Advisory Committee on Immunization Practices (ACIP) Recommended Immunization Schedule for Adults Aged 19 Years and Older—United States, 2013
2013; Elsevier BV; Volume: 13; Issue: 5 Linguagem: Inglês
10.1111/ajt.12279
ISSN1600-6143
AutoresCarolyn B. Bridges, LaDora O. Woods, Tamera Coyne‐Beasley,
Tópico(s)Hepatitis B Virus Studies
ResumoUpdated adult immunization guidelines include the use of PCV13 for immunocompromised adults, zoster vaccine for “normal” hosts at age 60 and expanded indications for human papillomavirus vaccination in young adult men. Updated adult immunization guidelines include the use of PCV13 for immunocompromised adults, zoster vaccine for “normal” hosts at age 60 and expanded indications for human papillomavirus vaccination in young adult men. February 1, 2013/62(01);9–19 (Supplements) Vaccines are recommended for adults on the basis of age, prior vaccinations, health conditions, lifestyle, occupation, and travel. Current levels of vaccination coverage among adults are low (1). Health-care providers should be aware of the importance of routinely assessing patients’ vaccination histories and recommending and providing routinely recommended vaccines. A strong recommendation from a health-care provider is associated with increased uptake of vaccines (2,3). Other interventions shown to increase vaccine uptake, such as implementation of reminder/recall systems and standing orders, have been summarized by the Community Guide (3). The Advisory Committee on Immunization Practices (ACIP) annually reviews and updates the adult immunization schedule, which is designed to provide vaccine providers with a summary of existing ACIP recommendations regarding the routine use of vaccines for adults (Figures 1 and 2). The adult schedule also includes a table summarizing the primary contraindications and precautions for routinely recommended vaccines (Table 1). In October 2012, ACIP approved the adult immunization schedule for 2013. This schedule also incorporates changes to vaccine recommendations voted on by ACIP at its October 24–25, 2012 meeting.Figure 2:Recommended vaccinations indicated for adults based on medical and other indications1.Show full captionAlternate Text: The figure above shows recommended vaccinations indicated for adults based on medical and other indications. For Figure 2, the recommendation for Tdap vaccination with each pregnancy is included, with a single dose of Tdap recommended for all other groups. A correction was made to change the color for PPSV23 from yellow to purple for men who have sex with men (MSM). PPSV23 is recommended for MSM who have another risk factor such as age group or medical condition. A row for PCV13 was added.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Table 1:Contraindications and precautions to commonly used vaccines in adults1Vaccine package inserts and the full ACIP recommendations for these vaccines should be consulted for additional information on vaccine-related contraindications and precautions and for more information on vaccine excipients. Events or conditions listed as precautions should be reviewed carefully. Benefits of and risks for administering a specific vaccine to a person under these circumstances should be considered. If the risk from the vaccine is believed to outweigh the benefit, the vaccine should not be administered. If the benefit of vaccination is believed to outweigh the risk, the vaccine should be administered. A contraindication is a condition in a recipient that increases the chance of a serious adverse reaction. Therefore, a vaccine should not be administered when a contraindication is present.,*Adapted from CDC. Table 6. Contraindications and precautions to commonly used vaccines. General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices. MMWR 2011;60(No. RR-2):40–41 and from Atkinson W, Wolfe S, Hamborsky J, eds. Appendix A. Epidemiology and prevention of vaccine preventable diseases. 12th ed. Washington, DC: Public Health Foundation, 2011. Available at http://www.cdc.gov/vaccines/pubs/pinkbook/index.html.,†Regarding latex allergy. Consult the package insert for any vaccine administered.VaccineContraindicationsPrecautionsInfluenza, inactivated vaccine (IIV)Severe allergic reaction (e.g. anaphylaxis) after previous dose of any influenza vaccine or to a vaccine component, including egg protein.Moderate or severe acute illness with or without feverHistory of Guillain–Barré syndrome (GBS) within 6 weeks of previous influenza vaccinationPersons who experience only hives with exposure to eggs should receive IIV with additional safety precautions.2CDC. Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP)—United States, 2012–13 influenza season. MMWR 2012;61:613-8.Influenza, live attenuated (LAIV)3LAIV, MMR, and varicella vaccines can be administered on the same day. If not administered on the same day, these live vaccines should be separated by at least 28 days.Severe allergic reaction (e.g. anaphylaxis) after previous dose of any influenza vaccine or to a vaccine component, including egg protein.Moderate or severe acute illness with or without feverHistory of GBS within 6 weeks of previous influenza vaccination.Conditions for which the Advisory Committee on Immunization Practices (ACIP) recommends against use, but which are not contraindications in vaccine package insert: immune suppression, certain chronic medical conditions such as asthma, diabetes, heart or kidney disease, and pregnancy.4For a complete list of conditions that CDC considers to be reasons to avoid getting LAIV, see CDC. Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010. MMWR 2010;59(No. RR-8). Available at http://www.cdc.gov/vaccines/pubs/acip-list.htm.Receipt of specific antivirals (i.e. amantadine, rimantadine, zanamivir, or oseltamivir) 48 hours before vaccination. Avoid use of these antiviral drugs for 14 days after vaccinationTetanus, diphtheria, pertussis (Tdap); tetanus, diphtheria (Td)Severe allergic reaction (e.g. anaphylaxis) after a previous dose or to a vaccine componentModerate or severe acute illness with or without feverGBS within 6 weeks after a previous dose of tetanus toxoid-containing vaccineFor pertussis-containing vaccines: encephalopathy (e.g. coma, decreased level of consciousness, or prolonged seizures) not attributable to another identifiable cause within 7 days of administration of a previous dose of Tdap or diphtheria and tetanus toxoids and pertussis (DTP) or diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccineHistory of arthus-type hypersensitivity reactions after a previous dose of tetanus or diptheria toxoid-containing vaccine; defer vaccination until at least 10 years have elapsed since the last tetanus toxoid-containing vaccineFor pertussis-containing vaccines: progressive or unstable neurologic disorder, uncontrolled seizures, or progressive encephalopathy until a treatment regimen has been established and the condition has stabilizedVaricella2Severe allergic reaction (e.g. anaphylaxis) after a previous dose or to a vaccine componentRecent (within 11 months) receipt of antibody-containing blood product (specific interval depends on product).6Vaccine should be deferred for the appropriate interval if replacement immune globulin products are being administered.,7See CDC. General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2011;60(No. RR-2). Available at http://www.cdc.gov/vaccines/pubs/acip-list.htm.Known severe immunodeficiency (e.g. from hematologic and solid tumors, receipt of chemotherapy, congenital immunodeficiency, or long-term immunosuppressive therapy5 or patients with human immunodeficiency virus (HIV) infection who are severely immunocompromised)Moderate or severe acute illness with or without feverPregnancyReceipt of specific antivirals (i.e. acyclovir, famciclovir, or valacyclovir) 24 hours before vaccination; avoid use of these antiviral drugs for 14 days after vaccinationHuman papillomavirus (HPV)Severe allergic reaction (e.g. anaphylaxis) after a previous dose or to a vaccine componentModerate or severe acute illness with or without feverPregnancyZosterSevere allergic reaction (e.g. anaphylaxis) to a vaccine componentModerate or severe acute illness with or without feverKnown severe immunodeficiency (e.g. from hematologic and solid tumors, receipt of chemotherapy, or long-term immunosuppressive therapy 5 or patients with HIV infection who are severely immunocompromised)Receipt of specific antivirals (i.e. acyclovir, famciclovir, or valacyclovir) 24 hours before vaccination; avoid use of these antiviral drugs for 14 days after vaccinationPregnancyMeasles, mumps, rubella (MMR)3LAIV, MMR, and varicella vaccines can be administered on the same day. If not administered on the same day, these live vaccines should be separated by at least 28 days.Severe allergic reaction (e.g. anaphylaxis) after a previous dose or to a vaccine componentModerate or severe acute illness with or without fever.Known severe immunodeficiency (e.g. from hematologic and solid tumors, receipt of chemotherapy, congenital immunodeficiency, or long-term immunosuppressive therapy5 or patients with HIV infection who are severely immunocompromised)Recent (within 11 months) receipt of antibody-containing blood product (specific interval depends on product).6Vaccine should be deferred for the appropriate interval if replacement immune globulin products are being administered.,7See CDC. General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2011;60(No. RR-2). Available at http://www.cdc.gov/vaccines/pubs/acip-list.htm.PregnancyHistory of thrombocytopenia or thrombocytopenic purpuraNeed for tuberculin skin testing.8Measles vaccination might suppress tuberculin reactivity temporarily. Measles-containing vaccine may be