Adult Vaccination

1. See Also
   1. Immunization in Pregnancy
   2. Pediatric Vaccination
   3. Immunization Status Unknown
   4. Immunizations in HIV
   5. Vaccines in Immunocompromised Patients
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 50 years
   1. Periodic Boosters
      1. Influenza Vaccine
         1. Offer annual Vaccination in all patients and especially high risk groups
      2. Tetanus Vaccine
         1. At least one Tdap (Adacel), then Td or Tdap booster every 10 years
   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)
4. Protocol: Age 50 years and older
   1. Influenza Vaccine
      1. Annual Vaccination in all patients (esp. over age 65 years)
   2. 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
   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
      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
5. Resources
   1. CDC Immunization Schedules (last accessed 10/28/2020)
      1. https://www.cdc.gov/vaccines/schedules/