Vaccines Indicated for Adults Based on Medical Indications-Shell, CDC

Tick ​​vaccination — indications, contraindications, vaccination features

Always make recommendations by determining needed vaccines based on age (Table 1), assessing for medical conditions and other indications (Table 2), and reviewing special situations (Notes).

  • Vaccines in the Adult Immunization Schedule
  • Learn how to display current schedules from your website.
  • Hard copies of the schedule are available for free using the CDC-info on Demand order form.

Legend

Recommended vaccination for adults who meet age requirement, lack documentation of vaccination, or lack evidence of past infection

Recommended vaccination for adults with an additional risk factor or another indication

Precaution—vaccination might be indicated if benefit of protection outweighs risk of adverse reaction

Delay vaccination until after pregnancy if vaccine is indicated

No recommendation/ Not applicable

adult conditions vaccine schedule

Vaccine Pregnancy Immuno-compromised
(excluding HIV infection)
HIV infection
CD4 count
Asplenia, complement deficiencies End-stage renal disease; or on hemodialysis Heart or lung disease, alcoholism 1 Chronic
liver disease
Diabetes Health care personnel 2 Men who have sex with men
1 dose annually
Tdap or Td 1 dose Tdap each pregnancy 1 dose Tdap, then Td or Tdap booster every 10 yrs
MMR NOT RECOMMENDED 1 or 2 doses depending on indication
VAR NOT RECOMMENDED 2 doses
RZV(preferred) DELAY 2 doses at age ≥50 yrs
ZVL NOT RECOMMENDED 1 dose at age ≥60 yrs
HPV DELAY 3 doses through age 26 yrs 2 or 3 doses through age 26 yrs
PCV13 1 dose
PPSV23 1, 2,or 3 doses depending on age and indication
HepA 2 or 3 doses depending on vaccine
HepB 2 or 3 doses depending on vaccine
MenACWY 1 or 2 doses depending on indication, see notes for booster recommendations
MenB PRECAUTION 2 or 3 doses depending on vaccine and indication, see notes for booster recommendations
Hib 3 doses HSCT 3 recipients only 1 dose

Administer recommended vaccines if vaccination history is incomplete or unknown. Do not restart or add doses to vaccine series if there are extended intervals between doses. The use of trade names is for identification purposes only and does not imply endorsement by the ACIP or CDC.

Notes

Recommended Adult Immunization Schedule for ages 19 years or older, United States, 2020

For vaccine recommendations for persons age 0 through 18 years, see the Child and Adolescent Immunization Schedule.

Haemophilus influenzae type b vaccination

Special situations

  • Anatomical or functional asplenia (including sickle cell disease): 1 dose if previously did not receive Hib; if elective splenectomy, 1 dose, preferably at least 14 days before splenectomy
  • Hematopoietic stem cell transplant (HSCT): 3-dose series 4 weeks apart starting 6–12 months after successful transplant, regardless of Hib vaccination history

Hepatitis A vaccination

Routine vaccination

  • Not at risk but want protection from hepatitis A (identification of risk factor not required): 2-dose series HepA (Havrix 6–12 months apart or Vaqta 6–18 months apart [minimum interval: 6 months]) or 3-dose series HepA-HepB (Twinrix at 0, 1, 6 months [minimum intervals: 4 weeks between doses 1 and 2, 5 months between doses 2 and 3])

Special situations

  • At risk for hepatitis A virus infection: 2-dose series HepA or 3-dose series HepA-HepB as above
    • Chronic liver disease (e.g., persons with hepatitis B, hepatitis C, cirrhosis, fatty liver disease, alcoholic liver disease, autoimmune hepatitis, alanine aminotransferase [ALT] or aspartate aminotransferase [AST] level greater than twice the upper limit of normal)
    • HIV infection
    • Men who have sex with men
    • Injection or noninjection drug use
    • Persons experiencing homelessness
    • Work with hepatitis A virus in research laboratory or with nonhuman primates with hepatitis A virus infection
    • Travel in countries with high or intermediate endemic hepatitis A
    • Close, personal contact with international adoptee (e.g., household or regular babysitting) in first 60 days after arrival from country with high or intermediate endemic hepatitis A (administer dose 1 as soon as adoption is planned, at least 2 weeks before adoptee’s arrival)
    • Pregnancy if at risk for infection or severe outcome from infection during pregnancy
    • Settings for exposure, including health care settings targeting services to injection or noninjection drug users or group homes and nonresidential day care facilities for developmentally disabled persons (individual risk factor screening not required)

