Chapter 116. Immunization Principles and Vaccine Use (Part 7)

As noted above, the number of licensed vaccines and the strategies for their best use change constantly as new products, new indications, and new information become available. The Advisory Committee on Immunization Practices (ACIP) regularly amends immunization recommendations to reflect the evolution of vaccines and vaccination policy in the United States. Changes for 2006 include the following points:to implement standing orders to administer hepatitis B vaccine—soon after birth and before hospital discharge—to all infants except those with documented hepatitis B–negative mothers;to target adults at high risk for hepatitis B vaccination....
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Chapter 116. Immunization Principles and Vaccine Use (Part 7) Chapter 116. Immunization Principles and Vaccine Use (Part 7) As noted above, the number of licensed vaccines and the strategies for theirbest use change constantly as new products, new indications, and new informationbecome available. The Advisory Committee on Immunization Practices (ACIP)regularly amends immunization recommendations to reflect the evolution ofvaccines and vaccination policy in the United States. Changes for 2006 include thefollowing points: to implement standing orders to administer hepatitis B vaccine—soonafter birth and before hospital discharge—to all infants except those withdocumented hepatitis B–negative mothers; to target adults at high risk for hepatitis B vaccination; to use a new tetanus toxoid/reduced-dose diphtheria toxoid plusacellular pertussis combination vaccine (Tdap) formulated for adolescents andadults in place of Td; to provide meningococcal conjugate vaccine (MCV4) to all childrenat 11–12 years of age, to unvaccinated adolescents at age 15, and to all collegefreshmen living in dormitories; to administer hepatitis A vaccine to all children at 1 year of age; to administer three doses of the newly licensed rotavirus vaccine at 2,4, and 6 months of age, with the first dose given by 12 weeks of age and the lastby 32 weeks of age; to immunize children 6 months to 5 years of age with influenzavaccine and to expand routine use of the vaccine for their household contacts andout-of-home caregivers; to administer Tdap to protect health care personnel from pertussisand to reduce their potential to transmit nosocomial infections, assigning thehighest priority to those who have direct contact with infants Infants and Children It is current practice for all children in the United States to receive DTaP,poliovirus, MMR, Hib, hepatitis B, and varicella vaccines and to receivepneumococcal conjugate, hepatitis A, and rotavirus vaccines in the absence ofspecific contraindications (Fig. 116-1; www.cdc.gov/vaccines/vpd-vac/vaccines-list.htm). Annual influenza seasonal vaccine is recommended for all children 6months to 5 years old and to other children who have certain risk factors or whoreside with persons with certain chronic disorders. In several European countries,meningococcal C conjugate vaccine is routinely recommended for children. Teenagers It is now recommended that all adolescents routinely receive quadrivalentmeningococcal conjugate vaccine for serogroups A, C, Y, and W135 and the new-formulation Tdap vaccine. Girls should be given HPV vaccine, ideally at the ageof 11–12 years but certainly before becoming sexually active (Fig. 116-1;www.cdc.gov/vaccines/recs/schedules/teen-schedule.htm). Adults, Including College Students (Fig. 116-2) Immunization recommendations for adults (≥18 years old) fallinto four categories: (1) routine vaccines for all adults; (2) vaccines for high-riskexposure groups (health care and other institutional workers, prisoners, students,military personnel, travelers to endemic areas, injection drug users, and men whohave sex with men); (3) vaccines for persons at high risk for severe outcomes ofinfection (pregnant women; the elderly; persons with chronic medical conditions,including diabetes, alcoholism, immunodeficiency, and renal, hepatic, respiratory,or cardiac disease); and (4) vaccines for household contacts of persons in group 3. Because a substantial proportion of adults in the United States no longerhave protective levels of antibodies to tetanus or diphtheria, all adults shouldreceive routine booster doses of Td every 10 years. For those under age 65 years,one-time substitution of Tdap suitable for adults (Adacel, Sanofi-Pasteur) in placeof the usual Td booster is recommended. Pregnant women who received their lastTd booster >10 years previously may receive Td during the second or thirdtrimester; those boosted nonpregnant women of childbearing age. Rubella-susceptible pregnant womenshould be vaccinated as early as possible in the postpartum period. Live-virusvaccines, such as MMR and varicella vaccines, are contraindicated in pregnantwomen and immunosuppressed individuals. Routine immunization against polio(with inactivated vaccine) is not recommended for adults unless they are atparticular risk of exposure because of travel to the remaining endemic areas.College students, particularly freshmen living in dormitory settings, are atincreased risk of meningococcal meningitis, as are military recruits; individuals inboth of these groups should be offered the meningococcal polysaccharide orconj ...