Clinical Medicine: Adult Immunization

Immunization
- www.immunize.com or CDC website updated every October
- Prototype for health promotion and disease prevention
- Life long-pediatrics to geriatrics
- Cost effective
- Constantly evolving and changing
- Need to be aware of changes/where to look

Adult Immunization
NOTES ARE ALL SUMMARIZED AND MORE
- Influenza COMPREHENSIVE ON ATTACHED CHARTS
- Pneumococcus PCV 13, PCSV 23
- Hepatitis B
- Hepatitis A
- Tetanus, Diphtheria, Pertussis
- Varicella
- Meningococcus
- Measles, Mumps, Rubella
- Human Papilloma virus
- Herpes Zoster

Influenza
- Yearly vaccine after 18
Vaccine is an estimate of the antigen sequence
Efficacy is up to chance
- All Adults over fifty
- Any person with medical problems
- Health care workers
- Avoid if egg allergy no longer
- Live attenuated vaccine also available for adults <50
Injectable is inactivated
Recombinant inactivated can only give up to age 49
- Snort vaccine is LIVE vaccine (18-49)
Cant give if pregnant
- Yearly administration
- Many types, especially for the elderly population
- FluZone for over 65
- Dont give if have egg allergy or anaphylactic reaction to vaccine

Pneumovax
- Pneumonicoccal vaccine (13 pediatrics and 23 adults)
 Number has to do with # of serotypes of bacteria vaccine is against
These serotypes are most common causative agents for infection
- Having pneumonia is not an indication for getting this vaccine
- Adult 65 and older immunocompromised
- Persons with chronic illness or risk factors or splenectomy, smokers or asmatic
- One dose with booster 5 years after first one
- Polyvalent 23
- New indication for PCV 13

Hepatitis B
- Infancy through adulthood
- High risk persons
- Three dose series
- Non responders
- Twinrix (Hep A and Hep B)
- Health care workers
- Patients with chronic liver disease
- Increased risk for diabetics
- Risk for liver cirrhosis and liver cancer if get Hep B

Hepatitis A
- Travelers
- Chronic liver disease and others at risk
- Two dose series
- Prevaccination testing
- Twinrix
- Dont eat raw shellfish in a month that DOESNT have an R
Hep A thrive in shellfish in these summer months

Tetanus
- Three dose series with booster
- Td or Tdap
- ALL health care personnel should now receive Tdap vaccine, ok to give if received Td previously
- Adults in contact with infants 12 months of age or less
- No need to wait between Tdap / Td

Varicella
- All adults without evidence of immunity
- Two dose series
- Health care workers
- Stricter guidelines to diagnoses of immune status
Meningococcal vaccine
- One dose vaccine
- At risk groups
- Menactra
- Splenectomy patients
- College students

MMR
- Measles
- Mumps
- Rubella
- Proof of immunity
- One or two dose series
- Live vaccine
- Health care workers

Human Papillomavirus
- Women age nine through twenty six
- Three dose series
- Costly
- Administer even if already diagnosed with HPV
- HPV 4 men
- HPV 4 or HPV 2 for women

Herpes Zoster
- Shingles not a contraindication
- All adults greater than sixty
- Expensive, not covered by Medicare yet
- Effective in preventing post-herpetic neuralgia
- Insurance coverage issues

Important Notes!!
- Influenza, Hep B, MMR, TDap, Varicella must have if healthcare worker
- Spleen takes care of encapsulated agents:
Pneumococcis
Meningococcus
Influenza

SHE SAID AS A HINT THAT SHE REALLY LIKES THE LAST SLIDE!!!!!
Vaccine Description Indications Contraindications / Types and Frequency
Dont have to get it
Influenza -estimate of antigenic sequence -adults over 50 -if have egg allergy -yearly
so efficacy is up to chance -anyone with medical problems -anyone that has
-healthcare workers anaphylactic rxn Live attenuated
-if pregnant cant give live -adults <50
vaccine
Injectible
-inactivated
-<49

Snort vaccine
-live
-18-49 y/o

FluZone
-over 65
Pneumovax -against Pneumococcal -adult 65 and older (immunocompromised) -having pneumonia is not -one dose with booster 5 years after first
-13 serotypes for peds -chronic illness an indication one
-23 serotypes for adults -risk factors
-polyvalent 23 -splenectomy
-new indication for PCV 13 (might -smokers
give both) -asthmatic
Hepatitis B -Twinrix (Hep A and Hep B) -Infancy through adulthood -Three dose series (efficacy is 90%)
-high risk for liver disease -If you dont response, can get another 3
Hep C doses
-increased risk for sexual activity -If after 6 doses you dont get HepB titer,
-health care worker wont get immunity
-IV drug user
-homosexual men
-tattoos
-Diabetics
-under age 60

Hepatitis A -Prevaccination testing
-Twinrix (Hep A and hep B)
-Recover from Hep A (not
chronic) unless you have liver
disease
Tetanus -50% mortality
-Tdap will build up MORE
immunity
-Travelers -Already had Hep A -Two dose series (need good dose to
-Chronic liver disease and others at risk (dont need to get receive vaccine)
-If you eat raw shellfish during months that dont vaccine)
have R
-Horrible if you get Hep A on top of Hep B/C
-All health care personnel (okay to give if received -Three dose series with booster
Td before) -Td or Tdap
-Adults in contact with infants 12 months of age or -dont have to wait between Tdap/Td
less -NEED ONE DOSE Tdap IN YOUR LIFE
-<1 year old
Varicella -stricter guidelines to diagnose of -all adults without evidence of immunity -Two dose series
immune status -health care workers
Meningococcal -Menactra -at risk groups -One dose vaccine
vaccine -splenectomy patients
-college students
-military recruits
-before going into OR
MMR -measles, mumps, rubella -health care workers -pregnant women -one or two dose series (now two doses
-rare but lately some resurfacing -immunocompromised because of higher international emergence
of measles of measles)
-have to show proof of immunity LIVE VACCINE! -live vaccine
(BLOOD WORK)
Human -HPV4 men (can cause genital -women age nine through 26 -three dose series
papillomavirus warts in men) -administer if even already diagnosed with HPV -costly
-HPV 4 or HPV 2 women
-several serotypes
-16 and 18 cause cancer the most
-6 and 11 cause genital warts
Herpes Zoster - effective in preventing post- -shingles is NOT a contraindication -got varicella vaccine -expensive, not covered by medicare yet
Shingles herpetic neuralgia -all adults greater than 60 (zostawax) wait till 60 -insurance coverage issues
your vaccination lasts longer than getting it at 50 -zostawax
-got chickenpox -70% effective