Information about http://www.immunize.org/catg.d/p2011.pdf
Summary of Recommendations for Adult Immunization …
Tags: adult immunization, advisory committee on immunization practices, anaphylactic reaction, contraindications, eggs, immunization action coalition, influenza, laiv, likelihood, mild illness, persons age, tions, vaccination services, vaccine administration,Pages: 3
Language: english
Created: Fri Apr 18 15:14:00 2008
Display cached document
Page 1
Page 2
Page 3
Summary of Recommendations for Adult Immunization (Page 1 of 3)
Adapted from the recommendations of the Advisory Committee on Immunization Practices (ACIP)* by the Immunization Action Coalition, April 2008
Vaccine name Schedule for vaccine administration Contraindications and precautions
For whom vaccination is recommended
and route (any vaccine can be given with another) (mild illness is not a contraindication)
Influenza Note: LAIV may not be given to some of the persons listed below; see contraindica- · Give 1 dose every year in the fall or Contraindications
tions listed in far right column. winter. · Previous anaphylactic reaction to this vaccine,
Trivalent
· All persons who want to reduce the likelihood of becoming ill with influenza or of · Begin vaccination services as soon as to any of its components, or to eggs.
inactivated
spreading it to others. vaccine is available and continue un- · For LAIV only, age 50 years or older, preg-
influenza
· Persons age 50yrs and older. [TIV only] til the supply is depleted. nancy, asthma, reactive airway disease or other
vaccine
(TIV) · Persons with medical problems (e.g., heart disease, lung disease, diabetes, renal · Continue to give vaccine to unvacci- chronic disorder of the pulmonary or cardiovas-
dysfunction, hemoglobinopathy, immunosuppression). [TIV only] nated adults throughout the influenza cular system; an underlying medical condition,
Give IM season (including when influenza including metabolic disease such as diabetes,
· Persons with any condition that compromises respiratory function or the handling of
respiratory secretions or that can increase the risk of aspiration (e.g., cognitive dys- activity is present in the community) renal dysfunction, and hemoglobinopathy; a
Live and at other times when the risk of known or suspected immune deficiency disease
function, spinal cord injury, seizure disorder, or other neuromuscular disorder). [TIV
attenuated influenza exists. or current receipt of immunosuppressive
only]
influenza · If 2 or more of the following live therapy.
vaccine · Persons living in chronic care facilities. [TIV only]
· Persons who work or live with high-risk people. virus vaccines are to be given-- Precautions
(LAIV) LAIV, MMR, Var, and/or yellow · Moderate or severe acute illness.
· Women who will be pregnant during the influenza season (Decemberspring). [If cur-
Give fever vaccine--they should be given · For TIV only, history of Guillain-Barré syn-
rently pregnant, TIV only]
intranasally on the same day. If they are not, drome (GBS) within 6wks of previous TIV.
· All healthcare personnel and other persons who provide direct care to high-risk space them by at least 28d.
people. · For LAIV only, history of GBS within 6wks of
· Household contacts and out-of-home caregivers of children age 059m. a previous influenza vaccination.
· Travelers at risk for complications of influenza who go to areas where influenza
activity exists or who may be among people from areas of the world where there is
current influenza activity (e.g., on organized tours ). [TIV only]
· Students or other persons in institutional settings (e.g., residents of dormitories or
correctional facilities).
Pneumococcal · Persons age 65yrs and older. · Give 1 dose if unvaccinated or if pre- Contraindication
poly- · Persons who have chronic illness or other risk factors, including chronic cardiac or vious vaccination history is unknown. Previous anaphylactic reaction to this vaccine
saccharide pulmonary disease, chronic liver disease, alcoholism, diabetes, CSF leak, as well as · Give a 1-time revaccination at least or to any of its components.
people living in special environments or social settings (including Alaska Natives 5yrs after 1st dose to persons Precaution
(PPV)
and certain American Indian populations). - age 65yrs and older if the 1st dose Moderate or severe acute illness.
