# Presentation: 008576

## Adult Immunization 2006
Satellite Broadcast
December 7, 2006

Tdap Vaccine Segment

**Satellite Broadcast**
**December 7, 2006**
**Tdap Vaccine Segment**

**Graphics subject to change**
**This material in the public domain**

## NOTE:Participants are strongly encourage to have a copy of the current adult immunization schedule available during this program. The current schedule can be downloaded from the National Immunization Program website atwww.cdc.gov/nip/recs/adult-schedule.htm 

## Tetanus and Diphtheria Immunity

**More than 50% of adults 20 years of age and older in the U.S. do not have a protective level of antibody against tetanus and diphtheria**
**Many adults 60 years of age and older have not received a primary series of tetanus- and diphtheria-containing vaccine**
**Many adults of all ages do not receive routine Td booster doses every 10 years**

## Reported Pertussis by Age Group, 1990-2005

**<11 yrs**

**11-18 yrs**

**>18 yrs**

## Tetanus and DiphtheriaVaccines for Adults

**Tetanus and Diphtheria Toxoid (Td)**
**formalin-inactivated toxins**
**3 doses induces protective antibody in nearly everyone**
**protection for at least 10 years**

## Tetanus and DiphtheriaVaccines for Adults

**Tdap (Adacel****®****)**
**only Tdap brand approved for   adults**
**single dose**
**approved for persons 11 through 64 years of age**

## Use of Tdap Among Adults

**Single dose of Adacel to replace a single dose of Td**
**May be given at an interval less than 10 years since receipt of last tetanus toxoid-containing vaccine**
**Special emphasis on adults with close contact with infants (e.g., childcare and healthcare personnel, and parents)**

## Tdap for Persons Withouta History of DTaP

**All adults should have documentation of having received a series of DTaP, DTP, DT, or Td**
**Adults without documentation should receive or complete a series of 3 doses**
**Preferred schedule*:**
**single dose of Adacel**
**Td at least 4 weeks after the Tdap dose**
**second dose of Td at least 6 months after the Td dose**

***off-label recommendation. See *****MMWR***** 2006;55(RR-3) **

## Tdap and Pregnancy*

**Td is generally preferred during pregnancy**
**All women should receive a dose of Tdap in the immediate postpartum period**
**Any woman who might become pregnant is encouraged to receive a single dose of Tdap**
**A clinician may choose to administer Tdap to a pregnant woman in certain circumstances, such as during an outbreak of pertussis in the community**
**Pregnancy is not a contraindication to vaccination with Tdap **

***provisional ACIP recommendation, June 2006**

## Tdap/Td Adverse Reactions

**Local reactions**
** ****(pain, redness)**
**Temp **_**>**_**100****o**** F**
**Systemic events**

**70%-75%**
**3%-5%**
**30%-40%**

## Tdap Contraindications

**Severe allergic reaction to a vaccine component  or following a prior dose**
**Encephalopathy within 7 days of administration of a pertussis vaccine that is not attributable to another identifiable cause**

## Tdap Precautions

**History of an Arthus-type reaction following a previous dose of tetanus or diphtheria toxoid-containing vaccine**
**Progressive neurologic disorder, uncontrolled epilepsy, or progressive encephalopathy**
**History of Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of tetanus toxoid-containing vaccine**
**Moderate or severe acute illness**

## Adult Immunization 2006
Satellite Broadcast
December 7, 2006

Zoster Vaccine Segment

**Satellite Broadcast**
**December 7, 2006**
**Zoster Vaccine Segment**

**Graphics subject to change**
**This material in the public domain**

## Herpes Zoster (shingles)

**Caused by reactivation of the varicella zoster virus**
**Can occur years or decades after illness with chickenpox**
**Generally associated with normal aging and with anything that causes reduced immunocompetence**
**Lifetime risk of 20% in the United States**
**Estimated 500,000 to 1 million cases zoster diagnosed annually in the U.S. **

## Herpes Zoster Vaccine(Zostavax®)

**Contains the same live attenuated varicella virus but at a much higher titer than regular varicella vaccine**
**Must be stored at freezer temperature at all times**
**Use within 30 minutes of reconstitution**
**Administered by the subcutaneous (subQ) route**

