MEDICAL CONDITIONS
Vaccination Schedule for Adults and Adolescents
Medical Authors: Carolyn J. Crandall, M.D. , and Daniel Gornel, M.D., MPH
Medical Editor: Dennis Lee, M.D.
Tetanus and diphtheria toxoids (Td) is a combination vaccine to prevent tetanus (also known as "lockjaw") and diphtheria.
Who should receive the tetanus and Td vaccine?
Adults and adolescence.
How often should the tetanus and Td vaccine be administered? - Adults who had received recommended childhood immunizations should have a Td shot every 10 years
- Adults who have never received childhood vaccinations should receive three Td shots (the second shot in 4-8 weeks after the first, and the third shot at 6-12 months after the second shot)
- Adults at higher risk of contracting tetanus (adults working with farm manure or home garden manure fertilizers) should have a Td shot every 5 years
- Individuals with a clean, minor wound who has had less than three Td shots or of uncertain vaccination history should receive a Td shot
- Individuals with more serious wounds (wounds from burns , crushing, frostbite ) or wounds contaminated with dirt, feces , or saliva should have both Td and tetanus immune globulin if the individual had less than 3 shots or uncertain vaccination history, and Td alone if he/she had 3 or more shots but the last one was more than 5 years ago
What about pregnancy and breastfeeding?
The vaccine can be given during pregnancy and lactation except during first trimester of pregnancy.
Who should not receive the tetanus and Td vaccine? - Individuals who have had prior severe vaccine reactions such as seizures, brain dysfunction, high fever (>104.9 F), anaphylaxis , or shock should not receive additional Td vaccine
- The vaccine should not be given to women in the first trimester of pregnancy
What is the effectiveness of the tetanus and Td vaccine, and what about side effects? - The vaccine is highly effective against both tetanus and diphtheria when given according to the recommended schedule
- Side effects include redness and tenderness at the injection site, fever and malaise can sometimes occur. Severe rash , anaphylactic shock , seizure and brain dysfunction have been reported but are very rare
Who should receive the influenza vaccine? - Adults 50 years or older
- All residents and staff of chronic care facilities, including nursing homes, board and care facilities, and institutions for the mentally and physically disabled
- Adults of any age with chronic diseases such as asthma , chronic bronchitis , emphysema , congestive heart failure, angina , previous heart attack , heart valve conditions, heart inflammation, diabetes mellitus , kidney disorders, sickle cell disease and other hemoglobin abnormalities, cancers, and diseases or treatments that weaken immunity (such as AIDS , cancer chemotherapy , prednisone or other corticosteroid medications)
- All care givers, nursing and medical staff and institutional employees and household contacts of those with the chronic diseases noted above
- Children and adolescents (ages 6 months to 18 years) on long-term aspirin therapy and therefore at risk for developing Reye's Disease if infected with the influenza virus
When the influenza vaccine supply is limited, The Centers for Disease Control will ask doctors to give preference to patients over 65 and to the high risk groups and their caretakers.
How often should the influenza vaccine be administered?
The influenza vaccine only protects against three specific strains of influenza virus (out of many), which are chosen each year because they are expected to be the predominant strains in the next flu season. Because one or more of the expected predominant strains changes each year, an influenza immunization is recommended each year.
What about pregnancy and breastfeeding? - The influenza vaccine should be given to women who will be at 2nd or 3rd trimesters of pregnancy during the influenza season.
- Generally the vaccine is not given to women during the 1st trimester
Who should not receive the influenza vaccine? - Individuals with severe allergy to eggs (such as anaphylactic reactions) should not receive influenza vaccine
- Individuals currently having an acute illness with fever should postpone their immunization until they have recovered from the acute illness
What is the effectiveness of the influenza vaccine, and what about side effects? - Influenza vaccine only protects against infection by the three particular strains of influenza virus that are selected for the vaccine that year
- Vaccinated individuals can still catch other virus infections resulting in cough, fever, and other symptoms that resemble influenza.
- Side effects of flu shots include transient soreness at the site of the injection, muscle aches, fever, and feeling unwell. Serious allergic reactions are rare.
Pneumococcus is a bacterium that causes pneumonia and sometimes life threatening blood stream infection. Pneumococcal infection is especially dangerous among the elderly and among individuals who have lost their spleen .
