A Detailed Guide to Adult Immunizations
With updated guidelines for the immunization of adults 19 years or older in the United States published in February 2017, it is important for pharmacists to be aware of recommended vaccines, the contraindications for administering certain vaccines, and the populations of patients who are eligible for receiving vaccines.
With updated guidelines for the immunization of adults 19 years or older in the United States published in February 2017, it is important for pharmacists to be aware of recommended vaccines, the contraindications for administering certain vaccines, and the populations of patients who are eligible for receiving vaccines.1
The Advisory Committee on Immunization Practices (ACIP) recommends 13 major types of vaccines for prevention of illness in adults 19 years or older. These vaccines protect against a variety of diseases, including influenza, tetanus, diphtheria, pertussis, measles, mumps, rubella, varicella, herpes zoster, human papilloma virus, pneumococcal disease, hepatitis A, hepatitis B, meningococcal disease (serotypes A, B, C, W, and Y), and infection with Haemophilus influenzae type B bacteria. In many cases, the decision to vaccinate or not to vaccinate is complex and based on many factors that must be discussed in detail with patients.1
A single dose of the seasonal influenza vaccine is recommended for all patients 6 months or older who do not have contraindications for vaccination. Although the influenza vaccine is typically thought of as a single entity, multiple formulations are available. In general, influenza vaccines are classified based on how they are produced, with most produced using chicken eggs (trade names: Fluarix, FluLaval, Fluzone, Afluria, and Fluvirin), 2 vaccines produced using cell culture (trade names: Flucelvax and Flublok), and 1 intranasal vaccine containing a live attenuated virus (trade name: FluMist). For the 2016-2017 influenza season, the live attenuated intranasal vaccine is not recommended for use in any patient because of evidence of insufficient efficacy against influenza A (H1N1) pandemic strain 2009.1,2
Considerations for individual patients include use of specialized vaccines for adults 65 years or older, such as the high-dose vaccine (trade name: Fluzone High-Dose) or the adjuvanted inactivated influenza vaccine (trade name: Fluad). Other considerations may include use of influenza vaccines produced in cell cultures for patients with an allergy to egg protein, the intradermal influenza for patients who may be uncomfortable with longer needles, latex-free vaccine dosage forms for patients with a true latex allergy, and mercury-free dosage forms for patients concerned about preservatives. Vaccine-specific characteristics are described in Table 32.1,2
Adults with a history of egg allergy severe enough to cause symptoms such as angioedema, respiratory distress, lightheadedness, or recurrent vomiting should receive the influenza vaccine under the supervision of an inpatient or outpatient health care provider able to recognize and manage severe allergic reactions. However, for patients with an egg allergy limited to hives with no other symptoms, pharmacy-based immunization remains appropriate. Of note, women who are pregnant or who may become pregnant in upcoming influenza seasons should be vaccinated. Pregnancy is not a contraindication to use of the influenza vaccine, and ensuring that pregnant women receive the influenza vaccine is an important priority for pharmacists.1,2
TETANUS, DIPHTHERIA, AND ACELLULAR PERTUSSIS
Available vaccines include the tetanus, diphtheria, and acellular pertussis vaccine (tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis [Tdap]; trade names: Adacel and Boostrix) and the tetanus and diphtheria vaccine (tetanus and diphtheria toxoids [Td]; trade name: Tenivac). After initial vaccination with Tdap, a Td booster is recommended every 10 years. Patients with an unknown history of Tdap vaccination may receive a single dose of Tdap; however, for patients who may never have completed a Tdap vaccine series (ie, patients with an unknown or incomplete history of vaccination), a 3-dose primary series should be considered. This 3-dose series consists of 2 doses administered at least 4 weeks apart and the third dose 6 to 12 months after the second dose.1,3
According to current ACIP vaccine schedules for adults, a single dose of the Tdap vaccine should be administered in the third trimester of every pregnancy to offer additional protection against pertussis for both the mother and the unborn fetus. Since 2005, ACIP has also recommended vaccination of close contacts to protect infants from pertussis, a practice known as cocooning. In cocooning, patients who may be close contacts of infants younger than 12 months require a single dose of Tdap (not 1 dose for every new infant), which they should receive at least 2 weeks before coming in contact with the infant.1,4,5
