Disease: Vaccination Schedule for Adults and Adolescents

    What are vaccine-preventable diseases?

    Vaccine preventable diseases are those diseases for which there is a shot that helps the immune system prepare for an infection. A person develops immunity after he or she has received a vaccine and responded to it. When a vaccinated person is exposed to a virus (for example, hepatitis B) or bacteria (for example, diphtheria), his or her body is able to destroy the virus or bacteria and prevent the disease. No vaccine is perfect, and some people who receive a vaccine can still get the disease. This is why it is important for everyone to get the vaccine. This gives the community what experts call "herd" immunity and means that, basically, there are very few people who could serve as a reservoir for the disease. Herd immunity prevents severe outbreaks of diseases.

    Disease Vaccine Diphtheria Tetanus, diphtheria, and pertussis (Tdap) Hepatitis A Hepatitis A Hepatitis B Hepatitis B Human papillomavirus Human papillomavirus (HPV) (three doses) Influenza Annual influenza vaccine Measles Measles, mumps, and rubella (MMR) Meningococcal disease Meningococcal Mumps Measles, mumps, and rubella (MMR) Pertussis Tetanus, diphtheria, and pertussis (Tdap) Pneumococcal disease Pneumococcal Polio Inactivated polio vaccine (IPV) Rubella Measles, mumps, and rubella (MMR) Tetanus Tetanus, diphtheria, and pertussis (Tdap) Varicella Varicella

    What is the vaccination schedule for adolescents?

    Recommended vaccination schedule for adolescents Vaccine Recommended Age for Vaccination Tetanus, diphtheria, pertussis (Tdap) 11-12 years Human papillomavirus (HPV) (three doses) 11-12 years Meningococcal conjugate vaccine (MCV4) 11-12 years (first dose)
    13-18 years (second dose) Influenza (flu) Yearly Pneumococcal Recommended for some children with certain medical conditions (check with the child's physician) Hepatitis A
    Hepatitis B
    Inactivated polio vaccine (IPV)
    Measles, mumps, rubella (MMR)
    Varicella Recommended if the child is catching up on missed vaccines

    What is the vaccination schedule for adults?

    Recommended vaccination schedule for adults Vaccine Recommended age of vaccination Influenza (flu) Yearly Tetanus, diphtheria, pertussis (Tdap)
    or
    tetanus, diphtheria (Td) Tdap once as an adult
    Td every 10 years Varicella (chickenpox) Two doses (unless had documented disease or immunized as a child or adolescent) Human papillomavirus (HPV) (three doses) Three doses before 26 years of age (unless already immunized as an adolescent) Zoster (shingles) One dose after 60 years of age Measles, mumps, rubella (MMR) Two doses (unless immunized previously) Pneumococcal All people over 65 years of age
    People in special high-risk groups and who have certain chronic illnesses should receive one or both of the two different pneumococcal vaccines as soon as possible Hepatitis A Two doses in certain patients who are high risk (unless immunized previously) Hepatitis B Three doses in certain patients who are high risk (unless immunized previously) Haemophilus influenza type b (Hib) One to three doses in certain patients who are high risk (unless immunized previously)

    What vaccines should a pregnant woman get?

    The concerns surrounding the dangers of vaccines during pregnancy is mostly theoretical. The concern is related to the risk of transfer to the fetus. There is no evidence of any risk associated with the use of inactivated (killed) vaccines in pregnant women. The biggest concern is related to the use of live vaccines. While the risk is extremely low, the concern is that the live virus will be transferred from the mother to the fetus. There must be a discussion between the physician and the mother whenever a live vaccine is considered during pregnancy. The CDC has issued a guide to help expectant mothers and physicians make good decisions related to the risk and benefits of using a vaccine during pregnancy (http://www.cdc.gov/vaccines/pubs/preg-guide.htm). Tetanus-diphtheria with acellular pertussis (Tdap) vaccine, hepatitis A, hepatitis B vaccine, meningococcal vaccine, and rabies vaccine are generally considered safe during pregnancy. It is currently recommended that pregnant women not receive the following vaccines: human papillomavirus, live nasal influenza vaccine, measles, mumps, rubella, varicella, and zoster.