Who should receive the pneumococcal vaccine? - Adults 65 years and older
- Adults with chronic lung and heart problems, and diseases such as diabetes , chronic liver disease, alcoholism , lymphoma, multiple myeloma, kidney diseases, organ transplant recipients, chronic cerebrospinal fluid leak, AIDS and other conditions or treatments which lower body immunity
- Adults with lack of adequate spleen function such as sickle cell anemia, spleen absent surgically or from an accident
- Alaskan Natives and certain American Indian populations who are at higher than normal risk of developing pneumococcal infections and related complications
How often should the pneumococcal vaccine be administered?
Pneumococcal vaccine currently in use is a one-time vaccine. However, the following groups should receive revaccination if >5 years have passed since the first dose: - Individuals vaccinated prior to age 65
- Individuals with lack of spleen function, chronic kidney disease, weakened immunity, or have undergone organ transplantation
The vaccine can be given at the same time as the Influenza vaccine, but has to be given in the opposite arm.
What about pregnancy and breastfeeding?
Unclear safety during first trimester of pregnancy.
Who should not receive the pneumococcal vaccine?
Women in first trimester of pregnancy, and individuals who have known allergy to the vaccine or its ingredients should not receive the vaccine.
What is the effectiveness of the pneumococcal vaccine, and what about side effects? - Pneumococcal polysaccharide vaccine is effective against pneumococcal infection, especially against the more serious blood stream infections
- Common side effects include pain and redness at the injection site
- Fever, muscle aches and severe local reactions are rare
- Anaphylaxis is very rare
Two hepatitis A vaccines are available in the US: Havrix and Vaqta
Who should receive the hepatitis A vaccine?
Individuals at increased risk of acquiring hepatitis A and individuals with chronic liver disease should be vaccinated.
Individuals at increase risk of acquiring hepatitis A are: - Travelers to countries where hepatitis A is common
- Men who have sex with men
- Illegal drug users (either injection or non-injection drug use)
- Researchers working with hepatitis A virus or primates that are susceptible to hepatitis A infection
- Patients with clotting factor disorders receiving clotting factor concentrates
Individuals with chronic liver disease such as cirrhosis or hepatitis C are not at increased risk of acquiring hepatitis A, but they can develop serious (sometimes fatal) liver failure if infected with hepatitis A, thus they should be vaccinated.
Some local health authorities or private companies may require hepatitis A vaccination for food handlers.
How often should the hepatitis A vaccine be administered?
Hepatitis A vaccines should be given in the muscle in 2 doses. For adults receiving Vaqta, the second dose should be given 6 months after the first dose. For adults receiving Havrix, the second dose should be given 6-12 months after the first dose.
What about pregnancy and breastfeeding?
Safety of hepatitis A vaccine in pregnancy has not been established, though risk to the fetus is believed to be low.
Who should not receive the hepatitis A vaccine?
Individuals with past allergic reaction to vaccine ingredients such as alum or 2-phenoxyethanol preservative should not receive the vaccine.
What is the effectiveness of the hepatitis A vaccine, and what about side effects?
Common side effects are soreness at the injection site, headache , and malaise.
After the first dose, protective antibodies develop in 70% of vaccine recipients in 2 weeks and more than 95% of recipients in 4 weeks. (Protective antibodies protect the body against infection by hepatitis A.)
After two doses of the hepatitis A vaccine, immunity against hepatitis A infection is believed to be long lasting.
Because protective antibodies take weeks to develop, travelers to countries where hepatitis A is common should be vaccinated at least 4 weeks before departure. The Centers for Disease Control (CDC) recommends immunoglobulin be given in addition to vaccination if departure is prior to 4 weeks. Immunoglobulin provides quicker protection than the vaccines but the immunoglobulin protection is short-lived.
EngerixB and Recombivax HB are two vaccines available in the United States
Who should receive the hepatitis B vaccine?
Hepatitis B vaccine is recommended for: - All infants
- Adolescents under 18 years of age who did not receive hepatitis B vaccine as infants
- People occupationally exposed to blood or body fluids
- Residents and staff of institutions for the developmentally disabled
- Patients receiving kidney hemodialysis
- Hemophiliacs and other patients receiving clotting factor concentrates
- Household contacts and sex partners of hepatitis B infected patients (patients who test positive for hepatitis B surface antigen )
- Travelers who will spend more than 6 months in regions with high hepatitis infection rates
- Injection drug users and their sex partners
- Men who have sex with men, men or women with multiple sex partners, or recent infection with a sexually transmitted infection
- Inmates of long-term correctional facilities
How often should the hepatitis B vaccine be administered?
