Internal Medicine
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Objectives
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Adult Vaccination
Cancer Screening
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PREVENTION & SCREENING
PREVENTIVE MEDICINE - ADULT VACCINATION RECOMMENDATIONS
1. INFLUENZA
Influenza has caused in excess of twenty thousand deaths in each of 10 different epidemics from 1972 to 1991. Inactivated influenza vaccine contains antigens for influenza A and B viruses. The vaccine has been shown to prevent or reduce severity of influenza in 70-80% of healthy children and adults under age 65. In one case control study, influenza vaccine prevented 3 1-45% of hospitalizations for pneumonia and influenza and 43-45% of deaths due to all respiratory conditions.
RECOMMENDATION: Influenza vaccine should be given annually to all persons aged 50 or older; residents of chronic care facilities; and persons with cardiopulmonary disease, diabetes, renal failure, immunosuppression, or hemoglobinopathies. Additionally, the AAP recommends that children between the age of 2 months and 6 years of age receive the vaccine. Lastly, the CDC has recommended that the vaccine be given to anyone who asks for it.
2. PNEUMOCOCCAL DISEASE
Pneumococcal disease accounts for 15% of severe community acquired pneumonia and a case fatality rate of 9-26%. Elderly carry a 30-43% case fatality rates. The current vaccine is a 23 valent polysaccharide injection.
RECOMMENDATION: Pneumococcal vaccine should be given every 5-6 years in persons 65 and over; residents of chronic care facilities; and persons with cardiopulmonary disease, diabetes, renal failure, asplenia, alcoholism, cirrhosis, cancer, immunosuppression, multiple myeloma, or sickle cell disease,
3. TETANUS AND DIPHTHERIA
As a result of routine immunization, tetanus an diphtheria are uncommon now in the U.S. Adults over age 50 account for the majority of cases of tetanus. Persons over 70 have a case fatality rate of 26%. Diphtheria is a potentially severe illness with a 5-10% case fatality rate.
RECOMMENDATION: A Td booster should be given every 10 years. Td should also be administered after a dirty would if a booster has not been given within 5 years
4. RUBELLA
Rubella is a mild adult illness that can cause miscarriage, stillbirth, and congenital rubella syndrome when contracted by pregnant women. The vaccine is 95% effective at conferring lifetime immunity. It is a live vaccine that should not be given to pregnant women. Women should be advised not to become pregnant prior to 3 months after the vaccine is administered.
RECOMMENDATION: All women of childbearing age should be revaccinated OR have serology confirming immunity in adulthood Childhood vaccination alone is not an acceptable strategy for adult women of childbearing age.
5. HEPATITIS B
An estimated 200,000 - 300,000 persons contract hepatitis B Virus (HBV) each year with 10,000 hospitalizations. The risk of chronic HPV is 6-10% after acute infection. Cirrhosis and hepatocellular cancer from HPV causes 5,000 deaths each year. The completed hepatitis B vaccination series is 85- 95% protective in immunocompetent individuals.
RECOMMENDATION: All infants and previously unvaccinated children! adolescents are actively being vaccination before adulthood. All high risk adults (IV drug use, male homosexuals, multiple sex partners, health care workers) should be vaccinated. All other adults who have not been vaccinated should be individually assessed and counseled about the potential benefits of this vaccine. In adults HiB vaccine is given at 0, 1, and 6 months.
6. VARICELLA
Varicella is a common childhood disease which carries a higher morbidity in adults and pregnant women. Studies with children and adolescents have shown an 86-98% efficacy. All children and previously unvaccinated adolescents are now actively being vaccinated before adulthood. Adults have a poorer immune response and 2 doses are required for optimal seroconversion.
RECOMMENDATION: Two doses of varicella vaccine given 4-8 weeks apart are recommended for healthy adults with no history of varicella or vaccination.
* Recommendations taken primarily from the U.S. Preventive Services Task Force, Guide to Clinical Preventive Services, 1996
Updated 2002 version can be viewed online at http://www.ahrg.gov/clinic!prevnew.htm
http://odphp.osophs.dhhs.gov/pubs/guidecps