    Do health-care workers need any different vaccines?

    It is very important that health-care workers are up to date on all of their required vaccines. Additionally, the CDC recommends that health-care workers receive varicella (chickenpox) vaccine unless there is proof of immunity, prior vaccination, or documented history of the disease. Also, health-care workers with direct patient contact, who have not previously received a pertussis-containing tetanus shot (Tdap), are required to receive one dose. For the complete recommendations, please consult the CDC web site at http://www.cdc.gov/vaccines/adults/rec-vac/hcw.html. Health-care workers are required by most employers to have hepatitis B vaccination and annual influenza vaccinations.

    What is the Td/Tdap vaccine, and who should receive it?

    The Td and Tdap vaccines both contain vaccines against tetanus (lockjaw) and diphtheria. The Tdap also contains a vaccine against pertussis (whooping cough). Most adults are used to getting a tetanus shot when they get a cut. Up until 2005, adolescents and adults were not recommended to receive the pertussis vaccine due to an unacceptable rate of negative reactions. In 2005, a new acellular pertussis vaccine became available for both children and adults (although there are different ones for each group using different amounts of each vaccine). Whooping cough has become a serious problem again due to the lack of vaccination in adolescents and adults. It is therefore recommended that all adolescents and adults receive at least one dose of Tdap when they are due for their next tetanus shot. Health-care workers should get one Tdap vaccination as soon as possible but at least two years since the last tetanus shot (Td).

    What is the HPV vaccine, and who should get it?

    Human papillomavirus (HPV) infection is the cause of cervical cancer. There are over 100 different types of HPV, and the most commonly used vaccine contains the four strains most commonly linked to cervical cancer. Studies have shown that use of the vaccine will decrease the chance that a woman will get cervical cancer. As such, the vaccine must be given before the first sexual contact. Unfortunately, girls are having sexual intercourse at younger and younger ages. The CDC recommends that all girls and boys receive the three-shot series beginning at 11 years of age. This was a change in recent years to reflect the fact that boys need vaccination in order to prevent spread to girls. Adult women who have not received the vaccine should do so up to 26 years of age. After 26 years of age, it is believed that most women would have been exposed to the virus and the vaccine would be of no use.

    What is the meningococcal vaccine, and who should receive it?

    Meningococcal disease is a serious acute illness caused by a bacterium. Patients can develop meningitis and sepsis, and these are often fatal diseases. There are two different quadrivalent meningococcal polysaccharide-protein conjugate vaccines that provide protection against meningococcal serogroups A, C, W, and Y: MenACWY-D (Menactra) and MenACWY-CRM (Menveo). The disease is more common in adolescents and college students. Therefore, meningococcal vaccine is recommended for all children between 11-12 years of age, with a booster dose at 16 years of age. If the child has not received the vaccine by 11-12 years of age, they should receive it up to age 18. College freshmen who have not received the vaccine should be vaccinated. The vaccine is also recommended for adults with special medical conditions.

    What is the MMR vaccine, and who should receive it?

    The MMR vaccine contains vaccines against the diseases measles, mumps, and rubella (German measles). These are all dangerous and potentially fatal diseases that have been successfully limited in the United States through aggressive vaccine programs. Adolescents and adults who have not received the MMR or MMRV (MMR, plus the varicella vaccine) should receive two doses of the vaccine at least one month apart. People who do not have medical documentation of having had the diseases or cannot prove previous vaccination should have titers (blood tests to check levels of immunity) drawn to make sure they are immune to these agents. If they do not have laboratory evidence of immunity, they should receive a two-dose series of vaccine.

    What is the varicella vaccine, and who should receive it?

    Varicella is the virus that causes chickenpox. While the disease is usually self-limited, it can cause death and permanent injury. The groups at greatest risk are infants, people over 15 years of age, and immunocompromised people. The vaccine came out in the mid-1990s and unfortunately does not offer complete protection, but even those who get the disease after vaccination have a milder form of the condition. Prior to use of the vaccine, hundreds of children died every year from chickenpox. It is recommended that all adolescents and adults without documented evidence of chickenpox or previous vaccination receive the two-dose series.

