IMMUNIZATIONS

As in the case for well child care, the provision of age and condition appropriate immunizations is an important component of well adult care. Recommendations for immunizations change from time to time and the most up-to-date source of vaccine recommendations is the Advisory Committee on Immunization Practices. Its immunization schedules are widely published and are available at the Centers for Disease Control and Prevention Web site (among other places), www.cdc.gov The CDC has recently recommended that all adults between 19 and 65 years of age should receive a booster of Tdap in place of a scheduled dose of Td booster in 10 years or more and who have never had a dose of Tdap. Persons who may need an increase in protection against pertussis, including health care workers, childcare providers, or those who anticipate having close contact with infants younger than 1 year, should receive a Tdap booster. An interval of 2 years from the last Td is recommended, although a shorter interval may be used if necessary. Influenza vaccination is recommended every year for adults older than 50 years. It is also recommended annually for those younger than 50 years with certain medical conditions and for persons who may transmit the infection to others who are at high risk (health care or nursing home workers, household contacts of high risk individuals,etc). High risk conditions include chronic diseases of the cardiovascular, pulmonary, and renal systems and metabolic diseases such as diabetes, hemoglobinopathies, and immunodeficiencies. Pneumococcal polysaccharide vaccination is recommended as a single dose for all adults aged 65 years or older. It is also recommended for adults younger than 65 years who have chronic cardiovascular, pulmonary, renal, or hepatic diseases, diabetes, or an immunodeficiency, or who are functionally asplenic. One time revaccination after 5 years is recommended for those older than 65 years if they were vaccinated longer than 5 years previously and were younger than 65 years at the time of initial vaccination. Other vaccinations may be recommended for specific populations, although not for all adults. Hepatitis B vaccination should be recommended for those at high risk of exposure, including health care workers, those exposed to blood or blood products, dialysis patients, intravenous drug users, persons with multiple sexual partners or recent sexually transmitted diseases, and men who engage in sexual relations with other men. Hepatitis A vaccine is recommended for persons with chronic liver disease, who use clotting factors, who have occupational exposure to the hepatitis A virus, who use IV drugs, men who have sex with men, or who travel to countries where hepatitis A is endemic. Varicella vaccination is recommended for those with no reliable history of immunization or disease, who are seronegative on testing for varicella immunity, and who are at risk for exposure to varicella virus. Meningococcal vaccine is recommended for persons with certain complement deficiencies, functional or anatomic asplenia, or who travel to countries where the disease is endemic.

Clinical Pearls  There is no such thing as “routine blood tests” or a “routine chest x-ray.” All tests that are ordered should have evidence to support their benefit. High-quality, evidence-based recommendations for preventive health services are available at www.preventiveservices.ahrq.gov

REFERENCES

Blaha, MJ et al. “A Practical “ABCDE” Approach to the Metabolic Syndrome.” Mayo Clinic Proceedings. August 2008;83(8): 932-943. Centers for Disease Control and Prevention Web site

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