## Zostavax Clinical Trial

**Compared to the placebo group the vaccine group had: **
**51% fewer episodes of zoster**
**Less severe disease**
**66% less postherpetic neuralgia**
**No significant safety issues were identified **

***NEJM***** 2005;352(22):2271-84.**

## ACIP Recommendations* for Zoster Vaccine

**Single dose of zoster vaccine for adults 60 years of age and older whether or not they report a prior episode of shingles**
**Persons with a chronic medical condition may be vaccinated unless a contraindication or precaution exists for their condition**

***provisional (as of December 2007)**

## Adult Immunization 2006
Satellite Broadcast
December 7, 2006

Influenza Vaccine Segment

**Satellite Broadcast**
**December 7, 2006**
**Influenza Vaccine Segment**

**Graphics subject to change**
**This material in the public domain**

## Impact of Influenza and Pneumococcal Disease

**Approximately 36,000 influenza-associated deaths during each influenza season**
**Persons 65 years of age and older accounted for more than 90% of deaths**
**>2,000 deaths from invasive pneumococcal disease among persons 65 years and older**

**Source:***** MMWR***** 2006;55 (RR-10); ABCs**

## Influenza Virus Strains

**Type A**
**moderate to severe illness**
**affects all age groups**
**affects humans and other animals (particularly migratory waterfowl)**** **
**Type B**
**milder disease**
**primarily affects children**
**humans only****	**

## Influenza Virus

## Antigenic Drift and Shift

**Antigenic Drift**
**minor change, same subtype**
**associated with epidemics**
**Antigenic Shift**
**major change, new subtype**
**associated with pandemics**

## Influenza Vaccines

**Inactivated subunit (TIV)**
**intramuscular**
**trivalent**
**viruses grown in chicken eggs**
**Live attenuated vaccine (LAIV)**
**intranasal**
**trivalent**
**viruses grown in chicken eggs****	**

## Inactivated Influenza Vaccine (TIV) Efficacy

**70%-90% effective among healthy persons <65 years of age**
**30%-40% effective among persons 65 years and older with underlying medical conditions**
**Prevents complications and death from influenza among those who get the disease**

## Influenza and Complications Among Nursing Home Residents

**Influenza and Complications Among Nursing Home Residents**

**RR=1.9**

**RR=2.0**

**RR=2.5**

**RR=4.2**

***Inactivated influenza vaccine. Genesee County, MI, 1982-1983**

## Live Attenuated Influenza Vaccine (LAIV)

**Approved only for healthy persons 5 - 49 years of age**
**Do not administer to persons younger than 5 years or older than 49 years**
**Dose is 0.5 mL**

## All persons 50 years of  age or older
Persons >6 months of  age with chronic illness
Healthy children 6 - 59 months of age

**Persons **_**>**_**6 months of  age with chronic illness**
**Healthy children 6 - 59 months of age**

**Inactivated Influenza Vaccine ****Recommendations**

## Inactivated Influenza Vaccine Recommendations

**Persons with the following chronic illnesses should be considered for inactivated influenza vaccine:**
**Pulmonary**
**Cardiovascular**
**Metabolic**
**Renal dysfunction**
**Hemoglobinopathy**
**Immunosuppression**
**Any condition that can compromise respiratory function or the handling of respiratory secretions or that can increase the risk of aspiration**

## Residents of long-term care facilities
Persons 6 months - 18 years receiving chronic aspirin therapy
Pregnant women

**Persons 6 months - 18 years receiving chronic aspirin therapy**
**Pregnant women**

**Inactivated Influenza Vaccine ****Recommendations**

## Pregnancy and Influenza Vaccine

**Risk of hospitalization >4 times higher than nonpregnant women**
**Risk of complications comparable to nonpregnant women with high risk medical conditions**
**ACIP recommends vaccination with inactivated influenza vaccine for ALL women who will be pregnant during influenza season (December through March) **