    What is the pneumococcal vaccine, and who should receive it?

    Streptococcus pneumoniae (also called pneumococcus) is a bacterium that can cause severe illness, including meningitis and pneumonia. The vaccine is routinely given to children; however, it is only given to adolescents and adults who are at higher risk (patients with chronic diseases like heart disease and diabetes, immunocompromised individuals, smokers, and asthmatics). Elderly adults are one group that is considered at higher risk, and it is recommended that all adults receive one dose of the vaccine after 65 years of age.

    What is the influenza vaccine, and who should receive it?

    Influenza (flu) is an acute viral illness that can kill even healthy people. Unfortunately, the influenza virus changes a little each year, and scientists have to make educated guesses about which forms of the virus will be infecting people and circulating each year. Based on the best available evidence, they create a vaccine each year containing three of the likely influenza virus types.

    There are two types of vaccine: a live attenuated vaccine (nasal spray) and an inactivated vaccine (shot). You cannot get the flu from getting the flu shot because it has inactivated virus (killed virus with heat or chemicals). The immunity from the vaccines is limited, and vaccinations must be repeated yearly. In August 2008, the Advisory Committee on Immunization Practices changed the recommendation on adolescents. It is now recommended that all people between 6 months and 18 years of age receive an annual vaccination. New for 2013-2014 is a vaccine for people with egg allergy: recombinant hemagglutinin influenza vaccine (RIV). Although the CDC encourages that any adult who wants to decrease the chance of getting the flu get the influenza vaccine, certain high-risk groups are recommended to always get the annual flu vaccine. Adults over 50 years of age are considered to be at high risk and should receive the yearly influenza vaccination.

    Can people with egg allergies still get the influenza vaccine?

    Starting in 2013, there is now a vaccine specifically for people with egg allergy. Most influenza vaccines are made using eggs. Therefore, people with severe egg allergy had previously been recommended not to receive the influenza vaccine. However, now there is a new vaccine, recombinant hemagglutinin influenza vaccine (RIV), that is not made using eggs. This vaccine is safe for patients with egg allergy.

    What is the hepatitis A vaccine, and who should receive it?

    Hepatitis A is an acute viral illness that is spread through contaminated water and food. It is less common in the United States but is still a common cause of hepatitis worldwide. The disease is very common in many other parts of the world, including Central and South America, Africa, the Middle East, the Western Pacific, and Asia. It is primarily prevented by using good hygiene and through vaccination. Hepatitis A vaccine is routinely given to children; however, it is only recommended for certain high-risk adolescents and adults. Foreign travel is the most common reason for adults and adolescents to receive hepatitis A vaccination.

    What is the hepatitis B vaccine, and who should receive it?

    Hepatitis B is an acute viral illness that is primarily spread through the exposure to body fluids of an infected individual. It can be transmitted through sexual intercourse and is highly contagious. Approximately 50% of infected individuals will be asymptomatic (have no symptoms of the disease). Most cases resolve without long-term complications; however, 1%-2% will develop chronic hepatitis. Hepatitis B vaccine is given routinely to children. Adolescents who did not receive their three-shot series as a child should be given the vaccine. Adults are not routinely given the hepatitis B vaccine unless they belong to certain high-risk groups. One high-risk group is health-care workers.

    What is the polio vaccine, and who should receive it?

    Polio is an acute viral illness that can cause severe paralysis and even death. Prior to the use of vaccine, tens of thousands of children developed paralytic polio (the worst form) in the U.S. every year. Since instituting an aggressive vaccine campaign, polio has been almost completely eradicated in the U.S. Most cases now in the U.S. are seen in people traveling from other countries or unvaccinated people from the U.S. traveling to other countries.

    There are two forms of the polio vaccine: an oral form made from a live attenuated virus and an injection form made from an inactivated virus. The oral form of the vaccine (oral polio vaccine or OPV) is no longer used in the U.S. because it has been shown to cause polio in a small number of people. Only the shot form of the vaccine (intramuscular polio vaccine or IPV) is now used in the U.S. All children receive four doses of IPV. Adolescents who did not receive all four doses should be given an additional vaccine. Adults are not recommended to receive the polio vaccine unless they will be traveling to areas where polio still exists.