Give IM or SC · Those at highest risk of fatal pneumococcal infection, including persons who was given prior to age 65yrs
- have anatomic asplenia, functional asplenia, or sickle cell disease - at highest risk of fatal pneumococ-
- have an immunocompromising condition, including HIV infection, leukemia, cal infection or rapid antibody loss
lymphoma, Hodgkin's disease, multiple myeloma, generalized malignancy, (see the 3rd bullet in the box to left
chronic renal failure, or nephrotic syndrome for listings of persons at highest
- are receiving immunosuppressive chemotherapy (including corticosteroids) risk)
- have received an organ or bone marrow transplant
- are candidates for or recipients of cochlear implants.
Zoster (shingles) ACIP has voted to recommend herpes zoster (shingles) vaccine for all persons age 60yrs and older who do not have contraindications. Provisional recommendations are
(Zos) Give SC online at www.cdc.gov/vaccines/recs/provisional/default.htm#acip.
*This document was adapted from the recommendations of the Advisory Committee on Immunization Practices (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 Coalition
Technical content reviewed by the Centers for Disease Control and Prevention, April 2008. www.immunize.org/catg.d/p2011.pdf · Item #P2011 (4/08)
Immunization Action Coalition · 1573 Selby Avenue · Saint Paul, MN 55104 · (651) 647-9009 · www.immunize.org · www.vaccineinformation.org · admin@immunize.org
Summary of Recommendations for Adult Immunization (continued) (Page 2 of 3)
Vaccine name Schedule for vaccine administration Contraindications and precautions
For whom vaccination is recommended
and route (any vaccine can be given with another) (mild illness is not a contraindication)
Hepatitis B · All persons through age 18yrs. · Give 3 doses on a 0, 1, 6m schedule. Contraindication
(HepB) · All adults wishing to obtain immunity against hepatitis B virus infection. · Alternative timing options for vaccination Previous anaphylactic reaction to this vaccine
· High-risk persons, including household contacts and sex partners of HBsAg-posi- include 0, 2, 4m and 0, 1, 4m. or to any of its components.
Give IM
tive persons; injecting drug users; sexually active persons not in a long-term, · There must be at least 4wks between doses Precaution
Brands may mutually monogamous relationship; men who have sex with men; persons with #1 and #2, and at least 8wks between doses Moderate or severe acute illness.
be used HIV; persons seeking evaluation or treatment for an STD; patients receiving he- #2 and #3. Overall, there must be at least
interchangeably. modialysis and patients with renal disease that may result in dialysis; healthcare 16wks between doses #1 and #3.
personnel and public safety workers who are exposed to blood; clients and staff of · Schedule for those who have fallen
institutions for the developmentally disabled; inmates of long-term correctional behind: If the series is delayed between
facilities; and certain international travelers. doses, DO NOT start the series over.
· Persons with chronic liver disease. Continue from where you left off.
Note: Provide serologic screening for immigrants from endemic areas. If patient is
chronically infected, assure appropriate disease management. Screen sex partners For Twinrix® (hepatitis A and B combi-
and household members; give HepB at the same visit if not already vaccinated. nation vaccine [GSK]) for patients age
18yrs and older only: give 3 doses on
· All persons wishing to obtain immunity to hepatitis A virus infection. a 0, 1, 6m schedule. An alternative Contraindication
Hepatitis A Previous anaphylactic reaction to this vaccine
· Persons who travel or work anywhere EXCEPT the U.S., Western Europe, New schedule can also be used at 0, 7,
(HepA) Zealand, Australia, Canada, and Japan. or to any of its components.
2130d, and a booster at 12m.
Give IM · Persons with chronic liver disease; injecting and non-injecting drug users; men Precautions
who have sex with men; people who receive clotting-factor concentrates; persons · Give 2 doses. · Moderate or severe acute illness.
Brands may who work with hepatitis A virus in experimental lab settings (not routine medical · The minimum interval between doses #1 · Safety during pregnancy has not been deter-
be used laboratories); and food handlers when health authorities or private employers and #2 is 6m. mined, so benefits must be weighed against
interchangeably. determine vaccination to be appropriate. · If dose #2 is delayed, do not repeat dose potential risk.
