Adult Vaccination

1. See Also
   1. Immunization in Pregnancy
   2. Pediatric Vaccination
   3. Immunization Status Unknown
   4. Immunizations in HIV
2. 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
3. Protocol: Age 18 to 60 years (or 65 years old)
   1. Influenza Vaccine
      1. Offer annual Vaccination in all patients and especially high risk groups
   2. Tetanus Vaccine
      1. At least one Tdap (Adacel)
   3. HPV Vaccine (Gardasil)
      1. Women for catch-up under age 26 years (typically vaccinated at age 11-12 years old)
      2. Men for catch-up under age 22 years old, and in high risk groups up to age 26 years
   4. Hepatitis B 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. Required by many colleges (those in 36 U.S. states)
      2. However, Meningitis cases are sporadic and of serotype B (not covered by U.S. meningoccal Vaccine)
4. Protocol: Age 60 years (or 65) and older
   1. Influenza Vaccine
      1. Annual Vaccination in all patients
   2. Tetanus Vaccine
      1. Repeat every 5-10 years
      2. Consider giving at hospital discharge
      3. At least one Tdap (Adacel) even for over age 65 years
   3. Pneumococcal Vaccine (after age 65 years)
      1. Additional doses needed earlier for other indications (e.g. Asplenic, immunosuppressed, Tobacco Abuse)
      2. Consider giving at hospital discharge
      3. No prior Pneumovax 23
         1. Prevnar 13 after age 65 year birthday AND
         2. Pneumovax 23 at 6-12 months after Prevnar 13 dose
      4. Prior Pneumovax 23 after age 65 year birthday
         1. Prevnar 13 after age 65 year birthday (at least 12 months after Pneumovax)
         2. No further Pneumovax 23 needed
      5. Prior Pneumovax 23 before age 65 year birthday
         1. Prevnar 13 after age 65 year birthday AND
         2. Pneumovax 23 at 6-12 months after Prevnar 13 dose AND 5 years after last Pneumovax 23
      6. References
         1. (2014) Presc Lett 21(11): 63-64
   4. Zoster Vaccine (Zostavax)
      1. Give one dose
      2. Offer for age 50 years and older (especially over age 60 years old)