Cvs Nur 732 Adult Imminuzations

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(Td/Tdap)?

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Tetanus, diphtheria, and acellular pertussis vaccination

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Tdap should replace a single dose of Td for adults aged ?

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19–64 years who have not received a dose of Tdap previously.

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Adults with uncertain or incomplete history of primary vaccination series with tetanus and diphtheria toxoid-containing vaccines should ?

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begin or complete a primary vaccination series.

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A primary series for tetanus and diphtheria toxoid-containing vaccines for adults is?

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3 doses of tetanus and diphtheria toxoid-containing vaccines, administer the first 2 doses at least 4 weeks apart and the third dose 6–12 months after the

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Tdap can substitute for?

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any one of the doses of Td in the 3-dose primary series. The booster dose of tetanus and diphtheria toxoid-containing vaccine should be administered to adults who have completed a primary series and if the last vaccination was received >10 years previously.

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Tdap or Td vaccine may be used, as indicated. If a woman is pregnant and received the last Td vaccination >10 years previously, administer?

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Td during the second or third trimester. If the woman received the last Td vaccination <10 years previously, administer Tdap

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During the immediate postpartum period, a dose of Tdap is recommended for postpartum women, close contacts of infants aged <12 months, and all health-care personnel with direct patient contact if they have not previously received Tdap. An interval as short as 2 years from the last Td vaccination is suggested

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shorter intervals can be used. Td may be deferred during pregnancy and Tdap substituted in the immediate postpartum period, or Tdap can be administered instead of Td to a pregnant woman.

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Ideally, vaccine should be administered before potential exposure to HPV through sexual activity

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however, females who are sexually active should still be vaccinated consistent with age-based recommendations. Sexually active females who have not been infected with any of the four HPV vaccine types (types 6, 11, 16, 18, all of which HPV4 prevents) or any of the two HPV vaccine types (types 16 and 18, both of which HPV2 prevents) receive the full benefit of the vaccination. Vaccination is less beneficial for females who have already been infected with one or more of the HPV vaccine types. HPV4 or HPV2 can be administered to persons with a history of genital warts, abnormal Papanicolaou test, or positive HPV DNA test, because these conditions are not evidence of prior infection with all vaccine HPV types.

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A complete series for either HPV4 or HPV2 consists of 3 doses. The second dose should be administered 1–2 months after the first dose

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the third dose should be administered 6 months after the first dose.

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All adults without evidence of immunity to varicella should receive 2 doses of single-antigen varicella vaccine if not previously vaccinated or the second dose if they have received only 1 dose, unless they have a medical contraindication. Special consideration should be given to those who 1) have close contact with persons at high risk for severe disease (e.g., health-care personnel and family contacts of persons with immunocompromising conditions) or 2) are at high risk for exposure or transmission (e.g., teachers

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child-care employees

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Evidence of immunity to varicella in adults includes any of the following: 1) documentation of 2 doses of varicella vaccine at least 4 weeks apart

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2) U.S.-born before 1980 (although for health-care personnel and pregnant women, birth before 1980 should not be considered evidence of immunity)

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Measles component: Adults born during or after 1957 should receive 1 or more doses of MMR vaccine unless they have 1) a medical contraindication

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2) documentation of vaccination with 1 or more doses of MMR vaccine

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A second dose of MMR vaccine, administered 4 weeks after the first dose, is recommended for adults who 1) have been recently exposed to measles or are in an outbreak setting

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2) have been vaccinated previously with killed measles vaccine

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Mumps component: Adults born during or after 1957 should receive 1 dose of MMR vaccine unless they have 1) a medical contraindication

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2) documentation of vaccination with 1 or more doses of MMR vaccine

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A second dose of MMR vaccine, administered 4 weeks after the first dose, is recommended for adults who 1) live in a community experiencing a mumps outbreak and are in an affected age group

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2) are students in postsecondary educational institutions

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Medical: Chronic disorders of the cardiovascular or pulmonary systems, including asthma

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chronic metabolic diseases (including diabetes mellitus)

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Other: Residents of nursing homes and other long-term care and assisted-living facilities

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persons likely to transmit influenza to persons at high risk (e.g., in-home household contacts and caregivers of children aged <5 years, persons aged >50 years, and persons of all ages with high-risk conditions).

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Medical: Chronic lung disease (including asthma)

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chronic cardiovascular diseases