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Much of the decline in the incidence and fatality rates of infectious diseases is attributable to public health measures—especially immunization, improved sanitation, and better nutrition.

Immunization remains the best means of preventing many infectious diseases. Recommended immunization schedules for children and adolescents can be found online at, and the schedule for adults is at (see also Chapter 30). Substantial morbidity and mortality from vaccine-preventable diseases, such as hepatitis A, hepatitis B, influenza, and pneumococcal infections, continue to occur among adults. Increases in the number of vaccine-preventable diseases in the United States (eg, regional epidemics) highlight the need to understand the association of vaccine refusal and disease epidemiology.

Evidence suggests annual influenza vaccination is safe and effective with potential benefit in all age groups, and the Advisory Committee on Immunization Practices (ACIP) recommends routine influenza vaccination for all persons aged 6 months and older, including all adults. When vaccine supply is limited, certain groups should be given priority, such as adults 50 years and older, individuals with chronic illness or immunosuppression, and pregnant women. An alternative high-dose inactivated vaccine is available for adults 65 years and older.

The ACIP recommends two doses of measles, mumps, and rubella (MMR) vaccine in adults at high risk for exposure and transmission (eg, college students, health care workers). Otherwise, one dose is recommended for adults aged 18 years and older. Physician documentation of disease is not acceptable evidence of MMR immunity.

Routine use of 23-valent pneumococcal polysaccharide vaccine (PPSV23) is recommended for adults aged 65 and older. If PPSV23 was administered prior to age 65 years, administer one dose PPSV23 at least 5 years after previous dose. A shared clinical decision-making approach is recommended for use of 13-valent pneumococcal conjugate vaccine (PCV13) in average-risk individuals aged 65 and older.

The ACIP recommends routine use of a single dose of tetanus, diphtheria, and five-component acellular pertussis vaccine (Tdap) for adults aged 19–64 years to replace the next booster dose of tetanus and diphtheria toxoids vaccine (Td).

Both hepatitis A vaccine and immune globulin provide protection against hepatitis A; however, administration of immune globulin may provide a modest benefit over vaccination in some settings. Hepatitis B vaccine administered as a three-dose series is recommended for all children aged 0–18 years and high-risk individuals (ie, health care workers, injection drug users, people with end-stage renal disease). The ACIP recommends vaccination for hepatitis B in diabetic patients aged 19–59 years. The hepatitis B vaccine should also be considered in diabetic persons age 60 and older.

Human papillomavirus (HPV) virus-like particle (VLP) vaccines have demonstrated effectiveness in preventing persistent HPV infections and thus may impact the rate of cervical intraepithelial neoplasia (CIN) II–III. The ACIP recommends routine HPV vaccination for children and adults aged 9–26 years. Shared decision-making is recommended for some individuals between 27 and 45 years of age (vaccine is not ...

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