    What is the zoster vaccine, and who should receive it?

    Herpes zoster is a reactivation of an old infection with the varicella virus (chickenpox). This rash can occur shortly after the infection with chickenpox or many years later. It causes a severely painful skin rash, and it can lead to chronic pain even after the rash is gone. In order to prevent the severe rash and the chronic pain, a vaccine (Zostavax) was developed and is recommended for all adults over 60 years of age.

    What is the typhoid vaccine, and who should receive it?

    Typhoid fever is an acute febrile illness caused by the bacterium Salmonella typhi. It is spread by contaminated food and water. Although quite common at one time in the U.S., it is very rare today. Most cases are in people who have traveled outside the U.S. Worldwide, the disease affects 13 million people. People who are traveling to areas with high rates of typhoid fever should receive the vaccine prior to leaving the U.S. Travelers should consult the CDC web site for specific recommendations depending on the countries they plan to visit (http://wwwn.cdc.gov/travel/).

    What is the yellow fever vaccine, and who should receive it?

    Yellow fever is an acute illness caused by a virus. The disease is extremely rare in the U.S., and it is usually found in people who have traveled outside the country. The disease is mild in many people, but it can cause liver failure and death. Approximately 20% of those who get the disease will die. Travelers to going to sub-Saharan Africa and tropical South America are required by international health regulations to have a yellow fever vaccination. Travelers should consult the CDC web site for specific recommendations depending on the countries they plan to visit (http://wwwn.cdc.gov/travel/).

    What vaccines should a pregnant woman get?

    The concerns surrounding the dangers of vaccines during pregnancy is mostly theoretical. The concern is related to the risk of transfer to the fetus. There is no evidence of any risk associated with the use of inactivated (killed) vaccines in pregnant women. The biggest concern is related to the use of live vaccines. While the risk is extremely low, the concern is that the live virus will be transferred from the mother to the fetus. There must be a discussion between the physician and the mother whenever a live vaccine is considered during pregnancy. The CDC has issued a guide to help expectant mothers and physicians make good decisions related to the risk and benefits of using a vaccine during pregnancy (http://www.cdc.gov/vaccines/pubs/preg-guide.htm). Tetanus-diphtheria with acellular pertussis (Tdap) vaccine, hepatitis A, hepatitis B vaccine, meningococcal vaccine, and rabies vaccine are generally considered safe during pregnancy. It is currently recommended that pregnant women not receive the following vaccines: human papillomavirus, live nasal influenza vaccine, measles, mumps, rubella, varicella, and zoster.

    Do health-care workers need any different vaccines?

    It is very important that health-care workers are up to date on all of their required vaccines. Additionally, the CDC recommends that health-care workers receive varicella (chickenpox) vaccine unless there is proof of immunity, prior vaccination, or documented history of the disease. Also, health-care workers with direct patient contact, who have not previously received a pertussis-containing tetanus shot (Tdap), are required to receive one dose. For the complete recommendations, please consult the CDC web site at http://www.cdc.gov/vaccines/adults/rec-vac/hcw.html. Health-care workers are required by most employers to have hepatitis B vaccination and annual influenza vaccinations.

    What is the Td/Tdap vaccine, and who should receive it?

    The Td and Tdap vaccines both contain vaccines against tetanus (lockjaw) and diphtheria. The Tdap also contains a vaccine against pertussis (whooping cough). Most adults are used to getting a tetanus shot when they get a cut. Up until 2005, adolescents and adults were not recommended to receive the pertussis vaccine due to an unacceptable rate of negative reactions. In 2005, a new acellular pertussis vaccine became available for both children and adults (although there are different ones for each group using different amounts of each vaccine). Whooping cough has become a serious problem again due to the lack of vaccination in adolescents and adults. It is therefore recommended that all adolescents and adults receive at least one dose of Tdap when they are due for their next tetanus shot. Health-care workers should get one Tdap vaccination as soon as possible but at least two years since the last tetanus shot (Td).

    What is the HPV vaccine, and who should get it?

