PPRNet Practice Guidelines

Immunization Clinical Practice Guidelines

Tetanus Vaccine

Practice guideline:

Vaccine in patients >=12 years every 10 years

CDC recommendations for tetanus immunization in adults were revised to include a single dose of Tdap to replace tetanus and diphtheria toxoids vaccine (Td) for booster immunization against tetanus, diphtheria, and pertussis in December 2006. Recommendations suggest that Tdap may be administered within two years of Td.

Additional resources:

“Preventing Tetanus, Diphtheria, and Pertussis Among Adults.” Recommendations of the Advisory Committee on Immunization Practices (ACIP).

Influenza Vaccine

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Practice guideline:

Vaccine in the following patients annually:

Age 6 months to 5 years
Over 50 years of age
Comorbidities of diabetes, asthma, COPD, heart disease (CHD or CHF), chronic renal disease, or alcohol abuse

Approximately 35 million persons in the United States are aged >65 years; an additional 10-14 million adults aged 50-64 years, 15-18 million adults aged 18-49 years, and 8 million children aged 6 months--17 years have >1 medical conditions that are associated with an increased risk for influenza-related complications (unpublished data, NIP, CDC, 2002).

Regular updates regarding influenza supply issues and annual recommendations are posted on the CDC Flu Vaccination Resource page. (see reference)

Additional resources:

CDC: Influenza Vaccination Resources for Health Care Professionals

Pneumococcal Vaccine

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Practice guideline:

Vaccine in the following patients:

At least 65 years of age or older
Comorbidities of diabetes, COPD, heart disease (CHD or CHF), chronic renal disease, or alcohol abuse

Pneumococcal vaccine is recommended for the following patients:

Persons Aged greater than or equal to 65 Years
All persons in this category should receive the pneumococcal vaccine, including previously unvaccinated persons and persons who have not received vaccine within 5 years (and were less than 65 years of age at the time of vaccination). All persons who have unknown vaccination status should receive one dose of vaccine.
Persons Aged 2-64 Years Who Have Chronic Illness or Functional or Anatomic Asplenia
Persons aged 2-64 years who are at increased risk for pneumococcal disease or its complications if they become infected should be vaccinated. Persons at increased risk for severe disease include those with chronic illness such as chronic cardiovascular disease (e.g., HF or cardiomyopathy), chronic pulmonary disease (e.g., COPD or emphysema, but not asthma), diabetes mellitus, alcoholism, chronic liver disease (cirrhosis), CSF leaks, and functional or anatomic asplenia.

Routine revaccination is not recommended at this time, although a one-time revaccination should be considered in high-risk patients age 2-64 years if at least 5 years have passed since their initial immunization. Data from studies of the duration of pneumococcal antibody response are pending and may objectively delineate what patient groups should be revaccinated and how frequently.

Additional resources:

Prevention of Pnuemococcal Disease: Recommendations of the Advisory Committee on Immunization Practices

Hepatitis A Vaccine

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Practice guideline:

Two vaccinations in children at 1 year of age
Two vaccinations in patients with liver disease

To reduce hepatitis A incidence in the United States , routine vaccination of children was recommended in 2006. Although not at increased risk for HAV infection, persons who have chronic liver disease are at increased risk for fulminant hepatitis A. Death certificate data indicate a higher prevalence of chronic liver disease among persons who died of fulminant hepatitis A compared with persons who died of other causes.

All susceptible persons traveling to or working in countries that have high or intermediate HAV endemicity should be vaccinated or receive IG before departure. Sexually active men who have sex with men (both adolescents and adults) should be vaccinated. Vaccination is also recommended for users of injecting and non-injecting illegal drugs. In addition, susceptible persons who are administered clotting-factor concentrates, especially solvent-detergent-treated preparations, should be administered hepatitis A vaccine.

Additional resources:

Revised ACIP Recommendations on the Prevention of Hepatitis A through Active or Passive Immunization. Recommendations of the Advisory Committee on Immunization Practices

Meningococcal Vaccine

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Practice guideline:

Vaccine in patients 11 years of age

Beginning in 2005, the CDC recommends routine immunization with meningococcal conjugate vaccine (MCV4) for adolescents at 11 to 12 years of age. The goal is routine vaccination of all adolescents beginning at 11 years of age by 2008. For those persons who have not previously received MCV4, vaccination should be administered before high-school entry (at approximately age 15 years). Routine vaccination with meningococcal vaccine also is recommended for college freshmen living in dormitories and for other populations at increased risk.

Additional resources:

Prevention and Control of Meningococcal Disease: Recommendations of the Advisory Committee on Immunization Practices (ACIP).

Human Papillomavirus (HPV) Vaccine

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Practice guideline:

Vaccine in female patients at 11 to 12 years of age

The first CDC recommendation for the use of HPV was published in March 2007. The vaccine can be administered as young as age 9 years and catch-up vaccination is recommended for females aged 13 to 26 years.

Additional resources:

Quadrivalent Human Papillomavirus Vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP)

Herpes zoster vaccine

Practice guideline:

· Vaccine in patients 60 years of age or older

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The first CDC recommendation for the use of Herpes zoster vaccine was published in May 2008. The vaccine is recommended for patients 60 years of age or older to prevent herpes zoster (ie, shingles) and its sequelae. The vaccine has been available since 2006 and preliminary recommendations supported its use. A 2007 telephone-based survey revealed that only 1.9% of patients 60 years of age or older had received the vaccine.

Additional resource:

Prevention of Herpes Zoster: Recommendations of the Advisory Committee on Immunization Practices (ACIP)

2007 National Immunization Survey Results