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While the
importance of childhood immunizations is commonly understood, many
adults are surprised to learn that immunizations are recommended
throughout life. Most adult vaccines are in the form of “booster
shots” following the primary series from childhood but some vaccines
are specifically licensed and recommended for adults. As of 2008
only 2% of adults in the United States had been fully vaccinated
with recommended vaccines. Ensuring that immunization status is up
to date should be a part of routine adult health care.
There are
many compelling reasons for adults to be vaccinated:
·
Each year, many adults die from vaccine-preventable diseases such as
influenza, pneumococcal and meningococcal disease, and less commonly
tetanus. For many of these diseases, death rates increase as people
age. Outside of infancy, the highest hospitalization and death rates
caused by influenza occur in adults age 65 years and older.
·
Many vaccine-preventable diseases are more serious in adults than in
children. Complications such as pneumonia and/or death are more
likely to occur when an adult contracts varicella (chickenpox) than
a child.
·
Some vaccine-preventable diseases such as chickenpox, influenza and
tetanus can cause more severe illness in pregnant women or can harm
the developing fetus, cause miscarriage or stillbirths (rubella and
chickenpox). Learn more about the need for
vaccines in pregnancy.
·
Some adults did not receive childhood vaccinations.
·
Some recommended vaccines were not available when many adults were
children.
·
Some vaccines do not give lifelong protection. As immunity to infections
fades over time, adults once again become susceptible to getting the
infection (such as tetanus, diphtheria and pertussis) and all the
complications that go with it.
·
Adults can have jobs that put them at increased risk of both acquiring
and spreading vaccine-preventable diseases. These diseases may then
spread to those who are least well able to fight them and have a
high risk of complications and death, including very young infants,
the elderly and people with impaired immune systems.
| Specific vaccine recommendations for adults |
The Centers for Disease Control and Prevention (CDC) issue
recommendations for vaccination in adults. A separate
vaccination schedule is available
for pregnant women
and for adolescents.
Tdap (which
differs from the DTaP vaccine given in the primary infant/child
series in the amount of vaccine components it contains) should be
substituted for one Td dose in adults who are receiving the primary
series for the first time. It also should be given as a booster to
adults under 65 years who have not previously received a dose of
Tdap vaccine. One dose of Tdap should be given as early as 2 years
after a Td booster to people whose risk of acquiring pertussis and
transmitting it to infants is high, for example women in the
immediate postpartum period (prior to hospital discharge), close
contacts of infants < 12 months of age and all health care workers
with direct patient contact.
Tetanus-diptheria (Td) vaccine is
recommended for adults who have not completed their primary
vaccination series for tetanus or diphtheria. Those for whom a
reliable history cannot be obtained should begin or complete their
primary series. The primary series consists of 3 doses of tetanus
and diphtheria toxoid-containing vaccines. After completing the
primary series of vaccination, a Tdap booster is recommended at 10
year intervals. For wound prophylaxis, Td can be administered more
frequently and the ACIP statement dealing with wound management
should be consulted.
Pregnant women who received Td more than
two years previously should have Tdap
in the immediate post-partum period (prior to hospital discharge).
In almost all situations, Td can be deferred during pregnancy and
Tdap given in the immediate post-partum period or Tdap can be given
instead of Td in pregnancy after discussion between the pregnant
woman and her doctor. Learn more about Td and Tdap vaccines.
Human papillomavirus (HPV) vaccine is recommended for all female
adolescents and young women aged 11 to 26 years who have not already
had the three-dose vaccine series. HPV vaccine is recommended for
women even if they have a history of genital warts, abnormal
Papanicolaou test (Pap smear) or positive HPV test because the
vaccine may protect against other forms of HPV. To best protect
women against acquiring HPV this vaccine should be given before
women are exposed to HPV through sexual intercourse, however, women
<27 years of age who are already sexually active should also be
vaccinated. The vaccine is not recommended in pregnancy. Learn
more about HPV vaccine.