In some cases, use of the Td or Tdap vaccine may be necessary to protect injured patients with certain types of wounds from tetanus. Recommendations depend both on the number of previous doses of tetanus toxoid—containing vaccines and the nature of the wound. In the context of tetanus vaccination, wounds that are not clean or not minor might include wounds that are contaminated with dirt, puncture wounds, or traumatic wounds.1,6,7
Patients who have an unknown history of receiving tetanus toxoid—containing vaccines, who have received less than 3 doses of tetanus toxoid–containing vaccines, with clean and minor wounds who have not been vaccinated in the past 10 years, and with major wounds or contaminated wounds who have not been vaccinated in the past 5 years should receive a dose of either Td or Tdap for prevention of tetanus. Importantly, patients who have received less than 3 doses of tetanus toxoid– containing vaccines who have major wounds or wound contamination should receive both a tetanus toxoid–containing vaccine and tetanus immune globulin (Table 46).6
MEASLES, MUMPS, AND RUBELLA
The measles, mumps, and rubella vaccine (MMR; trade name: M-M-R II) is a live vaccine indicated for patients 12 months or older. The first dose should be administered between the ages of 12 and 15 months, with the second dose given between the ages of 4 and 6 years, preferably before entering school. Two doses of the MMR vaccine separated by at least 28 days are recommended for students in or entering postsecondary education and adults who plan to travel internationally. In addition, for patients aged 19 to 59 years who do not have evidence of immunity to measles, mumps, or rubella, either 1 or 2 doses of the MMR vaccine may be recommended.1,8
The MMR vaccine is contraindicated in pregnancy and in immunocompromised individuals, including patients with HIV with a CD4+ T-cell count below 200 cells/mcL. Conditions of immunodeficiency severe enough to restrict MMR vaccination include primary immunodeficiency, cellular immunodeficiency, and malignancy, such as malignancy of the bone marrow or lymphatic system. Special considerations in MMR vaccination include vaccination after pregnancy and vaccination of older individuals who may not have been vaccinated or may have received earlier, less effective vaccines against mumps and measles.1
For pregnant women who have either completed or terminated a pregnancy and who do not have evidence of immunity to rubella, 1 dose of MMR should be administered before they leave a health care facility. Additionally, women of childbearing age who are not pregnant and who do not have evidence of rubella immunity should receive a single dose and should be advised not to become pregnant for 3 months after vaccination.1,8
For adults born in 1957 or earlier who do not have laboratory-confirmed evidence of immunity to measles, mumps, and rubella, 1 dose of the vaccine is recommended. However, health care professionals born in 1957 or earlier who do not have evidence of immunity should consider receiving a full 2-dose series of the MMR vaccine (unless there is laboratory-confirmed evidence of immunity to measles and mumps, but not rubella, in which case only 1 dose of the vaccine is necessary). Notably, in health care professionals born in 1957 or earlier, a documented diagnosis of measles, mumps, and rubella is not sufficient evidence of immunity in the absence of laboratory confirmation.1
Historical vaccines continue to have relevance in contemporary vaccination guidelines. These include the inactivated mumps vaccine and the inactivated measles vaccine, both of which have since been removed from the market. The insufficient efficacy of these vaccines has created confusion that may complicate vaccination of some patients.1 The inactivated mumps vaccine was available in the United States starting in 1950, but because it offered only transient immunity, it was withdrawn in 1978. To ensure that patients who may have received the inactivated mumps vaccine are fully vaccinated, individuals who are at high risk of mumps infection (eg, those who work in a health care facility) who received any mumps vaccine before 1979 should receive a 2-dose series of MMR at least 28 days apart.1,9
The inactivated measles vaccine and the live attenuated measles vaccine were both approved in 1963. Because exposure to the inactivated measles vaccine resulted in a severe atypical measles syndrome in some cases, the vaccine was withdrawn in 1967. Adults who are at high risk for developing measles infection (eg, workers in a health care facility) who received the inactivated measles vaccine or a measles vaccine of an unknown type between 1963 and 1967 (when both the inactivated and live attenuated measles vaccines were available) should be revaccinated with 1 or 2 doses of the MMR vaccine.1,9,10
The varicella vaccine (trade name: Varivax) is a live vaccine to prevent varicella zoster, commonly known as chickenpox. For full vaccination, patients require 2 doses separated by at least 28 days. Adult patients who should receive the vaccine include those who have not received it and have no evidence of a past infection, as well as adults in close contact with individuals at high risk of developing serious complications of varicella infection.1
