InternalMedicine:AGuidetoClinicalTherapeutics,2013>Immunizations

RebeccaL.Attridge,MonicaL.Miller,RebeccaMoote,LaurajoRyan+
TableB-1SelectedRecommendedAdultImmunizations

Vaccine Type/DoseRoute Indication Schedule Contraindications Comments

Trivalent
Inactivated
Numberofdoses&targetgroup
Influenza 1doseeveryyearinthefallor Anaphylaxistovaccine
Inactivated0.5mLIM Alladults mayvarydependingonflu
Vaccine(TIV) winter components;eggallergy*
season
Live-attenuatedInfluenza
Vaccine(LAIV)

Liveattenuated0.1mL/nostril
(0.2mLtotal)
For249yohealthy
nonpregnantpatients
1doseeveryyearinthefallor
winter
Anaphylaxistogentamicin,
gelatin,arginine,orvaccine PneumococcalPolysaccharide
Inactivated0.5mLIM/SQ
components;eggallergy*; Vaccine(PPSV)
pregnancy

Revaccinateyoungerpatients
(264y)in5yif:chronicrenal
failure;functionaloranatomic Tetanus,DiphteriaVaccine
One-timedoseif1stdose
Anaphylaxistovaccine asplenia; (Td)
65y;264yathighrisk given65y Inactivated0.5mLIM
components immunocompromised; Tetanus,Diphteria,Pertussis
2-doselifetimemax
revaccinate Vaccine(Tdap)
65yifinitialdose5yago
ANDif<65yat1stdose

Alladolescents&adults
Alladolescents&adults<65
IfhistoryofArthusreactions, >65ifcontactwithinfant
Anaphylaxistovaccine
Every10y donotadministersoonerthan Inactivated0.5mLIM anticipated
components
every10y TdapshouldreplacenextTd
boosterifnopriorTdap

Historyofencephalopathy
(e.g.,comaorprolonged
1lifetimedose;regardlessof
seizures)notattributabletoan
timingoflastTddose
identifiablecausewithin7dof
administration
Defervaccinationifunstable
neurologiccondition;ifdecision
madetocontinuevaccination
withtetanustoxoidafter
Guillain-Barrsyndrome(6wk
Zoster Liveattenuated0.65mLSQ 50yotopreventshingles
afterdoseoftetanustoxoid),
TdappreferredtoTd
Noneedtowaitaminimumof
2ybetweenTdap&Td
containingvaccinesanymore

Anaphylaxistogelatinor
neomycin;immunodeficiency,
1lifetimedose
immunosuppressivedrugs,
pregnancy
DefervaccinationifTB&/or
MeningococcalConjugate
acuteillness;unknown
Vaccine(MCV4) Adolescents1112y;255yat
protection>4y;maybe Inactivated0.5mLIM
MeningococcalPolysaccharide highrisk
coadministeredwithTIV;donot
Vaccine(MPS4V)
givewithPPSV

Boosterdose:
Age16ifprimarydoseatage
11or12y
Age1618yifprimarydoseat components(including
age1315y
Noboosterifprimarydoseon
orafterage16y
Mayrevaccinatein5yifstillat
riskforinfection
Menactra(9mo55yo);
Menveo(255yo)
preferreddrug55yo;donot
useMenactraiflatex
hypersensitivity(vialstopper
containslatex);noneedto
Anaphylaxistovaccine
revaccinateifdormlivingisrisk
factor Anaphylaxistovaccine
diphtheriatoxoid);historyof Inactivated0.5mLSQ Patients2yathighrisk
A2-doseprimaryseries components
Guillain-Barrsyndrome
administered2moapartis
(Menactra)
recommendedforpersons
254yowithpersistent
complementcomponent
deficiency,functionalor
anatomicasplenia,&for
adolescentswithHIV

FootnotesforTableB-1
IM,intramuscular;IN,intranasal;SQ,subcutaneous;HIV,humanimmunodeficiencyvirus
*Patientswhocaneatlightlycookedeggs(e.g.,scrambledeggs)withoutreactionareunlikelytobeallergic.Conversely,egg-allergicpersonsmighttolerateegginbakedproducts(e.g.,breadorcake);toleranceto
egg-containingfoodsdoesnotexcludethepossibilityofeggallergy.Personswhohaveexperiencedonlyhivesfollowingexposuretoeggmaybegiventhevaccinebytrainedpersonnel.
High-riskgroupspneumococcus:medical(chroniclungdisease[includingasthma];chroniccardiovasculardiseases;diabetesmellitus;chronicliverdiseases,cirrhosis;chronicalcoholism;functionaloranatomic
asplenia[e.g.,sicklecelldiseaseorsplenectomy];immunocompromisingconditions[includingchronicrenalfailureornephroticsyndrome];&cochlearimplants&cerebrospinalfluidleaks,other(residentsofnursing
homesorlong-termcarefacilities&personswhosmokecigarettes)
High-riskgroupsmeningococcus:travelerstocountrieswithendemic/epidemicdisease,anatomic/functionalaspleniaorpersistentcomplementcomponentdeficiencies,1st-yearcollegestudentslivingindorms,
microbiologistsroutinelyexposedtoNeisseriameningitides.
Personsaged2through55ywithpersistentcomplementcomponentdeficiencyorfunctionaloranatomicalaspleniashouldreceiveaboosterevery5y.
Dateofdownload:05/23/17fromAccessPharmacy:accesspharmacy.mhmedical.com,CopyrightMcGraw-HillEducation.Allrightsreserved.