Vaccination

Question 1

Influenza vaccine

Answer 1

All adults, annually.
Choose between trivalent or quadrivalent inactivated influenza vaccine (IIV), quadrivalent recombinant influenza vaccine (RIV4) or live attenuated influenza vaccine (LAIV, intranasal spray, age 2-49 w/o contraindications)
If >65, consider high-dose trivalent IIV or adjuvanted trivalent IIV formulations

Question 2

Tetanus vaccine

Answer 2

One dose Tdap, then either Td booster or Tdap every 10 years.
Recommend Tdap if >65 and close contact with infant <1yo

Question 3

MMR vaccine

Answer 3

One dose if no evidence of immunity (born after 1957, documentation of MMR vaccine, lab evidence of immunity or disease)

Question 4

Varicella vaccine

Answer 4

2-dose series 4-8 weeks apart if no evidence of immunity (US-born after 1980, documentation of 2-dose vaccination series, diagnosis or verified history of varicella by health care provider, lab evidence of immunity or disease)

Question 5

Shingles vaccine

Answer 5

Age 50 and older, 2-dose series 2-6 months apart (min 4 weeks) for RZV (Shingrix)

Question 6

HPV vaccine

Answer 6

Adults until age 45, 3-dose series at 0, 1-2 and 6 months (min 4 weeks between doses 1 and 2, 12 weeks between doses 2 and 3, 5 months between doses 1 and 3)

Question 7

Meningococcal vaccine (ACWY)

Answer 7

1. 1st year college students living in student housing
2. Military recruits
3. Travel to countries with hyperendemic or epidemic meningococcal disease
4. Anatomical or functional asplenia, HIV infection, persistent complement component deficiency, complement inhibitor use (eculizumab, ravulizumab) - also give MenB for these patients

Question 8

Pneumococcal vaccine in immunocompetent patients

Answer 8

Age 65+

• Give 1 dose PPSV23 (if received prior dose before age 65, wait until 5 year before last dose)
• Use shared decision making for PCV13 (if administering both, give PCV13 first, PPSV23 and PCV13 formulations should be given 1 year apart)

Question 9

Pneumococcal vaccination in special populations

Answer 9

• 19-64 w/ chronic medical conditions (heart, lung or liver disease, diabetes), alcoholism or cigarette smoking: 1 dose PPSV23
• 19+ w/ immunocompromising conditions (congenital or acquired immunodeficiency, chronic renal failure, nephrotic syndrome, leukemia, lymphoma, Hodgkin disease, generalized malignancy, iatrogenic immunosuppression, solid organ transplant, multiple myeloma) or anatomical/functional asplenia: 1 dose PCV13 then 1 dose PPSV23 at least 8wk later, then repeat PPSV23 5 years after previous PPSV23 dose; repeat PPSV23 at age 65+ with 5 year interval min since last dose
• 19+ w/ CSF leak or cochlear implant: 1 dose PCV13 then 1 dose PPSV23 at least 8wk later; repeat PPSV23 at age 65+ with 5 year interval min since last dose1

Question 10

Hib vaccine

Answer 10

• Anatomical/functional asplenia: 1 dose, give at least 14 days prior to splenectomy
• Hematopoietic stem cell transplant: 3-dose series 4 weeks apart starting 6-12 months after successful transplant regardless of prior vaccination status

Question 11

Hepatitis A vaccine

Answer 11

Give either 2-dose HepA series (Havrix 6-12mo apart or Vaqta 6-18 months apart) or 3-dose HepA-HepB series (Twinrix at 0, 1, 6 months)
Consider in special populations:
-Chronic liver disease
-HIV infection
-MSM
-Injection or noninjection drug use
-Persons experiencing homelessness
-Researchers working with HepA
-Travel to endemic countries
-Close, personal contact with international adoptee

Question 12

Hepatitis B vaccine

Answer 12

Give either 2-dose series (Heplisav 4wk apart) or 3-dose series (Engerix-B or Recombivax HB at 0, 1, 6mo) or 3-dose HepA-HepB series (Twinrix at 0, 1, 6 months).
Consider in special populations:
-Chronic liver disease
-HIV infection
-Sexual exposure risk
-Current or recent IV drug use
-Percutaneous or mucosal risk of exposure to blood
-Incarcerated persons
-Travel to endemic countries