Most patients without past evidence of varicella infection or vaccination should receive a series of 2 doses at least 28 days apart. However, in patients with HIV with a CD4+ T-cell count ≥200 cells/mcL, doses of the varicella vaccine should be separated by at least 3 months.1
Use of the varicella vaccine is contraindicated in pregnant and immunocompromised patients, including those with HIV who have a CD4+ T-cell count below 200 cells/mcL. Conditions of immunodeficiency severe enough to restrict varicella vaccination include malignancy (eg, of the bone marrow or lymphatic system) and use of systemic immunosuppressive therapy.1
Varicella vaccination also should be emphasized in certain groups of patients without evidence of varicella immunity, especially patients living and working in environments where varicella transmission has been reported, college students, health care personnel, teachers, childcare workers, military personnel, international travelers, nonpregnant women of childbearing age, staff and residents of correctional institutions, and those who live in close contact with immunocompromised individuals. Additionally, health care facilities must ensure that all health care personnel have evidence of immunity to varicella or have received the vaccine.1
Although adults born in the United Sates before 1980 are generally considered to be immune to varicella, this rule does not apply to pregnant woman and health care personnel. Laboratory evidence of immunity to varicella or prior varicella vaccination, a diagnosis of varicella or herpes zoster—like disease by a health care professional, or having received 2 doses of the varicella vaccine separated by at least 4 weeks are all considered adequate evidence of varicella immunity.1
It is important to remember that the varicella vaccine is contraindicated in pregnant women. However, women without evidence of varicella immunity who recently completed or terminated a pregnancy should receive a dose of the varicella vaccine, with the first dose administered before leaving the health care facility and the second dose given 4 to 8 weeks after their initial dose. Women who are vaccinated with the varicella vaccine should be reminded to avoid pregnancy for at least 3 months after vaccination.1,11
The herpes zoster vaccine (trade name: Zostavax) is a live vaccine indicated for prevention of reactivations of herpes zoster infection (shingles) in patients 50 years or older. Although the vaccine is indicated for adults 50 years or older, ACIP recommends that adults 60 years or older receive 1 dose of the herpes zoster vaccine. This single dose of the herpes zoster vaccine should be administered whether or not a patient has had shingles in the past.1,12
Because the herpes zoster vaccine is a live vaccine, its use is contraindicated in pregnant and immunocompromised patients, including patients with HIV who have a CD4+ T-cell count below 200 cells/mcL. Conditions of immunodeficiency severe enough to restrict herpes zoster vaccination include malignancies (eg, malignancies of the bone marrow or lymphatic system) and use of systemic immunosuppressive therapy.1
Because many patients eligible for the herpes zoster vaccine may also be eligible for pneumococcal vaccination, current product labeling recommends that health care professionals consider separating administration of the herpes zoster vaccine and the 23-valent pneumococcal polysaccharide vaccine (PPSV23; trade name: Pneumovax 23) by 4 weeks.12,13
Although the immune response to herpes zoster vaccine may be reduced in patients receiving PPSV23 concomitantly versus at least 4 weeks apart, a large retrospective cohort study found that the incidence of shingles in patients receiving PPSV23 and herpes zoster vaccination simultaneously was not significantly different from patients who received the vaccines at least 4 weeks apart. As a result, administering PPSV23 and the herpes zoster vaccine concomitantly is not disallowed by current ACIP guidelines and may improve the likelihood that patients receive both recommended vaccines.13-15
HUMAN PAPILLOMA VIRUS
Three human papilloma virus (HPV) vaccines are available in the United States: a bivalent vaccine (trade name: Cervarix), a 4-valent vaccine (trade name: Gardasil), and a 9-valent vaccine (trade name: Gardasil 9). Although the same vaccine formulation for all required doses is preferable, if the type of vaccine used in earlier doses is unknown, any available HPV vaccine product may be used to complete the series.3,16
Although the HPV vaccine series is recommended in children as young as 11 to 12 years, if the series is not completed during childhood, ACIP recommends a 3-dose series for adult females as old as 26 years and adult males as old as 21 years. In general, the 3-dose series is administered at months 0, 1-2, and 6. Males should receive the vaccine by the age of 21, but vaccination may still be considered for some men as old as 26 years. An extended window of vaccination should especially be considered in immunocompromised men, HIVinfected men (regardless of CD4+ T-cell count), and men who have sex with men.1
