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 1. Influenza vaccination
Annual vaccination against influenza is recommended for all persons 6 months of age and older.
Persons 6 months of age and older, including pregnant women, can receive the trivalent inactivated vaccine (TIV).
Healthy, nonpregnant adults younger than age 50 years without high-risk medical conditions can receive either intranasally administered live, attenuated influenza vaccine (LAIV) (FluMist), or TIV. Health-care personnel who care for severely immunocompromised persons (i.e., those who require care in a protected environment) should receive TIV rather than LAIV. Other persons should receive TIV.
The intramuscular or intradermal administered TIV are options for adults aged 1864 years.
Adults aged 65 years and older can receive the standard dose TIV or the high-dose TIV (Fluzone High-Dose).
2.
Tetanus, diphtheria, and acellular pertussis (Td/Tdap)
vaccination
Administer a one-time dose of Tdap to adults younger than age 65 years who have not
received Tdap previously or for whom vaccine status is unknown to replace one of the 10-year
Td boosters.
Tdap is specifically recommended for the following persons:
pregnant women more than 20 weeks gestation,
adults, regardless of age, who are close contacts of infants younger than age 12 months
(e.g., parents, grandparents, or child care providers), and
health-care personnel.
Tdap can be administered regardless of interval since the most recent tetanus or diphtheriacontaining vaccine.
Pregnant women not vaccinated during pregnancy should receive Tdap immediately postpartum.
Adults 65 years and older may receive Tdap.
Adults with unknown or incomplete history of completing a 3-dose primary vaccination series with Td-containing vaccines should begin or complete a primary vaccination series. Tdap should be substituted for a single dose of Td in the vaccination series with Tdap preferred as
the first dose.
For unvaccinated adults, administer the first 2 doses at least 4 weeks apart and the third dose 612 months after the second.
If incompletely vaccinated (i.e., less than 3 doses), administer remaining doses.
Refer to the ACIP statement for recommendations for administering Td/Tdap as prophylaxis in wound management
2b.
Tdap recommended for ≥65 if contact with *12 month old child. Either Td or Tdap can be used if no infant contact
3.
Varicella vaccination
All adults without evidence of immunity to varicella (as defined below) should receive 2 doses of single-antigen varicella vaccine or a second dose if they have received only 1 dose.
Special consideration for vaccination should be given to those who
have close contact with persons at high risk for severe disease (e.g., health-care personnel and family contacts of persons with immunocompromising conditions) or
are at high risk for exposure or transmission (e.g., teachers; child care employees; residents and staff members of institutional settings, including correctional institutions; college students; military personnel; adolescents and adults living in households with children; nonpregnant women of childbearing age; and international travelers).
Pregnant women should be assessed for evidence of varicella immunity. Women who do not have evidence of immunity should receive the first dose of varicella vaccine upon completion or termination of pregnancy and before discharge from the health-care facility. The second dose should be administered 48 weeks after the first dose.
Evidence of immunity to varicella in adults includes any of the following:
documentation of 2 doses of varicella vaccine at least 4 weeks apart;
U.S.-born before 1980 (although for health-care personnel and pregnant women, birth before 1980 should not be considered evidence of immunity);
history of varicella based on diagnosis or verification of varicella by a health-care provider (for a patient reporting a history of or having an atypical case, a mild case, or both, healthcare providers should seek either an epidemiologic link to a typical varicella case or to a laboratory-confirmed case or evidence of laboratory confirmation, if it was performed at the time of acute disease);
history of herpes zoster based on diagnosis or verification of herpes zoster by a health-care provider; or
laboratory evidence of immunity or laboratory confirmation of disease.
4.
Human papillomavirus (HPV) vaccination
Two vaccines are licensed for use in females, bivalent HPV vaccine (HPV2) and quadrivalent HPV vaccine (HPV4), and one HPV vaccine for use in males (HPV4).
For females, either HPV4 or HPV2 is recommended in a 3-dose series for routine vaccination at 11 or 12 years of age, and for those 13-26 years of age, if not previously vaccinated.
