ADULT IMMUNIZATION

Aduna, Naomi Bless S.

Sy, Diana P.
VACCINE IMPACT

• blunt the severity of clinical illness

• reduce transmission of infectious disease agents

from immunized people to others, thereby reducing
the impact of infection spread

• herd immunity
OUTBREAK DETECTION AND CONTROL

• Several factors can give rise to increases in vaccine-

preventable disease:

– low rates of immunization that result in an accumulation of

susceptible people (e.g. anti-vaxers)

– changes in the infectious agent that permit it to escape

vaccine-induced protection

– waning of vaccine-induced immunity

– point-source introductions of large inocula

Recommended Immunization for Adults

HPIM 20th ed.

Recommended Immunization for Adults

HPIM 20th ed.

PHILIPPINES
Contraindications and Precautions for Commonly
Used Vaccines in Adult
Contraindications and Precautions for
Commonly Used Vaccines in Adult
Contraindications and Precautions for
Commonly Used Vaccines in Adult
Storage and Handling

• Injectable vaccines are packaged in multidose

vials, single-dose vials, or manufacturer-filled
single-dose syringes
Live attenuated nasal
spray influenza Single dose sprayer
vaccine
Oral typhoid vaccine Capsules
MMR, varicella, Lyophilized (freeze-dried) powders
Zoster, and
Meningococcal Shelf-life:
polysaccharide Varicella, Zoster – protect from light and administer within
vaccines 30min after reconstitution
MMR - protect from light but can be used up to 8h after
reconstitution
Meningococcal Polysaccaride Vaccine – Single dose vial (30
mins); multidose vial (35 days)
Storage and Handling
• Vaccines are stored either at refrigerator
temperature (2–8°C) or at freezer temperature (–
15°C or colder).
• The temperature of refrigerators & freezers used for
vaccine storage must be monitored and recorded at
least twice each workday.
Inactivated Vaccines (inactivated influenza, Pneumococcal
Stored at refrigerator
polysaccharide, meningococcal conjugate vaccines
Lyophilized powder live virus vaccines (varicella, zoster and
Stored at freezer
MMR)
Stored at refrigerator
Diluents for lyophilized vaccines
or room temperature
Live attenuated influenza vaccine—a live-virus liquid
Stored at refrigerator
formulation administered by nasal spray
Administration of Vaccines
• Most parenteral vaccines recommended for routine
administration to adults in the United States are
given by either the IM or the SC route
• Most inactivated vaccines are given IM

Influenza vaccine formulation approved for use in

Intradermal
adults 18–64 y/o
Live-virus vaccines (varicella, zoster, and MMR) Subcutaneous
Intramuscular (preferred) /
23-valent pneumococcal polysaccharide vaccine Subcutaneous
Administration of Vaccines
• SC route are administered with a 5/8-inch needle
into the upper outer-triceps area
• IM route are injected into the deltoid muscle with a
needle whose length should be selected on the basis
of the recipient’s sex & weight to ensure adequate
penetration into the muscle.
men and women weighing <152 lbs (<70 kg) 1-inch needle
women weighing 152–200 lbs (70–90 kg)
men weighing 152–260 lbs (70–118 kg) 1- to 1.5-inch needle

women weighing >200 lbs (>90 kg)

1.5-inch needle
men weighing >260 lbs (>118 kg)
Administration of Vaccines
• Aspiration, the process of pulling back on the plunger
of the syringe after skin penetration but prior to
injection, is not necessary because no large blood
vessels are present at the recommended vaccine
injection sites.
• Multiple vaccines can be administered at the same visit
• If more than one vaccine must be administered in the
same limb, the injection sites should be separated by
1–2 inches so that any local reactions can be
differentiated.
• If a vaccine and an immune globulin preparation are
administered simultaneously (e.g., Td vaccine and
tetanus immune globulin), a separate anatomic site
should be used for each injection.
Administration of Vaccines

• For certain vaccines (e.g., HPV vaccine and

hepatitis B vaccine), multiple doses are
required for an adequate and persistent
antibody response.
• oral typhoid vaccination - an interruption in
the schedule does not require restarting of
the entire series or the addition of extra
doses.
Administration of Vaccines
• Adolescents and adults should be seated or lying
down during vaccination
• Syncope may follow vaccination, especially in
adolescents and young adults
• The majority of reported syncope episodes after
vaccination occur within 15 min.
• The ACIP recommends that vaccine providers
strongly consider observing patients, particularly
adolescents, with patients seated or lying down
for 15 min after vaccination.
• If syncope develops, patients should be observed
until the symptoms resolve.
Administration of Vaccines

• Anaphylaxis is a rare complication of

vaccination.
• All facilities providing immunizations should
have an emergency kit containing aqueous
epinephrine for administration in the event of
a systemic anaphylactic reaction.
Maintenance of Vaccine Record

• Documentation should include

- date of administration
- name or common abbreviation of the vaccine
- vaccine lot number
- Manufacturer
- administration site
- VIS edition
- date the VIS was provided
- name, address, and title of the person who
administered the vaccine
VACCINE SAFETY MONITORING AND ADVERSE EVENT REPORTING

• Prelicensure Evaluations of Vaccine Safety

- small, usually involving fewer than 100 volunteers.
Phase 1 - provide a basic evaluation of safety and to identify common adverse
Trial events

- larger and may involve several hundred participants, collect

additional information on safety and are usually designed to evaluate
Phase 2 immunogenicity as well.
Trial - Data gained can be used to determine the composition of the
vaccine, the number of doses required, and a profile of common
adverse events

- Vaccines that appear promising are evaluated

Phase 3 - involve several hundred to several thousand volunteers and are
Trial generally designed to demonstrate vaccine efficacy and provide
additional information on vaccine safety
VACCINE SAFETY MONITORING AND ADVERSE EVENT REPORTING

• Postlicensure Monitoring of Vaccine Safety

• Adverse events are defined as untoward
events that occur after immunization and that
might be caused by the vaccine product or
vaccination process.
STRATEGIES FOR PROVIDERS AND HEALTH CARE FACILITIES

1. Recommendation from the provider

2. System supports
3. Immunization requirements
4. Vaccination of Health Care Staff
- recommend influenza vaccination of all health care
personnel
FUTURE TRENDS IN VACCINATION

prevents hepatitis B–related cirrhosis and

Hepatitis B Vaccine
hepatocellular carcinoma
prevents some types of cervical cancer,
genital warts, and anogenital cancers and
HPV Vaccine
may also prevent some oropharyngeal
cancers
improve protection against zoster and
New herpes zoster subunit vaccine
postherpetic neuralgia.