Because a complete series of the HPV vaccine consists of 3 doses, some patients may have only received 1 or 2 doses previously. In some cases, patients who have previously received 2 doses of the vaccine are considered fully vaccinated.1 In determining whether a patient who previously received 2 doses of the HPV vaccine requires the third dose, it is important to assess whether the first vaccine dose was given before or after the age of 15 years. Patients who received their first dose of the HPV vaccine series before the age of 15 years and an additional dose 5 or more months later are considered fully vaccinated against HPV. However, those who received their first vaccine dose before the age of 15 years and either did not receive a second dose or received it less than 5 months after the first dose are not considered adequately vaccinated.1
Although ACIP provides no recommendation on administering the HPV vaccine to pregnant women, there is no evidence that this vaccine is harmful to them, and ACIP does not recommend pregnancy testing before its administration. Even so, ACIP cautions that women who are found to be pregnant after starting an HPV series delay subsequent doses until after pregnancy.1
Two major types of pneumococcal vaccines for adults are available in the United States: the 13-valent pneumococcal conjugate vaccine (PCV13; trade name: Prevnar13) and PPSV23. Routine vaccination is recommended for immunocompetent individuals without major underlying medical conditions, starting at age 65. These patients should receive 1 dose of PCV13 followed by 1 dose of PPSV23 at least 1 year later. If immunocompetent adult patients 65 years or older accidentally receive PPSV23 before PCV13, the doses should still be separated by at least 1 year.1,13,17
Although most patients will receive pneumococcal vaccination starting at age 65, earlier pneumococcal vaccination is recommended for adults aged 19 to 64 for 2 groups of patients: immunocompetent patients with major underlying medical conditions and immunocompromised patients. This additional vaccination series helps provide immunocompromised patients and immunocompetent patients with major underlying medical conditions with improved protection against infection with pneumococcal bacteria.1
For purposes of pneumococcal vaccination, immunocompetent patients with major underlying medical conditions include patients who are cigarette smokers and those with chronic liver disease (including alcoholism), chronic heart disease (including congestive heart failure or cardiomyopathy, but excluding hypertension), and chronic lung disease (including chronic obstructive pulmonary disease, emphysema, or asthma). Patients with diabetes, cerebrospinal fluid leaks, or cochlear implants are also considered immunocompetent patients with major underlying medical conditions.1,18
In the context of pneumococcal vaccination, immunocompromised patients include those with functional or anatomic asplenia (eg, congenital asplenia, sickle cell disease, and other hemoglobinopathies), HIV, congenital or acquired immunodeficiency (eg, B- or T-lymphocyte deficiency, complement deficiency, and phagocytic disorders [but not chronic granulomatous disease]), kidney disease (eg, chronic renal failure or nephrotic syndrome), or generalized malignancy (eg, Hodgkin disease, leukemia, lymphoma, or multiple myeloma). Patients who have undergone a solid organ transplant and patients receiving immunosuppressive therapy (eg, radiation therapy or long-term systemic corticosteroid therapy) are also considered immunocompromised in the context of pneumococcal vaccination guidelines.1,18
One way to understand pneumococcal vaccination conceptually is by first understanding PCV13 and PPSV23 individually and then understanding appropriate sequencing and timing of each vaccine separately. With regard to PCV13, it is important to remember that the vaccine need be administered only once during adulthood: in healthy patients at age 65 or older and in immunocompetent patients with major underlying medical conditions and in immunocompromised patients, age 19 or older.1,18
Unlike PCV13, PPSV23 may be administered 1, 2, or 3 times during adulthood. In otherwise healthy patients, PPSV23 should be administered once at the age of 65 or later (for a total of 1 dose). In immunocompetent patients with major underlying medical conditions, PPSV23 should be administered once between the ages of 19 and 64 years, and once at the age of 65 years or later (for a total of 2 doses). In immunocompromised patients, PPSV23 should be administered 3 times, with 2 doses separated by at least 5 years administered between the ages of 19 and 64 years, and the final dose administered at the age of 65 years or later (for a total of 3 doses).1,18