For males, HPV4 is recommended in a 3-dose series for routine vaccination at 11 or 12 years of age, and for those 13-21 years of age, if not previously vaccinated. Males 22-26 years of age may be vaccinated.
HPV vaccines are not live vaccines and can be administered to persons who are immunocompromised as a result of infection (including HIV infection), disease, or medications. Vaccine is recommended for immunocompromised persons through age 26 years who did not get any or all doses when they were younger. The immune response and vaccine efficacy might be less than that in immunocompetent persons.
Men who have sex with men (MSM) might especially benefit from vaccination to prevent condyloma and anal cancer. HPV4 is recommended for MSM through age 26 years who did not get any or all doses when they were younger.
Ideally, vaccine should be administered before potential exposure to HPV through sexual activity; however, persons who are sexually active should still be vaccinated consistent with age-based recommendations. HPV vaccine can be administered to persons with a history of genital warts, abnormal Papanicolaou test, or positive HPV DNA test.
A complete series for either HPV4 or HPV2 consists of 3 doses. The second dose should be administered 12 months after the first dose; the third dose should be administered 6 months after the first dose (at least 24 weeks after the first dose).
Although HPV vaccination is not specifically recommended for health-care personnel (HCP) based on their occupation, HCP should receive the HPV vaccine if they are in the recommended age group.
5. Zoster vaccination
A single dose of zoster vaccine is recommended for adults 60 years of age and older regardless of whether they report a prior episode of herpes zoster. Although the vaccine is licensed by the Food and Drug Administration (FDA) for use among and can be administered to persons 50 years and older, ACIP recommends that vaccination begins at 60 years of age.
Persons with chronic medical conditions may be vaccinated unless their condition constitutes a contraindication, such as pregnancy or severe immunodeficiency.
Although zoster vaccination is not specifically recommended for health-care personnel (HCP), HCP should receive the vaccine if they are in the recommended age group.
5. Measles, mumps, rubella (MMR) vaccination
Adults born before 1957 generally are considered immune to measles and mumps. All adults born in 1957 or later should have documentation of 1 or more doses of MMR vaccine unless they have a medical contraindication to the vaccine, laboratory evidence of immunity to each of the three diseases, or documentation of provider-diagnosed measles or mumps disease. For rubella, documentation of provider-diagnosed disease is not considered acceptable evidence of immunity.
Measles component:
A routine second dose of MMR vaccine, administered a minimum of 28 days after the first dose, is recommended for adults who
are students in postsecondary educational institutions;
work in a health-care facility; or
plan to travel internationally.
Persons who received inactivated (killed) measles vaccine or measles vaccine of unknown type from 1963 to 1967 should be revaccinated with 2 doses of MMR vaccine.
Mumps component:
A routine second dose of MMR vaccine, administered a minimum of 28 days after the first dose, is recommended for adults who
are students in postsecondary educational institutions;
work in a health-care facility; or
plan to travel internationally.
Persons vaccinated before 1979 with either killed mumps vaccine or mumps vaccine of unknown type who are at high risk for mumps infection (e.g., persons who are working in a health-care facility) should be considered for revaccination with 2 doses of MMR vaccine.
Rubella component:
For women of childbearing age, regardless of birth year, rubella immunity should be determined. If there is no evidence of immunity, women who are not pregnant should be
vaccinated. Pregnant women who do not have evidence of immunity should receive MMR vaccine upon completion or termination of pregnancy and before discharge from the healthcare
facility.
Health-care personnel born before 1957:
For unvaccinated health-care personnel born before 1957 who lack laboratory evidence of measles, mumps, and/or rubella immunity or laboratory confirmation of disease, health-care
facilities should consider routinely vaccinating personnel with 2 doses of MMR vaccine at the appropriate interval for measles and mumps or 1 dose of MMR vaccine for rubella.