Hepatitis B vaccination

Routine vaccination

  • Not at risk but want protection from hepatitis B (identification of risk factor not required): 2- or 3-dose series (2-dose series Heplisav-B at least 4 weeks apart [2-dose series HepB only applies when 2 doses of Heplisav-B are used at least 4 weeks apart] or 3-dose series Engerix-B or Recombivax HB at 0, 1, 6 months [minimum intervals: 4 weeks between doses 1 and 2, 8 weeks between doses 2 and 3, 16 weeks between doses 1 and 3]) or 3-dose series HepA-HepB (Twinrix at 0, 1, 6 months [minimum intervals: 4 weeks between doses 1 and 2, 5 months between doses 2 and 3])

Special situations

  • At risk for hepatitis B virus infection: 2-dose (Heplisav-B) or 3-dose (Engerix-B, Recombivax HB) series or 3-dose series HepA-HepB (Twinrix) as above
    • Chronic liver disease (e.g., persons with hepatitis C, cirrhosis, fatty liver disease, alcoholic liver disease, autoimmune hepatitis, alanine aminotransferase [ALT] or aspartate aminotransferase [AST] level greater than twice upper limit of normal)
    • HIV infection
    • Sexual exposure risk (e.g., sex partners of hepatitis B surface antigen [HBsAg]-positive persons; sexually active persons not in mutually monogamous relationships; persons seeking evaluation or treatment for a sexually transmitted infection; men who have sex with men)
    • Current or recent injection drug use
    • Percutaneous or mucosal risk for exposure to blood (e.g., household contacts of HBsAg-positive persons; residents and staff of facilities for developmentally disabled persons; health care and public safety personnel with reasonably anticipated risk for exposure to blood or blood-contaminated body fluids; hemodialysis, peritoneal dialysis, home dialysis, and predialysis patients; persons with diabetes mellitus age younger than 60 years and, at discretion of treating clinician, those age 60 years or older)
    • Incarcerated persons
    • Travel in countries with high or intermediate endemic hepatitis B
    • Pregnancy if at risk for infection or severe outcome from infection during pregnancy. Heplisav-B not currently recommended due to lack of safety data in pregnant women

Human papillomavirus vaccination

Routine vaccination

  • HPV vaccination recommended for all adults through age 26 years: 2- or 3-dose series depending on age at initial vaccination or condition:
    • Age 15 years or older at initial vaccination: 3-dose series at 0, 1–2, 6 months (minimum intervals: 4 weeks between doses 1 and 2/12 weeks between doses 2 and 3/5 months between doses 1 and 3; repeat dose if administered too soon)
    • Age 9 through 14 years at initial vaccination and received 1 dose or 2 doses less than 5 months apart: 1 dose
    • Age 9 through 14 years at initial vaccination and received 2 doses at least 5 months apart: HPV vaccination complete, no additional dose needed.
  • If completed valid vaccination series with any HPV vaccine, no additional doses needed

Shared clinical decision-making

  • Age 27 through 45 years based on shared clinical decision-making:
    • 2- or 3-dose series as above

Special situations

  • Pregnancy through age 26 years: HPV vaccination not recommended until after pregnancy; no intervention needed if vaccinated while pregnant; pregnancy testing not needed before vaccination

Influenza vaccination

Routine vaccination

  • Persons age 6 months or older: 1 dose any influenza vaccine appropriate for age and health status annually
  • For additional guidance, see www.cdc.gov/flu/professionals/index.htm

Special situations

  • Egg allergy, hives only: 1 dose any influenza vaccine appropriate for age and health status annually
  • Egg allergy more severe than hives (e.g., angioedema, respiratory distress): 1 dose any influenza vaccine appropriate for age and health status annually in medical setting under supervision of health care provider who can recognize and manage severe allergic reactions
  • LAIVshould not be used in persons with the following conditions or situations:
    • History of severe allergic reaction to any vaccine component (excluding egg) or to a previous dose of any influenza vaccine
    • Immunocompromised due to any cause (including medications and HIV infection)
    • Anatomic or functional asplenia
    • Cochlear implant
    • Cerebrospinal fluid-oropharyngeal communication
    • Close contacts or caregivers of severely immunosuppressed persons who require a protected environment
    • Pregnancy
    • Received influenza antiviral medications within the previous 48 hours
  • History of Guillain-Barré syndrome within 6 weeks of previous dose of influenza vaccine: Generally should not be vaccinated unless vaccination benefits outweigh risks for those at higher risk for severe complications from influenza