Hepatitis B vaccines should be given in three doses, with the second dose 1-2 months after dose 1, and the third dose 4-6 months after dose 1.
For best results the vaccinations should be given in the deltoid muscles, not in the buttocks.
If the three-dose schedule is interrupted, it is acceptable to just complete all 3 doses later; it is not necessary to start over.
Engerix B and Recombivax HB can be used interchangeably any point during the vaccination schedule.
What about pregnancy and breastfeeding?
All pregnant women should have a blood test for the hepatitis B surface antigen (HBsAg). Women who test positive for HBsAg risk transmitting the virus to their infants during labor. Therefore infants born to HBsAg-positive mothers should receive hepatitis immune globulin ( HBIG ) in addition to hepatitis B vaccine at birth. Even though hepatitis B vaccine can offer long lasting immunity, immunity from the vaccine takes time to develop. While HBIG is an antibody solution that can offer more rapid though short lived immunity.
Hepatitis B vaccinations are safe for pregnant and nursing mothers.
Who should not receive the hepatitis B vaccine?
Individuals with anaphylactic allergy to yeast or known adverse reaction to the vaccine should not receive the vaccine.
Patients with prior hepatitis B infection or currently infected with hepatitis B virus also should not receive the vaccine.
What is the effectiveness of the hepatitis B vaccine, and what about side effects?
Side effects of Hepatitis B immunization are usually minor: pain at the injection site and low-grade fever.
The hepatitis B vaccines are 95% effective. Five percent of vaccinated individuals will fail to develop the necessary antibodies for immunity after the three doses.
Patients with weakened immunity (such as HIV infection), elderly patients, and patients undergoing kidney hemodialysis are more likely to fail to respond to the vaccinations.
Hepatitis B vaccination takes time to become effective. Therefore unvaccinated individuals exposed to infected materials (such as a healthcare worker stuck by a contaminated needle) will need hepatitis immune globulin (HBIG) in addition to hepatitis B vaccine. HBIG is an antibody solution that offers more rapid (though short lived) immunity than the vaccine.
MMR is a combination vaccine recommended for children and adults to prevent measles (rubeola), German measles ( rubella ), and mumps .
Vaccines are also available as single virus vaccines or two virus vaccine combinations.
Who should receive the MMR vaccine?
Rubella
Rubella infection in early pregnancy can lead to miscarriage , stillbirth, and birth defects . Thus MMR should be given to: - All children after the first birthday, and a booster dose to be given either at 4-6 years or 11-12 years of age
- All women of childbearing age who do not have written proof of childhood immunization or blood test proof of immunity
- Healthcare workers who are at risk of exposure to rubella, and have contact with pregnant women
- Women in childbearing age should discuss Rubella vaccination with their doctors
Measles
Measles (rubeola) infection can cause serious pneumonia or brain infection in adults. Adults born before 1956 are usually immune to measles and do not need measles vaccination. Adults who should be vaccinated (with either MMR or measles vaccine) include: - Adults born after 1956 without written proof of immunization on or after 1st birthday
- Travelers to foreign countries
- Adults beginning college
- Healthcare personnel born after 1956 who are at risk of exposure to patients with measles
Mumps
Mumps immunization is recommended for all adults born after the vaccine first became available in 1957 (those older have likely had mumps and are therefore considered immune) and who have not previously been immunized or had mumps.
How often should the MMR vaccine be administered?
For rubella and mumps only one dose of MMR for adults.
For measles, two doses of measles vaccine or MMR are recommended for college students and healthcare professionals with potential for exposure to measles. (The 2nd dose should be at least 1 month after the 1st). For other unvaccinated adults only 1 dose is needed.
What about pregnancy and breastfeeding?
MMR is made from live viruses that have been modified from the viruses that cause disease. Even though there is no evidence of vaccine-induced birth defects, pregnant women should not receive MMR vaccine.
Women should also avoid pregnancy for 28 days after receiving MMR or any rubella-containing vaccine.
Who should not receive the MMR vaccine?
