TABLE 7-2 Summary of Recommendations for Adult Immunization—cont’d

Vaccine Name and Route For Whom It Is Recommended Schedule Contraindications and Precautions
(Mild Illness Is Not a Contraindication)
Hepatitis A (hcp-A)— give IM: brands may be used interchangeably
  • People who travel outside of the United States (except for Northern and Western Europe, New Zealand, Australia, Canada, and Japan).
  • People with chronic liver disease, including people with hepatitis C virus infection; people with hepatitis B who have chronic liver disease: illicit drug users: men who have sex with men: people with clotting-factor disorders; people who work with hepatitis A virus in experimental lab settings (this does not refer to routine medical laboratories); and food handlers where health authorities or private employers determine vaccination to be cost-effective.

    Note: Prevaccination testing is likely to be cost-effective for persons >40 yr of age, as well as for younger persons in certain groups with a high prevalence of hepatitis A virus infection.
  • Two doses are neeeded
  • The minimum interval between dose #1 and #2 is 6 mo.
  • If dose #2 is delayed, do not repeat dose #1. Just give dose #2.
  • May be given with all other vaccines but at a separate site.
  • Previous anaphylactic reaction to this vaccine, to any of its components.
  • Moderate or severe acute illness.
  • Safety during pregnancy has not been determined, so benefits must be weighed against potential risk.
Td(tetanus, diphtheria)—give IM
  • All adolescents and adults.
  • After the primary series has been completed, a booster dose is recommended every 10 years. Make sure your patients have received a primary series of 3 doses.
  • A booster dose as early as 5 years later may be needed for the purpose of wound management, so consult ACIP recommendations.
  • Booster dose every 10 years after completion of the primary series of three doses.
  • For those who have fallen behind: The primary scries is three doses:
    • Give dose #2 four weeks after fl.
    • #3 is given 6-12 months after #2.
  • May be given with all other vaccines but at a separate site.
  • Previous anaphylactic reaction to this vaccine, to any of its components.
  • Moderate or severe acute illness.
MMR(measles, mumps, rubella)—give SC
  • Adults born in 1957 or later who arc ≥18 yr of age (including those born outside the United States) should receive at least one dose of MMR if there is no serological proof immunity or documentation of a dose given on or after 1st birthday.
  • Adults in higli-risk groups, such as health care workers, students entering colleges and other post-high school educational institutions, and international travelers should receive a total of two doses.
  • All women of childbearing age (i.e., adolescent girls and premenopausal adult women) who do not have acceptable evidence of rubella immunity or vaccination.

    Note: Adults born before 1957 are usually considered immune, but proof of immunity may be desirable for health care workers.
  • One or two doses are needed.
  • If dose #2 is recommended, give it no sooner than 4 wk after dose #1.
  • May be given with all other vaccines but at a separate site.
  • If varicella vaccine and MMR are both needed and are not administered on the same day, space them at least 4 wk apart.
  • Previous anaphylactic reaction to this vaccine or to any of its components. (Anaphylactic reaction to eggs is no longer a contraindication to MMR.)
  • Pregnancy or possibility of pregnancy within 3 months.
  • Immunocompromised persons due to cancer, leukemia, lymphoma, immunosuppressive drug therapy, including high-dose steroids or radiation therapy.
  • If blood products or immune globulin has been administered during the past 11 months, consult the ACIP recommendations regarding time to wait before vaccinating.
  • Moderate or severe acute illness.

    Note: MMR is not contraindicated if a PPD test was done recently. PPD should be delayed for 4-6 weeks after an MMR has been given.