Measles, mumps, and rubella vaccination

Routine vaccination

  • No evidence of immunity to measles, mumps, or rubella: 1 dose
    • Evidence of immunity: Born before 1957 (health care personnel, see below), documentation of receipt of MMR vaccine, laboratory, laboratory evidence of immunity or disease (diagnosis of disease without laboratory confirmation is not evidence of immunity)

Special situations

  • Pregnancy with no evidence of immunity to rubella: MMR contraindicated during pregnancy; after pregnancy (before discharge from health care facility), 1 dose
  • Nonpregnant women of childbearing age with no evidence of immunity to rubella: 1 dose
  • HIV infection with CD4 count ≥200 cells/μL for at least 6 months and no evidence of immunity to measles, mumps, or rubella: 2-dose series at least 4 weeks apart; MMR contraindicated in HIV infection with CD4 count adult vaccine schedule Vaccines Abbreviations Trade names Haemophilus influenzae type b Hib ActHIB ®
    Hiberix ®
    PedvaxHIB ® Hepatitis A vaccine HepA Havrix ®
    Vaqta ® Hepatitis A and hepatitis B vaccine HepA-HepB Twinrix ® Hepatitis B vaccine HepB Engerix-B ®
    Recombivax HB ®
    Heplisav-B ® Human papillomavirus vaccine HPV vaccine Gardasil 9 ® Influenza vaccine, inactivated IIV Many brands Influenza vaccine, live, attenuated LAIV FluMist ® Quadrivalent Influenza vaccine, recombinant RIV Flublok Quadrivalent ® Measles, mumps, and rubella vaccine MMR M-M-R ® II Meningococcal serogroups A, C, W, Y vaccine MenACWY Menactra ®
    Menveo ® Meningococcal serogroup B vaccine MenB-4C
    MenB-FHbp Bexsero ®
    Trumenba ® Pneumococcal 13-valent conjugate vaccine PCV13 Prevnar 13 ® Pneumococcal 23-valent polysaccharide vaccine PPSV23 Pneumovax ® 23 Tetanus and diphtheria toxoids Td Tenivac ®
    Tdvax™ Tetanus and diphtheria toxoids and acellular pertussis vaccine Tdap Adacel ®
    Boostrix ® Varicella vaccine VAR Varivax ® Zoster vaccine, recombinant RZV Shingrix Zoster vaccine live ZVL Zostavax ®

This schedule is recommended by the Advisory Committee on Immunization Practices (ACIP) and approved by the Centers for Disease Control and Prevention (CDC), American College of Physicians (ACP external ), American Academy of Family Physicians (AAFP external ), American College of Obstetricians and Gynecologists (ACOG external ), and American College of Nurse-Midwives (ACNM external ).

The comprehensive summary of the ACIP recommended changes made to the adult immunization schedule can be found in the February 6, 2020 MMWR.

  • Suspected cases of reportable vaccine-preventable diseases or outbreaks to the local or state health department
  • Clinically significant postvaccination reactions to the Vaccine Adverse Event Reporting System external or 800‑822‑7967
  • All vaccines included in the adult immunization schedule except pneumococcal 23-valent polysaccharide and zoster vaccines are covered by the Vaccine Injury Compensation Program. Information on how to file a vaccine injury claim is available at www.hrsa.gov/vaccinecompensation or 800-338-2382.
  • Clinically significant postvaccination reactions to the Vaccine Adverse Event Reporting System external or 800‑822‑7967

This schedule is recommended by the Advisory Committee on Immunization Practices (ACIP) and approved by the Centers for Disease Control and Prevention (CDC), American College of Physicians (ACP external ), American Academy of Family Physicians (AAFP external ), American College of Obstetricians and Gynecologists (ACOG external ), and American College of Nurse-Midwives (ACNM external ).

The comprehensive summary of the ACIP recommended changes made to the adult immunization schedule can be found in the February 6, 2020 MMWR.

www.cdc.gov

Who is shown to be vaccinated against tick-borne encephalitis,contraindications, price, side effects

Update: October 2018

Tick-borne encephalitis is an infectious disease caused by
tick-borne encephalitis virus and manifested damage to the central
and peripheral nervous system.

It should be understood that an encephalitic tick is not some kind of
a certain type of tick (ticks about 30 thousand species,
encephalitis can be only 5 thousand), and the tick infected
erbovirus causing encephalitis in humans.

