at highest risk of fatal pneumococcal infection, including 3rd bullet in the box to left for listings of - Have anatomic or functional asplenia, including sickle cell - Have an immunocompromising condition, including HIV infection, leukemia, lymphoma, Hodgkin’s disease, multiple myeloma, generalized malignancy, chronic renal failure, or - Are receiving immunosuppressive chemotherapy (including - Have received an organ or bone marrow transplant.
- Are candidates for or recipients of cochlear implants.
*This document was adapted from the recommendations of the Advisory Committee on Immunization Practices tion (IAC) website at www.immunize.org/acip. This table is revised periodically. Visit IAC’s website at (ACIP). To obtain copies of these recommendations, call the CDC-INFO Contact Center at (800) 232-4636; www.immunize.org/adultrules to make sure you have the most current version. visit CDC’s website at www.cdc.gov/vaccines/pubs/ACIP-list.htm; or visit the Immunization Action Coali- Technical content reviewed by the Centers for Disease Control and Prevention, April 2010.
www.immunize.org/catg.d/p2011.pdf • Item #P2011 (4/10) Immunization Action Coalition • 1573 Selby Avenue • Saint Paul, MN 55104 • (651) 647-9009 • www.immunize.org • www.vaccineinformation.org • [email protected] Summary of Recommendations for Adult Immunization (continued)
(Page 2 of 4)
Vaccine name
For whom vaccination is recommended
Schedule for vaccine administration
Contraindications and precautions
and route
• People born in 1957 or later (especially those born outside the • Give 1 or 2 doses (see criteria in 1st Contraindications
U.S.) should receive at least 1 dose of MMR if there is no labora- • Previous anaphylactic reaction to this vaccine or to any of its tory evidence of immunity or documentation of a dose given on • If dose #2 is recommended, give it no • Pregnancy or possibility of pregnancy within 4wks.
• People in high-risk groups, such as healthcare personnel (paid, • Severe immunodeficiency (e.g., hematologic and solid tumors; unpaid, or volunteer), students entering college and other post– receiving chemotherapy; congenital immunodeficiency; long- high school educational institutions, and international travelers, term immunosuppressive therapy; or severely symptomatic HIV). Note: HIV infection is NOT a contraindication to MMR for those
• People born before 1957 are usually considered immune, but who are not severely immunocompromised (i.e., CD4+ T-lympho- evidence of immunity (serology or documented history of 2 doses cyte counts are greater than or equal to 200 cells/µL).
of MMR) should be considered for healthcare personnel.
Precautions
• Women of childbearing age who do not have acceptable • Moderate or severe acute illness.
evidence of rubella immunity or vaccination.
• If blood, plasma, and/or immune globulin were given in past 11m, • Within 72hrs of measles exposure, give see ACIP statement General Recommendations on Immuniza- tion* regarding time to wait before vaccinating. • History of thrombocytopenia or thrombocytopenic purpura.
Note: Routine post-vaccination serologic Note: If TST (tuberculosis skin test) and MMR are both needed
but not given on same day, delay TST for 4–6wks after MMR.
Varicella
• All adults without evidence of immunity. Contraindications
Note: Evidence of immunity is defined as written documentation
• Dose #2 is given 4–8wks after dose #1.
• Previous anaphylactic reaction to this vaccine or to any of its of 2 doses of varicella vaccine; a history of varicella disease or • If dose #2 is delayed, do not repeat herpes zoster (shingles) based on healthcare-provider diagnosis; • Pregnancy or possibility of pregnancy within 4wks.
laboratory evidence of immunity; and/or birth in the U.S. before • Persons on high-dose immunosuppressive therapy or who are immunocompromised because of malignancy and primary or - Healthcare personnel (HCP) born in the U.S. before 1980 who acquired cellular immunodeficiency, including HIV/AIDS do not meet any of the criteria above should be tested or given (although vaccination may be considered if CD4+ T-lymphocyte the 2-dose vaccine series. If testing indicates they are not counts are greater than or equal to 200 cells/µL. See MMWR immune, give the 1st dose of varicella vaccine immediately. Precautions
- Pregnant women born in the U.S. before 1980 who do not meet • Moderate or severe acute illness.
any of the criteria above should either 1) be tested for suscepti- Note: Routine post-vaccination serologic • If blood, plasma, and/or immune globulin (IG or VZIG) were
bility during pregnancy and if found susceptible, given the 1st given in past 11m, see ACIP statement General Recommendations dose of varicella vaccine postpartum before hospital discharge, on Immunization* regarding time to wait before vaccinating.
or 2) not be tested for susceptibility and given the 1st dose of • Receipt of specific antivirals (i.e., acyclovir, fam ciclovir, or varicella vaccine postpartum before hospital discharge. Give valacyclovir) 24hrs before vaccination, if possible; delay resump- tion of these antiviral drugs for 14d after vaccination.
Summary of Recommendations for Adult Immunization (continued)
(Page 3 of 4)
Vaccine name
For whom vaccination is recommended
Schedule for vaccine administration
Contraindications and precautions
and route
• All adults who lack written documentation of a primary series consisting of Contraindications
at least 3 doses of tetanus- and diphtheria-toxoid-containing vaccine.
• Previous anaphylactic reaction to this vaccine or to any • A booster dose of tetanus- and diphtheria-toxoid-containing vaccine may be needed for wound management as early as 5yrs after receiving a previous • For Tdap only, history of encephalopathy within 7d • Using tetanus toxoid (TT) instead of Td or Tdap is not recommended.
Precautions
• In pregnancy, when indicated, give Td or Tdap in 2nd or 3rd trimester. If not • Give Td booster every 10yrs after the • Moderate or severe acute illness.
administered during pregnancy, give Tdap in immediate postpartum period.
• Guillain-Barré syndrome within 6wks following previ- For Tdap only:
ous dose of tetanus-toxoid-containing vaccine.
• All adults younger than age 65yrs who have not already received Tdap.
• Adults in contact with infants younger than age 12m (e.g., parents, grandpar- • Intervals of 2yrs or less between Td and • History of Arthus reaction following a previous dose of ents younger than age 65yrs, childcare providers, healthcare personnel) who tetanus- and/or diphtheria-toxoid-containing vaccine, have not received a dose of Tdap should be prioritized for vaccination.
• Healthcare personnel who work in hospitals or ambulatory care settings and Note: Tdap may be given to pregnant women at the
have direct patient contact and who have not received Tdap.
Hepatitis A
• All people who want to be protected from hepatitis A virus (HAV) infection. • Give 2 doses.
Contraindication
• People who travel or work anywhere EXCEPT the U.S., Western Europe, • The minimum interval between doses #1 Previous anaphylactic reaction to this vaccine or to any New Zealand, Australia, Canada, and Japan.
• People with chronic liver disease; injecting and non-injecting drug users; • If dose #2 is delayed, do not repeat dose Precautions
men who have sex with men; people who receive clotting-factor concentrates; • Moderate or severe acute illness.
people who work with HAV in experimental lab settings; food handlers • Safety during pregnancy has not been determined, so when health authorities or private employers determine vaccination to be benefits must be weighed against potential risk.
• People who anticipate close personal contact with an international adoptee from a country of high or intermediate endemicity during the first 60 days following the adoptee’s arrival in the U.S.
• Adults age 40yrs or younger with recent (within 2 wks) exposure to HAV. For people older than age 40yrs with recent (within 2 wks) exposure to HAV, immune globulin is preferred over HepA vaccine.
Hepatitis B
Contraindication
• All adults who want to be protected from hepatitis B virus infection.
Previous anaphylactic reaction to this vaccine or to any • High-risk people, including household contacts and sex partners of HBsAg-positive people; injecting drug users; sexually active people not in a Precaution
long-term, mutually monogamous relationship; men who have sex with men; people with HIV; persons seeking evaluation or treatment for an STD; Give 3 doses on a 0, 1, 6m schedule.
patients receiving hemodialysis and patients with renal disease that may • Alternative timing options for vaccina- result in dialysis; healthcare personnel and public safety workers who are exposed to blood; clients and staff of institutions for the developmentally disabled; inmates of long-term correctional facilities; and certain interna- • People with chronic liver disease.
Note: Provide serologic screening for immigrants from endemic areas. If
patient is chronically infected, assure appropriate disease management. For • Schedule for those who have fallen
sex partners and household contacts of HBsAg-positive people, provide sero- behind: If the series is delayed between
logic screening and administer initial dose of HepB vaccine at same visit.
Summary of Recommendations for Adult Immunization (continued)
(Page 4 of 4)
Vaccine name
For whom vaccination is recommended
Schedule for vaccine administration
Contraindications and precautions
and route
• All previously unvaccinated women through age 26yrs.
• Give 3 doses on a 0, 2, 6m schedule.
Contraindication
papillomavirus
• Consider giving HPV4 to men through age 26yrs to reduce their Previous anaphylactic reaction to this vaccine or to any of its likelihood of acquiring genital warts.
Precautions
• Data on vaccination in pregnancy are limited. Vaccination should be delayed until after completion of the pregnancy.
Contraindications
• Previous anaphylactic reaction to any component of zoster vaccine.
• Primary cellular or acquired immunodeficiency.
virus vaccines are to be given—MMR, • Pregnancy.
Zos, and/or yellow fever—they should Precautions
• Moderate or severe acute illness.
• Receipt of specific antivirals (i.e., acyclovir, famciclovir, or valacyclovir) 24hrs before vaccination, if possible; delay resumption of these antiviral drugs for 14d after vaccination.
Meningococcal
• All people age 11 through 18yrs.
Contraindication
conjugate vaccine • Unvaccinated college freshmen who live in dormitories.
Previous anaphylactic reaction to this vaccine or to any of its • People with anatomic or functional asplenia or persistent comple- components, including diphtheria toxoid (for MCV4).
Precautions
• People who travel to or reside in countries in which meningococ- • Moderate or severe acute illness.
cal disease is hyperendemic or epidemic (e.g., the “meningitis • For MCV4 only, history of Guillain-Barré syndrome (if not at extremely high risk for meningococcal disease).
Meningococcal
• Microbiologists routinely exposed to isolates of N. meningitidis. • In pregnancy, studies of vaccination with MPSV4 have not docu- mented adverse effects so may use MPSV4, if indicated. No data • If the only risk factor is living in a are available on the safety of MCV4 during pregnancy.
• Not routinely recommended for U.S. residents age 18yrs and Contraindication
regarding unique situations, schedules, Previous anaphylactic reaction to this vaccine or to any of its Note: Adults living in the U.S. who never received or completed a
primary series of polio vaccine need not be vaccinated unless they Precautions
intend to travel to areas where exposure to wild-type virus is likely. • Moderate or severe acute illness.
Previously vaccinated adults can receive 1 booster dose if travel- ing to polio endemic areas or to areas where the risk of exposure is

Source: https://www.baruch.cuny.edu/undergrad/documents/p2011.pdf