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Recommended adult immunization schedule, United States. (Infectious Diseases).

Recommended Adult Immunization Schedule, United States, 2002-2003

                                             Age
Vaccine                        19-49 years

Tetanus, Diphtheria (Td) *     1 dose booster every 10
                               years (1)

Influenza                      1 doze annually for persons
                               with medical or occupational
                               indications, or household
                               contacts of persons with
                               indications (2)

Pneumococcal (polysaccharide)  1 dose for persons with
                               medical or other indications.
                               (1 dose revaccination for
                               immunosuppressive conditions)
                               (3,4)

Hepatitis B *                  3 doses (0, 1-2, 4-6 months)
                               for persons with medical,
                               behavioral, occupational, or
                               other indications (5)

Hepatitis A                    2 doses (0, 6-12 months) for
                               persons with medical,
                               behavioral, occupational, or
                               other indications (6)

Measles, Mumps                 1 dose if mensles, mumps, or
Rubella (MMR) *                rubella vaccination history is
                               unreliable; 2 doses for
                               persons with occupational,
                               geographic, or other
                               indications (7)

Varicella *                    2 doses (0, 4-8 weeks)
                               for persons who are
                               susceptible (8)

Meningococcal                  1 dose for persons
(polysaccharide)               with medical or other
                               indications (9)

                                     Age
Vaccine                        50-64 years

Tetanus, Diphtheria (Td) *


Influenza                      1 annual dose





Pneumococcal (polysaccharide)





Hepatitis B *




Hepatitis A




Measles, Mumps
Rubella (MMR) *





Varicella *



Meningococcal
(polysaccharide)


                                                Age
Vaccine                        65 years and older

Tetanus, Diphtheria (Td) *


Influenza





Pneumococcal (polysaccharide)  1 dose for unvaccinated persons (3)
                               1 dose revaccination (4)




Hepatitis B *




Hepatitis A




Measles, Mumps
Rubella (MMR) *





Varicella *



Meningococcal
(polysaccharide)


Note: Based on the Recommendations of the Advisory Committee on
Immunization Practices, Centers for Disease Control and Prevention.

* Covered by the Vaccine Injury Compensation Program. For information
on how to file a claim; call 800-338-2382. Please also visit
http://www.hrsa.osp.gov /vicp, accessed Feb. 21, 2002. To file a claim
for vaccine injury, write: U.S. Court of Federal Claims, 717 Medison
Place, N.W., Washingotn, DC 20005; (202) 219-9657.

This schedule indicates the recommended age groups for routine
administraiton of currently licensed vaccines for persons 19 years of
age and other. Licensed combination vaccines may be used whenever any
components of the combination are indicated and the vaccine's other
components are not contraindicated. Providers should consult the
manufacturers' package inserts for detailed recommendations.

Report all clinically significant postvaccination reactions to the
Vaccine Adverse Event Reporting System (VAERS). Reporting forms and
instruction on filing a VAERS report are available by calling
800-822-7967 or from the VAERS Web site at http://www.vaers.org.

For additional information about the vaccines listed above and
contraindications for immunization, visit the National Immunization
Program Web site at http://www.cdc.gov/nip or call the National
Immunization Hotline at 800-232-2522 (English) or 800-232-0233
(Spanish).

(1)Tetanus and diphtheria (Td): A primary series for adults is three
doses: the first 2 doses given at least 4 weeks apart and the third
dose, 6-12 months after the second. Administer 1 dose if the person
had received the primary series and the last vaccination was 10 years
ago or longer. MMWR 1991; 40 (RR-10):1-21. The ACP Task Force on Adult
Immunization supports a second option: a single Td booster at age 50
years for persons who have completed the full pediatric series,
including the teenage/young adult booster. Guide for Adult
Immunization. 3rd ed. ACP 1994:20.

(2)Influenza vaccination: Medical indications: chronic disorders of
the cardiovascular or pulmonary systems including asthma; chronic
metabolic diseases including diabetes mellitus, renal dysfunction,
hemoglobinopathies, immunosuppression (including immunosuppression
caused by medications or by human immunodeficiency virus [HIV])
requiring regular medical follow-up or hospitalization during the
preceding year; women who will be in the second or third trimester of
pregnancy during the influenza season. Occupational indications:
health care workers. Other indications: residents of nursing homes
and other long-term care facilities; persons likely to transmit
influenza to persons at high risk (in-home caregivers to persons with
medical indications, household contacts and out-of-home caregivers
of children birth to 23 months of age, or children with asthma or
other indicator conditions for influenza vaccination, household
members and caregivers of elderly and adults with high-risk
conditions); and anyone who wishes to be vaccinated. MMWR 2002;
51 (RR-3):1-31.

(3)Pneumococcal polysaccharide vaccination: Medical indications:
chronic disorders of the pulmonary system (excluding asthma),
cardiovascular diseases, diabetes mellitus, chronic liver diseases
including liver disease as a result of alcohol abuse (e.g.,
cirrhosis), chronic renal failure or nephrotic syndrome, functional
or anatomic asplenia (e.g., sickle cell disease or splenectomy),
immunosuppressive conditions (e.g., congenital immunodeficiency, HIV
infection, leukemia, lymphoma, multiple myeloma, Hodgkin's disease,
generalized malignancy, organ or bone marrow transplantation),
chemotherapy with alkylating agents, antimetabolites, or long-term
systemic corticosteroids. Geographic/other indications: Alaskan
Natives and certain American Indian populations. Other indications:
residents of nursing homes and other long-term care facilities.
MMWR 1997; 47 (RR-8):1-24.