**Source:***** MMWR***** 2006;55 (RR-10)**

## Household members of high-risk persons
Healthcare providers, including home care personnel
Employees of long-term care facilities
Providers of essential community services
International travelers
Persons in institutional settings
Anyone who wants to reduce the likelihood of influenza

**Healthcare providers, including home care personnel**
**Employees of long-term care facilities**
**Providers of essential community services**
**International travelers**
**Persons in institutional settings**
**Anyone who wants to reduce the likelihood of influenza**

**Inactivated Influenza Vaccine ****Recommendations**

## Live Attenuated Influenza Vaccine (LAIV)

**Approved only for healthy persons 5 - 49 years of age**
**Healthcare providers**
**Persons in close contact with   high-risk groups**
**Persons who want to reduce their risk of influenza**

## Use of LAIV Among CloseContacts of High-Risk Persons

**Inactivated influenza vaccine is preferred for close contacts of severely immunosuppressed persons who require care in a protective environment **
**Persons who receive LAIV should refrain from contact with severely immunosuppressed persons for 7 days after vaccination **

## TIV Adverse Reactions

**Local reactions**
**(pain, redness)**
**Systemic reactions**
**(fever, malaise)**
**Severe allergic **
**reactions**
**Neurological reactions**

**15%-20%**
**<1%**
**Rare**
**Very rare**

## LAIV Adverse Reactions

**Significantly increased rate of cough, coryza, nasal congestion, sore throat, chills**
**No increase in fever**
**No serious adverse reactions have been identified**

## Inactivated Influenza VaccineContraindications and Precautions

**Severe allergic reaction to a   vaccine component or following a prior dose**
**Moderate or severe acute illness**

## Live Attenuated Influenza VaccineContraindications and Precautions

**Persons 50 years of age and older**
**Chronic illness**
**Immunosuppression**
**Pregnancy**
**History of Guillain-Barre**** ́**** Syndrome**
**Moderate or severe acute illness**

## Adult Immunization 2006
Satellite Broadcast
December 7, 2006

Pneumococcal Polysaccharide Segment

**Satellite Broadcast**
**December 7, 2006**
**Pneumococcal Polysaccharide Segment**

**Graphics subject to change**
**This material in the public domain**

## Pneumococcal Polysaccharide Vaccine

**Purified capsular polysaccharide antigen from 23 types of pneumococcus**
**Account for 88% of bacteremic  pneumococcal disease**
**Cross-react with types causing additional 8% of disease**

## Pneumococcal PolysaccharideVaccine

**60% to 70% efficacy against invasive disease**
**Duration of immunity at least 5 years**
**Schedule 1 dose, selective revaccination (at least 5 years after the first dose)**

## Pneumococcal Polysaccharide Vaccine Recommendations

**Adults **_**>**_**65 years of age**
**Adults of any age with a normal immune system who have chronic illness**
**cardiovascular or pulmonary disease**
**diabetes**
**alcoholism, cirrhosis**
**cerebrospinal fluid leak**
**cochlear implant**

## Pneumococcal Polysaccharide Vaccine Recommendations

**Immunocompromised adults**
**Persons with HIV infection**
**Persons living in special environments  or social settings with an identified increased risk of invasive pneumococcal disease**

## Candidates for Pneumococcal Revaccination

**Functional or anatomic asplenia**
**Immunosuppression**
**Chronic renal failure**
**Nephrotic syndrome**
**First dose before 65 years of age and **_**>**_**5 years since first dose**
**First dose at >65 years of age AND later develop a condition for which revaccination is recommended AND at least 5 years since the first dose**

## Pneumococcal Polysaccharide Vaccine Adverse Reactions

**Local reactions**
**(pain, redness)**
**Systemic reactions**
**(fever, malaise)**
**Severe adverse **
**reactions**

**30%-50%**
**<1%**
**Rare**

## Pneumococcal Polysaccharide VaccineContraindications and Precautions

**Severe allergic reaction to a   vaccine component or following a prior dose**
**Moderate or severe acute illness**

## Adult Immunization 2006
Satellite Broadcast
December 7, 2006

Human Papillomavirus Vaccine Segment

**Satellite Broadcast**
**December 7, 2006**
**Human Papillomavirus Vaccine Segment**

**Graphics subject to change**
**This material in the public domain**

## Human Papillomavirus

**More than 100 types**
** ****More than 60 cutaneous types**
**Can lead to skin warts**
** ****40 mucosal types**
**High risk types (particularly 16 and 18)**
**cervical cell abnormalities**
**certain anogenital cancers**
**Low risk types (particularly 6 and 11)**
**cervical cell abnormalities- usually resolve spontaneously and do not lead to cancer**
**genital warts**
**respiratory papillomatosis**