Note: Prevaccination testing is likely to be cost effective for persons older than age #1. Just give dose #2.
40yrs, as well as for younger persons in certain groups with a high prevalence of
hepatitis A virus infection.
· All adults who lack written documentation of a primary series consisting of at · For persons who are unvaccinated or Contraindications
Td, Tdap · Previous anaphylactic reaction to this vaccine
least 3 doses of tetanus- and diphtheria-toxoid-containing vaccine. behind, complete the primary series with
(Tetanus, Td (spaced at 0, 12m, 612m intervals). or to any of its components.
· A booster dose of tetanus- and diphtheria-toxoid-containing vaccine may be
diphtheria, One-time dose of Tdap may be used for
needed for wound management as early as 5yrs after receiving a previous dose, · For Tdap only, history of encephalopathy
pertussis) any dose if age 1864yrs.
so consult ACIP recommendations.* within 7d following DTP/DTaP.
Give IM · Using tetanus toxoid (TT) instead of Td or Tdap is not recommended. · Give Td booster every 10yrs after the Precautions
· In pregnancy, when indicated, give Td or Tdap in 2nd or 3rd trimester. If not primary series has been completed. For · Moderate or severe acute illness.
administered during pregnancy, give Tdap in immediate postpartum period. adults age 1864yrs, a 1-time dose of Tdap · GBS within 6wks of receiving a previous
For Tdap only: is recommended to replace the next Td. dose of tetanus-toxoid-containing vaccine.
· All adults younger than age 65yrs who have not already received Tdap. · Intervals of 2yrs or less between Td and · Unstable neurologic condition.
Tdap may be used. · History of arthus reaction following a previ-
· Healthcare personnel who work in hospitals or ambulatory care settings and have
direct patient contact and who have not received Tdap. Note: The two Tdap products are licensed ous dose of tetanus- and/or diphtheria-toxoid-
for different age groups: AdacelTM (sanofi) for containing vaccine, including MCV4.
· Adults in contact with infants younger than age 12m (e.g., parents, grandparents
use in persons age 1164yrs and Boostrix® Note: Use of Td/Tdap is not contraindicated in
younger than age 65yrs, childcare providers, healthcare personnel) who have not
(GSK) for use in persons age 1018yrs. pregnancy. Either vaccine may be given during
received a dose of Tdap should be prioritized for vaccination.
trimester #2 or #3 at the provider's discretion.
Not routinely recommended for persons age 18yrs and older. · Refer to ACIP recommendations* regard- Contraindication
Polio Note: Adults living in the U.S. who never received or completed a primary series ing unique situations, schedules, and Previous anaphylactic or neurologic reaction to
(IPV) of polio vaccine need not be vaccinated unless they intend to travel to areas dosing information. this vaccine or to any of its components.
Give IM or SC where exposure to wild-type virus is likely (i.e., India, Pakistan, Afghanistan, and Precautions
Nigeria). Previously vaccinated adults can receive one booster dose if traveling to · Moderate or severe acute illness.
polio endemic areas. · Pregnancy.
Summary of Recommendations for Adult Immunization (continued) (Page 3 of 3)
Vaccine name Schedule for vaccine administration Contraindications and precautions
For whom vaccination is recommended
and route (any vaccine can be given with another) (mild illness is not a contraindication)
· All adults without evidence of immunity. · Give 2 doses. Contraindications
Varicella
Note: Evidence of immunity is defined as written documen- · Dose #2 is given 48wks after · Previous anaphylactic reaction to this vaccine or to any of its components.
(Var)
(Chickenpox) tation of 2 doses of varicella vaccine; born in the U.S. be- dose #1. · Pregnancy or possibility of pregnancy within 4wks.
fore 1980 (exceptions: healthcare personnel and pregnant · If the second dose is delayed, do not · Persons immunocompromised because of malignancy and primary or
Give SC women); a history of varicella disease or herpes zoster acquired cellular immunodeficiency, including HIV/AIDS (although vac-
repeat dose #1. Just give dose #2.
based on healthcare-provider diagnosis; laboratory evidence · If 2 or more of the following live vi- cination may be considered if CD4+ T-lymphocyte counts are greater
of immunity; and/or laboratory confirmation of disease. rus vaccines are to be given--LAIV, than or equal to 200 cells/µL. See MMWR 2007;56,RR-4).
