Chapter 116. Immunization Principles and Vaccine Use (Part 8)

Current recommendations also include influenza vaccine for routine annual administration to individuals with chronic illness at any age, to persons living in the same household as chronically ill individuals, and to all adults 50 years of age. Polyvalent pneumococcal polysaccharide vaccine is similarly recommended for adults ≥65 years of age and for all chronically ill persons. Hepatitis B vaccine should be given to adults at high risk from clinical, occupational, behavioral, or travel exposures, including patients undergoing hemodialysis, routine recipients of clotting factors, health care workers exposed to potentially infected blood or blood products, individuals living and working in...
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Chapter 116. Immunization Principles and Vaccine Use (Part 8) Chapter 116. Immunization Principles and Vaccine Use (Part 8) Current recommendations also include influenza vaccine for routine annualadministration to individuals with chronic illness at any age, to persons living inthe same household as chronically ill individuals, and to all adults >50 years ofage. Polyvalent pneumococcal polysaccharide vaccine is similarly recommendedfor adults ≥65 years of age and for all chronically ill persons. Hepatitis B vaccineshould be given to adults at high risk from clinical, occupational, behavioral, ortravel exposures, including patients undergoing hemodialysis, routine recipients ofclotting factors, health care workers exposed to potentially infected blood or bloodproducts, individuals living and working in institutions for the mentallyhandicapped, travelers to highly endemic countries, persons at excess risk forsexually transmitted diseases, injection drug users, and household contacts ofknown carriers of hepatitis B surface antigen. Hepatitis A vaccine is recommendedfor these same groups and for persons with clotting disorders or chronic liverdisease. There are a number of other special-use vaccines whose administration isrelated to travel and occupational exposures (e.g., Japanese B encephalitis, typhoidfever, yellow fever, and rabies); specific recommendations for the use of thesevaccines in the United States can be found at www.cdc.gov/nip/recs/adult-schedule.htm. Simultaneous Administration of Multiple Vaccines There are no contraindications to the simultaneous administration ofmultiple individual vaccines, although the use of licensed combination vaccinescan significantly reduce the required number of injections during the first 2 yearsof life. Combination DTaP/Hib vaccine should not be used for primaryimmunization of infants because it results in a blunted, suboptimal response toHib; the combination may be used for booster immunizations. Simultaneous administration of the most widely used live and inactivatedvaccines has not resulted in impaired antibody responses or in elevated rates ofadverse reactions. In fact, this approach increases the likelihood that a child willultimately be fully immunized. The simultaneous administration of vaccines isuseful in any age group when the potential exists for exposure to multipleinfectious diseases during travel to endemic countries. Live-virus vaccines may begiven together on the same day; if this approach is not feasible, an interval of atleast 30 days should be allowed to avoid interference in the response to one oranother of the administered vaccine strains. Because high doses of immune globulin can inhibit the efficacy of measlesand rubella vaccines, an interval of at least 3 months is recommended between theadministration of immune globulin and that of MMR vaccine or its components.However, postpartum vaccination of rubella-susceptible women should not bedelayed because of the administration of anti-Rho(D) immune globulin or anyother blood product during the last trimester or at delivery. Should theadministration of an immune globulin preparation become necessary aftervaccination, it should be postponed, if at all possible, for at least 14 days to allowtime for vaccine-virus replication and development of immunity. In general, thereis little interaction of immune globulin with inactivated vaccines, andpostexposure passive prophylaxis can be given together with hepatitis B vaccineor tetanus toxoid, resulting in both immediate and long-lasting protection. Adverse Events Vaccines are generally very safe. Serious adverse events proven to be dueto currently licensed vaccines are rare. Concerns about vaccine safety have attimes become inflated in conjunction with complacency about the consequences ofinfections no longer routinely transmitted in the United States. As a result, someparents have refused to have their infants and children immunized. An adverse reaction or vaccine side effect is an untoward vaccine effectthat is extraneous to the vaccines primary purpose (to produce immunity). Anadverse event can be either a true vaccine reaction or an event whose occurrence istemporally related to a vaccine dose but is entirely unrelated to the vaccine itself.As vaccines are routinely administered through childhood, coincidental events areinevitable. Because our understanding of the underlying biologic mechanisms thatcause adverse events remains limited, a few highly publicized claims—unsubstantiated by validated data or analysis—can easily heighten the suspicionthat some or all vaccines routinely cause unacceptable adverse events. Antivaccineadvocacy groups actively encourage the ...