## Natural History of HPV Infection

**Within 1 Year**

**1-5 Years**

**Up to Decades**

**Initial****HPV Infection**

**Persistent**
**Infection**

**CIN 2/3**

**Cervical Cancer**

**CIN 1**

**Cleared HPV Infection**

**Natural History of HPV Infection**

## Cancer Attributable to HPV - 2002

**Cervical**
**Anal**
**Vulvar/vaginal**
**Penile**
**Oral/pharynx**

**Cancer Attributable to HPV - 2002**

**Estimated**
_**Cases**_
**12,000**
**3,700**
**4,480**
**1,000**
**10,000**

**Attributable**
_**Fraction**_
**100%**
**90%**
**40%**
**40%**
**12%**

## HPV-associated Conditions

_**HPV 16, 18**_
**Cervical cancer**
**High/low grade cervical **
**    ****abnormalities**
**Anal, Vulvar, Vaginal, Penile          **
**Head and neck cancers            **
_**HPV 6, 11**_
**Low grade cervical **
** ****abnormalities**
**Genital warts**
**RRP**

**Estimated %**
**70%**
**30%-50%**
**10%**

**10%**
**90%**
**90%**

## Human PapillomavirusVaccine Recommendations*

**Women 19-26 years of age are recommended to receive the HPV series if they have not already received it **

***provisional (as of December 2007)**

## Human PapillomavirusVaccine

**3 dose series**
**Administered intramuscularly**
**Schedule: 0, 2 months, and 6 months**
**Minimum intervals:**
**dose 1-2: 4 weeks**
**dose 2-3: 12 weeks**

## Human PapillomavirusVaccine

**Effective only in preventing infection, not in curing disease, or treating a current infection**
**Recommended for all women in the approved age range (through 26 years) regardless of sexual history, prior HPV infection, or prior disease**

## Human Papillomavirus VaccineContraindications and Precautions

**Severe allergic reaction to a vaccine component or following a prior dose**
**Moderate or severe acute illness**
**Defer HPV vaccine until after pregnancy**

## Adult Immunization 2006
Satellite Broadcast
December 7, 2006

Hepatitis B Vaccine Segment

**Satellite Broadcast**
**December 7, 2006**
**Hepatitis B Vaccine Segment**

**Graphics subject to change**
**This material in the public domain**

## Risk Factors for Hepatitis B

**CDC Sentinel Sites.  2001 data.**

## Hepatitis B VaccineLong-Term Efficacy

**Immunologic memory develops following vaccination**
**Antibody level declines following successful vaccination**
**Anamnestic response upon exposure (antibody level increases quickly)**

## Dose
Primary 1
Primary 2
Primary 3  

**Primary 1**
**Primary 2**
**Primary 3  **

** ****Minimum**
_**Interval**_
**---   **
** ****	****4 weeks**
** ****	****8 weeks***

**   ****Usual**
**  **_**Interval**_
**      ****---**
**1 month**
**4-6 months**

**Hepatitis B Vaccine**
**Adult Schedule**

***third dose must be separated from**
** ****first dose by at least 16 weeks**

## Hepatitis B Vaccine

**Booster doses are **_**NOT**_** recommended routinely for any group**

## Hepatitis B Vaccine Adult Candidates

**Men who have sex with men**
**Heterosexual with multiple partners**
**Persons with a recently acquired sexually transmitted disease**
**Commercial sex workers**
**Injection drug users**
**Male prison inmates**
**Persons receiving hemodialysis**

