Vaccines

CDC

• 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

• 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

• 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