administered on the same day as tuberculin skin testing. If testing cannot be performed until after the day of MMR vaccination, the test should be postponed for at least 4 weeks after the vaccination. If an urgent need exists to skin test, do so with the understanding that reactivity might be reduced by the vaccine.VaccineContraindicationsPrecautionsPneumococcal polysaccharide (PPSV)Severe allergic reaction (e.g. anaphylaxis) after a previous dose or to a vaccine componentModerate or severe acute illness with or without feverPneumococcal conjugate (PCV13)Severe allergic reaction (e.g. anaphylaxis) after a previous dose or to a vaccine component, including to any vaccine containing diphtheria toxoidModerate or severe acute illness with or without feverMeningococcal, conjugate, (MCV4); meningococcal, polysaccharide (MPSV4)Severe allergic reaction (e.g. anaphylaxis) after a previous dose or to a vaccine componentModerate or severe acute illness with or without feverHepatitis A (HepA)Severe allergic reaction (e.g. anaphylaxis) after a previous dose or to a vaccine componentModerate or severe acute illness with or without feverHepatitis B (HepB)Severe allergic reaction (e.g. anaphylaxis) after a previous dose or to a vaccine componentModerate or severe acute illness with or without fever5Immunosuppressive steroid dose is considered to be 2 or more weeks of daily receipt of 20 mg prednisone or the equivalent. Vaccination should be deferred for at least 1 month after discontinuation of such therapy. Providers should consult ACIP recommendations for complete information on the use of specific live vaccines among persons on immune-suppressing medications or with immune suppression because of other reasons.1 Vaccine package inserts and the full ACIP recommendations for these vaccines should be consulted for additional information on vaccine-related contraindications and precautions and for more information on vaccine excipients. Events or conditions listed as precautions should be reviewed carefully. Benefits of and risks for administering a specific vaccine to a person under these circumstances should be considered. If the risk from the vaccine is believed to outweigh the benefit, the vaccine should not be administered. If the benefit of vaccination is believed to outweigh the risk, the vaccine should be administered. A contraindication is a condition in a recipient that increases the chance of a serious adverse reaction. Therefore, a vaccine should not be administered when a contraindication is present.2 CDC. Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP)—United States, 2012–13 influenza season. MMWR 2012;61:613-8.3 LAIV, MMR, and varicella vaccines can be administered on the same day. If not administered on the same day, these live vaccines should be separated by at least 28 days.4 For a complete list of conditions that CDC considers to be reasons to avoid getting LAIV, see CDC. Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010. MMWR 2010;59(No. RR-8). Available at http://www.cdc.gov/vaccines/pubs/acip-list.htm.6 Vaccine should be deferred for the appropriate interval if replacement immune globulin products are being administered.7 See CDC. General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2011;60(No. RR-2). Available at http://www.cdc.gov/vaccines/pubs/acip-list.htm.8 Measles vaccination might suppress tuberculin reactivity temporarily. Measles-containing vaccine may be administered on the same day as tuberculin skin testing. If testing cannot be performed until after the day of MMR vaccination, the test should be postponed for at least 4 weeks after the vaccination. If an urgent need exists to skin test, do so with the understanding that reactivity might be reduced by the vaccine.* Adapted from CDC. Table 6. Contraindications and precautions to commonly used vaccines. General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices. MMWR 2011;60(No. RR-2):40–41 and from Atkinson W, Wolfe S, Hamborsky J, eds. Appendix A. Epidemiology and prevention of vaccine preventable diseases. 12th ed. Washington, DC: Public Health Foundation, 2011. Available at http://www.cdc.gov/vaccines/pubs/pinkbook/index.html.† Regarding latex allergy. Consult the package insert for any vaccine administered. Open table in a new tab Alternate Text: The figure above shows recommended vaccinations indicated for adults based on medical and other indications. For Figure 2, the recommendation for Tdap vaccination with each pregnancy is included, with a single dose of Tdap recommended for all other groups. A correction was made to change the color for PPSV23 from yellow to purple for men who have sex with men (MSM). PPSV23 is recommended for MSM who have another risk factor such as age group or medical condition. A row for PCV13 was added. 