6. Pneumococcal polysaccharide (PPSV)
vaccination
Vaccinate all persons with the following indications:
age 65 years and older without a history of PPSV vaccination;
adults younger than 65 years with chronic lung disease (including chronic obstructive pulmonary disease, emphysema, and asthma); chronic cardiovascular diseases; diabetes mellitus; chronic liver disease (including cirrhosis); alcoholism; cochlear implants; cerebrospinal fluid leaks; immunocompromising conditions; and functional or anatomic asplenia (e.g., sickle cell disease and other hemoglobinopathies, congenital or acquired asplenia, splenic dysfunction, or splenectomy [if elective splenectomy is planned, vaccinate at least 2 weeks before surgery]);
residents of nursing homes or long-term care facilities; and
adults who smoke cigarettes.
Persons with asymptomatic or symptomatic HIV infection should be vaccinated as soon as possible after their diagnosis.
When cancer chemotherapy or other immunosuppressive therapy is being considered, the interval between vaccination and initiation of immunosuppressive therapy should be at least 2 weeks. Vaccination during chemotherapy or radiation therapy should be avoided.
Routine use of PPSV is not recommended for American Indians/Alaska Natives or other persons younger than 65 years of age unless they have underlying medical conditions that are PPSV indications. However, public health authorities may consider recommending PPSV for American Indians/Alaska Natives who are living in areas where the risk for invasive pneumococcal disease is increased.
7. Revaccination with PPSV
One-time revaccination 5 years after the first dose is recommended for persons 19-64 years of age with chronic renal failure or nephrotic syndrome; functional or anatomic asplenia (e.g., sickle cell disease or splenectomy); and for persons with immunocompromising conditions.
Persons who received PPSV before age 65 years for any indication should receive another dose of the vaccine at age 65 years or later if at least 5 years have passed since their previous dose.
No further doses are needed for persons vaccinated with PPSV at or after age 65 years.
9. Meningococcal
vaccination
Administer 2 doses of meningococcal conjugate vaccine quadrivalent (MCV4) at least 2 months apart to adults with functional asplenia or persistent complement component deficiencies.
HIV-infected persons who are vaccinated should also receive 2 doses.
Administer a single dose of meningococcal vaccine to microbiologists routinely exposed to isolates of Neisseria meningitidis, military recruits, and persons who travel to or live in countries in which meningococcal disease is hyperendemic or epidemic.
First-year college students up through age 21 years who are living in residence halls should be vaccinated if they have not received a dose on or after their 16th birthday.
MCV4 is preferred for adults with any of the preceding indications who are 55 years old and younger; meningococcal polysaccharide vaccine (MPSV4) is preferred for adults 56 years and older.
Revaccination with MCV4 every 5 years is recommended for adults previously vaccinated with MCV4 or MPSV4 who remain at increased risk for infection (e.g., adults with anatomic or functional asplenia or persistent complement component deficiencies).
9. Hepatitis A vaccination
Vaccinate any person seeking protection from hepatitis A virus (HAV) infection and persons
with any of the following indications:
men who have sex with men and persons who use injection drugs;
persons working with HAV-infected primates or with HAV in a research laboratory setting;
persons with chronic liver disease and persons who receive clotting factor concentrates;
persons traveling to or working in countries that have high or intermediate endemicity of hepatitis A; and
unvaccinated persons who anticipate close personal contact (e.g., household or regular babysitting) with an international adoptee during the first 60 days after arrival in the United States from a country with high or intermediate endemicity. (See footnote 1 for more information on travel recommendations). The first dose of the 2-dose hepatitis A vaccine series should be administered as soon as adoption is planned, ideally 2 or more weeks before the arrival of the adoptee.
Single-antigen vaccine formulations should be administered in a 2-dose schedule at either 0 and 612 months (Havrix), or 0 and 618 months (Vaqta). If the combined hepatitis A and hepatitis B vaccine (Twinrix) is used, administer 3 doses at 0, 1, and 6 months; alternatively, a 4-dose schedule may be used, administered on days 0, 7, and 2130 followed by a booster dose at month 12.