(4)Revaccination with pneumococcal polysaccharide vaccine: Onetime
revaccination after 5 years for persons with chronic renal failure
or nephrotic syndrome, functional or anatomic asplenia (e.g., sickle
cell disease or splenectomy), immunosuppressive conditions (e.g.,
congenital immunodeficiency, HIV infection, leukemia, lymphoma,
multiple myeloma, Hodgkin's disease, generalized malignancy, organ
or bone marrow transplantation), chemotherapy with alkylating agents,
antimetabolites, or long-term systemic corticosteroids. For persons
065 and older, one-time revaccination if they were vaccinated 5 or
more years previously and were aged less than 65 years at the time
of primary vaccination. MMWR 1997; 47 (RR-8):1-24.

(5)Hepatitis B vaccination: Medical indications: hemodialysis
patients, patients who receive clotting-factor concentrates.
Occupational indications: health care workers and public-safety
workers who have exposure to blood in the workplace, persons in
training in schools of medicine, dentistry, nursing, laboratory
technology, and other allied health professions. Behavioral
indications: injecting drug users, persons with more than one sex
partner in the previous 6 months, persons with a recently acquired
0sexually transmitted disease, all clients in STD clinics, men who
have sex with men. Other indications: household contacts and sex
partners of persons with chronic HBV infection, clients and staff
of institutions for the developmentally disabled, international
travelers who will be in countries with high or intermediate
prevalence of chronic HBV infection for more than 6 months, inmates
of correctional facilities. MMWR 1991; 40 (RR-13): 1-25.
(www.cdc.gov/travel/diseases/hbv.htm)

(6)Hepatitis A vaccination: For the combined HepA-HepB vaccine, use 3
doses at 0, 1, 6 months. Medical indications: persons with
clotting-factor disorders or chronic liver disease. Behavioral
indications: men who have sex with men, users of injecting and
noninjecting illegal drugs. Occupational indications: persons working
with HAV-infected primates or with HAV in a research laboratory
setting. Other indications: persons traveling to or working in
countries that have high or intermediate endemicity of hepatitis A.
MMWR 1999; 48 (RR-12): 1-37. (www.cdc.gov/travel/diseases/hav.htm)

(7)Measles, Mumps, Rubella vaccination (MMR): Measles component:
Adults born prior to 1957 may be considered to be immune to measles.
Give 2 doses of MMR for adults with one or more of the following
conditions and without vaccination history:

* adults born after 1956

* persons vaccinated with killed measles virus vaccine 1963-1969

* students in postsecondary education institutions

* health care workers

* susceptible international travelers to measles-endemic countries.
Mumps component: 1 dose of MMR should be adequate for protection.

Rubella component: Give 1 dose of MMR to women whose
rubella-vaccination history is unreliable, and counsel women to avoid
becoming pregnant for 4 weeks after vaccination. For women of
child-bearing age, regardless of birth year, routinely determine
rubella immunity and counsel women regarding congenital rubella
syndrome. Do not vaccinate pregnant women or those planning to become
pregnant in the next 4 weeks. If pregnant and susceptible, vaccinate
as early in postpartum period as possible. MMWR 1998; 47 (RR-8):1-57.

(8)Varicella vaccination: Recommended for all persons who do not have
reliable clinical history of varicella infection or serologic evidence
of varicella zoster virus (VZV) infection, health care workers and
family contacts of immunocompromised persons, those who live or work
in environments where transmission is likely (e.g., teachers of young
children, day care employees, and residents and staff members in
institutional settings), persons who live or work in environments where
VZV transmission can occur (e.g., college students, inmates and staff
members of correctional institutions, and military personnel),
adolescents and adults living in households with children, women who
are not pregnant but who may become pregnant in the future,
international travelers who are not immune to infection. Note: Greater
than 90% of U.S.-born adults are immune to VZV. Do not vaccinate
pregnant women or those planning to become pregnant in the next 4
weeks. If pregnant and susceptible, vaccinate as early in postpartum
period as possible. MMWR 1996; 45 (RR-11):1-36.
MMWR 1999; 48 (RR-6): 1-5.

(9)Meningococcal vaccine (quadrivalent polysaccharide for serogroups
A, C, Y, and W-135): Consider vaccination for persons with medical
indications: adults with terminal complement component deficiencies,
with anatomic or functional asplenia. Other indications: travelers
to countries in which disease is hyperendemic or epidemic ("meningitis
belt" of sub-Saharan Africa, Mecca, Saudi Arabia, for Hail).
Revaccination at 3-5 years may be indicated for persons at high risk
for infection (e.g., persons residing in areas in which disease is
epidemic). Counsel college freshmen, especially those who live in
dormitories, regarding meningococcal disease and the vaccine so that
they can make an educated decision about receiving the vaccination.
MMWR 2000; 49 (RR-7):1-20. Note: The American Academy of Family
Physicians recommends that colleges should take the lead on providing
education on meningococcal infection and vaccination and offer it to
those who are interested. Physicians need not initiate discussion of
the meningococcal quadrivalent polysaccharide vaccine as part of
routine medical care.
COPYRIGHT 2002 International Medical News Group
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2002 Gale, Cengage Learning. All rights reserved.

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Date:Nov 1, 2002
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