5Immunosuppressive steroid dose is considered to be 2 or more weeks of daily receipt of 20 mg prednisone or the equivalent. Vaccination should be deferred for at least 1 month after discontinuation of such therapy. Providers should consult ACIP recommendations for complete information on the use of specific live vaccines among persons on immune-suppressing medications or with immune suppression because of other reasons. The primary updates include adding information for the first time on the use of 13-valent pneumococcal conjugate vaccine (PCV13) and the timing of administration of PCV13 relative to the 23-valent pneumococcal polysaccharide vaccine (PPSV23) in adults (4). PCV13 is recommended for adults aged 19 years and older with immunocompromising conditions (including chronic renal failure and nephrotic syndrome), functional or anatomic asplenia, cerebrospinal fluid leaks, or cochlear implants. The schedule also clarifies which adults need 1 or 2 doses of PPSV23 before age 65 years. Other changes to the PPSV23 footnote include adding information regarding recommendations for vaccination when vaccination status is unknown. For tetanus, diphtheria, and acellular pertussis (Tdap) vaccine, recommendations have been expanded to include routine vaccination of adults aged 65 years and older and for pregnant women to receive Tdap vaccine with each pregnancy. The ideal timing of Tdap vaccination during pregnancy is during 27–36 weeks’ gestation. This recommendation was made to increase the likelihood of optimal protection for the pregnant woman and her infant during the first few months of the infant’s life, when the child is too young for vaccination but at highest risk for severe illness and death from pertussis (5,6). Manufacturers of the live, attenuated influenza vaccine (LAIV) have obtained Food and Drug Administration (FDA) approval for a quadrivalent influenza vaccine that contains one influenza A (H3N2), one influenza A (H1N1) and two influenza B vaccine virus strains, one from each lineage of circulating influenza B viruses. In approximately half of the recent influenza seasons, the trivalent influenza vaccine has included an influenza B vaccine virus from the lineage different from the predominant circulating influenza B strains (7). Inclusion of both lineages of influenza B virus is intended to increase the likelihood that the vaccine provides cross-reactive antibody against a higher proportion of circulating influenza B viruses. For LAIV, beginning with the 2013–14 season, it is expected that only the quadrivalent formulation will be available and manufacture of the trivalent formulation will cease. It is possible that quadrivalent inactivated influenza vaccine formulations might be available for the 2013–14 season as well. Because a mix of quadrivalent and trivalent influenza vaccines might be available in 2013–14, the abbreviation for inactivated influenza vaccine has been changed from trivalent inactivated influenza vaccine (TIV) to inactivated influenza vaccine (IIV). The abbreviation for LAIV remains unchanged. Minor wording changes, clarifications, or simplifications have been made to footnotes for measles, mumps, rubella vaccine (MMR), human papillomavirus vaccine (HPV), zoster vaccine, and hepatitis A and hepatitis B vaccines. A correction has been made to Figure 1 for MMR vaccine: the bar that indicated the vaccine might be used in certain situations by persons born before 1957 has been removed. Persons born before 1957 are considered immune, and routine vaccination is not recommended. Considerations for the possible use of MMR vaccine in outbreak situations are included in the 2011 MMWR publication on vaccination of health-care personnel (8). In addition, a correction was made to Figure 2 for PPSV23. This vaccine is indicated for men who have sex with men if they have another risk factor (e.g. age or underlying condition); the bar has been changed from yellow to purple to more accurately reflect the recommendation. Vaccine providers are reminded to consult the full ACIP vaccine recommendations if they have questions and to bear in mind that additional updates might be made for specific vaccines during the year between updates to the adult schedule. Printable versions of the 2013 adult immunization schedule and other information is available at http://www.cdc.gov/vaccines/schedules/hcp/adult.html. Information about adult vaccination is available at http://www.cdc.gov/vaccines/default.htm. ACIP statements and information for specific vaccines is available at http://www.cdc.gov/vaccines/pubs/acip-list.htm. Adverse events from vaccination should be reported at http://www.vaers.hhs.gov or by telephone, 800-822-7967. This schedule has been approved by the American Academy of Family Physicians, the American College of Physicians, the American College of Obstetricians and Gynecologists, and the American College of Nurse-Midwives. The adult immunization schedule is published in the Annals of Internal Medicine at the same time that it is published in MMWR. •Information was added to footnote #1 to direct readers to additional information regarding recommendations for vaccination when vaccination status is unknown.•The influenza vaccination footnote (#2) now uses the abbreviation IIV for inactivated influenza vaccine and drops the abbreviation TIV for trivalent inactivated vaccine (TIV). For the 2013–14 influenza season, it is expected that the LAIV will be available only in a quadrivalent formulation; IIV might be available in both trivalent and quadrivalent formulations.•The tetanus, diphtheria, and acellular pertussis (Td/Tdap) vaccination footnote (#3) is updated to include the recommendation to vaccinate pregnant women with Tdap during each pregnancy, regardless of the interval since prior Td/Tdap vaccination and to include the recommendation for all other adults, including persons aged 65 years and older, to receive 1 dose of Tdap vaccine.•The varicella (#4) and HPV (#5) footnotes were simplified; no changes in recommendations were made. Additional information was added to the HPV footnote regarding HPV vaccination and pregnancy.•The zoster footnote (#6) was changed to clarify that ACIP recommends vaccination of persons beginning at age 60 years both for persons with and without underlying health conditions for whom the vaccine is not contraindicated.•The measles, mumps, rubella (MMR) vaccine footnote (#7) was modified to reflect the new recommendation that a provider diagnosis of measles, mumps, or rubella is not considered acceptable evidence of immunity. Previously, a provider diagnosis of measles or mumps, but not rubella, was considered acceptable evidence of immunity.•Information was added to the pneumococcal polysaccharide (PPSV23) vaccination footnote (#8) and PPSV23 revaccination footnote (#9) to clarify that persons with certain medical conditions are recommended to receive 2 doses of PPSV23 before age 65 years. In addition, even those who receive 2 doses of PPSV23 before age 65 years are recommended to receive PPSV23 at age 65 years, as long as it has been 5 years since the most recent dose. The PPSV23 footnote refers to footnote #10 for pneumococcal conjugate 13-valent vaccine (PCV13) regarding the timing of PCV13 vaccine relative to PPSV23 for those persons recommended to be vaccinated with both pneumococcal vaccines.•A new footnote (#10) was added for PCV13 vaccine. This vaccine is recommended for adults aged 19 years and older with immunocompromising conditions (including chronic renal failure and nephrotic syndrome), functional or anatomic asplenia, cerebrospinal fluid leaks, or cochlear implants. Those not previously vaccinated with PCV13 or PPSV23 should receive a single dose of PCV13, followed by a dose of PPSV23 at least 8 weeks later. Those previously vaccinated with PPSV23 should be vaccinated with PCV13 one year or more after PPSV23 vaccination (4).•The hepatitis A vaccine footnote (#12) was updated to clarify that vaccination is recommended for persons with a history of either injection or noninjection illicit drug use.•The hepatitis B vaccine footnote (#13) includes minor wording changes and adds information on the vaccine schedule for hepatitis B vaccine series for the Recombivax HB vaccine. The dosing schedules for other hepatitis B vaccines were included in prior years’ schedules. •For Figure 1, the bar for Tdap/Td for persons aged 65 years and older has been changed to solid yellow because all adults, including those 65 years and older, are now recommended to receive one dose of Tdap vaccine (5).•The bar for MMR vaccine for persons born before 1957 has been removed. MMR vaccine is not recommended routinely for persons born before 1957. Considerations for vaccination in measles or mumps outbreak settings are discussed in the ACIP recommendations for health-care personnel (8).•A new row for PCV13 vaccine has been added.•For Figure 2, the recommendation for Tdap vaccination with each pregnancy is included, with a single dose of Tdap recommended for all other groups (6).•A correction was made to change the color for PPSV23 from yellow to purple for men who have sex with men (MSM). PPSV23 is recommended for MSM who have another risk factor such as age group or medical condition.•A row for PCV13 was added (4). •The inactivated influenza vaccine precautions were updated to indicate that persons who experience only hives with exposure to eggs should receive IIV rather than LAIV.•Pregnancy was removed as a precaution for hepatitis A vaccine. This is an inactivated vaccine, and similar to hepatitis B vaccines, is recommended if another high risk condition or other indication is present.•Language was clarified regarding the precaution for use of antiviral medications and vaccination with varicella or zoster vaccines. 1CDC. Noninfluenza vaccination coverage among adults—United States, 2011. MMWR 2013;62(4).