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Immunizations for the adult patient.

One of the greatest achievements in modern medicine is the use of vaccinations to eradicate or reduce greatly the spread of communicable diseases (Sevin, Romeo, Gagne, Brown, & Rodis, 2016). Vaccinations have reduced morbidity and mortality associated with diseases such as polio and smallpox (Hale & Marshall, 2016). In spite of this, adult immunization rates rarely meet target goals established by Healthy People 2020 (Boyle & Flaherty, 2013; Hale & Marshall, 2016; Sevin et al., 2016). Failure to meet target vaccination goals further reinforces the need to educate adult patients with accurate information regarding vaccinations.

Non-Hispanic Whites with higher educational levels have a better rate of immunization compliance when compared with other patient populations (Sevin et al., 2016). Although vaccines are safe with few side effects, barriers remain that hinder vaccination use by adults (Hale & Marshall, 2016). These include attitude toward vaccines, belief vaccinations are not needed, concern regarding vaccine side effects, and the opinion vaccines cause illness. Nurses should understand these barriers when educating adult patients about immunizations (Sevin et al., 2016).



For adults age 19 and older, several vaccinations are needed to maintain optimal health: influenza; tetanus, diphtheria, and pertussis (Td/Tdap); mumps, measles, and rubella (MMR); varicella; varicella zoster; and pneumococcal pneumonia. For patients with certain heart, lung, and renal disease conditions, immunizations are tailored based on their healthcare provider's recommendations. Patients who are pregnant, immunocompromised, or HIV positive should not receive varicella, varicella zoster, and MMR. With any vaccination, patient education should be provided. While allergic reactions are rare, they can occur a few minutes to hours following administration. The following symptoms should be reported immediately in order to seek emergency care: hives, swelling, difficulty breathing, tachycardia, dizziness, facial/throat edema, and weakness (Centers for Disease Control and Prevention [CDC], 2016).


Influenza causes 23,000 deaths annually (Hale & Marshall, 2016). Because the vaccine is based on the most common influenza virus anticipated for the upcoming flu season, this vaccination is given annually. Two forms of the vaccine include the inactivated influenza vaccine (IIV) and the recombinant influenza vaccine (RIV). RIV is given to persons over age 18 with any level of egg-related allergy. Persons with egg allergies should not be given IIV (U.S. Department of Health & Human Services [HHS], 2016).


Patients age 11 and older who have not received Tdap or cannot remember their administration dates should receive an initial dose of Tdap. Every 10 years following, a booster (Td) will be given. Immunization is contraindicated for persons who have had an allergic reaction to the vaccine in the past. Pertussis-containing vaccinations are contraindicated in patients with encephalopathy or uncontrolled seizure (HHS, 2016).


Varicella (chickenpox) is a contagious disease caused by the varicella zoster virus. It causes blister-like rashes along with itching, malaise, and fever. This vaccine is recommended for persons who have never had chickenpox, especially if they are at high risk for exposure to the disease. These high-risk individuals include teachers, healthcare providers, childcare workers, and persons working in institutional settings. Immunization is contraindicated for pregnant or immunosuppressed persons. The vaccination is a series of two injections given at least 4 weeks apart (CDC, 2016).

Varicella Zoster

Varicella zoster immunization is recommended at age 60 for persons who have had chickenpox or varicella to protect against shingles. When a person has a history of chickenpox, the virus remains dormant in the nerve roots. As a person ages, the virus can activate and cause shingles (Hale & Marshall, 2016). Even if a patient has had shingles in the past, he or she can receive the zoster vaccine to prevent future occurrences. A patient who currently has shingles must wait until the shingle rash disappears. In this case, the patient should consult with the healthcare provider regarding timing of zoster administration. The vaccination is contraindicated for persons with immunodeficiency, pregnancy, and allergy to gelatin or neomycin (CDC, 2016).


Community-acquired pneumonia (CAP) is caused most commonly by Streptococcus pneumoniae (Hale & Marshall, 2016). The pneumococcal vaccine is used to reduce complications related to CAP. This vaccine is available in two types: PCV or PCV 13 pneumococcal conjugate vaccine; and PPSV or PPSV 23 pneumococcal polysaccharide vaccine (CDC, 2016).

PCV or PCV 13 vaccine is given to children younger than age 2, all adults age 65 and older, and patients ages 2-64 with certain immunocompromising conditions. The vaccine is given in a single dose to adults. This vaccine covers 13 types of pneumococcal bacteria. It is contraindicated for anyone with a reaction to Prevnar[R] (an earlier pneumococcal vaccine) or diphtheria toxoid (CDC, 2016).

PPSV or PPSV 23 vaccine is administered to adults age 65 and older, patients ages 2-64 with certain immunocompromising health conditions, and ages 19-64 who smoke tobacco products. A single dose is recommended for adults age 65 and older. However, one or two boosters may be recommended for some patients. This vaccine protects against 23 types of pneumococcal bacteria. It is contraindicated for anyone with allergies to the vaccine (CDC, 2016).


Patient education regarding adult immunizations is an important part of nursing care. For adults, recommended vaccinations are based on the patient's age, immunization status, and medical conditions. In educating patients, the nurse should correct any misconceptions about vaccinations and provide the latest evidence-based recommendations for adult vaccinations (HHS, 2016).

Sonya H. Blevins, DNP, RN, CMSRN[R], CNE, is Associate Dean, Greenville Campus-University of South Carolina Upstate, Spartanburg, SC; and MEDSURG Nursing Editorial Board Member.


Boyle, DP., & Flaherty, J.R (2013). Adult immunization and its impact on children. Pediatric Annals, 42(8), 159-163. doi:10.3928/0090448120130723-10

Centers for Disease Control and Prevention. (CDC). (2016). Adult vaccination information for healthcare and public health professionals. Retrieved from https://www.cdc.govA/accines/hcp/adults/index.html

Hale, D., & Marshall, K. (2016). The benefits of immunizations for older adults. Home Healthcare Now, 34(8), 458-459. doi:10.1097 /N H H.0000000000000436

Sevin, A.M., Romeo, C., Gagne, B., Brown, N.V., & Rodis, J.L. (2016). Factors influencing adults' immunization practices: A pilot survey study of a diverse, urban community in central Ohio. BMC Public Health, 76(424), 1-8. doi:10.1186/s12889-016-3107-9

U.S. Department of Health & Human Services (HHS). (2016). Adults schedule. Retrieved from when/adults/index.html
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Title Annotation:Nurses as Educators
Author:Blevins, Sonya H.
Publication:MedSurg Nursing
Date:Mar 1, 2017
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