The following are recommended as a standard of care.
Figure 1: Recommended Adult Immunization Schedule by Age Group
Figure 2: Recommended Adult Immunization Schedule by Medical Condition -- United States, 2003-2004*
Click image to enlarge.
- For women without chronic diseases/conditions, vaccinate if pregnancy will be at second or third trimester during influenza season. For women with chronic diseases/conditions, vaccinate at any time during the pregnancy.
- Although chronic liver disease and alcoholism are not indicator conditions for influenza vaccination, administer 1 dose annually if the patient is aged >50 years, has other indications for influenza vaccine, or requests vaccination.
- Asthma is another indicator condition for influenza but not for pneumococcal vaccination.
- For all persons with chronic liver disease.
- For persons aged <65 years, revaccinate once after 5 years have elapsed since initial vaccination.
- Persons with impaired humoral but not cellular immunity may be vaccinated.
- For hemodialysis patients use special formulation of vaccine (40 mg/mL) or two 1.0 mL 20 microgram doses administered at one site. Vaccinate early in the course of renal disease. Assess antibody titers to hepatitis B surface antigen (anti-HBs) levels annually. Administer additional doses if anti-HBs levels decline to <10 mlU/mL.
- No data have been reported specifically on risk for severe or complicated influenza infections among persons with asplenia. However, influenza is a risk factor for secondary bacterial infections that might cause severe disease in asplenics.
- Administer meningococcal vaccine and consider Haemophilus influenzae type b vaccine.
- In the event of elective splenectomy, vaccinate >2 weeks before surgery.
- Vaccinate as close to diagnosis as possible when CD4 cell counts are highest.
- Withhold MMR or other measles-containing vaccines from HIV-infected persons with evidence of severe immunosuppression.