## Staff and clients in institutions for the developmentally disabled
Alaska Natives, Pacific Islanders
Household members of adoptees from hepatitis B endemic areas
Household members and sex partners of HBV carriers
Persons who travel to HBV-endemic areas
Recipients of certain blood products

**Alaska Natives, Pacific Islanders**
**Household members of adoptees from hepatitis B endemic areas**
**Household members and sex partners of HBV carriers**
**Persons who travel to HBV-endemic areas**
**Recipients of certain blood products**

**Hepatitis B Vaccine ****Adult Candidates**

## Hepatitis B VaccineAdverse Reactions

**Pain at injection site**
**Mild systemic complaints****(fatigue, headache)**
**Temperature >100****o****F**
**Severe systemic reactions**

**13%-29%**
**11%-17%**
**1%**
**rare**

## Adult Immunization 2006
Satellite Broadcast
December 7, 2006

Hepatitis A Vaccine Segment

**Satellite Broadcast**
**December 7, 2006**
**Hepatitis A Vaccine Segment**

**Graphics subject to change**
**This material in the public domain**

## Hepatitis A

**Fecal-oral transmission**
**Indistinguishable from other types of hepatitis**
**Does not lead to chronic infection**
**Complications related to the acute disease**

## Source of Hepatitis Infection, 1990-2000

**Source of Hepatitis Infection, 1990-2000**

**Source:  NNDSS/VHSP**

## Hepatitis A Vaccines

**Inactivated whole virus**
**Pediatric and adult formulations**
**Adult formulations for persons 19 years and older**
**2 dose series (0, 6-18 months)**
**Minimum interval between doses is 6 calendar months**
**Not necessary to repeat the first dose if the interval is longer than the recommended 6 to 18 months**

## Twinrix®

**Hepatitis B (adult dose) and hepatitis A (pediatric dose)**
**3-dose series at 0, 1, 6 to 12 months**
**Approved only for adults 18 years of age and older**

## Hepatitis A VaccineRecommendations

**International travelers**
**Men who have sex with men**
**Persons who use illegal drugs**
**Persons with occupational risk (limited to certain laboratory personnel and animal handlers)**
**Persons with chronic liver disease, including hepatitis C**

## Hepatitis A VaccineAdverse Reactions

**Local reactions**
**Systemic reactions**
**(fever, malaise)**
**No serious adverse reactions reported**

**20%-50%**
**<10%**

## Hepatitis A VaccineContraindications and Precautions

**Severe allergic reaction to a vaccine component or following a prior dose**
**Moderate or severe acute illness**

## Adult Immunization 2006
Satellite Broadcast
December 7, 2006

MMR Vaccine Segment

**Satellite Broadcast**
**December 7, 2006**
**MMR Vaccine Segment**

**Graphics subject to change**
**This material in the public domain**

## Measles-Mumps-RubellaVaccine (MMR)

**Contains live attenuated viruses**
**Effective in preventing disease caused by these viruses in up to 95% of recipients of one dose**
**Variation in the efficacy of the components (mumps efficacy lower than for measles and rubella)**
**All adults born after 1956 should have documentation of at least 1 dose (or other evidence of immunity)**

## Adults at High Risk forMeasles

**College students**
**International travelers**
**Healthcare personnel**

## MMR Adverse Reactions

**Fever****	****	****	****	****5%-15%**
**Rash****	****	****	****	****  5%**
**Joint symptoms****	****  ****	****25%**
**Thrombocytopenia****	****	****<1/30,000 ****doses**
**Parotitis****	****	****	****  ****	****rare**
**Deafness****	****	****	****  ****	****rare**
**Encephalopathy****	****  ****	****<1/1,000,000 ****doses**

## MMR VaccineContraindications and Precautions

**Severe allergic reaction to vaccine component or following prior dose**
**Pregnancy**
**Immunosuppression**
**Moderate or severe acute illness**
**Recent receipt of a blood product**

## Measles Vaccine and HIV Infection

**MMR recommended for persons with asymptomatic and mildly symptomatic HIV infection**
**NOT recommended for persons with evidence of severe immuno-suppression**
**Prevaccination HIV testing not recommended**

