Footnotes for Recommended Adult Immunization Schedule, United States, 2002-2003

Alabama Nurse,  Sep-Nov 2003  

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1. Tetanus and diphtheria {Td} - A primary series for adults is 3 doses: the first 2 doses given at least 4 weeks apart and the 3rd dose, 6-12 months after the second. Administer 1 dose if the person had received the primary series and the last vaccination was 10 years ago or longer. MMWR 1991;40(RR10): 1-21 The ACP Task Force on Adult Immunization supports a second option: a single Td booster at age 50 years for persons who have completed the full pediatric series, including the teenage/young adult booster. Guide for Adult Immunization. 3rd ed. ACP 1994:20.

2. Influenza vaccination - Medical indications: chronic disorders of the cardiovascular or pulmonary systems including asthma; chronic metabolic diseases including diabetes mellitus, renal dysfunction, hemoglobinopathies, immunosuppression (including immunosuppression caused by medications or by human immunodeficiency virus [HIV]}, requiring regular medical follow-up or hospitalisation during the preceding year; women who will be in the second or third trimester of pregnancy during the influenza season. Occupational indications: health-care workers. Other indications: residents of nursing homes and other long-term care facilities: persons likely to transmit influenza to persons at high-risk (in-home caregivers to persons with medical indications, household contacts and out-of-home caregivers of children birth to 23 months of age. or children with asthma or other indicator conditions for influenza vaccination, household members, and caregivers of elderly and adults with high-risk conditions): and anyone who wishes to be vaccinated. MMWR 2002; 51(RR-3): 1-31.

3. Pneumococcal polysaccharide vaccination - Medical indications: chronic disorders of the pulmonary system (excluding asthma}, cardiovascular diseases, diabetes mellitus. chronic liver diseases including liver disease as a result of alcohol abuse (e.g..cinrhosis),chronic renal failure or nephrotic syndrome, functional or anatomic asplenia (e.g., sickle cell disease or splenectomy), immunosuppressive conditions (e.g., congential immunodeficiency, HIV infection, leukemia, lymphoma, multiple myeloma, Hodgkins disease, generalized malignancy, organ or bone marrow transplantation), chemotherapy with alkylating agents, antimetabolites, or long-term systemic corticosteroids.

Geographic/other indications: Alaskan Natives and certain American Indian populations Other indications: residents of nursing homes and other long-term care facilities. MMWR 1997;47 (RR-8):1-24.

4. Revaccination with pneumococcal polysaccharide vaccine - Onetime reyaccination after 5 years for persons with chronic renal failure or nephrotic syndrome, functional or anatomic asplenia (e.g., sickle cell disease or splenectomy), immunosuppressive conditions (e.g., congenital immunodeficiency, HIV infection, leukemia, lymphoma, multiple myeloma, Hodgkins disease, generalized malignancy, organ or bone marrow transplantation), chemotherapy with alkylating agents, anti-metabolites, or long-term systemic corticosteroids. For persons 65 or older, one-time re vaccination if they were vaccinated 5 or more years previously and were aged less than 65 years at the time of primary vaccination. MMWR 1997;47(RR-8): 1-24.

5. Hepatitis B vaccination - Medical indications: hemodialysis patients, patients who receive clotting-factor concentrates. Occupational-indications: health-care workers and public-safety workers who have exposure to blood in the workplace, persons in training in schools of medicine, dentistry, nursing, laboratory technology, and other allied health professions. Behavioral indications: injecting drug users, persons with more than one sex partner in the previous 6 months, persons with a recently acquired sexually transmitted disease (STD), all clients in STD clinics, men who have sex with men. Other indications: household contacts and sex partners of persons with chronic HBV infection, clients and staff of institutions for the developmentally disabled, international travelers who will be in countries with high or intermediate prevalence of chronic HBV infection for more than 6 months, inmates of correctional facilities. MMWR 1991;40(RR-13):1-25. (www.cdc.gov/lravel/diseases/hbv.htrn)

6. Hepatitis A vaccination - (For the combined HepA-HepB vaccine, use 3 doses at 0, 1, 6 months). Medical indications: persons with Clotting-factor disorders or chronic liver disease. Behavioral indications: men who have sex with men, users of injecting and non injecting illegal drugs. Occupational indications: persons working with HAV-infected primates or with HAV in a research laboratory setting. Other indications: persons traveling to or working in countries that have high or intermediate endemicity of hepatitis A. MMWR 1999; 48 {RR-12): 1-37. (www.cdc.gov/travel/diseases/hav.htm)

7. Measles, Mumps, Rubella vaccination (MMR} - Measles component: Adults born before 1957 may be considered immune to measles. Adults born in or after 1957 should receive at least one dose of MMR unless they have a medical contraindication, documentation of at least one dose or other acceptable evidence of immunity. A second dose of MMR is recommended for adults who: