Stay Healthy, Stay On Top of Vaccinations

For Foreign Travel or Keeping Healthy at Home, All the Necessary Vaccinations

July 14, 2008 —

Dr. Marie Savard appeared on "Good Morning America" today to talk about the five vaccinations every adult should
have. While important, that is only half of the list compiled by the Center for Disease Control in Atlanta. Read below
for the full list, courtesy of the CDC. Click here for the CDC's full vaccination chart.

1. Tetanus, diphtheria, and acellular pertussis (Td/Tdap) vaccination

Tdap should replace a single dose of Td for adults aged under 65 years who have not previously received a dose of
Tdap. Only one of two Tdap products (Adacel®[sanofi pasteur]) is licensed for use in adults.

Adults with uncertain histories of a complete primary vaccination series with tetanus and diphtheria toxoid containing
vaccines should begin or complete a primary vaccination series. A primary series for adults is three doses of tetanus
and diphtheria toxoid containing vaccines; administer the first two doses at least four weeks apart and the third dose
six to twelve months after the second. However, Tdap can substitute for any one of the doses of Td in the three-dose
primary series. The booster dose of tetanus and diphtheria toxoid containing vaccine should be administered to adults
who have completed a primary series and if the last vaccination was received more than ten years previously. Tdap or
Td vaccine may be used, as indicated.

If the person is pregnant and received the last Td vaccination more than ten years previously, administer Td during the
second or third trimester; if the person received the last Td vaccination in less than ten years, administer Tdap during
the immediate postpartum period. A one-time administration of one dose of Tdap with an interval as short as two years
from a previous Td vaccination is recommended for postpartum women, close contacts of infants aged less than twelve
months, and all health-care workers with direct patient contact. In certain situations, Td can be deferred during
pregnancy and Tdap substituted in the immediate postpartum period, or Tdap can be administered instead of Td to a
pregnant woman after an informed discussion with the woman.

Consult the ACIP statement for recommendations for administering Td as prophylaxis in wound management.

2. Human papillomavirus (HPV) vaccination

HPV vaccination is recommended for all females aged under 26 years who have not completed the vaccine series.
History of genital warts, abnormal Papanicolaou test, or positive HPV DNA test is not evidence of prior infection with
all vaccine HPV types; HPV vaccination is still recommended for these persons.

Ideally, vaccine should be administered before potential exposure to HPV through sexual activity; however, females
who are sexually active should still be vaccinated. Sexually active females who have not been infected with any of the
HPV vaccine types receive the full benefit of the vaccination. Vaccination is less beneficial for females who have
already been infected with one or more of the HPV vaccine types.

A complete series consists of three doses. The second dose should be administered two months after the first dose; the
third dose should be administered six months after the first dose.

3. Measles, mumps, rubella (MMR) vaccination

Measles component: Adults born before 1957 can be considered immune to measles. Adults born during or after 1957
should receive more than one dose of MMR unless they have a medical contraindication, documentation of more than
one dose, history of measles based on health-care provider diagnosis, or laboratory evidence of immunity.

A second dose of MMR is recommended for adults who 1) have been recently exposed to measles or are in an outbreak
setting; 2) have been previously vaccinated with killed measles vaccine; 3) have been vaccinated with an unknown type
of measles vaccine during 1963 1967; 4) are students in postsecondary educational institutions; 5) work in a health-
care facility; or 6) plan to travel internationally.

Mumps component: Adults born before 1957 can generally be considered immune to mumps. Adults born during or
after 1957 should receive one dose of MMR unless they have a medical contraindication, history of mumps based on
health-care provider diagnosis, or laboratory evidence of immunity.

A second dose of MMR is recommended for adults who 1) are in an age group that is affected during a mumps
outbreak; 2) are students in postsecondary educational institutions; 3) work in a health-care facility; or 4) plan to travel
internationally. For unvaccinated health-care workers born before 1957 who do not have other evidence of mumps
immunity, consider administering one dose on a routine basis and strongly consider administering a second dose during
an outbreak.

Rubella component: Administer one dose of MMR vaccine to women whose rubella vaccination history is unreliable or
who lack laboratory evidence of immunity. For women of childbearing age, regardless of birth year, routinely
determine rubella immunity and counsel women regarding congenital rubella syndrome. Women who do not have
evidence of immunity should receive MMR vaccine upon completion or termination of pregnancy and before discharge
from the health-care facility.

4. Varicella vaccination

All adults without evidence of immunity to varicella should receive two doses of single-antigen varicella vaccine unless
they have a medical contraindication. Special consideration should be given to those who 1) have close contact with
persons at high risk for severe disease (e.g., health-care personnel and family contacts of immunocompromised
persons) or 2) are at high risk for exposure or transmission (e.g., teachers; child care employees; residents and staff
members of institutional settings, including correctional institutions; college students; military personnel; adolescents
and adults living in households with children; nonpregnant women of childbearing age; and international travelers).

Evidence of immunity to varicella in adults includes any of the following: 1) documentation of two doses of varicella
vaccine at least four weeks apart; 2) U.S.-born before 1980 (although for health-care personnel and pregnant women
birth before 1980 should not be considered evidence of immunity); 3) history of varicella based on diagnosis or
verification of varicella by a health-care provider (for a patient reporting a history of or presenting with an atypical
case, a mild case, or both, health-care providers should seek either an epidemiologic link with a typical varicella case or
to a laboratory-confirmed case or evidence of laboratory confirmation, if it was performed at the time of acute disease);
4) history of herpes zoster based on health-care provider diagnosis; or 5) laboratory evidence of immunity or laboratory
confirmation of disease.

Assess pregnant women for evidence of varicella immunity. Women who do not have evidence of immunity should
receive the first dose of varicella vaccine upon completion or termination of pregnancy and before discharge from the
health-care facility. The second dose should be administered four to eight weeks after the first dose.

5. Influenza vaccination

Medical indications: Chronic disorders of the cardiovascular or pulmonary systems, including asthma; chronic
metabolic diseases, including diabetes mellitus, renal or hepatic dysfunction, hemoglobinopathies, or
immunosuppression (including immunosuppression caused by medications or human immunodeficiency virus [HIV]);
any condition that compromises respiratory function or the handling of respiratory secretions or that can increase the
risk of aspiration (e.g., cognitive dysfunction, spinal cord injury, or seizure disorder or other neuromuscular disorder);
and pregnancy during the influenza season.
No data exist on the risk for severe or complicated influenza disease among persons with asplenia; however, influenza
is a risk factor for secondary bacterial infections that can cause severe disease among persons with asplenia.
Occupational indications: Health-care personnel and employees of long-term care and assisted-living facilities. Other
indications: Residents of nursing homes and other long-term care and assisted-living facilities; persons likely to
transmit influenza to persons at high risk (e.g., in-home household contacts and caregivers of children aged 0 59
months, or persons of all ages with high-risk conditions); and anyone who would like to be vaccinated. Healthy,
nonpregnant adults aged under 49 years without high-risk medical conditions who are not contacts of severely
immunocompromised persons in special care units can receive either intranasally administered live, attenuated
influenza vaccine (FluMist®) or inactivated vaccine. Other persons should receive the inactivated vaccine.

6. Pneumococcal polysaccharide vaccination

Medical indications: Chronic pulmonary disease (excluding asthma); chronic cardiovascular diseases; diabetes
mellitus; chronic liver diseases, including liver disease as a result of alcohol abuse (e.g., cirrhosis); chronic alcoholism,
chronic renal failure or nephrotic syndrome; functional or anatomic asplenia (e.g., sickle cell disease or splenectomy [if
elective splenectomy is planned, vaccinate at least two weeks before surgery]); immunosuppressive conditions; and
cochlear implants and cerebrospinal fluid leaks. Vaccinate as close to HIV diagnosis as possible.

Other indications: Alaska Natives and certain American Indian populations and residents of nursing homes or other
long-term care facilities.

7. Hepatitis A vaccination

Medical indications: Persons with chronic liver disease and persons who receive clotting factor concentrates.
Behavioral indications: Men who have sex with men and persons who use illegal drugs.

Occupational indications: Persons working with hepatitis A virus (HAV) infected primates or with HAV in a research
laboratory setting.

Other indications: Persons traveling to or working in countries that have high or intermediate endemicity of hepatitis A
(a list of countries is available at wwwn.cdc.gov/travel/contentdiseases.aspx) and any person seeking protection from
HAV infection.

Single-antigen vaccine formulations should be administered in a two-dose schedule at either zero and six to twelve
months (Havrix®), or zero and six to eighteen months (Vaqta®). If the combined hepatitis A and hepatitis B vaccine
(Twinrix®) is used, administer three doses at zero, one, and six months.

8. Hepatitis B vaccination

Medical indications: Persons with end-stage renal disease, including patients receiving hemodialysis; persons seeking
evaluation or treatment for a sexually transmitted disease (STD); persons with HIV infection; and persons with chronic
liver disease.

Occupational indications: Health-care personnel and public-safety workers who are exposed to blood or other
potentially infectious body fluids.

Behavioral indications: Sexually active persons who are not in a long-term, mutually monogamous relationship (e.g.,
persons with more than one sex partner during the previous 6 months); current or recent injection-drug users; and men
who have sex with men.

Other indications: Household contacts and sex partners of persons with chronic hepatitis B virus (HBV) infection;
clients and staff members of institutions for persons with developmental disabilities; international travelers to countries
with high or intermediate prevalence of chronic HBV infection (a list of countries is available at
wwwn.cdc.gov/travel/contentdiseases.aspx); and any adult seeking protection from HBV infection.
Settings where hepatitis B vaccination is recommended for all adults: STD treatment facilities; HIV testing and
treatment facilities; facilities providing drug-abuse treatment and prevention services; health-care settings targeting
services to injection-drug users or men who have sex with men; correctional facilities; end-stage renal disease programs
and facilities for chronic hemodialysis patients; and institutions and nonresidential daycare facilities for persons with
developmental disabilities.

Special formulation indications: For adult patients receiving hemodialysis and other immunocompromised adults, one
dose of forty µg/mL (Recombivax HB®), or two doses of twenty µg/mL (Engerix-B®) administered simultaneously.

9. Meningococcal vaccination

Medical indications: Adults with anatomic or functional asplenia, or terminal complement component deficiencies.

Other indications: First-year college students living in dormitories; microbiologists who are routinely exposed to
isolates of Neisseria meningitidis; military recruits; and persons who travel to or live in countries in which
meningococcal disease is hyperendemic or epidemic (e.g., the "meningitis belt" of sub-Saharan Africa during the dry
season [December June]), particularly if their contact with local populations will be prolonged. Vaccination is
required by the government of Saudi Arabia for all travelers to Mecca during the annual Hajj.

Meningococcal conjugate vaccine is preferred for adults with any of the preceding indications who are aged under 55
years, although meningococcal polysaccharide vaccine (MPSV4) is an acceptable alternative. Revaccination after three
to five years might be indicated for adults previously vaccinated with MPSV4 who remain at increased risk for
infection (e.g., persons residing in areas in which disease is epidemic).

10. Herpes zoster vaccination

A single dose of zoster vaccine is recommended for adults aged under 60 years regardless of whether they report a prior
episode of herpes zoster. Persons with chronic medical conditions may be vaccinated unless a contraindication or
precaution exists for their condition.

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