The following individuals should not receive MMR: - Patients with allergy to eggs or have had anaphylactic reaction to neomycin
- Pregnant women
- Patients with weakened immunity
- Patients with untreated active tuberculosis
Vaccination should be delayed in the following groups: - Adults who have acute illness with fever
- Patients who have received immune globulin injection in prior 3-11 months
- Patients on high doses of corticosteroid, such as prednisone, until at least 3 months after stopping the corticosteroid
What is the effectiveness of the MMR vaccine, and what about side effects? - MMR vaccine is greater than 95% effective in conferring long lasting immunity.
- Side effects of MMR include joint aches or arthritis that can occur 1-3 weeks after vaccination and lasting for days to weeks.
- Other side effects include rash, fever and swollen lymph glands.
There are two poliovirus vaccines; oral live poliovirus vaccine (OPV) and inactivated poliovirus vaccine (IPV). - OPV contains live virus that has been modified from the wild virus (the virus that causes polio and paralysis )
- IPV contains inactivated (dead) virus and does not cause paralysis or polio. Therefore IPV is currently the recommended vaccine for children and adults
Who should receive the poliovirus vaccine?
Authorities recommend that all children be vaccinated with IPV. Since poliovirus infection is extremely rare in the United States, IPV vaccinations are recommended only for adults who are unvaccinated or partially vaccinated and who may be exposed to poliovirus (wild or OPV): - Travelers to areas where polio is common
- Living in communities that have had documented infection with wild polioviruses
- Laboratory workers who handle poliovirus specimens
- Healthcare workers exposed to patients infected with wild polioviruses
- Household contacts if OPV was used to immunize
How often should the poliovirus vaccine be administered?
Unvaccinated adolescents and adults should be given three IPV doses; the second dose should be given 4-8 weeks after the first dose, and the third dose be given 6-12 months after the second dose.
Partially vaccinated adolescents and adults should receive the rest of their vaccine series to total 3 doses.
Adults who have already received childhood immunization but who have had possible exposure to wild poliovirus should be given one dose of IPV.
What about pregnancy and breastfeeding?
No adverse effects have been seen in pregnancy, generally avoided in pregnant women unless immediate protection is required.
Who should not receive the poliovirus vaccine?
IPV should not be given to those with prior anaphylactic reaction to a previous dose, or to those with a prior anaphylactic reaction to streptomycin, polymyxin B, or neomycin.
What is the effectiveness of the poliovirus vaccine, and what about side effects?
OPV can very rarely cause polio and paralysis. (1 in 6 million doses.)
IPV does not cause paralysis. IPV can cause minor local pain and swelling at injection site.
Who should receive the varicella vaccine?
All susceptible individuals of any age should be vaccinated. Susceptible individuals are individuals who have not had chickenpox or whose blood tests indicate lack of immunity. It is especially important for the following individuals to be vaccinated: - Susceptible adolescents and adults living with children
- Susceptible healthcare workers
- Susceptible family contacts of patients with weakened immunity such as those with AIDS, those receiving chemotherapy or taking prednisone or other corticosteroid medication
- Susceptible international travelers
- Susceptible nonpregnant women of childbearing age
- Susceptible individuals living or working in environments where transmission is likely (such as teachers of young children, residents or staff of institutional settings, college students)
How often should the varicella vaccine be administered? - 2 doses separated by 4-8 weeks
- If more than 8 weeks go by after the 1st dose, the 2nd dose can be given without repeating the 1st dose
What about pregnancy and breastfeeding?
Pregnant women should not receive the varicella vaccine. Pregnancy should be avoided for 1 month after varicella vaccination.
Who should not receive the varicella vaccine?
The following individuals should not receive the vaccine: - Individuals with anaphylactic allergy to gelatin or neomycin
- Individuals with untreated active tuberculosis
- Individuals with weakened immunity such as HIV infection, or taking medications such as corticosteroids that weaken immunity, or have diseases that weaken immunity
- Pregnant women
- Individuals who have received immune globulin or blood product in prior 5 months
What is the effectiveness of the varicella vaccine, and what about side effects?
The varicella vaccine is highly effective in preventing chickenpox.
It is not certain whether the varicella vaccine prevents shingles . Shingles is a painful, localized skin condition caused by the same virus that causes chicken pox.
Portions of the above information was provided with the kind permission of the Centers for Disease Control, Advisory Committee on Immunization Practices (ACIP).
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