Written By: Hanan Khalaf. RPH.What vaccines are included in the immunization schedules for adults?
Immunization schedules for adults cover vaccines like Tetanus-diphtheria (Td), MMR, Varicella, and Influenza. Number of Doses required from the mentioned vaccines (except Influenza which is usually given annually) depends on history of primary vaccination.
Other vaccines are also recommended for adults but only for specific indications as occupational lifestyle, and certain medical problems. Such vaccines include:
Pneumococcal polysaccharide vaccine PPV: recommended for adults with certain medical problems as chronic pulmonary disorders, cardiovascular diseases, diabetes mellitus, chronic liver diseases, functional or anatomic asplenia and certain immunosuppressive conditions. It is given as a single shot with a revaccination after 5 years.
Hepatitis A vaccine: is required for persons with certain medical conditions as chronic liver disease and with certain occupations as laboratory personnel and for travelers. It is given in 2 doses separated by 6months at least. Hepatitis A vaccine is recommended now in the primary vaccination schedule of children in USA starting at one year of age.
Hepatitis B vaccine: Indicated for adults with certain medical conditions as hemodialysis patients, or for health workers or healthy adults who are at risk of acquiring the infection either through their work or personal life. It is given in a similar way to children as 3 doses the first and second dose are separated by 1month and third dose is given 6 months after the second.
Meningococcal vaccine: Two kinds of this vaccine exist the polysaccharide MPSV4 and conjucate MCV which is most recent. Meningococcal conjucate vaccine is indicated in certain medical conditions as functional or anatomic asplenia, adolescents and adults traveling to endemic areas or being at a risk of acquiring the disease.
MCV is indicated for age group 11-55 years, while MPSV4 is indicated for children 2-10 years of age and adults > 55years of age. MPSV4 can be used instead of MCV whenever it is not available.
What vaccines should be considered for travelers?
Vaccination for travelers depends on several factors as, country of destination, duration of residence, presence of certain medical conditions, age, and risk of exposure to rural areas. There is no standard schedule since each case should be individualized. Vaccines commonly involved in travel as:
Meningococcal and Hepatitis A vaccine, as mentioned in the previous question.
Yellow fever vaccine: used to protect against yellow fever virus which is transmitted by mosquito bite and is found is certain parts of Africa and South America. It is not transmitted from one person to another. It is given as a single shot for infants > 9 months of age and adults, should not be given to infants less than 4 months of age. Vaccination is usually accessible through specialized clinics. Revaccination is recommended after 10 years.
Japanese encephalitis vaccine: is similar to Yellow fever caused by a virus that is transmitted through a mosquito bite and found in some rural parts of Asia. It is not transmitted from one person to another. The vaccine is recommended for persons staying for > 4 weeks in endemic areas and is given as a series of 3 shot given at 0, 7, and 30days.
Cholera vaccine: is used to protect against cholera which is caused by a bacteria,is usually acquired through contaminated food and water, attacking gastrointestinal tract causing severe diarrhea. This vaccine is not recommended by CDC (center of disease control) and is not available is USA, because cholera is not a problem there and can be controlled and treated easily by taking appropriate sanitary measures. Cholera oral vaccine is available in few countries only on limited scale.
Typhoid vaccine: used to prevent typhoid fever, a serious disease caused by a bacterium, Salmonella typhi. It is available in 2 forms; an oral live attenuated, and injectable inactivated. Vaccination is recommended when traveling to endemic areas.
Injectable vaccine should not be given to children < 2 years of age and is given as a single shot 2 weeks before traveling with a booster after 2 years if indicated.
Oral vaccine is given as 4 doses 2 days apart with the last dose given 1 week before traveling. It should not be given to children < 6years of age. A booster can be given if indicated after 5 years.
How about vaccination during pregnancy?
Vaccination during pregnancy can be carried out with certain vaccines only if indicated, keeping in mind risk to the fetus versus benefit to the mother. In general, the best period for vaccination during pregnancy is during second trimester (middle period of pregnancy).
All live-attenuated viral vaccines are considered contraindicated in pregnancy as MMR, Varicella, and intranasal Influenza vaccine.
Some vaccines should be considered for pregnant women, if otherwise indicated, like
inactivated influenza, hepatitis B, Td, and meningococcal polysaccharide vaccine.
