This document summarizes various adult immunization guidelines. It discusses vaccines for tetanus, diphtheria, pertussis, human papillomavirus, influenza, varicella, herpes zoster, measles, mumps, rubella, pneumococcus, meningococcus, hepatitis A, hepatitis B, and Japanese encephalitis. For each vaccine, it provides information on disease burden, target populations for vaccination, vaccine types, dosing schedules, efficacy, contraindications and precautions. The document was written by Dr. Sshrutkirti Gupta and provides a comprehensive overview of recommended adult immunizations.

1. Adult immunization
By Dr. Sshrutkirti gupta
Consultant
Microbiologist
KEM MUMBAI

2.  Tetanus pertussis & diphtheria
 Human Papillomavirus
 Influenza
 Varicella
 Zoster
 MMR
 Pneumococcus
 Meningococcus
 Hepatitis A
 Hepatitis B
 JAPANESE B ENCEPHALITIS
 SWINE FLU

3. Vaccine- Definition
 A vaccine is any preparation intended
to produce immunity to a disease by
stimulating the production of antibodies.
 Suspensions of killed or live attenuated
microorganisms, or products or
derivatives of microorganisms.

4. Tetanus pertussis & diphtheria
 Burden of pertussis:
 1 to 3 million cases annually,
increases in adult.
 Morbidity: 13,278 cases reported
in 2008 U.S
Ages 15 and older – 4,145 cases
Ages 25 and older – 2,760 cases
• Objective:
Protection from pertussis
Reduce reservoir of Bordetella
pertussis in adult.

5. Tdap Vaccines
Recommendation
 Adults with incomplete history of primary
immunization or who have not received primary
immunization.
 Adult with pri. Immunization should get booster
every 10 yrs wt Tdap or Td.
 In pregnant women 2nd &3rd trimester.
 Wound management in adult or adolescent.
 Health care worker contact wt infants &children.

6.  VACCINE (Killed vaccine-adsorbed tetanus toxoid)
1.Adacel : 5 pertussis antigen
2.Boostrix: 3 pertussis antigen
◦ 3 doses : single dose of Tdap
◦ Td at least 4 weeks after the1st dose
◦ 3rd dose of Td at least 6 months after the Td dose.
 0.5 ml ,IM Advice
 92% protection rate
 Contraindication
 Anaphylaxis to component to vaccine like thiomersal.
 History with unstable neurologic condition.
 Encephalopathy within 7 days of administration of a
pertussis vaccine that is not attributable to another
identifiable cause.

8. Human Papillomavirus
 Burden : 6 million cases annually, 3 out of 4
younger female in US
 More than 100 types
 More than 60 cutaneous types- skin warts
 40 mucosal types(16, 18,6,11)
 HPV16, 18 – Cervical cancer 70%
 Low or high grade cervical abnormalities 30-
50%
 Head and neck cancers 10%
 HPV 6, 11 -Low grade cervical abnormalities
10%
Genital warts 90%
Resp.papillomatosis 90%

9.  Target population :
Female 9 to 26 yrs
Males 9 to 26 yrs
 HPV vaccine
 HPV4 (Gardasil)
◦ Contains types 16 and 18 (high risk) and types 6
and 11 (low risk)
 HPV2 (Cervarix)
◦ Contains types 16 and 18 (high risk)
◦ 3Doses advised : 0 ,2,6,( Gardasil)&
0,1,6,(Cervarix )
• Males – HPV4
• Females –HPV2 as well as HPV4
• 0.5 ml IM rout
• Not recommended during pregnancy

10. Influenza
 BURDEN: 10-20% of US population affected
annually
200,000 hospitalizations
36,000 deaths (average)
INDIA-May2003 influ.A(H3N2) outbreak in
Murshidabad (West Bengal).211 cases wt Res.
Illness.
 Recommendation:
 Adults aged 50 years or older.
 Pregnant women during the influenza season.
 Chronic diseases:( Pulmonary including asthma,
heart diseas,Renal ,Hepatic, diabetic).
 Immunosuppressed persons.
 Those with any condition that can compromise

11.  VACCINE
 Two forms are available
1. Inactivated influenza vaccine TIV(H3N2, H1N1, B)
 s/c route o.5 ml
 70%-90% effective among healthy persons <65
years of age
 30%-40% effective among persons 65 years and
older.
2. Live attenuated influenza vaccine
persons 2 through 49 years of age who are healthy
and not pregnant.
 Nasal spray ,Immunity lasts for 1yrs .
 Booster require on annual basis.