Understanding overall schedules related to pneumococcal vaccine sequencing and timing can be reduced to 4 rules. First, with regard to sequencing, PCV13 is preferably administered before PPSV23. Second, in healthy adults without major chronic illnesses, doses of PCV13 should be separated from doses of PCV23 by at least 1 year. Third, in immunocompetent patients with major underlying medical conditions and immunocompromised patients, doses of PCV13 should be separated from doses of PCV23 by at least 8 weeks (however, if PCV23 is accidentally administered before PCV13, the doses should be separated by at least 1 year). Fourth, subsequent doses of PPSV23 should be separated by at least 5 years. The application of these rules is summarized in Table 518.1,18
The hepatitis A vaccine is administered as 2 or 3 doses, depending on the vaccine used. Available vaccines that provide protection against hepatitis A include Havrix, Vaqta, and Twinrix (trade names). Havrix and Vaqta each is administered as a 2-dose series. With Havrix, the first dose is administered at month 0 followed by the second dose between months 6 and 12, whereas Vaqta is administered at month 0 and between months 16 and 18. Doses of Twinrix, which is a combined vaccine for hepatitis A and B, are administered at 0, 1, and 6 months.1,3
ACIP recommends vaccination against hepatitis A in adults with chronic liver disease, men who have sex with men, patients who have received clotting factor concentrates, users of injectable or noninjectable illicit drugs, and those who work in a laboratory research setting with primates infected with hepatitis A virus. Other groups that should receive the hepatitis A vaccine include adults traveling in countries with intermediate- or high-level endemic hepatitis A infection and current or future close contacts of international adoptees from countries with intermediateor high-level endemic hepatitis A infection, unless the adoptee has been in the United States for at least 60 days.1
The hepatitis B vaccine should be administered as a 3-dose series for adults with certain medical conditions or indications for the vaccine. It is available in 2 single-vaccine formulations (trade names: Engerix-B and Recombivax HB) and as a dual hepatitis A/B vaccine (Twinrix). ACIP recommends hepatitis B vaccination in patients with HIV (regardless of CD4+ T-lymphocyte count), kidney failure, end-stage renal disease, diabetes (patients <60 years and at the discretion of the provider in patients 60 years or older), and chronic liver disease (including any patient with aspartate aminotransferase or alanine aminotransferase levels higher than twice the upper limit of normal); health care personnel; men who have sex with men; and patients undergoing hemodialysis (with an altered dosing schedule of the vaccine).1,3
Other populations may be considered for hepatitis B vaccination based on their lifestyle habits or occupational risks. These populations may include household contacts or sexual contacts of patients with a positive test result for hepatitis B surface antigen (HBsAg); patients who are sexually active, but not in a mutually monogamous relationship; persons seeking evaluation or treatment for a sexually transmitted infection; and recent or current users of injectable drugs. Hepatitis B vaccination is also recommended for the residents or staff of facilities for developmentally disabled persons, incarcerated individuals, public safety workers at risk of coming in contact with blood or body fluids, and travelers to areas with high or intermediate levels of endemic hepatitis B virus infection.1
Pregnant women with certain risk factors should also receive the hepatitis B vaccine. These risk factors include having more than 1 sexual partner during the prior 6 months, an HBsAgpositive sexual partner, a history of IV drug abuse, or evaluation or treatment for a sexually transmitted infection.1
Available forms of the meningococcal vaccine that protect against Neisseria meningitidis groups A, C, W, and Y include the meningococcal conjugate vaccine (MenACWY; trade names: Menactra and Menveo) and the meningococcal polysaccharide vaccine (MPSV4; trade name: Menomune). Two serogroup B meningococcal vaccines (MenB) are also available (trade names: Trumenba and Bexsero), but are not interchangeable. All doses of a MenB vaccine series should be of the same vaccine type.1,3
In determining which patients should receive these vaccines, it is important to consider who is at greatest risk of developing meningococcal disease. These populations of patients include those with anatomical or functional asplenia, persistent complement component deficiencies, or HIV; those who may have been exposed to N. meningitidis during outbreaks; microbiologists working with N. meningitidis isolates; patients traveling to certain countries; military recruits; and first-year college students living in dormitories.1
Patients with anatomical or functional asplenia and those with persistent complement component deficiencies should receive 2 doses of the MenACWY vaccine administered at least 2 months apart and be revaccinated with the 2-dose series every 5 years. These patients should also receive the MenB vaccine, either as 2 doses of Bexsero administered at least 1 month apart or 3 doses of Trumenba administered at months 0, 1-2, and 6.1