•CDC. Influenza vaccination coverage among pregnant women—2011–12 influenza season, United States. MMWR 2012;61:758–63.•Community Preventive Services Task Force. Vaccinations to prevent diseases: universally recommended vaccinations. Available at http://www.thecommunityguide.org/vaccines/universally/index.html. Accessed December 21, 2012.•CDC. Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine for adults with immunocompromising conditions: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2012;61:816–9.•CDC. Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine in adults aged 65 years and older — Advisory Committee on Immunization Practices (ACIP), 2012. MMWR 2012;61:468–70.•CDC. Update on use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine in pregnant women. Atlanta, GA: US Department of Health and Human Services, CDC. Available at http://www.cdc.gov/vaccines/recs/provisional/downloads/tdap-pregnant-oct-2012.pdf. Accessed December 21, 2012.•Reed C, Meltzer MI, Finelli L, Fiore A. Public health impact of including two lineages of influenza B in a quadrivalent seasonal influenza vaccine. Vaccine 2012;30:1993–8.•CDC. Immunization of health-care personnel: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2011;60(No. RR-7). Work Group Chair: Tamera Coyne-Beasley, MD, Chapel Hill, North Carolina (ACIP). Work Group Members: Tammy Clark, Jackson, Mississippi; Kathleen Harriman, PhD, Richmond, California; Molly Howell, MPH, Bismarck, North Dakota; Laura Pinkston Koenigs, MD, Springfield, Massachusetts; Marie-Michele Leger, MPH, Alexandria, VA; Susan M. Lett, MD, Boston, Massachusetts; Robert Palinkas, MD, Urbana, Illinois; Diane Peterson, Saint Paul, Minnesota; Gregory Poland, MD, Rochester, Minnesota; Laura E. Riley, MD, Boston, Massachusetts; William Schaffner, MD, Nashville, Tennessee; Kenneth Schmader, MD, Durham, North Carolina; Litjen Tan, PhD, Chicago, Illinois; Jonathan L. Temte, MD, PhD, Madison, Wisconsin; Richard Zimmerman, MD, Pittsburgh, Pennsylvania. Work Group Contributors (CDC): Lisa Grohskopf, MD, Craig Hales, MD, Charles LeBaron, MD; Jennifer L. Liang, DVM, Lauri Markowitz, MD; Matthew Moore, MD; Amy Parker Fiebelkorn, MSN, MPH; Sarah Schillie, MD; Raymond A. Strikas, MD, MPH; and Walter W. Williams, MD, Atlanta, Georgia. Work Group Secretariat (CDC): Carolyn B. Bridges, MD, Atlanta, Georgia. 1Additional information•Additional guidance for the use of the vaccines described in this supplement is available at http://www.cdc.gov/vaccines/pubs/acip-list.htm.•Information on vaccination recommendations when vaccination status is unknown and other general immunization information can be found in the General Recommendations on Immunization at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6002a1.htm.•Information on travel vaccine requirements and recommendations (e.g. for hepatitis A and B, meningococcal, and other vaccines) are available at http://wwwnc.cdc.gov/travel/page/vaccinations.htm.•Influenza vaccination•Annual vaccination against influenza is recommended for all persons aged 6 months and older.•Persons aged 6 months and older, including pregnant women, can receive the inactivated influenza vaccine (IIV).•Healthy, nonpregnant persons aged 2–49 years without high-risk medical conditions can receive either intranasally administered live, attenuated influenza vaccine (LAIV) (FluMist), or IIV. Health-care personnel who care for severely immunocompromised persons (i.e. those who require care in a protected environment) should receive IIV rather than LAIV.•The intramuscularly or intradermally administered IIV are options for adults aged 18–64 years.•Adults aged 65 years and older can receive the standard dose IIV or the high-dose IIV (Fluzone High-Dose).•Tetanus, diphtheria, and acellular pertussis (Td/Tdap) vaccination•Administer one dose of Tdap vaccine to pregnant women during each pregnancy (preferred during 27–36 weeks’ gestation), regardless of number of years since prior Td or Tdap vaccination.•Administer Tdap to all other adults who have not previously received Tdap or for whom vaccine status is unknown. Tdap can be administered regardless of interval since the most recent tetanus or diphtheria-toxoid containing vaccine.•Adults with an unknown or incomplete history of completing a 3-dose primary vaccination series with Td-containing vaccines should begin or complete a primary vaccination series including a Tdap dose.•For unvaccinated adults, administer the first 2 doses at least 4 weeks apart and the third dose 6–12 months after the second.•For incompletely vaccinated (i.e. less than 3 doses) adults, administer remaining doses.•Refer to the Advisory Committee on Immunization Practices (ACIP) statement for recommendations for administering Td/Tdap as prophylaxis in wound manage
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