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Hepatitis A Vaccine
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.
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 human immunodeficiency virus (HIV) and sexually transmitted diseases
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| Two doses at 0 and 6—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
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Hepatitis B 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.
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
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Three doses at 0, 1, and 6 months
(For immunocompromised patients and hemodialysis patients, increase dose to 40 micrograms.)
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- 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 their 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 hepatitis B virus (HBV) infection
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| No routine booster |
Immunity from the vaccine series is currently felt to be lifelong. |
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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.)
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| One dose |
- Adults, ≥ 60 and old, whether or not they report a prior episode of herpes zoster. Persons with chronic medical conditions may be vaccinated, unless a contraindication precaution exists.
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Human Papilloma Virus (HPV) Vaccine, Quadrivalent
Note: In women of child bearing age, avoid pregnancy for at least 4 weeks after immunization
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| Three doses at 0, 2, and 6 months. Minimum interval of 24 weeks between doses 1 and 3. |
- Females < 26 years old who have not received the vaccine or completed the series. If a woman turns 27 years old after the first dose is administered but before the third dose is given, complete the series using the recommended intervals between doses.
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| 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 less than 6 years old or adults ≥ 65 years old
- Others who can transmit influenza to a high risk population
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| Initial dose: Live attenuated (intranasal) |
- For non-pregnant healthy persons <50 years old in priority populations, live attenuated vaccine may be used as an alternative to inactivated vaccine.
(Non-priority healthy persons <50 years old may receive either vaccine if supply allows.)
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| Revaccinate annually |
- Persons eligible under criteria for initial immunization vaccine
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| Measles, Mumps, Rubella (MMR) Vaccine (use combined MMR vaccine)
Note: Live virus vaccine
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| Initial dose |
- No evidence of immunity* to measles, to mumps, 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*
* 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)
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| 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―1967 with an unknown measles vaccine
- In age group affected during a mumps outbreak
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Meningococcal Vaccine
(Use meningococcal conjugate [Menactra™] for adults <55 years and meningococcal polysaccharide [Menomune®] for those >55 years)
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| 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
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| 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™)
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| Pneumococcal Polysaccharide Vaccine |
| Initial dose |
- All adults >65 years old [B]
- Persons 19 through 64 years old who smoke cigarettes of have asthma
- Residents of nursing home and long-term care facilities
- Persons with chronic illness (e.g., cardiovascular, pulmonary), 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 younger than 65 years old who are living in areas where there is an increased risk of invasive pneumococcal disease
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Revaccinate once >5 years after initial dose only for the following high risk patients
Note: Maximum of 2 doses PPSV23 in a lifetime
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- Age: persons >65 years old, if initial vaccine was given >5 years previously at age <65 years old [A*].
- Chronic disease: highest risk for pneumococcal infection or rapid decline in antibody (e.g., functional or anatomic asplenia, sickle cell disease, transplant recipient, HIV, nephrotic syndrome, chronic renal failure, immunosuppressed)
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Tetanus, Diphtheria, Pertussis Vaccines (Td/Tdap) (primary series assumed)2
2 If primary series not given: 3 doses Td at 0, 4 weeks, and 7―12 months
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| Revaccinate every 10 years |
- All patients [A*]
- A one-time dose of tetanus, diphtheria, and pertussis (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 tetanus-diphtheria (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)
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| Revaccinate in >5 years |
- Patients with wounds (other than clean or minor wounds)
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Varicella Vaccine
Note: Live virus vaccine
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| 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 original guideline document for further details)
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