Adult Vaccination

Aka: Adult Vaccination, Adult Immunization

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II. Precautions

  1. Adults are under-vaccinated
    1. As of 2014, only 17% of U.S. adults have had a Tdap
  2. References
    1. (2015) Presc Lett 22(3): 13

III. Protocol: Age 18 to 50 years

  1. Periodic Boosters
    1. Covid-19 Vaccine
      1. Transitioning to an annual Vaccination (similar to Influenza Vaccine)
    2. Influenza Vaccine
      1. Offer annual Vaccination in all patients and especially high risk groups
    3. Tetanus Vaccine
      1. At least one Tdap (Adacel), then Td or Tdap booster every 10 years
      2. Also Tdap given in pregnancy at 27 to 36 weeks gestation
      3. Given post-exposure to Tetanus prone wound when >5 years from last dose
  2. Catch-Up Vaccines to consider
    1. HPV Vaccine (Gardasil)
      1. Boys and girls should be vaccinated with 2 doses as part of Primary Series at age 11-12 years
      2. Age 15 years and older are vaccinated with 3 doses
      3. Recommended for age up to 26 years (and may consider for ages 27 to 45 years)
    2. Varicella Vaccine
      1. Two doses (4-8 weeks apart) if born after 1980 and no evidence of Immunity
    3. Hepatitis B Vaccine
    4. Hepatitis A Vaccine
    5. MMR Vaccine
      1. One MMR Vaccine if born in 1957 or later
      2. Two MMR Vaccine if a college student, health care worker or travelers to certain regions
    6. Meningococcal Vaccine
      1. Menactra (MenACWY) is part of Primary Series, given as 2 doses (age 11 and 16 years)
      2. Required by many colleges (those in 36 U.S. states)
      3. However, Meningitis cases are sporadic and of serotype B (covered by MenB, not MenACWY Vaccine)
    7. Inactivated Polio Vaccine (EIPV)
      1. Unvaccinated adults: Give 3 doses
      2. Previously vaccinated adults with increased exposure risk: Give a single lifetime booster dose

IV. Protocol: Age 50 years and older

  1. Covid-19 Vaccine
    1. Transitioning to an annual Vaccination (similar to Influenza Vaccine)
  2. Respiratory Syncytial Virus Vaccine
    1. Indicated in all patients age 75 years and older
    2. Indicated in age >60 years old with high risk comorbidities
  3. Influenza Vaccine
    1. Annual Vaccination in all patients (esp. over age 65 years)
  4. Tetanus Vaccine
    1. At least one Tdap (Adacel) even for over age 65 years, then Td or Tdap booster every 10 years
    2. Consider giving at hospital discharge
  5. Pneumococcal Vaccine (after age 65 years)
    1. Additional doses needed earlier for other indications (e.g. Asplenic, immunosuppressed, Tobacco Abuse, Diabetes Mellitus)
    2. Consider giving at hospital discharge
    3. See Pneumococcal Conjugate Vaccine for schedule (which is updated frequently and can be confusing)
  6. Zoster Vaccine (age >50 years old)
    1. Zoster Recombinant (Shingrix) - preferred
      1. Two dose series (2-6 months apart)
    2. Zoster Live (Zostavax)
      1. Live Vaccine with contraindications (e.g. pregnancy, AIDS)
      2. Single dose

V. Resources

  1. CDC Immunization Schedules (last accessed 11/17/2022)
    1. https://www.cdc.gov/vaccines/hcp/imz-schedules/index.html

VI. References

  1. Greenberg (2022) Am Fam Physician 106(5): 534-42 [PubMed]

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