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Updated: Nov 1 2021

Vaccines

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  • Snapshot
    • A 54-year-old man presents to her primary care physician for a worsening productive cough. His cough began approximately 2 months ago, and over the past week, he has been producing more yellow sputum. Medical history is significant for chronic obstructive pulmonary disease. He drinks occasionally and smokes 1-pack per day for the past 35 years. The patient is started on broad-spectrum antibiotics and receives 23-valent pneumococcal polysaccharide vaccine (PPSV23) due to his current cigarette use and chronic lung disease.
  • Introduction
    • Definition
      • an effective preventative health measure of disease
    • Terminology
      • live-attenuated vaccine
        • microorganism pathogenicity is lost but can still induce a cellular and humoral response
      • killed or inactivated vaccine
        • pathogen is inactivated but the epitope structure is maintained, inducing a humoral response
      • subunit vaccine
        • contains only that antigen that stimulates the immune system best
      • toxoid vaccine
        • bacterial toxoid with an intact receptor binding site
  • Vaccinations in Children (0-6 Years of Age)
      • Vaccinations in Children
      • Vaccine
      • Age
      • Comments
      • Hepatitis B
      • First dose within the first 24 hours of life
      •  Second dose at 1-2 months of age
      •  Third dose at 6-18 months of age
      • Subunit vaccine
      •  In HBsAg-positive mothers, the infant should receive the hepatitis B vaccine and hepatitis B immune globulin 
      • Rotavirus
      • First dose at 2 months
      • Second dose at 4 months
      • Third dose at 6 months
      • Live-attenuated vaccine
      • Can increase risk for intussusception
      • Diphtheria, tetanusand/or pertussis
      • First dose at 2 months
      • Second dose at 4 months
      • Third dose at 6 months
      • Fourth dose at 15-18 months
      • Fifth dose at 4-6 years of age
      • Booster doses are given starting at 11 years of age
      • Inactivated vaccine
      • H. influenzae type b conjugate
      • First dose at 2 months
      •  Second dose at 4 months
      •  Third dose at 12-15 months
      • Inactivated vaccine
      • Pneumococcal conjugate (PCV 13)
      • First dose at 2 months
      •  Second dose at 4 months
      •  Third dose at 6 months
      •  Fourth dose at 12-15 months
      • Inactivated vaccine
      • Poliovirus
      • First dose at 2 months
      •  Second dose at 4 months
      •  Third dose at 6-18 months
      •  Fourth dose at 4-6 years 
      • Inactivated vaccine
      • Influenza
      • Annually ≥ 6 months of age
      • Intramuscular vaccine is an inactivated vaccine
      •  Intranasal vaccine is a live-attenuated vaccine
      • Measles, mumps, and rubella
      • First dose at 12-15 months
      •  Second dose at 4-6 years of age
      • Live-attenuated vaccine
      • Varicella
      • First dose at 12-15 months
      •  Second dose at 4-6 years of age
      • Live-attenuated vaccine
      • Hepatitis A
      • First dose at 12-24 months
      •  Second dose given at least 6 months after the first dose
      • Inactivated vaccine
  • Vaccinations in Adolescents (7-18 Years of Age)
      • Vaccinations In Adolescents 
      • Vaccine
      • Age
      • Comments
      • Tetanus, diphtheria, acellular pertussis (Tdap)
      • 11-12 years of age
      • Inactivated vaccine
      • Human papillomavirus
      • Two doses at 9-14 years of age
      • in patients between the ages of 9-14, the 2 dose are administered 6-12 months after the first dose
      •  Three doses at ≥ 15 years of age
      • given at 0, 1-2, and 6 months
      • Subunit vaccine
      •  Three doses of this vaccine are also recommended in immunocompromised adolescent patients
      • Meningococcal
      • First dose at 11-12 years of age
      •  Second dose at 16 years of age
      • Inactivated vaccine
      • Influenza
      • First dose given at 7-10 years of age and then annually
      • Intramuscular vaccine is an inactivated vaccine
      •  Intranasal vaccine is a live-attenuated vaccine
  • Vaccinations in Adults (> 18 Years of Age)
      • Vaccinations in Adults
      • Vaccine
      • Age
      • Comments
      • Influenza
      • One dose annually
      • Inactivated vaccine
      •   In HBsAg-positive mothers, the infant should receive the hepatitis B vaccine and hepatitis B immune globulin 
      • Tetanus, diphtheria, acellular pertussis (Tdap) or tetanus and diphtheria (Td)
      • One dose Tdap and then a Td booster every 10 years 
      • In pregnant women, 1 dose of Tdap should be given during each pregnancy between 27-36 weeks gestation
      • Varicella
      • Two doses 4-8 weeks apart if the patient is without immunity to varicella
      • Zoster
      • Two doses given 2-6 months apart at ≥ 50 years of age
      • Pneumococcal (PPSV23)
      • Given at least 1 year after PCV13 administration in adults ≥ 65 years of age
      •  PPSV23 is indicated in
      • - patients 19-64 years of age with the following
      • chronic heart disease (excluding hypertension)
      • chronic liver disease
      • chronic lung disease
      • diabetes mellitus
      • cigarette smoking
      • - patients ≥ 19 with
      • immunodeficiency disorders
      • HIV
      • anatomical or functional asplenia
      • chronic renal failure or nephrotic syndrome
      • cerebral spinal fluid leak
      • cochlear implant
      • PPSV23 is given after PCV13
      •  PPSV23 is not conjugated and does not stimulate a helper T-cell response
  • Special Circumstances
    • Splenectomy
      • patients should receive vaccines to protect against encapsulated organisms
        • S. pneumoniae (pneumococcus)
        • H. influenzae
        • N. meningitidis (meningococcus)
      • vaccine regimen
        • PCV13 followed by PPSV23 ≥8 weeks later
        • H. influenzae type b vaccine
        • meningococcus vaccine
      • antibiotic prophylaxis
        • most children with anatomy or functional asplenia/hyposplenism
          • antibiotic prophylaxis (with penicillin V or amoxicillin) until the age of 5 for at least 1-year post splenectomy
    • HIV
      • inactivated vaccines are generally safe in this patient population
      • live-attenuated vaccines can be given in this patient population when their CD4+ T-cell count is ≥ 200 cells/μL
    • Patients with an egg allergy
      • can receive the measles, mumps, and rubella vaccine
      • cannot receive the yellow fever vaccine
    • Pregnancy
      • live vaccines are generally avoided in pregnancy
      • vaccines to be avoided
        • human papillomavirus
        • measles, mumps, and rubella
        • varicella
          • give post-exposure prophylaxis via varicella immune globulin (VZIG) within 10 days of exposure to varicella to confer passive immunity
        • zoster
    • Prematurity
      • no need to delay vaccination schedule based on prematurity
      • one exception, first dose of hepatitis B vaccine (typically given in the first 24-48 hours of life) can be delayed only if the infant is born with a birth weight of under 4 pounds 6 ounces
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