Moreover, encephalitis can be infected by using
raw milk from cows, sheep, most often goats – because in milk
This virus may be contained during a mass tick attack
pets.

Symptoms of tick-borne encephalitis

The first symptoms of tick-borne
encephalitis develop in 1-2 weeks after the bite and
manifestations resemble a cold. These include fever,
headache, muscle pain, aching joints. Symptoms
persist for a week. After which most patients
is recovering.

Approximately every third patient develops more severe
encephalitis form, which is accompanied by:

  • persistent temperature rise to high numbers
  • unbearable headaches
  • neck pain
  • vomiting and lethargy

If such symptoms occur, you must immediately
обратиться к to the doctor. In severe cases, encephalitis leads to
irreversible damage in the form of paralysis or death of the patient.

Every year around 10-12 thousand are registered in the world.
случаев tick-borne encephalitis. Highest frequency
incidence is noted in the Baltic countries, Slovenia and Russia.
On the territory of the Russian Federation, the incidence is 2.5 per
100 thousand population, but in some endemic areas (north,
northwest), this index increases by more than 5 times.

The increasing danger of tick-borne encephalitis is due to
the occurrence of incidence cases in areas not previously considered
endemic (Scandinavia, Switzerland, Germany).

The source of the virus are more than 100 species of animals, including
foxes, voles, deer, dogs, monkeys and horses. Exists
probability of tick-borne encephalitis virus penetration
infected cows in milk. When used unpasteurized
milk infection occurs in humans alimentary way.

The disease is characterized by two periods of increased
incidence: May-June and August-September. Immunization of the population
It is planned based on the given time frame.

Endemic regions of tick-borne encephalitis
are rural areas of Russia, Central and Eastern Europe and
Japan. Tick-borne encephalitis vaccination is recommended.
residents of these regions, as well as tourists and tourists traveling to these areas
the worker. The risk of tick-borne encephalitis increases during
high activity of ticks (from April to October).

In these areas, tick-borne encephalitis is
serious economic problem due to the need for long
treatment of neurological complications. Use of vaccination in countries
Europe for ten years allowed to reduce economic losses
at 80 million dollars.

Vaccination scheme

Two vaccines are most common in Russia:
�”Tick-E-Vac” and “Tick-borne encephalitis vaccine”. This drugs
domestic production containing inactivated virus.
Vaccination against tick-borne encephalitis with these drugs is not
can cause disease. After vaccination, the human body
produces specific antibodies to the introduced virus,
providing immunization to this type of pathogens.

Exists две схемы иммунизации: двух- и трехкомпонентная.
Both provide the production of the required amount of antibodies to
virus, but differ in the duration of maintaining their concentration
at the required level.

Two component scheme

The first dose of vaccine should be administered in 1-3
months before the start of the season of increased morbidity. Two stage
vaccination scheme is as follows:

  • 1-3 months before high risk of tick-borne encephalitis
    (approximately April);
  • 1-7 months after the first dose.

The best effect is provided by immunization planning.
Thus, the second injection was carried out 1 month before
intended trip or before the season. Revaccination should
be made after 1 year, and then every 5 years. However,
according to studies, a sufficient concentration of antibodies in
The body persists for 6-8 years.

The vaccine is injected intramuscularly in the upper third of the shoulder. Graft
from tick-borne encephalitis may not be effective enough
people with congenital or acquired immunodeficiency. To this group
include patients undergoing or receiving immunosuppressants
(chemotherapy, high doses of corticosteroids, immunosuppressive
drugs), patients with HIV / AIDS (see symptoms of HIV infection,
AIDS dissidents), with congenital anomalies of immune function
system.

Three-part scheme

The introduction of the vaccine in a three-component scheme is
in the following way:

  • Day the first dose is indicated as day “0”;
  • The second dose is administered 1-3 months after the first;
  • The introduction of the third dose of the vaccine is carried out in 5-12 months
    after the second.

Other features of vaccination

Subsequent supportive vaccinations in both cases.
produced every three years while maintaining risk factors
diseases. If a person changes his place of work or residence,
no need for immunization.

Vaccination for children from 3 to 15 years old is made in a reduced
dosage – ½ of the adult dose. Vaccine can be administered simultaneously.
with other vaccines. Precautions include carrying
injecting different vaccines into different places and using different
syringes. Maximum immunization is observed one week after
the introduction of the second dose.

