Routine vaccination is among the most significant of all medical advances and is a cornerstone for all preventive medical goals. Although many vaccine-preventable diseases (VPD) such as Haemophilus influenzae type b (Hib) infection are now rarely encountered, others such as pertussis persist despite widespread vaccination. Despite demonstrated vaccine effectiveness, concerns about vaccine efficacy, safety, and duration of protection continue to interfere with universal acceptance of some vaccines, and misinformation abounds. Important facets of vaccination include the patient’s age and underlying medical conditions, disease burden, vaccine efficacy and adverse reactions, and official recommendations.
General Rules for Vaccination
To achieve optimal protection, every clinician should vaccinate all patients in accordance with the timeline of the Centers for Disease Control and Prevention (CDC) universal vaccine schedules, found at https://www.cdc.gov/vaccines/schedules/index.html. The schedules are updated annually, so rather than printing any here, the reader is referred to CDC’s website. Full compliance with CDC schedules now protects individuals against 16 VPDs, many of which have multiple types such as the 3 types of polio, 4 types of influenza, or 5 types of meningococcus. With few exceptions, notably rabies vaccine, all vaccine doses count for all time, even if separated by years, as long as minimal intervals are met. Prolonged delay between vaccine doses does not necessitate restarting a vaccine series, but a dose should not be given ≥4 days before the recommended age. A handy information source is the Shots Immunizations App by AAFP and STFM at https://www.aafp.org/patient-care/public-health/immunizations/shots-app.html, which is also downloadable to any iPhone/Android device. A useful childhood CDC Catch-Up Vaccine Scheduler is available at https://www.vacscheduler.org/index.html. Correct storage and management of vaccines are critical to effectiveness. These issues are covered in CDC publications and online at https://www.cdc.gov/vaccines/hcp/admin/storage/index.html. A discussion of specific vaccine products can be found on the Immunization Action Coalition website, which offers an exceptionally broad range of information in an easy-to-use format at http://www.immunize.org/.
Five hepatitis B vaccines (HepB) are available in the United States: Engerix-B or Recombivax HB, both monovalent vaccines given at birth and in a three-dose series at times 0, 1–2, and 6 months; Pediarix, a pentavalent vaccine given at age 2, 4, and 6 months (maximum age 6 years); Heplisav-B, given at time 0 and 1 month and at a minimum age of 18 years; and Twinrix, a bivalent vaccine given at time 0, 1, and 6 months and at a minimum age of 18 years. All children should be immunized against HBV. Adults with diabetes mellitus or other specific conditions like hepatitis C or travel or workplace risk (healthcare workers) should also be vaccinated (see https://www.cdc.gov/vaccines/hcp/vis/vis-statements/hep-b.html).
Rationale for Routine Hepatitis B Vaccination
The estimated number of persons in the United States chronically infected with hepatitis B virus (HBV) is 1.25 million, 36% of whom acquired HBV ...