RECOMMENDED IMMUNIZATION SCHEDULE FOR ADULTS AGED 19 YEARS OR OLD, 2018

1. Influenza vaccination:

• Administer 1 dose of age-appropriate inactivated influenza vaccine (IIV) or recombinant influenza vaccine (RIV) annually
• Live attenuated influenza vaccine (LAIV) is not recommended for the 2017–2018 influenza season
• Administer age-appropriate IIV or RIV to: Pregnant women – Adults with hives-only egg allergy Adults with egg allergy other than hives (e.g., angioedema or respiratory distress): Administer IIV or RIV in a medical setting under supervision of a health care provider who can recognize and manage severe allergic conditions

2. Tetanus, diphtheria, and pertussis vaccination:

• Administer to adults who previously did not receive a dose of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) as an adult or child (routinely recommended at age 11–12 years) 1 dose of Tdap, followed by a dose of tetanus and diphtheria toxoids (Td) booster every 10 years .
• Pregnant women: Administer 1 dose of Tdap during each pregnancy, preferably in the early part of gestational weeks 27–36

3. Measles, mumps, and rubella vaccination:

• Administer 1 dose of measles, mumps, and rubella vaccine (MMR) to adults with no evidence of immunity to measles, mumps, or rubella
• Pregnant women and nonpregnant women of childbearing age with no evidence of immunity to rubella: Administer 1 dose of MMR (if pregnant, administer MMR after pregnancy and before discharge from health care facility)
• HIV infection and CD4 cell count ≥200 cells/μL for at least 6 months and no evidence of immunity to measles, mumps, or rubella: Administer 2 doses of MMR at least 28 days apart
• Students in postsecondary educational institutions, international travelers, and household contacts of immunocompromised persons: Administer 2 doses of MMR at least 28 days apart (or 1 dose of MMR if previously administered 1 dose of MMR)
• Health care personnel born in 1957 or later with no evidence of immunity: Administer 2 doses of MMR at least 28 days apart for measles or mumps, or 1 dose of MMR for rubella (if born before 1957, consider MMR vaccination)
• Adults who previously received ≤2 doses of mumps containing vaccine and are identified by public health authority to be at increased risk for mumps in an outbreak: Administer 1 dose of MMR
• MMR is contraindicated for pregnant women and adults with severe immunodeficiency

4. Varicella vaccination:

• Administer to adults without evidence of immunity to varicella 2 doses of varicella vaccine (VAR) 4–8 weeks apart if previously received no varicella-containing vaccine (if previously received 1 dose of varicella-containing vaccine, administer 1 dose of VAR at least 4 weeks after the first dose)
• Adults with HIV infection and CD4 cell count ≥200 cells/μL: May administer, based on individual clinical decision, 2 doses of VAR 3 months apart
• VAR is contraindicated for pregnant women and adults with severe immunodeficiency

5. Zoster vaccination:

• Administer 2 doses of recombinant zoster vaccine (RZV) 2–6 months apart to adults aged 50 years or older regardless of past episode of herpes zoster or receipt of zoster vaccine live (ZVL)
• Administer 2 doses of RZV 2–6 months apart to adults who previously received ZVL at least 2 months after ZVL
• For adults aged 60 years or older, administer either RZV or ZVL (RZV is preferred)
• ZVL is contraindicated for pregnant women and adults with severe immunodeficiency

6. Human papillomavirus vaccination:

• Administer human papillomavirus (HPV) vaccine to females through age 26 years and males through age 21 years (males aged 22 through 26 years may be vaccinated based on individual clinical decision)
• The number of doses of HPV vaccine to be administered depends on age at initial HPV vaccination , No previous dose of HPV vaccine: Administer 3-dose series at 0, 1–2, and 6 months (minimum intervals: 4 weeks between doses 1 and 2, 12 weeks between doses 2 and 3, and 5 months between doses 1 and 3; repeat doses if given too soon) ,Aged 9–14 years at HPV vaccine series initiation and received 1 dose or 2 doses less than 5 months apart: Administer 1 dose , Aged 9–14 years at HPV vaccine series initiation and received 2 doses at least 5 months apart: No additional dose is needed Special populations
• Adults with immunocompromising conditions (including HIV infection) through age 26 years: Administer 3-dose series at 0, 1–2, and 6 months
• Men who have sex with men through age 26 years: Administer 2- or 3-dose series depending on age at initial vaccination (see above); if no history of HPV vaccine, administer 3-dose series at 0, 1–2, and 6 months
• Pregnant women through age 26 years: HPV vaccination is not recommended during pregnancy, but there is no evidence that the vaccine is harmful and no intervention needed for women who inadvertently receive HPV vaccine while pregnant; delay remaining doses until after pregnancy; pregnancy testing is not needed before vaccination