In this case, the doctor must determine the level of antibodies in the blood.
after the introduction of the second dose and decide on the issue
additional supportive vaccination. Be sure to put
the doctor is informed of the vaccinations received earlier from the Japanese
encephalitis, yellow fever or dengue fever. The presence of antibodies to
causative agents of these diseases may affect the assessment
results of a control immunological study.

Vaccination, carried out after the tick bite, is
ineffective. In this case, for the prevention of disease
The administration of a specific immunoglobulin is recommended.

Average cost of vaccination

Regarding the cost of vaccination – the cost of a single dose of vaccine
is 400-500 rubles for drugs manufactured in Russia and
1000 – 1500 – for foreign ones. It is also worth considering that this is the price.
only one vaccination, but it takes 2 or 3 doses of the vaccine according to the scheme.
As a rule, special offers are provided in each clinic.
and discounts when ordering a collective immunization. Despite the difference in
cost, efficacy of domestic and European vaccines
stays approximately on the same level.

Indications for vaccination

Who shows tick-borne encephalitis vaccine first of all?
Vaccination against tick-borne encephalitis is carried out:

  • Persons traveling to endemic areas with a humid climate
    and forest landscape, especially in spring and summer, when
    tick activity increases;
  • People who are fond of hiking, hunting and working in areas
    endemic for the incidence of tick-borne encephalitis;
  • Environmental workers, logging workers, farmers and
    military, operating in endemic regions.

It is desirable that immunization be completed in more than a month.
before the intended departure to the region. In this case, provided
reliable protection against all strains of the virus.

Contraindications

Before the start of immunization necessarily taken into account
vaccination contraindications:

  • Confirmed anaphylactic reaction after the previous
    administering the vaccine or one of its components;
  • Severe allergies to eggs or chicken meat (anaphylactic
    reactions);
  • Allergy to formaldehyde, neomycin, gentamicin and protamine
    sulfate;
  • Acute inflammatory diseases (vaccination is delayed until
    recovery).

Vaccination for children under 1 year is not made. With the development of any
allergy manifestations after vaccination be sure to refer to
to the doctor.

  • Pregnancy and breastfeeding are not contraindications.
    for vaccination, however, be sure to inform the doctor about
    that you are pregnant or are planning a pregnancy.
  • There is currently no reliable hit information.
    vaccine components in breast milk. Put a vaccine nursing
    mothers are only possible when the intended benefits of
    immunization will exceed the potential risk to the child.
  • Some people have increased after the first vaccination.
    temperature Usually this symptom develops within 12 hours.
    after an injection and passes independently in 24-48 hours.

The effectiveness of vaccination is 99%. According to statistical
data, after the introduction of the practice of vaccination incidence
tick-borne encephalitis decreased by 90%.

Side effects

Adverse effects of vaccination in the form of side effects
more likely in patients with:

  • Mild egg allergy
  • Latex allergy
  • Autoimmune Diseases (Rheumatoid Arthritis, Scattered
    sclerosis)
  • Neurological disorders

Possible adverse reactions after tick-borne vaccination
encephalitis include:

  • Soreness at the injection site
  • Headache
  • Fever, usually in children under 3 years
  • Loss of appetite (in children)
  • Excitement and insomnia (in children)
  • Nausea and vomiting, diarrhea
  • Muscle or joint pain, cramps
  • Fatigue, feeling tired
  • General malaise, increased heart rate
  • Swollen lymph nodes
  • Itching and tightening of the skin at the injection site, skin rashes

Read more about the effects of vaccinations.

Far from each patient develops the above
complications after vaccination. Studies have shown that new forms
Vaccines are fairly safe.

At the same time, some side effects have been observed quite
often. Transient redness and soreness at the injection site
were noted in 45%, and fever – in 5-6%. Symptoms had transient
character and did not represent threats to health.

WHO position

Immunization provides the most effective protection against
tick-borne encephalitis. Vaccines used in Russia are safe and
shown for use by people from the age of three.
After their use, a strong immunity develops, providing
protection against most types of tick-borne encephalitis virus,
characteristic of Asia and Europe.

Before the start of mass immunization in each
The region needs a thorough assessment of the number of cases.
incidence among the population. With a low risk of morbidity
vaccination is considered inappropriate. Consider
vaccination is necessary if the incidence in the region is from
5 cases per 100 thousand population.

In areas with increased risk, vaccination should be included in
national immunization program. In other cases, vaccination
held individually by people planning a trip to
endemic area or shift workers.

Автор: Коробов Никита Александрович врач-анестезиолог

cujournals.com

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