MMR, Var, and/or yellow fever vac- Precautions
cine--they should be given on the · If blood, plasma, and/or immune globulin (IG or VZIG) were given in
same day. If they are not, space them past 11m, see ACIP statement General Recommendations on Immuniza-
by at least 28d. tion* regarding time to wait before vaccinating.
· Moderate or severe acute illness.
Note: For those on high-dose immunosuppressive therapy, consult ACIP
recommendations regarding delay time.*
Meningo- · All persons age 11 through 18yrs. · Give 1 dose. Contraindication
coccal · College freshmen living in a dormitory. · If previous vaccine was MPSV, revac- Previous anaphylactic or neurologic reaction to this vaccine or to any
Conjugate vaccine · Persons with anatomic or functional asplenia or with terminal cinate after 5yrs if risk continues. of its components, including diphtheria toxoid (for MCV4).
(MCV4) complement component deficiencies. · Revaccination after MCV4 is not rec- Precautions
Give IM · Persons who travel to or reside in countries in which menin- ommended. · Moderate or severe acute illness.
Polysaccharide gococcal disease is hyperendemic or epidemic (e.g., the · MCV4 is preferred over MPSV for · For MCV4 only, history of Guillain-Barré syndrome (GBS).
vaccine "meningitis belt" of Sub-Saharan Africa). persons age 55yrs and younger, although
(MPSV) · Microbiologists routinely exposed to isolates of N. menin- MPSV is an acceptable alternative.
Give SC gitidis.
MMR · Persons born in 1957 or later (especially those born outside · Give 1 or 2 doses (see criteria in 1st Contraindications
the U.S.) should receive at least 1 dose of MMR if there is and 2nd bullets in box to left). · Previous anaphylactic reaction to this vaccine or to any of its components.
(Measles,
no serologic proof of immunity or documentation of a dose · If dose #2 is recommended, give it no · Pregnancy or possibility of pregnancy within 4wks.
mumps,
given on or after the first birthday. sooner than 4wks after dose #1. · Persons immunocompromised because of cancer, leukemia, lymphoma,
rubella)
· Persons in high-risk groups, such as healthcare personnel, · If a pregnant woman is found to be immunosuppressive drug therapy, including high-dose steroids or radiation
Give SC students entering college and other posthigh school rubella susceptible, administer MMR therapy. Note: HIV positivity is NOT a contraindication to MMR except
educational institutions, and international travelers, should postpartum. for those who are severely immunocompromised (i.e., CD4+ T-lympho-
receive a total of 2 doses. · If 2 or more of the following live virus cyte counts are less than 200 cells/µL).
· Persons born before 1957 are usually considered immune, vaccines are to be given--LAIV, Precautions
but proof of immunity (serology or vaccination) may be MMR, Var, and/or yellow fever vac- · If blood, plasma, and/or immune globulin were given in past 11m, see
desirable for healthcare personnel. cine--they should be given on the ACIP statement General Recommendations on Immunization* regarding
· Women of childbearing age who do not have acceptable same day. If they are not, space them time to wait before vaccinating.
evidence of rubella immunity or vaccination. by at least 28d. · Moderate or severe acute illness.
· History of thrombocytopenia or thrombocytopenic purpura.
Note: If PPD (tuberculosis skin test) and MMR are both needed but not
given on same day, delay PPD for 46wks after MMR.
Human All previously unvaccinated women through age 26yrs. · Give 3 doses on a 0, 2, 6m schedule. Contraindication
papillomavirus · There must be at least 4wks between Previous anaphylactic reaction to this vaccine or to any of its components.
(HPV) doses #1 and #2 and at least 12wks Precaution
Give IM between doses #2 and #3. Overall, Data on vaccination in pregnancy are limited. Vaccination should be
there must be at least 24wks between delayed until after completion of the pregnancy.
doses #1 and #3.