12.  Contraindications :
 severe allergic reaction to eggs or vaccine
component.
 For LAIV only: pregnancy .
Underlying medical conditions
Immunosuppression
History of Guillain-Barre´ syndrome within 6 weeks
following a previous dose of influenza vaccine

13. Varicella (chicken pox)
 Burden of varicella : in US
 3,000 deaths annually.
 5.4 cases/1,000 person-years for all ages.
 11.7/1,000 person-years for 65 years and
older.
 Recommendation:
All adults who never had chicken pox or
vaccinated.
 Special consideration- Teachers of young
children
Military personnel.
International travelers.

14. Varicella Vaccine
 Live vaccine
 Varilrix & okavax
Both contain attenuated live VZV(oka strain)
 Schedule - 2 doses separated by at least 4
weeks
 Efficacy
70%-90% against varicella disease.
95%-100% against severe diseas.
Varicella zoster immuneglobulin (VZIg)
post exposure prophylaxis within 72 hrs
125U/10 kg of body wt. up to 625 U max.

15.  Contraindication:
 Pregnancy
 Immunocompromised pt .like leukemia, lymphoma,
malignant neoplasm affecting bone marrow or
lymphatic system.
 Precautions : persons who have received blood or
bl. Products in the past 1 yr.
 Adverse reaction:
 Injections site complaints - 20%
 Rash - 4% - 6%.
 Temperature 102°F or higher - 10% - 15%
 Two or more vaccines can be introduced on the
same time but should be at diff. locations

16.  Reactivation of a latent
varicella zoster virus
infection in the form of
painful skin rash.
 Can occur years or
decades after illness with
chickenpox
 More common in older
people, people with weak
immune system, healthy
children& young adult
SHINGLES (HERPES ZOSTER)

17.  Burden :
 About 1 million cases annually, 1in3 Americans will
get shingels in their life time.
 Recommendation:
 All adult after 60 yrs of age & older.
 People who had previous infections.
 VACCINE
 Live attenuated vaccine.
 Subcutaneous route,0.65 ml in deltoid region.
 No booster required.
 Contraindicated in immuno compromised persons.

18. Measles-Mumps-Rubella
 Measles
Each year about 450 people died, 48,000 were
hospitalized, 7,000 had seizures, &about 1,000
permanent brain damage or deafness.
 Mumps
Is rarely fatal, causes a bilateral parotitis or
occasionally orchitis.
 Rubella
”German measles” mild disease including fever &
rash. In pregnancy-congenital rubella syndrome.
 Target population:
 All adult, all women of childbearing age, college
student healthcare workers and travelers to
endemic areas.

19. MMR VACCINE:
 Live attenuated strain is use.
1.Edmonston Zagrab for measles
2.L- zagreb for Mumps
3.Potkins RA 2713 for rubella
 Dose efficacy varies from 80% (mumps) to 95%
(measles & rubella)
 Duration of immunity probably lifelong
 2 doses at least 1month apart, 0.5 ml S.C route
 Contra indication:
Receipt of blood products or immune globulin within
the preceding 3 to 12 months,
Pregnancy allergy to vaccine component (neomycin
or gelatin), immune compromised person.

