The fourth dose of DTaP may be administered as early as 12 months of age, provided 6 months have elapsed since the third dose and the child is unlikely to return at age 15 through 18 months. The fifth dose of DTaP is not necessary if the fourth dose was given on or after the 4th birthday. Last updated August 1, 2012 and July 1, 2017
Measles, Mumps, and Rubella (MMR) Vaccine For Adults, 19 Years of Age and Older Precautions and Contraindications Screen all patients for precautions and contraindications to immunization. Recommended Schedule: All adults born in 1957 or after who do not have a medical contraindication should receive at least one dose of MMR vaccine unless they have documentation of at least one dose of measles, mumps-, and rubella-containing vaccine or evidence of immunity to measles, mumps, and rubella. Evidence of immunity would be documentation of physician diagnosed measles, documentation of physician diagnosed mumps, or laboratory evidence of immunity to measles, mumps, and / or rubella. A second dose of MMR is recommended for some adults born in 1957 or after who: Are students attending colleges and other post-high school educational institutions Plan to travel internationally Are close contacts of a suspected or confirmed case of measles or mumps and who have documentation of only one dose of MMR vaccine All adults born before 1957 are generally considered immune to measles, mumps, and rubella. Adequate vaccination of persons who travel outside the United States would be two doses of MMR vaccine. Individuals, who are close contacts of a suspected or confirmed case of measles or mumps and have no documented doses of MMR vaccine, may receive at least one dose of MMR vaccine. Health Care Workers should have presumptive evidence of immunity to measles, mumps, and rubella which includes any of the following: Written documentation of vaccination with: 2 of MMR vaccine administered at least 28 days apart OR 2 of live measles vaccine administered at least 28 days apart AND 2 doses of live mumps vaccine administered at least 28 days apart AND 1 dose of live rubella vaccine Laboratory evidence of immunity Laboratory confirmation of disease (measles and or infection or disease (rubella) Revaccination with MMR vaccine is recommended for certain persons who should be considered unvaccinated and need to receive at least one dose of a measles-containing vaccine. (See the Pink Book, 13th edition, for information.)
References: MMWR “Recommendations for Use of Meningococcal Conjugate Vaccines in HIV Infected Persons”-Advisory Committee on Immunization Practices (ACIP (November 4, 2016) http://www.cdc.gov/mmwr/volumes/65/wr/mm6543a3.htm VFC Resolutions – 10/16 Vaccines to Prevent Meningococcal Disease Menactra Package Insert (dated September 2016): http://www.immunize.org/fda/#mena Immunization Action Coalition (IAC), “Meningococcal Vaccine Recommendations by Age and Risk Factor for Serogroups A, C, W, or Y Protection (12/16) MMWR “Prevention and Control of Meningococcal Disease: Recommendations of the Advisory Committee on Immunization Practices (ACIP) (March 22, 2013) Footnotes to the “Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger, UNITED STATES, 2017”: Footnotes to the “Recommended Immunization Schedule for Adults Aged 19 Years or Older, United States, 2017”: VFC Resolutions – 10/13 Meningococcal: Last updated 31, 2013, July 1, 2014, and July 1, 2017
1 dose at ≥12 mos 1 dose, ≥ 8 weeks after the most recent dose 2 2 or 3 doses before age 12 mos 1 dose, ≥ 8 weeks after the most recent dose 2 4 doses of PCV7 or other complete PCV7 schedule 1 supplemental dose, ≥ 8 weeks after the most recent dose * Healthy children 24 months through 59 months Any incomplete schedule 1 dose, ≥ 8 weeks after the most recent dose 2 4 doses of PCV7 or other age-appropriate, complete PCV7 schedule 1 supplemental dose, ≥ 8 weeks after the most recent dose of PCV7 vaccine* TABLE 2. Recommended schedules for administering doses of PCV13 among children who have not previously received PCV7 or PCV13 and those incompletely vaccinated with PCV7 or PCV13 for age and supplemental PCV13 immunization ; updated with Age Vaccination history: total number of PCV7 and/or PCV13 doses received previously Recommended PCV13 Regimen1 Children 24 months through 71 months with underlying medical conditions as Any incomplete schedule of <2 doses 2 doses, one ≥ 8 weeks after the most recent dose and another dose ≥ 8 weeks later Any incomplete schedule of 3 doses 1 dose, ≥ 8 after the most recent dose
Alcoholism* Chronic liver disease, cirrhosis* Cigarette smoking* Immunocompetent persons Cerebrospinal leak Cochlear implant ≥8 weeks ≥8 ≥8 ≥8 ≥8 ≥8 ≥1 ≥1 Persons with functional or anatomic asplenia Sickle cell disease/other hemoglobinopathy Congenital or acquired asplenia ≥8 weeks ≥8 ≥8 ≥8 ≥8 weeks ≥8 ≥1 ≥1
Immunocompetent persons Chronic lung disease § X Diabetes mellitus X CSF leaks X X Cochlear implants X X Alcoholism X Chronic liver disease, cirrhosis X Cigarette smoking X Persons with functional or anatomic asplenia Sickle cell disease/other hemoglobinopathies X X X Congenital or acquired asplenia X X X Immunocompromised persons Congenital or acquired immunodeficiencies ¶ X X X HIV infection X X X Chronic renal failure X X X Nephrotic syndrome X X X Leukemia X X X Lymphoma X X X Hodgkin disease X X X Generalized malignancy X X X Iatrogenic immunosuppression ** X X X Solid organ transplant X X X Multiple myeloma X X X
Abbreviations: PCV13 = 13-valent pneumococcal conjugate vaccine; PPSV23 = 23-valent pneumococcal polysaccharide vaccine. TABLE 1. Summary of recommended intervals, by risk and age groups, for persons with indications to receive PCV13 and PPSV23 sequence — Advisory Committee on Immunization Practices, United States, September 2015 Risk medical condition Intervals for sequence, by age group Intervals for sequence, by age group 24–71 ≥65 24–71 ≥65 No underlying chronic conditions NA NA NA ≥1 year NA NA NA ≥1 Immunocompetent persons Chronic heart disease Chronic lung disease Diabetes mellitus Alcoholism* Chronic liver disease, cirrhosis* Cigarette smoking* ≥8 weeks NA NA ≥1 year ≥8 weeks NA NA ≥1 Immunocompetent persons Cerebrospinal fluid leak ≥8 weeks ≥8 ≥8 ≥8 ≥8 ≥8 ≥1 ≥1
Positive results must be reported in the National Electronic Disease Surveillance System (NEDSS) or on a Hepatitis B Infection in Pregnant Women or Child (EPID 394) form. Forward all HBsAg-positive results on pregnant women, reported on the EPID 394 form, to the Kentucky Perinatal Hepatitis B Prevention Coordinator by mail or fax, within one business day of results being reported: Mail the results to: Perinatal Hepatitis B Prevention Coordinator 275 East Main Street, HS2E-B Frankfort, KY 40621 Fax the results to 502-564-4760 1: Interpretation of Hepatitis B Serologic Tests Test Results Interpretation HBsAg Anti-HBc Anti-HBs Negative Negative Negative Susceptible to infection HBsAg Anti-HBc Anti-HBs Negative Negative Positive with ≥10 mIU/mL+ Immune due to vaccination HBsAg Anti-HBc Anti-HBs Negative Positive Positive Immune and recovered from past hepatitis B virus (HBV) infection HBsAg Anti-HBc IgM anti-HBc Anti-HBs Positive Positive Positive Negative Acutely infected