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1-03: Prevention of Infectious Diseases

Michael Pignone; René Salazar

Much of the historic decline in the incidence and fatality rates of infectious diseases is attributable to public health measures—especially immunization, improved sanitation, nonpharmacologic interventions (eg, mask-wearing to prevent respiratory-transmissible conditions), and better nutrition. This observation has been reinforced by the experience during the global COVID-19 pandemic.

Immunization remains the best means of preventing many infectious diseases. Recommended immunization schedules for children and adolescents can be found online at http://www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html, and the schedule for adults is at http://www.cdc.gov/vaccines/schedules/hcp/adult.html (see also Chapter 30 and Chapter 32). In addition to the severe toll in morbidity and mortality from COVID-19, substantial morbidity and mortality continues to occur from vaccine-preventable diseases, such as hepatitis A, hepatitis B, influenza, and pneumococcal infections. The high incidence and mortality rates from COVID-19 and other recent outbreaks of vaccine-preventable diseases in the United States highlight the need to understand the association of vaccine hesistancy or refusal and disease epidemiology and methods for overcoming it.

The Advisory Committee on Immunization Practices recommendations for the following vaccines appears in Table 1–3: influenza; measles, mumps, and rubella; 23-valent pneumococcal polysaccharide vaccine; tetanus, diphtheria, and acellular pertussis; hepatitis B; and HPV.

Table 1–3.Advisory Committee on Immunization Practices vaccine recommendations, 2021.
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Table 1–3. Advisory Committee on Immunization Practices vaccine recommendations, 2021.
Vaccine Recommendation Comment
Influenza

Routine vaccination for all persons aged 6 months and older, including all adults

An alternative high-dose inactivated vaccine is available for adults aged 65 years and older

 When vaccine supply is limited, certain groups should be given priority, such as adults aged 50 years and older, individuals with chronic illness or immunosuppression, and pregnant women
MMR Two doses for adults at high risk for exposure and transmission (eg, college students, health care workers); otherwise, one dose for adults aged 18 years and older Physician documentation of disease is not acceptable evidence of MMR immunity
PPSV23

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 PCV13 in average-risk individuals aged 65 and older

  
Tdap Routine use of a single dose of for adults aged 19–64 years Replaces the next booster dose of Td
Hepatitis B

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 ESKD)

Recommended for diabetic patients aged 19–59 years

Should be considered in diabetic persons age 60 and older

 Prevents chronic hepatitis B and cirrhosis and their predispositions to HCC
HPV VLP

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 licensed for adults older than 45 years)

 Prevents persistent HPV infections effectively and thus may impact the rate of CIN II–II

CIN, cervical ...

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