Note from the National Guideline Clearinghouse (NGC): The following key points summarize the content of the guideline. Refer to the original guideline document for additional information.
The levels of evidence [A-D] are defined at the end of the "Major Recommendations" field.
Hepatitis A Vaccine Series
Note: For combined hepatitis A and B vaccination, use Hepatitis A/Hepatitis B Vaccine (Twinrix Adult) three doses at 0, 1, and 6 months or accelerated schedule1 if indicated.
Two doses at 0 and 6 to 18 months
- Persons with chronic liver disease
- Persons who receive clotting factor concentrates
- Men who have sex with men, illicit drug-users
- Travelers to countries where there is higher or intermediate hepatitis A virus (HAV) endemicity
- Persons with occupational risk who work with HAV-infected primates or HAV in a research lab
Hepatitis B Vaccine Series
Note: For combined hepatitis A and B vaccination, use Hepatitis A/Hepatitis B (Twinrix Adult), three doses at 0, 1 and 6 months or accelerated schedule1 if indicated.
Three doses at 0, 1, and 6 months (For immunocompromised patients and hemodialysis patients, increase dose to 40 micrograms.)
- Individuals with multiple sex partners
- Men who have sex with men
- End-stage renal disease (ESRD) and hemodialysis patients (early in disease)
- Intravenous (IV) drug users and sexual partners
- Immigrants from and travelers to high risk areas
- Persons with recent sexually transmitted diseases (STDs) (see original guideline document for further details)
- Persons with human immunodeficiency virus(HIV)/acquired immunodeficiency disease syndrome (AIDS)
- Healthcare workers/public safety workers/students exposed to blood
- Clients and staff of institutions for the developmentally disabled and correctional facilities
- Persons seeking protection against hepatitis B virus (HBV)
- Household contacts & sexual partners of persons with chronic HBV infection
No routine booster. Immunity from the vaccine series is currently felt to be lifelong.
1Accelerated dosing schedule: Hepatitis A/ Hepatitis B Vaccine (Twinrix Adult):
Three doses in 3 weeks (0, 7days, 21-30 days); booster at 12 months. Consider for:
- Emergency first-care responders
- Individuals preparing to travel to high-risk areas on short notice
- Those with risk factors for hepatitis such as HIV and sexually transmitted diseases
Herpes Zoster Vaccine
Note: Live virus vaccine. (This vaccine may not be covered by all payers or all Medicare Part D policies. Patients should confirm coverage.)
One dose
- Adults, age 60 and older, whether or not they report a prior episode of herpes zoster. Persons with chronic medical conditions may be vaccinated, unless a contraindication precaution exists.
Human Papilloma Virus (HPV) Vaccine, Quadrivalent
Note: In women of child bearing age, avoid pregnancy for at least 4 weeks after immunization
Three doses at 0, 2, and 6 months
- Females < 26 years old who have not received the vaccine or completed the series.
Booster uncertain. Efficacy beyond 5 years is presently unknown.