Measles,
mumps, rubella (MMR) vaccine is recommended for adults based on the
risk of acquiring and need for protection against measles, mumps or
rubella in a given situation. Adults born before 1957 are assumed to
have had natural infection with measles and mumps and are considered
immune to both infections.To protect against measles adults born
during or after 1957 should receive one or more doses of MMR unless
they have:
-
A medical contraindication (for
example people with HIV/AIDS, weakened immune systems, cancer,
low platelet counts, those being treated for another condition
with steroids or those who have recently received a blood
transfusion)
-
Documentation that they received ≥
two
doses of MMR already
-
A history of measles infection from
their healthcare provider
-
Laboratory evidence that they are
immune
A second dose of MMR (given at least 4
weeks after the first dose) is recommended for adults who:
-
Were recently exposed to measles or if
there is a measles outbreak
-
Were vaccinated with killed measles
vaccine rather then the currently available live vaccine
-
Were vaccinated with an unknown type
of measles vaccine during 1963-1967
-
Are students
-
Work in a health care setting
-
Plan to travel internationally
To protect against mumps adults
born during or after 1957 should receive one or more doses of MMR
unless they have:
-
A medical contraindication (for
example people with HIV/AIDS, weakened immune systems, cancer,
low platelet counts, those being treated for another condition
with steroids or those who have recently received a blood
transfusion)
-
A history of mumps infection from
their healthcare provider
-
Laboratory evidence that they are
immune
A second dose of MMR (given at least 4
weeks after the first dose) is recommended for adults who:
-
Are in an age group affected during a
mumps outbreak
-
Are students in a postsecondary
institution
-
Work in a health care facility
-
Plan to travel internationally
To protect against rubella, MMR
vaccine is recommended for women who cannot prove they received
rubella vaccine in the past or who do not have laboratory evidence
that they are immune. Women of childbearing age should routinely
have their rubella immunity checked.
Pregnant women should not receive MMR
vaccine and women of child-bearing age should be advised to avoid
pregnancy for 4 weeks after receiving MMR. Rubella non-immune women
should receive MMR as soon as their pregnancy is completed before
discharge from the hospital and can be given at the same time as the
Tdap vaccine. Learn
more about MMR vaccine.
Varicella
vaccine is recommended for adults who do not have evidence of
immunity to varicella (prior chickenpox infection). They should
receive two doses of this vaccine. This is especially important for
people who have close contact with people at high risk of developing
severe varicella disease, such as health-care workers and family
contacts of people with immunodeficiency, or people who are at high
risk of coming into contact with or spreading varicella (for example
teachers, daycare workers, college students, those living with young
children, non-pregnant women of child-bearing age and international
travelers. Acceptable evidence of immunity includes:
·
Documentaed proof that two doses of
varicella vaccine have been given at least 4 weeks apart
·
Born in the US before 1980 (people with immunodeficiency, healthcare
workers and pregnant women need additional proof of immunity)
·
History of varicella infection documented by a health care provider
·
History of herpes zoster infection (shingles) documented by a healthcare
provider
·
Laboratory evidence of immunity
Pregnant
women should not receive varicella vaccine and women of
child-bearing age should be advised to avoid pregnancy for four
weeks after receiving varicella vaccine. Women without evidence of
varicella immunity should receive varicella vaccine as soon as their
pregnancy is completed. Learn
more about varicella vaccine.
Influenza vaccine is recommended annually for all
adults who are 50 years old or older. For adults between the ages of
19 and 49, annual vaccination is recommended in the following
situations:
-
Medical indications
-
Occupational indications (health care workers including those
employed in long-term care and assisted living facilities)
-
Residents of nursing homes, long-term care and assisted-living
facilities
-
People
likely to transmit influenza to those at high risk for
complications of influenza, for example, those living with or
caring for children under the age of 5 years or people with any
medical indication listed above.
-
Anyone who would like to be protected against influenza
Two influenza vaccines are available for
use in adults. The live, attenuated influenza vaccine (LAIV) that is
given via intranasal spray can be given to healthy non-pregnant
adults who are younger than 49 years old, who do not have any
medical conditions listed above and are not contacts of severely
immunocompromized persons (such as bone-marrow transplant patients).