    Human papillomavirus (HPV) infection is the cause of cervical cancer. There are over 100 different types of HPV, and the most commonly used vaccine contains the four strains most commonly linked to cervical cancer. Studies have shown that use of the vaccine will decrease the chance that a woman will get cervical cancer. As such, the vaccine must be given before the first sexual contact. Unfortunately, girls are having sexual intercourse at younger and younger ages. The CDC recommends that all girls and boys receive the three-shot series beginning at 11 years of age. This was a change in recent years to reflect the fact that boys need vaccination in order to prevent spread to girls. Adult women who have not received the vaccine should do so up to 26 years of age. After 26 years of age, it is believed that most women would have been exposed to the virus and the vaccine would be of no use.

    What is the meningococcal vaccine, and who should receive it?

    Meningococcal disease is a serious acute illness caused by a bacterium. Patients can develop meningitis and sepsis, and these are often fatal diseases. There are two different quadrivalent meningococcal polysaccharide-protein conjugate vaccines that provide protection against meningococcal serogroups A, C, W, and Y: MenACWY-D (Menactra) and MenACWY-CRM (Menveo). The disease is more common in adolescents and college students. Therefore, meningococcal vaccine is recommended for all children between 11-12 years of age, with a booster dose at 16 years of age. If the child has not received the vaccine by 11-12 years of age, they should receive it up to age 18. College freshmen who have not received the vaccine should be vaccinated. The vaccine is also recommended for adults with special medical conditions.

    What is the MMR vaccine, and who should receive it?

    The MMR vaccine contains vaccines against the diseases measles, mumps, and rubella (German measles). These are all dangerous and potentially fatal diseases that have been successfully limited in the United States through aggressive vaccine programs. Adolescents and adults who have not received the MMR or MMRV (MMR, plus the varicella vaccine) should receive two doses of the vaccine at least one month apart. People who do not have medical documentation of having had the diseases or cannot prove previous vaccination should have titers (blood tests to check levels of immunity) drawn to make sure they are immune to these agents. If they do not have laboratory evidence of immunity, they should receive a two-dose series of vaccine.

    What is the varicella vaccine, and who should receive it?

    Varicella is the virus that causes chickenpox. While the disease is usually self-limited, it can cause death and permanent injury. The groups at greatest risk are infants, people over 15 years of age, and immunocompromised people. The vaccine came out in the mid-1990s and unfortunately does not offer complete protection, but even those who get the disease after vaccination have a milder form of the condition. Prior to use of the vaccine, hundreds of children died every year from chickenpox. It is recommended that all adolescents and adults without documented evidence of chickenpox or previous vaccination receive the two-dose series.

    What is the pneumococcal vaccine, and who should receive it?

    Streptococcus pneumoniae (also called pneumococcus) is a bacterium that can cause severe illness, including meningitis and pneumonia. The vaccine is routinely given to children; however, it is only given to adolescents and adults who are at higher risk (patients with chronic diseases like heart disease and diabetes, immunocompromised individuals, smokers, and asthmatics). Elderly adults are one group that is considered at higher risk, and it is recommended that all adults receive one dose of the vaccine after 65 years of age.

    What is the influenza vaccine, and who should receive it?

    Influenza (flu) is an acute viral illness that can kill even healthy people. Unfortunately, the influenza virus changes a little each year, and scientists have to make educated guesses about which forms of the virus will be infecting people and circulating each year. Based on the best available evidence, they create a vaccine each year containing three of the likely influenza virus types.

    There are two types of vaccine: a live attenuated vaccine (nasal spray) and an inactivated vaccine (shot). You cannot get the flu from getting the flu shot because it has inactivated virus (killed virus with heat or chemicals). The immunity from the vaccines is limited, and vaccinations must be repeated yearly. In August 2008, the Advisory Committee on Immunization Practices changed the recommendation on adolescents. It is now recommended that all people between 6 months and 18 years of age receive an annual vaccination. New for 2013-2014 is a vaccine for people with egg allergy: recombinant hemagglutinin influenza vaccine (RIV). Although the CDC encourages that any adult who wants to decrease the chance of getting the flu get the influenza vaccine, certain high-risk groups are recommended to always get the annual flu vaccine. Adults over 50 years of age are considered to be at high risk and should receive the yearly influenza vaccination.