## MMR Vaccination of Women of Childbearing Age

**Ask if pregnant or likely to become so in next 4 weeks**
**Exclude those who say "yes“**
**For others**
** ****explain theoretical risks**
** ****vaccinate**

## Adult Immunization 2006
Satellite Broadcast
December 7, 2006

Varicella Vaccine Segment

**Satellite Broadcast**
**December 7, 2006**
**Varicella Vaccine Segment**

**Graphics subject to change**
**This material in the public domain**

## Varicella Vaccine

**Composition****	****	****Live virus **
**	****	****	****	****	****(Oka/Merck strain)**
**Efficacy****	****	****	****70%-90%**
**	****	****	****	****	****(any disease)**
**	****	****	****	****	****95%-100%**
**	****	****	****	****	****(severe disease)**

## Varicella VaccineAdverse Reactions

**Local reactions**
** ****(redness, pain)**
**Rash**
**Fever >100****o****F**

**20% to 30%**
**6% (first dose)**
**1% (second dose)**
**10%**

## Varicella VaccineContraindications and Precautions

**Severe allergic reaction to vaccine component or following prior dose**
**Pregnancy**
**Immunosuppression**
**Moderate or severe acute illness**
**Recent receipt of a blood product**

## Varicella VaccineUse in Immunocompromised Adults

**Most immunocompromised persons should not be vaccinated**
**Vaccine is effective and safe in persons with isolated humoral immunodeficiency**
**passive antibody used to treat the  condition may interfere with vaccine**

## Adult Immunization 2006
Satellite Broadcast
December 7, 2006

Meningococcal Vaccine Segment

**Satellite Broadcast**
**December 7, 2006**
**Meningococcal Vaccine Segment**

**Graphics subject to change**
**This material in the public domain**

## Meningococcal Disease

**Caused by *****Neisseria meningiditis***
**Infants <1 years of age highest risk**
**College freshmen who live in a dormitory at increased risk**
**Two meningococcal vaccines available in the United States**
**Polysaccharide vaccine approved in 1978 (Menomune****®****)**
**Conjugate vaccine approved in 2005 (Menactra****®****)**

## Meningococcal PolysaccharideVaccine (MPSV) - Menomune®

**Quadrivalent (serogroups A, C, Y, W-135)**
**Approved for persons 2 years of age and older**
**Administered by subcutaneous injection**

## Meningococcal ConjugateVaccine (MCV) - Menactra®

**Quadrivalent (serogroups A, C, Y, W-135) conjugated to diphtheria toxoid**
**Approved for persons 11-55 years of age**
**Administered by **_**intramuscular**_** injection**
**MCV is preferred for persons 11- 55 years of age**
**MPSV is acceptable if MCV is not available**

## Meningococcal VaccineRecommendations

**Recommended for certain high-risk persons:**
**military recruits**
**certain research and laboratory personnel**
**travelers to and U.S. citizens residing    in countries in which N. meningitidis    is hyperendemic or epidemic**
**college freshmen living in a dormitory**

## Meningococcal VaccineRecommendations

**Recommended for certain high-risk persons:**
**terminal complement**
**component deficiency**
**HIV infection**
**functional or anatomic asplenia**

## Meningococcal VaccineRevaccination

**Most persons with an indication for meningococcal vaccine need only one dose **
**Some very high risk persons (e.g., asplenic persons) may need a second dose if the first dose was meningococcal polysaccharide vaccine***
**A booster dose following meningococcal conjugate vaccine is currently not recommended  **

***see *****MMWR***** 2005;54(RR-7) for details **

## Adult Immunization 2006
Satellite Broadcast
December 7, 2006

Adult Immunization Strategies Segment

**Satellite Broadcast**
**December 7, 2006**
**Adult Immunization Strategies Segment**

**Graphics subject to change**
**This material in the public domain**

## Influenza Vaccination Coverage for Adults, 2005

**18- 49 years of age**
**   ****with high risk**
**   ****conditions**
**50-64 years of age**
**HP 2010 goal**

**18%**
**34%**
**60%**

## Pneumococcal Vaccination Coverage for Adults, 2005

**18- 49 years of age**
**   ****with high risk**
**   ****conditions**
**50-64 years of age**
**HP 2010 goal**

**15%**
**31%**
**60%**

## Vaccination Coverage for Adults 65 Years and Older

**Influenza vaccine**
**Pneumococcal vaccine**
**HP 2010 goal**

**60%**
**56%**
**90%**

## One of the most importantreasons adults identify for not receiving a vaccine is the lack ofa provider recommendation for the vaccine.

