Who Needs What, When, and How Frequently?
Vaccination recommendations in the United States come from the Advisory Committee in Immunization Practices (ACIP), which is part of the Centers for Disease Control (CDC). The ACIP revises and updates their recommendations annually for all age groups and special populations. The Society of Teachers of Family Medicine created a reliable, user-friendly tool: Shots On-line, which has both web and mobile versions. The tool is updated annually based on ACIP guidelines. Use one of these two resources on your clerkship.
Immunization can be integrated into most primary care office visits, regardless of the initial visit agenda. Prevention is best achieved over time—family doctors, internists and pediatricians have long-term relationships with patients, so they can spread preventive recommendations over multiple visits. However, preventive measures should not always be delayed to the next visit. For example, tetanus boosters are often out of date in many adult patients, both in healthy people because they rarely come to the doctor, and among the chronically ill, because they have competing priorities to address at visits. Also, groups recommended to receive influenza, pneumococcal polysaccharide (PPSV23) and zoster can change over time, so reviewing the latest ACIP guidelines online at the point of care is essential. The ACIP guidelines usually come out in the beginning of each calendar year and are subject to change at any time.
The latest ACIP vaccine recommendations are available on the CDC website.
IMPORTANT: Learning objectives for this section of the module include:
- Formulating recommendations based on a patient’s age, gender, and risk factor status for the following vaccines in adults: Influenza, Pneumococcal polysaccharide (PPSV23), MMR, Td/Tdap, Zoster, Hepatitis A, Hepatitis B, Meningococcal vaccine, Human papillomavirus (HPV); and
- Prevention counseling of patients and their families using appropriate guidelines, such as the U.S. Preventive Services Task Force (USPSTF), Advisory Committee on Immunization Practice (ACIP) recommendations, or other appropriate guidelines.
The learning objectives for vaccinations in this module only include adults. For clinical care, specific recommendations are also available for children, adolescents, and special populations (for example, health care workers).
Traveler’s vaccination recommendations can be found at this CDC website.
Returning to our case: Y.S. is 24 year old white female medical student who presents to you at the student health clinic today for her first visit. She has no complaints but just wants “a check up”. She is in good health. She used to suffer from acne as a teenager but her skin has cleared up since she turned 18. She takes no medications currently and has no known drug allergies. She has no history of surgeries. Y.S. denies any mental health history and denies any issues with depression or eating disorders, and is doing well academically in medical school. She has been sexually active only with her boyfriend for three years. They use condoms exclusively. They have a “good relationship” and she denies any arguments or abuse. Y.S. has not smoked or used recreational drugs in the past or currently. She drinks one or two “Cosmos” on Saturday nights with her friends. She does not drive, but her boyfriend has a car.
Her immunization record shows vaccinations to meningococcal vaccine while in college; her last Tdap was placed at age 23; she has her MMR and polio series; and she had chicken pox when she was 8 years old.
Using the ACIP website, which one of the following immunizations should be offered to Y.S.?
M.J. is a 58 year old woman with diabetes for 12 years who is transferring her care to your office. At her first visit with you a month ago, you found her diabetes under good control (A1c 6.9%) and you refilled her medications. She is coming back today to attend to health care maintenance items, and would like to know what vaccinations she should receive. She is retired and does not have any travel coming up. She is widowed and is not sexually active. She cares for her 1 year old grandson twice a week. She had always refused vaccines at her prior doctor’s office, but as she has a good deal of confidence in you, she’s decided to follow whatever you recommend. Which four of the following vaccines would you counsel her to receive? Click on the vaccines to find out if you are correct: