Vaccinating the unvaccinated adult

Dillon Cason; Paul Williams

doi:10.3949/ccjm.88a.20046

Article Figures & Data

Tables

View popup

TABLE 1

Vaccinations recommended for unvaccinated adults

Vaccine	Dosing	Contraindications	Precautions
Tetanus, diphtheria, acellular pertussis (TDaP)	3 doses: 1–2 months between doses 1 and 2 and 6–12 months between doses 2 and 3 Give TD booster every 10 years after initial regimen completed	Prior severe allergic reaction to the vaccine or its components	Moderate or severe acute illness with or without fever For pertussis-containing vaccines only, in patients with progressive or unstable neurologic disorder, uncontrolled seizures, or previous encephalopathy, defer use until a treatment regimen has been established and the condition stabilizes
Measles, mumps, rubella (MMR)	Give 1 dose if born in 1957 or later Give 2 doses (no sooner than 4 weeks after initial dose) to high-risk groups: Any healthcare personnel Students entering college International travelers If pregnant, MMR should be given postpartum	Prior severe allergic reaction to the vaccine or its components Pregnancy or possible pregnancy within 4 weeks Severe immunodeficiency (hematologic and solid tumors, active chemotherapy, congenital immunodeficiency, HIV with severe immunocompromise)	Moderate or severe acute illness with or without fever If blood, plasma, and/or immunoglobulin were given in the last 11 months, follow the ACIP best practices¹⁴ History of thrombocytopenia or thrombocytopenic purpura
Varicella (chicken-pox)	Give 2 doses: second dose 4–8 weeks after first dose; if delayed, do not start over, just give second dose	Prior severe allergic reaction to the vaccine or its components Pregnancy or possible pregnancy within 4 weeks People who are on long-term immunosuppression or are immunocompromised Vaccine can be considered in patients with CD4 count ≥ 200 cells/mm³	Moderate or severe acute illness with or without fever If blood, plasma, and/or immunoglobulin were given in last 11 months, follow ACIP best practices¹⁴ Recipient of specific antivirals (acyclovir, famciclovir, valacyclovir) 24 hours before vaccination Use of aspirin-containing products as there is an increased risk of Reye syndrome

ACIP = Advisory Committee on Immunization Practices (part of the US Centers for Disease Control and Prevention); HIV = human immunodeficiency virus Adapted from reference 16.

View popup

TABLE 2

Vaccinations not routinely recommended for unvaccinated adults

Vaccine	Indications	Dosing	Contraindications
Hepatitis A	Desire to be protected from hepatitis A virus (HAV) Travel or work outside of United States Chronic liver disease, use of injected or noninjected drugs, homeless, receiving clotting-factor concentrates, works with HAV in laboratory, food handlers when appropriate Close contact with international adoptee from country where HAV is endemic during the first 60 days after adoptee’s arrival	2 doses, 6–18 months apart depending on brand If second dose is delayed, do not start over, just give dose	Prior severe allergic reaction to the vaccine or its components Cautions: Moderate or severe acute illness with or without fever
Hepatitis B	Wants to be protected from hepatitis B virus Has close household contact of hepatitis B surface antigen-positive people, chronic liver disease, injects drugs, sexually active with multiple partners, male who has sex with men, human immunodeficiency virus-positive, hemodialysis patients or may soon need dialysis, diabetes and younger than 60 Is a healthcare worker or person exposed to blood, inmates of long-term correctional facilities	Heplisav-B: 2 doses, 1 month apart Engerix-B and Recombivax HB: 3 doses (1 mL each) at 0, 1, 6 months If patient is receiving hemodialysis or is immunocompromised: Recombivax HB: 1 dose of 4 mL at 0, 1, 6 months Engerix-B: 2 doses of 2 mL given simultaneously at 0, 1, 2, 6 months Heplisav-B: 2 doses 1 month apart If schedule delayed, do not start over, continue from where schedule was interrupted	Prior severe allergic reaction to the vaccine or its components Cautions: Moderate or severe acute illness with or without fever
Haemophilus influenzae type B	Anatomic or functional asplenia Undergoing elective splenectomy Received a hematopoietic stem cell transplant (HSCT)	Give 1 dose of any H influenzae type B conjugate vaccine If received HSCT, 3 doses at least 4 weeks apart beginning 6–12 months after transplant	Prior severe allergic reaction to the vaccine or its components Cautions: Moderate or severe acute illness with or without fever
Inactivated polio	Plans to travel to areas where exposure to wild-type virus is likely	0, 2, 4, 16 months 4–6 year schedule with minimum interval of 4 weeks between doses	Prior severe allergic reaction to the vaccine or its components Cautions: Moderate or severe acute illness with or without fever; pregnancy
Meningococcal conjugate	Student younger than age 21 living in residence hall Has anatomic or functional asplenia, is HIV-positive, or has persistent complement component deficiency Travel to countries where meningococcal disease is endemic Microbiologist routinely exposed to isolates of Neisseria menningitidis	If college student age 19–21 living in residence hall, give 1 dose If asplenic, give 2 initial doses at 0 and 2 months with booster every 5 years If traveling or has exposure risk, give 1 initial dose with booster every 5 years	Prior severe allergic reaction to the vaccine or its components Cautions: Moderate or severe acute illness with or without fever
Meningococcal sero-group B	Anatomic or functional asplenia or persistent complement component deficiency Microbiologist routinely exposed to isolates of N menningitidis At risk because of a serogroup B meningococcal outbreak	Bexsero at 0 and 1 months OR Trumenba at 0, 1–2, and 6 months	Prior severe allergic reaction to the vaccine or its components Cautions: Moderate or severe acute illness with or without fever