## Interventions to ImproveAdult Vaccination Coverage

**Client reminder and recall systems**
**Provider reminder and recall systems**
**computer notification**
**flow sheet or checklist**
**flagging medical record with   sticker or stamp**
**Assessment and feedback for providers**

## Interventions to ImproveAdult Vaccination Coverage

**Standing orders**
**allow nonphysician personnel to prescribe or deliver vaccines using a protocol**
**Reducing out-of-pocket costs for patients**
**Expanding access**
**increasing or changing hours when immunization services are offered**
**“****express lane” for immunizations**

## Adult Immunization 2006
Satellite Broadcast
December 7, 2006

Vaccination of Healthcare Personnel Segment

**Satellite Broadcast**
**December 7, 2006**
**Vaccination of Healthcare Personnel Segment**

**Graphics subject to change**
**This material in the public domain**

## Sources of Healthcare Personnel Vaccination Recommendations

***Immunization of Health-care Workers: Recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Hospital Infection Control Practices Advisory Committee (HICPAC).*****  *****MMWR***** 1997;46(No. RR-18):1-42.**
**Annual adult immunization schedule, available at**
**   ****www.cdc.gov/nip/recs/adult-schedule.htm**
**Vaccine-specific ACIP statements**

## Diseases with Occupational Riskfor Healthcare Personnel

**Hepatitis B**
**Influenza**
**Measles**
**Mumps**
**Rubella**
**Varicella**
**Meningococcal disease (certain laboratory personnel only)**

## Influenza Vaccination ofHealthcare Personnel

**Only 42% of U.S. healthcare personnel were vaccinated in 2004**
**Resource for improving influenza vaccination of healthcare personnel available: **
***   ******MMWR***** 2006; 55 (No. RR-2):1-15 (February 9, 2006)**
**   **

## Measles Vaccination ofHealthcare Personnel

**Born in 1957 or later**
**documentation of 2 doses of   measles-containing or other   evidence of immunity (e.g., serology)**
**Born before 1957**
**1 dose of measles-containing    vaccine should be considered**

## Mumps Vaccination ofHealthcare Personnel

**Routine vaccination**
**same criteria for immunity as for measles**
**During a mumps outbreak**
**facilities should strongly consider  recommending 2 doses of mumps  vaccine to unvaccinated personnel   born before 1957 who do not have  evidence of mumps immunity**

## Varicella Immunity AmongHealthcare Personnel

**Laboratory evidence of immunity**
**Clinician diagnosed or verified history of varicella or zoster**
**Age-appropriate vaccination**
**Birth before 1980 should NOT be considered as evidence of immunity for healthcare personnel**

## Healthcare Personnel Withouta Written Vaccination Record

**If a written vaccination record cannot be located, healthcare personnel should be considered susceptible  and should be vaccinated as age-appropriate**
**Serologic testing can be considered for diseases with an established serologic correlate of immunity (e.g., measles, rubella)**

## Hepatitis B Postvaccination Serologic Testing

**ACIP recommends testing for hepatitis B surface antibody 1- 2 months after the third dose**
**Anti-HBs of **_**>**_**10 mIU/mL indicates immunity**
**If negative, repeat series of 3 doses followed by repeat serologic testing**
**“****Catch-up” serologic testing of persons vaccinated (and not tested) in the past is not recommended (test if exposed)  **

## National Immunization Program

**Telephone      (800) CDC-INFO**
**Email****	****	****      nipinfo@cdc.gov**
**Website****	****      www.cdc.gov/nip**
**Broadcast Updates and Resources **
**   ****Web Page**
**	****www.cdc.gov/nip/ed/UpdatesandResources.htm **