Influenza Vaccines
Initial dose: Inactivated (injectable)
- Adults >50 years old [B*]
- Persons with chronic illnesses (e.g., cardiovascular, pulmonary, renal, metabolic, sickle cell disease, immunosuppression/HIV, disorders increasing risk of aspiration), asplenia
- Residents of long-term care facilities [B*]
- Women who are pregnant
- Health care workers, including home care and long-term care workers [A*]
- Household contacts and out-of-house caregivers of children 0 to 59 months
- Others who can transmit influenza to a high risk population
Initial dose: Live attenuated (intranasal)
Revaccinate annually
- Persons eligible under criteria for initial immunization vaccine
Measles, Mumps, Rubella (MMR) Vaccine (use combined MMR vaccine)
Note: Live virus vaccine
Initial dose
- No evidence of immunity* to measles, to mumps, and/or (if woman of childbearing age) to rubella
- Consider giving initial dose to unvaccinated health-care workers born before 1957 who do not have other evidence of mumps immunity*
Second dose at >1 month
- Health care workers (for measles, mumps)
- College students (for measles, mumps; first dose may be required before start classes)
- Travelers to foreign countries (for measles, mumps)
- Recently exposed to measles or are in an outbreak setting
- Previously vaccinated with killed measles vaccine, or between 1963 to 1967 with an unknown measles vaccine
- In age group affected during a mumps outbreak
* Evidence of immunity: (a) documentation of MMR vaccination requires 2 doses for measles, 1 dose for rubella or mumps (b) laboratory evidence of immunity, (c) documentation of physician diagnosis or (d) born before 1957 (age exceptions: rubella immunity not assumed for women of child-bearing age who could become pregnant; measles and mumps immunity possibly not assumed for health care workers)
Meningococcal Vaccine (Use meningococcal conjugate [Menactra™] for adults <55 years and meningococcal polysaccharide [Menomune®] for those >55 years)
Initial - one dose
- College freshman living in dormitories
- Persons who have functional or anatomic asplenia and terminal complement component deficiencies
- Travelers to sub-Saharan Africa from Senegal in the west to Ethiopia in the east, especially from December to June
- Microbiologists routinely exposed to isolates of Neisseria meningitidis
Revaccinate: once every 3 to 5 years
- The above persons if indications still exist for vaccination and the last vaccination was given with Meningococcal polysaccharide
- No need to revaccinate if previously vaccinated with meningococcal conjugate (Menactra™)
Pneumococcal Polysaccharide Vaccine
Initial dose
- All adults >65 years old [B]
- Residents of nursing home and long-term care facilities
- Persons with chronic illness (e.g., cardiovascular, pulmonary [except asthma - see original guideline document], diabetes, kidney or liver disease, alcoholism, cerebrospinal fluid leak, cochlear implants, sickle cell disease, asplenia and other immunosuppressive conditions, chemotherapy, steroid use - see original guideline document)
- Native Americans and Native Alaskans
Revaccinate once >5 years after initial dose only for the following high risk patients
- Age: persons age >65 if initial vaccine was given >5 years previously at age <65 [A*].
- Chronic disease: highest risk for pneumococcal infection or rapid decline in antibody (e.g., asplenic, sickle cell disease, transplant recipient, HIV, nephrotic syndrome, chronic renal failure, immunosuppressed)
Tetanus, Diphtheria, Pertussis Vaccines (Td/Tdap) (primary series assumed)2
Revaccinate every 10 years
- All patients [A*]
- A one-time dose of Tdap should be given to:
- Postpartum women, close contacts of infants <12 months old, and health care workers with at least a 2 year interval from previous Td vaccine
- Adults <65 years old who have not previously received a dose of Tdap and are due for a tetanus vaccine (for booster or wound management)
Revaccinate in >5 years
- Patients with wounds (other than clean or minor wounds)
2If primary series not given: 3 doses Td at 0, 4 weeks, and 7 to12 months.
Varicella Vaccine
Note: Live virus vaccine
Two doses at 0 and >4 weeks
- All non-pregnant adults without evidence of immunity to varicella3. Give special consideration to those who have close contact with persons at high risk for severe disease (e.g., healthcare workers and family contacts of immunocompromised persons) or are at high risk for exposure or transmission (e.g., teachers of young children; child care workers; college students; residents and staff of institutional settings, including correctional facilities; military personnel; international travelers; and non-pregnant women of childbearing age).
3 Evidence of immunity to varicella: (a) documentation of 2 doses of varicella vaccine; (b) U.S.-born before 1980 (except for immunocompromised, health-care workers and pregnant women); (c) history of diagnosis of varicella by a health-care provider; (d) history of herpes zoster based on health-care provider diagnosis; or (e) laboratory evidence of immunity or laboratory confirmation of disease. (see text for further details)
Definitions:
Levels of Evidence
- Randomized controlled trials
- Controlled trials, no randomization
- Observational trials
- Opinion of expert panel