20. Pnemococcus
 Burden: Among older adults is substantial (50
cases/100,000)
 More than 40,000 invasive infections annually
 More than 4,500 deaths
 Target population:
 Adults 65 years of age and older.
 Adults of any age with who have chronic illness.
 CVS disease ,pulmonary disease, diabetes,
alcoholism, cirrhosis,CSF leak.
 Functional or anatomic asplenia or in elective
spleenectomy.
 Other high risk state

21.  VACCINE
 Pneumococcal polysaccharide vaccine PPV
 Purified capsular polysaccharide antigen from 23
types of pneumococcus
 88% of pneumococcal disease
 Schedule 1 dose
 60% to 70% efficacy.
 Immunity at least 6 years
 Revaccination in high risk ( 5 years after the 1st
dose)
 Pneumococcal conjugate vaccine PCV13 is used in
younger individuals
 Contraindications:
 Anaphylactic reaction to the vaccine or its
components.

22. Meningococcal diseases
 1400 to 2800 infected annually in US.
 1 in 10 people die & up to 2 in 20 survivors will have
permanent disabilities( deafness, brain damage.)
 Target population:
 Adolescents ,college student live in a dormitory
 Military personnel
 Those with anatomic or functional asplenia
• Complement component deficiency &HIV infection.
 Travelers to a country with an outbreak of
meningococcal disease.

23.  Vaccine:
Two types of vaccine
1.Polysaccharide vaccines:
 Bivalent (A+C) & Quadrivalent (A,C,Y,W135)
 vaccine advised age >55 years
 MPSV is administered as a single 0.5-mL dose
2. Conjugate vaccines.(MCV4)
 Covalent linkage of polysaccharide to a carrier
protein (diphtheria/tetanus toxoid), which converts
the polysaccharide to antigen which enhances Ab
formation.
 Preferred in 2 to 55 yrs
 Revaccination for after 5 yrs

24. Hepatitis A
 13,000 total cases in 2007 annually in US.
 Target population:
 Men who have sex with men.
 Recipients of clotting factor concentrates.
 Drugs user.
 Persons with chronic liver disease.
 Individuals traveling to or working in countries
where HAV is endemic.
 Vaccine:
 Inactivated single antigen vaccine(HAV)
 e.g., Havrix® (GlaxoSmithKline) Vaqta® (Merck &
Co);
 Combination vaccine e.g., Twinrix®

25.  Doses :
2 dose -0,6-18 M apart
1 to 18 yrs- 0.5 ml IM
More than 19yrs- 1 ml IM
Combination (HAV+HBV) 1ml IM – 3 doses 0,1,6.
80-90% efficacy
Immunity begins 2-4 weeks after injection.
 Post-exposure prophylaxis
 Healthy person 1-40yrs HAV vaccine is preferred
over anti-HAV immunoglobulin coz of long term
protection, equivalent efficacy of vaccine.
 anti-HAV immunoglobulin (0.02 ml/kg,
intramuscularly) as soon as possible, within two
weeks

26. Hepatitis B
 Estimated 25,000 total cases in 2007
 Most of the deaths with HBV infection are due to
hepatocellular carcinoma.
 Target population:
 Persons with end-stage renal disease.
 Persons wt. sexually transmitted infection (STI)
 HIV
 Chronic liver disease
 Healthcare workers exposed to blood or body fluids
 Sexually active individuals.
 IV drug users
 Men who have sex with men

27.  Vaccine(HBV) RECOMBINANT DNA VACCINE
 Derived from cultures of yeast cloned with HBsAg s
gene
 Series of 3 doses at 0,1 and 6 months.
 0.5 ml IM injection.
 90% protection rate.
 When antibody levels decline to less than 10 mIU/mL, a
booster dose is recommended.
 Contraindications:
 Severe allergic reaction such as anaphylaxis after a
previous vaccine dose or hypersensitivity to yeast.

29. JAPANESE B
ENCEPHALITIS
 3 TYPES OF VACCINE
 Mouse brain derived
purified and inactivated
vaccine
 Cell culture derived
inactivated JE vaccine
 Cell culture derived live
attenuated vaccine SA-
14-14-2 for 1-15 yrs
 2 doses 28 days apart
 Booster after one year
and than every 3 years

30. THNK YOU