Few medical interventions of the past century can rival the effect that immunization has had on longevity, economic savings, and quality of life.
Vaccines have both a direct impact (protecting the vaccinated individual against infection) and indirect effects (reducing transmission of infectious agents from immunized people to others).
Vaccine programs attempt to control, eliminate, or eradicate a disease.
– Control programs: limit the disruptive impacts associated with outbreaks in a defined geographic area
– Elimination programs: require a blockage in the indigenous sustained transmission of an infection in a defined geographic area, with possible importation of sporadic cases from other areas requiring ongoing interventions
– Eradication programs: considered successful if elimination of a disease can be sustained without ongoing interventions. Smallpox is the only vaccine-preventable disease that has been globally eradicated; considerable effort is ongoing in attempts to eradicate polio.
IMMUNIZATION PRACTICE STANDARDS
Figure 214-1 summarizes the adult immunization schedules for 2011.
Before vaccination, pts must be screened for contraindications (conditions that substantially increase the risk of a serious adverse reaction) and precautions (conditions that may increase the risk of an adverse event or that may compromise the ability of the vaccine to evoke immunity). Table 214-1 summarizes the contraindications and precautions for vaccines used commonly in adults.
A vaccine information statement must be provided to all vaccine recipients; current VISs are available online at www.cdc.gov/vaccines and www.immunize.org/vis/. (The latter website includes translations.)
Any adverse event that occurs after immunization and that may or may not be related to the vaccine should be reported to the Vaccine Adverse Event Reporting System (www.vaers.hhs.gov).
TABLE 214-1CONTRAINDICATIONS AND PRECAUTIONS FOR COMMONLY USED VACCINES IN ADULTS |Favorite Table|Download (.pdf) TABLE 214-1CONTRAINDICATIONS AND PRECAUTIONS FOR COMMONLY USED VACCINES IN ADULTS
|Vaccine Formulation ||Contraindications and Precautions |
|All vaccines || |
Severe allergic reaction (e.g., anaphylaxis) after a previous vaccine dose or to a vaccine component
Moderate or severe acute illness with or without fever; defer vaccination until illness resolves
|Td || |
GBS within 6 weeks after a previous dose of TT-containing vaccine
History of Arthus-type hypersensitivity reactions after a previous dose of TT-containing vaccine; defer vaccination until at least 10 years have elapsed since the last dose
|Tdap || |
History of encephalopathy (e.g., coma or prolonged seizures) not attributable to another identifiable cause within 7 days of administration of ...