======Vaccines====== [[https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html|CDC]] =====Pneumococcal===== * Routine/incompetent, age 65+: * No prior PCV13: PCV13, followed by PPSV23 1y after receiving PCV13 AND 5y after any prior PPSV23 * Previously received PPSV23 but not PCV13 at 65+: PCV13 at least 1y after PPSV23 * When both PCV13/PPSV23 indicated, give PCV13 first, PPSV23 at different visit * Special situations * Age 19-64, heart/lung/liver disease, DM, alcohol, tobacco: PPSV23 * Age 19+ and immunocompromised (including CKD/nephrotic syndrome) or anatomic/functional asplenia (sickle cell/hemoglobinopathy) * PCV13 * PPSV23 8 weeks after PCV13 * If under 65, give second PPSV23 5 years after most recent PPSV23 * Age 19+ with CSF leak or cochlear implant: * Give PCV13 x 1 * Give PPSV23 x 1 at least 8 weeks later * (?) After age 65+, give another PPSV23 at least 5 years later prior PPSV23, but no more than one total PPSV23 after age 65 * https://www.cdc.gov/vaccines/vpd/pneumo/hcp/who-when-to-vaccinate.html =====Zoster===== * Routine vaccination * Age 50+: RZV x 2, 2–6 m apart (minimum interval: 4 weeks; repeat dose if administered too soon) regardless of previous herpes zoster or previously received ZVL (administer RZV at least 2 months after ZVL) * Age 60+: * RZV x 2, 2–6 m apart (minimum interval: 4 weeks; repeat dose if administered too soon) * ZVL x 1 if not previously vaccinated (if previously received ZVL, administer RZV at least 2 months after ZVL) * RZV preferred over ZVL * Special situations * Pregnancy: ZVL contraindicated; consider delaying RZV until after pregnancy if RZV indicated * Severe immunocompromising conditions: ZVL contraindicated; recommended use of RZV under review =====Hepatitis B===== * Routine for children and adolescents * Routine vaccination for normal risk, but elective: 2- or 3-dose series * Heplisav-B x 2 at least 4 weeks apart * Engerix-B or Recombivax HB x 3 at 0, 1, 6 months * minimum 0, 4w, and 16w, with at least 8w between doses 2 and 3 * Twinrix (HepA-HepB) x 3 at 0, 1, 6 months * Same as above for at-risk: HCV infection, chronic liver disease, HIV infection, sexual exposure, current/recent IVDU, percutaneous/mucosal risk for exposure, incarceration, travel to countries with endemic HBV * Diabetes * Adults < 60: as soon as possible after diagnosis of diabetes or with previous diagnosis of diabetes * 3 shots at 0, 1, 6 months * Adults > 60: at discretion of health care provider