| |
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. 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 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 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 severe illness in
pregnant women or can harm the developing fetus, cause
miscarriage or stillbirths (such as 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 the current adult population 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.
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 Td
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.
Tdap (which differs from the DTaP vaccine given in the primary
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 single
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 aged < 12 months and all health care workers
with direct patient contact.
Pregnant women who received Td more than 10 years previously may
have Td during the second or third trimester. If the last Td booster
was less than 10 years ago, Tdap should be given in the immediate
post-partum period (prior to hospital discharge). In certain
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
adolescents and young women aged 11 to 26 years who have not already
had the vaccine series as an adolescent. 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
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) 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 ≥ 1
dose 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
-
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 and be counseled regarding
congenital rubella syndrome.
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. Non-immune women should
receive MMR as soon as their pregnancy is completed. 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:
-
Documentary proof that two doses of varicella vaccine were given
four 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
-
Immunodeficiency including HIV and drug-induced
-
Chronic cardiac or respiratory diseases including asthma
-
Chronic metabolic diseases including diabetes mellitus, renal
failure, hemoglobinopathies
-
Any condition that compromises respiratory function
-
Women who will be pregnant during the influenza season
-
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 < 5 years or people with any medical
indication listed above.
-
Anyone who would like to be vaccinated
Two influenza vaccines are available for
use in adults. The live, attenuated influenza vaccine (LAIV) that is
given via intranasal spray may be given in preference to the
inactivated (killed) vaccine (TIV) or “the flu shot” 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 in special care units. 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 aged 10-64 years 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 although MPSV4 is an acceptable alternative. Meningococcal
vaccination in adults is indicated for the following situations:
-
Medical indications
-
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 after five years might be considered 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 aged 60 years or older even if they have previously had
herpes zoster infection. People with chronic medical conditions may
receive the vaccine unless a specific contraindication or precaution
exists for their condition. Learn more about
Herpes zoster vaccine.
 
|
|
