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Recommended Adult Immunization Schedule, United States, 2002-2003. (News).

Recommended Adult Immunization Schedule, United States, 2002-2003

Age 19-49 years
Vaccine

Tetanus, Diphtheria (Td) * 1 dose booster every 10
 years (1)
Influenza 1 dose annually for persons
 with medical or occupational
 indications, or household
 contacts of persons with
 indications (2)

Pneumococcal 1 dose for persons with
(polysaccharide) 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 measles, 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 with
(polysaccharide) medical or other
 indications (9)

Age 50-64 years 65 years and older
Vaccine

Tetanus, Diphtheria (Td) *

Influenza 1 annual dose





Pneumococcal 1 dose for unvaccinated
(polysaccharide) 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 Madison Place, N.W., Washington, DC 20005; (202) 219-9657.

This schedule indicates the recommended age groups for routine administration of currently licensed vaccines for persons 19 years of age and older. 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 instructions 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 wi shes 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, H IV 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 65 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 sexually 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 non-injecting 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 perio d 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 Hajj). 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 men ingococcal quadrivalent polysaccharide vaccine as part of routine medical care.
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