Like patients with asplenia or persistent complement component deficiencies, patients with HIV who have not previously received the MenACWY vaccine should receive 2 doses of the MenACWY vaccine administered at least 2 months apart and should be revaccinated with the 2-dose series every 5 years. However, because N. meningitidis serogroups C, W, and Y are the primary causes of meningococcal disease in adults with HIV, ACIP does not recommend routine vaccination with MenB vaccines in HIV-infected adults.1
ACIP also recommends that microbiologists working with isolates of N. meningitidis receive MenACWY vaccines as a single dose and revaccination with a single dose every 5 years. Microbiologists at risk of infection should also be protected against serogroup B meningococcal disease with either 2 doses of Bexsero administered at least 1 month apart or 3 doses of Trumenba administered at months 0, 1-2, and 6.1 During disease outbreaks, those at risk of developing meningococcal disease should receive 1 dose of MenACWY if the outbreak is caused by N. meningitidis serogroups A, C, W, or Y, but 2 doses of Bexsero administered at least 1 month apart or 3 doses of Trumenba at months 0, 1-2, and 6 if the outbreak is caused by N. meningitidis serogroup B.1
Those traveling to or living in countries with hyperendemic or epidemic meningococcal disease should receive 1 dose of MenACWY with revaccination every 5 years as long as they will be exposed. Because N. meningitidis serogroup B is generally not the causative organism in cases of meningococcal disease associated with travel, the MenB vaccines are not routinely recommended for these patients.1
Military recruits should receive 1 dose of MenACWY and be revaccinated with 1 dose of MenACWY every 5 years if the risk of developing meningitis remains. ACIP also recommends that first-year college students 21 years or younger living in residence halls receive a dose of MenACWY, but only if they had not previously received a dose of MenACWY at 16 years or older.1
In some cases, MenB vaccination is recommended in adult patients who are healthy and not at increased risk of developing serogroup B meningococcal disease. The preferred age range for administration of the MenB vaccine is 16 through 18 years; however, healthy patients aged 16 to 23 years who have not previously received a MenB vaccine series may receive either 2 doses of Bexsero separated by at least 1 month or 2 doses of Trumenba at least 6 months apart. In this population, the vaccination series for Trumenba consists of only 2 doses at months 0 and 6 rather than the 3-dose series administered at months 0, 1-2, and 6. According to ACIP, the 2-dose series in this population provides short-term protection against MenB.1
The current use of MPSV4 is limited to a very narrow band of patients. These patients include adults 56 years or older who have not previously received MenACWY and who require only a single dose of meningococcal vaccine. Because neither MenACWY vaccine is indicated for use in adults older than 55 years, MPSV4 is preferred in adults 56 years or older who require a single dose of the meningococcal vaccine. Despite the lack of an indication, ACIP recommends that adults 56 years or older who require multiple doses of meningococcal vaccine receive MenACWY. In the absence of MPSV4, pharmacists may vaccinate patients 56 years or older with MenACWY vaccines.1,19-21
HAEMOPHILUS INFLUENZAE TYPE B
Use of the H. influenzae type b (Hib) vaccine is not routinely recommended for adult patients. In fact, of the 3 single-vaccine formulations of the Hib vaccine (trade names: ActHIB, PedavaxHIB, and Hiberix), none are indicated for use in adults. Nevertheless, ACIP recommends administration of 1 dose of the Hib vaccine in patients with anatomical or functional asplenia at least 14 days before they undergo a planned splenectomy and in patients with persistent complement component deficiencies. The Hib vaccine is not routinely recommended in adults with HIV.1,3
The only group of adult patients requiring multiple doses of the Hib vaccine are adults who have undergone a hematopoietic stem cell transplant (HSCT). Starting at 6 to 12 months after completion of HSCT, these patients should receive 3 doses of the Hib vaccine administered at intervals that are at least 4 weeks apart. All 3 doses should be administered whether or not the patient received the Hib vaccine in the past.1
Although vaccination of adults is complex, the vaccination needs of most patients can be assessed by consulting schedules published by the CDC. Pharmacists must remain aware of updates to recommendations and be ready to answer questions about the many nuances of adult vaccination. By reviewing the key points of the 2017 schedule, pharmacists can appropriately select and administer vaccinations for adult patients.
Michael R. Page, PharmD, RPh, has worked as a community pharmacist at CVS Pharmacy and is currently a clinical editor at Pharmacy Times®.
- CDC. Recommended immunization schedule for adults aged 19 year or older, United States, 2017. CDC website. cdc.gov/vaccines/schedules/downloads/adult/ adult-combined-schedule.pdf. Accessed February 21, 2017.