7. Pneumococcal vaccination

• Administer to immunocompetent adults aged 65 years or older 1 dose of 13-valent pneumococcal conjugate vaccine (PCV13), if not previously administered, followed by 1 dose of 23-valent pneumococcal polysaccharide vaccine (PPSV23) at least 1 year after PCV13; if PPSV23 was previously administered but not PCV13, administer PCV13 at least 1 year after PPSV23
• Administer to adults aged 19 through 64 years with the following chronic conditions 1 dose of PPSV23 (at age 65 years or older, administer 1 dose of PCV13, if not previously received, and another dose of PPSV23 at least 1 year after PCV13 and at least 5 years after PPSV23): ʱ Chronic heart disease (excluding hypertension) ʱ Chronic lung disease ʱ Chronic liver disease

8. Hepatitis A vaccination

• Administer to adults who have a specific risk, or lack a risk factor but want protection, 2-dose series of single antigen hepatitis A vaccine (HepA; Havrix at 0 and 6–12 months or Vaqta at 0 and 6–18 months; minimum interval: 6 months) or a 3-dose series of combined hepatitis A and hepatitis B vaccine (HepA-HepB) at 0, 1, and 6 months; minimum intervals: 4 weeks between first and second doses, 5 months between second and third doses .

9. Hepatitis B vaccination

• Administer to adults who have a specific risk (see below), or lack a risk factor but want protection, 3-dose series of single antigen hepatitis B vaccine (HepB) or combined hepatitis A and hepatitis B vaccine (HepA-HepB) at 0, 1, and 6 months (minimum intervals: 4 weeks between doses 1 and 2 for HepB and HepA-HepB; between doses 2 and 3, 8 weeks for HepB and 5 months for HepA-HepB) Special populations
• Administer HepB or HepA-HepB to adults with the following indications: Chronic liver disease , HIV infection, Percutaneous or mucosal risk of exposure to blood (e.g., household contacts of hepatitis B surface antigen [HBsAg]-positive persons; adults younger than age 60 years with diabetes mellitus or aged 60 years or older with diabetes mellitus based on individual clinical decision; adults in predialysis care or receiving hemodialysis or peritoneal dialysis; recent or current injection drug users; health care and public safety workers at risk for exposure to blood or blood-contaminated body fluids) Sexual exposure risk (e.g., sex partners of HBsAg positive persons)Receive care in settings where a high proportion of adults have risks for hepatitis B infection (e.g., facilities providing sexually transmitted disease treatment, drug abuse treatment and prevention services, hemodialysis and end-stage renal disease programs, institutions for developmentally disabled persons, health care settings targeting services to injection drug users or MSM, HIV testing and treatment facilities, and correctional facilities)  Travel to countries with high or intermediate hepatitis B endemicity

10. Meningococcal vaccination

Special populations: Serogroups A, C, W, and Y meningococcal vaccine (MenACWY)

• Administer 2 doses of MenACWY at least 8 weeks apart and revaccinate with 1 dose of MenACWY every 5 years, if the risk remains, to adults with the following indications: Anatomical or functional asplenia (including sickle cell disease and other hemoglobinopathies) HIV infection , Persistent complement component deficiency ,Eculizumab use

11. Haemophilus influenzae type b vaccination
    
    Special populations

• Administer Haemophilus influenzae type b vaccine (Hib) to adults with the following indications: Anatomical or functional asplenia (including sickle cell disease) or undergoing elective splenectomy: Administer 1 dose if not previously vaccinated (preferably at least 14 days before elective splenectomy) , Hematopoietic stem cell transplant (HSCT): Administer 3-dose series with doses 4 weeks apart starting 6 to 12 months after successful transplant regardless of Hib vaccination history

  
  By:
  Dr. Geetika Thakur
  MBBS & MD