However TIV is recommended for all other adults. Learn more about
LAIV and
TIV vaccines.
Pneumococcal polysaccharide vaccine is recommended for all adults 65
years of age or older. For adults under 64 years of age annual
vaccination is recommended in the following situations.
-
Medical indications:
-
Chronic respiratory disorders except asthma
-
Cardiovascular disease
-
Diabetes mellitus
-
Chronic liver disease
-
Chronic alcoholism
-
Chronic renal failure or nephrotic syndrome
-
After removal of the spleen or when the spleen is not functioning
-
Disorders of the immune system
-
Certain malignancies
-
People undergoing chemotherapy or taking drugs that affect the
immune system
-
People with cochlear implants who are at high risk of getting pneumococcal meningitis
-
People with cerebrospinal fluid
leaks
-
Alaskan natives and certain Native
American populations
-
Residents of nursing homes, longterm-care and assisted living
facilities
The vaccine should be repeated once five years after the first dose
is given in the following situations.
-
Chronic renal failure or nephrotic syndrome
-
After removal of the spleen or when the spleen is not functioning
-
Disorders of the immune system
-
Certain malignancies
-
People undergoing chemotherapy or taking drugs that affect the
immune system
-
People who are 65 years of age or older who were vaccinated more
than five years previously and who were aged less than 65 years old
at that time
Hepatitis A vaccine is recommended for adults who have
risk factors for acquiring the illness including:
Hepatitis B vaccine is recommended for adults who have
risk factors for acquiring the illness including:
-
Medical indications
-
Renal failure including patients receiving hemodialysis
-
People being evaluated or treated for a sexually transmitted
infection (STI)
-
People with HIV infection
-
Chronic liver disease
-
Occupational indications
-
Behavior indications
-
People with more than one sex partner in the previous six months
-
Men who have sex with men
-
Current or past intravenous drug users
-
Household contacts and sex partners of people with chronic
hepatitis B virus (HBV) infection
-
Members and workers in institutions for people with developmental
disabilities
-
Travelers to or workers in countries where chronic HBV is common.
See
http://wwwn.cdc.gov/travel/contentDiseases.aspx and
TCH travel medicine
clinic.
-
Any adult who wants to be protected from HBV
In addition
HBV vaccine is recommended for all adults in STI, HIV or drug-abuse
facilities, health care facilities for men who have sex with men or
for drug abuse, correctional facilities, facilities for patients
with end-stage renal disease and hemodialysis and facilities for
persons with developmental disabilities. Learn more
about Hepatitis B vaccine.
Meningococcal vaccines licensed for use in adults (meningococcal
polysaccharide vaccine [MPSV4] and meningococcal conjugate vaccine
[MCV4]) protect against 4 types of meningococcal disease, types A,
C, Y and W135. MCV4 is licensed for ages 11-55 years and is the
preferred meningococcal vaccine in this age group. Meningococcal
conjugate vaccination in adults is indicated for the following
situations:
-
Medical indications
-
People who have a damaged spleen or have had their spleen removed
-
People with certain immune
deficiencies, including asplenia, t complement deficiency or
HIV
-
First-year college students, especially those who will live in
dormitories
-
Military recruits
-
Microbiologists who could be exposed to
meningococcus
-
People traveling to parts of the world
where meningococcal disease is common, for example the
“meningitis belt” of Sub-Saharan Africa.
See
http://wwwn.cdc.gov/travel/contentDiseases.aspx
-
Travelers to Mecca for the annual Hajj are required
by the government of Saudi Arabia to have had meningococcal
vaccine.
Revaccination with MCV4 after five years
is recommended for adults previously vaccinated with MPSV4 who
remain at high risk for infection. Learn more about
Meningococcal vaccine.
Herpes
zoster vaccine is recommended for adults 60 years of age or older
even if they have previously had herpes zoster infection. People
with chronic medical conditions can receive the vaccine unless a
specific contraindication or precaution exists for their condition.
Learn more about
Herpes zoster vaccine.
 
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