Skip to Main Content

Chapter 2: Community and Preventive Medicine

Amanda Ashcraft Pannu

PREVENTIVE MEDICINE

  • 1° prevention: Disease prevention measures such as counseling for at-risk behaviors, immunizations, and chemoprevention that are taken before the disease develops.

  • 2° prevention: Defined as early detection and treatment of asymptomatic disease, including risk assessment.

  • 3° prevention: Management of chronic diseases to prevent or minimize complications.

  • Characteristics that make a disease appropriate for screening include:

    • Disease leads to significant morbidity and mortality.

    • Effective treatment is available.

    • Disease is detectable in the asymptomatic period.

    • Testing is accurate and simple.

    • Treatment administered during the asymptomatic period yields a better outcome than treatment in the symptomatic period.

  • Characteristics of risk factors that would be appropriate for screening are:

    • High prevalence of the risk factor in the population to be screened.

    • Large portions of those with the risk factor are unidentified.

    • Associated disease should have a high incidence in the population to be screened.

    • Disease should have serious consequences.

    • Readily available treatment that can modify the risk factor.

    • Risk modification should ↓ disease incidence.

Adult Immunizations

Table 2.1 outlines common adult immunizations and their indications. For information on immunization of pediatric populations, refer to the Child and Adolescent Medicine chapter.

Table 2.1Recommended Adult Immunization Schedule
View Table||Download (.pdf)
Table 2.1 Recommended Adult Immunization Schedule
VACCINE SCHEDULE
Td/Tdap

Give the complete 1° series if the patient has not been previously vaccinated (first dose, Tdap; second dose, Td 4 weeks later; third dose, Td 6 months later)

Tdap can substitute for only one of the three Td doses in the series

Booster doses of Td should be given every 10 years thereafter
Human papillomavirus Vaccinate girls and boys at 11 or 12 years (or as early as 9 years) with catch-up vaccination for young women and young men between 13 and 26 years, and for men aged 22-26 years if immunocompromised (including HIV) and men who have sex with men (MSM)
Varicella If the patient has a history of chickenpox, consider immune; otherwise, vaccinate with two doses given 1-2 months apart
Herpes zoster Single dose recommended for adults ≥60 years regardless of whether they report a prior episode of herpes zoster
Measles, mumps, rubella

If the patient was born before 1957, consider immune

If the patient was born after 1957, two doses should be given at least 1 month apart

For rubella specifically, ensure that women of childbearing potential have immunity
Influenza One dose annually recommended for all persons aged ≥6 months, including all adults

Pneumococcal (polysaccharide):

PPSV23 (older)

PCV13 (newer)

Give to all adults ≥65 years: PCV13, then PPSV23 12 months later

Adults 19-64 years with comorbid conditions (chronic pulmonary disorders excluding asthma, CVD, DM, chronic liver or renal disease): PPSV23 vaccine only, give second dose ≥5 years later

Adults with asplenia or immunosuppression: Both vaccines (PCV13 first, then PPSV23 8 weeks later)
Hepatitis A

Vaccinate any person seeking protection or people of the ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.

This site uses cookies to provide, maintain and improve your experience. MH Privacy Center Close