    Can people with egg allergies still get the influenza vaccine?

    Starting in 2013, there is now a vaccine specifically for people with egg allergy. Most influenza vaccines are made using eggs. Therefore, people with severe egg allergy had previously been recommended not to receive the influenza vaccine. However, now there is a new vaccine, recombinant hemagglutinin influenza vaccine (RIV), that is not made using eggs. This vaccine is safe for patients with egg allergy.

    What is the hepatitis A vaccine, and who should receive it?

    Hepatitis A is an acute viral illness that is spread through contaminated water and food. It is less common in the United States but is still a common cause of hepatitis worldwide. The disease is very common in many other parts of the world, including Central and South America, Africa, the Middle East, the Western Pacific, and Asia. It is primarily prevented by using good hygiene and through vaccination. Hepatitis A vaccine is routinely given to children; however, it is only recommended for certain high-risk adolescents and adults. Foreign travel is the most common reason for adults and adolescents to receive hepatitis A vaccination.

    What is the hepatitis B vaccine, and who should receive it?

    Hepatitis B is an acute viral illness that is primarily spread through the exposure to body fluids of an infected individual. It can be transmitted through sexual intercourse and is highly contagious. Approximately 50% of infected individuals will be asymptomatic (have no symptoms of the disease). Most cases resolve without long-term complications; however, 1%-2% will develop chronic hepatitis. Hepatitis B vaccine is given routinely to children. Adolescents who did not receive their three-shot series as a child should be given the vaccine. Adults are not routinely given the hepatitis B vaccine unless they belong to certain high-risk groups. One high-risk group is health-care workers.

    What is the polio vaccine, and who should receive it?

    Polio is an acute viral illness that can cause severe paralysis and even death. Prior to the use of vaccine, tens of thousands of children developed paralytic polio (the worst form) in the U.S. every year. Since instituting an aggressive vaccine campaign, polio has been almost completely eradicated in the U.S. Most cases now in the U.S. are seen in people traveling from other countries or unvaccinated people from the U.S. traveling to other countries.

    There are two forms of the polio vaccine: an oral form made from a live attenuated virus and an injection form made from an inactivated virus. The oral form of the vaccine (oral polio vaccine or OPV) is no longer used in the U.S. because it has been shown to cause polio in a small number of people. Only the shot form of the vaccine (intramuscular polio vaccine or IPV) is now used in the U.S. All children receive four doses of IPV. Adolescents who did not receive all four doses should be given an additional vaccine. Adults are not recommended to receive the polio vaccine unless they will be traveling to areas where polio still exists.

    What is the zoster vaccine, and who should receive it?

    Herpes zoster is a reactivation of an old infection with the varicella virus (chickenpox). This rash can occur shortly after the infection with chickenpox or many years later. It causes a severely painful skin rash, and it can lead to chronic pain even after the rash is gone. In order to prevent the severe rash and the chronic pain, a vaccine (Zostavax) was developed and is recommended for all adults over 60 years of age.

    What is the typhoid vaccine, and who should receive it?

    Typhoid fever is an acute febrile illness caused by the bacterium Salmonella typhi. It is spread by contaminated food and water. Although quite common at one time in the U.S., it is very rare today. Most cases are in people who have traveled outside the U.S. Worldwide, the disease affects 13 million people. People who are traveling to areas with high rates of typhoid fever should receive the vaccine prior to leaving the U.S. Travelers should consult the CDC web site for specific recommendations depending on the countries they plan to visit (http://wwwn.cdc.gov/travel/).

    What is the yellow fever vaccine, and who should receive it?

    Yellow fever is an acute illness caused by a virus. The disease is extremely rare in the U.S., and it is usually found in people who have traveled outside the country. The disease is mild in many people, but it can cause liver failure and death. Approximately 20% of those who get the disease will die. Travelers to going to sub-Saharan Africa and tropical South America are required by international health regulations to have a yellow fever vaccination. Travelers should consult the CDC web site for specific recommendations depending on the countries they plan to visit (http://wwwn.cdc.gov/travel/).

    Source: http://www.rxlist.com

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