- Grohskopf LA, Sokolow LZ, Broder KR, et al. Prevention and control of seasonal influenza with vaccines. MMWR Recomm Rep. 2016;65(5):1-54. doi: 10.15585/mmwr.rr6505a1.
- CDC. List of vaccines used in United States. CDC website. cdc.gov/vaccines/ vpd/vaccines-list.html. Accessed February 21, 2017.
- CDC. Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine (Tdap) in pregnant women and persons who have or anticipate having close contact with an infant aged <12 months --- Advisory Committee on Immunization Practices (ACIP), 2011. MMWR Morb Mortal Wkly Rep. 2011;60(41):1424-1426.
- CDC. Surround babies with protection. CDC website. cdc.gov/pertussis/pregnant/ mom/protection.html. Updated June 24, 2015. Accessed February 21, 2017.
- Kretsinger K, Broder KR, Cortese MM, et al; CDC; Advisory Committee on Immunization Practices; Healthcare Infection Control Practices Advisory Committee. Preventing tetanus, diphtheria, and pertussis among adults: use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine recommendations of the Advisory Committee on Immunization Practices (ACIP) and recommendation of ACIP, supported by the Healthcare Infection Control Practices Advisory Committee (HICPAC), for use of Tdap among health-care personnel. MMWR Recomm Rep. 2006;55(RR-17):1-37.
- Tenivac (clostridium tetani toxoid antigen [formaldehyde inactivated] and corynebacterium diphtheriae toxoid antigen [formaldehyde inactivated] injection, suspension) [package insert]. Swiftwater, PA: Sanofi Pasteur Inc; 2016.
- M-M-R II (measles, mumps, and rubella virus vaccine live) [package insert]. Whitehouse Station, NJ: Merck Sharp & Dohme Corp; 2015.
- Watson JC, Hadler SC, Dykewicz CA, Reef S, Phillips L. Measles, mumps, and rubella—vaccine use and strategies for elimination of measles, rubella, and congenital rubella syndrome and control of mumps: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 1998;47(RR-8):1-57.
- CDC. Measles. CDC website. cdc.gov/vaccines/pubs/pinkbook/downloads/ meas.pdf. Accessed February 21, 2017.
- Varivax (varicella virus vaccine live injection, powder, lyophilized, for suspension) [package insert]. Whitehouse Station, NJ: Merck Sharp & Dohme Corp; 2014.
- Zostavax (zoster vaccine live) [package insert]. Whitehouse Station, NJ: Merck Sharp & Dohme Corp; 2016.
- Pneumovax 23 (pneumococcal vaccine polyvalent) [package insert]. Whitehouse Station, NJ: Merck Sharp & Dohme Corp; 2015.
- Wyman MJ, Stabi KL. Concomitant administration of pneumococcal-23 and zoster vaccines provides adequate herpes zoster coverage. Ann Pharmacother. 2013;47(7-8):1064-1068. doi: 10.1345/aph.1R742.
- Tseng HF, Smith N, Sy LS, Jacobsen SJ. Evaluation of the incidence of herpes zoster after concomitant administration of zoster vaccine and polysaccharide pneumococcal vaccine. Vaccine. 2011;29(20):3628-3632. doi: 10.1016/j. vaccine.2011.03.018.
- Markowitz LE, Dunne EF, Saraiya M, et al; CDC. Human papillomavirus vaccination: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2014;63(RR-05):1-30.
- Prevnar 13 (pneumococcal 13-valent conjugate vaccine [diptheria CRM197 protein]) [package insert]. Philadelphia, PA: Wyeth Pharmaceuticals (a subsidiary of Pfizer); 2016.
- CDC. Pneumococcal vaccine timing for adults. CDC website. cdc.gov/vaccines/ vpd/pneumo/downloads/pneumo-vaccine-timing.pdf. Accessed February 21, 2017.
- Menveo (meningococcal [groups A, C, Y, and W-135] oligosaccharide diphtheria CRM197 conjugate vaccine) [package insert]. Cambridge, MA: Novartis; 2013.
- Menactra (meningococcal [groups A, C, Y, and W-135] polysaccharide diptheria toxoid conjugate vaccine) [package insert]. Swiftwater, PA: Sanofi Pasteur Inc; 2016.
- Menomune (A/C/Y/W, meningococcal polysaccharide vaccine, groups A, C, Y, and W-135 combined) [package insert]. Swiftwater, PA: Sanofi Pasteur Inc; 2016.