10. Hepatitis B
vaccination
Vaccinate persons with any of the following indications and any person seeking protection from hepatitis B virus (HBV) infection:
sexually active persons who are not in a long-term, mutually monogamous relationship (e.g., persons with more than one sex partner during the previous 6 months); persons seeking evaluation or treatment for a sexually transmitted disease (STD); current or recent injection-drug users; and men who have sex with men;
health-care personnel and public-safety workers who are exposed to blood or other potentially infectious body fluids;
persons with diabetes younger than 60 years as soon as feasible after diagnosis; persons with diabetes who are 60 years or older at the discretion of the treating clinician based on increased need for assisted blood glucose monitoring in long-term care facilities, likelihood of acquiring hepatitis B infection, its complications or chronic sequelae, and likelihood of immune response to vaccination;
persons with end-stage renal disease, including patients receiving hemodialysis; persons with HIV infection; and persons with chronic liver disease;
household contacts and sex partners of persons with chronic HBV infection; clients and staff members of institutions for persons with developmental disabilities; and international travelers to countries with high or intermediate prevalence of chronic HBV infection; and
all adults in the following settings: STD treatment facilities; HIV testing and treatment facilities; facilities providing drug-abuse treatment and prevention services; healthcare settings targeting services to injection-drug users or men who have sex with
men; correctional facilities; end-stage renal disease programs and facilities for chronic hemodialysis patients; and institutions and nonresidential daycare facilities for persons with developmental disabilities.
Administer missing doses to complete a 3-dose series of hepatitis B vaccine to those persons not vaccinated or not completely vaccinated. The second dose should be administered 1 month after the first dose; the third dose should be given at least 2 months after the second dose (and at least 4 months after the first dose). If the combined hepatitis A and hepatitis B vaccine (Twinrix) is used, give 3 doses at 0, 1, and 6 months; alternatively, a 4-dose Twinrix schedule, administered on days 0, 7, and 2130 followed by a booster dose at month 12 may be used.
Adult patients receiving hemodialysis or with other immunocompromising conditions should receive 1 dose of 40 μg/mL (Recombivax HB) administered on a 3-dose schedule or 2 doses of 20 μg/mL (Engerix-B) administered simultaneously on a 4-dose schedule at 0, 1, 2, and 6 months.
Changes for 2012
The Advisory Committee on Immunization Practices (ACIP) annually reviews the recommended Adult Immunization Schedule to ensure that the schedule reflects current recommendations for the licensed vaccines. These changes were published in MMWR and in brief, the primary changes include:
A new footnote to links for the full ACIP vaccine recommendations and where to find additional information on specific vaccine recommendations for travelers.
Table summarizing precautions and contraindications was added.
Tdap and Td vaccines - Footnote for updated to indicate:
- Tdap vaccine is recommended for all persons who are close contacts of infants younger than 12 months of age (e.g., parents, grandparents, and child-care providers) and who have not received Tdap previously.
- Tdap vaccine is recommended for pregnant women during later pregnancy (>20 weeks gestation).
- Other adults who are close contacts of children younger than 12 months of age continue to be recommended to receive a one-time dose of Tdap vaccine.
HPV vaccine - Footnote updated to include routine vaccination of males 1112 years of age, with catch-up vaccination recommended for males 1321 years of age. Also now recommended for previously unvaccinated males 2226 years of age who are immunocompromised, or who test positive for human immunodeficiency virus (HIV) infection, or who have sex with men.
Hep B vaccine - Footnote updated to include the recommendation to vaccinated adults younger than 60 years old who have diabetes, as soon as possible after diabetes is diagnosed. Also now recommended at the discretion of the treating clinician for adults with diabetes who are 60 years or older based on a patients likely need for assisted blood glucose monitoring, likelihood of acquiring hepatitis B, and likelihood of immune response to vaccination.
Zoster vaccine Notes recently approved by FDA for administration to persons 50 years of age and older; however, ACIP continues to recommend that vaccination begin at age 60 years.
Influenza vaccine - Footnote revised to specify age indications for the different licensed formulations of trivalent inactivated influenza vaccine (TIV).
MMR vaccine - Footnote simplified to focus only on routine use of this vaccine in adults. Readers referred to ACIP MMR and health-care personnel recommendations regarding the use of MMR vaccine in outbreak settings.
MCV4 and MPSV4 vaccines - Specific information added about for specific age and risk groups.
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