diabetes; anemia or other blood disorders; HIV/AIDS; patients with weakened immune systems) cirrhosis; diabetes; CSF leaks; alcoholism; cancer …
MEMORANDUM
To: Len Pogach, MD
Chair, VA/DoD National Clinical Practice Guidelines Council
Office of Quality and Performance, Veterans Health Administration
From: VA National Center for Health Promotion and Disease Prevention
Re: Proposal for new Clinical Practice Guideline for Adult Immunizations
Date: 21 Sept 2004
Proposed VA/DoD Clinical Practice Guideline:
|Immunize adults according to the following schedule: |
| |
|Influenza Immunization |
|Administer to: |
|All adults age 50 and older |
|Adults less than age 50 with chronic illness ie heart, lung or kidney |
|disease; asthma; diabetes; anemia or other blood disorders; HIV/AIDS; |
|patients with weakened immune systems |
|Residents of long-term care facilities |
|Women who will be pregnant any time during the influenza season |
|Patients
with spinal cord injury or disease |
|Health care workers |
|Administer annually between September and February optimal time is |
|October and November |
|Give the vaccine intramuscularly |
|Do not administer to: |
|People with a history of anaphylactic reaction to the vaccine, to any of |
|its components, or to eggs |
|People who have moderate or severe acute illness |
|Use inactivated influenza vaccine only |
| |
|Pneumococcal Immunization PPV 23 |
|Administer to: |
|All adults age 65 and older |
|Adults less than age 65 with chronic illness that places them at highest |
|risk for serious pneumococcal infection HIV/AIDS; sickle cell
disease; |
|immunosuppressive treatment with radiation, chemotherapy or long-term |
|steroids; anatomic or functional asplenia; s/p organ or bone marrow |
|transplant; nephritic syndrome or renal failure |
|Adults less than age 65 with chronic illness that places them at high risk|
|for serious pneumococcal infection heart disease; lung disease; |
|cirrhosis; diabetes; CSF leaks; alcoholism; cancer including leukemia, |
|lymphoma, multiple myeloma; spinal cord injury or disease |
|Residents of long-term care facilities |
|Native Americans |
|Candidates for or recipients of cochlear implants |
|Administer once at any time of the year |
|Give the vaccine intramuscularly or subcutaneously |
|Patients who qualify for a second and final dose are those for whom five |
|or more years have elapsed since the previous PPV immunization and the |
|patient is: |
|Age 65 or older and received PPV
immunization when less than age 65 |
|At highest risk for serious pneumococcal infection see definition above |
|and/or likely to have a rapid decline in pneumococcal antibody levels |
|Do not administer to: |
|People with a history of anaphylactic reaction to the vaccine or to any of|
|its components |
|People who have moderate or severe acute illness |
| |
|Hepatitis B Immunization |
|Administer to: |
|High-risk adults, including household contacts and sex partners of |
|HbsAg-positive persons; users of illicit injectable drugs; heterosexuals |
|with more than one sex partner in 6 months; men who have sex with men; |
|people with recently diagnosed sexually transmitted diseases; patients |
|receiving hemodialysis and patients with renal disease that may result in |
|hemodialysis; recipients of certain blood products; health care workers
|
|exposed to blood |
|Administer a series of 3 injections on a 0, 1, and 6 month schedule |
|Give the vaccine intramuscularly |
|If the series is delayed between doses, do not start the series over; |
|continue from where it was left off |
|Do not administer to: |
|People with a history of anaphylactic reaction to the vaccine or to any of|
|its components |
|People who have moderate or severe acute illness |
| |
|Hepatitis A Immunization |
|Administer to: |
|Patients with chronic liver disease, including people with hepatitis C; |
|people with hepatitis B who have chronic liver disease; illicit drug |
|users; men who have sex with men; patients with clotting factor disorders|
|Administer two doses, with a minimum interval
between dose 1 and dose 2 |
|of 6 months If dose 2 is delayed, do not repeat dose 1 |
|Give the vaccine intramuscularly |
|Do not administer to: |
|People with a history of anaphylactic reaction to the vaccine or to any of|
|its components |
|People who have moderate or severe acute illness |
| |
|Tetanus/Diphtheria Td Immunization |
|Administer: |
|Primary series at 0, 1-2 months, and 6-12 months to all adults who have |
|not been previously vaccinated if the series has been interrupted, do not|
|restart from the first dose |
|Booster dose every ten years to those whose primary series has been |
|completed |
|Give vaccine intramuscularly |
|Do not administer to:
|
|People with a history of anaphylactic or neurologic reaction to the |
|vaccine or to any of its components |
|People who have moderate or severe acute illness |
| |
|RA |
Advisory Committee on Immunization Practices ACIP Recommendation:
Adult Immunization Schedule
Evidence:
Attached are links to ACIP recommendations of the prevention of
vaccine-preventable diseases in adults
Recommendations for the Prevention and Control of Influenza
Recommendations for the Prevention of Pneumococcal Disease
Recommendations for the Prevention of Tetanus, Diphtheria, and
Pertussis
Recommendations for the Prevention of Hepatitis B
Recommendations for the Prevention ofHepatitis A
Source:oqp.med.va.gov
